Therapy Support

[Redhorse93]

Hello, I have a question about financial support for young adult therapy. 

We have been paying for our daughter's outpatient therapy for the past 17 months.  When she began she needed IOP therapy, and we were in full support of assisting her as she had just resigned from a job of 2 1/2 years.  At that time, she had lost over twenty pounds in a span of one year, was withdrawn working 24/7 remotely and was beginning to significantly struggle with executive functioning.  We also suspected some marijuana mis-use.  We were struggling to communicate with her because when the conversation went in a direction she did not like, the emotional dysregulation would set in.  She would lash out at me, place blame and dredge up the past.  Most often citing her father as the root of her inability to make decisions (because she'd spent her whole life trying to please her father and wasn't allowed to make choices for herself), her relationship struggles/inability to maintain friendships (her father made her question her reality and shattered her self-esteem) and abandonment (we treated her brother differently because he had ADHD, we spent money on his early education that we did not do for her - she graduated from a public high school then went to a competitive out-of-state college graduating magna cum laude. During the pandemic we chose for her brother to finish his last two years in private school because he was struggling with virtual/hybrid high school). 

Our daughter moved back home in May.  Not employed.  No semblance of a healthy daily schedule.  Seems paralyzed.  One day at 2PM she told me she could a)clean her room or b)do research for 'work' on her computer.  Her room is a disaster.  She rarely eats with us at the dinner table (that is the one meal I prepare for everyone 5 nights a week.  Seems like avoidance.).  When we asked her about her ongoing (virtual) therapy (it has been virtual since she moved home as therapist is in another city) - goals, progress, etc.  She became defensive.  Stated she was in therapy for her father's invalidation, but didn't/couldn't say more.  We expressed that to continue to pay for her weekly therapy sessions we needed to observe greater accountability and forward direction.  It was not sustainable to pay for her to have talk therapy that was not enhancing her mental health and motivation.  Would it be possible to accomplish in two sessions a month what she was currently doing in four?  Did her therapist have any recommendations for other modalities of therapy that might compliment what they were working towards or  to address specific goals?  She has told us we are abandoning her by cutting back on her therapy.  We responded, that we weren't cutting back her therapy, nor abandoning her - That as an adult she could choose to seek as much therapy as needed, but at some point she would need to share the financial responsibility.  In response, her victimization has skyrocketed.  It is truly exhausting not being able to have a rational conversation with our once self-disciplined, responsible young adult.

We sent a very thoughtful email to her therapist.  We explained our observations over the past three months.  We sought her professional opinion.  After two weeks of no response, we sent a follow-up. Crickets.  Most recently our daughter stated that her therapist is worried about her feeling 'unsafe' in our home and defeated by our unwillingness to understand her.  She said it is as if we are choosing not to understand her.  A day later she called from the road and told me she wanted us to research a topic.  She then sent a link to an article on Traumatic Invalidation that came from a therapist she saw on Tik-Tok.  She has also mentioned in heavy discussions that she can no longer 'do this', and that she may have to go no contact.  Our marriage therapist feels we are being reasonable to want to understand what our daughter is working towards in therapy. Especially if we are currently paying for the therapy sessions as well as providing shelter, food at home, a car to drive and cell service.  We haven't paid for clothing, spending money, entertainment, etc since January.  She has been told in January 2027 she will be responsible for her cell phone and insurance.  In April, she becomes responsible for health insurance and medical co-pays.

Thanks for hanging in there with me...

My question is: For those parents who pay for their young adults therapy, do you receive 'progress' reports from the therapist?  Is your young adults therapist responsive to inquiries or parental input?  Has your young adult signed a waiver giving their therapist ability to communicate?  We have asked for the possibility of a joint therapy session to work on healing/repair - should that happen with their therapist or another family therapist? 

We only want our daughter's mental health to be properly treated so she can begin functioning again as an adult who can support themselves and find joy in life.  We don't want to 'control' her.  We don't put a price tag on her mental health, but we have become exhausted by the vicious cycle of entitlement, projecting and blame.  My physical and mental health is at an all time low.  I don't feel capable of being her mother and therapist. 

 

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

[CC43]

My question is: For those parents who pay for their young adults therapy, do you receive 'progress' reports from the therapist?  Is your young adults therapist responsive to inquiries or parental input?  Has your young adult signed a waiver giving their therapist ability to communicate?  We have asked for the possibility of a joint therapy session to work on healing/repair - should that happen with their therapist or another family therapist? 

Hi Redhorse,

Welcome to the group!  Your story will resonate with that of many parents here, myself included.  First off, I think there are some positives in your daughter's journey.  She managed to hold down a job for more than two years!  That's major, and it tells me she's high-functioning when she wants to be.  Secondly, she has you as an extremely caring and supportive parent.  My opinion is that you're probably her biggest ally in her treatment journey.  Thirdly, she's getting some therapy.  That's great.

Nevertheless, your daughter's situation has taken a turn for the worse.  You suspect she's misusing marijuana.  I'll tell you flat out that my BPD stepdaughter's dysfunction got way, way worse when she was self-medicating with marijuana.  I'm pretty sure she thought it was helping her deal with her anxiety and emotional lability; but in reality, it sapped her motivation and made her scatterbrained.  I'd say that marijuana noticeably reduced her verbal fluency, as well as led to deficits in executive function:  trouble with starting tasks, focusing, planning, problem-solving, doing adult-level tasks.  Worse, she started getting extremely paranoid.  On the domestic front, her room was a mess, and she neglected her general health and hygiene.  In my opinion, that was a reflection of her general mental state:  chaotic, disordered, unhealthy.  My advice?  You do not allow any marijuana use in your home.  You can't control what your daughter does outside the home, but she shouldn't use in your home in my humble opinion.

The other aspect of your story which is an orange flag is that your daughter appears to be avoiding adult life by taking refuge in your home.  Let me guess, it started out as a taking a needed break, perhaps as a transitional living situation, as your daughter rested up, saved up and got back on her feet.  But her daily habits quickly took a turn for the worse:  sleeping most of the day, avoiding the family, not helping out, making a mess, being passive-aggressively angry, moody, negative, accusatory.  Let me guess, your daughter has quit working on herself?  She'll barely look for a job--only just enough so that you don't kick her out of the house?  She'll put up a major fuss if you ask her to contribute, to do anything for the benefit of the family?  She'll throw a conniption fit if you ask her about progress on the job/housing/financial front?  She'll blame you for her problems, rehashing the same old stories from more than a decade ago?  She'll have energy to do some things she wants to do from time to time, but otherwise, she's morose and unhelful?  Her aura is a black cloud, and you're sick of it?  She spends way, way more time rehashing the negative past than looking forward?  If that sounds about right, it's because I've lived through it, multiple times in fact.

Now I'll turn to some of your questions concerning your daughter's therapy.  In my adult BPD stepdaughter's case, she did permit her dad (my husband) to have access to her treatment information.  I'm not sure if she did this intentionally, or whether she mistakenly assumed she'd have to share her health information with her dad because he was paying for the therapy.  But setting that aside, I believe it has been a huge positive to include a supportive parent in the therapeutic process, not only for the financial support, but also to create a positive alliance with the therapist.  I'm not saying my husband received regular reports from the therapist.  Nevertheless, there were various critical junctures where conversations between the therapist and parent were helpful.  Sometimes they'd be conversations initiated by the therapist, to get more insight into a situation (such as housing).  And sometimes the conversation would be initiated by my husband, to report a major change or incident, share insights and strategize with the therapist.  The point of the conversations was to have a reality check and discuss how best to support the pwBPD in coming days or weeks.  Finally, there were a couple of occasions when my husband was invited to attend a therapy session or two with his daughter.  I think those sessions were valuable in the treatment process.

You might wonder, when do the therapist and parent connect?  An example might be when the patient skips a therapy session or two without notice or explanation.  Another example might be when the patient seems to be on the brink or has a major episode.  Generally, any major life change (e.g. leaving the parental home, starting a new job) might trigger a conversation. 

There's a big caveat to all this.  Your daughter needs to trust her therapist.  If your daughter thinks you are meddling or sabotaging, then that trust could be broken.  And my humble opinion is that "family" therapy probably won't help much.  I'd say, if you need therapy, then you get your own therapist.  As for your daughter's therapy, what has been proven to be effective is DBT or CBT, as opposed to traditional "talk" therapy.

Hope that perspective helps a little.

[Redhorse93]

CC43,

Thank you for your perspective and thoughtful message!  Yes, it does help me to further discern our direction.  I sincerely appreciate the time you spent sharing your experience, and the positive outcomes of continued therapy as well as parent/therapist communication. Regretfully, our daughter feels we are trying to control the situation.  With time we hope she will realize we only want healthy collaboration that allows for greater understanding.  I will delve into educating myself about DBT and CBT therapy models.  Again, thank you for sharing your wisdom.

[Notwendy]

If you are in the US, the situation with therapy is similar to the child in college. Even though parents may be paying, the student's information about grades, and what they are doing remain confidential. There are ways for the child to consent to limited information- grades, financial information- to parents but parents dont get progress reports, or communication from professors. It's the same with therapists who are bound to HIPPA, confidentiality laws. 

Still, there is a boundary and that is it's your money involved here and so you have the choice to pay or not- either for college or therapy or anything these. With therapy, its difficult to know what is actually going on. All you know from your D is what she tells you and all the therapist knows from your D is what she tells her. What your D tells the therapist has a big influence on how effective therapy is.

BPD can be challenging due to the pwBPD projecting, and perceiving situations from victim perspective. It's clear that you love your D and are doing all you can to be supportive of her and to help her make progress. It's discouraging when she blames others and you for issues that she is facing. This isn't about you as much as her perspective with her BPD. Her work with the therapist is entirely between the two of them. There isn't a way to have a specific timeline for progress, but even without that, there could be benefits to her from having someone objective to talk to, and be a source of support, even if your D isn't entirely transparent with the T.

Your boundaries are your money, your house, your rules- at any age. The employment situation is hard to gage but the cleanliness of the room, in your house, is. You can have expectations that your D maintains a level of cleanliness, while still allowing her the freedom to have her room as she likes it. It can be messy without being past a standard of clean. You can decide on what you can manage financially with regards to paying for therapy. These aren't easy boundaries, and expect your D to be angry and blaming for them, but without these, you and your H will feel resentful.

This is a difficult situation. It was the reverse for me in terms of relationships- my mother had BPD. Little was known at the time about BPD in her era and so the response of family members was to keep her from feeling stressed. However, without any expectations of her, she didn't accomplish things and so didn't become competent. Rather than to take on a task that she felt uncertain about, she would escalate her behaviors, blame others and so tasks were done for her in order to avoid her BPD behaviors but this perpetuated them.

She had therapy and while it didn't lead to a solution to her BPD, it may have helped in other ways, that we don't know about. It was strictly confidential to her. She was very sensitive to the possibility that someone would "talk about her" and expose her. We were not allowed any communication with her therapists and in addition, if she had a close friend, it was best for me (as an adult)  to not have a relationship with that person and let that be her own world. As CC43 mentioned, your getting involved in your D's therapy can result in your D's losing trust in that relationship.

[CC43]

Hi again,

I think you're generally on point with your concern about your daughter seeming stuck, as opposed to moving forward and working on herself.  I empathise with your concern about whether or not therapy is helping your daughter, because it's expensive as well as time-consuming.  In my own situation, there were times that I felt like therapy became my BPD stepdaughter's "occupation," as well as an excuse for not really doing other things in her life.

I'll share with you my own mindset concerning my BPD stepdaughter.  While my husband was mostly focused on her mood (i.e. wanting her to be happy), I was mostly focused on her actions.  I could tolerate all sorts of negativity, sulkiness and disengagement from family, as long as my stepdaughter was generally doing what she was supposed to be doing.  Was she going to her therapy sessions?  Was she working on her classes?  Was she earning some money?  If she was unemployed, was she working hard to find a job?  If she got fired, did she look for a new job?  If she couldn't find a job, was she at least volunteering?  Did she pick up after herself in the common areas of the home?  Was she eating reasonably well?  Was she getting some exercise?  Did she shower and get dressed daily?  Did she go to bed at night?  Was she spending time with friends from time to time?  Did she resist the urge to lash out and send mean texts?  Did she find time for hobbies (not including passive consumption of social media and TV)?  In other words, in spite of her sour mood, did she follow a "normal," age-appropriate daily routine?  I guess that this approach hinges on my belief that you are what you do every day.  Since my BPD stepdaughter seemed to struggle so much with her identity, my hope was that after a few months of following a healthy routine, she'd come to realize who she was (for example, an attractive, athletic college graduate working towards a career in XYZ, starting out with volunteer work in an adjacent area, who loves caring for pets, spending time at the spin studio, and painting in her free time).  In other words, something other than her ongoing narrative:  an angry, entitled, victimized girl with a terrible childhood whose family mistreats her and who has given up on herself because she's too overwhelmed by adult life.

As an aside, my stepdaughter would struggle with handling stress, which tends to increase in early adulthood.  I emphasized to her that keeping a regular sleep and mealtime schedule helps reduce physical stress, by resting and nourishing the body.  The same goes for regular exercise.  Spending a few minutes every day to tidy one's living quarters will help make the environment pleasant, setting her up for success.  Thus keeping a schedule can help "automate" daily living, reducing stress and the mental bandwidth spent on routine tasks, freeing it up for other things.  In fact, whenever stress feels overwhelming, the more important it is to focus on healthy habits.  It's not "stupid" or "boring" to have a healthy routine; it's part of the scaffolding that supports you to achieve what you want in life.

I guess my point is, it's less about knowing the actual content or goals of your daughter's therapy, and more about taking ACTION and building momentum towards carving out an independent adult life.  I think that starts at home.  The rules of my home would be, adult children are welcome any time, provided that they are drug-free, respectful and take care of the home environment (clean up after themselves), while they are working full-time on themselves, through some combination of study, work and/or volunteering.  In addition, I think they should be responsible for paying for all their own luxuries (phone, travel, etc.)--it's their choice entirely.  In other words, they aren't allowed to give up on themselves and on life in general.  If they insist that they are adults, they can choose to do whatever they want whenever they want, well that's absolutely true, and they are free to leave, you wish them all the best.  But for as long as you're providing free room and board, they are not allowed to be on vacation, to freeload and sit on the sidelines of adult life, because that's not the "real" world.

How do you enforce these rules?  It can be difficult sometimes.  Typically my stepdaughter would start out OK, but then she'd regress--sleeping in late, taking long afternoon naps, prioritizing fun travels over looking for work, etc.  I didn't want to police or regiment her days, or have to inquire about daily status reports, but it was clear to me she wasn't working hard on getting her life on track.  I might suggest to disable wifi at night, to prevent all-night streaming.  If she's sleeping the days away and not working on herself, then you have to ask her to leave.

I have a few ideas on finances, but I get the sense you're on the right track there.  It's true that emerging adults might benefit from financial support--but there's a fine line between support and enablement of dysfunction.  I think that the principle of "skin in the game" is an important one, especially as your daughter matures.  If your daughter wants therapy, then maybe you start out paying for 100%, but then you ratchet that down over time, to maybe 50% (or a set amount per month) and then lower.  Let your daughter take the lead on working out the details--maybe she reduces the frequency of therapy sessions; maybe she asks her therapist for a lower rate; maybe she finds a cheaper therapist, or one that's covered in her insurance plan.  She has to learn to work within budgetary constraints, because that's the "real world."  If she has skin in the game, she's much more likely to appreciate your support, as well as work out a solution.  But if you're paying for everything, she'll just hold out her hand for more money, while resenting you for not giving her enough.