I'm annoyed with my DD's therapist

[Yepanotherone]

Hey guys looking for your thoughts about my most recent conversation with my DD's therapist . Yesterday, the therapist brought me in towards the end of DD's session to discuss moving forward . Apparently my DD has said she doesn't feel motivated right now to practice the DBT skills that the therapist is trying to teach her so the therapist suggested giving my DD a bit of a break for now . I get her point... .She can't force my DD to want to apply the skills ... .But to " give her a break for now " is freaking me out ! I wanted to scream " have you seen the state of her legs lately ? They are cut to within an inch of her life !". I stayed calm and put forward my concerns . Given that my DD does not open up to me or to anyone else in our family , in any way , shape or form, then if she's heading into a crises situation it could be easily missed , and her stability changes very very quickly . That, together with the fact I'm trying to get her as much help as I can while she's still only 16 and I have that authority to do so . The therapist said she understood my concerns , assured me that while my daughter is self harming severely right now , she's not suicidal and while cutting is not healthy , it's her coping strategy of choice for the moment . The therapist suggested that she can continue to support the situation by starting sessions with myself and my husband ( which is something I'd asked her about before ) to help us understand and cope better , which will also be helpful for my DD , and she also said she'll continue to do " check in " sessions with my DD every couple of weeks until DD is ready to change. She said she needs to respect my DD's wishes . Really?  We are talking about a 16 year old girl who doesn't necessarily have good judgement ! Of course she doesn't want to go to therapy , she'd rather be doing fun stuff ! I know that ! I get that ! But whether she likes it or not , the therapy in my mind is a priority for her , even if it's not her own priority right now .
I'm feeling really anxious about this , angry and disappointed. And scared . I do understand she can't help my DD if she's not going to put in the work , but by all accounts I could literally think up quite a few ways to " bribe " ( or blackmail!) my DD into continuing with her skills training , but would that be for the best ? Is it truely best to give her a break for a bit ? What are your thoughts ?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[DisneyMom]

I'm sorry you're going through this. I also have a 16 year old BPD DD in twice weekly DBT therapy, plus she still sees her old therapist periodically. I'm been extremely frustrated that my DD seems to not be taking in the lessons from her therapy and putting them into practice. Right now cigarettes are her coping skill of choice. She's sad that she's addicted, but not willing to quit either.  And I noticed she goes to smoke during times her anxiety builds rather than use any of the healthy coping skills or lessons from her therapy. This is her 2nd go around with DBT. She's bored with it. We have the most amazing DBT program and therapist in our city and I feel like she is just showing up half hearted because we're bringing her there. I'm actually worried she will be asked to leave the program for not doing the work. Unlike your DD, she's in a fairly stable place emotionally (for the time being - summer is always easier for her. She has longer stretches without cutting in the summer) We could pull her out now altogether. But then the fall/winter, she will inevitably slip back into crisis (school is stressful and hard both academically and peer-wise and she gets cooped up, bored, isolates), and then what? We start over AGAIN with new therapists? I'm afraid she will truly give up at that point. So I keep bringing her.

If your DD's therapist wants to give her a break, I think she's trying to communicate to her that she can't help her until she herself decides she wants to change. I admit I often remind and bribe by waiting on requests from my DD until she fills out her diary card. It doesn't feel right, but I know my DD has severe executive functioning challenges. I keep doing it because I'm more afraid of what would happened if DD is left to her own devices and doesn't do the work. It feels like treading water, though.

What else is your DD doing this summer? Mine is in summer school, and actually enjoying it. It gives a structure to her day to get out of the house, be with her peers, etc.

Maybe you allow the break, but ask the therapist keep her door open when your DD is ready. In the meantime, if she's not going to do therapy, can you make her get a job or commit to some volunteer work, or other meaningful activity in it's place? Just a thought.

[nobueno]

Hi Yep,

I'm totally with you on this.  My 16 yr old daughter is very similar as she will not speak to us or the therapist. And she is suicidal at times.  It sounds to me as your therapist is feeling unsuccessful with your daughter's case and, while that's not surprising, it's not acceptable to just let her fly on her own when she's like this. In fact, we just accidentally received my daughter's discharge letter from her IOP psychiatrist and it's alarming and very upsetting, to say the least. 

We are in the process of getting in-home intensive psychiatric therapy for my daughter.  She just can't have NOTHING.  No good will come from nothing, IMO.

Best of luck and ((hugs))

[lbjnltx]

This is one of the toughest decisions to know how to make.

This is what we did when my d was not participating in/showing signs of benefiting from outpatient therapy (2 years of CBT w/DBT mixed in).  We chose long term residential care.  No therapy was not an option.  I understand that it may not be a possibility for every family.  We made the sacrifices and we all were pleased with the outcome of our choice.

One thing that comes to mind is that you can have your d sign a contract that if she feels the need to self harm that she use alternatives to cutting like popping a rubber band on her wrist, holding ice cubes in her fists, and if the site of her own blood is part of her release then she will use a red washable marker.  All of this in combo with her coming to you to discuss her feelings and allowing you to validate her so that she can self soothe.  Also, you might want to make filling out workbook pages at home on a weekly basis part of the agreement.  there are some very good dbt skills workbooks for teens.  ":)on't Let Your Emotions Run Your Life" is one.

DBT is a very abstract form of therapy and can be difficult for teens to grasp and invest in.  Combining it with other forms of therapy may be an option.  Like equine, art, music, and my personal favorite Positive Peer Culture.

lbj

[Bright Day Mom]

I agree with LBJ, no therapy is not an option.  LB also provided you with many tools for self harm urges.

So far as therapy, you all may need another therapist.  It often takes more than 1 or 2 to find the one that makes your family most comfortable and ease.  Keep trying and let your D know you are going to work as a family and will not give up, she can feel better and needs to be an active participant.

[Yepanotherone]

I'm sorry you're going through this. I also have a 16 year old BPD DD in twice weekly DBT therapy, plus she still sees her old therapist periodically. I'm been extremely frustrated that my DD seems to not be taking in the lessons from her therapy and putting them into practice. Right now cigarettes are her coping skill of choice. She's sad that she's addicted, but not willing to quit either.  And I noticed she goes to smoke during times her anxiety builds rather than use any of the healthy coping skills or lessons from her therapy. This is her 2nd go around with DBT. She's bored with it. We have the most amazing DBT program and therapist in our city and I feel like she is just showing up half hearted because we're bringing her there. I'm actually worried she will be asked to leave the program for not doing the work. Unlike your DD, she's in a fairly stable place emotionally (for the time being - summer is always easier for her. She has longer stretches without cutting in the summer) We could pull her out now altogether. But then the fall/winter, she will inevitably slip back into crisis (school is stressful and hard both academically and peer-wise and she gets cooped up, bored, isolates), and then what? We start over AGAIN with new therapists? I'm afraid she will truly give up at that point. So I keep bringing her.

If your DD's therapist wants to give her a break, I think she's trying to communicate to her that she can't help her until she herself decides she wants to change. I admit I often remind and bribe by waiting on requests from my DD until she fills out her diary card. It doesn't feel right, but I know my DD has severe executive functioning challenges. I keep doing it because I'm more afraid of what would happened if DD is left to her own devices and doesn't do the work. It feels like treading water, though.

What else is your DD doing this summer? Mine is in summer school, and actually enjoying it. It gives a structure to her day to get out of the house, be with her peers, etc.

Maybe you allow the break, but ask the therapist keep her door open when your DD is ready. In the meantime, if she's not going to do therapy, can you make her get a job or commit to some volunteer work, or other meaningful activity in it's place? Just a thought.

Thanks for your replies ladies my DD hasn't been doing the DBT one on one for very long at all , she really just started it with a new therapist after her most recent hospitalization in April. Just before her hospitalization she had recently started a DBT teen group once weekly but that's been given the go by too  There's no way she's given it a real shot and nowhere near learning the skills she needs to learn . She thinks she already knows it all and it's just not working for her . So frustrating .
School was a complete shambles this last year with us moving State , her grades completely tanked and she had a really tough time trying to settle into her new school. ( we didn't know of her mental health issues until after we'd moved or else we simply wouldn't have moved ! The move exposed her issues and cane as quite a shock to us ). She's going to try online school for this next semester to see if that works better for her and there's an actual campus here locally for the " online school" kids to clock into . It's actually a very structured, supportive environment so I'm keeping everything crossed that she has some success there .
In regards to what she's doing with her summer while school is out , she has a job she absolutely loves and would spend every day and night there given the chance . She likes the people she works with and she's forever picking up extra shifts . She likes the money she earns too. Its her job that in part makes her reluctant to attend therapy because she doesn't like to have to refuse a shift because of therapy appointments . She also has a new boyfriend and friends she chills with so therapy is just so low on her list of priories right now .
She just passed her driving test and I've already laid down the rules and expectations that she has to prove herself to be responsible for her mental health before she's handed the keys to the car to have free reign with it , so I have that as a bargaining tool !

I meet with the therapist on Thursday just myself and my husband , so I'm going to ask the therapist just what on earth she's playing at by allowing my daughter to lay down the therapy schedule !  It feels like the therapist is giving in pretty easily ! My DD has only been attending her since mid April . Maybe I just haven't found the right therapist yet . She seems to be allowing my DD to manipulate things to her own wishes .

[Yepanotherone]

I seem to have messed up my reply and mixed it In with a quote! Joys of typing on a cellphone   please see above for my reply ladies and thanks for the thoughts and great suggestions

[Yepanotherone]

I'm thinking the same thing myself . The therapist who evaluated my daughter (who was male) when she was last in ER ( following an overdose ) told me that my DD is an extremely intelligent girl who will very quickly right off any therapist who isn't going to challenge her thinking processes effectively . I wonder if lady therapists are mollycoddling her too much . Her school guidance counsellor is a male and she likes him a lot , he seems to be able to get her to open up . Maybe I need to think about a male DBT therapist rather than a female .
When I think about her last three hospitalizations, it seems to be the male therapists who take a slightly more challenging stance with her and she seems to respond better to that !

I agree with LBJ, no therapy is not an option.  LB also provided you with many tools for self harm urges.

So far as therapy, you all may need another therapist.  It often takes more than 1 or 2 to find the one that makes your family most comfortable and ease.  Keep trying and let your D know you are going to work as a family and will not give up, she can feel better and needs to be an active participant.

[Yepanotherone]

So I met with my DD's therapist on my own today ( my husband couldn't make it ) and it was time well spent . I was able to share with her some history that shed some light On her end in perhaps understanding and helping me to understand where this BPD monster perhaps originated from .
The therapist told me it was a very deliberate move on her part to " threaten " the removal of therapy attention away from my DD due to her lack of participation , in order to try and encourage her to " buy into " the process again . She did say that right now , my DD doesn't really want to stop the self harm , it's her " tool" for coping with emptiness and her " tool" for expressing her pain to her family and friends , but it doesn't mean she is suicidal and my DD is actually " okay with who she is right now ". So the motivation to change continues to be an issue . She'll be seeing her next week and I'm going to also continue seeing the therapist on my own ( and/or with my husband as his work schedule permits) as it helps to get little windows of insight into my DD's world .

[Gorges]

Hi,
I hear your love for your daughter and you really want to fix this problem.  When my daughter was 16 she was seeing a therapist weekly and going to weekly DBT groups.  I really do not know if they helped her or not.  SHe stopped seeing the therapist after a year and 1/2 when she got too busy with an after school job and when we felt that therapy was not reaping benefits. BY that point we had been through several therapists and actually liked who she was with.  Now she is 18 and became much more mature through a big mistake, separation from us for 5 months.  ON her own she became very interested in astrology because it described people's temperaments and helped explain her behavior and that of others. WHile I think it is crazy, it has really calmed her down and made her more thoughtful.

I guess my point is that you never know what works! But it would need to be something that they need to be motivated for... .

THe most effective therapy for us involved a program through our county that only involved my husband and myself. THe therapist never even met my daughter. It got us on the same page so that the house was calmer and we felt more in control that we were doing our job and the rest was up to her.

THis is only my opinion from a distance, but I think your therapist has a reasonable suggestion. THat said, trust your instinct... .and a big hug to you to help you cope!