Daughter - BPD Treatment

[Parents! Get help here!]

Hello. 

I live in South Africa, and am a proud father to 3 girls. 

My 17 year old daughter, has recently been diagnosed with traits consistent with BPD.  This has been getting progressively worse for the last 5 years, and has had a big impact on our entire family. The problem became so acute, that after 2 attempts at self harm (with medication), we decided to provide residential care for my daughter in a center that dealt with behavioral and addictive problem adolescents.

After 3 months, we have realized that while there has been some benefit at the center, the root cause has not been dealt with, and my daughter has been able to avoid "opening up" and therefore has been manipulating the treatment process in order to complete it and live her life independently once she turns 18 (in 6 months time). 

We have three choices for the next step in the process: 1) change her treatment facility, to one that is more geared towards behavioral and psychiatric treatment.  It is not a BPD center, but one that has dealt with BPD patients in the past.  It is a residential care facility and the treatment will involve intensive psychotherapy, CBT, DBT etc.  The center have agreed to a 6 week probation period, after which a decision to continue or commit my daughter to a state facility are the options. This is based on her level of co-operation and willingness to engage. 2) Bring her home and try and manage a treatment process from home.  This we feel is not a feasible option, as her condition has not been treated, and the damage to the family would be detrimental. 3) Provide an environment for her to complete her studies and live independently, giving her the decision-making to obtain treatment or not. My wife and I are not aligned on the third option, as I believe it will result in further regression and self harm, while the advise my wife has been given is that my daughter needs to make the decision to get treatment, and only then will she improve.  The advise from a clinical psychologist (who only treated my daughter 6 years ago for anxiety) to my wife was that a residential care facility will not be effective, as the condition is too entrenched.    BTW - there are no dedicated BPD centers in South Africa. Any advise welcome.

[Dadx3]

Hello. 

I live in South Africa, and am a proud father to 3 girls. 

My 17 year old daughter, has recently been diagnosed with traits consistent with BPD.  This has been getting progressively worse for the last 5 years, and has had a big impact on our entire family. The problem became so acute, that after 2 attempts at self harm (with medication), we decided to provide residential care for my daughter in a center that dealt with behavioral and addictive problem adolescents.

After 3 months, we have realized that while there has been some benefit at the center, the root cause has not been dealt with, and my daughter has been able to avoid "opening up" and therefore has been manipulating the treatment process in order to complete it and live her life independently once she turns 18 (in 6 months time). 

We have three choices for the next step in the process: 1) change her treatment facility, to one that is more geared towards behavioral and psychiatric treatment.  It is not a BPD center, but one that has dealt with BPD patients in the past.  It is a residential care facility and the treatment will involve intensive psychotherapy, CBT, DBT etc.  The center have agreed to a 6 week probation period, after which a decision to continue or commit my daughter to a state facility are the options. This is based on her level of co-operation and willingness to engage. 2) Bring her home and try and manage a treatment process from home.  This we feel is not a feasible option, as her condition has not been treated, and the damage to the family would be detrimental. 3) Provide an environment for her to complete her studies and live independently, giving her the decision-making to obtain treatment or not. My wife and I are not aligned on the third option, as I believe it will result in further regression and self harm, while the advise my wife has been given is that my daughter needs to make the decision to get treatment, and only then will she improve.  The advise from a clinical psychologist (who only treated my daughter 6 years ago for anxiety) to my wife was that a residential care facility will not be effective, as the condition is too entrenched.    BTW - there are no dedicated BPD centers in South Africa. Any advise welcome.

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 Dadx3,

Welcome to the parenting board.  I'm sorry to hear that your d17 is still struggling with the traits of BPD.  The teen years are challenging enough without having to deal with disorders and dysregulated emotions too. 

It sounds like you are doing everything possible for your daughter.  Moving her to a treatment center that addresses her psychiatric issues sounds like the best next move.  Will she be able to stay there past her 18th birthday?  Can you force this issue or will she be able to leave of her own will once she is 18?

It is very very important to have a high level of family involvement in residential adolescent treatment.  Will that be the case at this  new RTC?

We have many Lessons and Tools for you and your other family members to put into practice to help you take care of yourselves, improve your relationship with your daughter17 and help her help herself.  They are located in the right side bar.

Which behaviors of your daughter do you find the most difficult to cope with and understand?

I look forward to hearing back from you and learning how to best support you.

lbj

[Dadx3]

Thanks LBJ - very much appreciated

The treatment facility can force continued treatment through a court order, but we are obviously hoping that she makes enough progress that would result in her staying voluntarily.  I think we have settled on the residential care option as a next step.    There will be a level of family involvement, albeit logistically a bit different as home and the treatment facility are in two different cities.

There are a number of difficulties we are facing at present, and any assistance would be greatly appreciated.

1. To diagnose or not - there are different opinions on how to approach the BPD patient in terms of communicating whether they have BPD or not.  What is your advice?

2. Acceptance of a problem - how best should we approach the need for my daughter to accept that there is a mental disorder (whether BPD or not)

3. How do we manage the balance of being supportive as parents and breaking the mindset of a parent/child co-dependent relationship.

4. What should we as a family be doing, apart from individual therapy to deal with the impact of my daughters actions, in readiness for the future?

There are many other questions, but these are the most pressing.

Thanks!

[lbjnltx]

Thanks LBJ - very much appreciated

The treatment facility can force continued treatment through a court order, but we are obviously hoping that she makes enough progress that would result in her staying voluntarily.  I think we have settled on the residential care option as a next step.    There will be a level of family involvement, albeit logistically a bit different as home and the treatment facility are in two different cities.

Regular family therapy over the phone, weekly phone calls, letter writing any time, family visits on campus (quarterly or more frequently), off campus visits with family, and home visits are all typical for RTC's here in the states. Parent's homework (reading assignments, skills learning (SET, Validation, DEARMAN, Mindfulness, Boundaries), are where we learn what our kids are learning, model them for our kids, and benefit from them personally.

There are a number of difficulties we are facing at present, and any assistance would be greatly appreciated.

1. To diagnose or not - there are different opinions on how to approach the BPD patient in terms of communicating whether they have BPD or not.  What is your advice?

From personal experience I left this to the judgment of my daughter's therapist.  He did not give her a diagnoses until she asked "what is wrong with me?"

2. Acceptance of a problem - how best should we approach the need for my daughter to accept that there is a mental disorder (whether BPD or not)

In my opinion it is far more important that she accepts responsibility for her thoughts, feelings, belief systems, and behaviors than a diagnoses.

3. How do we manage the balance of being supportive as parents and breaking the mindset of a parent/child co-dependent relationship.

It is important to allow individual thoughts and beliefs so that she can individuate from you.  Allowing her to make choices gradually and not stepping in to save her from her choices is the best teacher there is.  Offering support through validation and validating questions can help her feel heard/understood and cared about without telling her what to do and at the same time give her some guidance and things to think about.

4. What should we as a family be doing, apart from individual therapy to deal with the impact of my daughters actions, in readiness for the future?

Learn all you can about the disorder, how her belief systems, emotions, behaviors are interrelated and how to help her learn to meet her needs in healthier ways.  Take good care of selves, live your value based boundaries, set limits, be steadfast in enforcing boundaries and limits, don't do for her what she is capable of doing for herself, and see #1  and most importantly, tell her you love her and the she is of the highest value just because she is HER!

It's a lot Dadx3! 

Most all of this information is in the Tools and Lessons except these 2:

Validation and Teens

The Power of Asking Validating Questions

You have some great questions, it will take an investment to learn all there is to learn and put it all into practice.  We are here to help.

lbj