Psychotherapy Through the Phases of Bipolar Disorder: Evidence for General Efficacy and Differential Effects  Sakina Rizvi and Ari E. Zaretsky University of Toronto The obstacle facing pharmacotherapy for bipolar disorder is that almost half of the patients do not achieve recovery over the duration of treatment. Although the reason for this disappointing clinical outcome remains unclear, structured psychotherapy has helped to fill these gaps in the treatment of bipolar disorder. Psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, and cognitive behavior therapy have all received attention in the research literature. In this review, by assessing the out- comes from randomized control trials across the phases of bipolar dis- order, we demonstrate that psychotherapy is an effective adjunctive treatment. We also show that the use of psychotherapy for bipolar dis- order has differential results depending on when and under what condi- tions it is administered. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 491–506, 2007. Keywords: bipolar disorder; comorbidity; cognitive behavior therapy; psychoeducation; family-focused therapy; interpersonal therapy Introduction Lifetime prevalence of bipolar disorder is estimated to affect 4% of the general popula- tion (Kessler, Berglund, Demler, Jin, & Walters, 2005). It is a chronic, complex illness that decreases functionality and quality of life in patients who are not treated adequately. Although the mainstay of therapy for bipolar disorder is pharmacotherapy (American Psychiatric Association, 2002; Yatham et al., 2006), evidence is now emerging that, as with severe unipolar depression (DeRubeis et al., 2005) and schizophrenia (Turkington, Kingdon, & Weiden, 2006), psychosocial therapies play a critical role in this challenging illness by adding new dimensions of efficacy to clinical treatment strategies. Despite the benefit of psychotherapy, as patients go through the phases of an episode, from onset to remission, the standard therapies confer varying benefits depending on whether the illness is acute or remitted. In addition, bipolar disorder is especially Correspondence concerning this article should be addressed to: Ari Zaretsky, Department of Psychiatry, Uni- versity of Toronto, Head Cognitive Behavior Therapy Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada; e-mail: ari.zaretsky@utoronto.ca JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 63(5), 491–506 (2007) © 2007 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20370