Is residential treatment right and safe? thoughts on programs? Focused on DBT.

[trestags]

My teen daughter has BPD (anxiety and mild depression).  High IQ.  Dyslexia which compounds the challenges and pressures of school. She recently had a suicide attempt and previously self harmed one time. She gets great grades and is generally a great well behaved kids.  No other issues.  Dr suggested places like below.  Everything online about these places scare me (except for 3East) and they don't look like they make much of a difference.  Thoughts from any parents on this situation or these programs? or suggestions for others?  It seems like DBT is the right path for her.

3east at Mclean
Summit achievement
Pacific quest in Hawaii
Cascade academy in Utah
Silver hill
Mountain valley in NH

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

[ForeverDad]

While I cannot speculate on which programs or locations are right for your daughter, in general residential treatment programs have multiple benefits.

One is that the patient is immersed in an environment totally devoted toward recovery.  Admittedly, recovery would be a long road and maybe only partially successful, but some level of progress is better than the current alternative.

Another is that BPD is noted for being an emotional dysregulation disorder most evident and impacting in close relationships.  One aspect is that those closest to them emotionally are also the ones they can't seem to respond to... the emotional and perceptual baggage of the close familial relationship gets in the way.  The professionals there are trained to focus on what works best for recovery, however limited it might be.

It would then be up to the patient to demonstrate how much cooperation and how much diligent application of the therapy.

[CC43]

OK,

First off, your kid is getting good grades and is generally well behaved, in spite of BPD and learning differences.  That is remarkable considering the circumstances.  But making suicide attempts is very serious.

You might approach finding an intensive therapy program as you would selecting a college:  finding an institution with a strong reputation and a solid track record is important, but at the end of the day, your kid will get out of it what she puts into it.  Just like college, if she doesn't do the work, it's basically worthless--it might even be worse than worthless, because of the huge costs in time and money involved.  Just like college, the programs available might hinge on the financial assistance provided (e.g. insurance coverage vs. tuition assistance/scholarships).  Just like college, staying close to home might be important to your family, and long-distance travel might not be ideal or even economical.  Just like college, your daughter might not be admitted right away, because there is competition for the most coveted slots.  Maybe she can wait for one to open up, or maybe it's better to get treatment sooner at an institution that has availability.

Most of all, for therapy to work, your daughter has to be the one to want to do the work, because therapy IS work.  She needs to feel "ready" to embrace a change.  If she's spending all her time blaming you, she's probably not ready.  If she thinks you're making her do intensive therapy against her will, it probably won't work.  And if she's using therapy as an escape from other life obligations, it's probably not ideal either, especially if the provider is like a "resort."  But if she feels like she's exhausted all other options, and she really wants professional help to have a chance to feel better, then it might be transformative for her.  In addition, follow-up is key.  There's no magic pill for BPD.  Changing one's mindset and behavioral response to stress/perceived threats is tough, and it takes time as well as lots and lots of practice.

On the plus side, your daughter is young, she might really benefit and have more mental plasticity.

Having said all that, anxiety and depression are distinct from, but often comorbid with, BPD.  When you write your daughter has had no other issues, it makes me wonder if she really has BPD.  Has she been diagnosed?  Typically pwBPD have a host of issues, like severe moodiness, misplaced anger, a pattern of fractured relationships, unstable identity/self-image, distress intolerance, a victim mindset, constant blaming of others, intrusive negative thinking patterns, impulsivity, strongly avoidant behaviors and difficulties functioning day-to-day (problems completing schoolwork/keeping a job/solving everyday problems).  Many of these issues seem like typical "teen" behavior, but in a full-grown adult they seem more noticeable and dysfunctional.

[In4thewin]

I have a different opinion. It's my understanding that the best outcomes occur when you can keep a child home, and residential should be a last resort. If you live in an area where theres a major hospital with a PHP or IOP, I'd try that before sending my daughter away as long as you are confident that the acute medical issues have been resolved.