We had a meeting today with Kitty’s psych hospital therapist, and I have to admit I have some BIG concerns. He’s already talked to one of her therapists, and would like to talk to someone at the school about his recommendations for how to help Kitty in school. The school psychologist said she’d contact him tomorrow. It looks like Kitty will probably be discharged on Monday.
The good news:
· They’ve reduced the sleep med that we were concerned might be triggering mania (Traz*done - 300mg to 100mg), and she’s slept a full 8 hours for the last couple of nights.
· She’s increased the new mood stabilizer, Dep*kote, from 250mg to 750mg with no apparent negative side effects.
The bad news:
· The self harming behavior is increasing. She’s actually leaving marks with her nails, and she’s now restricted from using pencils without supervision because she’s been using them to hurt herself.
· She appears to be in a constant fight/flight/freeze mode, and very hyper. She said others have been commenting on her mood swings, and she made several aggressive, nasty comments in the short time she tolerated our presence before demanding to be allowed to go back to her friends. {I left the hospital practically in tears. We'd just had a great session with Kitty's therapist who really "gets it," and he was totally reassured that we were good therapeutic parents... and then we met with Kitty and she was even worse than she's been the last few weeks. She blamed everything on us, and was obviously LOVING the kids at the hospital and getting tons of validation. She was reinforcing all the negatives and reasons she wanted to leave home and didn't want to come home. When I called her later she continued with the diatribe and was angry because she feels I'm discounting her feelings by saying it's her "perception" when she says things like, "Daddy thinks I'm ugly" or "You're punishing me for having issues." Plus, I get "everyone" on my side - "everyone" being the "therapist and my friends."}
· She presents to the therapist at about a 10 yr old maturity level (which coincides with our estimate) and this is about the level of responsibility she seems to be able to handle (except for those chores/issues that are trauma triggers which cause her to react in a fight, flight or freeze manner), but she is adamant that she must have “16 year old” privileges, even though she often admits she doesn’t want the responsibilities that come with them. She is constantly comparing herself negatively to her super responsible, mature, YOUNGER sister Bob who is in the same grade at school.
· She is forming friendships at the hospital with the same kinds of kids she’s attracted to at school. Our current theory is that because of her black and white thinking, she is attracted to “bad boys” because they make her feel like a “good girl,” they are tolerant of her issues because they have issues of their own, they make her feel part of the group, and they validate her feelings about us (we are “overly strict, over-protective, we care about the other kids more than her…”) which justifies her pushing us away and the feelings of anger that she has against her “mother” (which she takes out on me).
· She is blaming EVERYthing on Hubby and me (with some special hate for Bob), especially because she is really afraid if she admits any problem at school it will mean she’ll end up in the special school.
Suggestions:
- Kitty had some ideas on how school could be more comfortable for her. Apparently she ends every day with the double block of math, which she says means she goes home all stressed out. She said this class is too loud and chaotic and ends her day on a stressful note, which means she has no reserves left for dealing with the rest of the day.
- She also doesn’t think she needs the double block of math. That of course is up to her math teacher.
- Of course most of her visits to the nurse, including the day she wet her pants, have been earlier in the day.
- She continues to have big issues with social skills. The boy, she is accusing of teasing her by calling her “ugly,” rides her bus. As does the senior boy who is into “shrooms” that she is highly attracted to. She continues to spread rumors about Bob and accuse Bob of spreading rumors about her. My personal feeling is that the unstructured time on the bus to and from school is a huge source of stress and until she can get some help improving these skills, maybe we should consider having her on the special ed bus. As you can imagine she would be highly against this option, and if it’s considered I would greatly appreciate if it was not attributed to me.
- Lunch seems to also be a big source of stress for her for the same reason. Time in the hallway too. (Ms. V, the school guidance counselor, relayed a story of hearing Kitty announce to a friend that she was pregnant. It was possible she was joking, but Ms. V was too far away to talk to her about it. I asked Kitty about it, and she denied the incident, but seemed to understand that even if she was joking, all the people who overhear her when she’s teasing and joking like this don’t always know she’s trying to tease (or that she can’t handle being teased in return).
- The therapist is suggesting we start the ball rolling on getting her into residential treatment (since the only place that accepts Medic*id has a 6-9 month waiting period). He’s also suggested partial day hospitalization/ intensive out patient, but her insurance does not cover this. He is not familiar with the special school so didn’t feel comfortable making this recommendation.
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