adoption, mental illness

When It’s Not Enough: Adventures in Getting Help

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It’s not enough. I’m not enough. All of the work we have been doing for the last 3 years is not enough to help our Little Bit. 10-year-old Mary is starting puberty. She is also starting to unravel in terms of her mental health. She is back inpatient again at the psychiatric hospital. So, yes, I feel like I am not enough for our girl right now.

During her last meltdown she locked the door to her room and then jumped out of her window. Barefoot. Mary then got into a fight with our outside garbage bin (she won) while screaming at me. I couldn’t stop her. She ran a mile to a friend’s house in bare feet screaming that she needed the police because her mom was trying to kill her. Of course the police came with the ambulance. But they came to take her back to the psychiatric hospital.

We have used up all of the local resources. We have In-Home Intensive Child and Adolescent Psychiatric Services (IICAPS.) She’s been through trauma-focused cognitive behavioral therapy (TF-CBT,) Family Systems therapy, ongoing trauma work, Intensive Outpatient Treatment (IOP,) Partial Hospitalization Placement (PHP,) medication management, and many inpatient stays. Was that all one sentence? We’ve also read every book, checked all of the research we could find on developmental trauma, and parented therapeutically using the Trust Based Relational Intervention model (TBRI) No matter how many acronyms we throw around, she is still stuck in a downward spiral.

I am helpless to heal the deep wounds she carries from trauma. They will never be entirely healed, let’s be honest. But we want to get her to the point where she is functioning at home, as opposed to being in fight/flight mode most of the time. I think puberty has started to re-trigger some of the trauma that she had already come to terms with.

Our entire goal is to keep her safe. We want her safe at home, not inpatient. I did find a great model for attachment and trauma work done in the home. In-home services are the most effective for our daughter, but most programs are not specifically  trauma-focused. Even if they are, it is not for complex, developmental trauma. Thank goodness I found the Attachment, Regulation, Cooperation model (ARC ) through The Justice Resource Institute (JRI.)

JRI is dedicated to helping children and adolescents mental health. They are one of the leaders in the field of research on developmental, complex trauma. (Often referred to as C-PTSD. More letters, I know!) Unfortunately, they won’t take insurance. They won’t take cash. They only contract through the Department Of Children and Families (DCF.)

So we are asking begging for their help. We are in the process of applying for voluntary services. I’m not sure what will happen, but I’m hopeful. We are in the fight of our lives right now. It isn’t us against our child. It’s us fighting with our child against the trauma of her past. The question is not if we will continue the fight. The question is whether or not the state of Connecticut will join us.

So here I sit, typing away my jumble of letters and acronyms. Since when did the alphabet take over my life?! All that’s left to do is wait. And hope. Will you hope along with us?

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**Names have been changed to protect the privacy of those involved.

**If you want information about ARC or JRI you can go to www.JRI.org or www.traumacenter.org to learn more.

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adoption, family

Therapeutic Strategies for Sleep Disturbances

Our Daughter has such a difficult time sleeping at night. She used to physically fight for her life when bedtime came (you can read about it here.) Bedtime triggered her fight/flight response because she experienced trauma at this time in her biological home. Luckily we have the very best trauma therapists to work with us and out children with therapeutic strategies. These are some of the best strategies to calm our daughter’s fear response at night. She needs to feel safe in order to rest.

  1. Comforting Smells: I like to use lavender scented baby lotion to give her arms a deep-pressure massage before bed if she needs it. She will also put a drop of essential oil onto a tissue and rub it together. Then she holds it to her face and breathes in slowly. Smells activate the brain’s Amygdala, which triggers memories from the hippocampus and can activate an emotional response. The mom-massage is a good smell, thus triggering feelings of love and safety. I also rub a bit of my hair conditioner in her hair before bed sometimes.
  2. Comforting Sounds: We have a noise machine for both of our children. They can choose to listen to white noise, rain sounds, a forest, the ocean, a brook, etc. They use these sounds as a coping skill when they need to calm down throughout the day. The sounds also give them a sense that they are not alone in a scary place.
  3. Soothing Light: Our children have always needed a night light to sleep. Complete darkness means they can’t see if any danger is approaching. Although there isn’t a real threat inside our home, our children have an overactive fight/flight response. In order to calm this fear we provide creative nightlights. Our daughter had one that was activated whenever a the light was turned off. We also have a mushroom nightlight probably intended for infants. It projects a series of flowers and stars onto the ceiling with slowly changing colors and designs. This is mesmerizing to look at and soothing for her to watch. Our son has a moon-light that comes with a remote control. He can switch the phases of the moon depending on his mood. A quarter moon if he feels safe, a full moon if he is feeling afraid, and a rotating phase moon to look at if he can’t sleep.
  4. Soothing Taste: Fruits and vegetables are always available for our children in the house. Our kids choose an apple or a clementine (Yuck! After brushing teeth?) before bed. Sometimes our daughter will choose to eat a lemon. I can’t explain that one! Tasting food before bed helps to ease the constant fear that there won’t be enough food and they will starve. This is another leftover fear from their bio-home.
  5. Calming touch: We have given our children physical objects that they can hold throughout the night in order to help them. One of these is a giant stuffed dog named “Mr. Luke” that my daughter has slept with since she got home. It always wears one of daddy’s dirty shirts (preferably from that day) so that she can hold it and feel like daddy is there, protecting her. We also bought Mary a large body pillow and our family wrote positive messages all over it. We used fabric markers but permanent markers might have been just as good. Then we wiped my deodorant all over it and dressed it in my dirty shirt from that day. This way Mary can feel like she is sleeping between mommy and daddy.
  6. ROUTINE, ROUTINE, ROUTINE: Every night we keep the same schedule so that our children know exactly what is going to happen. This gives them a sense of control over a world that was previously chaotic and unpredictable. Their bedtimes remain the same, even on weekends (with maybe a 30 minute difference.) While one child showers, the other child gets to choose an activity  with mom or dad, completely led by them.  Every night I say the same goodnight. I rub their backs, slowly counting down from 10. Then I touch their faces in the same pattern and say the words, “I love you forever, no matter what, and I am so glad your home!” Then we both make a “pop!” sound with our lips and hug each other.

 

At the end of the day, I wish I could tell you that everything is fine and our daughter has no trouble whatsoever sleeping with these strategies in place. Unfortunately, That simply isn’t true in our case. Ever since she’s come home from an inpatient stay, she’s been seeing “monsters” and hearing “talking things” downstairs. If I had a completely healthy back, I might sleep downstairs with her for a night to show her it’s OK. But I can’t. So we’ve moved the bedroll upstairs to the hallway right outside our bedroom. This way she knows mommy and daddy are close. My fingers are crossed that this stage won’t last long. Either way? She’s our girl and we will do whatever it takes to make her feel safe at night!

 

**Names have been changed to protect the privacy of those involved

 

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family, parenting

Why I Don’t Co-Sleep, and I Don’t Care If You Do

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I Lied. This entire post is about to be a lie! My husband and I always had a pact. We would be the only two people in our bed.

We would make time to spend with just each other, every night. Mom and Dad’s “Special Married Time” was sacred in our house. Yes, sometimes our kids would wake with nightmares, and we’d tuck them back into bed. But then Luke and I would return to bed. Alone. We like to spend time together and we like to have sex (and here’s how I had to explain it to my kids!) We both think it’s important to our marriage. So the bottom line is, “no kids allowed.”

But then we adopted kids. Traumatized kids who came from hard places. We did our best to maintain that boundary, until last night. It was our 9 year wedding anniversary. We’d been together for 10 years exactly (We got married on the first anniversary of our very first date.) After a decade together, we wanted to do something special. Since my recent back surgery, I haven’t been able to do much, though. The original “out-on-a-date” plan was replaced with a tentative plan to make very, very gentle love, then have chinese food and watch our new favorite zombie show in bed. I even put on make-up! (Carl’s comment was, “What happened to your face?!)

And so, we put our children to bed. Mary began to sob and cry. Her eyes weren’t even open but she was crying. She hasn’t been afraid of bedtime in almost 3 years. Ever since she got back from the hospital, and I had my back surgery, she’s been afraid again. We’ve done our best to soothe her fears. We use a soothing sounds noise machine, a sensory pillow, her blankie, essential oils, and her favorite cat. Carl even slept on the floor of his room one night so that she could see him across the narrow hallway and wouldn’t feel “alone.” He tired of that after about 3 nights of her waking up crying.

OK, I lied again. We attempted to put Mary to bed. First dad stayed with her. Then I awkwardly hobbled in on my walker to lie uncomfortably on her bed to hold her. She claimed she “couldn’t breathe” because she was so scared. I held her back against my chest as we breathed in and out together using a “belly breathing” technique to calm her. Then I rubbed her back in circles and whispered soothingly, “mommy’s here,” over and over again until she finally fell asleep. Then I clumsily angled of of her bed and back to my walker. Ouch! Definitely time for my pain medication.

Now, Luke and I knew she would wake up again at some point. She is really and truly scared, probably because she is triggered. It may be my back injury that makes her scared to be away from me. It may be that she has been away from us at the inpatient unit in the hospital. Either way, Luke and I knew our anniversary celebration was on a time schedule. So we got to it right away. And then we put our Pajamas back on and went to sleep.

Sure enough, Carl woke us up around 1:00 AM to tell us, “Mary is crying AGAIN!” Not being able to go up and down the stairs more than twice, a day I gave in. We ALL needed sleep after the last week of Mary waking to cry repeatedly through the night. “Send her up,”I said, defeatedly.

Mary came up, clutching her blankie, hiccuping and trying to stifle her sobs. “Climb in,” I told her. And she did with an instant sigh of relief. We all slept amazingly well after that. Mary was snuggly and warm. I typically snuggle Luke but this was even rather pleasant.

I realize that every family is different. Some people do this all of the time. Hey, I don’t judge that. If this is what works for a family, then why not? After last night I am able to see the appeal of holding your child close and helping them to feel safe. I just don’t personally want to do it all the time.

So I spoke to Mary about how we would need to address her new night fear with her therapists. She agreed. I explained in a gentle way that we love her and we want her to feel safe. We just don’t want her in our bed every night. I held my breath and waited for her to protest, or beg, or even cry.

Instead she nodded and said, “Yeah, I don’t want to hear Daddy snoring all night, either.” Well, there you have it!

 

**Names have been changed to protect the privacy of those involved.

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mental illness

Thank Hospital Vacation?

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I must be the weirdest mom ever to think that my major spinal surgery seems like a vacation. Trust me, a little fusion surgery was nothing compared to the chaos Mary was experiencing at home.  I had some complications, and needed a cat scan. They found one of my vertebrae was actually fractured. I sobbed in pain while they gave me every narcotic pain killer intravenously they could. Finally strong muscle relaxants were administered and I calmed down. I clutch Luke the entire time while he whispered soothing things into my hair and stroked my arm. Vacation, right?

I had trouble breathing so I went to the ICU for a day. I had an oxygen tank sort of plugged into my nose in order to help me continue breathing. Vacation, right?

I am in constant, excruciating pain. However, my meals are brought to me, and my daughter Mary isn’t attacking me here. There is significantly less screaming here than Mary is doing at home. I feel deep pain at the incision sight where the doctors cut so deeply into my spine. It doesn’t matter.  I’m safe and safe feels good. Yes, even with the deep and unrelenting pain, this might be a vacation.

Everyone smiles at me and offers to bring me things at the hospital. They help me use my walker (really hard for me to walk right now.) I get to order my meals from a menu. No one yells at me. No one is throwing things. And I haven’t seen one tantrum since I’ve been here. Not even from the patients! This MUST be some form of vacation.

The truth is I’m doing very poorly. The Physical Therapist came to see me and opened with,”I’m not trying to be mean” before helping me to a chair. That is where she wanted me to try and sit for an hour. I couldn’t do it.

The pain was so unbearable that I clutched the chair arm and  sobbed for a half an hour straight. I had an ice pack. I tried the PTSD calming strategies we use with Mary. I grounded myself by what I could see and hear. I sipped water and counted my breaths, trying to breathe in and out slowly. I tapped my fingers in a method I learned at a trauma workshop. I tried to picture the happy place I keep in my mind. I counted to 100 and back. I asked for a stress ball, in between giant, hiccuping sobs. There was mucus everywhere. Tears soaked my hospital gown I just couldn’t stop sobbing. .

“Stop crying,” they kept telling me, “You’ll hyperventilate.” 

“I’m trying!” I gasped, “I’m using my coping skills!”

Did it work? No. They ended up peeling me out of the chair after 30 hysterical minutes. I even had them close the sliding doors so I couldn’t disturb the other her ICU patients. I wanted to be so strong and finish the full hour sitting in a chair. I wanted to stop my sobbing hyperventilation and soldier through. I wanted to be in charge of my own body! But I was basically locked into an adult form of out-of-control behavior. I didn’t yell or throw things. I was very polite when I could get a word out. “Please,” I’d say, “I’m trying!”

I just couldn’t do it. They put me back in bed and administered strong pain medication and  more ice packs. My doctor was baffled. She didn’t know why it hurt so much but she was very concerned that I was adamant to keep going.

My doctor and the PT were concerned with my pain. I wasn’t. Here’s why: my pain is physical. When Mary sobs uncontrollably, tantrums, or panics, her pain is emotional. We can’t administer more pain medication and send her back to bed.

Her trauma is as real as my surgery. Her emotional pain is as real as my physical pain. I’ve made it home now and all I can do is be grateful. That was the absolute worst vacation ever.

**Names have been changed to protect the privacy of those involved.

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family

Contingency Plan: In Case I Don’t Make It

The back brace Mary decorated for me

Anyone who reads my blog knows that our daughter, Mary, has been inpatient at the psychiatric hospital for almost 2 weeks now. It’s her second stint since right before Christmas. It’s been terribly hard on all of us. Children with attachment issues need to be close to their caregivers. Mothers of any kind need to be near their children.

In this case, safety is paramount in all of our decisions. I have a serious spinal injury, . Therefore I cannot physically assist in any way, if Mary has a dangerous dissociative episode. She hasn’t had one in almost 2 years until now. Just our luck that it happens when I’m at my most vulnerable, physically.

They’ve been titrating a new medication for her. We aren’t sure yet if it’s at a therapeutic level. Her emotions are still all over the place. She fluctuates from one minute to the next. She is angry, then giggly, then despondent within 10 minutes. She’s had several physical outbursts on the unit. She’s been defiant towards staff, throwing things at them. During one incident, she pounded on the window of her door, trying to break it. Too bad we don’t have unbreakable plexiglass on our windows at home.

No, she isn’t “there” yet. She isn’t at that place that keeps her safe enough to access all of the therapies and interventions we have in place for her. No amount of TBRI parenting, PHP treatment, TF-CBT therapy, coping skills, or sensory diet can help her until her brain is in a place to process it. The medication helps her brain to get there.

I need a contingency plan. I admit, I plan for all scenarios as much as possible. It helps me to feel productive and in control. Frankly, there are some things entirely beyond my control. But I’ll probably never accept that. At least, not in this lifetime (I swear, I’ve tried!)

My spinal fusion surgery takes place this Tuesday. We are taking our girl home from the hospital on Monday. We will have a meeting to hear the results of the full psychological evaluation they gave her. Maybe we will gain some insight. Maybe not. Either way, she comes home with us.

We have to take her home because I need all of my chickens together on Monday night. We’ve planned a “Pajama Party” where we all pile onto the king-sized bed in our matching Jammies (lame, I know!) and have popcorn.

The next day is my surgery. This is a big long, serious operation. I can face anything if I’ve had my family with me. I’m one tough Mama so I feel like it will turn out just fine. But if it doesn’t? I’ve had that one last family night.

When I was little, my mom used to read to me all the time. Even a series of books called “Sweet Valley  High,” which she hated yet read anyway. My mom has probably made me macaroni and cheese thousands of times. She’s tucked me in, kissed my boo-boos, and generally made things better for me my whole life. She’s taught (or tried) to teach me good lady-like manners my whole life.

I’m not the best student but she loves me anyway (remember my zombie centerpiece at Christmas dinner, mom?) She has perfect hair, perfect make-up, and a perfectly dirty joke when you least expect it. My mom could give Emily Post, Lauren Bacall, and Elizabeth Taylor a run for their money. In the same breathe she can out-do Chris Rock for shockingly funny dry wit. And she’s mine. I’ve gotten to have her for my entire 35 years on this earth. Lucky me.

Mary hasn’t had me since infancy, so I’m making up for lost time. By my calculation, I still have dozens of horrible books from a predictably plotted children’s series to read to her. I have thousands more mac and cheese meals to go. And let’s face it, I’ll probably never have the center-piece thing down. But still. Mary is owed the full mommy experience. The kind I got to have. The kind that always makes it better.

My kids need me. They can’t afford to lose another mom. But if the worst should happen, I cannot, I WILL NOT allow Mary to think that it was all somehow her fault.

It like an oncoming storm. Maybe it will hit and maybe it won’t. Maybe my surgery will be a shining success, maybe it won’t. Maybe Mary has to go back inpatient this week, maybe not.

Either way, we are going to batten down the hatches, and ride it out. Together. As a family. Because that is the most important thing I have ever had in this lifetime. My family.

**Names have been changed to protect the privacy of those involved. 

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mental illness

Trauma Team Super-Heros: Safety Planning

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It seems like we are running through grade-school fire drills, but that isn’t the case. Right now we are preparing for our daughter, Mary, to return from an inpatient stay at a psychiatric hospital. She’s been having violent outbursts on the unit, so it’s possible she may still have them when she comes home. As they adjust her medication in the unit, we are making adjustments at home.

As we create a safety-plan for her return home we are simultaneously planning for my impending spinal fusion surgery. It’s all going to happen at some unknown point in time that is also very soon (?!??) Here’s what the plan looks like:

  • I will not be alone with Mary at any point in time until I am fully healed from surgery. Period.
  • We will remove heavy objects or anything that could be thrown, knocked over, or smashed from Mary’s room. This is for her safety and ours.
  • We will increase the amount of coping skills she can access from her room: body sock, thera-bands, play-doh, cardboard to crush, paper to rip, journal for writing, soft objects to throw or punch etc.
  • Luke and I have our phone always on us. If Mary shows signs of escalating we call for the mobile crisis team to come out. If she has auditory of visual hallucinations we will call mobile crisis for a safety evaluation.
  • If she becomes violent or dangerous, we call 911 for transport back to the hospital
  • Luke stays with Mary to keep her safe until help arrives.

Also, we have super heros helping us!

The Super-Hero Team supporting us when Mary transitions home consists of:

Superman: Their trauma therapist has some serious skills that can only been described as Kryptonion. Her X-Ray vision can see right through our kids into what’s really going on with them.  Her Trauma Focused Cognitive Behavioral Therapy has had almost supernatural success over the years. Sort of like Superman flying up to catch our kids when they were falling through trauma and PTSD. She sees the children no matter what other kinds of therapy they are having at the time.

Batman: The therapist at the partial hospitalization day program Mary will be attending is definitely batman. She has a batcave (office) with tons of coping skills (bat-gadgets.) She’s worked with both of our kids before, and she knows our family. You might even say she is familiar with Gotham City!

Wonder Woman: My husband and I see a therapist while our kids are in session to get better at being awesome trauma-informed therapeutic parents. She is Wonder Woman, because she has the “lasso of truth,” and can always get us to open up honestly about things.

Alfred: I think the Psychiatrist that will treat Mary at PHP is a lot like Alfred was to Batman. Instead of gadgets, he will be titrating Mary’s medication which will allow Batman to do her job.

The Scooby Gang: This consists of my parents, our children’s godparents, and family friends who are willing to watch the children (in separate settings) while I am in surgery. My parents have offered to take Carl for a few days if Mary isn’t safe with him while I’m in the hospital. This way, Luke can help Mary settle and regulate, while Nana and Papa spoil Carl.

 

I think we are about as prepared as possible. Now all we can do is wait.

Dear Trauma,

You might have won this time, but we’ll be back. And next time we will be ready for you!

Love,

Dedicated Trauma Parents

**Names have been changed to protect the privacy of those involved.

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