How to handle therapy for child w/ BPD parent

[How to communicate after a contentious divorce...]

It's been a long time since I've posted here and I'm glad to see people still benefitting from this place so much.

My ex-wife (undiagnosed BPD) and I have been divorced co-parents (50/50 custody) for nine years now. The kids are now 12 and 15. The years have included the difficulties one would expect (terrible volatility, outbursts, lying to the children, making them feel like she is my victim, etc.). It's been awful, but the kids are very sweet and I'm very proud of them. My relationship with them is very positive when I'm with them. When they go back to her, she sends me texts telling me how much they hate being with me and that I should just never see them again and stuff. But I try to not take that too much to heart. I don't say anything negative about their mother to the kids.

My 15 year old son has recently requested therapy and I've been very happy to oblige - thinking that would be great for him. But he is, of course, seemingly very unaware of the issues with his mother - instead seeming to just think of her as a loving victim that needs all his affection and support. He is struggling to do work for school but quickly assumed it's ADHD. He is suffering from anxiety but figures he should just get SSRIs. Both may be true, but from my perspective, he's also going through what must be an enormously confusing childhood and probably has no basis upon which to understand it.

I've set him up with multiple mental health professionals that he's found helpful, but I've also been very carefully hands-off about the whole thing. I have a ton of concerns I could articulate to these people, but feel that doing so is... unfair, I suppose? Dangerous, in some ways? But the effect is seemingly that my son tells these people he has ADHD so they give him medicine. He tells them he has anxiety so they give him medicine. As far as I can tell, any of the enormous challenges he's facing in trying to grow up with a BPD parent are completely unidentified and ignored. Which seems like, perhaps, a terrible, terrible missed opportunity for him to get crucially important counsel and help. He also sometimes replicates some of her behavior patterns, which, of course, makes the stakes feel very, very high.

Due to a recent move, I'm tasked with finding him a new therapist now and am wondering if I should approach this differently. Have people had success being more candid with their children's therapists about the concerns of co-parenting with someone with BPD? If so, is there a method to finding therapists that will be particularly capable of understanding this issue?

Thank you.

[just me.]

It's been a long time since I've posted here and I'm glad to see people still benefitting from this place so much.

My ex-wife (undiagnosed BPD) and I have been divorced co-parents (50/50 custody) for nine years now. The kids are now 12 and 15. The years have included the difficulties one would expect (terrible volatility, outbursts, lying to the children, making them feel like she is my victim, etc.). It's been awful, but the kids are very sweet and I'm very proud of them. My relationship with them is very positive when I'm with them. When they go back to her, she sends me texts telling me how much they hate being with me and that I should just never see them again and stuff. But I try to not take that too much to heart. I don't say anything negative about their mother to the kids.

My 15 year old son has recently requested therapy and I've been very happy to oblige - thinking that would be great for him. But he is, of course, seemingly very unaware of the issues with his mother - instead seeming to just think of her as a loving victim that needs all his affection and support. He is struggling to do work for school but quickly assumed it's ADHD. He is suffering from anxiety but figures he should just get SSRIs. Both may be true, but from my perspective, he's also going through what must be an enormously confusing childhood and probably has no basis upon which to understand it.

I've set him up with multiple mental health professionals that he's found helpful, but I've also been very carefully hands-off about the whole thing. I have a ton of concerns I could articulate to these people, but feel that doing so is... unfair, I suppose? Dangerous, in some ways? But the effect is seemingly that my son tells these people he has ADHD so they give him medicine. He tells them he has anxiety so they give him medicine. As far as I can tell, any of the enormous challenges he's facing in trying to grow up with a BPD parent are completely unidentified and ignored. Which seems like, perhaps, a terrible, terrible missed opportunity for him to get crucially important counsel and help. He also sometimes replicates some of her behavior patterns, which, of course, makes the stakes feel very, very high.

Due to a recent move, I'm tasked with finding him a new therapist now and am wondering if I should approach this differently. Have people had success being more candid with their children's therapists about the concerns of co-parenting with someone with BPD? If so, is there a method to finding therapists that will be particularly capable of understanding this issue?

Thank you.

[Notwendy]

I think the information about his parents and environment is very important and since he is a minor - I think you are able to speak to his therapist and give them this information.

I would also ask for a full evaluation for the "ADHD" diagnosis if he has not had one already. Anxiety can cause attention problems and attention problems can cause anxiety- chicken and egg- but seeing what is going on might help.

I think it's insightful that your son is asking for support. Maybe he needs medication but therapy needs to be more than that. He needs someone to help him process and cope with the family dynamics. Wise kid- I'd be open with the therapist about what he's dealing with.

[just me.]

Right. Thank you very much for the reply!

My concern is that telling a therapist what I perceive of the situation seems potentially very complicated and risky. I don't think my son is anywhere near the stage of realizing his mother's behavior is strange at all, and would likely be very defensive at the suggestion. And if either my son, or even his mother, were to know that I was portraying things that way to the therapist, then that could be a GIANT blowout. I'd honestly be concerned about that starting dominoes falling that could result in me losing custody.

For the therapist's part, if they just hear me "armchair-diagnosing" my ex and listing the reasons of my concerns - wouldn't they be very justified to be skeptical of my perspective and take it for a grain of salt?

I guess I'm feeling like these are dangerous waters and I'm wondering if other people have had experience with this. Have people found therapists that actually understood BPD well enough to handle this with the understanding and caution that the situation requires? If so, how do you find someone like that? Or am I overthinking and, in fact, most therapists would handle this well? Are there horror stories of people's attempts at doing something like this?

[kells76]

just me., I have to take off in 1 minute but couldn't leave before recommending:

look up the article "jiu-jitsu parenting" by Dr. Craig Childress. It deals with your exact situation -- how do you convey the reality of the dysfunction to professionals without coming across as a blamer, the problem, vindictive, etc.

should be google-able, if not I'll be back later.

[yeeter]

I vote for sharing your concerns with the therapist.  But not labeling, simply describing some of the dynamics and providing some examples.

At a minimum you can say that the relationship between you and his mother is a difficult one, and again give a couple examples of the types of things he is exposed to and needs to sort through and process.

It is very reasonable and expected even, to share with a T the environment and dynamics that could be contributing to stress for your child.

You dont have to point fingers  - simply statements of fact of the interactions between you and mom that the child is subjected to - the T will probe from there and learn the childs perspective.  Ultimately, it does a disservice to your child to 'normalize' abnormal behavior - and the T can help them work through that for themselves.

As for finding someone with expertise handling difficult personalities, I have no recommendations and spent months finding my own T.  Many of them will say they have experience, but in reality havent experienced the extremity that is common here.  Pretty much all professionals will go into with the 'two sides to every story' approach - assume that

Its great that your child is willing to see a therapist.  These are things that 'you' can not call out/address, just for the reasons you state.  But they shouldnt be normalized, and a T can help sort it out.

Just my $.02.  Tricky as you say, and less is more.

[kells76]

I also wonder if your son's quick assumption of "it's ADHD" is a roundabout way of him acknowledging that there is a problem and he wants help for it, but he doesn't have the language to say "I have a problem with Mom".

Is there a way to have him assessed to "rule out" ADHD/ADD/other? Or to "see if he meets the criteria"?

Sort of -- yeah, ok, you will take his concern seriously, and the way it looks to take it seriously ISN'T to immediately prescribe pills, it's to go through the steps the professionals recommend to see what's going on.

I guess it depends on how committed he is to "it's definitely ADHD and I'm ready to get a prescription". If he's pretty stubbornly adhered to that, then yeah, "take him seriously" and get the assessment. If not, then maybe let his T work on that in whatever timing s/he sees fit.

Also, here's the link to the article:

https://bpdfamily.com/message_board/index.php?topic=320051.0

Same ideas as yeeter -- focus on description versus labels, focus on your kid's experience and challenges vs his mom's dysfunction (at least, at first). Certainly saying "Sadly, there's been a lot of long-term conflict in the parental relationship" is fair.

Also present yourself as someone who is willing to learn and do things differently if it benefits the kids. Let's say there's some challenge for your son, and the only sources of that challenge are either you or Mom. A family therapist (not sure about a child's individual T, but maybe) might say "Hey Dad, what your son needs from you is instead of reacting like ABC, try responding with DEF to slow things down." If, then, you diligently try DEF for a few months, and your son is saying in sessions "yeah Dad is doing this DEF stuff", but the T still sees your son having a challenge that can ONLY come from a parent's behavior, a good T will be able to connect the dots.

So a vital part of interacting with professionals is having a true willingness to change and try something new for your kids' sake. That says a LOT about they family dynamics, because if you're doing everything they recommend, but the issues are still occurring... yeah, they'll get it.

[ForeverDad]

I emphatically agree with all the other replies, you have information and knowledge crucial to aid the new therapist in more quickly determining how best to proceed with counseling.

I also wonder if your son's quick assumption of "it's ADHD" is a roundabout way of him acknowledging that there is a problem and he wants help for it, but he doesn't have the language to say "I have a problem with Mom".

If adults have a hard time figuring out their issues, imagine how much more difficult it is for kids.

[just me.]

look up the article "jiu-jitsu parenting" by Dr. Craig Childress. It deals with your exact situation -- how do you convey the reality of the dysfunction to professionals without coming across as a blamer, the problem, vindictive, etc.

I found it! I'm reading it now. I still have a ways to go in it but so far it's seeming really, really spot-on and helpful! Quite re-affirming, really, to see much of what I've been experiencing explained by someone else. Thank you so much!

And thanks to you and everyone for all the other insights, too. I'm not in my son's sessions, but I get the sense he probably just conveys things very, very narrowly (that he suffers from anxiety and has trouble concentrating). And I get the sense the therapist either just talks medication (which always seems fast to me) or very symptom-focused exercises (e.g. "when you get stressed, try this"). My concern isn't so much the ADHD or not (or medicine or not) - it's more that I feel there is a whole mess of confusing stuff that he could probably really use counsel on and this could be a terrible missed opportunity.

I'm not included in the process at all other than a brief introductory conversation, and then after that, to schedule appointments, so there are no natural dialogues for me to engage in. I would need to force the issue.

I vote for sharing your concerns with the therapist.  But not labeling, simply describing some of the dynamics and providing some examples.

At a minimum you can say that the relationship between you and his mother is a difficult one, and again give a couple examples of the types of things he is exposed to and needs to sort through and process.

This is basically what I've done in the past - just in a very gentle form. I think I'm so reluctant to point fingers that the therapists probably just take it as normal divorce stuff and don't really end up appreciating the severity of the problem. Trying to get past that incurs all the problems I'd have if I were to try to describe this to any new person I'd just met (Why should they believe me? How do they know I'm not actually just a closed-minded jerk? Etc.), but with what feels like very high stakes to me.

I'm gathering that people feel I just need to do my best; be open-minded, but specific. And that advice is compatible with my instincts on this, so I really appreciate the help. I just really am scared that, with the wrong therapist, this could go really wrong. I think I have to try, though.

I don't suppose anyone has advice of how to find the right one for this approach? I'm just using google to find adolescent therapists that are covered by my insurance. Is there any methodology at all to finding someone that understands the challenges with BPD parents? Finding someone that understood this would be so, so helpful, I think.

[just me.]

If adults have a hard time figuring out their issues, imagine how much more difficult it is for kids.

Yes, that's absolutely how I see it. I don't want to be insensitive to the possibility that he has ADHD, of course. But I am also quite certain he must be feeling a lot of things that he can't fully make sense of. I want someone to help him really dig into that. I haven't found that to be the case yet, which is why I'm feeling I need to do more to help make that happen.

Scary stuff, though. Man - if my ex were to somehow learn that I was directly expressing concerns regarding her stability to our son's therapist, I think that could be really, really disastrous. Like, I may never the see kids again type of stuff, possibly, in an extreme scenario. But I'm also feeling like I'm probably not going to give these kids their best chances at healthy lives by only playing it safe, I guess.

[Notwendy]

Maybe he has ADHD but poor attention can be due to anxiety and I think it would be good to know what is going on with him. Medication might be needed- or not- or which one.


I don't know the extent of your wife's behaviors but a teen can be enlisted as an emotional caretaker, parentified, as well as be walking on eggshells around a parent.


I understand the therapist would not want to get involved in a "he said" "she said" situation. I agree with being careful of how you frame it and rather than be critical of your son's mother, say things such as "the marital relationship has been difficult and may be affecting him" allowing her to ask him specific questions to get the bigger picture. Report behaviors rather than labels if you fear being seen as diagnosing her.

[kells76]

I think I'm so reluctant to point fingers that the therapists probably just take it as normal divorce stuff and don't really end up appreciating the severity of the problem.

If/when you have an opportunity, maybe discuss how long it's been going on -- I feel like bringing up that it's been nine years and the conflict is ongoing should raise some eyebrows and push it past "normal divorce stuff".

Someone else mentioned it on this thread, but you should be able to meet with your child's T yourself. I think even in our state, which is biased towards minor's rights (another discussion), the T is allowed to share with the parent generally how things are going. That should be good enough to open a door. And, consider "collaborating" with your son about it, so it's in the open: "Hey buddy, T and I are going to catch up about how things are going. They're not going to share all the details with me, just generally what things are like. Would you prefer it if we met before you guys had your session, or after?" That could give him an appropriate level of decision-making in the process. You're the adult, you decide if you meet with the T or not, but he can offer input as to when you meet with the T.

[yeeter]

I dont have concrete answers, but want to provide support to your line of thinking:

You dont want to point fingers but you do want to highlight the issues needing considered.  It is tricky to not come across as part of the problem causing conflict.  To some degree, you can not overcome this.  Some possible pieces:

Acknowledge the conflict with the T.  It just 'is'.  Ask the T to share any insights on what adjustments you can make to reduce the conflict your son is experiencing.  State that you also would like less conflict.

Offer for you sons T to connect with your own T if you have one (I have found T to T calibration to accelerate learning)

Therapist LOVE medication.  The entire medical field does (I work adjacent to it and have a lot of friends that are docs).  I am also cautious about how much medication to apply - the most comforting thing I can recommend here is finding a pediatrician that you feel is highly competent and that you trust.  Then calibrate with them regularly.

The wrong therapist can make things worse.  Unfortunately, a pandemic makes it hard to find ANY therapist.  I searched the therapy finder sites on key words and found mine indirectly through an author of a publication on the topic.  DBT might be good skillset for a T to have.  Any cluster B or PD experience is worth noting (sometimes listed in the bio).  Beware of those that 'think' they have dealt with difficult clients but have not.  I would require a PhD, and/or very experienced T just thinking maybe if they have seen a lot of cases they may have seen some of the more extreme behaviors.

Never seeing your kids again - a consideration.  It happens.  Do not take that possibility lightly and if such language comes up kick into full blown legal mode immediately, in stealth manner, to build data and support and documentation

It is hard to know the balance.  But you are asking some great questions.

 

(ps:  Prescribing docs HATE to be challenged or second guessed, and this is true regarding meds.  As I told one recently; 'any doctor worth a damn does not object or feel threatened by second opinions or consultations with others.  There is almost ZERO black and white answers on these things so any doc that comes across that way I would fire.  Especially psych meds are somewhat trial and error (each person responds differently) - they take a little time to build up/come down, have some real side effects, so it is a somewhat lengthy process to even try them.