Q&A with Geoff: Our Daughter May Need Residential Treatment

Question:

Our daughter is sixteen and has been dealing with depression from a traumatic event that happened to her when she was eight. We have had her in various counseling therapies over the last year and a half. She tried to commit suicide earlier this year. We are still paying some of her medical bills. She is now living with a family member hours from us. We feel she isn’t ready to be home because she would not be safe. So, we are contemplating residential treatment that could last several months. We only have a short time until she is a legal adult and feel this is our last chance to get her help. My husband and I don’t always agree that she needs outside help or on what kind of treatment to look for. The cost for the right placement for her is mind-boggling. We would have to see if our insurance would pay anything, and then still ask our family and our church for help. This has put a lot of strain on our not-super-strong marriage. We don’t even know if our daughter would cooperate with a residential treatment program. What do you suggest?

Answer:

I can see how worried you are watching your daughter march toward adulthood while she still needs so much help and support. I’m glad she’s safe with family, even though it’s not a viable long-term solution. You’ve obviously expended tremendous effort to help your daughter, so I recognize there are no easy solutions. I hope I can provide some insight that might help guide your future efforts.

Since I don’t know the specifics of the type of therapy she’s received, I’m going to make some suggestions you may want to consider. Sometimes when an adolescent is a danger to herself, all of the treatment resources are used up to keep her safe (such as hospitalization and behavioral plans). Even though these efforts are essential, treating the underlying trauma often gets neglected.

Intensive outpatient trauma treatment works best when an individual has a strong support network of family, clergy, friends, and professionals to provide ongoing stability during the treatment process. If she’s safe enough to live with your family member for the time being, would she have the support needed to intensify her outpatient therapy?

If she’s already tried an intensive program of outpatient trauma therapy, such as Eye Movement Desensitization and Reprocessing (EMDR), Lifespan Integration, or Somatic Experiencing, then inpatient care may be the only way to provide her an environment where she can have adequate supervision and daily trauma treatment.

You’re right that inpatient treatment options are costly. Obviously, if it’s a true life and death emergency, money becomes a secondary consideration. I don’t know your daughter or her full treatment needs, but make sure whatever program you consider includes a trauma component. Unfortunately, some programs are so behavioral in nature that they miss the underlying causes and only focus on extinguishing problematic behaviors.

While you can’t know if she’ll cooperate in an inpatient setting, you do know that she’s struggling to function in a regular home environment. There may be no other option for her. Running her back to the behavioral unit at the hospital every time she’s suicidal is not going to address anything other than acute stabilization.

Hopefully you have a trusted team made up of people who know and love your daughter and who can help you make this critical decision. I don’t know if you have a trusted therapist, church leader, other family members, school teachers, or others who can talk through these options with you. Don’t make this decision in isolation with all of your fears and anxieties running the show. People are willing to help in a multitude of ways.