Marriage counselling and dysphoric mania

I (39F) believe my husband of 20+years (40M, asd, ADHD) is having a dysphoric manic episode. Personality changes, mood swings, highly irritable, delusions of grandeur, crying for hours, self medicating, completely scattered, behaving erratically and unsafely while looking after the kids etc. We're currently bird nesting with the kids - parents taking turns to stay elsewhere, turns with nights on with the kids.

How do you participate safely in couples counselling with someone like that? What kind of counselling protocol/strategies can be used that keep everything fair when one of the pair is not in touch with his own limitations or behaviour?

Those with lived experience, is it better for me to hold my boundaries and refuse changes to negotiated plans, or do I be flexible and compassionate? Like today, he wanted to meet earlier than arranged to exchange kids because he didnt want to pay for parking but I said no.

Or, he got angry because although I told him one of our kids had a birthday party during his time, I didn't explicitly ask him to take said kid to the party, and he hadn't factored driving kid there and picking him up into his day. I could have done it, but it was supposed to be my turn for a rest, he's about to go away for 2 weeks by himself on a non compulsory work trip, leaving me with the kids.