Is there ANY program that is genuinely therapeutic?

[Act UP]

My son, 17, has been diagnosed with Bipolar 2 and currently is stable via medication. He has been in individual therapy and we are going to start family work (again).

He has struggled since early childhood with low self esteem, depression, possible ODD, ADD, passive/aggressive, anger. As I understand it, he is bordering on a diagnosis of personality disorder. The PD is the scariest of all, since only by changing the way he views the world and his place in it can he be saved from this diagnosis and all the unhappiness it brings.  His thinking and way of looking at the world is truly skewed.

I understand that DBT (and CBT) has been extremely effective with adolescents like him. Does anyone know of a program that uses these therapies and not just behavioral modification to achieve compliance?

He is currently attending a dept of ed funded TBS, which in the past I have described as benignly negligent. I have my own guilt for accepting this placement but have done so because of the fear that a different placement might be “overkill”.  I am afraid that if we do not act now, he could lead a very difficult and lonely life.

It seems impossible to cut through the façade and lies if a program is intent on enrolling your child. If anyone has information that a genuine program exists I would really appreciate hearing about it.

I understand that one size does not fit all.
Thanks.

[nimdA]

edited due to excessive fail.

[nimdA]

My son, 17, has been diagnosed with Bipolar 2 and currently is stable via medication. He has been in individual therapy and we are going to start family work (again).

He has struggled since early childhood with low self esteem, depression, possible ODD, ADD, passive/aggressive, anger. As I understand it, he is bordering on a diagnosis of personality disorder. The PD is the scariest of all, since only by changing the way he views the world and his place in it can he be saved from this diagnosis and all the unhappiness it brings.  His thinking and way of looking at the world is truly skewed.

I understand that DBT (and CBT) has been extremely effective with adolescents like him. Does anyone know of a program that uses these therapies and not just behavioral modification to achieve compliance?

He is currently attending a dept of ed funded TBS, which in the past I have described as benignly negligent. I have my own guilt for accepting this placement but have done so because of the fear that a different placement might be “overkill”.  I am afraid that if we do not act now, he could lead a very difficult and lonely life.

It seems impossible to cut through the façade and lies if a program is intent on enrolling your child. If anyone has information that a genuine program exists I would really appreciate hearing about it.

I understand that one size does not fit all.
Thanks.

The more I think about your post the less I like my first response. Let me first say I'm no expert when it comes to programs, bipolar disorder, or most other things. I can claim I'm an expert internet troll, but that isn't the sort of advice you are looking for.

I know a few things about programs. I worked in two for about 4 years.

I do know what you are hoping for with your son is very noble, but it won't come to him in a program.

You want to avoid this:

I am afraid that if we do not act now, he could lead a very difficult and lonely life.

It isn't up to you to determine what sort of life your son lives. That decision is his alone and most likely will be years in the making through a process of trial and error.

Programs can protect a child, they can help a child, they can harm a child, and they even kill children. You can get all of the above at every single program of any sort. But what you can't get from a program is the opportunity to screw up and live with it. Programs are an artificial world that cuts a kid off from the cause and effect reality of society.

What artificially imposed consequence can even come close to the learning gained from natural consequences, which are incurred by each and everyone of us every single time we make a mistake? An artificial world can't prepare anyone for the real world, and I don't mean the MTV version of the real world either. It doesn't get you ready for holding a job, paying your bills, doing your laundry, or any other obvious thing you need to do to get by.

I'm happy that your son is stabilized. Unfortunately as soon as he comes home he will go into a tail spin. He has been stabilized in the artificial world of a TBS that doesn't adequately prepare him for reality.

Expect him to fail, because sadly it will happen.

You can help him though.

Bring him home and let him find his own way. Stop treating him like he is something out of the ordinary for having Bipolar disorder and all the rest of the alphabet soup syndromes. In the end he is a person not the disorder.

Don't start every day asking yourself what you have to do for him. Start everyday asking him what he is going to do today for himself and nod. Don't smother him with your opinion. Bottom line opinions are like assholes.. everyone has one. Let him figure out his own asshole.. its a painful process but it is a needed one.  Don't treat his failures in life as a problem, but learn to embrace them as a learning experience for him and you.

I guess in short I'm saying bring the kid home and let him grow up before you end up with a nonfunctional couch potato in your basement who is 25 years old and can't even hold a job at the nearest 7/11.

[hanzomon4]

The best advice I could give you is to take him home and stop putting him under the diagnosis microscope. Who dxed this kid and at what age? It could be that all of this treatment is only making the kid worse. It's hard to be normal when everyone treats you like a crazy person.

Start talking to your kid and listen to what he thinks should happen in his treatment. You shouldn't force the kid into any long term treatment without his consent, thats the beginning of the end of any protection he has against abuse because what he says no longer has weight. Abusers use this crack as a foot hold to become the person that controls parent/child communication  and thus become the parents only authority on what "really" is happening to the kid.

Short term emergence hospitalizations are different because their rare and are meant only as a short term option.

Last thing, you can't force a person with mental illness to "get better" and not do some harm to the person. Sometimes you have to understand that these things get better with gentle approaches and years of patience. To often Doctors and parents want to fix the mentally ill by resorting to brutal methods. You find that after years of this the person being helped is worse off.

I guess what I'm saying is is don't use long term residential placements, it's not worth the risk and proof of any real benefit is shady at best. Make sure your kid isn't getting needlessly pinned with Dx(diagnosis). Talk, listen, and ensure that what your child says has real power in determining what happens to him. That last bit did wonders for me and I avoided getting placed in abusive facilities or any of the bizarre treatment my egotistical and desperate doctor wanted to subject me to after his pills didn't fix me.

Good luck, I understand from the kid perspective that living with a kid with mental illness ain't easy.

[psy]

My son, 17, has been diagnosed with Bipolar 2 and currently is stable via medication. He has been in individual therapy and we are going to start family work (again).

He has struggled since early childhood with low self esteem, depression, possible ODD, ADD, passive/aggressive, anger. As I understand it, he is bordering on a diagnosis of personality disorder.

From what it sounds like to me, he is a somewhat normal teenager with the baggage normally associated.  Who stuck these labels on him?  Was it the same people who recommended the program, or was it the program itself?

The PD is the scariest of all, since only by changing the way he views the world and his place in it can he be saved from this diagnosis and all the unhappiness it brings.

That is a dangerous philosophy.  Trying to change the way a person views the world around him requires a lot of pressure, and it rarely works.  Generally, the more pressure you exert on a person, the more he will resist.  Teenagers grow up, and when they do, they attempt to break free.  This is a natural part of growing up.  In my opinion, the best thing you can do is let him be free.  The more you try and hold onto him, the more extreme his rebellion is going to have to be to counter your attempts a control.  It's a battle you will not win.  You may gain compliance in the short term, only to have him rebel even more when the pressure is released... and that isn't even to mention the resentment he may harbor for having his individual choice suppressed.

His thinking and way of looking at the world is truly skewed.

I understand that DBT (and CBT) has been extremely effective with adolescents like him. Does anyone know of a program that uses these therapies and not just behavioral modification to achieve compliance?

He is currently attending a dept of ed funded TBS, which in the past I have described as benignly negligent. I have my own guilt for accepting this placement but have done so because of the fear that a different placement might be “overkill”.  I am afraid that if we do not act now, he could lead a very difficult and lonely life.

It would be a huge mistake to let fear guide your decisions in this matter.  Programs rely on fear in their marketing.  They know that when parents are afraid for the lives/safety/wellbeing of their children they are often willing to make extreme choices.  Fear makes them more pliable... More willing to set back and "listen to the advice of the experts".  In any case, if your child does not want help, forcing it on him is not going to ever help (for a myriad of reasons too many to list here).

It seems impossible to cut through the façade and lies if a program is intent on enrolling your child.

Yes.  It is impossible.  

If anyone has information that a genuine program exists I would really appreciate hearing about it.

So why ask this?

My advice is not to trust anybody willing to refer to programs.  That includes parents who my be getting paid for referrals.  Programs will pay for covert advertisement, and there is no way to know, ultimately, whether or not a program is a good or bad one.  It's that simple.  It's like playing Russian roulette with 5 bullets in the gun.

[Act UP]

P.S. I hate the image you added which I guess was the goal.
I AM REACHING OUT..... but you are not hearing me, telling me to throw every single thing out. How about when they say the same things and are at home.... after taking a bottle full of pills, or cut their wrists? I GET IT AND I AM NOT GIVING UP YET.
Funny Psy told me to come here and now I am told to go back there. Thanx.

----------------------------------------------------------------------------

I want to address some points you made and also clarify a few of my own.
You are right in advising against projecting my fears for my child’s future happiness because of an unspoken DX. It is not my place, it is unfair and can be detrimental to him and our relationship. Who am I to judge his future? But that is my fear, and I was being honest about it.

“what you can't get from a program is the opportunity to screw up and live with it.”

This is true but as we also know this is true w/o a program. My child made 2-3 suicide attempts and IF he had succeeded I could never have lived with it.

“Programs are an artificial world that cuts a kid off from the cause and effect reality of society.”

Maybe. My child lives in society as you and I do but he does not get it! He is above the rules that we abide by, even those of us to pride ourselves in our Acting UP! But he does not see the cause and effect of HIS actions. He interprets effects as external causes.

To have unbiased information on who are running these programs, what their motivations are and what the documented results are would be invaluable. It is very difficult (if not impossible) for me to trust anyone with my child, for fear that they might have little or no good motives.
In an ideal world, wouldn't a genuinely therapeutic program be able to create an environment where the client could benefit, that they could see themselves and their role in that microcosm of society, their causes and the effects would be tangible and indisputable.

I know that I and many other parents are grasping for straws in the dark… WE GET IT! But doing nothing is also putting their lives at risk this is why I am here. When he is ready to do for himself that will be a wonderful day. I am only trying to offer him the best opportunity and it is up to him to take it or not. Sort of leading the horse to water.

“What artificially imposed consequence can even come close to the learning gained from natural consequences, which are incurred by each and everyone of us every single time we make a mistake?”

He feels there are no consequences… within the home, or even within the school's society. He weighs the effort it would take to just try, just to make an effort and he just does not want to make that effort.
He has no interest in being part of the family, interacting with anyone, shows no basic respect for those he lives with at home. He has very few friends (maybe 2) and spends too many hours isolated.  I want to shake him and say wake up.... but I know I can not, anymore. That’s why I thought maybe a professional could help him make things "click"
 

“He has been stabilized in the artificial world of a TBS that doesn't adequately prepare him for reality.”

He comes home each week from Friday to Sunday, at a minimum. This can be and often is a comfort for all of us. While he is at school we talk whenever he wants (cell phones are allowed.) When he feels he needs more time away from school he comes home early to where we have no means to keep him engaged. I understand it needs to come from him. We are trying to just keep some level of contact with the “outside” world in his life until he is ready to do it himself.  

The school has an opportunity to provide a meaningful therapeutic environment for him, to hold him accountable (as I have not been able to do) for his actions. They could be taking even just “baby steps” to help him learn some basic coping strategies, take ownership of himself, his actions, his relationships… and hopefully his dreams and goals… but they don’t.

“Bring him home and let him find his own way. Stop treating him like he is something out of the ordinary for having Bipolar disorder and all the rest of the alphabet soup syndromes. In the end he is a person not the disorder.”

You are right. It is not the dx of Bipolar that is the problem. It is his refusal to live in the world with others with at least a minimum of respect and accountability. It hurts us to see his lack of effort, hope, goals. He acknowledges he is lonely and wants friends but avoids making any friends because “friendships hurt too much”.

[nimdA]

I think you need to focus a bit more on the right now and the future rather than the past.

I never said much about sending your son to a program.

Everything my post said was for one purpose:

What I think you should do now.

Not what you did.

You came asking for advice and I gave you some. The right or wrong of you sending your boy to a program isn't for me to judge. I'm not in your position and I have no actual knowledge of the situation. I can tell you that from my experience keeping him in the program is a disservice to him.

That is in fact if it is even a program.

You said he comes home every weekend. Most programs don't have anything like this. This home visitation gives him access to telephones, computers, and all sorts of ways of reporting abuse. Seems like a pretty transparent place to me from what you are talking about.

He also seems to get some sort of actual therapy at the place that includes family therapy.

Most programs don't have any of that sort of thing either.

Unless you give me some sort of idea about the place I really can't continue the conversation in a more useful format.

My advice now?

Bring him home as soon as you can.

also..

What is the name of this place? Doesn't sound like any sort of facility I've heard about for quite sometime.

[otherside]

Yes, there are programs that are genuinely therapeutic, although perhaps not fitting what your son needs.

Unlike many (most??) here, I do think many "programs" do a lot of good for a lot of teens.  That said, I don't think that is what your son should have now.  The right therapist, using an effective approach (be that DBT, CBT or maybe XYZ). and involving the family, is important, and it appears that is roughly what you  are trying.  If something more intensive is in order, and his current therapist should have some good sense of that in fairly short order, if not already, something residential may be right.  

Given your comments and apparent prospects for DBT, you might talk with: McLean Hospital's Acute Residential and Partial Hospitalization program for adolescents (Belmont. MA); and Brattleboro Retreat (Retreat Healthcare), Brattleboro, VT.

You might also consider an Outward Bound program to build self-esteem after any residential treatment, if the treating doctors think it appropriate/worthwhile.  On some of their programs, I believe parents and/or families are welcomed.

[nimdA]

I'd be cautious with DBT or CBT given the behavioralist roots of the therapy. The articles I've read do indicate that the treatment has been successful in reducing suicidal behaviors in its patients for borderline personality disorder. Though the articles seemed to indicate the application of CBT/DBT in an outpatient setting rather than in the environment of a program.

For otherside:
 
What experience do you base your opinion that programs have the potential for good for teens? Both psy and I are first hand witnesses as to evil of programs.

[*]

I disagree with the advise from "otherside" regarding Outward Bound.  

http://wwf.fornits.com/viewtopic.php?t= ... ward+bound

As far as the other residential treatment centers go, its a crapshoot.  By your description of the school he is in, how were they negligent?  Can you bring him home and seek outside sources from there?  I think having your child away from you is not going to make him bond with the family.  Instead of spending money on what is marketed as a "fixim' up program." Spend those resources on local medical professionals.  Even if you need extra help in your home to work with him one on one.  

Check out this link, you might be able to find information to help you seek appropriate care for your son.  Please stay away from any type of "program." (TBS, Wilderness Therapy &/or Bootcamps) Your direct hands on involvement in his treatment is what will help him through hard times with his illness.

[HLA Truth]

I understand your need to feel like you have tried everything, especially with him getting closer to 18.  It is scary.  It sounds like you have done a lot to help him already and it is probably irresponsible for those on this site, myself included, to tell you what to do having never met your son.  Speaking in general terms I will say that programs can do a lot of good, but my experience has been that the further a child gets from the 14/15 year old range, the less effective programs become for a child.  Again, this is a generalization.  My advice would be to talk with your therapist (maybe a few therapists) about whether or not your child needs a program.  It may be that a program is the right choice for your child, but it could also be that you have done everything that is likely to help and you have come to the point that you have to let go and let him make his own decisions.  Again, get advice from your local therapist before taking advice from anyone on this board, including myself.

You can feel free to pm me with any specific questions you have.

[Act UP]

Waygookin – The school is transparent. Which is why we accepted the lack of therapeutic services for our child, for the community there, and for all the families. What is not transparent about the school is if you do not know the right questions to ask you will not get the information.

We compromised on this placement because he can come home, has his telephone and his calls are unmonitored – allowing us to feel confident that he is not being “mistreated”, just undertreated. (I guess better to have guilt over that than something much worse.)

I doubt this place qualifies as a “program” in the sense it is used on this board. It is a boarding school for emotionally fragile teens and funded through our state’s dept of education. Our initial hope in his attending there was that he would be safe during the days when we could not be with him and that he would be able to attend a school that is suppose to understand his emotional and intellectual needs and work with him. Because of the ADD/LD issues he has low self esteem (traumatized in elementary school with some teachers from hell) inspite of above average IQ (very common). He suffers from the “learned helplessness” syndrome and here we hoped they would be more hands on in the classroom, some teachers are some aren’t. You have heard of this facility – it is in numerous threads – but being of the paranoid type, I am not comfortable in saying…. I’ll think about it.

The little I know aout DBT I like, that it can help (not force) the person to see that at times their thinking is faulty and this faulty thinking is what hurts them, gets them into dangerous situations and/or isolates them. That at the same time in having the goal of changing their faulty thinking they also accept themselves for who they are and where they are at.

My dream of the ideal setting – the "client" and their entourage (family and significant others) are essential to the program - each doing their work individually and collectively – without distractions of TV, jobs, telephones… working together. Having the luxury of sleeping in a bed, eating decent food and not hiking 5 miles a day in 90-degree weather. Sounds like a great vacation we just need to bring our own therapist along.  
 
Otherside – His therapist, the school social worker, and his psychiatrist all agree that an outdoor program would be great for him – but none have any first hand info. I was really frustrated by the fact that the s.w. could not recommend something. She game me the name of “The Camp Lady” DUH! The therapist recommended Family Foundation and that made my jaw drop, at the very least I know that he does not know!

I know of McLean and is a great facility. I know first hand people who have been there and it has been very helpful in their lives. Thankfully he does not need acute care. I have spoken with my son about an outward-bound type of program that just has a “vacation” focus not with an emphasis on “difficult” teens – this he is considering, WOW!

Nilla – the school is “benignly negligent” - they do not want to go beyond their comfort zone of blahzay. One example of mediocre is they lead us to believe that the kids come home every other weekend, but in fact 90% come home every weekend, they have minimal staff coverage and no activities, no access to the computer lab, no access to the library, no nothing, even the kitchen is on a modified schedule. It is total boredom for the students. They are not open to any change of enrichment or even suggestions. They have no use for the parents or guardians of their students either. In their opinion we are the cause of our children's problems. Their views on MI is archaic. They do not follow any evidence based practices and do not see the importance of collaborative effort.  They are unwilling to challenge themselves so how can they challenge our children in any meaningful way to foster growth and ownership?

My son is (just) getting by there – my issues are that while he is willing to be there I beg them to make the most of it therapeutically/emotionally for him and us. As for coming home and staying - he is better there because at least he attends school, he interacts with other students, and he likes most of his residence staff. This is good. It also gives him a break from his mother.... me - this is good too.

So not to throw the baby out with the bath water it works on some level but has the potential to be so much more….

[nimdA]

Wilderness programs are a very poor place to deal with Bipolar Disorder.

More later when I've sobered up some.

I still think you need to specify exactly what school, facility, or whatever it is your son is at.

[nimdA]

I understand your need to feel like you have tried everything, especially with him getting closer to 18.  It is scary.  It sounds like you have done a lot to help him already and it is probably irresponsible for those on this site, myself included, to tell you what to do having never met your son.  Speaking in general terms I will say that programs can do a lot of good, but my experience has been that the further a child gets from the 14/15 year old range, the less effective programs become for a child.  Again, this is a generalization.  My advice would be to talk with your therapist (maybe a few therapists) about whether or not your child needs a program.  It may be that a program is the right choice for your child, but it could also be that you have done everything that is likely to help and you have come to the point that you have to let go and let him make his own decisions.  Again, get advice from your local therapist before taking advice from anyone on this board, including myself.

You can feel free to pm me with any specific questions you have.

You still work at HLA don't you?

[nimdA]

Nilla – the school is “benignly negligent” - they do not want to go beyond their comfort zone of blahzay. One example of mediocre is they lead us to believe that the kids come home every other weekend, but in fact 90% come home every weekend, they have minimal staff coverage and no activities, no access to the computer lab, no access to the library, no nothing, even the kitchen is on a modified schedule. It is total boredom for the students. They are not open to any change of enrichment or even suggestions. They have no use for the parents or guardians of their students either. In their opinion we are the cause of our children's problems. Their views on MI is archaic. They do not follow any evidence based practices and do not see the importance of collaborative effort. They are unwilling to challenge themselves so how can they challenge our children in any meaningful way to foster growth and ownership?

This alone tells me everything I need to know. This place has very little interest in working on the social and family dynamics of the problem. It doesn't really matter what sort of therapy the kid gets while at the place.

Sadly this sort of mentality and practices show up in the entire industry than they don't.

My advice now is for you to pull your son out of that place immediately.