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.

[Pook075]

My advice is different as well. 

I raised a BPD daughter, also very high IQ, and things were progressively worse in her later teens.  My wife and I did what you're doing now- trying to figure out the best thing for her.

I now know the answer.  The best thing for your daughter is to accept that she needs help and decide on how to get help.  As mom and dad, you're involved with that, but your kid must be the one to take the lead. 

No amount of therapy can do an ounce of good until she's personally ready to work towards change.  If you try to force her, she'll only become more rebellious and things may go downhill quickly.  She has to be the one to ask for help.

[CC43]

Hi again,

I second Pook's analysis. In my experience with an adult BPD stepdaughter, her dad had arranged for a couple of intensive treatment programs, including one residential program.  At the time, my BPD stepdaughter seemed just to "go along with" getting treatment, without really being committed to working at it, because she felt she was "forced" to do the programs by her parent.   In fact, one time she characterized the situation as being "assaulted" by her parent to get her into treatment against her will.  Her victim mentality kicked in, and she continued to blame her family for all her problems.  She felt her parents had to change, not her.  And while it's true the programs helped stabilize her, the benefits were short-lived.  My BPD stepdaughter was allowed to resume her "normal" life (e.g. go back to college full-time), which in hindsight was basically setting her up to fail.  She did, over and over again.  Each successive failure made my BPD stepdaughter feel even worse about herself and sunk her deeper into a black hole of anger and despair.

Anyway, when did a residential program work for my adult BPD stepdaughter?  When SHE checked herself in--not her dad or mom.  Granted, I'm pretty sure she wouldn't have been able to research nor select a treatment program all by herself--she just wasn't that high-functioning nor blessed with a genius-level IQ that some posters talk about.  She didn't agree with the BPD diagnosis in the first place.  But her dad, therapist and medical team knew about the various treatment options available.  She had been in and out of hospitals enough that it was clear to others what program would be a good fit for her.  In fact, her doctor had suggested a specific program in the past, but she declined to participate at the time.  My point is, only when my stepdaughter was the one who took herself to the hospital and asked for help, did the program actually work the way it's supposed to work.

Thus the inflection point was when my stepdaughter took an Uber to the hospital.  Her dad met her at the hospital and struck a "deal" with her, which was, for her to continue to receive financial support, she had to follow doctors' orders (and not decline to do recommended treatment(s) because she wanted to do something else).  She was free to go her own way--she was an adult after all--but then she wouldn't get financial support from her dad.  In essence, he refused to continue to enable her dysfunction.  Another nuance is that she agreed to allow doctors to share treatment information with her dad, especially because he agreed to pay the bills.  Previously she had denied the sharing of her medical information.  I don't know if this decision was intentional, or if she just checked the relevant box on the admission forms, mistakenly reasoning that since her dad was paying the bills, he had a right to know her medical information and confer with her doctors.  But at the end of the day, I think it was a big plus that her dad was able to know (in general terms at least) what was going on with his daughter's treatment plan.  At the time, which was exceedingly stressful by the way, I told my husband--This is a turning point.  Your daughter is deciding to get the help she needs.  The doctors know what to do, they are professionals.  Your job right now is to ensure she follows doctors' orders, whatever they are.  She needs to prioritize therapy right now, and everything else can wait.  I think he was relieved by this perspective, because he was exhausted from trying to fix his daughter.  Everything he had tried in the past hadn't worked, even if he tried his hardest and did everything out of love for his daughter.

As an aside, I think my stepdaughter actually warmed to the notion of getting help from "professionals."  It generally validated her narrative of needing help to get past traumatic experiences.  In addition, I'm pretty sure she was sick of getting well-meaning advice from her dad and me--there was too much emotional baggage attached to it.  Fortunately, with hard work, she turned her life around, and it looks much better today.  I'm not saying everything is perfect--she's experienced several setbacks, and she's estranged from all her family members, including her dad at the present moment.  But her dad keeps tabs on his daughter through a periodic dialogue with her therapist, and we know she's OK.  She's living semi-independently in an apartment with her pet and a roommate right now and working as a restaurant hostess.  That's significant progress indeed.

[CC43]

Hi,

I re-read my latest post and felt that I might have come off as too negative and stern.  It's probably because the situation I described was extremely tense, bordering on traumatic.

Anyway, if the time comes that your daughter decides for herself she's ready to get help, you might frame it in these terms:  We love you and are glad you're being proactive about your health and wellness.  Doctors are professionals, they know what to do, they help people manage overwhelming emotions/cope with trauma/deal with suicidal thoughts all the time.  We will support you on your journey to improve your mental health.  It's mature of you to prioritize that right now.  We know that this probably feels overwhelming right now, but this treatment program has good success.  Your doctor thinks it's a good fit for you.

It's just that with my stepdaughter, many of her decisions were tied to needing more money from her dad.  Historically, her dad basically wrote checks for anything she wanted--cars, apartments, tuition, international travel, expensive hobbies--in the vain hope that if she had whatever she wanted and were "set up" in various "new" environments, she'd be happy.  But what was really happening is that the bottomless ATM was enabling continued dysfunction.  She wasn't in school, she wasn't working, she wasn't in therapy, at least not consistently.  She was an adult but not functioning like one.  I felt she veered way "off track," she was miserable, and she was making everyone around her miserable, too.  And so her dad felt compelled to use the remaining financial leverage he had to get his daughter to focus on therapy, because the emotional leverage had been exhausted.  Basically, the threat of withdrawal of continued financial support was needed to get her to re-focus on therapy.  But my guess is her dad framed it more positively than as I described:  If you focus on therapy, don't worry, I've got your back and will pay the bills.  But for me to do that, you need to do whatever the doctors say this time.  That's the only way this is going to work.  You're an adult, you can choose to do whatever you like, and I respect that.  But if you want my continued financial support, you really need to focus on therapy right now.  I can't stand to see you continue to struggle so much.

[ForeverDad]

Here is a prior post years ago which explains why I wrote that those of us parents and family members can't make much progress with those pwBPD close to us - the baggage of the relationships is quite a hurdle to overcome - but others trained and emotionally neutral sometimes can.

Can you help her?  Probably not, and you would be putting yourself at great risk.  The best person to help her would be a professional of some sort who allows no emotional attachment to blur the therapy and counsel the person should apply in his life.  This reminds me of a post I made recently.  This woman, after years of therapy, did recover from BPD but she emphasized her therapist always maintained a professional separation, no emotional strings.  If you tried to do that you would fail, your emotional ties would be used to sabotage you.

Have you read Get Me Out of Here — My Recovery from Borderline Personality Disorder by Rachel Reiland?  It's a paperback account by someone recovered from BPD.  It was exceedingly tough for her, but it turned out well for her and her family.

What helped so much was that her therapist drew a strong line/boundary concerning their interactions.  Her therapist remained absolutely neutral emotionally, not even touching.  (That's why you bear so much of the brunt of her behaviors, because your spouse can't get past the past emotional baggage of the years of close relationship with you to really listen to you.)

That book ended on a high note.  Only when her therapy was completed, she got to hug her therapist for the very first and only time.