We've debated residential treatment (RT) for Kitty off and on for quite awhile. I've been adamantly against it actually. I was afraid it would damage the progress we made with attachment, and I just couldn't justify it. Here's the pros and cons.
1. Attachment - I was afraid it would damage what little attachment we have. I thought this would happen when she had to go to respite while they were investigating Hubby for child abuse, but I was wrong - If anything it made it stronger. When we sent Bear to RT, I thought Kitty would never forgive us, but it brought her closer to us. Sent her to psychiatric hospitalization -didn't damage her attachment to me. If anything her attachment issues seem worse lately, because her issues seem worse. So I've decided this is no longer a concern.
2. Diagnoses - we sent Bear to RT and he was undiagnosed bipolar, so when he was properly medicated he had an almost 180 degree personality change. I've always felt Kitty was already properly diagnosed so that wouldn't help; however, she has not had neuropsychological testing. Our insurance won't cover any psychological testing (short-sighted on their part) - so apparently this means we have to send her to RT for the testing if we want it done. This RT is very well-known for their neuro-psychological assessments and treatment.
3. Medication - the psychiatrist we have actually consults with the RT so anything they would do, he could do too, but right now her meds don't seem to be making much difference, plus it would be nice to have her somewhere else while they "muck" with her meds.
4. Therapy - our experience with Bear tells us that this RT has no knowledge of RAD, and the family therapy was a joke, but we're used to that. With Kitty so out of control, her attachment therapist isn't really able to make much progress with her anyway. We still have another 3-5 years to work through therapy (3 years if she moves out at 17 like she's threatening, and 5 years if she waits until she graduates high school at age 19). She has so many severe issues that it's hard to help her. Trying to figure out what's causing the behavior so we know how to treat it - is it the ODD, the bipolar, the ADHD, the RAD, the abuse, some brain damage we're unaware of, a current issue... or more likely a combination of all of the above.
Best part about having Bear having gone to this RT already, is we know a little more about our options. This time we won't stick with a useless therapist for the whole time she's there. We'll complain if we are being patronized or if the therapist seems to be being manipulated by the child. Plus, this time we've known the child longer than 6 months.
5. Getting Help - with Bear we let his abuse of the family go on too long. The whole family had symptoms of PTSD. Mostly though we just should have gotten him help sooner. It was easier to see his progress because he wears everything on his sleeve. Plus when he came home, it was to a family that had had time to reconsolidate and refresh.
Kitty has always been harder to help because she keeps everything locked inside and numb. She has for so long that she is almost completely disconnected from her physical and emotional feelings. I think we didn't realize how much help she needs because she wasn't physically violent - at least not when compared to Bear. I do know that her constant vengeance issues, constant verbal abuse of others, and constant threats to herself are negatively effecting the whole family. As we uncover layers we just discover that there are more layers and each layer is thicker than the one before.
6. Timing - The sooner the better, for many reasons. One, because she's already 14, and shouldn't have to keep living with this - and the longer we wait the harder it's going to be to reach her. Two, because if she goes in during the Summer she might not miss any school (which might help her with accepting this since she "loves school"). Three, because she's home all summer she is around Ponito and Grandma which seems to be triggering/activating her issues more than usual (me too for that matter). Four, because she finally seems to be a tiny bit aware that her issues are interfering with her life.
She's going to be upset no matter what the reason, but now that I'm on board, I feel like I can help sell it to her once we get a spot. (Until then I'm not telling her anything). We should know soon if they will be accepting her.