Hand off

Took Bear to the orthopedist today for x-rays and a cast on his broken hand bone.  Apparently it's not a "boxer's fracture," although it is the same bone.  It's on the side of his hand just below his pinky.

Bear was wearing his splint from the ER, but freely admitted he took it off all the time.  When he found out he was going to have to be in a non-removable cast for  6 weeks, he flat refused.  The doctor (one we've never met before) was a little taken aback.  He asked if Bear wanted treatment at all, and was perfectly ready to walk out the door.  Bear's issues are not evident just by looking at him, or even talking to him for a few minutes. I instantly started placating Bear, talking about the bad things that could happen if he doesn't wear a cast, and trying to soothe his macho ego.

I managed to get him to allow them to put the cast on... but if he's still wearing it in a couple of days I'll be shocked.  He spent the whole time it was setting talking about how to get it off.  *sigh*

I was exhausted and frustrated by the time it was over.  I know it's not my problem, but it's hard watching someone self-destruct.

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Kitty will be discharged from the residential treatment facility on Friday.  She was home this weekend on a 48 hour pass for her 17th birthday.  During the 3+ hour drive home from Metro City we talked quite a bit.  One thing we talked about was emotional age.  I used my developmentally delayed and my emotionally delayed nieces as examples.  She was surprised because no one had ever told her that she was considered emotionally delayed.  I know she didn't "get it" this time, but I know at least some of it will sink in as she hears it over and over.  I'm not telling her this to be cruel.  I need her to understand why she's treated differently from other kids her age.

On the way back to Metro City at the end of the pass, we started working on her discharge packet.  She has a lot of essays and paperwork to fill out.  Honestly the Center has told me they don't expect her to have enough insight to be able to complete it.  Still, she knows this is something that has to be done before she leaves though, and she expects to do it.

In going over the discharge paperwork it showed me just how far she's come, but how far she has to go too.  You can definitely tell that the lower stress level at the Center has given her the ability to handle things she would never have been able to handle before.  I only wish I could believe that this was a true change, and wasn't going to disappear the instant the stress of family and school comes back.

In the car it took a lot of work on both our parts for her to stay calm enough to work on the discharge paperwork.  Several times I tried to get her to put it aside when I could tell she was so overwhelmed she was close to losing it, but she was able to pull it together.  I did have to basically feed her the answers though.  She had some insights (parroted?), but she couldn't voice them and get them in writing.

Here's a letter I sent to her Center therapist and her attachment therapist when they asked me how we were doing:

Did you get a chance to review Kitty’s discharge paperwork?  It was a little confusing, because we weren’t sure what kind of "Goals" you were looking for (immediate/discharge, short-term, long-term).  She got pretty overwhelmed, and I did a lot of the work, but I think it was pretty accurate.  Can we get copies of this for her therapist?

To confirm, we’re picking her up Friday at 3pm from the Center and she has therapy with {attachment therapist} on Tuesday at 4:30pm.

I reviewed the DBT Diary card and I think we’d have to make a custom one that is a LOT simpler, but I agree she needs to continue to do this daily. Can I see a copy of one she’s filled out, and maybe one filled out by another child (identifying info removed of course).  I wish I could have gone to a DBT orientation class so I could help her more with this.  I’ve looked over the DBT manual you gave me, but I just don’t have time to really learn it.

You mentioned Kitty’s tendency to isolate {as an example of a trait to work for her diary card}.  This isn’t something we’ve seen a lot of at home, but I do think she’s been going to psych hospitals as a way to get respite from feeling stressed and overwhelmed.  This is one of the biggest issues I don’t feel we covered while she was at the Center, because it was something she didn’t really experience there (for her the Center is respite).

Kitty’s therapist is asking how she’s doing, and this is what I think is important.  Could you please add anything you’re seeing or that I missed?

I think we can expect a short honeymoon period, but nothing really deep has changed.  Here’s some things we’ve covered over the last few months:

1.       She is a people-pleasing perfectionist who can’t stand others seeing her as less than perfect and therefore can’t handle criticism of any kind. 

•         She would “rather die” than let anyone see she’s less than perfect so she stuffs the emotions and takes them home.  
•       She’s working on “standing up for herself”, primarily with her peers, but is still in early stages.  
•        She and I have discussed using a mantra (would like to introduce tapping, but she’s pretty resistant).  I’m thinking something along the lines of, “Even though I’m not perfect, people still like me.”

2.       She can’t process if overwhelmed.  Her tolerance level for being overwhelmed is very low, especially when she is dealing with the stress of family and school. 

•      What she can handle while at the Center is higher, but I fully expect that to change when she gets back to “real life.” 
•        I do think she feels that because she can handle certain things at the Center, that she is entitled to these privileges and more.

3.       Clutter and the smell of garbage (from dishes especially) trigger meltdowns because they remind her of her childhood.  Biomom never cleaned and just bought them new clothes rather than do laundry.  Combine this with feeling criticized and overwhelmed by chores and you get a formula for meltdowns.

4.       She knows, and almost understands, that she’s emotionally delayed (between ages 6 and 10), but doesn’t have a really good grasp on what that means.  She does get that she is more emotional than others.

5.       She’s agreed to try to stay scheduled. This schedule will include stalking time in the backyard, journaling/ diary card, chores, exercise (yea, right!), and computer time.