Joint therapy with DDw/bpd helpful?

[Josie C]

I need a bit of advice.

After going a week with dd(29) blocking my calls (first time that’s ever happened), she called several days ago because she needed help with clearing up some health insurance issues. She was verbally abusive, accusatory, threatening to harm me, threatening to harm herself…all the usual.  She accused me of not caring because I didn’t try to contact her once she blocked me. (I decided it was best to respect her decision and use the time apart to take care of my own weakened mental health) She is blaming me for everything that is wrong in her life. I understand that this recent bout of emotional dysregulation is tied to her losing her job two months ago.  I’m trying to be compassionate and understanding. I did my very best to validate the intensity of her feelings, and when she demanded I come to her apartment so that she could hurt me, I told her I was willing to help only if she stopped threatening harm to me/herself. I also told her if she threatened suicide, I would call 911. By some miracle, we made it through, and by the next day I had the insurance figured out.

Then today, she abruptly texted asking if I would attend a therapy session with her next week. I’ve offered multiple times over the years to try therapy together.  She has vehemently refused. Why now? I said yes but I admit to feeling anxious— are she and her T going to gang up on me with the blame game? Am I going to be put in a position of defending myself?

As I’ve mentioned in previous posts, she has been much better over the past two years, and our relationship has improved in this time, too. She held a job she felt good about. I retired and had more time to spend casually with her. Her finances have become more stable. We’ve even shared a few experiences that were nothing short of amazing.  But I’m still hesitant to talk with her about mental health matters because things could flip from calm to catastrophe in a heartbeat. And then I feel like all our progress is erased in an instant.

I desperately want to try this and I’m terrified it will backfire. I would appreciate any thoughts on what a good mindset would be going in. Has anyone done a therapy session with their pwBPD and had a beneficial outcome?

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

[Sancho]

Hi JosieC
You have put all the aspects of this situation very well. Congrats on the way you handled things - and even managed to get the insurance thing sorted! Amazing!

Yes there are all the questions about therapy - why now - and the sorts of things that could happen at the session such as it becoming a blame session with you in the hot seat.

It could certainly end up like this, but it might also give the therapist some insight into DD's distorted world. There are some things I think would be important such as:

Your demeaner: Even though you expect a difficult time, I think it is important to be in a really calm, confident 'zone'.
Enough rope: By this I mean be prepared to just let it all flow because sometimes a therapist - a good one - is able to see what is truly happening when a person is given enough space to actually trip themself up.
Have stock replies: agree where you can, but have some general replies such as 'there can be different perspectives/recall in any situation'.
Don't JADE: A good therapist should pick up things just as much by what is not said as what is said.
Reversal: this can be a simple way to both indicate what is actually happening but putting it to the therapist that you would like them to guide you to an appropriate response. For example, you can say 'I am glad we are able to both be supported in our relationship. I do try but find it difficult at times to know how to respond. For example when DD says something like 'You are a terrible mother and you are the cause of all my problems - or something like this, how can I respond because I know I have done the best that I possibly can do.

You probably have thought of all this and more and have a plan worked out - so sorry if I am going through stuff that is already old hat for you.

I hope it goes well in that it doesn't explode into a blaming session. Stand tall through it all and you are in my thoughts.

[CC43]

Hi Josie,

To answer your question, I think that joining your daughter on therapy sessions has more upside than downside, especially if the therapist is one your daughter trusts.

My husband attended a few therapy sessions with his diagnosed BPD daughter, and I think they were extremely helpful.  Like in your situation, this was a few years into therapy, after some progress had been made, and some relapses occurred.  I think the joint therapy sessions helped clarify what was going on, let the daughter feel heard/validated, and helped her establish strategies for coping better, with her dad becoming her main ally in the process.  It seemed like the therapist, daughter and dad came up with a short-term plan for progress, like part-time work, part-time studies and continued therapy.  It seemed to me that once the old grievances were aired and processed with the therapist, she could start to heal and look forward for once.

For a time, my stepdaughter would attend therapy each week, and on alternating weeks her dad would attend.  I think that also helped improve the dialogue between the therapist and her dad--on occasion, he could call the therapist when things started to go awry with his daughter, and get the therapist's view and advice.  (Skipping sessions is a sure sign that something is amiss with my stepdaughter.)  And, I think the therapist had a better overall understanding of the BPD issues, by getting another person's perspective, not just the stories told by the pwBPD.

Look, I bet your daughter is unhinged after losing her job.  Losing a job is tough on anyone, and probably ten times worse for someone with BPD.  Though that isn't an excuse for blaming you or being abusive to you, it is an explanation.  But if you step back, you might see that your daughter was capable of holding down a job, which is a major accomplishment for someone fighting such intense emotions.  If she did it once, she can do it again.  There are millions of jobs out there.  It's just that her internal dialogue is very negative right now.  She probably needs help processing the loss, before she can move forward again.  And I know all about the suicide threats.  I've been through several attempts with my stepdaughters, and it is horrible.  I think you are absolutely right to say that if she threatens suicide, you dial 911.  That way, she knows what's going to happen.  And maybe she'll think twice.  Because if she's threatened or attempted suicide before, she knows that she ends up in the hospital for a few days.  Some people have to learn the hard way, by repeating that experience several times.  But they do learn I think.  I'm happy to say that my stepdaughter has taken suicide threats and attempts off the table, at least for the time being.  It's been almost a year.

I know this is so upsetting for you, and tiring after all these years.  But I see it as a good thing.  It sounds like she wants you on her side, and she really needs you.

[Josie C]

Thanks so much for your input and insight. Considering possible positive outcomes has helped me get to a better mindset. I think I’ve been so overwhelmed and beaten down lately that I couldn’t imagine a scenario that she wanted me there for help.  I could only focus on her wanting to belittle and blame me.

I’ve reviewed my dbt skills, particularly GIVE and FAST. And Sancho, thanks for the no-JADE reminder. Validation has come slow for me these past weeks, mostly because of dd’s reactions.  I’ve worked out a few better phrases to try to reach her and I hope I have an opportunity to try them out.

CC43 and Sancho, I’m re-reading both of your posts before I head in tomorrow.  You’ve given me much to think about.

[Sancho]

Good luck tomorrow Josie C

[kells76]

Going in with a listening posture may help: "I'm just here to listen and learn and take in where my D is coming from and how she feels".

It may also help to remember that you don't have to (and won't!) solve everything in one session. No pressure to fix/resolve everything in one hour. This may be the first step in a longer process; it's ok to be patient with everyone involved, including yourself. It will be ok if you don't get a chance today to share your perspective.

Wishing you all well today.

[Josie C]

The session was close to what I expected.  My daughter went on a tear, blaming me for her BPD and demanding I “fix things.” I followed Sancho’s suggestion to “give her rope”—just let her talk and hope the therapist saw the distorted and illogical thoughts.  It did help me to finally have her T hear the words I’ve been subjected to during every crisis.

Unfortunately, the outcome of the session was her therapist suggesting one month of no contact. I’m confused and grieving. I feel awful, like it’s all my fault that I can’t figure out the words that will help her. And I feel rotten for being irritated that while we have no contact, she still has no job and we’ll be paying her bills. That is, if she lets us know how much money she needs. She had enough money to pay bills at the start of the month but chose not to. It is likely she won’t pay and we’ll be dealing with shut-off notices and late fees. We will make it work to handle the expenses, but I’m resentful.

She had very intense emotions as a child and I didn’t realize (until recently) that she perceived things very very differently than what was intended. While my husband and I worked to deal with her sensitivities—we could only help with the ones we saw and not with what she was processing in her head. So we worked with teachers, family members (siblings and extended family) to help them understand her difficulty with transitions, loud environments, crowds, for example.  It wasn’t enough. She has a litany of things she is blaming us for —some make sense given her skewed perceptions, others are really off-base. And it’s like playing whack-a-mole…as soon as a truth was reflected back to her (ex: she claimed we never took her to therapy but she had two therapists as a child) she would ricochet into another area. 

It is heartbreaking to see my cherished daughter in such pain, feeling like we don’t care about her, hating herself, and feeling worthless.  She’s a bucket with holes and no matter how much love/attention/help we pour in, she can’t hold onto it. In fact, as much as she demands help and words of apology, it’s never enough or the ‘right way.’  I know she must be able to plug her own bucket with self-love and care. It’s just hard to witness.

[CC43]

Hi Josie, hang in there. Your daughter needs you, and she’ll pull through. You’re a trooper. When my diagnosed stepdaughter had an adult tantrum, she invariably needed an adult time out, to have time and space to get her emotions under control. That may be why the therapist recommended a break.

I get the resentment about finances and being responsible, I often feel that way. If she doesn’t pay utilities then they will get cut off, which is a natural consequence of her decision. It’s probably best that she experiences the consequence, or she might never learn. If you jump in and pay for everything, she could come to expect you to do that for the rest of her life, while blaming you for rendering her incompetent. If you feel resentment it’s because you believe your daughter is capable of paying bills on time. And that is a good thing. She just needs to learn to believe in herself.

[Sancho]

Hi Josie C
You must be emotionally exhausted after that. It was good that your intuition was  correct, and also good that the therapist got to hear what you hear over and over again - as you say, whenever there is a crisis.

The intensity of these sessions inevitably leads to a 'down' afterwards I think - because there is no sense of moving forward, not necessarily resolution - that would be something eh? - but even just moving a little forward.

My sense is that DD is deeply distressed at her current situation, and you will be the target of blame for her situation. It will be whack-a-mole because DD is letting the distress out and is not able to allow herself to feel any responsibility or blame for her situation, so will just keep on and on at you. There is no obvious easy solution, because while in this state and putting her support people in a corner, it is hard to see the way forward.

It is good to spend a small amount of time remembering all that we have done for our loved child. We are hit with a barrage of blame, all with intense emotion, and somehow - this is the case with my DD in any case - they know what button to push to activate the guilt response. They cannot be responsible, so need to tell us/show us that we are responsible.

When I am drawn into this I take a few moments to remember - I have done . . . ; I have worried  . . . ; I have tried  . . .

It's also good to remember that we are on a journey with out children and we do our best with what we see and what options we have at any given point in time. I look back and sometimes find myself thinking 'If only I had . . ' but I quickly shut that door with 'I know I did the best I could at the time'.

You will have a sense of 'down' now - DD still raging, bills mounting, etc etc. But the therapist was able to experience something of what is going on . . . and that is important progress I think.

I hope it is not too long before there is the possibility of moving towards what you had for that couple of years. Hold on to the fact that is was possible - and hopefully it will be possible again.

[Josie C]

Thanks so much for the support.  It surely helps to write these posts and reading your responses is really helpful.

It is good to spend a small amount of time remembering all that we have done for our loved child. We are hit with a barrage of blame, all with intense emotion, and somehow - this is the case with my DD in any case - they know what button to push to activate the guilt response. They cannot be responsible, so need to tell us/show us that we are responsible.

When I am drawn into this I take a few moments to remember - I have done . . . ; I have worried  . . . ; I have tried  . . .

It's also good to remember that we are on a journey with out children and we do our best with what we see and what options we have at any given point in time. I look back and sometimes find myself thinking 'If only I had . . ' but I quickly shut that door with 'I know I did the best I could at the time'.

It’s interesting that my husband doesn’t feel the guilt.  He has confidence that we did the best we could and that as we learn more we do even better. I know that too, but still have a hard time not second-guessing myself. Self-doubt is my part-time job.

This is an interesting point:

When my diagnosed stepdaughter had an adult tantrum, she invariably needed an adult time out, to have time and space to get her emotions under control. That may be why the therapist recommended a break.

The more I consider this, the more it makes sense.  If we were still communicating, she would use the time to rage and blame.  Without me around, she has to face the issues herself w/help from her therapist. 

[CC43]

Hi Josie,

I understand the worry and the stress you've been feeling for a long time now.  It is not fun being on the receiving end of the rage and blame.  You can't help but wonder if you could have done things better, even if you know that logically, you did the best you could, and you continue to be a very supportive parent.  It's just that BPD is so complex and pervasive in your daughter's life, and you hate to see her suffer, even if you resent being the punching bag and ATM, after all you've done for her.

But as you "recover" from the stressful therapy session, you might see some baby steps towards progress.  First, though the session might not have gone as you hoped, it did confirm that you have a pretty good grasp of what's going on with your daughter right now (there were no surprises, right?).  At least you semi-confirm that there isn't something else that's plaguing her (drugs? rape? unplanned pregnancy?), and that she didn't act like a completely different person from the one you know well.  She's using her usual tactics of projecting blame for her current misfortunes onto you, by dredging up the ancient grievances from childhood.  At least she's talking, instead of stonewalling the therapist.  And indeed, if she's challenged on fact patterns, she'll change tack, her usual M.O.  It's probably extremely helpful for the therapist to see how her patient is thinking and interacting with her mom, as the mother-daughter relationship is probably the most important one in her life right now.  And I bet the therapist noted how you reacted--you showed up, and you came with concern, love and support.  The therapist will probably soon conclude that you aren't the horrible person your daughter makes you out to be, but rather that you are an important ally in her patient's long and winding road to learning how to cope with her emotions better.  Does that sound fair?

I mentioned previously that my husband attended multiple therapy sessions with his BPD daughter.  Many of the sessions were intense, as you describe.  I think that at one point, he basically admitted something like, "I can see how you might find that situation very upsetting . . . and feeling abused is a horrible way to feel, especially after all these years."  I imagine that he basically had to agree that she felt abused, and she had to feel heard, before she could consider starting to look forward.  Eventually the focus shifted to the present and the future, and I imagine the therapist had a good sense of what changes her patient could handle at any given time.  That my husband had a dialogue with the therapist, inside and outside the sessions, was very helpful in my opinion.  It was also helpful to me (the stepmom), in the sense that there was a professional therapist with more insight into my stepdaughter's current emotional state, who could make some recommendations and minimize the risk of derailment/relapse.

All my best to you on this journey.  I can say that I was close to the point of losing hope, basically mourning the loss of my stepdaughter to BPD, when things finally started to turn around.  And when did that happen?  When my husband started going to some joint therapy sessions.  That might be coincidence, but I want to believe it was a turning point, because BPD is so tough on young adults, and I think they really need a loving parent on their side to get through.

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

[Sancho]

Hi Josie C
Your remarks about self doubt etc are interesting. For a while now I have looked at my journey with BPD DD as an opportunity to look at myself - to understand myself better etc.

I found I was the one in my family - my family of origin that is - as the 'responsible' one, the one who solved the problem etc. It's part of my identity which developed in my family and became just 'who I am'.

In dealing with BPD DD I've had to challenge that identity in order to 'let go' and to know that I cannot be totally responsible for another.

It is interesting how life throws up these challenges!

[Nekorb]

Josie -

I’m new and don’t have a ton to offer right now except to say I hear you. It is sad and heartbreaking to watch your child suffer. My daughter attempted suicide five times in her later teen years. For my own sanity I really had to learn to let go of the idea that I had any control over her or her decisions or that I could somehow affect the outcome for her beyond getting hr connected with therapists, etc.

Right or wrong, it helps me not completely lose myself in the sadness over it. She is an adult. She knows she has mental health issues. She is responsible for dealing with it, as many before her have learned to do. I don’t have to subject myself to her toxic behaviors in the interim.

But it’s hard.

Nekorb

[Minty50]

Hi Josie -

I'm hanging on by a thread myself so I don't have anything to offer except to comment on your very wise statement "She had very intense emotions as a child and I didn’t realize (until recently) that she perceived things very very differently than what was intended. While my husband and I worked to deal with her sensitivities—we could only help with the ones we saw and not with what she was processing in her head." 

This was so so so true in our case and it reminded me of something my struggling 30+ daughter revealed recently.  On a trip to Disney World when she was about 6, we were waiting in line at the Hollywood Studio park to get into a 101 Dalmatians show and there was an animatronic of a dog with it's head removed to demonstrate how the figures were made - all the wires and such on display.  She said that she thought we were all waiting in line to have our heads removed and she didn't understand how I and her dad could be so calm knowing what was going to happen.  I understand that no parent in the world could have anticipated this reaction by their child but it still breaks my heart to think of it.  In my mind, it is an example of her being a brave little soldier trying to handle a scary world until years later when she couldn't any longer.  I feel so bad for all of our struggling kids.

[Storm cloud]

Hi Josie I feel your pain. My daughter asked me and my husband to attend therapy with her. I am also fearful. When we did before it was awful and all out blame to us and our other daughter without anything concrete coming out of it.
Right now I am feeling fragile after a recent rage by my daughter and our attempts to understand what is going on. In a recent text exchange we tried validating her feelings in the hopes that might help. She acknowledged that it did but then asked us to join her in therapy and everything inside of me is making me fearful of another battering. I don’t feel like it will be a safe space for me.
After reading how it went for you I am even more reluctant given my own experience. I wonder if there is another alternative?

[Peche]

Hi people,
I’m sorry you are all facing similar issues to me with my pwBPD (DD age 21.) She has been away for a year, living with family overseas, and I thought things were getting better. Then she switched and cut off contact with me again a month ago. But she’s moving back to this country today and I‘m very nervous.

She maintains contact w/her other parent. We are married and have other highly-functioning, non BPd children. She says she will not be in a room with me but I think the only way forward for us is through therapy. My spouse and I have decided to not engage in any talk of the abusive childhood/the traumatic past…no backwards-looking, rage- blaming conversations at all, unless it is with a therapist present.

She had a few months of DBT therapy here before she left, then 3 months in her new country, and has said it was useful. She learned some coping skills.We want her to take up therapy again and are willing to go to therapy with her; I want to, in fact., But at the same time, I am also worried that being raged at in front of a therapist will make me spiral down as has often happened the past 3 years when she rage-blamed.
I don‘t have much to contribute to this discussion other than encouragement. If your DD wants to go to therapy with you, take it as a sign she needs help and wants you in her life. Brace yourself, take the advice of wiser posters than yours truly, and know you are a good mother. Good luck.

[Peche]

Hi Josie,
I replied to your post a few weeks ago and was just wondering how things are going. Hope they are stable at least.
-Peche

[Josie C]

Hi Peche
Thanks for contributing to the thread and reaching out. My H and I are still catching our breath from an awful weekend with our DD.  We got the abuse stemming from her underlying issues with friends that provoked intense anxiety, feelings of loneliness, self-hatred. I don’t know that things would have gone differently had I tuned in to this sooner. Most likely not as she cycles through emotions very rapidly.

My daughter was begging her dad and I to help her.  Repeatedly said if we don’t get her help, there will be dire consequences. Seeing your beautiful child in such tremendous pain is gut-wrenching.  Yet no matter what we offer, she shoots it down.  Some reasons are valid, others make no sense. 

I have come to understand that joint therapy is very unlikely.  She fears that I will get the therapist on “my side” by “being fake and pretending that I love” her. It doesn’t matter if it’s her current therapist or a new one.  She doesn’t have trust in us or her T. 

I am doing my best (which currently isn’t very good) to radically accept this and bear the discomfort and fear.  Slowly, oh so slowly, I’m coming to terms with the idea that there is nothing I can do to help.  We can support her once she chooses the help, but if she’s unwilling to participate no program, therapist, hospital, etc will make an impact.

As Nekorb said,
 

For my own sanity I really had to learn to let go of the idea that I had any control over her or her decisions or that I could somehow affect the outcome for her beyond getting hr connected with therapists, etc.

But it’s hard.

How has it been for you since your daughter returned, Peche?  It sounds really hopeful that she recognized that dbt skills have been helping.  Have you learned dbt, too?  (I find that when I use my skills, things don’t go south as often or as quickly…I’ve been beaten down pretty hard these last few months and all my skills went AWOL; it’s going to take time to get my confidence back.) I understand you feeling tentative about her return and like your idea to refrain from having blame/rage exchanges without a therapist to help facilitate. Let us know how things are going.

Thanks to everyone who has shared their thoughts and experiences. Good, strong,helpful words of understanding and encouragement.

Josie