Daughter moved from long term inpatient to residential; wants to come home

[lafleur]

Hello all.  My daughter is 17 and diagnosed with BPD.  She has been self harming for ~2 years.  Lots of cutting, ingesting whatever is around, and self strangulation.  Almost all of 2021 she was in an inpatient facility.  Three separate stays.  The first stay when she asked to go to the hospital, which resulted in the inpatient hospital. The last two she asked to go there because she didn't feel safe by herself.  It's really only intended for short term, but while she was there she continued to self harm so her stay extended to 6 months.  To the point where she finally hated being there and wanted to come home.  She has improved, somewhat, and there haven't been any serious incidences in a about a month or more.  A residential school several states away agreed to take her in.  It's supposed to be the step in the right direction for her to return home.  I dropped her off yesterday.  She expressed to me she doesn't want to be there and just wants to go home.  I explained this is the on the right path to returning home and a place where she can continue to use the tools she has for coping.  But it was a no win conversation and she hung up mad at me.  But if I just bring her home I am afraid she will just go back to the self harming.  She's extremely sensitive to what people say.  And I have to work, so until she is able to monitor herself better, what am I supposed to do?  Sad days.

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

[PearlsBefore]

It's a tough position, because while the immediate gut feeling when a 30-year old says that is "I've seen this behavior for twenty years, I know it's not stopping even if you promise today you've turned over a new leaf" - it's a different scale for weighing a 17-year old; it's possible this HAS all just been a desperately insecure teenager acting out for attention and now she realises it's counter-productive and this will basically become her "goth phase" - something to which she never returns and a blip in her teenaged years. If this is just a "goth phase" of BPD-like actions, you don't want to be turning her down and telling her to just stay the course...

...basically, I don't have a good answer.

[lafleur]

Thanks PearlsBefore.  I considered the goth/teenage phase long ago.  Her cuts are too many, too deep, and she's been gone a long time.  She certainly has teenage tendencies.  She's totally immature with relationships and you cannot get on too deep of a level with her or she'll withdraw.  But I've seen her reason circles around me before and figured she'd be a lawyer.  At this stage, I believe her that she really wants to come home.  But we I ask her about any self harming incident, she appears honest to me that she was either triggered by another kid or whatever.  She wears a subtle shame about her actions and I've come around to understand that it is largely beyond her control at times. 

[kells76]

Hey lafleur, glad you reached out.

Your post reminded me of when I was 19 and in an IOP (eating disorder). I'd already done a stint in a PHP at 16 and then had done outpatient therapy at the same clinic that whole time. By 19 I was pretty stable, successful in college though living at home, had a part time job I really loved. My parents wanted me to do the IOP and due to our relationship I believed I had to. Likely I wasn't as stable as I thought, though it also wasn't to the level of self harm etc.

Anyway, either at the end of the first day or the first week, I remember calling my mom from my grandparents' house (where I was staying, as the IOP was out of town), and being SOO angry. "All we do is  crafts -- this is POINTLESS and I quit my job for THIS?" I hated it there, I missed my job, and it felt so meaningless and petty -- sitting around making collages 3 days a week. And, they'd promised me it was the kind of program where I could keep my job. I felt let down, betrayed, and furious.

I remember my mom just listening, and not trying to convince me of anything. I think I remember being surprised by that -- that she wasn't going to argue with me about why I needed to be there.

Looking back, I think I needed that space to vent all that anger and loss and, to my mom's credit, she gave me that (she was not always successful with being empathetic and available in the past).

She expressed to me she doesn't want to be there and just wants to go home.

lafleur, I wonder if next time you guys have a call, if you can tap into whatever emotion is behind your D's words. Loneliness? Frustration? Adjusting to a new place? Maybe she has some feelings that need room... I bet you would love to provide that to her.

I explained this is the on the right path to returning home and a place where she can continue to use the tools she has for coping.  But it was a no win conversation and she hung up mad at me.

With "normal" people, we can explain why something "has to be", and that helps. With emotionally sensitive people, it can come across as hurtful and invalidating, regardless of what we intended. While it's true that being there will help her return home and it's true she can practice her tools there, I'm wondering if she hung up angry because she felt unheard and unempathized with? It'd be interesting when you guys talk again, if she is able to deescalate and self soothe (i.e. not hang up mad) if she experiences you listening to her openly, without taking the "explanation" route. She may do better with less explanation.

And also, don't lose sight of the fact that she reached out to you -- she wanted you in her life at that moment. Really important.

Hope this is a helpful perspective...

kells76

[kells76]

I will add to my last comment:

Forgot to add that I stayed the whole 12 weeks at the IOP. Providing space to listen/hear the complaints doesn't mean that she gets to come home.

[lafleur]

Thanks, Kells76.  Very insightful on all of your points.  We've since had better conversations and I believe we have an understanding that I will advocate for her to come home as long as she remains committed to her progress.  We'll see what happens in the next coming days when we have our first treatment meeting with the staff. 

[kells76]

Glad you've had better conversations with your D!

Good idea checking in with the treatment team. Having a united front with them will help your D not play one side off of the other. It might also help everyone, and make things less "personal", if there's a checklist or specific metrics she needs to hit in order to graduate. Then, instead of it being "well the doctors just hate me, can't you tell them I'm doing awesome and can be done", you can say "hey let's all look at your contract together, ok it says that there need to be at least 3 occurrences of 4 or more consecutive days of no self harm. You got two done, that's good, once that third one is done, then you'll be closer to graduating".

Something really specific where it isn't "Mom you could just tell them you're taking me home and they couldn't stop us".

Interested to hear how it goes!

Also, is there a parent/family support group associated with her program? Could be a good resource.

Hang in there;

kells76