taking into consideration all these aspects , in what follows we present a model of an individualized therapy , in a case of bipolar affective disorder . it is the case of a 44-year - old male patient , included in our psychiatric records in 1997 , with the diagnosis bipolar affective disorder type i ( manic - depressive psychosis )  ; for the past two years he was admitted five times for affective episodes , especially of manic type ( four of them ) , while the latest one , which needed hospitalization , was of the depressive type . after the improvement of the symptomatology , specific of the acute phase , the patient , in the phase of remission , participated in cognitive psychotherapy sessions , associated to maintenance pharmacotherapy ( antidepressants plus mood stabilizers ) . the hereditary - collateral history reveals that his 20-years old son was diagnosed with  schizophrenia , paranoid type  , in 2004 . the onset of his latest affective episode was favored by the reduction of his compliance with the medication ( the patient says he failed to take his treatment for approximately ten days , as he was very busy at work - he works as an engineer in a private construction company ) - and by the association of psycho - traumatic factors , such as the risk of unemployment , generated by his frequent relapses that needed hospitalizations and a large number of medical leaves , his family s conflictual state , generated by financial problems and his son s disease . the purpose of the first psychotherapy sessions was to educate the patient regarding the bipolar disorder , the characteristics of the treatment he needed to follow and the importance of the compliance with the treatment , the particularities of the affective symptoms , as well as their attentive monitoring . it begins by establishing an agenda specific to each session . at the end of each session , the patient was asked to summarize what he had understood from the session in question , and we agreed on the conclusions of the session . the patient is helped to become aware of his own thoughts , about which he knows very little , so that he can analyze the extent to which these thoughts trigger and maintain his emotions and behaviors that make him suffer and that he wants to change . therefore , he is explained how cognitive therapy can help him , when he is depressed or choleric , thinks in an illogical and systematically negative way and acts to his own detriment without realizing it . he will learn to identify and eliminate these negative thoughts , in order to be more productive . the patient is also explained that this disorder manifests by symptoms found in two different poles , one made of joy and the other one of sadness (  it opposes during the day the image of joy to the endless night of depression  ) . to illustrate the symptomatology of this disorder , we used the patient s previous experiences and he was provided with written informative material . in the following session , the patient s knowledge was evaluated and he was provided with the necessary clarifications . i informed the patient of the physical , emotional , cognitive and behavioral symptoms , characterizing the manic and the depressive episode , as well as the characteristics of the euthymic state . we began with the presentation of the characteristics of the latest affective ( depressive ) episode . this list was initiated during the psychotherapy session : for the depressive episode , he mentioned a decrease in his capacity to focus , for the manic episode , the feeling that his thoughts and ideas were too many and he could not deal with them , and for the euthymic state , the capacity of reading the newspaper daily and of successfully performing all his activities . he continued his list at home , as homework , with the help of his family and friends feedback . the patient was informed of the prodromes of the manic episode : the decrease of the need to sleep ; irritability ; exaggerated optimism ; involvement in numerous activities ; logorrhea ; accelerated idea flow ; increased sociability ; distractibility , and the prodromes of the depressive episode : low interest in different activities ; little communication with the people around ; sadness ; sleep disorders ; increased tiredness ; low concentration capacity ; low motivation . for instance , an early sign of the manic episode is the fact that sometimes he finds the colors brighter , more vivid . these prodromes generally occur in a social context , like in the patient s case , which is why the patient s attendance of these psychotherapy sessions plays an important role in identifying and monitoring them . as homework , the patient made a graph of the daily evolution of the changes in his affective , cognitive and behavioral area and physical symptoms , which were evaluated , depending on certain daily activities : his capacity of watching his favorite tv show to the end , the performance of his proposed daily activities , medication administration . in order to identify the behavioral and cognitive changes in the manic episode , the over - stimulating factors were evaluated , in order to limit their negative effect . thus , i found out that almost every evening , before going to bed , the patient would talk on the telephone to his employees to establish the schedule for the following day . this determined the frequent emergence of his sleep disorders and the decrease in his need to sleep and a risk of manic decompensation . this way , we established the clear limits of the duration of his phone conversations , which must end at least one hour before bed , in order for the patient to be able to perform relaxing activities , without having the tv or radio on . as the patient expressed his worry that he might lose important ideas that he could communicate to his employees , he was advised to write down all his ideas . he was forbidden to perform his evening activities in the room where he sleeps and instead of telephone conversations , he should prefer the company of his family and making a list with activities for the following day . after his dysfunctional thoughts were identified , cognitive restructuration was initiated , namely , the patient was instructed to use , as well as he could , his capacity of logical elaboration of cognitive answers . he used a thought record sheet , which was completed between sessions , containing : the date , situation , emotions , associated dysfunctional thoughts , and possible rational thoughts . these were generated by teaching the patient to ask himself the following question :  what else could i think in situation x ?  or ,  what else could someone else think in a similar situation ?  ,  what did i use to think in a similar situation , before becoming depressive ? the patient was taught to perform his activities according to a well established programme : for the prodromes of the manic episode , he was recommended to engage himself only in calm activities , to extend his resting hours , to reduce stimulating or exciting factors , to reduce the number of his activities ; for the depressive episode : to occupy his time with an increasing number of activities , and subsequently make a plan for the performance of his activities at work . the patient s evolution was favorable , meaning that his psychiatric disorder remission was consolidated , he increased his compliance with the treatment and the patient appreciated the importance of monitoring his own symptoms and solving psychosocial problems , thus consolidating a process of assisted resilience . i presented this case and its therapeutic management with the purpose of highlighting the assisted resilience process in these situations and also the possibility to individualize the therapy , according with each case situation . the psycho - educational programmes approach the following aspects : educating patients , ensuring their education and access to specific organizations for an appropriate therapeutic management . the organizations that offer care and support to patients and their families play an important role in the long - term management of the treatment of bipolar affective disorders in reducing the costs of the treatment and the burden of the family and community . these manners of organization will help the patient reintegrate in active productive life , especially for patients with a long evolution and frequent relapses . within the therapy for bipolar patients , all these roles must be shared by several family members and they should ask for the help of support groups of families and patients . the organizations support and information therefore , a better co - operation between patients , their families , psychiatrists , family physicians , governmental agencies is desirable to improve the quality of the psychiatry services . for the increase in the long - term efficiency of the therapy of psychiatric disorders in general , separate institutions were created for ambulatory , semi - ambulatory and hospital cares . for a long time , it was believed that by creating competition between the three types of facilities , the ambulatory would manage to limit the number of individuals who use the semi - ambulatory care system and both of them would limit the number of admissions in the psychiatric hospital . this way , the ambulatory unit could have functioned like a filter , allowing only severe cases use intramural facilities . despite all these , the hospital institutions continued to do what they were doing before and even more , under the pressure of the others . as the semi - mural facilities develop too slowly , as an alternative to intramural care , the ambulatory and extramural centers were invaded not only by psychiatric patients with a diagnosis in compliance with the dsm / icd , but especially by an increasing number of clients with psychosocial problems . for the past eight or ten years , fusions have occurred between psychiatric hospitals , mental health centers , group homes etc . nowadays , there are integrated mental health organizations that can deliver any care product to almost any place . the first is professional , in order to ensure the continuity of cares ; the other is economic , offering the benefit to a large organization and several possibilities to decentralize its functions and place them closer to the population . the interest in the economic aspects of the treatment of bipolar affective disorder is not only scientifically important , but it aims at improving different aspects of life quality . there is a series of prejudices related to patients with different psychiatric disorders , especially those with affective disorders , namely : the consequences of a psychiatric disorder are less harmful than those generated by somatic conditions ; the consequences of psychic disorders are relatively fixed , with small possibilities of improvement ; treatments are relatively inefficient , which is why social investments are very small . despite all these , social costs reflect in the decrease of the number of active days and the increase in the absence from work , productivity decrease , as well as costs associated with the legal system related to the aggressiveness risk . the elements whose costs are the hardest to evaluate are the reduction of the possibilities to complete one s education , divorces or family problems . the improvement of life quality must consider the identification of that priority group of patients whose life quality we will try to improve , in order to have higher social benefits . therefore , we should not focus only on reducing affective symptomatology , because , from the point of view of patients or their family members , functional rehabilitation is much more important .