intro

[feldsparkle]

The sign-up procedure encourage me to introduce myself - apologies in advance for asking questions that may have already been answered!

After several years of largely ineffective therapy and medication, our son was recently diagnosed with 'tendencies toward' (because he's not 18 yet) BPD and started DBT. We don't live in a large city, and the quality of the only DBT program here is doubtful, but he's found the books we got him helpful, as well as an online support group. We've also adapted our parenting, based on what we've read so far, and try to spend time every other day reading and talking with him about BPD and DBT.

Honestly, the results after just a few weeks are amazing. He's made more progress than in the past two years combined. A lot of this has to do with validation, I think. He says he finally feels for the first time that people understand what he is experiencing and how the world seems to him, and learning about DBT has reduced his hopelessness. He recently learned that his bio-mom was diagnosed with BPD (we adopted him as a pre-teen) and learning that his challenges may stem from genetic legacy and early childhood abuse / instability has also helped. He's a smart, talented child and I'm feeling a little hope for him to be okay as an adult for the first time in quite a while.

I have two major concerns right now:
- the results from DBT seem 'too good to be true' so far - we've restricted ourselves to mild praise with him, but I'm worried that he was strongly motivated to try DBT coming off of a suicide attempt and hospitalization and that he won't have the ability to 'stick with it' or will try to do to much too fast - how do we support him to maintain a slow, steady continuous effort and avoid overreaching?
- how big a problem is the poor quality of the local DBT program (group therapy once a week, which loosely follows DBT - sort of DBT-lite, I think - and weekly individual counseling with counselors who aren't DBT-trained)? There's a comprehensive adolescent DBT outpatient program with a family component in a city 2 hours drive away. We have other kids and can't move there due to employment, but do we need to be considering trying to drive him there? I'm worried that the 6 hours in the car every week and late nights would be a stressor in and of themselves... .

Looking forward to learning from others who have walked this road - thanks for having this group!

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

[wendydarling]

Hi feldsparkle

Welcome to the family   I'm glad you found us and reached out for support.
 
I understand your concerns and questions, is it too good to be true, will he stick with it, will the current treatment continue to work, I asked myself the exact questions and my worries here like you.  

He says he finally feels for the first time that people understand what he is experiencing and how the world seems to him, and learning about DBT has reduced his hopelessness.

This was my 29DD’s break through moment too.  

I have two major concerns right now:
- the results from DBT seem 'too good to be true' so far - we've restricted ourselves to mild praise with him, but I'm worried that he was strongly motivated to try DBT coming off of a suicide attempt and hospitalization and that he won't have the ability to 'stick with it' or will try to do to much too fast - how do we support him to maintain a slow, steady continuous effort and avoid overreaching?

You say he was ‘strongly motivated to try DBT’ it’s all happened so quickly from suicide attempt to too good to be true DBT, I understand your worries.  My experience was once DD broke through to where your son is, for her was a defining moment, she knew there was hope. I learnt while the path was not linear and yes she had some backs I now see those as part of her recovery, she’d get back up and lead the way forwards.

- how big a problem is the poor quality of the local DBT program (group therapy once a week, which loosely follows DBT - sort of DBT-lite, I think - and weekly individual counseling with counselors who aren't DBT-trained)? There's a comprehensive adolescent DBT outpatient program with a family component in a city 2 hours drive away. We have other kids and can't move there due to employment, but do we need to be considering trying to drive him there? I'm worried that the 6 hours in the car every week and late nights would be a stressor in and of themselves... .

As you say your son has made more progress in the last few weeks than in the last two years, its early days, he is making good relationships, he feels understood. See how it goes? My DD reaches out to the community online as we have here. There is a twitter DBT group on a Sunday that maybe of interest ... .I'll dig it out for you  .

Small gentle steps, day by day.

Welcome to the community  

WDx

[feldsparkle]

Hi Wendy,

Thanks so much for your response - I can't tell you what a relief it is to hear about your daughter and that sustainable breakthroughs are really possible.

It's been another week and he's still on the DBT bandwagon, though there are frequently wobbly moments.

He decided to disclose his diagnosis to his current and former friends, so he could talk to them about DBT. This felt like oversharing to me - too much, too soon. The reaction was mixed. One girl, who he'd alienated with his previous behavior, welcomed the info - she actually called me up to ask for online resources and said she wants to learn validation skills. She's told him they can be friends again if he makes a sincere effort with DBT (bless her!). She's into meditation and mindfulness and she's eager to share that interest with him. His other friends took longer to respond, and she helped him brainstorm and role play rational scenarios for why that was, so that he could fight the urge to assume the worst and start texting them incessantly. A few were ultimately supportive or sort of 'hey, that's cool, we like you when you aren't going all crazy, so that's good they figured out what's wrong' vein. Others basically said 'glad they figured it out and you're getting help, but it's too intense for me'. He took the latter pretty hard, of course, and I was certain he was going to go into a downward spiral again, but this time he a) shared with me how horrible he was feeling, and b) was open to trying to use the dbt skills to cope. It was touch and go for a day or two, but he worked hard (with much coaching) to act in opposition to his feelings and managed to get back on track eventually.

He got up on time two days ago, exercised, and made a healthy breakfast unprompted (the first time he's done that part of the self-management plan without any prompting). Then, he got so over-excited about the accomplishment - 'Mom, I'm acting dialectically!" - that he left the burner on and set the pot holder on fire, then he felt horrible about that and we had to talk him through using his distress tolerance skills again.

So, baby steps, but he's still on the balance beam.

Now I'm struggling with my anger at the local mental health system. They've apparently suspected BPD for a long time, but didn't want to mention it out of a misguided / outdated sense of wanting to spare him the stigma, and also due to capacity issues in their DBT skills group. I look at all the scars on his arms, think of the pain he's been through (and what his siblings have been through too), and wonder if much of this could have been prevented or mitigated. This is especially true, since I feel like most of his recent progress has been from self-study (he was really inspired by Marsha Linehan's personal story and has started studying her academic work too) and from coaching from friends and family who are learning validation and other support skills, resources that aren't dependent on the local supply of mental health services.

Nevertheless, for lack of other viable options, I think we're going to have to stick with the local DBT-lite group and DIY from books and online for the time being. We'll look into trying to supplement with occasional weekend sessions with a DBT-certified counselor in the city.

Thanks again so much for the advice - we've felt so alone in this... .