Help with Residential Meltdown

[FaintTheGoat]

This is my first post, and I'm really hopeful that someone in the community can provide some wisdom and help.

Our 15-year old daughter was diagnosed BPD. She's highly intelligent. She was in residential treatment last year after a suicidal gesture, and the facility did not follow up on the referring psychiatrist's recommendations to have her tested for BPD. They treated bipolar, depression, and anxiety, and the therapist ended up being manipulated. They essentially dropped the ball on investigating the BPD at all and by the time she was discharged, we realized that she had spent the last couple months having her most dangerous and unhealthy behaviors enabled because the treatment was focused on the wrong thing.

We were able to get the diagnosis for her before she went to a residential facility following her most recent attempt. While we were looking for treatment options following the last attempt, I found a facility called Newport Academy that markets itself as specializing in BPD among other disorders for teens. They have a ton of information published on their website about BPD, and in my Google search results, they were the top result for "BPD teen". I thought we had found a place that could help not just her, but help me, her step-dad, and her 16-year old brother (who has found her after each of her last 4 attempts) understand how to help her and keep ourselves okay in the process.

I've been trying to read as much as relevant and possible to understand what has been going on with her. Knowing about BPD has made her behavior make sense finally - or at least give me language to use to understand or identify the triangulation, deflection of blame, etc. I am just learning and only know the bits I've gathered from a couple books and from the psychiatrists we've spoken with - please forgive any ignorance and please share any resources or information that could be useful!

She's been with Newport Academy for about 3 months now. She was the first cohort at a new location they opened in Northern California (across the country from where we live in Florida). At every stage of admissions and considering Newport, I asked them about their experience with BPD. They consistently comforted me that they work with BPD teens all the time, have professionals who are experienced and qualified and know how to spot manipulation or triangulating. When I checked her in, the coordinator was a college student studying sociology. I expressed my concerns about residential and shared - as I had throughout the admissions process - the concern that we can not have another experience like the last residential where she isn't treated appropriately and is enabled, and ends up triangulating further with an un-equipped therapist as the rescuer and me and her family as the cause of all her pain. It puts us as her family in a nearly impossible position to try to set and reinforce safety and healthy boundaries with her.

I started to feel especially concerned after an early session with a family therapist assigned to us when she told me that she and the treatment team did not observe any BPD behaviors, and that what they saw was depression and sadness. When I asked if she had not seen or been working with the information from the two psychiatrists who referred her to them in the first place, she initially tried to avoid my question and downplay the value a psychiatrist outside of Newport could have. Her words to me were, "well we have a better sense of what's going on because we see them 24/7." When I countered that she has been seeing both psychiatrists for nearly two years, and the acute care psychiatrist had observed her following her attempts for weeks at a time of 24/7 with his treatment teams - she began to backpeddle.

I started trying to push for details about her treatment after that and get them to acknowledge and confirm that they were working with the appropriate diagnosis, but for a few weeks I kept getting deflection.

After an evening call with my daughter one evening, she told me she had been having heavy bleeding with her cycle. I suggested she let the care coordinator or nurse at the house know. She told me that "Newport hasn't sent a doctor here to treat anyone in weeks. There's literally a girl here with a broken arm/shoulder who has had her arm broken for two weeks, and they won't send a doctor or nurse to see her."

That immediately struck me as an exaggeration and her trying to get attention or a need met by creating a "bad guy" - and I realized that she was triangulating with Newport. I emailed the therapist with the situation, and reiterated that we need to make sure she's receiving appropriate treatment. I began to push harder for confirmation that their treatment team had gathered the appropriate background and information on my daughter to help her and help us, and push for confirmation that they had spoken with the two psychiatrists who referred her.

I heard from an MD psychiatrist about 1.5 months into her treatment, and he informed me he was also a forensic psychiatrist and would be able to tell if she was presenting symptoms or requesting medicine, etc., for ulterior motives or gain. I gave him the same background and context I'd provided through admissions, to the coordinator, and to the therapists so far.

I have been begging them for help on how to validate and speak with her without worsening the situation over seemingly small things - how to handle speaking with her when she is clearly lying or exaggerating - how to handle her when she melts down over something she takes as an extreme criticism but we intended as a simple check-in on something like the cat litter or dress code. I've told them we need help with the triangulation, total lack of trust, and especially with her brother who has been thrown under the bus repeatedly and told that he'll be to blame the next time she tries to kill herself if he tells us about her sneaking potato chips.

We're now a few days away from discharge for her. I've booked flights across the country, and we're trying to sort out getting her into school, counseling locally with a therapist who DOES work with BPD and back with her psychiatrist... We finished a family session on video conference a bit ago this afternoon, and it was a disaster. It's clear that the therapist has no experience with BPD and thinks she's treating a girl who is just depressed and very sad because of terrible family dynamics. The therapists was nearly in sync with my daughter as she rolled her eyes and at one point put her step dad on mute while he was talking. I am very worried the therapists and this last three months of treatment have not been focused on the right things.

Does anyone have any experience with a residential that made things worse - how did you recover afterword?

As a family that is new to BPD - what do we need to know and do to reduce the risk of meltdowns, triangulation, deflections of blame, suicidal attempts (or God-forbid, successful suicidal attempts)?

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

[PeaceMom]

Hi and welcome Faint,

I like your username. I feel your pain and frustration about your Daughter’s RTC not living up to their claims. My son needed specific Trauma therapy at his last RTC and they claimed to have trauma therapists trained and ready, but he never saw one in the several months he was there. My son has Bipolar. I’m so leery about these centers, as he was a part of a horrible patient brokering scheme in FLA. My son also needed DBT skills training and the facility told us they taught these skills, but it was actually passing out a worksheet to color once a week.

We also searched and searched for RTCs for DD19 uBpd but we could never find one with DBT Certified clinicians (except for Timberline Knolls in Chicago).

How do you feel that incorrect therapy may have hurt her? I’ve read that if we can’t get them to DBT, they should at least have CBT. Did they use CBT, but not DBT? From your post it sounds like Triangulation is a huge concern. pwBPD are so crafty with this. Have you read “Loving Someone with BPD” by Manning? She explains all this in layman’s terms. I’m fairly new here (a few months) and still reading thru all the excellent resources. You can search Triangulation and find articles and suggestions for avoiding it.

I’m sorry this is a wonky post. It’s been a rough week, but I wanted to welcome you here with us.
Peacemom

[livednlearned]

Hi Faint,

I'm not familiar with Newport, but I do know that the top listings in Google search results just means they know how to get their business to the top of the search results. I wasn't sure if that's what you meant about coming to the top of the search results?

The best expert on BPD teens that I know of is Blaise Aguirre who wrote the book BPD in Adolescence (he also has some talks recorded on youtube). The second edition has a list of RTCs that I'm assuming are considered reputable if they're in his book.

https://bpdfamily.com/book-reviews/borderline-personality-disorder-adolescents

You've probably already come across this resource but just in case you haven't, I wanted to share it.

If I remember correctly, there may also be a list of questions to ask a facility that claims to treat BPD?

[FaintTheGoat]

Thank you both, PeaceMom and LivedNLearned.

This has been such a hard journey. Lived - I hadn't found that resource yet, so thank you. I wish I had been smarter and more informed sooner. I feel to blame that she's in a spot now with counselors who I think are very used to treating addiction with teens, but aren't familiar with BPD and don't know how to work with her or with us, as a family very new to the diagnosis.

Peace, you asked how the wrong therapy could hurt. I don't know if the wrong therapy could necessarily hurt. She's been attending AA and NA meetings, and adventure therapy with surfing. But I've had to push for them to even acknowledge the diagnosis she came in with, and they have consistently been dodging my questions about if they're treating BPD. I'm worried because she's highly intelligent and extremely good at manipulating. Not that she's a bad person - but she will work people and situations in ways that aren't good for her and in ways that alienate her and her immediate family, teachers, friends, etc. What I've seen since we've had her first attempt is that she will emphasize scenarios where she seems like a victim or paint a picture of victimization, and downplay or deflect or distort situations where she may have had control or blame for something.

We've had her with therapists - before we knew about the BPD or had the diagnosis, where I've have seen her kind of take advantage of the therapy sessions in ways to either get out of something or get a privilege she wants. For example, she relayed to one therapist an incident where her brother had attacked her physically. Right before he relayed the incident, he started telling us that she had done really well and that she may be ready for an iPhone  (something she had been asking for and wanting to earn back). The therapist went on to say that he was very concerned about something and he started to relay the story of her brother punching her. When I heard it I was shocked - it was a true scenario, but my daughter had swapped the roles when telling it, and had left a critical part of the incident out: She had punched her brother when he told her she should probably stop sneaking potato chips. When he said he'd call us to tell us what was going on, she told him, "If you do that, you'll be responsible the next time I hurt myself." (And for context - her brother alerted us after her first attempt when she drank a bottle of Nyquil, found her turning blue on the floor with her throat constricting after her second attempt when she took all her Trazadone", and would soon be there to find her in the next two attempts.)

I found Newport because they do have a lot of literature positioning themselves as very experienced with BPD, but they're not - or at least not at the facility where she is. My knowledge of BPD is pretty limited at this stage - I've read "When Your Daughter Has BPD" which was eye-opening and hugely helpful for me, and am working through "Stop Walking on Eggshells" now. My hope with the current RTC was that we would get the education and support the whole family needs to help and support her (and keep ourselves okay and set boundaries on abusive behaviors). I started to notice in the first couple weeks through phone calls and ZOOM sessions that the therapists didn't seem to have answers to my questions, like how do I respond when she is clearly lying or saying something untrue?

I started to notice that the promises they had made during admissions didn't seem to be adding up, and whenever I asked about treatment or experience with BPD my questions were getting dodged.

We had heard about BPD as a possibility for her, but when she went to the last RTC after her third major meltdown. The psychiatrist at the acute care facility said that she needed to get a psych tests for BPD and sent the information along to the RTC with his referral. When we signed her in to that earlier RTC, they said they would get her the test, but somehow they completely dropped the ball and ended up trying to continue to treat depression. The counselor who worked with her wasn't experienced with BPD and ended up not able to see when she was exaggerating or distorting, and she left everyone in the immediate family out of sessions except me. When we picked her up after insurance ran out, we demanded to meet with the psychiatrist. After speaking with him, he said "this sounds like BPD - have you had her tested for BPD?" and I felt entirely exasperated. That was why she was with them!

Her third major meltdown was a suicidal threat/gesture in which she called the suicide hotline and said she was about to hang herself a few hours after we learned that she had been leaving school, had snuck a phone from someone at school and set up various secret social media accounts including snapchat and anonymous messaging apps to allow strangers to comment on pics, etc., and had been stealing my lingerie). When we found out about the phone and leaving school, she absolutely could not seem to admit to any of it even when the evidence was right in front of all of us. She tried to blame her brother, then a kid at school, then say that they weren't her social accounts, and a winding road of many other deflections or changed stories. It was like one lie or incident of rule-breaking was exposed, and she was so opposed to admitting it that she created a series of new ones or pushed them out on anyone she could. She told me that her prior suicide attempts were my fault and that she hates us, and that her step-dad is a narcissist. At one point she seemed completely melted down and out of control, and I told her we may need to go to the crisis center. She told me and her step-dad that we could take her there, but she would tell them we've been emotionally abusing her for the last two months. I was shocked, and when I looked over at him I noticed that he had turned pale and started slumping toward the ground. He wasn't able to get up on his own.

I thought he was having a heart attack, and my 16 year old son helped me get him down the stairs and into the car to the ER. My 15 year old BPD daughter called my cell 5 times and I refused to answer. I was so hurt and shocked and mad at how she had acted and what she had been lying to us about. After the hospital had checked in step-dad, son and I went back to the house to find my daughter on the stairwell with the phone. She handed it to me and said I'd want to speak with them. It was the Suicide Prevention hotline telling me she had a noose and was about to hang herself. I flew into action asking them and her if she was okay, where the noose was. She hadn't told them, and I had her eventually show me - she had a small 12" rope that had once been part of a laundry hamper. When she showed me I realized that this might have been a form of attention-seeking or a way to deflect from the lies and guilt or shame.

When she was in acute psychiatric care after this attempt, she called for a routine check-in call/chat one evening. It was toward the end of her stay and we had been trying to identify an RTC that would have availability and be accepted by insurance. We weren't sure yet on specific facilities or dates. Both her step-dad and I were on the phone, and it was a very typical, pleasant call until the very end, when she said, "Are you coming to pick me up? Brittany (a therapist) told me that if you don't get here to pick me up by 10 a.m. tomorrow you'll be arrested for child abandonment and neglect."

When I called to speak with the coordinator at acute care they were horrified, and said that a therapist would never say something like that and she may have overheard other kids talking. I recognize this now as triangulation. But I've seen it happen repeatedly while she's been in acute, including on therapists and staff at Newport, and they don't seem to recognize any of the basic behaviors they should be aware of. The result is that - if therapists aren't familiar with it - it seems to me that they tend to emphasize or focus solely on the presentation of symptoms/things like sadness and depression where my daughter seems to be a victim.

I know that there are emotional needs driving her strange behavior like the lying and deflecting blame and threats of self-harm, and I know we have a ways to go to be able to support her while keeping ourselves breathing and sane, too. I was really hoping the RTC would help us navigate how to help her while handling these tricky waters, but it just doesn't seem like that's happened. 

[PeaceMom]

My heart goes out to you and takes me right back to similar situations in our home.  Don’t be hard on yourself as you have followed professional advice and how are we lay people to know to question what the pros are telling us?

Your DD is young and in many ways you are ahead and time is on your side. Until recently, psychiatrists and psychologists wouldn’t even consider BPD until adulthood.

I spent hours w/therapists simply trying to make them understand what life w/DD looked like. When I finally read Lobel’s book, it was actually almost a cookie cutter case. Any well trained therapist should have picked up on it based on my detailed descriptions of her behavior.

We need to remember that many therapists claim to specialize in DBT, and may use bits and pieces. However, only the  ones certified thru Linehan program understand all the nuances and specific treatment that has evidenced based success w/ pwBPD.

In Texas there are 100s who advertise experience w/BPD and DBT, but only a handful who are certified.

Do you have a certified DBT therapist near you? The weekly group is an important piece where they think thru applying skills
In a group setting. Listening to other teenage girls share how they cope w/stress seems to be critical for this population.

My DD has to transfer from the big HS to our alternative school her junior year bc of drama, social dysfunction and some cognitive challenges. Will your DD start back to school soon?

I remember how I was filled with deep stress and a bit of hope every August wondering how the school year would unfold.
I’m sending you a big hug!