What comes first: neurofeedback vs residential treatment (and pandemic concerns)

[NorCalDad]

Backstory: My 24 year old son (still lives with my wife and I) was told of his BPD diagnosis 9 months ago. He's been struggling with mood disorders for the past 5 years (dropped out of college as a result) doing prescribed meds and monthly therapy off and on (all Kaiser would provide), but last October it got so bad he quit his job. He appeared ready to do whatever it took to get better. He went to IOP for depression, anxiety, marijuana abuse, and gambling addiction. It was during IOP with Kaiser that a psychiatrist told him he had BPD. Unfortunately, Kaiser offered little to treat it, and refused to refer him to outside help. So we then went the path of a private DBT therapist, which he seemed eager to do.

Well, 4 months later we find out he hasn't been doing the work, and not being forthcoming with his therapist about that, or being honest about the lack of progress with marijuana or gambling. Clearly he wasn't ready for DBT. Feels like we're back at square one.

We've been doing a lot of research on residential dual-diagnosis programs and neurofeedback as well, but we're having a problem trying to figure out which should come first. My first inclination was to get him in a residential program, then have him in neurotherapy in addition to the out-patient program run by the RTC. My concern is that with the pandemic situation, if he's released from the residential program, he won't be able to start transitioning to a "normal" life since we're all still locked down. So now I'm thinking neurofeedback for a few months first, then residential treatment might be more beneficial and we'd be closer to getting out of our collective self-quarantines. I'm not sure if neurofeedback will help curb his impulses for marijuana and gambling, and if those issues will stunt his progress with neurofeedback treatment.

The last consideration is insurance. I was told by the main RTC program we're looking at, Newport Institute, that insurance normally covers 30-60 days, and knowing Kaiser it would be 30 days if any at all. We might be able to cover up to a month with private pay, but what I really want to do is change insurance at the next open enrollment to one that allows us a better chance of getting a real "mental health team" to work with him. I just don't want to wait until January with new insurance to move forward. So I'm thinking neurofeedack treatments until January?

I've been reading this forum with a great deal of appreciation, learning a lot and feeling like we're not doing this alone. I figured it was about time I got involved, and hope some of you can share your own experiences to help us figure this out.

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 Norcaldad

Welcome  It's complicated isn't it, learning what's best, we don't know best until we do know. I'm in the UK, unfamiliar with US insurance options...

My inital thoughts are for you to engage and consult with a top BPD specialist. It may save you a lot of money and provide a pathway. As I learnt this is not a race, it's a marathon.

Well, 4 months later we find out he hasn't been doing the work, and not being forthcoming with his therapist about that, or being honest about the lack of progress with marijuana or gambling. Clearly he wasn't ready for DBT. Feels like we're back at square one.

. DBT is a process, and yes there are ups and downs, it is not linear result. My DD attended weekly DBT for 14 months, and gradually she worked through, and yes during this time she ended up in ER,  relapsed with alcohol and more. She got back up and fought to be well. Your son can too. Your son not being honest with the T? My DD's T told her she was the Queen of Avoidance, he validated her.

You are not alone.  I've been where you are, working it through. 

WDx

[Swimmy55]

Hi Norcaldad, Welcome
 My answer is yes.  What I mean by that is there is no one size fits all pathway to  help our BPD kids.   The good news though is your adult child wants help and  that is huge. I do agree with Wendy in that a good start would be to find a therapist that does specialize DBT  or even BPD  disorders .   Other options on how to find these would be to call your county or state mental health crisis team  they should be able to provide some sort of list.  In addition I have actually gone on Psychology Today.com and looked through therapists on there - they have their specialties listed  , you can search by state/ specialty .  I am not familiar with neurofeedback and BPD treatment , so I can't say whether or not it would work.  It does appear to be noninvasive, from what I read.  However the best treatment plan would be working with a psych you and your son can trust . 
Also, give yourselves and him time and patience, as this is a long journey.

[NorCalDad]

WDx, we definitely are in a marathon! Although it's been 9 months since learning of his diagnosis, we started this 5 years ago when he dropped out of college due to crippling anxiety and depression. Unknown to us, when he first saw a psychiatrist with Kaiser then, he was actually diagnosed with BPD, but was never told about it (I learned that after downloading his medical history). So for the first 4 years we were trying different psychiatrists and therapists (private and with Kaiser) but nothing made a dent. At least now we have a more firm grasp of the problem.

Swimmy55, we haven't yet gone to the county, that's on my radar to see what they may be able to assist with. We've been all over PsychologyToday.com since he was made aware of the diagnosis. There's a very limited number of practitioners in our area that specialize in BPD, and we've already gone through 3 of the clinics that offer DBT. One said he wasn't a good fit for their preferred clientele profile. He actually liked the 2nd one but she had to recuse herself from treating him after first accepting him during the initial intake for a reason she couldn't say (privacy issues?). So we landed on #3, but after 4 months he doesn't want to go back to her. I think she was probably too young and new to the field and he lost confidence in her. That's been an issue with him, once he loses confidence in someone he won't go back. That includes anyone associated with Kaiser 

I agree that his best bet right now is to find a psych that he trusts that will guide us through the long haul. I was actually trying to see if there was some type of "mental health navigator" that can assess his current situation and provide a road-map for the various avenues and opportunities available to him. With the overlapping federal, state, county, and city services (plus private options) it's pretty daunting to try and navigate it all. Especially with him being an adult, I'm limited in how far I can go (patient privacy and all), and getting him to take the initiative or a follow up is a crap-shoot. With this pandemic, you can't just show up at someone's office and talk to people first hand, and phone access is just a bear with government services. Ugh!

Thank you both for your help and encouragement  . I'll keep this thread updated as we continue our journey!