Bipolar Disorder, a condition that affects millions around the world, not only impacts the individual diagnosed but also their surrounding family. It’s becoming increasingly clear that the journey towards mental wellness is not solely an individual pursuit but a collective one. Incorporating family perspectives and integrating a family approach in treatment methodologies can be pivotal in achieving holistic healing and stability. As a part of this interview series, I had the pleasure of interviewing Natalie Fraize.

Natalie is a licensed mental health counselor in New York (LMHC) and Pennsylvania (LPC) who specializes in the mind-body connection and chronic pain and illness. In January 2022, Natalie created her own practice, Vitality Counseling Center, where she is building a team of integrated healthcare professionals passionate about preventative care and collaboration across disciplines in order to improve health outcomes. Some of the services Natalie and her team provide are healthy mindset workshops; Paint and Process workshops; Virtual Personal Training; Heart Disease, Bypass, and Cardiac Event Recovery Therapy Groups; and Walk and Talk therapy.

Thank you so much for joining us in this interview series! Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?

Absolutely! I grew up in Buffalo, NY where I stayed until college and returned during the pandemic to be closer to some of my family. I’m the middle child. I have always loved animals, being outdoors, solving problems, teaching, and connecting with people. I recall being perceived by others as shy and mature. When I was in seventh grade, my parents went through a divorce and the following year, my older sister’s first year of college, my dad passed away unexpectedly. Having to grow up quickly added to my sense of responsibility and awareness of the world around me. In retrospect, I see that my dad’s passing offered me my first opportunity for post traumatic growth. The situations have changed throughout the years but I repeatedly learn that both I and others are capable of more than we know and unthinkable tragedy and loss open space for new and wonderful growth. I was empowered by surviving such an experience and I began pushing outside of my comfort zone when I was passionate about things. I had this sense that if life can end at any time, I need to be acting on what is most important to me and make my life matter. By my senior year of high school, I was president of the upper school and regularly spoke at open houses and other events. I left Buffalo and went to Fredericksburg, VA for college. While I was there, I started to feel the emotional fallout of a lot of the things I experienced when I was younger, I’m sure exacerbated by a huge transition, move, and the alcohol that comes along with college. I hadn’t gotten therapy yet and my emotions were impacting my relationships. One of the traits I have honed from trauma is perfectionism. I think the reason I hadn’t gotten therapy is that most people didn’t see anything wrong–I would never let that happen. I hope that people can relate to that feeling of needing help but not wanting to show it, and learn from my experience that finding a way to ask someone is crucial. I started seeking treatment around 20 and have regularly seen therapists and been on different medications over the years. I believe that as a therapist, the work we do ourselves directly impacts the work we can do with our clients.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“You just can’t beat the person who never gives up.” Babe Ruth

I frequently look for words of wisdom to help me through difficult times and this quote is one that I turn to when things are really challenging. I have felt before that I can’t handle one more thing but I am a very competitive person, probably by nature of being the middle child, and the idea that if I don’t give up then I never lose is very compelling. It also gives me a sense of hope to know that what I do always matters and if I simply don’t give up then I have survived another day and sometimes that is a huge accomplishment. When my dad died, I remember realizing that the world never stops. Huge, tragic events happen that change your life and you wake up the next day and people go to work and school and it all keeps going. While I don’t always have control of what happens to me, I have control of my response and you can bet that I won’t give up. There’s a real power in persistence.

Let’s now shift to the main part of our discussion. Can you tell us a bit about your background and your professional career treating patients with bipolar disorder diagnoses?

I started out as a graduate trainee in a community mental health clinic and continued working there after I graduated. Right from the start, a lot of the clients I saw had a bipolar diagnosis. After about 4 years at the outpatient clinic, I began working on the FACT team and then all of the clients had what were considered chronic mental health issues, which included Bipolar disorders and Schizophrenia spectrum disorders. I learned that I really loved working with individuals with bipolar diagnoses even as many colleagues would avoid the same cases. What others saw as unpredictable, I saw as a challenge and one that people needed help with. I learned a lot about the patterns that we all have in our moods and behavior and how getting a better understanding of the things that influence those changes can help manage the intense fluctuations of bipolar disorder. I learned that focusing on the person first is the best way to be effective in treatment and that panicking or trying to throw solutions out too quickly will slow the process. I learned how much my own presence, empathy, patience, and hope influence the relationship that drives therapy to be successful.

When you work with patients, I understand that you often integrate family or friends into the treatment process. What do you consider the 3 primary benefits of including family?

Context, support, and collaboration. When you meet with an individual, you only get their perspective so you’re missing the context of their environment. Bringing in family and friends helps strengthen and prepare the support system, which is important for both the individual and the provider. When I’m working with someone who has Bipolar, I want everyone who is part of their support system to be aware of their warning signs for mania or hypomania, depression, and suicidality and for us all to be on the same page with a plan of action for when anyone notices those signs. This is best done as a team so the individual doesn’t feel targeted or ganged up on but wrapped around as though they don’t have to handle this alone. Collaboration is when we all share information and experiences, sometimes troubleshooting, brainstorming, or problem solving. This is key because we all take in different information and observe things from our own perspective so what one person thinks is important another might miss. When I have several people all sharing information then I get a better understanding of the full picture, which is key for providing effective treatment.

What are some of the challenges you run into when working with families? How do you balance responding to the needs of the family with the needs of the patient?

People in general want to pull you to their side. Families tend to have strong dynamics and individuals all want to feel understood as well as avoid blame or point the finger elsewhere. Families that have an individual with a diagnosis of Bipolar may feel valid in pointing the finger solely at that person for all the problems. It’s very important to clarify your role at the beginning primarily as the therapist for the identified client and to facilitate better communication for the family unit. It’s also my role to educate the whole family about Bipolar and how if we want anyone to make a change then we all have to acknowledge our role in the problem and work to support each other in making changes. I work to normalize everyone’s experiences (for example, using “we” language to join) and validate people’s feelings as they are expressed to encourage engagement. I also have the family set rules for the session when we first meet and identify at least one clear goal that everyone agrees on so we can always come back to it when things get hard.

Family dynamics can greatly vary depending on the sociocultural backgrounds of the individuals involved. How do you tailor your family approach to respect and incorporate different sociocultural perspectives and values?”

I have learned not to make any assumptions and to ask lots of questions. Often people’s beliefs are so ingrained in how they think that they aren’t even able to identify the influences so I see it as part of my job especially early on to take in information and build a conceptualization that includes information I’ve learned about the sociocultural background. Values identification is always a large part of my work with individuals, couples, and families as values provide a sort of compass for people when making decisions. On my end, values help me understand how people think about things and what drives their behavior.

Likewise, inter-generational dynamics can sometimes play a significant role in the therapy process. Can you share any insights or experiences on how inter-generational understanding and communication facilitate the healing process?

It’s helpful when working with families to ask parents about their experiences growing up. When we become parents, we often refer to our own childhood experiences for information about how to parent. This happens beyond our conscious level of awareness as most of us gained our parenting skills from being a child and having someone care for us. As adults we may realize that our parents were flawed and did the best they could, which is a healthy perspective. Unfortunately when people grow up in situations where one or both parents or primary care givers had mental health challenges, a substance use disorder, chronic physical health issues, or other trauma like domestic violence, child abuse or neglect is experienced, the child is predisposed to a higher likelihood of mental and physical health issues and they have learned that a normal home includes these kinds of situations. Whatever we learn is normal we tend to tolerate or even repeat. This is all important because when we are trying to address problems in the family, everyone is protective of themself and feels it is not their fault that things are the way they are. A child with Bipolar will likely blame their parents who in turn will blame their own parents. If we can acknowledge and make space for the pain that is behind the problematic behaviors and teach people how they have agency in improving the situation, they tend to process and let go of what is no longer working in service of taking action towards their values. They move from a place of trying to avoid pain and causing more damage to taking intentional actions that they feel good about regardless of their situation.

Many mental health professionals don’t have training in working with families. How did you learn the techniques you use and what would you recommend to professionals that want to learn more about this approach?

My first work in the field of psychology was using Applied Behavioral Analysis with teens who had autism. I worked in their homes among their families and I learned very quickly about how family dynamics impact a person’s behavior from seeing the way behavior changed when certain people were present or absent, including other ABA therapists. My ABA roots also exposed me to functional behavioral analysis or thinking about what purpose a behavior serves. When I worked in community mental health, family members would join sessions occasionally and I learned what a benefit that could be as I started to see some of the problems my clients described happen in real time. I learned pieces of information that my clients were unable to tell me because they were unaware and having another person in their life share it made a huge difference. I took a course on family therapy in my master’s program and pulled primarily from a Systems Therapy approach as well as from my supervisors’ guidance the first few years. Working with families is extremely complex and I would recommend doing it under supervision along with taking a course for more information.

Caring for a family member with bipolar disorder can sometimes be challenging and might lead to caregiver burnout. How does your approach incorporate strategies for self-care and support for family members who are involved in the caregiving process?

I’m a big believer in equity and to me that means that we all are human with feelings and needs and we are responsible for taking care of ourselves first. My approach stresses the importance of a sustainable plan that involves support and resources. A caregiver who is burned out is often part of the problem–the problem being a lack of adequate support and resources. When working with these families, we cannot just tell them to rest and take time for themselves. It often isn’t possible unless something changes. We need to help them get access to resources for healthcare, nutrition, housing, employment, and more. Generally everyone in the family needs access to care of some type in order for there to be a positive change.

Preventive education is often seen as a powerful tool in managing bipolar disorder symptoms. How do you integrate education and awareness for family members within your family approach to treating bipolar disorder?

Education is a key part of treating all mental health issues and it’s a big focus in working with families and individuals with bipolar disorders. Generally, people like to have a better understanding of why things are happening so families are usually open to learning about bipolar. I strive to help everyone understand their role in the system so that no one person feels as though they are being blamed and so that everyone knows what they are responsible for doing to make positive change. As I mentioned earlier, a key part of the work I do with the family is identifying patterns of behavior, both problematic and positive. It’s important to increase the awareness of everyone’s strengths at the same time as learning about warning signs and triggers. I ask a lot about what happens leading up to and during conflict, how the family works towards resolution, what it looks like when they are doing well or enjoying time together. I try to provide education in ways that it is relevant to their life, so that they have little lightbulb moments during the session.

Thank you. Here is the main question of our interview. What are 5 things you wish more people knew about people navigating life with bipolar disorder?

1 . They didn’t do anything to bring about or cause their illness. Bipolar disorder is a mood, not personality, disorder and there is believed to be a genetic component. They have to manage bipolar disorder for the rest of their lives and many of the medications used for treatment have unpleasant side effects. People with bipolar are often working harder than you can imagine to maintain stability and consistency.

2 . People who experience the world with bipolar often have incredible things to offer. Some of the most talented, influential, and creative people have bipolar disorder. It’s a disservice to those with bipolar, yourself, and the world to underestimate someone’s abilities based on a diagnosis.

3 . Bipolar disorder varies greatly from person to person and you shouldn’t think that you know what someone else’s experience is like because someone you know has it, even if they are a close loved one. In fact, all diagnoses are simply labels we have created to fit symptom clusters and while a good deal of research has gone into the process, we can’t forget that diagnoses are never a replacement for the full story of a person. Making assumptions is often harmful to relationships so ask questions and be open to new ways of understanding.

4 . While dealing with bipolar disorder is unique and complex, it mirrors in a more intense way the natural ebb and flow everyone experiences in life. Learning how to care for yourself is a lifelong process. As you learn and grow, what you value and need will change. As soon as you seem to figure out “what works for you” things shift again around you or within you and you find tension building in the form of stress or pain, mentally or physically. Learning how to tune in during these times and adjust while balancing the urge to disconnect and distract is critical. Be flexible; have grace and compassion for yourself. I urge everyone to know signs that they are feeling stress (ex: distracted by one train of thought, irritable, breathing changes), one thing they can do that gets them back to baseline physiologically (ex: deep abdominal breathing, yoga, playing music), and some resources or supports they can turn to for different needs they have when they’re under stress (ex: call my friend Jenn to take a walk, ask my partner to hold me).

5 . Community normalization and support can go a long way. We have stigmatized mental health treatment for so long that people find themselves needing it and don’t seek it out because they or people close to them have made some judgment about it and they fear people would see them the way they’ve seen others. The odds are that at some point in your life, you or someone you love will experience suicidality or another mental health challenge. Everyone deserves support. Make it normal all the time. Go to therapy. Talk about going to therapy. Better yet, actually talk about how things are really hard and how having your friends there for support listening and giving you the space to feel makes it easier somehow. Show everyone that they have value simply by listening and caring. That kind of community connection and healing is what everyone needs.

There is a lot of misunderstanding when it comes to mental illnesses, especially involving psychosis. What do you wish more people were aware of either in the professional field or the general public?

Psychosis actually occurs for a number of reasons and it’s not all due to mental illness. Sometimes lack of sleep or medical conditions can cause these symptoms so instead of being worried that you or someone else is crazy, seeking care from a doctor is the best course of action. At the same time, realize that your physical health is closely tied to your mental health and do things like get regular sleep, balanced nutrition, and daily movement in order to take preventative measures for your overall health.

Most people with mental health issues are not dangerous.

A large part of the mental health epidemic is homelessness. It is nearly impossible to mentally healthy when you lack a safe and stable home. Another root problem is inadequate childcare. Children who are not provided with safe and stable caregivers do not typically grow into healthy stable adults. Instead of shaming people with mental health disorders, we need to work on supporting our fellow humans. The more that we stigmatize people for getting treatment, the less that people who need help will seek it out. Caring goes a long way.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂

I would love to meet with Jordan Poyer of the Buffalo Bills to discuss plans for creating integrated healthcare centers and normalizing mental health treatment in Buffalo as he has been recognized for mental health advocacy.

How can our readers further follow your work online?

Please check out my website: www.vitalitycounselingcenter.com and follow my practice on instagram @vccbuffalo.

Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.

About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.