New to board, learning, scared for our daughter and am wondering about an RTC

[grichs]

Hello.  I am new.  We have a 15-year-old daughter.  She has been treated for ADHD with medication since kindergarten.  She has always had very intense emotions and impulse control issues.  :)uring middle school her behavior deteriorated.  She started cutting about a year ago after breaking up with her first "boyfriend".  (We apparently didn't see him quite like she did … she was much more involved emotionally than we thought.)  Like most teen girls, she is nuts about boys.  But, in her case, a little "too" nuts.

She has been hospitalized twice in the last year threatening suicide.  She made some progress over the summer; however, she is having depression issues again over a boy she liked who doesn't like her (he's probably a little scared!) and is acting out with anger towards us and is again consistently making VERY poor choices.  Her therapist (who I trust) has indicated that she and our daughter have begun to connect (and I believe that is true).  Our family therapist (who I also trust) has also indicated that she feels we have clinically made progress.  I'm happy about that but am wondering when we're going to see more practical gains with her depression and her acting out.

Her psychiatrist has indicated our daughter probably is an emerging BPD.  The therapist says she has front lobe deficits causing the behavioral problems that can be resolved with therapy.  I say I'm lost and don't know what to do.  I feel like she needs to be monitored 24/7 and is having a negative impact on the rest of the family.  I feel like I need to run a police state in our home.  She says she is not suicidal right now; however, she has been looking for songs on the net about death and suicide.  After having been repeatedly deceived we have definite "trust" issues going on.

I mentioned the possibility of an RTC to our therapist.  She is recommending against it right now since she feels like she is starting to make progress clinically with our daughter.  I also don't think the therapist believes our daughter is not in bad enough shape to warrant sending her to an RTC.  There is part of me that doesn't want our daughter to have to start over with a new therapist at an RTC; however, I'm worrying whether or not we can really manage her.  While she and the therapist are "connecting", she also seems to be sliding backwards in terms of her depression and associated behaviors.

I don't know how, as a parent, to assess what will best serve our daughter.  Of the various therapies she's involved with (Group, Individual and Family), the only one she likes are her group therapy sessions.  I think she likes being around other troubled teems with whom she can relate.  Between group sessions with her peers being enjoyable for her, my fear that we're not adequately managing her, our trust issues, the fact that we trigger her negative behaviors - I can't help but wonder if somehow we could financially manage it if she wouldn't be better off in an environment specifically set up for girls with similar issues.  Yet, at the same time, she isn't currently involved with drugs (although she tried marijuana and is now being drug tested weekly) or having eating disorder issues both of which seem to be prevalent at RTCs.  I'm not sure I want to put her in an environment where she'll be exposed to even more maladaptive behaviors.

So, I'm lost, trying to find some insight into how to help our daughter and our family.

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

[pessim-optimist]

Hello grichs,



I want to post a warm welcome to this site. Having a young child with emerging BPD can be so very stressful.

I am glad you found us.

We are here to offer you the support and encouragement to help you find answers to your questions. As you try to keep your child safe, it can get scary. But there is hope - there are things in our communication with our child, that can improve the overall situation. A great place to start is with this set of resources: What can a parent do? We look forward to seeing you on the Parenting a Son or Daughter Suffering from BPD board and hope you join us in learning how to understand and communicate with our children better.

There is also a section there specifically on RTCs and hospitalizations, and there is one very good thread that might be really helpful as you think about the possibility of RTC:

https://bpdfamily.com/message_board/index.php?topic=120563.0

Welcome again, and feel free to ask any questions you might have - we are here to support you.

[peaceplease]

grichs,

  I would like to join pessim-optimist in welcoming you to the parents board. 

I can imagine that you have many fears about your daughter.  It is a tough decison to make on sending your daughter(dd) to an RTC.  You are worried that she may pick up other behaviors copied from her peers.  I can totally understand that fear. There were times that I considered when my dd was a teen that I should send her to some type of treatment. I didn't know much about BPD then, and did not suspect she had it. However, her behaviors needed addressed, and I was lost as to what to do.  Also, at the time my dd was a teen, I worked in a psychiatric facility where we had a rtc.  I had the same fears, and my dd did not seem as sick as the girls at this rtc.  I can recall asking the unit director how to distinguish between bi-polar and BPD.  I was just starting to wonder if my dd had BPD.  However, I dismissed it, as my supervisor told me, that it came from neglect/abuse from mother.    Pessim-optimist gave you a great link where Distinguished member lbjnltx talks about her journey of her daughter's stay at an RTC.  She shared the whole journey with us here.  I am certain that you will find it encouraging and very hopeful.

You are fortunate as your dd is still so young. Her brain is n ot fully developed, and her chances of full recovery are higher.  Are you in individual therapy for yourself?  If so, you may want to discuss with your own therapist.   What does your family think about RTC treatment for your dd?  And, what does the therapist recommend for any type of treatment for BPD?  How often does she see the therapist? 

Again, welcome to the parent's board. 

peaceplease

[crumblingdad]

Welcome to the board and so sorry for the pain your family and dd are currently going through.  It's so hard to assess when it's time for an RTC and when outpatient care will resolve things.  Wish there was an easy answer for you.  I read your story and it has so much in common with our DD16 about 2 years ago.  You have the good fortune of an early diagnosis of emerging BPD - we weren't so lucky and it wasn't even brought to our attention until 6 months ago.

Throughout our long arduous journey my gut felt there was something worse behind diagnosis of PTSD and anxiety but no one told us.  I can tell you she was in a group program she loved and we always felt she loved it because it connected her with other troubled teens.  When all was said and done i look back and wished we followed our instincts as this indeed provided no real therapeutic value.  Not to say group therapy can't but this one didn't.

Is your dd involved in any DBT based therapy?  Have you looked at some of the other types of treatment that have showed some success with BPD and are your therapists trained in this?

Transference based or schema have shown some success - I've read some great things about schema lately.

All I can say and don't want to frighten you is read all the resources you can find and if your parental instincts say she needs more then follow those.  I delayed and pondered over RTC, we placed our DD into the states CHINS program which ended up bouncing her through 5 group homes all of which lacked the mental illness resources to truly treat our dd.  She has slowly spiralled from a story much like yours just two years ago to destructive behavior wed have never comprehended was possible including heroin addiction.

We finally just got her into Newport Academy and you can read about the road here in an active post I have going on her failed intervention followed by incarceration into YDC.  It's my belief the proper dual diagnosis RTC will have more positive then negative impact with exposure to other troubled teens but it's a tremendously difficult decision if she's making progress in outpatient treatment.

In my opinion keep reading learning and asking questions but don't ignore your gut or your instincts just weigh them with you're knowledge and with competent mental health professionals for the right path as the earlier you can make progress the better.

Good luck and thinking and praying for you, your dd,  and your family!

[grichs]

Thank you, crumblingdad.  My heart goes out to you and your family.  One thing I have definitely learned through this experience is how heart wrenching this whole experience can be.  I pray better days are ahead for your daughter and your family.

I have thought numerous times that no one knows our daughter like we do, and therefore our guts probably will give us some good indication of what we need to do.  I took your encouragement in that regard very much to heart.  That said I also want to also get educated and not just make an emotional decision based on our uneducated, unprepared gut instincts alone.  I am frightened that our daughter may ultimately follow the same path as yours.  I will read your posts about your daughter's experiences at the Newport Academy with great interest.  I want to be prepared and know what I'm doing should we wind up looking for an RTC ourselves.

Our therapist did her internship at the McLean Hospital where DBT is utilized.  She incorporates elements of DBT in her practice, but her therapy approach is primarily cognitive based.  I have heard her use terms that I have read in some of the DBT material such as using the "wise mind".  As I mentioned in earlier posts I am pleased with her therapist; however, I'm getting worried we aren't seeing more progress.  I'm also wondering if we're really doing the right things at home to parent such a child correctly.  I'm getting some good coaching on that point from the therapist; however, I wasn't trained to run a home the way I'm having to run it and I'm afraid I'm not doing a good enough job (which is one of the reasons I wonder if an RTC might provide a better environment for her successful treatment).  I'm also worried about the stress her behavior is placing on our son (who, knock on wood, is fine).

We'll see what unfolds for both our families over the weeks ahead.  I'll be hoping for the best for both of us. 

Thanks again.

[lbjnltx]

Hello grichs,

Happy to have you here and sorry to hear about your d15.

This is a long and arduous journey for her and yourself/family.  My d was diagnosed (dx) with odd prior to her "emerging BPD" and mdd (major depression) dx at 12 years old.  She was in outpatient family therapy (with a DBT component the last year) for 2 years without real change.  2 years without seeing any change in the direction she was going was a clear sign to me that she needed more help to have a healthy future than she was getting.

You are very correct in your thinking.  Being well educated about the disorder will help you make wisemind choices about your daughter's care... .choices based on knowledge and driven by hope instead of fear.

You are very correct in thinking that you and your family know your daughter best. You have been chosen to be her parents.  This carries a burden and privilege with it.

Making the choice to send your child to an RTC is a biggy!  The conventional wisdom of the professionals is to do it as a last resort.  I can't say that I share that opinion.  I could see from a place of wisemind that:

1. what we were doing wasn't working.

2. as my daughter got older her behaviors/thinking errors were becoming more entrenched

3. she would be encountering more substantially harmful opportunities as she got older

4. her chosen peer group had/has more influence on her than her family

5. other than her family (who she continued to rebel against in big and might ways) there was no one holding her accountable for herself, actions, and beliefs as the role of a therapist is one of support... not accountabililty.

6. the higher the mountain is to climb the more she would have to overcome to have a healthy life.


My d is now 17 years old.  I KNOW without a doubt she has learned all the skills and has all the tools to have a successful and healthy life.  I was responsible for providing her the opportunities to heal and I am responsible for being a living example/model of those skills and tools.  She graduated from RTC after 10+ months of excellent and family involved treatment in March 2011.  She is doing well!

[jdtm]

to lbjnltx - two questions - where did your daughter go after completing her residential term?  And is she on medication of any kind?  Just wondering ... .

[lbjnltx]

to lbjnltx - two questions - where did your daughter go after completing her residential term?  And is she on medication of any kind?  Just wondering ... .

My daughter came home to her family.  A family that learned before her and alongside her.  A family that forgave all past wrongs, owned their part in the dysfunction, and first practiced what we asked of her.

She was required to enroll in school when she came home even though she had finished the school year in RTC... .our state was still in session.  She did online public school to help her ease back into public life.  We continued outpatient therapy with her former t... .and stopped after a few months due to lack of accountability... .could see her losing ground.  The following school year she went to a very small  K-12 school as a best next step into public life.  She also participated in nuerofeedback therapy (50 sessions in all). She then enrolled as a sophomore in the regular public high school and is still there now as a Junior.

She continues to be on prozac and abilify (she had some psychotic features prior to RTC) at the same dosage she has been for 3 years, vitamins, and Omega 369 for healthier brain function.

She is bravely facing the impending loss of her Dad to cancer at this time.  She is a very compassionate young woman with much to offer.