Dialectical Behavioral Therapy (based on CBT but for me more intensive & I went to weekly DBT group for 2 years until therapist retired!) has been the MOST helpful for me in getting stable w/a dx of bipolar 1. I have been able to get off Abilify (anti-psychotic medication) after about 10 years on it w/the behavioral & thought changes from DBT.
I think of it as a challenge: NAME THAT COGNITIVE DISTORTION when I am having emotional dysregulation (including suicidal ideation). It takes time to learn to recognize them, but it is so helpful in changing your course when heading down, down, down into a depression vs. feeling a "normal" or "appropriate" sadness about something in your life. I learned not to "feed" my depression by ruminating on all the negative experiences I've had such as mother's suicide & abuse due to her being very ill w/schizo affective disorder or father's rejection due to being a "functioning" alcoholic (which are unfortunate but I have to learn to go on w/my life). I don't have to be a slave to my disorder or my past history.
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It's a good question. The context is important, as is the skill of the therapist. One thing to keep in mind is that the process between the therapist and patient is underway, the ground rules and expectations established, and the patient/client feels secure with their therapist.
The term 'challenge' sounds rather confrontational whereas in practice it is the patient who raises the way they think (encouraged by the therapist), and the therapist works with the thoughts to encourage alternatives. So, to answer your question, you shouldn't get worse but the process can feel a little uncomfortable because you may expose things about yourself that aren't easy to digest. Having said that, they are unlikely to be a surprise. In many ways the effort comes from trying to think in different ways - but it can and does work.
Just realised I haven't addressed the manual approach. I've certainly seen these DIY manuals and some people say they benefit. I haven't seen any studies however and I'm a little sceptical about how well this works without the guidance, feedback and structure a therapist can offer, especially during depression when thought processes are strongly affected.
Thanks for the clarification.
By manuals I did not mean self help books or programs, but rather the studies I looked at had very structured interventions with outlines for what to discuss at each appointment (flexible, of course, but only to a point), & homework assignments & a fixed number of appointments. I assume this was so several therapists could compare results/outcomes for the purpose of the study.
Based on the protocols I have seen and the actual therapy I have had (fired the therapist, we had not clarified goals after 8 weeks!) there was very little relationship between the two. I want to know sooner than 8 weeks in if I'm working with someone who doesn't work for me, so I'm wondering if seeming to have no structure is a red flag. He was a nice guy that I felt comfortable with and I thought that was what I was looking for. In retrospect I think it is a necessary component but not complete in itself.