I'm so mentally exhausted about the

[klmno]

therapist situation. I, at leaast, have identified the problem in my own mind but can't find words to articulate it well and briefly yet. I understand that maybe I just have a misconception, but I have a strong vision in my mind about what should be transipiring regarding psychotherapy so I don't really see why a therapist can't discuss that and tell me whether or not they can do it. My vision comes from the research I've done, primarily through the CABF website/materials and The Explosive Child techniques as an add-on. The big issue with me is that this information really hits home and when I approach these things with difficult child from this stanpoint, it is extremely effective. When I get school members to do the least little things from this standpoint, it is also very effective. So, I have faith in these recommendations being the right course of action for difficult child.

The problem- other than tdocs who put words in my mouth rather than just asking me how I feel and other than them having no clue what it is like to witness your child raging or being manic or suicidal, is that I haven't found ONE SINGLE therapist who has even been aware of CABF, much less their website, or their recommendations and they seem to be clueless about it all. Now, I ask you, if a dr told you your child had diabetes or asthma, wouldn't it be expected that they would mention the foundations for these illnesses and that they would mention that the recommendations listed with these agencies would be the well-known approaches to treatment? If they didn't mention the agencies, shouldn't you be able to expect that the dr's recommendations would be somewhat consistent with what is listed in the agencies' materials? I understand that child & adolescent bipolar hasn't been diagnosis'd for so long, on top of the issue about mental health not being an exact science. However, if you were a therapist stating to people that you could give therapy for this, am I expecting too much that the therapist would at least do a google search on the recommended treatment?

I think it was Marg (I can't say for sure) giving a suggestion to a therapist issue thread in the WC who said it is an opportunity to educate the therapist. Yes, that's true, especially when therapist is an intern. And, I think I already educated him about why every issue should not be discussed openly between parent, child, and therapist when mood disorders are involved. At least he remembered that yesterday when the subject came up again- he said, so , that situation can open up a can of worms then you go home with a PO'd kid. Yep, well, look at this way, this might be a kid who is not in a rational state of mind and this might have opened up a can of worms, driven a wedge between parent and child so they go home, kid is a bakestcase, parent hasn't learned strategies to deal with it, parent has less communication with child because wedge has been driven between them, and needless to say, situation escalates to a worse level and parent isn't any happier than child is at that point. So, what should have been dealt with through therapuetic strategies has now turned into an acute situation. Got it?

I showed him the printouts from CABF website- at first he acted like he didn't need to see them, then after his comment about things he said to a group of girls in Residential Treatment Center (RTC) (nothing sexual) to "get them on track" I realized that his technique would NEVER have worked with me, much less difficult child. So, I pulled out the page on recommended treatment and pointed to it and said "can you do this- where do I go to get this"? He looked and wrote some things down in his notes. This of course, tells me he has never seen it before. I don't know if he wrote the treatment suggestions down or the CABF website that was listed at the bottom of the page. All I know is that then he started saying that he couldn't guarantee that his help would prevent difficult child from ever becoming manic again (did I asked for that?) and that he understood that no one would ever be the expert on my child like I am. (What did that have to do with anything?)

SIGH..... sorry- do you think there is a way to contact somebody from the CABF website and find out if there is a single therapist in this area that even looks at their material? He also said that ig difficult child became manic, I could call and talk to him. I told him I appreciated that but I already had a forum with several shoulders to cry on. I thought we needed to learn pro-active strategies to prevent what we could and learn how to de-escalate or otherwise manage things the times when mania happened anyway.

 

[gcvmom]

Klmno,

It sounds like this therapist doesn't have much experience dealing with BiPolar (BP) kids. Are there any other people in your area you could go to? What about a teaching hospital? A children's hospital? I hate arrogant people who think they can't learn anything new.

 

[klmno]

Well, this guy is an intern at a teaching hospital. We've already tried 3 others in the past year- not to mention the ones tried before that. They ALL say they have experience with mood disorders, but once they find out that difficult child has been in trouble legally, they have the "I'm dealing with an ODD kid" attitude. What makes it so bad, is that I'm looking for someone who can help me stay level-headed when difficult child isn't stable and give me reminders not to criticize or blame him for it but to stick to constructive methods of de-escalation. They cannot do that if they don't understand that it isn't in the kid's control- it isn't in his control that he has this problem, but he can learn strategies himself. Example- he said something about telling kids to act their age and quit acting like a baby so he could help them. Well, when I was seeing a therapist for myself, that would have just put me on the defensive. If difficult child is manic and climbing around on the roof or trying to jump out of a car, this isn't going to help calm him down- this could drive him over the edge. He said several things that I knew wouldn't work well with us. But then, they all have. Really, I think they mis-represent themselves and we, as parents, tend to take it for face value when they say they experience dealing with certain issues. But so far, I see NO evidence that they really have experience dealing with mood cycling.

The best- albeit probably impossible- would be to find a therapist with the educational knowledge who had first hand experience (having a child with a mood disorder or working in a psychiatric hospital, etc) with kids who had this kind of issue. One of my triggers is for peopl to try to bash me out of having anxiety or feeling stress- I cannot ever accept that for difficult child- it is a STUPID approach.

 

[gcvmom]

What about contacting CABF (Child & Adolescent Bipolar Foundation) and asking about a workshop for parents? I know they have them in my area. They are designed to give parents some concrete tools for dealing with their difficult child's.

 

[susiestar]

I think you are asking for reasonable things, but I am just another parent. I think that any "professional" who tells a teen or pre-teen to "quit acting like a baby" needs to go back to school because they have NO CLUE. It wouldn't work for my kids (hasn't owrked - one therapist tried it adn was a total failure as he lost SO much credibility). I think that you need to contact the CABF people and ask about recommendations. And you need to keep trying, because it is pretty clear this guy is very arrogant and won't work well for you and difficult child.

Hugs.

 

[klmno]

I didn't know about that- but I will certainly look into it. difficult child is court ordered to see a counselor- I had to tesify in Jan to get the judge to remove a certain type of therapy, any particualr therapist's name, etc, so she re-wrote the order basicly leaving therapy/counseling up to me (thank God) but he does have to attend some sort of counseling until it is no longer recommended by psychiatrist or therapist for him. She (the judge) just has no idea what a waste of time and money this has been. We've gone to one who acted like he had all the answers, then 4 mos later is still asking what difficult child's diagnosis is and what we're there for.

 

[susiestar]

I don't know if they have a list of tdocs or other professionals, just thought it might not hurt to ask. Do you have the book The Bipolar Child? I seem to remember some resources listed in it that were quite helpful, but it has been several years.

I hope that you can find a therapist with (at the very least) some common sense. This seems like more of a battle than it should be. OR at least it does to me.

 

[klmno]

I just pulled the following from an article on CABF website- it was listed as available for copy and public use. Anyway- does anyone have any idea how I can find the article or book on therapy do's and don'Tourette's Syndrome that it refers to? I did a search and couldn't gain access to anything.

It is important for the therapist to have a good working
knowledge of Borderline (BPD) and other child psychiatric disorders.
Otherwise, it is very easy to fall into therapeutic
traps (e.g., being disappointed when a finely constructed
behavioral plan backfires when the child becomes manic
[Mackinaw-Koons and Fristad, 2004]). Therapy do’s
and don’Tourette's Syndrome are outlined elsewhere (Fristad and Arnold,
2004; Fristad and Goldberg-Arnold, 2002). In addition
to being ineffectual, therapy that ‘‘goes nowhere’’ uses
up time, money, and hope. Conversely, when a therapeutic
alliance is formed and the therapist is knowledgeable
about childhood Borderline (BPD), families can experience
tremendous support. Borderline (BPD) tends to be a chronic illness
like diabetes or epilepsy, and an alliance with a good
therapist can help the family maintain course through
the stormy seas of this illness.

 

[klmno]

Thanks, Susie- I have used their site, and others, to try to find a therapist. Oddly enough, there are never any listed in my area. They are in different parts of the state or when I'm lucky enough to find one around here, they are for adults only. I'm in a city, but it's pretty conservative- maybe people here still think all the kids are faking it...

 

[smallworld]

Chapter 7 of Mary Fristad and Jill Goldberg Arnold's book Raising a Moody Child is called "What Should I Expect from Therapy?" I think it answers some of your questions.

It's been my experience that mental health professionals prefer to get their information from clinical sources -- articles written in psychiatric or psychological journals, conferences they attend where experts present their findings, etc -- rather than parent groups like CABF, even though CABF has BiPolar (BP) experts on its board.

FWIW, we have had the most luck doing therapy with psychiatrists who have experience with BiPolar (BP). They are clearly the ones who are trained more in this disorder than psychologists.

 

[klmno]

Thanks, SW! difficult child's regular psychiatrist doesn't do counseling. Actually, it might be ok because he also seems to be behind in therapuetic approaches for BiPolar (BP)- just traditional in his methods. But, I wouldn't mind haviing a psychiatrist do counseling at all. Maybe I could make some calls and see if I can find one. I think there might be a problem with whether or not insurance would pay a psychiatrist's rate for 45 mins of session and I doubt any psychiatrist would accept the typical lower rate of a therapist. Anyway, I can look into it. I do see a clear-cut difference in attitude and understanding of BiPolar (BP) symptoms between psychiatrists and tdocs (whether social workers or psychs). This intern therapist is working under the psychiatrist who is a known specialist in mood disorders- they are startiing to use TEC techniques in their practice so I was thrilled to find someone who even knew about that. (He's the first therapist that had read anything about TEC/CPS and he had the therapist's book on it on his desk). Being that he's located at their psychiatric hospital and Residential Treatment Center (RTC) and works under this psychiatrist, I think he will eventually learn more about kids with mood disorders. I think he might be receptive to me "teaching" or giving him a parent's perspective. But, I don't think he can really understand it if he's never seen it first hand and I don't know that I have any time to waste with difficult child. Maybe I'm answering my own question- maybe we should stick with him, if he's open to me explaining some things to him rather than assuming things, but I could keep looking for someone (like a psychiatrist) with more experience in the meantime.

There is the other therapist we've seen that I can call and make an appointment with, but he's spent 4 mos going in circles asking the same questions about diagnosis. He always says just enough to make me think that at the next appointment we'll get into actual issues, but then it never happens. He had never heard of TEC or CABF.

The CABF list is what I used before to try to find a local therapist- the closest one they list would take me an hour to get to. I wouldn't even mind that if we didn't have to worry about school, work, homework schedules.

 

[OpenWindow]

Have you been able to talk to the psychiatrist the intern is working under? When we saw an intern in St. Louis, the psychiatrist always came in at the end of every session and talked to us for as long as we wanted, with the intern in the room. It was very helpful and usually much more productive than just the time with the intern.

If you haven't talked to him, can you request it?

 

[klmno]

No, Linda, that hasn't happened. Probably because the intern has never actually met difficult child yet. The psychiatrist was the one who lead difficult child's MDE last year and then I consulted with her several mos. ago. She, of course, has met difficult child because he was there both times. We had discussed switching from regular psychiatrist to her if we got counseling through this place. I do recall specifically asking her though, when she said she had a male therapist available but he would be an intern, if someone would be available periodically to provide more insight or somewhat monitor how things were going, since it was an intern. She said "yes" to that. I'm glad you brought that up!

It's been my experience that mental health professionals prefer to get their information from clinical sources -- articles written in psychiatric or psychological journals, conferences they attend where experts present their findings, etc -- rather than parent groups like CABF, even though CABF has BiPolar (BP) experts on its board.

(Posted by SW)

This is sticking out in my mind- the clinical publications must not be on the same track as what parents resources are stating. Which might explain everything- and that I keep wondering why my counselor- 20-some years ago was such a good fit but I can't find one now that I even feel understands anything. My counselor had a similar situation in her family as I had in mine, she delved into learning everything she could about that type of problem, then became a counselor who specialized in it. So, I guess most counselors are not going to try to learn anything outside of what the clinical resources suggest? HMMM- I wonder if an intern might be willing to? (I wonder if this intern would)

Another thing he said that stuck out in my mind-I mentioned that difficult child wanted a male therapist (this is a male therapist) and I said I understood that because if I'd grown up without my mom or any female in my household, then reached the adolescent age, I would need and want some feedback about becoming a woman from an adult female that I was comfortable with . He said he had an issue raised by another family along those lines and he had tried to tell them that he could provide that feedback to their daughter. I said, yes, he could provide some feedback but it wouldn't be the same as the need to get feedback from one's one gender. He said, well, whatever, he could have done it. I just chuckled and said well, I think the perspective would be a little different- there's no way I can give my son a male's perspective on age-related maturing questions, Know what I mean??

 

[klmno]

After thinking about this a little further- would it be so bad if I could get the psychiatrist who runs the place where the intern works to deal with the BiPolar (BP) issues and the intern worked with difficult child individually with the underlying issues, stress and anxiety skills? I do think he would be good with CBT for specific (pulled-out) issues as an individual therapist. It's the BiPolar (BP) issues I'm concerned about and I can't ignore them or put them off.

 

[susiestar]

The MALE therapist said he could give a girl an adult female's perspective and feedback? Is the guy smoking crack during your session?? Man, that is arrogance over the top, in my opinion. NO man can truly give a woman's input, and no woman can give a man's input. I don't care if that sounds chauvinistic. Men and women have different experiences and go through different things, along with having different brain and body chemistry.

I wonder if this guy could teach a girl how to use a tampon?? (I also wonder what he would say if you asked, LOL!! - off topic, I am sure, but geezle petes, how idiotic IS this therapist??)

Anyway, we ahd a psychiatrist who did counselling. We switched from him after hearing firsthand from some young women Wiz was in psychiatric hospital with that he was incredibly inappropriate with them. The stories rang true, not just like something the girls made up. They were backed up unofficially by a nurse too. So we switched. I rather liked the guy because he really held Wiz accountable for school and other issues. He pushed Wiz to work hard in school, said with Wiz' brain he owed it to himself and the rest of the world to work to his potential. When he had a longer session it was billed under a different code and covered at a different rate by insurance. We actually paid less (half as much) when he did counselling than when he just wrote scrips. When the office staff realized this they billed every session as therapy instead of medication adjustments. Not sure why, but it really helped our budget.

So don't give up hope on finding a psychiatrist who does therapy!!

 

[susiestar]

Sorry if my question about the intern giving female instructions was out of line. It just occurred to me it might bug someone. If it does, let me know and I will take it out of my post. Or the moderator can if they don't want to contact me to change it. I don't want to offend anyone.

 

[klmno]

I appreciate your post, Susie. I wasn't offended. I chuckled when he said it- but I wrote it up to that he probably doesn't have kids and came from a stereotypical household so he's probably never thought in depth about any of these issues- just about learning from the textbook how to be a psychiatric.

There's a lot going against this- but after seeing countless tdocs over almost 3 years, he is the first that has shown real signs of being able to give adolescents and teens CBT. I don't want to run away from him without being sure that it won't work. But if he can't approach the BiPolar (BP) issues in a constructive way and realize that by family therapy, I mean the things recommended for families dealing with BiPolar (BP)- not "fix our relationship because our home life is triggerring all these problems" therapy, then I don't want him going down that road. We've tried it- we end up feeling pressured to think of problems amongst ourselves to discuss and we end up with a wedge driven between us when really, I don;t believe that the big triggers are our relationship to begin with.

 

[klmno]

This might be a stupid question, but is it safe to assume that a psychiatrist can do the various types of therapy- like cognitive? And, how did you find a psychiatrist who would do it? Did you just call places and ask?

The psychiatrist who I've been referring to (not the regular psychiatrist that difficult child sees) would do it, I think. But, even though she's an expert in this field, English isn't her first language and difficult child has said it is difficult for him to understand her, also it's a teaching place so there's always at least one more person in the room- that was fine for a MDE and a consultation and probably even regular psychiatrist appts- but not for personal therapy. But the biggest issue- difficult child's big underlying problems (we all think) are related to his father never seeing him and difficult child trying to find his masculinity in spite of it without becoming a true loser, so to speak. I can't see difficult child ever discussing these things with a female, except the little bit that he discloses to me. The BiPolar (BP) issues (strategies, coping skills, etc)- I don't think he would mind so much if it was a male or female.

But- there is an "overlap" between these two areas, of course.

 

[witzend]

OK, don't get ticked at me for saying this, but you don't actually know what he wrote down. He might have written "Mom has an agenda".

I do like the idea of having the intern do therapy, if difficult child is receptive, and have a psychiatrist deal with BiPolar (BP) issues. in my humble opinion, BiPolar (BP) issues require medication, so a psychiatrist makes sense for that.

 

[klmno]

OK, don't get ticked at me for saying this, but you don't actually know what he wrote down. He might have written "Mom has an agenda".

LOL, Witz!! I DO have an agenda! Or, at least, I have a goal and an objective for being there. I guess I just hope that he wrote the website down or the recommendations listed by them.