Ups and downs of BPD--need advice

[rationalmind]

Hi all,

I've posted here a couple of times.  My daughter (18) has pretty severe undiagnosed BPD and also PTSD and we have struggled over the past 3 years with serious substance abuse. It finally culminated in an inpatient psychiatric admission followed by 3 weeks of inpatient rehab.  She's been home for over a month now--we struggled initially as she didnt want to do the program we selected (basically was an RTC but you come home at night, too intense per her) so we compromised and she's been going to outpatient rehab and her therapist and surprisingly has been following all the rules, curfew etc--only issue is she is still intermittently smoking weed (not in the house).  I was cautiously optimistic until inevitably the other shoe dropped!  Yesterday she went back to her old longstanding pattern of not coming home, poor communication, not going to treatment--I think she is upset as she realizes she's not going to be able to smoke and comply with treatment and do whatever it is she does.  She is not working and is out of school but has thus far passed 3/4 tests for the GED. But now she is 18 and I told her she can't live in the house if she's not following house rules and compliant with treatment--all the more stressful as we are moving cross country in two months. So I feel she needs to face real consequences,she doesn't learn from the past. And my mental health suffers--poor sleep and anxiety. I've already been at the end of the rope so I know what that feels like.I'm ready to do what it takes but wondering if anyone else has been in this situation and can give advice?  How can I let go and let her face her own natural consequences?

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

[lbjnltx]

Hello rationalmind,

Good to see you back!

Letting our kids go and allowing them to make their own choices is very very hard.  Our worst fears come creeping into our thoughts and feelings and then we are stressed over what hasn't even happened. 

We have to get ahold of ourselves and stop the negative dialogue that goes on inside our heads when we think about letting them make their own choices and live out from under the umbrella of our protection.  When I think about it in terms of what my daughter might do because she is living on her own compared to what she did when she 'lived' at home... .honestly... .not much difference.  If she was going to do it, living under my roof wouldn't have stopped her.

This is more about your boundaries and limits than her actions because your boundaries and limits are where you have power and choices.  If she cannot live within the rules/boundaries asking her to move out may be what you both need.

Do you have a plan of support for her if she moves?  Is this support conditional?

Many parents provide housing support, insurance coverage, and educational support.  These types of support are positive reinforcement at their core... .supporting that which is healthy/positive without enabling that which is not healthy/negative.  Tying the support to other healthy/positive choices such as paying for car insurance as long as they  have a job, or paying for rent as long as they are in school/passing their courses.

What kind of plan will you want to implement and hope for compliance from you daughter?

I look forward to hearing back from you.

lbj

[livednlearned]

Hi rationalmind,

You have been through a lot, and I'm sorry to hear your D18 is struggling. Would you be comfortable sharing what triggered the inpatient psychiatric admission?

I can imagine that the cross-country move must add some real stress to your decision, and make it feel even harder to set boundaries -- to have D18 face real consequences. Is inpatient RTC an option for her now that this outpatient therapy is not working out? Was DBT part of the outpatient rehab?

Please tell us more when you're comfortable doing so, and let us know how things are going for you.

LnL

[rationalmind]

Thank you both.  DD's issues were running away and substance use.  At the time she was hospitalized she had been couch surfing and staying with thirty something year old guys and had just started using heroin. She had also gotten into a physical altercation with my husband her Stepdad during one of her rages.  I had an emergency petition to get her evaluated and once the police caught these guys at a traffic stop and asked me to pick her up, I said no she had to be evaluated.  She was very angry initially but spent 7 weeks in inpatient/rehab and did/said what she needed so she would be able to come home. RTC is not an option, she is not willing and we are not able to spend the money at this time even if we were willing.  When she came back from rehab she did go to a program that was essentially RTC but live at home (kept her busy 9-7) but she couldn't tolerate that and ran off. I tried to get her into the only DBT program that would accept her insurance (and had an opening) and she was willing at the time but after an intake they felt she needed residential and wouldn't take her-- . I think her therapists have used some individual DBT techniques, she is very resistant to change.  She is in an outpatient rehab program and has been attending but I doubt she will continue.

Unfortunately DD has no job--she had a job but lost it due to them finding drugs at work (it was a childcare center!).  She claims she is looking for a job but not too hard as she had plans to move with us.  She should have her GED next week assuming she takes the last test--she is very smart and I don't doubt she will pass this last one.

She doesn't have a place to live but tends to couch surf at her friends--this is of course a temporary option.  She is working on a driver's license but doesn't have one (supposed to take the test in June, she has a permit).  I have told DD we will provide housing support if she is in school, and she will have health insurance coverage but that is about it.

That's the crazy thing--she doesn't have the skills to live on her own, but she basically couch surfs and does drugs.  I'm sure that will get old but she doesn't seem to be afraid/believe in homelessness.  She is just in her own fantasy world.

My husband and I are not willing to provide support with her current choices.  Once we move, she has the option to move with us--I was hoping to at least get her there for a "fresh start" but of course that is really stressful to her.  It's not really that she wants to live on her own, she just wants to be able to do whatever she wants and come and go as she pleases.  So those are our limits.We also have an infant son and the yelling and raging (less frequent now) is really unacceptable to me. 

I am willing to help her look for a job, to take her to her appointments, get her medications, and to have an adult relationship.  But she will invariably say if we cut off support she doesn't want to see us. 

DD is very stubborn and constantly pushes against the limits, from an early age. She may not believe the reality of the situtation, though we thought she was being "good" once she turned 18 because she was afraid of losing her privileges.  Unfortunately nothing really phases her, even not having a phone, car, job etc.  She just hangs out with her druggie guys.

Any tricks on validating techniques that can help reel our kids back in?  Not sure how to encourage her to make good choices--we are very willing to provide support if she's working on getting her life together.

[lbjnltx]

That is the dilemma isn't it... .consequences don't seem to motivate change.  Sometimes our kids have to hit rock bottom before they begin to look up!

For us... .our part in this is not coming into rescue them, to let them learn while we suffer in silence.  Hard hard and harder for us.  Radical Acceptance is a necessity when we care more than they do... .it can help lessen our pain and give us the opportunity to practice self care.  Are you familiar with Radical Acceptance?

Maybe you can glean something from this article rationalmind:

Validation and Teens

Hang in there   

lbj

[rationalmind]

Radical acceptance is something I've just been learning about. It's very helpful to frame it in terms of needed to know we can only control our own behaviors.  DD tried to come home yesterday.  She actually admitted to not being able to stop using weed.  She has some difficult decisions to make as neither us nor her grandparents will take her in if she's not in drug treatment.  She's staying with a friend right now but has no resources.  I only hope she will try to "earn her way back" home and get back into treatment but if not I've accepted she needs to face the consequences of her own decisions and I can't enable her.  I actually think we are preventing maturing and self-esteem by hindering independence. She says she is 18 and can make her own choices, and I say yes but she needs to be independent to make those choices.  I think she understands but is struggling. It's the first time she's admitted to me she has a drug addiction problem so at least that's one step in the right direction.  I've radically accepted that I need to do this to protect our family as well as have her face reality. While I fear like other parents she will end up prostituting herself or dead in a ditch, or in jail all these things will also happen if she lives at home.  So we shall see.  I'm surprisingly at peace today and have regained control I didn't think possible by not letting her manipulate me into what she wants.

[livednlearned]

It says a lot that your D can tell you that she is unable to quit using weed -- you are doing something right that she feels able to be that honest with you. There are a lot of adults with a long track record of substance abuse and wrecked lives who cannot admit as much. Does it make it a little easier to discuss your boundaries with her? I would think it does because you don't have to pretend. Is this a new development in your relationship with her?

I'm glad you're feeling at peace, rationalmind.  

Have you discussed any scenarios with her about the cross-country move, and how you will be involved (or not) once you've relocated?

[rationalmind]

Hi livnlearned,

DD worked on communication with her therapist for months and then was inpatient for a long while so I feel this is the one skill she has honed in on.  I think she also is tired in some ways about all the lying and deceit.  It does help to be more honest and I think she knows I won't back down off these boundaries.  However, when she is stressed she does revert back to her old patterns--I've only had one text today in response to my text.  The emotional dysregulation is pretty severe, and facing reality for her is really painful, so not sure what the outcome will be.  With this roller coaster I never know what to expect week to week so she could either be living on the streets or coming back round to us next week.  She knows she can't move with us without going into treatment so I think that is a real hard stop date for her. Her entire family(including her grandparents and baby brother and dog) are moving and that is really scary I'm sure.

This admitting of the problem with drugs to all of us (including her grandparents) is definitely new.  It's been years of denial that it is a problem. So I think she is coming to terms with it herself.  I will try to stay optimistic but also be realistic about what she may be able to do as per what DBT teaches she may just be doing the best she can for now.

[livednlearned]

Do you think your DD learned in rehab that there is an alternate, effective skill that she can use to replace her dependence on weed? And that this is what DBT is for, to help her gain those skills?

She must feel that she is walking off a cliff, not sure what could possibly be there to cushion the fall. Or perhaps it was too difficult to handle the transition between learning the new skills and giving up her old habits. Giving up something that is so important to her -- knowing that this means she cannot go with you across country -- must mean it is fulfilling something so essential to how she copes and survives.

I could see how important it would be to validate her about this, so that she feels accepted and loved even though she feels the edge of the cliff coming her way.

I walked off a "cliff" in my own relationship with my parents -- I was in my 40s when it happened, and it was just as difficult then as it would've been in my teens. I'm grateful for it now, although at the time it was awful. I do wish, though, that they had the skills to acknowledge and accept how I was feeling, and be able to communicate their love for me, while still having the boundaries they had. And it would've allowed me to see the individuation or whatever it was that we were doing as something that had to happen, instead of a door closing.

Validation is such a big deal