DD16 back in hospital

[crazedncrazymom]

Bad news about DD... .and good news.  DD has been doing really good at home.  She has been following rules and expectations, going to school, making friends etc.  We did find her with a razor blade a week or so ago which she was going to use for cutting.

She wasn't feeling safe on Monday and Tuesday.  Monday we tried using coping skills to get her through the bad feelings.  Tuesday she asked to go to the hospital.  She signed herself in.  Almost as soon as she got there she demanded to be moved to a different hospital because this one is awful.  They said no and she signed a 72 hour notice of her intent to leave on Thursday.

The clinician called and informed me about her signing the notice and was a little annoyed at my response.  She trusted me enough to talk to me about her feelings.  She made good safe choices and I was not going to force her to stay.  I've done that for more than 2 years now at various hospitals and rtf and it didn't do any good.

I showed up later that day for a family session and she was all defiant with me because she thought I'd make her stay.  I told her she was in charge of her treatment.  She requested to go to the hospital because she wasn't feeling safe.  She admitted herself.  These were her choices.  If she decided not to stay and get treatment that was also her choice.  However, she had to write down what was bothering her so much and give it to her therapist before she left the hospital and promise to work on these things so she didn't end up back in the hospital.  She agreed and I was very comfortable with the agreement.   Hospitals have never helped or done anything for her so I felt really good that she was finally willing to really open up to her therapist at home. 

The clinician called yesterday and said that they would allow dd to change hospitals.  I told clinician about how DD has signed or at least wanted to sign a 72 hour notice at every hospital we've been too.  Regardless of fond memories of a certain hospital... it wasn't that great and she hated it there too.  So the clinician talked to her and she decided to rescind her 72 hour notice and work on her trauma issues. 

Then DD called a couple of hours later and said she had to rescind the notice because they said they would 302 (involuntarily commit) her if she didn't.  I'm not sure what to make of it.  It's either two things.  They lied and manipulated a 16 year old girl.  Believe me I've seen things happen so it's completely possible.  OR... This is her decision and she didn't feel comfortable or safe telling me that she was staying because she felt she needed to.  Less likely because she knows I will support her decision on her treatment.  I made sure to tell her how proud of her I was at least 20 times.


So bad thing... she felt unsafe and suicidal.  GOOD thing... .she told me how she felt and tried to get through it with my help.  Another good thing... .she made some great safe decisions all on her own.  I'm hoping that since she is making these decisions on her own that she will be more open to working through some of her issues.


OK, all you smart ladies out there.  Some of you have been in this situation.  Some of you can imagine what it's like to be in this situation.  What is your take on this? 

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

[Rapt Reader]

Hi, crazedncrazymom   

I'm so glad your daughter is fighting her demons... .I agree that it was a huge step for her to realize she needed help, and then got it. I'm really happy she resisted the urge to hurt herself and got help instead; you must be very proud of her!

So, is she still in the hospital? Do you hear from her? How is she doing? I truly hope she is getting the exact therapy that she needs, and is growing and healing. Can you update us?

How are you holding up? I know that the two times my BPDs36 was in the hospital for suicidal ideations, and the 3 times he was in longer-term Rehabs for his substance abuse issues (28 days, then 39 days, then 21 days), I was on pins and needles while he was away. The dichotomy of being so relieved that he was somewhere safe, and then petrified of how he was doing--if he was really getting helped--and what would happen once he came back home, was painful and exhausting. Are you OK? Let us know how things are going, all right?

 

Rapt Reader

[lbjnltx]

I agree with you in regards to hospitals of being of little value for pwBPD.  They are crisis stabilization units at best.  If one is truly blessed they may walk away with a list of potentially helpful resources.

In a nut shell... .short term residential care is not enough to affect positive and lasting change UNLESS the client is highly motivated and committed to continued outpatient therapy.

Since your d gets to make the decisions regarding her treatment... .what is her short term and long term plan?

[vivekananda]

crazedandcrazymom, all I know is that it must be a hard situation to be in. I know you desperately want to do what is best and that you are getting mixed messages.

I wouldn't know what to do. I believe you are in the best position to know what to do for yourself. My question is do you have sufficient information and 'balance' to do just that. I understand too well that the 'experts' can mess us around. I understand that our dd's can do the same. So, I like lbj's question to help sort out a clear path:

Since your d gets to make the decisions regarding her treatment... .what is her short term and long term plan?

Your dd needs a treatment plan both short and long term, what is it? Is it sufficient to promote recovery?

On another tack completely, you must be feeling eased to be able to validate your daughter so that she trusts you. That is good news. I would like to suggest something to you though. I need to say I have been a tad blunt in my explanation and don't wish to upset you. I just don't know how else to put it so you can see what I mean.

I made sure to tell her how proud of her I was at least 20 times.

When I read this my 'alert antenna' pricked up. This is not a validating statement. If you believe that you are validating your dd with things such as this, then you might be on the wrong track. Let me try to explain.

Knowing what I know now, if I said to my dd I felt proud of her, I could hear her say/think: "What do I care about how you feel. This is about me not you. You feel proud, well good on you - but how do I feel? I don't feel proud when you say that, I feel let down. So, you feel proud for me in this situation, what about the other time when I didn't do that. Did you feel ashamed for me then? Who are you to assess whether I have done a good thing or not? You thought I wasn't doing the right thing before when I was trying so hard to do the right thing... .you're just being judgemental... ." and so on

Can you see it? Validation is identifying and naming the emotion that they are feeling. Instead, by saying you felt proud of her, you have given approval for her behaviour in the hospital and this is in direct contrast to how the experts see it, isn't it?

I hope I haven't made things harder for you,

Vivek       

[crazedncrazymom]

Hi Ladies,

Sorry, I had typed an update yesterday just before I was leaving for work and then got distracted so forgot to hit post and lost all that typing.

OK... DD is HOME!  I love her new therapist.  She is very knowledgeable about BPD and has worked with several BPD kids.  She enjoys working with them so much that she has a standing request with her agency to give her BPD patients.  She talks all the talk we like to hear.  Helping with distorted thought processes, validate validate validate, meeting dd where she is and working from there, validate validate validate.  The only thing we disagree on is that she does not believe BPD partly has a genetic/chemical component.  She believes it's 100% trauma related.  I decided to be ok with that since we do not have any dbt therapist in the area.  Can't have everything we want, but she's pretty close.  She also comes across as a very positive, sympathetic and happy person.  She also is very aware of the shame component of BPD and how we need to evaluate every traumatic experience dd has had/believes she's had and work on minimizing the shame.  I think dd will relate very well with her.  Also, she is very much against hospitalization and rtf except as a last resort.  So we are very much on the same page.

Our biggest problem with dd right now is getting her to start the work.  Even her therapist says with all these treatment teams/therapists/hospitals and rtf she has not done any work at all and we are almost still at ground zero.  I completely agree.


LBJ, according to dd her short and long term plans are "I don't know".  That is the answer to every question regarding her safety and future.  How will you keep yourself safe tomorrow?  I don't know!  She's going to wing it.  As long as she is letting me know when she's not ok, and we are able to get her through the day I am comfortable for the short term.  I think her new therapist will really be able to help her see that she can make a better plan.

Also, and this is HUGE!  The communication level with me and my daughter is so good.  I've been working so hard at gaining her trust and being easy to talk to and supportive.  Our relationship has improved 1000%.  I do need to work on my validation skills (ie what is validating and what I think is validating but isn't)  Yes Vivek , I read the book and I should know better!  But fortunately she received my words in a very positive way.

I met with her partial hospitalization team this morning and they are in agreement that since DD isn't talking with them regarding her issues that she should be in a rtf.  I can't remember exactly what I said to them, but I relayed the conversation to dd's therapist.  She said DD must have felt very validated by whatever it was that I said and that I not only showed dd that I believed in her but also proved to dd that we were a team and I had faith in her ability to work through her issues at home.

[lbjnltx]

Good to hear that your dd has a therapist that is so qualified.  I hope that she will begin to take ownership of her own recovery and learn the coping skills she needs to live a fulfilling and peaceful life.

My families experience with long term residential treatment was/is a very positive one.  Last resort... .why wait until it gets that bad and you, as a parent, have no power to get her the treatment she needs?  That was the basis for our decision because 2 years of  outpatient therapy (including partial DBT) did not work.  Each family has to make decisions for themselves.

Regarding the t's belief that BPD has no genetic component... .I think genetically people are born predisposed to developing the disorder... .ie... .hypersensitive.  This hypersensitivity causes them to process life events as traumatic... .therein lies the genetic component.  For example... .when my dd was  11 we had to have  her pony put down... .very sad for any child... .traumatic for her.

Perhaps you and the t can gain a better understanding of this by talking and being open to each other's perspectives.

Keep us updated on how you and your d are doing.

lbj

[jellibeans]

dear crazed

oh how happy I am to hear that you have found a therapist that your dd can talk to... .that has made a big difference to my dd. To feel finally heard... .validated.

I don't think there is a one size fits all approach to helping our children. One approach is not better than another it is just different and is based on the individual family.

what do you feel you are doing differently when you talk with your daughter that has made communicating with dd better? I have really enjoyed watching the videos Vive posted under the values post... .it has been very eye opening... .hugs to you... .

[vivekananda]

I feel so happy for you ccm you have had a break at last, phew! I am pleased you and your dd are getting on together so much better (am I allowed to feel a bit jealous  ) Really there is nothing so much better than hearing you have had a break through (except a message from my own dd... .)

You keep on with the learning, ok? It is a big journey for all in your family and because you are the grown up, it is important that you are on track too.

I am so glad you are able to work with your d's T. Who cares what she thinks about genetics etc as long as you and she are able to be a team for your dd.

Stay on the boards here for us so we can continue to share your story, ok? And yeah, what do you think is different in your communication with your dd, is it anything you are doing?

Cheers,

Vivek      

[crazedncrazymom]

Hmmm the biggest difference in our communication was made during rtc.  All we had was the phone for the most part.  There wasn't the distraction of shopping or music or tv or whatever.  It was just... .how are you?  Listen to long rant about how much she hated everything there, validate her feelings, encourage her, maybe a little chit chat and hang up for the day. 

Also I've noticed I catch things earlier.  If I notice she's being grumpy with everyone I take her aside and ask what's going on.  Usually there's something happening at school or with friends and whatever is happening at home at that moment (however big or small or miniscule) is triggering her.  In the past I probably would have just been grumpy right back (don't you talk to me that way).  I've learned the best way to get through to her is to say... .hey I'm your mom and I love you more than anything in the world.  She responds to that and opens up.  I'm not sure she would have done that before rtf, but I'm pretty sure I never spoke that way to her after she told me off or stomped herself upstairs, or refused to do chores or whatever.  The funny thing is after she tells me what's going on and I validate her feelings about it she does what she's supposed to without complaining. 

LBJ if you read this, I just wanted to say that rtf can be great.  It did help my dd and obviously yours.  I think it's wonderful that you were able to pay for that gift for your dd.  I do think that state run rtf is so much different.  Just the fact that most of the girls there have little to no contact with their parents or the parents may have lost custody of the girls makes a huge difference.  I wish I had the money to pay for a private rtf.  I do think dd would have been in a better situation and probably would have progressed even further.  However, I would recommend rtf for anyone who was in the same place with their child that I was with my dd.

[lbjnltx]

LBJ if you read this, I just wanted to say that rtf can be great.  It did help my dd and obviously yours.  I think it's wonderful that you were able to pay for that gift for your dd.  I do think that state run rtf is so much different.  Just the fact that most of the girls there have little to no contact with their parents or the parents may have lost custody of the girls makes a huge difference.  I wish I had the money to pay for a private rtf.  I do think dd would have been in a better situation and probably would have progressed even further.  However, I would recommend rtf for anyone who was in the same place with their child that I was with my dd.

It is very important to have a great deal of family participation to have a great outcome.  The wrong placement can do more harm than good for many children with BPD.  We all do and did the best we can and could at any given moment in time.

 

[qcarolr]

Also I've noticed I catch things earlier.  If I notice she's being grumpy with everyone I take her aside and ask what's going on.  Usually there's something happening at school or with friends and whatever is happening at home at that moment (however big or small or miniscule) is triggering her.  In the past I probably would have just been grumpy right back (don't you talk to me that way).  I've learned the best way to get through to her is to say... .hey I'm your mom and I love you more than anything in the world.  She responds to that and opens up.  I'm not sure she would have done that before rtf, but I'm pretty sure I never spoke that way to her after she told me off or stomped herself upstairs, or refused to do chores or whatever.  The funny thing is after she tells me what's going on and I validate her feelings about it she does what she's supposed to without complaining. 

The other part that is based in the current research in neuroscience - a balance of genetic and enviroment - is about the strong need for attachment we each need as humans. And for reciprocal relationship in our family to grow up with a balanced brain-body-emotional self.  Seems that with BPD this balance is skewed -- this may be what is seen through working with behaivors as 'trauma'.

I have been using some of the love-based attachment practices with my gd8 - who shows significant anxiety. Hard to say now what is from genetics (ADHD dx plus bioparents laundry list of issues - BPD mom, addicted messed up dad). They share a lot with validation practices. Your descriptions of how you have changed how you respond to your D reminds me of how I am changing how I respond to my gd8. Instead of immediately putting my logic/behavior response all over her, I get her close to me and tell her I love her and will keep her safe. Then we rock. Then we talk about whatever the issue is that brought on the acting out (screaming, hitting, throwing things, kicking/hitting me or dogs... .). Very scary for me - easy for me to get angry. And my reaching out for her, to console her, actually consoles me too. I get regulated, she gets regulated. Then we can use words to search out alternatives.

I am go glad this is working for you. Awesome you have found a T that gets it -- and includes you in the process. Our kids are with us 24/7 and only see the T a short time in outpatient setting. We need to be 'trained' as much as our kids do. It has to be a team effort to be successful longer term. To create real recovery.

qcr

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