Family therapy

[In4thewin]

Hi All. Sorry for another post so quickly. I know you all have problems of your own and I feel bad for even coming here again. I just want to swing something past you to check myself on something. Family therapy. Abbreviated back story is that I've been not only open to it for years, but have been the one pushing for it. The ongoing problem has been that my daughter refuses to adhere to basic rules of communication that keep the space safe for everyone and ensure that the general environment is conducive to healing and collective problem solving.... the purpose of family therapy. Going back years prior to her diagnosis, various therapists clearly established the "rules", and the importance of those rules were underscored in DBT sessions. Nonetheless, to date, my daughter won't even acknowledge that there should be rules of communication that apply to her, and she NEVER adheres to them in "therapy", so nothing can even begin to get resolved. It ends up being just another opportunity for her to come after me verbally.

Most recently we've been working with a so called family therapist online through a platform called Grow Therapy. After many sessions starting and continuing the same way....with my daughter using foul language, elevated tone and volume, and no sign of being there for any purpose other than to blame and dodge any personal accountability for anything, I started to not make these sessions a priority. The past couple sessions I didn't attend due to having other things scheduled, and my daughter took them alone. So late this afternoon I got a call from my daughter. I answered and she asked in a hostile tone if I was going to get on the therapy session, which I didn't even know was scheduled. She's technically the client. I calmly told her I would, and asked her to send me the link. So...... after I logged on, I just sat there. I didn't say a word, waiting for my daughter or the therapist to talk first. After a brief silence by all of us, the therapist said "okay, so I don't know how either one of you would like to start?" or something like that. Immediately my daughter started yelling, using foul language, and was demanding that I provide her with some answers pertaining to my reaction to her pregnancy. She wasn't even posing anything as a question. It was a "how dare you say this", "who do you think you are" kind of thing. So..... I sat there silently for a minute as the punching bag session started and then calmly interjected telling the therapist that I would be discontinuing the session. With that representation my daughter escallated to an immediate wail of a cry, saying "NO!!!!!", but I just ended the call the logged off. So far I haven't heard back from her, except to say via text that my not staying on the call only "proved" that I don't want to be "accountable". I haven't responded to that text.

So there's a couple things here from my perspective. First, this particular  "therapist" has never once intervened in toxic communications that are clearly the "norm" and can be nothing but counterproductive to any kind of relationship therapy , BPD aside. Not once has she attempted to take control in a session when it's clearly not "therapeutic" to anyone. She has never tried to lay down some "rules", although my daughter has been versed in them many times before, over many years by other therapists. It's like as long as my daughter keeps booking appointments and the therapist is getting her paycheck (which at this point comes from Medicaid), she's just going to keep showing up and doing/saying nothing but watching someone be out of control. I really have no respect for that. Secondly, I have shown my daughter over the course of many years that I want to address any issues she has with me, and given that this can never happen 1 on 1, I've kept trying the "family therapy" route with her. She has been informed by me many times over the past year or so especially that I would not participate unless she adheres to some rules that apply to both of us. This is not the first time I calmly discontinued a call.

I'm trying to hold to a healthy boundary for her good as well as my own. If abusive communications shouldn't be tolerated, why would that go out the window because she books a "therapy" session? Especially when the therapist doesn't have any competency with BPD and exhibits that she's not even trying to control of the session. Please let me know if any of you see this differently and if I'm off base with something. All circumstances considered, should I have stayed on the call or at least stayed on longer? Should I have said something more than I did? Any thoughts are appreciated.

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

[ChoosingPeace]

I would no longer waste my time or money on a therapist that clearly doesn’t know what’s she’s doing. It’s actually shocking to me that she allows that type of behavior during a session! I’m so sorry you experienced that and hope you can find a more appropriate person to work with.

[zachira]

Sometimes the most effective family therapy can be with the members affected by the disordered person and without the participation of the disordered family member to help the family members set the boundaries they need when dealing with the disordered family member. I tried to set up family therapy with my mother with BPD and her psychiatrist who had tried individual therapy withe my mother and had a good reputation as a therapist told me my mother was not a candidate for family therapy.

[js friend]

Hi Inforthewin,

I guess that there are good and bad therapists and I think this one is particularly bad by the sounds of it. I think you did the right thing to leave the session. The therapist has shown you overtime that she is ineffective in taking control of the therapy sessions so why stay to be verbally abused by your dd.

If it were me I would be fuming and I would contact her via email to let her know the reason why you ended the session and how you would like to move forward from this

[Pook075]

I have very little experience with group therapy- maybe 5 sessions total with three different therapists.  In two of the three, the therapist set the tone and we were answering them, not the others in therapy.  The third one let my daughter rant a bit, but eventually cut her off and asked us for responses.  When my daughter interrupted, she'd again cut her off and ask her to let us respond.

So I've only been part of a session like that once and it was with an old psychiatrist who never said a single word.  That wasn't group therapy, but you get what I'm saying.  The therapist you have does not sound like a good choice for group therapy.  And like you said, it's your kid's therapist so you don't have much control over that.

One thought though; if there's another therapy session that you're invited to, it might be worthwhile to use it to state some boundaries moving forward (no yelling, no abusive calls/messages, no financial support until the abuse stops).  It won't go over well, but at least the therapist can hear you and use that information in later sessions to correct what was actually said.

[In4thewin]

Prior to yesterday's appointment, I went online and signed up for a 1 on 1 session with this therapist because I know she continues to see my daughter. That appointment is this Thursday. I think she already knows why I left the session because I briefly spoke to her about my daughter's behavior during sessions previously. All she had to say on the matter was that she never had to lay down rules before.......okay, but she clearly does in our situation, but hasn't? This women is just some random therapist who my daughter hooked up with after attending an IOP for continuing care because she was available during a time slot that we both knew would continue to work once my daughter starting attending cosmetology school. There's nothing in her background that indicates that she's even BPD "informed", and it's been proven time and time again that nothing can get accomplished in sessions exclusively due to my daughter's words and behavior. For instance, during a time period that my daughter and I weren't really having any major issues, the session started out fine, but when I brought up the subject of my daughter getting a part time job and wanted to discuss a timeline by which she'd do that or I would stop payment on her internet bill (this was after she moved into the apartment but before she was attending school), all hell broke loose, and then she (my daughter) decided to end the call. It's always the same thing. She doesn't want to be held accountable for anything, big or small.

I plan on just letting the therapist know that I won't be attending any more family sessions as nothing productive takes place and it isn't good for my daughter or me to continue to engage in this way. I'm also going to remind her that my daughter has a legitimate BPD diagnosis that was a very long time coming with numerous doctors, Psychologists, and therapists all reaching the same conclusion over a 5 year period--- a diagnosis that my daughter doesn't want to face. I'll also let her know that the therapy she really needs is DBT (as I think should be very clear by her ongoing behavior in family therapy sessions) and that I've become aware that DBT is now being used to help expectant mothers mitigate challenges with hormones, and I really think it would be in my daughter's best interest if she'd (the therapist) encourage her to start practicing DBT, even if only for that reason. I can't control how this therapist decides to proceed with my daughter, but I do know if she's not engaging with my daughter appropriately given her diagnosis that she can't help her and could potentially make matters worse.

Rolling things back about a year, after my daughter was removed from my house following about the 4th inpatient hospital stay she was pink-slipped into by law enforcement, I had put up a boundary that I ended up dropping, where I told her that I'd communicate with her only when a therapist was present, and only when she engaged appropriately. This was just as she was entering a 3 month online IOP (in her apartment) where they were supposedly doing DBT. I say "supposedly", because many programs incorporate aspects of DBT but it's not really a comprehensive  "adherent" program that operates as Marsha Linehan dictates it should. Perhaps if I would have stuck to that boundary, my daughter and I would at least be able to engage in a healthy way with a therapist in between.... maybe not.

Today I decided to discontinue sessions with my current (personal) therapist and pivot over to a DBT practice that truly specializes in BPD and runs an adherent DBT program as well as offers individual therapy. It's a practice that my daughter was let go from about 4 years ago because she wouldn't do any DBT "homework" and wasn't complying with any aspect of the program. My current therapist is nice, and a Phd, but I'm really not getting what I need from her. I want to work with someone who is in the trenches when it comes to BPD, knows all the skills backwards and forwards, and can help me navigate the challenges I continue to face with my daughter in an informed way. So I called and they recommended that I work with a particular therapist who works with parents of pwBPD. It was explained to me that this BPD parent coaching is sort of like family therapy without having another family member there, which sounds like a good fit--- I hadn't even mentioned my inability to have family sessions with my daughter. The practice doesn't take insurance and the sessions aren't inexpensive but I'm starting to feel a little better better knowing that I'll have a solid resource for individual therapy/counsel that I really need.

[ChoosingPeace]

I was told it was unethical to do family therapy with an established therapist for one of the parties. The therapist will have understandably have a natural bias towards their own client. If this was your daughter’s therapist doing the “family therapy” that’s a huge red flag.

[In4thewin]

ChoosingPeace, this therapist isn't her "personal" therapist. She has one of those that she found on the same platform. This therapist was only supposed to be a "family therapist", but she's nonetheless taken appointments with my daughter seperate from me, and has stayed online with me at times that my daughter logged off of a session. I don't really want to make this about the therapist, although I really seen or heard anything from her that has impressed me, especially the not even attempting to lay down or enforce ground rules for communication. She's definitely not what my daughter or I need though, and I have no problem telling her that. BPD is a complex mental health disorder and it needs to be addressed by a provider who fully understands it and can competently treat it.

[ForeverDad]

Around here in peer support, we call what happened a "Blamefest".  Yes, this was a new experience for the therapist (T) but she should have learned from it and in the future she should know to step in and stop the Blaming cold.

This has been said many times that I don't know if there is an original quote to cite, but I remember on Star Trek the  Enterprise's engineer Scotty finally exclaimed to those on the Bridge, speaking of the Klingons trying to lure the Enterprise away from Captain Kirk and the landing party on a second false distress signal, "Fool me once, shame on you.  Fool me twice, shame on me!"

Remember, the T is more than a moderator or link, the T is the {polite but firm} Authority.  It mustn't be abdicated to your daughter or there will be no progress.

Over in the Tools & Skills workshops board we have a couple topics on Boundaries.  The fact is that some of the many hallmarks of BPD are: self-oriented perceptions, Denial, Projection, Blaming and Blame Shifting.  So it's obvious there is extreme disrespect and outrageous blaming.

But pwBPD also resist Boundaries.  So instead we place boundaries on ourselves, for us to follow.  In essence our boundary is our response to poor behavior.  In your case, your boundary was to exit a bad scenario.  That was entirely proper.  Frankly, the T should totally understand that you need that boundary.  However, it likely will require multiple instances of exercising your proper boundary for your daughter to accept it, well, sometimes, maybe.

Also, if not mentioned before, another aspect is the Karpman Drama Triangle (also found in Tools and Skills workshops) where there is a claimed victim (daughter), perceived persecutor (you) and stuck-in-the-middle savior (therapist).

[CC43]

Hi there,

I confess I have zero experience with therapy and family therapy.  However I can tell you what I think worked pretty well with my adult BPD stepdaughter.  She found a therapist whom she trusts, and she has been meeting with her regularly for years now, probably once a week when in distress and maybe twice a month thereafter.  At some critical junctures, there were some therapy sessions where her dad participated.  This happened maybe two or three times over as many years.  I wouldn't say this was "family" therapy, but rather attempts at a "reset" to improve communication.  I think these sessions were emotionally intense, where issues were aired out and put on the table, but they were ultimately valuable in helping everyone understand the pain points in an attempt to move forward, facilitated by the therapist.  My understaning is that her dad mostly listened, but by the same token, he understood better the depth and source(s) of his daughter's pain.  In addition, I think the therapist got to experience first-hand how committed (and loving and rational) her dad really was, even if he was frustrated that his daughter just couldn't see it, even if he reacted with big emotions sometimes too.

Anyway, I'm not sure if the "joint" therapy sessions were really turning points, even if they were highly emotionally charged.  I think the real work happened in the background.  First off, my bet is that the therapist could see that though the daughter-parent relationship was strained, there was love and commitment from the parent, beyond merely paying the bills for the therapy sessions.  But perhaps more importantly, my BPD stepdaughter had authorized her therapist to share information with her dad.  I'm not saying that the therapist was breaching her client's trust.  Rather, my husband has been allowed to speak with with the therapist, over email and the phone sometimes, sort of a reality check, to understand if there's imminent danger (e.g. delusions/paranoia/acting unhinged) when communication has been lacking, and to fill in critical information gaps.  When my stepdaughter seemed really unhinged, my husband felt he could call the therapist and try to understand if something was going on that he didn't know about, and he supplied some information as well (for example, she deteriorated after quitting school/her job).  Sometimes they exchange insights, always with the goal of helping my BPD stepdaughter.  My guess is that my husband clarifies the record sometimes.  I think that between the therapist's expertise with BPD, her ability to read between the lines and get clarifications from her dad from time to time, she has a pretty good sense of what is going on and what needs some work.  In summary, I'd say that the therapist sees the primary parent as a chief ally in helping her client function day-to-day, and the therapist treats him accordingly.

Having written all that, I have some loose opinions about therapy as well.  Though my stepdaughter has made a lot of progress and turned her life around, I can't help but wonder if talk therapy is really working for her right now.  I'm skeptical that "talk therapy" works with BPD at all.  My thinking is that talk therapy can help people reach a deeper understanding of themselves, get clarity, maybe seek closure/acceptance and a way fowrard.  I guess the underlying premise is that therapy can help clarify thoughts around troubling feelings.  But with BPD, I suspect that the reverse is true:  intense emotions are generating troubling thoughts (sometimes delusions), and talking more about these feelings only seems to amplify the negative thought patterns/delusions, not resolve them.  When I see my stepdaughter, I can't help but see someone who gets stuck in a mental rut.  It's like she's ruminating so much about ancient grievances that she finds it bizarrly comforting, possibly a distraction from thinking about current issues and challenges?  Talk therapy makes her revisit these unpleasant feelings, and rather than resolve them, she's reliving them, getting riled up and getting even further ensconced in her mental rut?  Sometimes I think, she should focus less on remembering and thinking deeply, and much more on action.  Moving forward.  Doing something TODAY.  Focus on TODAY, not the past, not the distant (scary) future.  Think less, do a whole lot more, get moving.  It's as if therapy itself becomes a distraction.  For example, I could ask, How was your day?  The answer would be, I had therapy--an event that consumes the mental energy of an entire day.  Whereas here I am thinking, a walk in the park, a coffee with a friend and a part-time job would do more for her mental wellbeing, if only she would prioritize action over thought, if only she would de-emphasize feeling.  Sometimes it seems like she wears therapy like a badge of honor, an identity based on pain and victimhood without really overcoming it?  Now maybe this reflects my own issues, because I'm a doer more than a talker/feeler . . . I think that feelings are mostly fleeting, but results are what matter and last . . .

No idea if that's helpful, but just a different perspective I suppose.