I guess I’m confused. Is Kitty capable of doing DBT at all? My understanding from our conversation in family therapy was that she could “practically teach” the DBT class, but was unable to access the skills when in the heat of the moment. I also heard from you that emotionally she’s only 6yrs old (which I certainly agree with), and therefore DBT and trauma work is beyond her. Which is it? In your email, you mentioned that the problem might be that the Center crams a year of info in 4 months and Kitty is not able to keep up, and suggested she might be better off doing outpatient DBT. I have several problems with this.
- I’m still confused as to whether or not Kitty is capable of doing DBT at this time.
- Another is that you mentioned the Center goes through the DBT skills so quickly because the kids in the center are in crisis, our biggest concern is that when Kitty is HOME, she is in CRISIS.
- If the Center is going through the course too quickly for Kitty, would it not be better to REPEAT the course while in the Center and not in active crisis from being with family and in school?
- Another big problem of course is that so far I’ve only found one DBT group for teenage girls and it is at LEAST $50 a session and they meet weekly. $200-250/month is of course NOT in our budget.
I have to tell you I am extremely overwhelmed by Kitty returning home without having made any improvements (as evidenced by her blow up on Friday – and repeated blow ups every family visitation). Another understanding I came away with from family therapy was that Kitty can’t handle trauma work right now so we will need to pull her out of EMDR/ trauma therapy. This means she would drop to therapy just once a week with her attachment/somatic therapist. You guys may not know what “freak out” means for Kitty {therapist mentioned that in a group, Kitty said if she was forced to go to the special school and deal with Bob that she would "freak out," but refused to clarify what "freak out" meant to her} , but we most certainly do, and I’m terrified about what this means for the family.
If therapy and coping skills are not going to work, then it feels our only recourse is medication. As you know, at staffing we decided to add another mood stabilizer to Kitty’s medications. Lamict*l is supposed to be very effective but takes a LONG time to build up in her system because it has to be increased very slowly to prevent a fatal rash. They had started her on it at home, but just before she came to the Center we did a “med wash” during one of her many psych hospitalizations and they took her off of it. I am glad you are acknowledging that she needs to stay at the Center until we can get her up to a therapeutic dose.
We also discussed at staffing starting Kitty on ADHD meds again, but she’s been hyper focused on hiding her difficulties with focus and impulsivity at school (more people pleasing) so the doctor wasn’t seeing a need to add the med. She mentioned her concerns to the doctor as well, but of course the Lamictal is first priority. I do have to wonder if getting her on ADHD meds would help with the impulsivity and give her a few seconds she might need to make a choice to use her DBT skills instead of dropping immediately into fight, flight or freeze mode.
I plan to bring Kitty’s sister (our biodaughter, Bob, age 15), to family therapy this week (tomorrow). If we’re moving up the time table then maybe it would help to deal with some of Kitty’s issues with jealousy about what Bob is able to do/handle despite being younger than Kitty. Somehow we need to get Bob to understand that even though the girls are in the same grade, they do not have the same skills or responsibilities/ privileges. Bob is still out of school with mono (The doctor is not concerned about her being contagious. She’s not showing many signs of mono at all – just a low grade fever, and she’s very conscientious about not getting her saliva on anyone – no licking! *grin*).
I’ll be honest; I think that if Kittyis released this soon, we’re going to go right back to Kitty being completely overwhelmed by life and right back to spending alternate weeks in the psych hospitals. The Center may not be the perfect place for her, but I’m not sure what our alternatives would be.
Thank you,
Mary
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