For some people with bipolar disorder, excessive self-trust in the manic phase conflicts with trusting themselves over time, and radical shifts in mood and activity can undermine their trustworthiness. Difficulties in trust interface with the ability to construct a narrative. Although the narrative self may be (for anyone) fragmented and disjointed, it can nevertheless provide an unfolding rationale for the shape that one’s life has taken and will take. Many people with bipolar disorder experience themselves as fragmented where neither self-trust nor narrative can appropriately develop. Clinicians play a crucial role in extricating patients from this struggle for meaning in their lives. One aim of therapy may be to develop appropriate self-trust and to enhance patient trustworthiness through construction of a narrative where the patient is able to make sense of her changes to herself and others. Part of this joint task involves helping the patient to construct a narrative that accounts for effects of bipolar illness but is not driven by it. Because explanations of change from one mood or set of desires to another need to be deep enough to facilitate trust relations, the criteria for a narrative self must not be overly demanding of unity and similarity. This aim requires that the clinician be trustworthy with regard to the specific vulnerabilities of patients with bipolar disorder. This paper offers an outline of an approach psychotherapists should take to provide a kind of self-narrative–oriented therapy to help patients with bipolar disorder develop a sense of self that will help them to account for their illness while allowing patients see themselves as something more than just their illness.