A month in the hospital and no sign of improvement

Discussion in 'General Parenting' started by WNC Gal, Jul 14, 2007.

  1. WNC Gal

    WNC Gal New Member

    We, as parents, are very concerned. Our daughter has been in and out of phospitals ten times in the past year and now is at a psychiatric residential treatment facility with a 180 day (6 month) stay. We had hoped this would be key to helping her get better and putting a halt to her endless cycle of suicidal impulses, gestures, self-injury, and pretending to be better, and then worse. This program came very highly recommended and sounds very good - they utilize positive peer culture so that the kids are held accountable to each other for improvements in attitude and behavior. BUT, she has spent the first 1/6th of her time there not doing much.

    They do have consequences for not participating, following rules, etc. But she is very smart and has figured out how to "fly below the radar". If something isn't important to her, she simply doesn't do it. She has been refusing school, groups and other therapies. She has been testing to see what would happen if she displayed different symptoms such as hallucinations, self-injury, etc. And now, that she is on the verge of earning off-campus privileges with the other patients, we fear she may be an elopement risk.

    Has anyone else been in this situation where you fear that your child will make it all the way through an intense program and come out no better than when they went in??

    She acts (at times) like a model kid and eagerly speaks to us by phone whenever we call. But when it comes time for family therapy sessions, either in person or via conference call, she either shuts down or is angry and manipulative.

    We are contemplating suggesting no family contact outside of therapy sessions to try to encourage her to participate fully. We also send her lots of encouraging letters and sometimes care packages. Perhaps we should withhold those too, or have the staff only give them to her IF she participates in the family sessions.

    Her volatility is hard to handle... on one day she claims to be completely suicidal - and will kill herself if she has the chance. Then the next day, she is just "fine"! and demanding to be treated like a VIP because her dad is so and so and she really doesn't belong there.

    I guess we need to let time take its course and trust that this secure placement will really keep her safe and teach her new coping skills.

    But we really want our loving, smart, and personable girl back - after months in phospitals with lots of highly dysfunctional and criminal kids, will she ever go back to "normal"??????
     
  2. meowbunny

    meowbunny New Member

    I think some kids do manage to get by without ever working a program, especially if they are savvy as to how to get around it and the staff. However, it does not sound like your daughter is getting around it. She is acting out, refusing to do what she doesn't like, threatening suicide, etc.

    Talk to the staff and her therapist and see what they think and what suggestions they have. I don't think I'd take away family contact, but I would definitely insist on no off-campus privileges until you felt she was no longer at risk to run.

    My daughter spent 12 months in a residential treatment facility. For the first 6 months, I was asked repeatedly why she was there because she was being so sweet and adorable and compliant. The next 3 months, the questions stopped and the honeymoon was over. The last 3 months was when she actually worked the program. It was also during the last 3 months that she ran away twice. The first time, she got about 3 miles in 3 hours. The second, she managed to get through 5 states in 12 days. There was a difference when she got home. I can't say the program was entirely successful but it wasn't a total failure, either.
     
  3. Steely

    Steely Active Member

    I have no experience with my own in Residential Treatment Center (RTC) - so I will let others answer the questions of getting better vs not. I do, however, have my own experience when I was 16 in a horrible, 1950's throwback of a mental hospital. This is, of course, not the norm nowadays, but back then it was the proper protocol to not let the teen see or talk to their parents for the duration of their stay. I was lucky to only be there only 6 months, but most were there for years. In my 6 months I had no contact, except for letters, from my parents or family. I know this lack of contact scarred me deeply. To this day, it evokes tears when I think about how much I wanted my mom to hug me, or my sister to be with me even for a minute.

    in my opinion, I would not suggest, under any circumstance, limiting you child's contact with you as a motivation. I would send as many care packages, letters, and phone calls as you can - because at 16 teens are actually still really little inside. They need their parents, despite their crazy antics. Please know this is only my opinion based on my own biased experiences. I would ask the doctors what their opinion is. But I just wanted you to know from a 16 year olds perspective how important parental contact is - even if they are being manipulative, suicidal, etc.

    On another note - has she made any progress revealing the abuse she wanted to tell you about? Or has that kinda dropped out of her radar screen. Do the doctors think she is still fabricating all of this? I really feel for you, as well as her......I can only imagine how hard this must be on all of you. You guys are in my thoughts.
     
  4. slsh

    slsh member since 1999

    I think it really depends more on the kid than the program (assuming it's a therapeutically sound, consistent program). Some kids are just really tough, and I've also come to believe, at least for my son, that timing and maturity had a *lot* to do with it.

    I do think that if she is not participating in group or school, off grounds privileges should be held. Will staff work with- you on that?

    I understand the family therapy issues. We spent years of thank you kind of sliding on the unit, with intermittent explosions, sliding in school, and then family sessions that were just horrible. Blame, deflection, diversion, smoke screens on his part, frustration on ours, and a bit on the traumatic side for the siblings. And this was after years in therapy before his first Residential Treatment Center (RTC).

    Have to ask.... does she know that it's only a 6-month program and that she will be discharged regardless at the end of that time? My beloved son, who is the king of manipulation, actually had the nerve to say "See, Mom - I knew I'd get out of here without having to work the program" when we pulled him from Residential Treatment Center (RTC) #2 (due to abuse issues). I think he only figured out we were not fooling around after he'd spent a solid year in Residential Treatment Center (RTC) #3.

    I still subscribe to thank you's therapist's theory that kids won't change until it becomes too expensive to stay the way they are. Unfortunately, thank you has a whopping tolerance for an incredibly limited quality of life. It's only been in the past year that it's finally clicked for him, thankfully - and he's been making progress by leaps and bounds since. (See last paragraph.)

    We were in much the same situation in 2002. thank you had been in Residential Treatment Center (RTC) for 2 years and just wasn't doing a doggone thing treatment-wise. We did a "no-contact" program, after much soul searching and a lot of discussions with- staff. It was kind of a last ditch effort, really. I still don't know how I feel about it. Don't regret it, but it certainly didn't have the desired effect with- thank you. He spiraled into a *massive* depression when it first started, and after about 2 weeks he recovered and went on, same as before. After over 6 months, we had a staffing and the general consensus was that he was as good as he was going to get until possibly puberty/maturity kicked in. We brought him home about 8 months after that. He lasted 3 months before completely falling apart again (violence, suicidal threats and a solid plan, etc.)

    Sigh, I don't know. I think treatment depends so much on the kid. Some of our kids don't mind getting boxed in by their choices, and it's a real bear trying to work with that. I think the contact issue needs to be separate from the rest of the perqs, but absolutely I would (and have for my son) work with staff to make sure that she's being held absolutely accountable for her choices. No way can she be close to off-grounds privileges if she's not participating.

    I say the contact issue is separate because, in my humble opinion, you don't want it to be a punitive measure. Family isn't a privilege, it *is* a right. When we instituted it, we presented it as "thank you, you've been here 2 years, you're no closer to coming home than you were the day you arrived, you're not working on your issues, and we feel that family is a distraction (again, family sessions inevitably ended up being all about how it was all our fault, or him exploding when we tried to hold him accountable, or just plain silliness/distracton that was a waste of time). We are going to step back and let the professionals do their job, let *you* do what you need to be doing, so that we can be a family in one home again. Staff will let us know when they feel we won't be a distraction anymore."

    I feel for you. It's incredibly frustrating dealing with- kids who are such chameleons and at the same time who really are not internalizing a doggone thing. While I'm cautiously optimistic about my son truly having made a change, I'm not 100% sure. Time will tell. But it's been a very long road, a lot of waiting him out, and I think in the end it was simply him deciding that he didn't belong in Residential Treatment Center (RTC) anymore and being willing to prove it consistently over a fairly long period of time.

    I don't mean to be discouraging. I think absolutely one of the keys to thank you finally getting it was consistency on staff's part, on our part, and him being held accountable 24/7 every single solitary day. There can be no free passes, in my humble opinion.

    Edited to add: I wanted to clarify on this because for a kiddo with- a mental illness, it's about so much more than applying pressure to change behavior. There's no question that thank you's disorted reasoning played a huge role in his capacity for what would be for most people a really miserable existence. In his skewed thinking, it makes much more sense to exert incredibly amounts of energy to avoid getting anywhere near the hoop than it does to simply jump through it. That's part of his illness. So it's a combination, in my humble opinion, of holding them accountable, having consistent consequences, as well as a lot of incredibly repetitive therapy and an artist psychiatrist for medication management. Our kids are not like pcs - ground a easy child for lying (as a simplistic example) a couple of times and they're going to get it. Ground a difficult child, in my experience anyway, and the degree of lying escalates because they just *know* one of these days they'll get away with- it and there's the payoff. It's worth the grounding. Hope that makes sense.
     
  5. On_Call

    On_Call New Member

    We have not had to go the Residential Treatment Center (RTC) route yet, although it is an option and has been discussed by our team.

    I will say, though, that through difficult child's inpatient psychiatric hospital stays over the years there has always been a honeymoon period. The first time he was hospitalized, the therapist in charge discharged him after only 36 hours - insisting he go - and looking at me as if I needed some evaluation of some sorts. Since your difficult child has been there only a month, perhaps her settling in period is almost up and she will be unable to cope and 'fly under the radar' for much longer? She still has '5/6' of her stay to go.

    I know that feeling of wanting them to act up and show their true colors so that the staff can witness it and maybe some real work can be started on difficult child. We have been in that same boat.

    I, too, would ask staff if you have any say over the off-campus privileges.

    We have taken different routes of support during difficult child's stays inpatient. The first few times, he was so young - 7 - that I was heartbroken. We brought coloring books and comic books and treats each time we visited - and mailed cards every other day. As he has gotten older, we have modified our actions in this situation, though.

    The last time few hospitalizations, he seemed to settle in to the institution a little too much for my liking - and expressed verbally his expectation of treats, etc. We still visited - one of us was there almost daily - and if the staff said his behavior merited it, we took a fun dinner in on Saturdays, but other than that, we brought him some of his books and CDs, etc. and bought a board game for the ward - but not much else.

    Our difficult child eerily seemed to feel rewarded by his psychiatric hospital stay - and by the attention and 'treats' he was receiving, so we curtailed it. husband and I would bring a card or dice game when we visited, but not toys, etc.

    I think you have to individualize it for your child. I am sending hopes that the rest of this stay brings signs of improvement for you and for difficult child. Sending you {{{hugs}}} and postive thoughts. :angel:
     
  6. TerryJ2

    TerryJ2 Well-Known Member

    I have no experience here but wanted to lend my support.
     
  7. jbrain

    jbrain Member

    I think one month is too soon to see progress. My dtr was in an Residential Treatment Center (RTC) for 8 1/2 months--she didn't start working with the program til she had been there about 3 months. This was after she did everything she could think of to get them to send her home. She was in a lockdown facility in Utah so she finally got the message that she couldn't come home til she worked. She became one of their model kids but I don't think she really internalized it at the time--she did fine as long as she was in the Residential Treatment Center (RTC) but couldn't maintain when she got out. Hers was also a positive peer culture facility and I think that was good--those other kids all had each other's numbers so they couldn't pull anything on each other.

    We spent a fortune on this place and she relapsed when she came home and ended up in another facility by court order. It was full of tough kids (versus the middle class kids at the one in Utah) but I think that was what she needed at the time.

    She is now 19 and on her own and functioning quite well as far as I know. I don't know how much can be attributed to her Residential Treatment Center (RTC) experiences or if she would be doing okay anyway. I sure hope she learned something--she can talk like a therapist so she does know the lingo and she is great at analyzing other people.

    Someone else asked if your difficult child knows this is a 6 month program and she will be released regardless of what happens. I know the staff at my dtr's first Residential Treatment Center (RTC) were very adamant about the kids knowing there was no time limit, they would be there as long as needed. I'm sure if my dtr had been given info on a release time she would have just faked her way through. I have asked her if indeed she did fake it but she says no, she really did work, she just couldn't do it once she left.

    Take care,
    Jane
     
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