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So my 15 yr old daughter was almost released from RTC due to an insurance issue this week. We were able to get it straightened out same day, but they allowed my daughter a 5 hr pass to come home that day. It was her first pass since entering the program almost 3 weeks ago. The home visit went very well. She was extremely happy to be able to take a bath and shave and relax in front of the tv. Her behavior was fine and she seemed to be effectively using some of the DBT skills that she has been learning.

The problem is, now, when i speak to her on the phone or see her at visitation there is a definite difference than before she got the pass. I thought she was making some great progress. She would say 'This happened, BUT I am ok with it because... .' Or 'so and so said this and it made me feel... .BUT I am pretty sure they meant it in this way.'  Now when we speak it's 'guess what so and so did! It was awful!' And 'so and so said this, they are always going out of their way to be mean to everyone.' She seems to be back in a depressed state and cries when we leave visitation and expresses concern that if she has a bad day she will never be allowed to come home.

I am very concerned as it is likely that she will be released in another week and she seems to be doing so much worse since coming home for just a few hours. Is it common for this to happen? I felt that we all worked very well with the DBT skills while she was here. I thought everything went great. I am just feeling very hopeless today.

hello busymind79,

No wonder you are disheartened... . 

Is the possible release again due to the insurance? RTC programs usually work on a longer-term basis. And even though your daughter was starting to make progress, it takes time to not only learn the skills but also to establish the new patterns of behavior to be able to consistently use the new skills. Is there hope for the insurance to come through and for you to be able to keep your daughter in this program?

In general, setbacks are part of BPD, and if she stays, you can validate her feelings during the phone calls and then ask her questions like: "what do you think is the best way to deal with this" or "how can you make yourself feel better in this situation" to gently nudge her in the right direction to start using the skills she is learning.

Was the 5 hr pass connected to the insurance issue, or was that separate? It might be a good topic to discuss with your dd's therapy team... .

Thank you for the reply pessim-optimist. Apparently my daughter's case is reviewed weekly and the RTC did not send in clinical information that was needed by the insurance and instead it was going to a doctor to doctor. We were able to head that off and have it approved directly last week. We are calling the insurance again today to make sure that the information has been sent in this time and try to make sure the approval is put in again. When she went on pass last week, it was directly related to the insurance issue. We were supposed to take her home and wait til they told us either to bring her back or come get her stuff (she did not know this). I was very upset since this dbt program is supposed to run for four weeks and she had only been there for two. We are just trying to keep her in at least the full cycle of the program. I think the problem is that she is being very cooperative with the staff. They aren't used to kids behaving themselves and have even told me that. However, I have told them that my daughter specifically said that she is not stupid and knows how to act so she will get out of there ASAP. We have a family session on Thursday, provided the insurance goes through, and I plan on talking to the therapist about the setback after her pass. She does seem to be moving in the right direction again. I feel this makes it clear that she needs the time in RTC still, based on that. Praying that today goes well and we don't drop the ball somewhere in the process of getting the insurance approval. I hate this whole week to week, moments notice stuff, but at least I feel more prepared for it!

Hi Busy-

I find it helpful to remember that my BPD's behavior runs in cycles. She is doing much better now at 23 than when she was a teen but she still cycles.

Could this be at least part of what is going on with her now? Maybe she is also picking up on your stress over what is going on with the insurance etc.

Thursday

Well, the insurance has been approved for another week, so that is good news.

Thursday, she does cycle. Usually very fast. Many times a day, although her meds could be slowing that down now. I know that she won't come home "all better" and have explained to her that this is a long process and we know it. I do tend to stress a whole lot and have been trying to keep it under wraps when speaking to her. But of course not to the point that she thinks stress should be hidden or doesn't happen to others in general. She is extremely sensitive to how others deal with things and is constantly comparing herself to them, and of course, she's never as good as everyone else.

We have a therapy meeting tomorrow and we are hoping to start planning for when she is released and what that will look like for her and for us. Crossing my fingers that we can come to an agreement.

Good news about the Insurance approval, busymind79  |iiii

And I truly hope that your Therapy meeting tomorrow goes well, also.

We have a series of Feature Articles under the 4 photos at the top of the threads on the Parenting Board main page, and though I highly recommend all of them, one is particularly relevant to your situation right now: Supporting a Child in Therapy for Borderline Personality Disorder (https://bpdfamily.com/content/support-child-therapy).  Here's the introduction:

Recovery is challenging for a person with Borderline Personality Disorder.  Studies have shown that individuals who have committed family support often heal faster and have higher recovery rates than those isolated or on their own.

For the family, being a caretaker of a person with Borderline Personality Disorder is both complicated and demanding, even self sacrificing. Being a caretaker requires strength, love, realistic expectations, protecting your family, and preserving your own emotional health.  Very little is intuitive. For example, people often assume that the person with BPD should know and respect them as any other adult would. This is not a realistic assumption regarding people with this disorder. You must collaborate with that family member to set limits.

This five part guide for supporting a loved one is based on recommendations from McLean's Hosital, a national center of excellence for Borderline Personality Disorder treatment affiliated with Harvard University.



I've read this Article several times, and there is so much good information, and so many tips for Parents of children--of all ages!--with BPD, even those who are not in treatment at this time. If you haven't checked this out yet, busymind79, I think it would be really helpful for you to do it when you have a chance