RTC help - any advice or thoughts welcome

[BStrong]

First, this board has been extremely helpful for us in the past month as we struggle to help our daughter. We have learned much but have so far to go.

Our BPDd-13 is currently in stabilization unit of a psychiatric hospital while we (parents) determine the best RTC to send her to. She suffers primarily from social anxiety, extreme negative self-image/judgment, and she self-harms by cutting. Her BPD traits are all inward directed, no anger/violence. At this point, the cutting and her desire to cut are in the way of any meaningful progress with therapy. After she cuts, she can go up to a week or two before succumbing to an overwhelming urge to cut. In between, she does work hard at trying to resist those urges through the DBT skills she's learned so far. However, she still wants to cut, and this desire and her acting on these urges has caused her to cut deeper each time and make many more cuts to get the same satisfaction from it. She knows the path is unsustainable yet goes to great lengths to find new ways to cut and get the relief she needs from it. Her psychiatrists have put her on naltrexone to treat her cutting as a drug addiction, which has worked very well to curb the high she was getting, but now she's refusing the medication for that very reason. We're hoping to get her onboard again soon with taking the medication, see some stabilization, then move her to an RTC. We can't decide where to send her. She's gone through 3 weeks of intensive DBT at McLean, but because of her cutting and her desire to, she couldn't continue there. She's learned a lot from it though, and we are hoping to find a place where she can continue using those skills. And wherever we choose, there needs to be good acute/intensive stabilization unit close by or on site preferably.

We're in the southeast. Places in UT seem too far, but we'll consider them. New Haven has been suggested, but we're just not sure whether this or the other places in UT are the right fit for a 13 year old. Plus, she's not an outdoors type nor does she like horses, both of which seem to be a big component of all UT RTCs. Maybe that would be great for her, we don't know. We're more concerned with putting her in a place with few peers her age. We also would like a place that has a good mix of therapy, activities, and some schoolwork. For our daughter, intensive (6hrs+) per day of therapy was too much.

The negative info available for some places is quite scary, which just adds to our fears of sending her anywhere. The one thing we do know is that she can't come home. Needless to say, we're heartbroken but hopeful.

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 BStrong,



And welcome to the Parenting board!

I see the hopefulness and the heartbreak - your suffering child, and the fact that she is not safe, and also the positives - she wants to get better and is working hard at using the DBT skills. That is really good news!

She is using the cutting as an unhealthy coping mechanism and she needs a new healthy one to replace the cutting. It can be a long road. The fact that she is 13 works in her favor - her brain is still developing and she has a big chance of getting better. The recovery rate of patients who are motivated to get better is very high, so that is a reason to be optimistic.

As far as finding a suitable RTC - that is a highly individualized process and it can be exhausting. I don't have any specific recommendations, but this post from another thread about RTCs is a really good guideline of how to proceed:

Remember first and foremost that you are looking for treatment for your child, not just a list of disorders.

Visit any place you are seriously considering before you decide on one.  Sometimes places sound good online regarding treatment options, staff, etc... .and it is whole differently story when you show up at the door.

And also:

Be prepared before you go.

Ask for a list of references (past families who have attended the RTC and have agreed to speak with potential future student parents).  Spend the time it will take calling/waiting for calls back.  Ask these parents tough questions and be prepared to be forthcoming with the same information you are seeking (ie... .diagnoses, medications, addiction issues).  I vetted out several by speaking with parents... .many told me of huge hidden fees that would have jeopardized our ability to keep our daughter in the program for the necessary amount of time.  Many thought their clinical directors were scatter brained.

After you narrow down your search schedule an appointment time to visit the facility.  Request a meeting with the heads of each department (education director, clinical director, residential director).  When I visited Falcon there were 8 staff members who attended the meeting with me.   Ask if you will be able to have semi private conversations with the girls who are attending currently.  If the answer is no... .that's a red flag.

I did not use an educational consultant.  They don't know my child... .I do.  The educational component is important and not nearly as important as treatment.  Be careful not to put all your therapeutic eggs in one basket... .a mix is very good because where one method may not succeed there are others to fill in the gap.  That is one of the benefits of Falcon... .PPC, Equine, Music, Individual, 12 step, and Group.  If I had looked only for a true DBT program I would not have chosen Falcon.  My d did not progress in outpatient DBT.  A program that uses the basic precepts of DBT and applies them in real world scenarios can be just as successful if not more so.

God Bless

lbj

This member had success in sending her teenage daughter to Falcon Ridge in UT (and I know that you say that your dd doesn't like horses), so that may or may not be a good option for you. However this member gives excellent advice on how to approach the search.

[jellibeans]

Bstrong

I am sorry your dd is struggling so but as pessim says she is young and there is time. My dd went through a stage of cutting and now does it very rarely at all. It has been well over 8 months. My dd like to mirror people and I do believe she picked this up at a hospital stay when she was 14. She is not 17 and it has been a long road for us. I do think we have seen improvements and that is hopeful but I also beleive it is going to take more time to see any real stability in her. We have been looking at RTC for her as well and many are in UT. Falcon Ridge I believe is a good place and I almost had her on the plane a couple of weeks ago but my H had second thoughts and we hired a education Consultant. We then changed course and she is going to Menninger's in Houston. We hope she can get some testing and stabilization there and they can give us greater insight into how to help her.

What did Mclean's recommend to you?

Most the RTC that I see are in Utah... .Vista Sage is a place we were looking at and I spoke with a parent that has a child there now. Another place was Discovery Ranch for girls. Both these places are extremely expensive. There is a horse component but I do not think they get to do that until they are on a higher level. I read a ton of reviews and that really scared me a great deal. There is so much opportunity for abuse. In my heart I still like Falcon Ridge Ranch. It is a place I have looked into for years and have never found a bad review.

My dd has been very ODD and has resisted help for years. Only now has she asked for help. She has a drug and alcohol problem now and that has probably replaced her other poor coping skills like cutting.

I will tell you to be hopeful... .I do think in time they will get better but I know the ride is pretty frightening in the meantime.

[busymind79]

My 15 yr old daughter is currently in an RTC program. She is due to be released within a week. She also deals with cutting issues and was on Naltrexone. Unfortunately it was making her so sick, she had to be taken off after a month. The one Thing she has found to help with her cutting is using ice on the area that she wants to cut. Has your daughter tried this method? I wish the best for you and your daughter.

[BStrong]

pessim-optimist - thank you for that info and the support! I have learned a lot from lbjnltx's posts, very helpful. I like the info I've seen on Falcon Ridge, but our problem is that at the moment, our daughter still needs a safe environment, either a locked facility or close to it. She still has overwhelming urges to cut every couple of weeks, and those episodes can be bad, often needing urgent medical attention. Ideally, we're also looking for a place with more girls who are closer in age to her, 13-15.

jellibeans - We've "only" been dealing with our new world for roughly 6 months, and we feel it's been for so much longer. I can't imagine how difficult it must be to be so many years along your struggle, but asking for help is a great step forward. I wish you luck at Menninger's. McLean's was too intensive for our daughter, plus there were few girls there close to her in age. I think she never felt comfortable in the environment because of her age, in addition to the anxiety she suffers from. However, she learned a lot, and when her urges to cut lessen in intensity, we think she'll be able to use DBT skills more effectively. Also, they are an open facility and are not set up to keep as close an eye on her as was needed, so we've had to take a step back, hopefully get her stabilized with the serious cutting, then place her in something longer term.

McLean makes recommendations based on their assessment and experience with your child, so for our daughter, they suggested New Haven in UT. They also suggested Rogers Memorial in WI, but they too are not a locked facility and turned us down.

I'm curious about your experience with an E.C. - you've obviously done a lot of research on your own. Do you believe the E.C. has been helpful and worth the expense?

busymind79 - congratulations! I wish you all the best. As for the ice for coping, yes, thank you, that's one of a few that our daughter likes to use. Her favorite is the frozen washcloth or frozen orange, then as a follow-on, she also likes using a microwaveable heating pad, stress balls, coloring in mandala designs while listening to music.

[jellibeans]

Bstrong

Have you talked with Falcon Ridge? The ranch is out in no where and I do think they are a locked facility for those on a certain level. I really do think all these places are able to handle cutters. They have a pretty strick list of things you can bring and use. A lot of these kids are cutters so I know most places have a way of dealing with them. Is it that they thought your dd was suicidal and not stable enough?

I think it is important to try and find a place that has girls with the same age. I do think the 13-15 is probably the most common. When they get closer to 17 it is hard to get them to these places and they are so close to 18 some don't want to take them.

The EC was my H's idea... .not mine. I have not found them helpful at all. In fact they increased my stress and have not been helpful. They have mislead us and also they tend to recommend RTC that they have a relationship with and any place out side that list is discouraged. The ones that were recommend to us were not all grreat... .some had very bad reveiws and some had just recently been sold and renamed to hide bad reveiws. I don't think the EC has been worth the money but there could be other EC that are great. I feel these people feed on your fears and try to make you second guess yourself.

My advise to you is to talk directly to the RTC and ask a lot of questions. Good luck

[BStrong]

jellibeans

I will definitely call Falcon Ridge to get more info. Our daughter is not the typical cutter. Her cutting is deep and/or many cuts per episode. There would need to be an ER relatively close by. She's making progress in the amount of time between episodes, but we're in a critical phase at the moment. I do think she could thrive in the right place, after making more progress, which could be just a few weeks away at this point. Suicidal thoughts have also been an issue, but no plans or attempts so far. The severity of the cutting makes crossing that line more of a possibility than we're comfortable with.

Thanks for the EC info. I'm with you. That's my worry as well, that if you don't get a great EC, you get so-so results or worse, and you could do much better on your own. It's hard enough going through the RTC research. I'm not sure I want to go through EC research too.