Syndicated from the Bipolar Blog with a couple minor edits

Q: I am a job coach. I help get jobs for disabled people and help train them. I have had several clients who have bipolar disorder. They do not seem to be able to keep jobs no matter what field we put them in. Many of them are great workers but getting them to come on time (if at all) is a big deal. Is there a way to work with people who have bipolar that would make them more successful? It is frustrating to know that they can do the job and they love the job and the people they work with, but they cannot keep the job because of not showing up on time or not calling in when they’re going to miss work. Please let me know if you have any ideas that can help us help them.
MaryAnn Cheney, Job Coach

A: In terms of working with clients on these types of problems, the task is to break it down into more specific concerns. While we can say broadly that individuals with bipolar disorder have trouble with time management—that doesn’t help us solve the problem for any one individual. Sitting with the client and identifying the more exact nature of the problem is the first step, so you can develop an individualized plan for addressing specific issues.

Start with the assumption that the client is not getting there on time because they can’t, rather than because they won’t. Next, try to break down the problem into much smaller issues so you can address the skill set deficits and solve the problems from a smaller, more manageable standpoint.

For example, does the person have trouble remembering to set the alarm, hearing the alarm when it rings, or getting up upon hearing the alarm? Does the person run into delays when showering and getting dressed? Is transportation a major issue? Does the person have other demands in the morning or conflict with another person prior to work? Is there a problem with medications—either not taking them or perhaps a side effect that makes the person less able to wake up in the morning?

Once you can break it down, you can start to address one issue at a time—with your client actively involved in developing possible solutions. If you try to tackle too many issues at once it won’t work, so focus on one issue at a time.

Remember: Changes, when they come, will be incremental—small changes at first. You and your client are working to solve problems that are occurring because of skill set deficits, so always consider skill set deficits when formulating your solutions to the problem.

For example if we’re talking about waking up when the alarm rings, what may be getting in the way might include medication hangover, general fatigue, and lack of mental and/or physical energy. One solution could be to work toward a very gradual process of waking up. Your client could try to set the alarm earlier and hit the Snooze button one or two times before waking up. If your client’s medications were suspected of causing some morning fatigue, your client may consider consulting with his or her doctor to determine if the times that the medications are taken could be adjusted.

It is also important to remember that as long as you are talking and working on solving the problem, you are still in the game with the client. The first solutions you develop may not work or may be effective only to a certain degree. Achieving an effective solution is a dynamic process and may require a good deal of tweaking along the way. Remain persistent and provide your client with plenty of encouragement.