[aMarylandfamily]

Lucyjoy ... I know you have done the RTC program ...

My question deals with the family session we had yesterday. Our 13 year old placement (of 2 years this June) who is currently in an RTC program following 3 months of intense psychiatric hospitalization (for bi-polar + a series of diagnoses) is currently in the process of sabotaging each and every home pass he has ... his therapist is rather frustrated at this time as she is beginning to see another side of him - the one that says one thing while meaning something opposite of his words/actions. At yesterday's session, which he chose not to attend ... which she is allowing at this point which we disagree with ... it was stated that the child has little or no attachment to anyone or anything and little or anything to offer any relationship and will required 100% giving/unconditional love from the adults in his life ... were we willing to do so ... meaning that we could have no expectations from him ... including not following house rules while here. This I disagreed to/with and she will be meeting with spouse to see if she can come to some agreement with him next week. She also raised the question of a step-down program (therapeutic foster care) which we had previously identified to the therapist who resigned just a progress was beginning that we were in agreement this would most likely be necessary to effect a successful reunification vs. the child returning directly here and facing the possibility of another rejection. She also asked if we still love him - we do but he must want to be part of our family to return ... he cannot have free reign of behaviors/actions/privileges ... just to be here. Do you think we are being unreasonable? Opinions please ... not really feeling guilty but having those thoughts cross my mind of "am I doing enough".

Thanks for listening and responding.

[lucyjoy]

You are not being unreasonable. Here's the problem:The therapist doesn't know what to do. She must have a discharge plan at all times. She knows he needs to remain locked up. She can't say that. That's her problem, not yours.

You have a couple problems. First, from what I've read, your child is not a good canidate for a step down program. He isn't taking any responsibility for himself. In order to be successful in a step down, he would have to work on being independant. Being bi-polar, his first step would be taking responsiblility for his medication. He also has to get along with other human people in the world. Do you think he can do that? Step down makes it easier for them to kick him into independant living. He doesn't sound like he can handle that.

Second, ignore the threats and blame they're laying on you. YOu need to be in charge of your child's care. If your son doesn't attend family therapy, he should lose his level and when my son did this, we refused to accept phone calls until the next session. He can't refuse to attend sessions and blame you. That's not treetment and the therapist knows it's easier to blame you and use "unconditional love" than to confront her client. She's helping him stay sick. It is not now, nor ever, o'kay for him to not follow house rules or sabatoge passes. If he isn't on his program, he gets no pass. Allowing him to not follow the rules at home does not show him unconditional love, it shows him he can control everyone and everything. He will never get better if he isn't held accountable for his choices. Let him know you love him, but the world has rules as does your home. Let him know you'll always be his mother, and that home is always there whenever he's ready to work on his life.

The therapist needs to be more confrontational. I'm sure the child's had enough therapy to hammer out his past. He gets why his life's a mess, except for the part where change is in his control. Dwelling on the past with a child like this(& mine)only allows them to continue being a victim. It's time to start talking about his future and what he(not you)is going to do about it.

I pm'd you my email if you wanna talk more.

[Dr. Art]

Unfortunatley, usual RTC care is ineffective for children with RAD (good for kids with conduct disorders and oppositional defiant disorder, and juvenile delinquents...but not children with trauma-attachment disorders). That is the basis for your problems now. Your son is not doing well because he is not getting the right treatment. Most RTC's use a behavioral model with points, levels and such...that just does not work with these kids.

There are a few RTC's that use an attachment model for treatment and they go have generally very good results. They include the parents at the center of treatment. These programs provide attachment based residential care and attachment based therapy. The parents are in the driver's seat and that is vital for success.

One such program is Villa St. Maria in NM. Another in Intermountain in Montana, and a third that is developing such a program and has done a good job implementing attachment-based treatment in an RTC setting is Wyndham Lawn in Lockport NY.

Regards,

[lucyjoy]

Dr. Art,

While those may be good places for kids, they often refuse children whose problems are severe. They refused mine. I managed to direct my child's therapy in a normal RTC. They didn't like me, but my son is now home and doing well. I had to write more limits into my child's levels which was easier after I educated his therapist about attachment.(Who , of course, didn't believe me but was smart enough to ask other professionals about what I said. They backed me up). What she can do, is hold her son accountable. Even an RTC cannot justify allowing a child to skip therapy and still get a pass. They also can not back up the theory that a child should be allowed to have no rules at home on a pass. Even normal RTC rules don't go along with that. My son had 2 attachment intensives and worked with a home based trained full time attachment therapist, I have extensive training on attachment parenting and my son was too dangerous to be anywhere but an RTC and 30 refused me before I found one that would take him. Until my child decided he had to change if he wanted a better life, nothing was going to work. We did not expect him to attach to us on his return home, only to follow societies and our house rules. He is attaching. A reguar RTC can have some effect if the parents remain proactive. The best set up? NO! But, for most of us, the only one.

[Dr. Art]

Dear LucyJoy,

You are correct that those center's I mentioned may refuse some kids with severe behaviors and they also have age limitations. However, they generally do better than the usual RTC with RAD kids...if the child is accepted...Of course another limitation is that the distance from home often makes frequent parental involvement difficult...and the cost factor may be another limitation.

That's why I found a local RTC to work with to help them develop a program for RAD kids that will have an attachment-based cottage and use an attachment-based model and not a behavioral model of treatment. Your suggestion is a good one...find an RTC that will work with you...but, as you clearly know from experience, that is difficult. I had to go through many RTC's in this region before I found one with enough insight and foresight to see the benefits of developing an Attachment-based program. They don't have the separate cottage set up yet (that's about 18 months into the future) but they do a great job of implementing attachment based treatment principals. The children don't work on points and levels. Priviledges and such are based on the child's relationship with the parents. Priviledges and rewards are clearly labeled as coming from Mom. The staff talk with the parents daily to discuss treatment and interventions. In addtion, the child sees me in treatment weekly and priviledges are based on how the child uses therapy...parents are in every session as is the child's primary worker.

So, to get an RTC to work for a RAD child, it is probably best if the parent can get an therapist who has experience and training in attachment-based treatment to be the parent's advocate to get all other providers on the same page using this model. Luckily, I've got enough of a track-record of success and research evidence to back me up, that it's easy for me to get this in place.

Regards,

[lucyjoy]

There are 3 therapists in our area working towards the same thing. They're also spending a great deal of time training the therapists in the RTC's to recognize this behavior and the treetment differences that are needed. (They do this part for free).

[Dr. Art]

Lucyjoy,

that is great!! Parents sure need more of that. As a Registered Clinical member of Attach, and having been nominated to the Board, I will want to be working with others across the country to see more of that.

Regards,

[Mackenzie]

To aMarylandfamily,

Your story is so similar to ours. We were headed uphill with our daughter for a very short time and now it's all going downhill again. What is very upsetting to us is how her therapist at the RTC is wanting us to "baby" her instead of making her accountable for her actions and behaviors. Our incidence this time was over lying straight to me and taking items that did not belong to her. She can not accept the fact that she got caught and was in the wrong and says she hates me ( nothing new there) and her anger towards me makes her want to physically hit me. Her therapist compared her behavior to a 4 yr. old, she is 14 1/2 yr. and knew exactly what she was doing. One of our major problems with her has been extreme lack of trust on our part. We've had her since Nov. 2000 and we can't leave her with anyone else due to not being able to trust her among other things. Having her in a RTC at least gives her more structure but we are slowing seeing how some of their methods are not going to help her.

They want us to continue visiting and taking her home for visits and this time I refused. I beleive it's time she is held accountable for her actions and realizes there are consequences. We have tried treating her as a younger child than she is, this only resulted in her behavior becoming worse. Knowing her the way we do, I honestly believe until she learns she is responsible for her own actions, she will not make much progress.

Lucyjoys advise to you and in my past postings makes a lot of sense to me. I have finally started telling the RTC what we want and are having a say in how her treatment is being done. I hope we can eventually have the same results but at this time we are not to hopeful.

Good luck, I know how difficult this is. Hang in there and work for what you feel is in your childs best interest.

Robin

[aMarylandfamily]

The advise and words of wisdom shared by lucyjoy and now by you really do help. Knowing we are not alone with our frustration helps so much.

Our hearts and support will always be with our child but we must be realistic as to what can and cannot be - he cannot hurt himself or others! Sabotaging visits home send a message loud and clear that he is not ready ... despite the therapist's opinion that this is a cry to return home faster - to be wanted/needed. He must account for himself ... we all do at many points in our lives from school to work to family. Our biggest hurdle is making him and them understand that two weeks afterwards without the issue at hand being addressed does not make things return to ok ... we will get there - the long road way but there.

Keep us posted on your situation too - also know that you are doing what is in the best interest for your child ... now and in the future as they won't have a future if we don't direct them the services needed to get there - even when it's painful for us to walk the steps associated with them getting there.

[lucyjoy]

It just amazes me that a child can continue the behaviors that landed him in an RTC and the staff can claim that means he wants to go home....hmm. So does that mean while he was home doing those things he really wanted to go to an RTC? Even if the sabatoging meant he wanted to come home, letting him think that's an acceptable way to get there is wrong.
I always like to ask therapists questions of this sort when there logic is obviously impaired(gone, completely missing....)