Weighing treatment options

[smallbirds]

Hello--
My 15 y.o. daughter has BPD traits/provisional BPD. She has made a lot of improvements over the last year: she started going to school, taking meds, and showing up for therapy without a fight (not always engaging with the therapist, but at least attending). She also stopped cutting herself. She does continue to have rage episodes, which sometimes turn into physical aggression toward me. And she turns to substance abuse to self-medicate. After a lot of improvement, she started backsliding significantly about 2 months ago, especially with substance abuse. We were able to get her into a wonderful short-term residential treatment program in our home state. She has been there for about three weeks and seems to be doing wonderfully. It's not a DBT program, but she has a DBT therapist there (her home therapist is also a DBT person). She says all of the right things--acknowledges that substance abuse was ramping up her emotion dysregulation, says she wants to actually use all of the skills she bas been learning, develop healthy habits like exercise and family activities...

The residential program is recommending that she move on to a long-term (year long) program in Utah. We are looking closely at Alpine Academy. Early in the process, I asked them about their DBT services and they said that they use it where appropriate, and have trained DBT therapists. But now that we're closer to enrolling her, they are saying that none of the DBT therapists are available, but that the person she will work with will get some DBT training at some point...

I have read just about every corner of the internet for information on residential programs, and my conclusion (not an expert!) is that most of the "failures" (which are absolute horror stories) are a result of BPD kids going into programs that don't know how to treat BPD.

One alternative is McLean Hospital's short-term program in MA. It's a 6 to 8 week residential program that is extremely expensive (we'd mortgage our home). But it is all DBT, and specific to treating BPD traits. It's the same type of program that she's in now (short term, unlocked, voluntary residential). Also, they are closed now because of COVID, so she'd come home until they re-open, and possibly fall back on all of her old bad habits...

Any 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

[Jen2020]

Hi smallbirds,

That is so great that your daughter is progressing in therapy!  My DD18 was recently admitted to inpatient (not her first rodeo) from her college and spent a lot of time researching and calling longer term treatment facilities.  Unfortunately I did not succeed in striking while the iron was hot and getting a door to door transfer, which greatly limited my insurance options, and then she decided that she felt better on her meds and needed no further therapy or treatment.  Defying all recommendations.  Since she is 18, I can only hope for the best but prepare myself for the next round of events.

Anyway, I just thought I would share the results of my research.  Among tons of other searching, I found this list: https://www.bpdvideo.com/borderline-personality-disorder-help/residential-treatment-centers.  It seems to have most all of the good BPD treatment centers I uncovered during rest of my searches.  I went through them systematically and called most of them to speak with admissions.  My finalists at the end of the day and with my insurance were Sierra Tuscon and Timberline Knolls.  Pros & Cons of each - which I'm sure you will fins with any treatment facility.  One place I spoke to that I was really impressed by (not on the list) is
https://paradigmmalibu.com/teen-borderline-personality-disorder-treatment/.  From talking to them the level of psychiatric attention, and creating individualized treatment plans was really impressive.  Downside, they are private pay upfront and 'assist' you with reclaiming insurance later.  They said the reason they don't have in network insurance is because the treatment plans are too individualized and insurance wants cookie cutter. 

If you looks at google reviews on Paradigm Malibu, it looks like leader of the pack.  If you are considering an upfront pay facility like McLean or Menninger, I would definitely check them out as an alternative. 

I hope this gives you some food for though.  Don't make the mistake I did in not getting the door to door transfer and insurance sees this as a psychiatrist declaring residential supervision is no longer necessary!

Best wishes to you and you daughter.

[Jen2020]

PS - excuse my typos , and feel free to direct message me if you have any questions on what I have gleaned through my research or want someone to bounce ideas off of.  I don't have advice per se, just my experience to share.