BPDFamily.com

Question:

Has anyone ever tried sending their child to a mindfulness coach / meditation coach / zen master / Hakomi therapist, either in lieu of or in addition to traditional counseling? What were the results? How did the regular medical system react? Am I insane to consider this at all?


Backstory:

My adopted teen son has been practicing self-harm and suicidal for the past 2 years. He has been to the emergency room more times than I can remember and we're on a first name basis with all the local police officers. If I weren't trained as an EMT, we would have probably already lost him. He became intermittently withdrawn and increasingly angry and manipulative towards us, his grandparents, his siblings and his friends, and his school performance tanked. We exhausted our savings on copays for emergency room visits and hospitalization to 'stabilize' him, and taking unpaid leave from work. We've also mostly tapped out our support network, as friends and extended family (who were initially supportive) have gradually distanced themselves. The other kids have suffered a lot from the chaos and stress and missing out on normal life, and we had to get them counseling to cope. I always thought I was a strong person, but this last year I've been struggling with huge waves of hopelessness and despair, both for him and for our family. I love my kids so much - it's been killing me that we've been failing them, especially our son.

He has been in weekly or biweekly therapy for the entire time and has been on medication that entire time as well. We've tried both of the major mental health providers in our rural area and switched therapists multiple times (each time the therapist starts off confident that they can help, but after a couple of months of no progress they start shrugging their shoulders and just going through the motions / shortening sessions). His diagnosis has always been PTSD, depression, and anxiety, and when he doesn't show improvement they just increase his meds until the side effects are so severe that he is either a zombie or can't sleep at all (which inevitably ends in a hospitalization). When I ask the therapists or psychiatrist whether it's safe to leave him alone / bring him home, or why he isn't improving, or what we need to be doing differently, they would just shrug and say 'it's hard to say'.

He has a 'safety plan' which calls for him to call a hotline if he feels suicidal and can't contact us (or can't bring himself to, i.e. if he's angry at us), but when he calls them, they inevitably call the police and he gets taken to the emergency room, where they just run through a checklist of holding him until the mental health person on-call sees him and verifies that he is still in treatment and has a 'support plan' and then release him right back to us. I've stopped asking them to hold him longer because they aren't as diligent as we are at watching him for subsequent attempts, and I realized that they weren't going to provide him with any services there. We live in a rural area, and the only residential treatment center that is remotely near and covered by insurance has a horrible reputation (a kid committed suicide there this year while supposedly under watch), so we've never been able to bring ourselves to go that route.

Two months ago he woke up in the middle of the night, trashed his room, started cutting himself, and then texted his cousin that he was suicidal. I was home alone with him and sleeping on the futon in the hall outside his room, but I was so exhausted I didn’t wake up when the cousin called me the first time, and so he called 911. The cops sent a new guy, and he was really young and nervous. He tried to take him to the local hospital, but they wouldn’t admit him, so he insisted he had to take him to another hospital in the next town, which is pretty far.

New hospital, same routine, except one difference - in addition to the emergency doc and the mental health counselor they called in, there was someone from the county health service who talked with him for a while. She caught me in the hall later and asked if I’d heard of BPD. It was kind of a strange conversation, because she wouldn’t really say anything except that I should ask his doctor about it.

I hounded his therapist until he returned my calls, and he admitted they’ve felt he has ‘BPD tendencies’ (not his word but something like that) for quite a while. After more pushing with him and the psychiatrist, their reasons for not mentioning BPD as a possibility to me basically boiled down to ‘you can’t diagnose BPD in someone under 18’, ‘we didn’t want to give you such a pessimistic diagnosis until we were sure because the prognosis is really bad’, and ‘there’s only one DBT skills group in the county and the waitlist is very long.

I went home and read everything on BPD I could find and DBT. Long story short, it fit my son so well. I downloaded Marsha Linehan’s interviews and some first hand accounts of people with BPD who had used DBT to recover, then I sat down and read them with my son and asked him if any of this made sense to him. He said it did, very much so, and he was incredibly relieved that there is a name and explanation for what he feels and how the world appears to him. It also gave him hope to hear that there was a treatment that might work. It was really a cathartic moment for both of us, and I felt like we were on the same team again for the first time in years.

So I badgered his counselors to put him in the DBT skills group and include DBT in his weekly individual counseling sessions, and ordered a bunch of books on BPD, DBT, and mindfulness for us to read. The quality of the DBT skills group is unclear - facilitator isn’t certified, there are too many participants, and my son’s descriptions of the methodology they use differs significantly from the Behavior Tech materials. It was useful initially for my son to meet other people with similar illness, but he is increasingly frustrated with the large size of the group and the wide range of needs, including some unmotivated participants who don’t do the homework and are negative and disruptive. My son says the facilitator spends most of the time on these people. My son is pretty bright and is currently motivated to learn and practice DBT, so this is frustrating to him. He is also frustrated with his regular weekly individual counseling sessions - my son wants to work on DBT skills, but the counselor isn’t trained in DBT and has continued to insist that they continue regular psychotherapy, which my son feels ‘helps a little but not really’.

Nevertheless, he’s made a lot of progress in learning and applying DBT skills the past 2 months, mostly through self-study. The other thing that has helped is that we’ve been using the DBT materials to radically change the way we communicate with him and using radical acceptance to adjust our expectations for him. It’s completely exhausting - we spend an hour or two every day studying and an hour or two in careful, crafted communication and coaching, but it has paid off - he agreed not to attempt suicide for two years while he gives DBT a go, he has gone two months without a self-harm incident, and he tells us when he has self-harm ideation and practices skills to manage it. His anger management, self-care skills, and interpersonal relations are also improving (baby steps, but you can see him making progress).
This week, his individual therapist informed us that he is moving to another state next month. He found another therapist from the same practice to take over my son’s counseling, but the new therapist also isn’t DBT-trained. At the same time, the skills group facilitator contacted me - she feels that his ‘advanced intellectual abilities and intense commitment to treatment’ make my son a poor fit for the skills group. He hasn’t done or said anything inappropriate, but she feels his rapid progress has inadvertently discouraged other group members who have been in treatment for a while.

So basically they want to punish him for committing to DBT and working hard on his skills by throwing him out of the group after 6 weeks. We live in a rural area, so finding other therapists or skills groups is not an option. He has made some improvement, but he is far from okay. He has flashes of insight where he is able to apply DBT skills tentatively and rather mechanically, but in between his emotional and interpersonal behavior is still extremely labile and immature. He has good intellectual understanding of mindfulness, but really struggles to turn that into practice on any consistent basis, preferring to use distraction and self-soothing, which are easier.

I’m about at the end of my tether with the local mental health system. Rather than having him start over again with the new therapist, and go on the ‘waitlist’ for a DBT skills group that is ‘a better fit’ (if that ever even materializes), I’m seriously considering pulling him out of the non-DBT weekly individual therapy altogether and trying to find him a meditation or mindfulness coach instead, while combining his self-study in DBT with once-a-month counseling sessions in the city with a DBT-trained therapist. The cost would be similar to what we’ve been paying already.

There is a local mindfulness coach / zen master who retired to our area and does some one-on-one coaching, though she has no experience with BPD or DBT. There is also a local Hakomi therapist who works largely outside the local medical system (doesn’t take insurance and I’m not sure how coordination with the psychiatrist for meds would work). I visited both of them; their meditation spaces were beautiful and soothing, but very foreign feeling - definitely outside of my comfort zone, as was their explanation of their approaches.

I’m afraid if I do this, I’ll irritate the local medical system - they might not take him back if it doesn’t work out. Also he still needs to keep his appointments with the psychiatrist for the meds, and the psychiatrist is in the same practice with the regular therapists, so I might have to find another doctor to renew his prescriptions. I'm really unsure what to do.

Hi feldsparkle

I have read your story and I think it is amazing what you have achieved with your son, you have dedication and resilience in abundance.

In answer to the question that you ask, I have no personal experience of sending my uBPD son to a mindfulness or meditation coach but in my opinion I think it could be very beneficial, especially as you say that your son already has a good understanding of mindfulness. Had my adult son considered anything like that I would have definitely encouraged him but he is in denial and thinks I am the one with the problem.

You say that you have done a lot of reading about BPD and dbt, I am just wondering, have you read The Buddha and the Borderline by Kiera van Gelder? If you haven't, I think you might find it interesting in view of the question that you have asked x

Thanks so much for the suggestion! It didn't occur to me before, but I think this is one of the books we ordered. My son probably has it - I will see if I can find it tonight.

I read your earlier posts and really want to say thank you for everything you've been doing to help others, especially with all you're dealing with yourself.

In the depths of his pain, my son said some horrible things about us as parents, including that we had never loved him as much as our biological kids, and that that was the cause of all his problems. He also told his then counselor this, and their discussions reinforced that belief. It made us second guess and blame ourselves so much. We obsessed over a lot of 'what if we'd just... .' scenarios. We also considered seriously sending him away to a residential treatment facility, because there were times when it seemed like he would never come back to us and we wondered if we should accept that we had lost him and focus on protecting ourselves and the other kids.

We still have a lot of healing to do, and my son is not yet at a place where he can discuss too much about the recent past, but he did say something that helped a bit. It was something like 'there's so much anger inside you, and in your heart of hearts you know it's you that is messed up, so mostly you turn it on yourself, but sometimes you turn it outwards because that fantasy that it's all justifiable anger and not you that's crazy is so much nicer than the truth'. I SO needed to hear that it wasn't mostly really about us and our parenting per se, even if he only said it indirectly. I'd really come to believe he hated us.

He said he honestly can't promise that he won't say things like that ever again - apparently that fantasy is pretty seductive and in some ways easier than DBT which asks you to accept the reality that you have a mental illness. His sister was somewhat dissatisfied with this answer, but finally she said 'If that's really the case, I still love you, but next time I'm making mom and dad put their own oxygen masks on before they try and attach yours, 'cause we're on this flight too and we need the pilots to keep flying.' He actually agreed that she should do that. They DO love us somewhere deep inside. This is a mental illness. It's not their fault, but it's also not ours either. We can only love them and do what we can and they allow, while also saving enough of ourselves to stay sane for the other people who need us.

What about an online DBT group? I enrolled in a structured group on yahoo when my daughter was first diagnosed. its free and like " real DBT " has homework and discussion.

There is also a website DBT self-help that has some online resources too.

I practice zen meditation and also considered taking my daughters with me to learn better mindfulness skills. My zen teacher pointed out that if someone is spending a lot of time ruminating and having constant negative thoughts that silent meditation can be excruciating and actually not helpful at all. However, if these practitioners are providing counseling from a mindfulness perspective it maybe very helpful.

The book mentioned above Buddha and the Borderline clarifies the difference between DBT mindfulness and Buddhist practice.