Joseph, fifty-two, has bipolar disorder, as does his brother, his mother and his maternal grandmother. His daughter, Elsa, age six, has some really bad temper tantrums and he is worried, I mean really worried, that Elsa also has bipolar disorder. “I just can’t sleep at night. Every time she gets upset I am asking myself if this is normal, or if this is the beginning of this dreaded disease.” Joseph says with terror in his voice. “We will have to keep an eye on Elsa and see how she handles stress,” I say, stating that I understand his fears, but it is premature to say that Elsa has bipolar disease. Dealing with Joseph’s anxiety is now my focus, although I also see the importance of monitoring Elsa’s behavior. I feel for Joseph in his fear that he has transmitted his illness, however unwillingly, to his daughter. There is this sense that Joseph would feel responsible for this genetic transmission, which although is not rational, I understand. My job is to help Joseph cope with and his fear of Elsa’s future. Worrying about his daughter is sweet and concerning in one way, but if it exceeds his ability to enjoy her, can be detrimental to her development. Joseph and I look together for that sweet spot of concern without negativity. It is a challenge.