3rd therapy appt...

[Guest guest]

My husband and I decided to use this appt for ourselves to air some

things out. We have been turning against each other in some ways,

when we should pull together for my daughter. For example, he

believed I had been turning my daughter against him by not supporting

him when she viewed him as the " bad guy " for trying to get her out of

the house-whereas I seemingly was " coddling " her or giving in. We had

this same scenario on many school mornings towards the end of the

year. I told my husband I never disagreed with him about the need

for my daughter to get out, only with his intimidating manner-

frustration leading to yelling, resulting in her panic and hysteria

and my feeling that " ok now she truly cannot go out like this... "

So now he knows I was telling my daughter all along that dad is not

the bad guy he is just trying to help-but my signals would get mixed

as I saw his build up towards frustration, and hers towards panic.

Now he knows how important it is to stay CALM (he has a tendency

towards bad temper and really blew it a few times, making me angry at

him and causing my daughter to hold a very bad grudge) so we can be

on the same page. And now I know how important it is not to back down

(I have a tendency to avoid conflict and smooth things over). We also

know that it is ok for her to get really mad, to take it out on one

or both of us-just don't take it personal and stay FIRM.

So, since one of her problems has been excessive time grooming (have

not determined if this is ocd), being late, and panic at appearing in

public due to thinking she looks horrible and due to embarrassment at

being seen with us (is there such a thing as body dysmorphic

disorder " projection " onto the family members, or is it normal teen

embarrassment, or is it an excuse not to admit her own fear?). We

decided that we will state that going to church (the only regular

family outing during the summer) is non negotiable. I had a problem

with making church into a battleground, but am willing to approach it

this way as a prelude/training ground for returning to school, and

since it is the thing she has currently had trouble with. (My twin

sister, who is a religious person, developed this same phobia,

overcoming it to a degree where she will stand at the back, not sit).

Same with my daughter, she does not resist church as a matter of

rebellion as could be typical for some teens, but simply because of

her fear, and she really does not like to miss it. Anyway, If she

can " do " church, then maybe she can see herself doing school, with

less anxiety, as well. I had a question, though, if church is non

negotiable and she must be in the car at the stated time, whether she

has the right clothes, her hair is still wet, or whatever, what do

we do if she isn't? The therapist said she wasn't sure because you

can't pick up a 13 yr old and put her in. She thinks if we are simply

very firm beforehand, meeting with her together to lay out the rules,

that it will work, and by going, she will overcome what has been

developing into a phobia (so did not really give us an answer). We

then decided on the way home that we will just have to leave if she

is not in the car and think of a consequence such as removing her cd

player, if she doesn't go. Does that sound reasonable? (it is hard to

remove a privelege when there are so few pleasures in her life). I

know it would all work better if she were willing to see the

therapist and work on the problem out of her own motivation.

So that was the one other issue we worked on, there is still the

matter of my 2nd daughter, and there are still many questionable

behaviors in my oldest daughter(skin picking, excessive time

grooming, fear of seeing her friends, staying in her room for hours,

feeling overwhelmed with assignments during the school year etc). The

therapist did not suggest a diagnosis other than panic and general

anxiety and seemed reluctant to give one ( I had been thinking ocd

spectrums-BDD and maybe trich). Maybe she needs to meet just with my

daughter. She also is reluctant to label a child at the outset,

before she sees if behavioral therapy will be effective. I think she

feels that diagnoses are for truly biologic conditions that require

meds, and that what we may have is a situational, environmentally

triggered problem, initially related to moving, and the subsequent

stress(?). Anyway, if we don't make progress on this " going out "

issue, for example, or it gets worse, then we will consider meds. She

did not use the words CBT or ER & P. She said that desensitization

through exposure to fears, relaxation techniques to offset panic,

changing negative thought patterns, and creating a hierarchy of

symptoms are the methods she uses.(Plus I also am interested in habit

reversal for the skin picking). This all sounded like CBT to me, but

I still am confused about how to use exposure whith what seems like

body dysmorphic disorder(my diagnosis, not the therapist's). Not

allow her to groom, use make-up, or to use the mirror? And I don't

know whether the grooming is ritualistic (like ocd) or because she

wants to look pretty like any adolescent. If she could stop worrying

about how she looks then she could go out more easily. The next step

(once she got out) would be for her to not think other people are

evaluating her so negatively. How do you use exposure for that?

Sorry this is so long-wondering if anyone with more experience with

therapists might comment, and also about exosure for BDD type fear.

Have to admit, I could not imagine making her go out without the

mirror checking, grooming, make-up etc. And many times she still does

not go out, after so much preparation- feeling she has to look

perfect, I guess. I try to model myself, by not wearing make-up, not

messing with my hair, not commenting about clothes, hair, skin etc

(notice how alot of women get into those conversations?)and not

commenting on other people. Wonder if that helps or hinders (since

she does not want to look like me!!!). Guess it is hard to

imagine " forcing " a 13 yr old to do anything she strongly resists, we

really need her to be motivated as well. Thanks for " listening "

Grace