Living Situation Assessment

The Living Situation Assessment helps us to make sure our environment is conducive to growth. In this self assessment we are evaluating things outside of ourselves from our own perspective and is done on our own. This assessment looks at the environment from the point of view of a person with depression or bipolar. The point of view of those around us is covered in the Family and Friends Assessment.

It is not an assessment of what is wrong with us, but one that addresses the changes that are necessary in our living spaces. We look at our home environment, our immediate needs for staying well, safe, and secure, what issues we have, our educational needs, relationship issues, skills, and strengths. The goal is to find opportunities for growth that are all around us in our daily lives.

The Living Situation Assessment and the Family and Friends Assessments should be worked on after the General Functionality Assessments have been completed and shared. That way, the deep work of looking at our depression and mania from the point of view of intensity, awareness, understanding, functionality, comfort, and value has already been covered. This leaves us free to focus on our environment without the distraction of thinking that we are missing important criteria.

The questions and answers below are examples of the form filled out by someone who has Bipolar IN Order. Please do not look at them as the "correct" answers, but as a guide to help you to better understand the process.

Jeanette is a 59 year old mother of three sons and has been married for 39 years. Although looking back she realizes she’s been bipolar from her youth, she wasn’t diagnosed until early 2009 at age 56 when her symptoms became severe. After her diagnosis she suffered two especially agonizing episodes in which she contemplated suicide and was hospitalized each time. Although she still rapid cycles with three complete cycles every two months, and has since experienced worse episodes than before, she has learned to live comfortably with them. Using the assessments and tools taught here, her faith, and having a caring husband and Health Team, Jeanette has found a life worth living.

Your home environment:

There may be several adjectives or phrases that you could think of to describe your home environment: harmony, zen, walking on eggshells, war zone, not my place, beautiful, the only peace I have, etc. Describe how the home environment feels to you.

My home is an oasis, tranquil and cheerful. 

What things can you do to improve the environment so that it is better for everyone?

Frank & I share a room we use as an office. We need to finish organizing our office storage closet and finish my husbands work area to make it more organized, enjoyable and efficient space for our work and hobbies. We recently finished my work area. Order in my environment helps me stay centered. Disorder in my home or life chips away at my sense of focus, it’s a distraction.

Immediate needs for staying well, safe, and secure:

What are your needs now for feeling well, safe, and secure?

An open and honest relationship with my husband and three grown children, paying attention to my diet and exercise, pursuing hobbies that interest me, friendships that are caring and trustworthy, and to have a caring family doctor, psychologist and psychiatrist. I am fortunate to have all of these. My husband, doctor, psychologist and psychiatrist are my team from whom I get valuable feedback and encouragement.

What is critical in your environment, or your friend’s/family member’s behavior, that must be improved immediately?

My husband is a free spirit and loves to be spontaneous. He is learning that unless we are on vacation or have company, I need to have some structure to my days. I prefer to complete my tasks in the morning before running errands or before taking a spontaneous day trip. If we leave home before I’ve done my tasks at home, when we return from a busy day out, I usually can’t complete everything I wanted to accomplish. I am involved with a few things outside my home during the week, so letting tasks at home pile up for too many days plants seeds of anxiety. Too much anxiety can sometimes trigger a mood swing.

Your Issues:

Please describe any of your own mental conditions that are contributing negatively to the situation.

Anxiety can trigger bipolar swings. So can arguments.

Describe any treatment or support that you are getting.

I am on a low dose of medications, prescribed by my psychiatrist, to slow down my bipolar rapid cycles and dampen the intensity. Occasionally, I will see my psychologist when a cycle is maxing out my abilities to manage it and I need his perspective on what I might be missing or a new idea to try.

Do you take any medication, drugs or alcohol? Does it help or hinder your family relationships?

The only medications I take are those prescribed for me and I take them as instructed. The medications interfere with my desire for intimacy with my husband. He understands and we work it out.

What fears do you have for yourself?

I fear having a manic episode that is totally beyond my skill set to control. I fear that someday, I might lose the thread of reality that keeps me centered when I have hallucinations so that I am swept away in them. I fear that someday, I could have a depression so agonizing, beyond anything I’ve ever experienced, that my skills will not be sufficient to keep my core centered and I will lose myself to it and die.

Education:

Explain your understanding of bipolar and depression.

Bipolar and depression are caused when the flow of energy and information to the brain is beyond what is considered "normal" by those in the medical field. With bipolar, one can experience a depressive state or a hypomanic or manic state. When any of those states are beyond one’s ability to function to a reasonably normal degree so that it is having a negative impact on one’s life and is outside of the person’s comfort zone, one is said to have bipolar disorder. The same is true concerning depression. It is possible to learn to function well during periods of increased energy and information flow. One can experience periods of mania, hypomania or depression, even intensely, and use learned skills to function well and remain comfortable and s/he is considered to have bipolar in order.

What is the difference between Disorder and IN Order?

Bipolar disorder is when one is uncomfortable and unable to function well with the intensity of energy and/or information flow. One’s life is negatively impacted in this state. Bipolar IN Order is when one has learned to live with and remain comfortable with the increased information flow. In this state one’s quality of life is not diminished.

Relationship Skills:

What skills do you practice to maintain the health of your relationships?

I take the focus off of me and invest myself in the other people in my life. I also keep our level of communication open and honest. I make my husband aware of when I am experiencing a particularly intense and difficult episode if it becomes lengthy for two reasons: one - so he will understand if I don’t seem quite myself and two - so he can alert me to unusual behaviors, if that should happen. I value the people in my life and appreciate their opinions. 

What processes do you follow or have in place to repair relationships when there has been an argument or a crisis?

We agree to calm ourselves and then come together to discuss what upset us. We agree we will respect the other person’s opinion and feelings. When we begin, each person gets to have their say without interruption. Thereafter, everything is open for discussion and we can usually resolve the issue and come up with a plan to prevent it from happening again. When we can’t agree, we agree to respectfully disagree and let go of ill feelings.

Describe how you calm yourself and re-establish a sense of peace before repairing your family relationships.

First, I breathe deeply and pray for wisdom. I try to think of how much I value the other person and how I don’t want to be the cause of his/her pain. Those three things calm me down. Then I am ready to look for and discuss the root cause of what caused our problem, how it affected each of us and how my part in it made him/her feel.

What gestures or communications do you use to demonstrate forgiveness and support?

I ask questions that let him/her know that I genuinely desire to understand how they feel and what I did that hurt him/her. I apologize for whatever I have said or done that hurt, even if I still feel my position was right, and then seek for us to find a way to prevent this type of situation from escalating in the future. Hopefully, I can finish with a hug, if we are close. If s/he prefers to be alone for awhile, I respect that and give him/her that space.

What situations create an intense reaction or cause an argument with your friends/family members?

If I start staying up late, my husband will get upset that I am not taking care of myself and inviting trouble. Both of us have a tendency to get hyper-focused on a project occasionally to the exclusion of the other, which can lead to frustration and an argument.

Describe a response or reaction on your part that is likely to escalate the intensity and make it harder for them to understand.

Occasionally I insist that my action or response is right and my husband’s concern, action or response is unfounded. If I am not thoughtful in how I express it, he sometimes feels that my response devalues his opinion and is hurtful. The more upset each of us get, the more at odds we will become, not truly hearing what the other is saying. We try to avoid this kind of scenario.

Describe a response or reaction from you that is more likely to calm the situation.

If I say, "I don’t understand, please help me to understand what you are feeling and what you mean, you are important to me", that has a calming effect on both of us.

What agreements would you like to have in place to calm an intense situation?

What we already have in place works well. We give ourselves about 15 to 30 minutes to calm down and gather our thoughts before sitting together to discuss our differences. We agree to allow each other to have our say uninterrupted in the beginning and we refrain from making accusations against each other. We stick to what happened and how it made us feel.

What would you tell a friend or family member in asking to postpone a discussion, for a short time, until you feel more capable of remaining calm?

I would tell them, "I am not thinking clearly right now and it is important to me to understand what you are feeling and thinking. Can we agree to take 15 or 30 minutes to allow me to calm down and gather my thoughts so I can discuss this with you with a clear head. You are important to me."

Skills Inventory:

What skills or tools do you have for managing your condition?

Eating balanced meals, limiting sugar and junk food, enjoyable activities-gardening and walking, thought shifting (changing focus as often at necessary), self awareness, self assessment, prayer and meditation, journaling, music, charting, 

What tools do you use for awareness or introspection?

At the end of each day I assess where my mood has been and how I responded to it. I take a look at how I handled my relationships, what I accomplished that day, whether I’ve acted responsibly, and my spiritual life. My psychiatrist still insists that I keep a mood chart in the form of a line graph for him so we can track how rapidly I cycle and any changes in intensity - it has proved useful in helping me know whether or not medications, when needed, have been helpful. I periodically go over my goals and make adjustments as needed. I’ve done a functionality assessment on a few occasions to have a visual way to measure my growth.

Strengths:

What strengths and personality traits do you possess that are going to help you in growing toward Bipolar IN Order?

I am fiercely independent and set the bar of expectations very high for myself so I work hard to expand my comfort zone and function at a normal level. I am sensitive to the feelings and needs of others and take pleasure in meeting those needs if I can. That helps keep me balanced in my perspective. 

What assets or strengths do your family or friends have that can help you?

My husband is a gem. He is an encourager, thoughtful and supportive. He learns as much as he can about bipolar. My family and close friends accept and love me for who I am. Some of them are good listeners with insight and wisdom and will give me honest opinions.

What assets or strengths do your family or friends have that will help them to change?

My husband is always supportive, learning, growing and changing, it is his nature. My family and friends are loving, caring and encouraging people. Some of them have a helpful nature. If I could impress on them and have them understand how helpful it would be to all of us if they would educate themselves about bipolar, it would open up more doors of communication. 

What would indicate positive change or growth in your own life?

My cycles have, in recent months, made a major change in intensity, length and also the regular addition of mixed episodes. Although I’ve been functioning well at both extremes, at times I’ve felt quite uncomfortable. Adapting my tools and perhaps acquiring new ones to achieve feeling fully comfortable at the extremes of both swings will indicate positive growth. Being able to help others gain insight into their lives, reactions vs. well chosen responses, indicates growth in my life as well.

Describe in what ways you view your family or friends as open to change and growth.

When my husband chose to attend a Bipolar IN Order workshop with me, which meant traveling across the country, that was a huge indication of his willingness to be open to change. He learned a great deal, and since then he has shared many things he has read concerning bipolar, depression and mental health in general. This has lead to many discussions and times of sharing our observations and feelings. He has learned what things are triggers for me and now avoids them when we are together. He willingly adapts to my needs for structure during a mood swing. I’m not very sure my family and friends are at the point of being ready for change yet. Our conversations about bipolar are still rather shallow. They are not aware of when I am in a mood swing unless I tell them. The few times I have, they’ve been accepting, asked a few questions and we moved on with our activities, allowing me to go at my pace. Being bipolar has not had much of an impact on them.

While the only correct answers to these questions are your own personal answers, a little discussion regarding Jeanette's answers will prove beneficial. Jeanette's answer to the first question regarding the feel of her environment is that it is "an oasis, tranquil and cheerful." Notice that even with such a positive home setting, she still finds room for improvement in her answer to the second question "What things can you do to improve the environment so that it is better for everyone." The lesson here? Even when everything seems just right, there are options and choices that will make the situation even better. Included in her answer to the second question is her understanding of what helps her stay centered - order in her environment.

Jeanette is open and honest even about her shortcomings. For example, when asked to describe a response or reaction on her part that is likely to escalate the intensity of a loved one's reaction, she acknowledges her part in the situation when she writes, "Occasionally I insist that my action or response is right and that my husband's concern, action or response is unfounded. If I am not thoughtful in how I express it…". Demonstrated in her answer is that each of us need to take responsibility for our own thought processes and actions as well as become aware of them. 

Obviously, Jeanette has put a lot of time, thought and energy into answering these questions honestly to her best understanding. The process is not touted as an easy route but a hard one that is well worth the work.

Not everyone's assessment will look like this. It is apparent that Jeanette has worked with her husband and health team and have found the things that work for her. However, Jane Doe may just be beginning. She will have a very different look to her assessment.

For example, the answer to the first question "Describe how the home environment feels to you" may look more like "My house is closing in on me and it is nothing but piles and piles of stuff. It is claustrophobic and doesn't feel safe, but it is the only place I have to go." That's a long way from the oasis Jeanette described. That doesn't mean the answer is wrong, it is an honest and correct answer for Jane Doe.

Consequently the answer to the second question, "What things can you do to improve the environment …?" would be more difficult. It could read, "It's just too much. I can't do anything about it and if I could I don't know where to start." Or, perhaps our Jane Doe could focus on one thing she could do to improve her environment. That one thing could  be, "to just do the laundry weekly." Again, not a wrong answer, simply what is true and helpful for Jane Doe at that time.

Jeanette and Jane Doe both have to dig deep to come up with the answers that are not only appropriate for their own situation but attainable as well. They both have to do the work and adjust the assessments according to the changes that come from following the first assessment.

If in three months Jeanette and her husband succeed in organizing the office, there will still be something that can be done to improve the environment of her home. Jeanette will have grown more, perhaps dealt with more mixed episodes, learned some more about herself and will have discovered something new in her environment that will better suit her and her husband.

If in three months Jane Doe finds that not only can she do her laundry once a week but she can also change the sheets on her bed at least once a month as well as make the bed she has also made great strides. If she can do those things even in a depressive episode or manic phase, she has become that much stronger and ready to move forward. At her next assessment her answer to the second question may then include keeping up with the dishes daily (or weekly) and cleaning out the refrigerator once a month along with continuing the laundry, sheets and bed making activities she has now made a regular part of her life. Again, not wrong answers but correct and attainable for Jane Doe.

And so it will go for each question. Jane Doe's answers will be correct for her. Jeanette's correct for her and yours, if you are open and honest, correct for you.

The difference between Jeanette's Living Situation Assessment and the one for Jane Doe is dramatic. However, as pointed out at the beginning of this chapter, the assessment is not used to show us what is wrong. While Jane Doe's struggles differ from those of Jeanette, Jane's assessment doesn't tell us or her how wrong she is. Just as it does for Jeanette, it gives Jane a starting place. It gives her hope that there is a way to make her environment a safe and comforting place to be.

NOTE: By sharing and discussing these questions, perhaps with the help of a professional, this process will begin an open dialog about how each member of the family can support the others in a non-blaming, respectful manner. It leads to a much deeper understanding of what is going on in the family dynamic and how to improve the situation so healing and wellness can begin. As you grow both separately and together, it is important to know there will be setbacks and there will be bad days. The important thing is to stay committed to helping and supporting each other.

This form should be used every 3 months to measure progress. What assets or strengths do your family or friends have that will help them to change?