Bipolar Illness,God, and Object Relations: The Treatment of M

This article explores the concomitant change in one client's object relations and his image of God that occurred in the context of psychoanalytically oriented psychotherapy. The case demonstrates the benefit of long-term psychoanalytically oriented treatment to help an individual with major mental illness to heal emotionally, mentally, and spiritually. The client, who suffers from bipolar I disorder, experienced significant developmental mastery as he moved from the paranoid/schizoid position to the depressive position (developmental stages conceptualized by theorists Melanie Klein and Douglas Fairbairn). In addition, the psychotherapy mitigated the effects of homonegativity on M's self-image and his experience of his homosexuality. Through our work, the client began to see and interact with this clinical social worker, others, and the God of his understanding, in a more realistic and healthy manner. M's participation in a 12-Step group and his adherence to its beliefs augmented changes he made through psychotherapy. Through a long-term psychoanalytically oriented psychotherapy and involvement in Al-Anon meetings, the client's belief in a punishing God shifted toward a more benevolent one—a God who had a plan for his life that was revealed through the transformation of his suffering. In summary, M's object relations changed toward a greater balance of emotions and development of more textured relationships, including his relationship toward himself and God.