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Author Topic: Residential treatment versus intensive outpatient home therapy  (Read 373 times)
Elles

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« on: November 13, 2017, 09:03:34 AM »

This is my first post on a blog ever.  I have a recently turned 17 year old daughter.  She is in a residential treatment center.  She went to a wilderness program first.  We are having a lot of doubts about the RTC process.  She is high functioning and is in 12th grade.  If she had started 12th grade at her school, she would have been valedictorian.  She is a national merit semi finalist. 

She is struggling with being homesick.  She has been in the hospital, Wilderness, or RTC since mid May.  She has been at RTC since the beginning of Sept.  The pace is excruciatingly slow and the process is not individualized.  She hasn't been suicidal since she went to Wilderness and isn't self harming.  She needs extensive therapy.  She is supposed to be getting 2 individual therapy sessions a week with an additional family therapy skype session per week.  Unfortunately, she frequently doesn't get 2 individual sessions per week for various reasons.  We don't know what she is getting out of the group sessions.  We know she doesn't participate a lot because she is too afraid that she will say something "stupid" and look dumb.  She has been expressing how much she misses home a lot.  However, she has realized that expressing these feelings will be held against her as she is not living in the moment.  These emotions will prevent her from phasing up.  My issue is that she doesn't express her true emotions and that is part of her treatment expectations.  I am not sure how suppressing very strong homesick emotions is therpeutic while she is encouraged to express all other emotions.  This whole process seems counter-intuitive.  We had to change therapists 3 weeks ago becuase the first therapist wasn't seeing through her perfectionist facade.  So, we have wasted alot of valuable time and a large amount of money.

We are starting to look for an experienced DBT therapist in our town that will see her at least 3 times a week individually with another day for family therapy.  We would like for someone to come into our home and stay from 3:30 to 6 or 6:30.  We would have the same restrictions as the RTC and she would have to earn privileges as she hits preset milestones.  We know this won't be easy but having her 1000 miles away with very litttle communication has been excrutiating.  She would be able to return to school and finish her senior year in a semi-normal fashion. 

Based on what we are experiencing, the RTC is a very artificial environment and she will not be able to go to college in August.    It appears that she will have to do some kind of step down program to get her into the real world and help her learn how to deal with it.  If she is at our house, she will be going to school and facing the same demons that she faced before she left.  With daily therapy occurring immediately after school, these feelings can be discussed real time.  She has a lot of relationship issues with her friends and family.  It seems to us that progress will be more real and quicker in this kind of setting than in the contrived environment. 

Another plus (if we can make this happen) would be her ability to attend college in our town and continue the relationship with the same therapist.  So, we would be starting a process that could continue for the next 4 years if needed.  If she stays at RTC, she will have to begin a new therapist relationship after she is discharges which would be who knows when. 

The obstacles are actually finding a therapist qualified in DBT and finding someone that would help us in the home.  We would be ok with a primary therapist that she would see in their office with another less qualified therapist that would work under the the direction of the primary therapist in our home.  We are going to need help keeping the rigid boundaries.  We know the raging will come when she wants to go out on her own with friends and the answer will consistently be no. 

Has anyone done anything like the scenario we are proposing?  What have the experiences with RTCs been?  Are there any studies that have explored these options and success rates?  Any advice, direction, help would be greatly appreciated.  Thanks

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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
Kwamina
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« Reply #1 on: November 13, 2017, 01:36:15 PM »

Hi Elles and welcome to bpdfamily

It isn't easy dealing with BPD, it definitely is a serious disorder and I am sorry your daughter is having these issues. On the one hand it is positive that she is getting treatment, yet on the other hand it becomes clear from your post that you are not very pleased with the help she's getting so far. What led to you choosing the RTC your daughter is currently at? Have you expressed your concerns to the staff there?

If you want to read about other member's experiences with RTC's, I encourage you to take a look at this thread:
Residential Treatment: Journal of 12 Month Journey

Your daughter is 17 now, at what point did she get the (likely) BPD diagnosis? I am glad suicidal ideation currently isn't an issue for your daughter and that she isn't self-harming

The Board Parrot
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Oh, give me liberty! For even were paradise my prison, still I should long to leap the crystal walls.
Elles

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« Reply #2 on: November 13, 2017, 02:17:27 PM »

Board Parrot,
She hasn't been officially diagnosed.  The extensive psych eval was done when she was 16 in June.  She just turned 17. Due to her age, BPD wasn't put on her evaluation.  However, traits of a personality disorder were all over it.  We asked if they were referring to BPD and were told yes.  We were advised to put her in an therapeutic boarding school or RTC.  I asked if we could stop the progression and the answer was yes as long as we were aggressive. 

We have had issues with the RTC we chose.  We hired a consultant to help us find the right one.  We were given about 6 options and went on tours of 3 of them.  We chose the one that had the most varied activities and the best academic option.  The RTC is on the larger side and the coordination between all the different sections hasn't been very good.  As parents, we don't get much information from the housing supervisors or the academic side.  Changing counselors after 9 weeks was tough but necessary for any progress to be made.

After reading lots of information on treatment for BPD, it seems that most people don't go to a RTC.  We love our daughter and there has been no abuse.  Although, you could say that we have been abused by her.  Regardless, it is still very unnatural for her to be so far away from us and not allowed on home visits until she reaches a certain level.  She hasn't been home since the end of May.  We are all as unhappy without her as we were with her.  She is in a much better place emotionally than she was when we started the whole process.  However, she has a lot farther to go.  We know that very clear and tight boundaries will have to be set and are willing to go through it if we can find professionals to help. 

We also want to know if this is something that anyone else has done.  I know that many people go to see a therapist on an outpatient basis but we are wanting to take it a step further.  The only freedom would be to go to school.  The rest of the time would be in house therapy, studying and being with the family.  We would allow friends to come over for a short period of time on certain days but the visit would not be behind closed doors.  We would essentially create a similar setting as the RTC but it would be in the real world with real world triggers to help her learn the coping skills that she needs.  We know that we have to set up ways to keep her safe while undergoing intensive individual treatment.  We are willing to pay for a part time therapist or even full time if that is necessary to accomplish our goals. 

I know this is a lot of information and I could go on and on.  When she left, she was suicidal, using alcohol until blackout, minimal self harm, raging behavior whenever caught and punished, borderline eating disorder, self loathing, no self esteem, and complete hatred of me (her mom).  She had a lot of unstable relationships but landed in a more stable group in the last few months because they were all partners in crime.  No one called anyone out for acting totally innappropriate.

We know that we are lucky.  We caught the process early.  She hadn't started using drugs or involved in any sexual activity.  i have a degree in Psychology and was very much watching her progression and say a ragid spiraling in the last months that required us to make a drastic move.  She was hopitalized for threatening suicide and then we got her into a Wilderness program.

I hope this answers your questions.  Thanks
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bpdmom99

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« Reply #3 on: November 15, 2017, 03:05:05 PM »

Hey Elles,
thank you for posting.  I am following along with your story with much interest.  My daughter is 16 1/2.  She has a lot of SI and self harming, and has also started along the path of abusing alcohol, not a good friend group, etc.   Similar to your daughter, she is very bright and we have had to fight hard for her issues to be validated because she appears to 'have it all together' on the outside ... .but underneath is a complete wreck.

She is currently in her second month of a RTC.  The difference with her program is that the requirement is that she come home every weekend, and after the first 30 days she also started coming home one night a week. 

From my point of view, the visits home were scary but necessary.  I really think that the necessity of spending time at home and with the family is a vital part of the process for integration and therapy. 

For the few months prior to her entering the RTC we had her in a very restrictive home environment (much like you were describing).  Now that she has the RTC to return to - and knowing that we have someone to call on weekends if things spiral out of control - we have been easing off on her restrictions.  Largely this is because I really want to know what she is capable of handling - while she is still in an environment where we all have so much supports.

One of the largest benefits that I see for my daughter in the RTC is being in a constantly supportive therapeutic environment.  Having everyone 'talk DBT' to her throughout the day is making a difference. I can see the seeds being sown.  Slowly.  And the only way I can really see that is when she comes home on the weekends for visits and is put back in her 'normal environment', even if it is only brief.

My fear is that she is going to show signs of improvement and be moved out of RTC quickly.  It is very apparent to me that, because of her BPD diagnosis, everyone is very quick to not let her get too comfortable in 'the system' and worry about her becoming institutionalized.  So from the day she entered the RTC they were already talking about discharge.

To have an individual DBT therapist to work with a few times a week would be ideal for sure!  If you have those resources available, I would be looking to go that route just so that you can have her closer to you.  But I would think there has to be some transition plan put in place so that she doesn't go from being out of your home so long, and from being away from you so long, to all of a sudden being at home all of the time ... .even if that is alongside a DBT therapist.

I feel for you.  It is so difficult to figure out what is best for your child.  I am trying to figure the same thing out.  The only bit of a advice I can give is that I don't think there is a 'right' answer.  You have to go with your gut to the best of your ability, and know that plans can always change.  Flexibility  - and radical acceptance that it will 'be what it will be' - is the key.

Best of luck to you and your family, and thanks for sharing!

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Elles

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« Reply #4 on: November 15, 2017, 07:54:01 PM »

Board Parrot,
She hasn't been officially diagnosed.  The extensive psych eval was done when she was 16 in June.  She just turned 17. Due to her age, BPD wasn't put on her evaluation.  However, traits of a personality disorder were all over it.  We asked if they were referring to BPD and were told yes.  We were advised to put her in an therapeutic boarding school or RTC.  I asked if we could stop the progression and the answer was yes as long as we were aggressive. 

We have had issues with the RTC we chose.  We hired a consultant to help us find the right one.  We were given about 6 options and went on tours of 3 of them.  We chose the one that had the most varied activities and the best academic option.  The RTC is on the larger side and the coordination between all the different sections hasn't been very good.  As parents, we don't get much information from the housing supervisors or the academic side.  Changing counselors after 9 weeks was tough but necessary for any progress to be made.

After reading lots of information on treatment for BPD, it seems that most people don't go to a RTC.  We love our daughter and there has been no abuse.  Although, you could say that we have been abused by her.  Regardless, it is still very unnatural for her to be so far away from us and not allowed on home visits until she reaches a certain level.  She hasn't been home since the end of May.  We are all as unhappy without her as we were with her.  She is in a much better place emotionally than she was when we started the whole process.  However, she has a lot farther to go.  We know that very clear and tight boundaries will have to be set and are willing to go through it if we can find professionals to help. 

We also want to know if this is something that anyone else has done.  I know that many people go to see a therapist on an outpatient basis but we are wanting to take it a step further.  The only freedom would be to go to school.  The rest of the time would be in house therapy, studying and being with the family.  We would allow friends to come over for a short period of time on certain days but the visit would not be behind closed doors.  We would essentially create a similar setting as the RTC but it would be in the real world with real world triggers to help her learn the coping skills that she needs.  We know that we have to set up ways to keep her safe while undergoing intensive individual treatment.  We are willing to pay for a part time therapist or even full time if that is necessary to accomplish our goals. 

I know this is a lot of information and I could go on and on.  When she left, she was suicidal, using alcohol until blackout, minimal self harm, raging behavior whenever caught and punished, borderline eating disorder, self loathing, no self esteem, and complete hatred of me (her mom).  She had a lot of unstable relationships but landed in a more stable group in the last few months because they were all partners in crime.  No one called anyone out for acting totally innappropriate.

We know that we are lucky.  We caught the process early.  She hadn't started using drugs or involved in any sexual activity.  i have a degree in Psychology and was very much watching her progression and say a ragid spiraling in the last months that required us to make a drastic move.  She was hopitalized for threatening suicide and then we got her into a Wilderness program.

I hope this answers your questions.  Thanks
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« Reply #5 on: November 16, 2017, 02:10:05 AM »

Hi there Elles, my DD is also 17 years old , diagnosed at  15 with bipolar disorder then BPD  was also diagnosed shortly after . I thought I’d share with you just a little bit of our story . In short , our DD has been putting us through the absolute ringer over the last 2 years , with 7 inpatient hospitalizations in the bag , medications trials galore , therapist after therapist , severe self harm with cutting ( all over her body ) , bulmia , poor attendance and failing at school , then came the drug abuse with a bad crowd and abusive boyfriend , legal issues /probation , rages with cursing and swearing and calling me all the names of the day , intensive outpatient therapy programs, substance abuse counseling , dressing like a prostitute , staying out all night long , meeting strange guys for sex , inviting strangers into our home for sex ... .you name a BPD behavior , she had it !  On her 17th birthday , we had the most awful fight ( long story ) and I ended up calling the state in absolute tears begging for their help and asking them to get her out of our home because i just couldn’t take anymore . I was a nervous wreck and felt such a failure and I literally almost had a breakdown myself that day . It was truelly horrific . Then came her hospitalization earlier in March this year , another suicide attempt after an incident with her then boyfriend ( who then came over and vandalized our home - there’s now a protection order in place ) . She was hospitalized beginning of March after what can only be described as the worst week of my life as she was so dysregulated and we decided at that point that she simply had to go into  a residential facility , for her own sake as well as our own well-being . We had literally reached the end of our tether . Doctors agreed that there was no other option and commended us for dealing with our situation for as long as we had ... .one doctor told me done parents would have given up on their child completely . I was almost at that point too though !  She was in acute inpatient for 2 weeks , earned herself yet another two diagnoses while in there ( multi substance abuse and oppositional defiance disorder in addition to bipolar 2 and BPD ) and during that time i searched endlessly for a RTC that would focus on DBT . I found a program in Indiana and it was all going to plan to get her transferred to this program . My husband and I planned to take the  time off work etc to escort her there .  She was then transferred into a local RTC for a week while waiting for a bed . This local RTC was absolutely horrific and my DD literally cried and cried begging for me to take her out . We stood our ground , we told her we loved her but we didn’t know how to help her anymore and we just couldn’t cope with life going on in the way it was going . She resigned herself to the fact she was going to a RTC in Indiana .
Long story short , the insurance company decided at the last minute that they would not fund her transferring to another RTC . And so she came home . She literally dodged the RTC placement by the skin of her teeth and she knew it !
She promised she would try everything in her power to reign in her behaviors . She decided she was not going to take any more medication and this scared us . She told us she couldn’t think straight on meds and she needed to be off them all as they were making her worse .She was absolutely adamant on this and no doctor could persuade her otherwise .
Fast forward 9 months and slowly but surely , she is definitely improving . We’ve had a few showdowns , she’s had a few nights where she stayed out all night and returned with her neck covered in hickies . But when I think back to where we were at the beginning of this year , I’ll take it !
She has not cut herself now for 5 months . This is HugE as she literally was shredding herself to pieces daily . Some scars she will have for life but many are now fading . She hasn’t raged or cursed and sworn at us since she came home . She’s completed her legal probation ( she was caught with marijuana late last year by the police ) ,she’s doing her online school ( though remains poorly motivated there and does the bare minimum that she can get away with ) , she got fired from her part time  job ( due to calling out too often ) but soon found another one , she no longer hangs out with the same group of friends , tends to steer clear of them now . She still smokes marijuana every now and again but considering where she was this time last year ( dabbing daily , schrooms  , acid , DXM and even ended up in ER with seizures following a Benadryl overdose where she had been trying to get her “ trip” ) , she  was about to start experimenting with cocaine too !) I can almost deal with the marijuana now but there are boundaries she has to respect and she will not drive our car until she quits completely.  I am cautiously optimistic that she seems to have turned a corner somewhere along the line . She even had a brief romantic relationship with a guy and myself and hubby were just waiting for the crash and burn with accompanying drama and returning to cutting , especially when the relationship ended . But nope . She seemed to cope with it . She even coped well when her best friend moved back to her home state . In my DD’s words , she said “ this time last year , my best friend leaving would have made me suicidal and while I’m sad she’s gone , I know I can deal with it “. Again , HUGE progress .
We are still cautious , we find we are still waiting for and anticipate the spiraling downturn that has happened in the blink of an eye previously. We are more hopeful now though . We can see potential light at the end of the tunnel .
It’s not perfect , she will still make dubious decisions , but she does seem to be creeping forward , trying to make more responsible choices . I noticed earlier this week , she’s also deleted her second secret  Instagram account ( where she had blogged literally daily for the last 2 years and had posted pics of her bleeding cut arms and legs and pics of her taking her drugs / “ trippin “  etc .
Tonight as we watched tv , she lay with her head on my lap and I stroked her hair and her cheeks just as I used to do . I have not done this in 2 years . She hasn’t let me . My girl has 2 months to go until she’s 18 . I’m just praying we can keep going as we are and that things can remain on an even keel . I’m keeping everything crossed .
I do wonder what might have happened had she gone into the DBT residential center . Would it have been a good thing ? Would it have made her worse ? She seems to be heading in the right direction now without it . She is still seeing her substance abuse counselor who integrates a lot of DBT into her approach and I feel my DD is definitely maturing now too . I’m not sure if sending her away 2000 miles away was going to do her more harm than good .
Anyway , I’ve not posted in a long time , but I wanted to share with you the progress we seem to be manning outwith an RTC setting .
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« Reply #6 on: November 20, 2017, 01:47:47 PM »

" She was in acute inpatient for 2 weeks , earned herself yet another two diagnoses while in there ( multi substance abuse and oppositional defiance disorder in addition to bipolar 2 and BPD )"

It's like you've been watching the movie of my life through my window... .

We use the term "picked up another diagnosis or two".

General Anxiety Disorder
Depression
Bipolar 2
Oppositional Defiance Disorder
PTSD
and now BPD.

You're not alone.  I'm glad we're not alone either.
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