Therapy for children of BPDs

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

I'm considering getting my daughters 8 and 5 into counseling.  They don't show acute signs of need.  The only things I notice are that they need an excessive amount of validation... .so much that it physically tires me.  They also have self-esteem issues.  As I'm typing this I realize that these two issues are precursors to developing BPD.  Before I started typing I wasn't sure if they needed counseling, but now I'm sure they will benefit from it.  I just wasn't sure because my daughter's aren't obviously in need of mental therapy to the average person.  I'm going to get them in for counseling for sure though.  There's excellent studies like this one that show the effects of BPD parents on children.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819472/
What are your thoughts?

[AnuDay]

I'm considering getting my daughters 8 and 5 into counseling.  They don't show acute signs of need.  The only things I notice are that they need an excessive amount of validation... .so much that it physically tires me.  They also have self-esteem issues.  As I'm typing this I realize that these two issues are precursors to developing BPD.  Before I started typing I wasn't sure if they needed counseling, but now I'm sure they will benefit from it.  I just wasn't sure because my daughter's aren't obviously in need of mental therapy to the average person.  I'm going to get them in for counseling for sure though.  There's excellent studies like this one that show the effects of BPD parents on children.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819472/
What are your thoughts?

[kells76]

Counseling was helpful for both kids, and especially for SD12 who was (is... .) parentified. It took the crisis of almost going to court over the PP for Mom to finally get them a counselor (she previously was pretty opposed). We weren't sure about her pick, but the C ended up being very, very insightful.

At your kids' ages, I think it might still be a good idea to get that therapeutic relationship established. That way, when a crisis hits down the road, you aren't bringing them in and having them work on The Crisis on Day 1. Instead, they'll already know the C and have that relationship established, so that instead of spending time on getting to trust the C, they can work on whatever needs working on. Does that make sense?

It sounds like you also have a bit of time now, so that instead of having to go with the first C you meet, you can take some time to "interview" different C's on your own and figure out who would be a good fit with your kids. Then, you could bring them in, not to talk about An Issue, but just to "hang out" and draw or play or something. Slowly build that relationship.

If I were in your position I'd probably check out ~3 providers on my own without bringing the kids right away.

  Thumbs up for planning ahead for what your D's need. Let me know if you want more info about our experience... .

kells76

[AnuDay]

Wow, thanks! I  forgot all about the parentification. My oldest daughter is thoroughly parentified. She's a totally different girl when her little sister isn't around. It would be good to take some of the load off of her.  What types of things do counselors recommend for reducing parentification. What are the harmful effects of parentification? I would assume that in the long run the child would look for a spouse that they could parent (hence codependence).  I'm pretty sure at least one of my daughters is codependent now.

[Harri]

By the time you start seeing obvious signs of trouble you have waited too long to get them in therapy.   Low self esteem and needing high levels of validation are, as you realized, pretty significant needs.

We have an article on the site that I think should be required reading for every parent and really every person who posts to people with kids here: Have Your Parents Put You at Risk for Psychopathology I hope this helps confirm your decision to get the girls in therapy.  So many of us adult children of BPD/ disordered parent showed no obvious signs of being abused or damaged by our home environments only to have difficulties later on in life 920's, 30's etc).  Having one healthy, aware and validating parent can be a huge plus for the kids but it is a daunting task for any one person.

Good luck to you.

[Notwendy]

I think counseling is a great idea, not necessarily only as a prevention for developing BPD but for the effects of having a BPD parent. My mother has BPD but none of her children have it. However, we did have to deal with the emotional effects of being raised in a family where a parent has BPD.

Why did I emphasize family and not just the person with BPD. IMHO, I think there is a lot of focus on the pwBPD being the problem. That was my perspective as well. I saw my mother as the problem and my father as the person who had to deal with it. He was the better parent in many ways, and clearly the more emotionally stable one, however, he was also her enabler. In retrospect- as an adult who has had counseling to deal with FOO issues- the family patterns were influential. My BPD mother's moods were a main focus- inevitably as they were so obvious, and other family members took on the role of enabler/caretaker. The drama triangle was a predominant way of interacting.

I think you are spot on with invalidation.  One of my mother's issues is feeling invalidated as a child and adult. I don't think this was the entire cause of her having BPD but I think it contributed and I also think that if someone grows up feeling invalidated they don't have the capacity to extend this to someone else.

When a child grows up in a home with dysfunction, this becomes a familiar pattern that feels normal to them- even if they don't grow up to have BPD. It was clear to me that my BPD mother's behaviors were not normal, but not my father's and so I tended to be co-dependent and enabling, not BPD and these were the issues I had to work on later as an adult.

I think probably every family has some craziness and no parents are perfect, but think about the things we would want for our kids: the ability to stand up for themselves, healthy boundaries, the ability to self soothe, and also to learn healthy coping skills. I think counseling can help with that along with the issues from being raised in a home with dysfunction. Also don't discount your own personal growth. Children learn from both parents.

[AnuDay]

Wow, amazing advice Notwendy and Harri, thank you!  Very insightful.  I was looking all over on the " children with BPD" board here and just about all of the posts are about teenagers or adult children. I couldn't find any about small children. A psychology student told me that it's hard to diagnose BPD any earlier than late teenage years because a lot of the behaviors and traits can be mistaken for typical adolescence and immaturity.  I'm definitely working on myself.  I was a codependent for a long time.  It's hard educating the children about life and school and at the same time helping them with their emotions.  A good psychiatrist will be a welcome aid. 

[zachira]

I worked with children who were the same age as your children, and it was very rewarding. Many of the children I worked with did not have serious mental health issues, and often times they had parents who put themselves before their children. The younger the child, the more he/she can benefit from therapy, and the less long term damage to repair.

[Turkish]

What kinds of excessive validation are you talking about? I mean what you perceive to be excessive versus what you feel would be normal. 

[livednlearned]

Everyone should be in therapy 

Especially kids with a BPD parent and one struggling with codependence. If nothing else, it will help them learn it's ok to have healthy boundaries.

Echoing Turkish, can you give us an example of their excessive need for validation? How do you respond?

It may also be helpful for you, the parent, to be involved in family therapy with the girls, if possible. Codependent parents can pat ourselves on the back for being *better* than BPD parents, and in the process, end up overlooking some of the unhealthy things we pass along to our kids, like having problems with boundaries. A skilled counselor can bring those dynamics safely to light in your parent-child relationship so that you work on improving them alongside raising the kids.

Are you able to get the girls in therapy without mom's permission?

[scraps66]

Therapy is good.  Therapy with the right therapist and the right kind of support between sessions.  These two things can be difficult if the BPD parent has to be involved in the therapy. 

In my case "we" have tried countless therapists and stopped/started so many times I've lost count.  My case is that therapy, and this goes back to the unsuccessful couples therapy, is looked at by the BP as a vehicle to feed neediness and collect information to allow the BP to develop scenarios where the child is running back to the disordered parent.

I don't know that my S14 has ever been to a "good" therapist.  Having joint legal custody there is no way of proceeding without at least consent of my exuBPDNPDw.  So, what she cannot control she destroys.     

[zachira]

In regards to needing the signature of both parents for a child to get therapy, and it can be nearly impossible to get the approval for therapy from a parent with BPD: In certain cases, and at a certain age, and depending on the state, a child can get therapy without the parent's permission. Also, the child's confidentiality is protected, and a parent cannot have access to the child's records or be told what is going on in therapy, if the therapist feels that it would be damaging to the child.

[ForeverDad]

Courts love counseling.  And court is likely to overrule a parent's refusal to agree to counseling.

However, you have to limit the ability of the ex to pick a gullible inexperienced counselor.  One way the court likes, since it involves both parents, is for you to pick a short list of well respected and experienced counselors who are also in your insurance network.  Then ex gets to pick from among your most excellent counselors.  If she delays then you get to proceed with your pick.

A good counselor is invaluable.  A lousy counselor can potentially sabotage your children and your parenting.

[livednlearned]

I was able to get my ex to agree to counseling for our son based on things that my ex noted (and attributed to my character defects).

How do you think your ex will respond if you mention therapy for the girls?

[AnuDay]

Wow, there's some powerful stuff in this thread.  To answer your questions, excessive validation to me is literally every 5-10 minutes wanting me to see something they did, wanting me to help them do something or answer a question.  A 10 minute stretch when my input is not needed is a loong time.  They have a high "dependency". I'm teaching them how to be independent, but they're behind.  Our court order says either parent can take the kids to a counselor (I believe). I may have to let the UBPD mom know in a reasonable amount of time. I haven't hit any roadblocks yet not telling the mom.  One daughter goes in for an initial assessment this week.  Regarding boundaries: I've had to literally spoonfeed my daughters lessons on boundaries. Luckily one understands intuitively, but the other struggles with the concepts.  Both have problems acting assertively to protect their boundaries. I never understood why until maybe this past Spring.  I knew they were traits picked up from their mom, I just didn't know the cause.

[Turkish]

Can you describe it more specifically? I don't know if this helps, but I fielded a call with their mom tonight.  D6 hit her head on S8's friend's arm yesterday. The call tonight went like:

"How are you D6?"

"My head hurts."

"Are you drinking enough water?" This wasn't it, it was a bruise.

"Yes." Me: tell Mommy you drank water at dinner (truth).she's obsessed about the kids drinking enough water.

"I drank water at dinner."

Mommy: "on a scale of 1-10 how much does it hurt? You need to tell daddy if it hurts too much." Like I need to take her to the hospital.

"Only when i touch it., a 1" I told her to say "Only when I touch it."  and she told her mom.  It was a bruise, minor. Not a dehydration headache. Then she asked our son of his butt hurt and to tell the teachers if it did. She still helps wipe him at almost 9.

I had to coach D6 to tell her it was the bruise, minor, from yesterday.  S8 seemed annoyed and didn't want to really talk to his mom after that. I  not going to apologize for coaching my daughter. Their mom was projecting anxiety, hers.

I know it's harder at your kids' ages to do it without alienating, but own rue fact that you are the last, best hope of them growing up healthily.

[livednlearned]

excessive validation to me is literally every 5-10 minutes wanting me to see something they did, wanting me to help them do something or answer a question.  A 10 minute stretch when my input is not needed is a loong time.  They have a high "dependency". I'm teaching them how to be independent, but they're behind.

In the book I Don't Have to Make Everything All Better by the Lundstroms there is a good chapter on asking validating questions. This helps kids internalize that 1) their feelings are valid and 2) they are competent and accountable for resolving problems -- both are part of building emotional resilience.

My SD21 is excessively needy, and it's hard to not just dispense advice, praise, solutions, whatever it is she's seeking. But that just perpetuates the myth that only other people can solve her problems. I have to validate her and then, if I'm available (sometimes I have to insist on setting up a better time to deal with whatever crisis is happening), I try to get her to problem solve out loud, with me constantly bouncing it back to her so she is responsible for soothing herself or whatever need she's trying to get met.

If you have codependent traits, you may find it challenging to put responsibility back on your kids to resolve whatever it is they're struggling with, and to manage your own distress when they struggle with difficult feelings.

It is not easy having a BPD co-parent, and sometimes we transfer rescue/fix/save behaviors to our kids. I have a friend who says it's not possible to be codependent with kids because by definition they are dependent. But I disagree. Especially if there is a BPD parent modeling learned helplessness and a codependent parent with strong rescue/fix/save impulses. It starts to show much more vividly when they prepare to launch to adulthood.

[AnuDay]

Update:
I took D8 to therapist.  In summary he said he doesn't think she needs therapy because her behaviors are not causing her or anyone else any problems.  There's nothing that he can diagnose her with.  He felt she was way too young to be diagnosed with anything.  He told me to keep my eye out for prolonged behavioral changes.  I'm going to look into some group therapy. 

[ForeverDad]

You can also brief the school counselor on the family dynamic and ask them to monitor her time at school, as needed.

You don't have to have her diagnosed with anything, just family-neutral support and insight providing additional guidance, ideas and tools.  Perhaps that therapist wasn't the sort of counselor who could help her?

[kells76]

You can also brief the school counselor

Good idea from FD. If part of why the T can't see her is that what's going on with her isn't at his "actionable" level, then getting the school to keep tabs on her behavior could help down the road if the school sees things rising to that level. Plus they'd document, I'd imagine.

I wonder if insurance coverage is part of what was going on with the T you talked with? So with SD12, the T was pretty reluctant to "diagnose" her with anything, but when insurance was going to stop paying for the visits, the T eventually did give her a diagnosis so that insurance would kick back in. To be fair, the diagnosis basically fit, but the T was more about working with the feelings, thoughts, and family dynamics, than slapping a label on stuff. Which is a good thing, I think.

The T you saw may have been right on the money that your D8 doesn't have anything diagnosable (which would be great!) but perhaps that impacts his ability to see/treat her, insurance-wise? Just thinking out loud.

I wonder if you could dialog with the T a bit (if you thought it would help): "Thanks for your feedback on D8, it's great you don't see anything diagnosable with her. Who would you recommend as a practitioner for building family skills/parenting skills/insight into behaviors/etc?"

I think you did great being proactive about your D's mental health.

[AnuDay]

Thank you Kells and Foreverdad.  Yes, he used the word "actionable".  I didn't have any actionable red flags to give him.  I think the insurance thing was also a thought, because if there's nothing "actionable" then there is no insurance coverage.  There's a therapy group around here that I'm just going to put her in.  I think they help with self-esteem.  My major issue was that I thought my daughter had precursor's to developing BPD, but the therapist said they may be precursors to other issues as well or they may be precursor's to nothing at all.  Also he said just because the mom has BPD doesn't mean the daughters will get it.  My daughter seems to have a lot of empathy and she doesn't seem totally disconnected.  There's no obvious red flags.   

[worriedStepmom]

My D12 has been a majorly needy child since birth, to the point that I almost didn't have a second child because I didn't know if I had that much emotional bandwidth to spare.  Neither her dad nor I have a personality disorder (although one short-term stepmom might have had one).  My kid was in the NICU for the first 3 weeks of her life, and I wonder sometimes if that is related to this level of needy.

I put her in therapy when she was 5-6 (after we divorced and then after I remarried).  Therapy helped her deal with her emotions, but didn't stop the constant desire for my attention. 

This is what I've done, with some input from therapists.

1) I set boundaries around myself and help the kids set and enforce their own boundaries in our house.  ("I'm busy right now, I will look at your drawing in 30 minutes."  "It's your sibling's turn for cuddles - I will <whatever she wants> with you when I'm done."  "I will spend 15 minutes watching <whatever>, and then I need to do something else.") 

When she is incessantly nagging me, she gets one warning, and then if she continues, whatever it is she is nagging about does not happen.  Period.

2) For a year (aged 10), every time D12 asked a question, I asked "what do you think the answer is?"  About 2/3 of the time, she already knew the answer.  I pointed out that she knew the answer, praised her for it, and asked why she asked the question.  She eventually started admitting that she wanted my attention and this was an easy way to get it, and I asked her for other ways she could get my attention that wouldn't annoy me as much as her asking "do ducks fly?".  Repeat repeat repeat.

The rest of the time, I validated her thought process behind the guess and then taught her how to look up the answers and see if she was right.  This means lifting my normally strict no-electronics-on-school-nights rule so that she can google answers.

The questions have DRASTICALLY reduced, to the point that sometimes she'll ask "Do you... .", stop, laugh, and say "I know the answer. I love you, Mom."

3) She's impulsive. When I'm busy, I have her write down her questions/concerns/whatever she wants me to look at.  Usually when I have time, she's decided she doesn't care about most of it anymore.  She was surprised when I pointed that out, and now she is trying to self-regulate more.

4) Guaranteed one-on-one time every night.  We started with a guaranteed 40 minutes a night of mom-and-D time after S went to bed and slowly shortened.  Now, on the nights she is with me, we do a family cuddle for about 10 minutes (me and all the kids and the dog), I spend about 10 minutes in her room with her before she goes to bed, and we have 10 minutes alone in the car before school most mornings. 

5) We are working on finding ways she can entertain and soothe herself.  When she doesn't have something to do, she gets anxious because her brain is always buzzing with 852 thoughts to process.  I help suggest things, and she'll try those out to see what works as part of her toolbox.  (When she's sad or angry, she listens to music and cleans her room.  When she's anxious, she reads.  When she's... ., she ... .).  It's taken 6 years of experimenting to figure out what works for her and make it a habit. 

6) We work on empathy for all those around us and talk a lot about how our actions might affect someone else, but also how our reactions are our responsibility.

They have to learn how to do all of these things that we take for granted, and some kids have a sharper learning curve than others.

... .and sometimes they learn the hard way.

Last year, I found out that D12 had a crush on a boy and texted him the word "hello" 16 times in 12 hours.  Why?  He didn't respond back and she wanted him to know she really wanted to hear from him. Sigh.  The poor boy literally turned around and ran away when he saw her in the hallway at school the next day.  D12 and I had a long conversation about appropriate communication behaviors and how you push away people when you are overly needy, because it isn't their job to fill that need.  It's yours.  I think she was finally old enough for that to really resonate.

Yours girls have a harder road since their mom is modeling all kinds of bad behavior.  They do have you in their corner, and I'm confident you'll find what works for them.

[AnuDay]

Wow.  This is a nightmare to read through, but a blessing to hear. My D4 seems to be somewhere where your
D4 is.  Luckily she is a little less emotionally needy than your daughter sounds.  She also has a lot more empathy which is
probably half the battle.
I just noticed that my D4 knows the answers
to some questions she asks me too.  Days can truly be draining.  She wants me to see everything she wears, everything she does
and everything she sees.  It's just not humanly possible.  I've noticed that if I make her wait a little while before
seeing or doing what she wants me to do that the urge will go away and she will forget what she wanted.  I like your approach with validating their thought processes.  The goal seems to be to
instill all the confidence that we can in them.  The last thing we want
to do is raise girls who grow into adult women who can't or won't think for themselves. 
From your post, I see now that a lot of what we should be doing is stamping out behavioral traits that may be identified as
BPD behavioral traits later in life. 

[worriedStepmom]

It really does get better if you work with them to learn to self-validate, self-soothe, and self-entertain, but it can be a very long process.  I really enjoy my kid now and I have every confidence she'll be an awesome, emotionally stable adult.

Since your daughter isn't reading or writing yet, I wonder if it would be good to encourage her to draw pictures?  She could create a visual representation of the highlights of her day and show you every evening after dinner.  That way she knows she will get to share all this cool stuff she experienced with you, but you are getting her to wait and do it in a smaller chunk that's more convenient.

[AnuDay]

Thank you,
I have been making small gains.  I do notice improvements.  They both love to color and spend a lot of time coloring and a little drawing.  I will try out your idea.  It seems to all be about getting them to be comfortable with their own feelings and ideas.  I guess the BPD mom did a lot to damage their self esteem.

[needPeace]

yes do it!  I regret not putting my D into counseling when she was that age.  Now at 17, and her parent w/ BPD back in her life, she is a mess.  I am fighting hard to get her into counseling again.