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Does Family Therapy Work? Especially if Stepparents are involved?

completely overwhelmed's picture

The current team working with SD at a mental health facility has recommended family therapy with DH, me and SD together using video conferencing (SD is in another state).

I’ve taken SD to therapy appointments, but never participated. DH doesn’t see therapy as useful. Has this worked for other people?

Is having a stepmom involved helpful? I’m not disengaged, but I think of myself as being as non-emotionally involved in what’s going on with SD as possible. She hates me and I don’t particularly like her. I feel very guilty about this and don’t want a therapist to put pressure on me to do more with SD or blame me for her problems.

Long story short: SD is almost 16. We’ve had her full time for 4 years. BM is in jail and has a long history of drug issues. SD has history of mental illness: suicide attempt, anxiety, depression, ODD, ADHD. SD was sent to an out of state residential treatment center but that failed miserably and she attempted suicide while there, so she needed an even higher level of care. Now SD is refusing to speak to DH and doesn’t want to come home. DH and SD simply don’t get along. They are complete opposites.

DH wants doctors to fix SD like she has a broken arm. He understands depression and anxiety as a chemical imbalance in the brain that can be corrected with medication (or possibly electroshock therapy).

He doesn’t believe talking to a therapist can fix a chemical imbalance in the brain. He blames BM and her drug use and drinking alcohol while pregnant for messing up SD’s brain chemistry and thinks doctors aren’t doing enough to fix this damage.

His conclusion is any type of therapy (talk therapy or cognitive behavioral therapy) is a huge waste of time and money. He wants doctors to concentrate on fixing the chemical imbalances in SD’s brain instead – and if the medication isn’t working then he wants them to use shock therapy which he’s read about online that works in cases where medication can’t. (This isn't done in minors and SD is scared to death of doing shock therapy. She also has a heart condition that increases the risks involved.)

Part of the reason he’s so against this is that it simply hasn’t work. He’s wasted a lot of money sending SD to therapy. SD has gone to talk therapy twice a month for over 4 years. And things have gotten far worse, not better. She’s had worksheets and workbooks trying to change how she thinks and she doesn’t do them. She still has the same dysfunctional thought patterns. Her IQ definitely is well below average and I’m not sure she has the intelligence to really understand what her therapists have told her.

SD is still refusing to talk to DH and there’s been several phone calls where it was 10 minutes of DH trying to talk to her and SD not saying a word or humming loudly so she couldn’t hear him. And DH has to pay for this.

DH’s grandparents were all immigrants from SE Asia and he was raised in a very traditional Asian culture that values hard work. Kids are expected to obey their parents without question. They are expected to do very well in school and want to make their parents proud.

SD is incredibly lazy. She’s developmentally delayed. She has Oppositional Defiance Disorder (the best example of this is DH tells SD her shoe is untied and to tie her shoe. She refuses on simple principle that she won’t do anything DH wants. DH tries to tie SD’s shoe and she literally walks away. The next day, both shoe laces are untied as if she’s daring DH to start the fight again. Literally, there is a war between them over tying shoes and she is 15 years old). Everything about her drives DH crazy. The therapist asked him to name one thing he liked about SD and he was at a loss of words.

DH usually goes for tough love over being incredibly supporting or more like a mom. For example, if SD is whining about not feeling good because of her hives and doesn’t want to get out of bed, DH encourages her that getting up and doing something will distract her and she’ll feel better rather than doing more of the mom thing and letting her stay in bed and making her soup or something.

When SD doesn’t do what her dad says, he does lose his temper. He does a lot of yelling at her, but has never raised his voice to our 4 year old daughter.

SD’s self-esteem on a scale from 0-10 is a -10. But there’s no way DH can really praise her since she refuses to do even simple things.

DH isn’t from a family that was at all physically affectionate. He’s more affectionate with our 4 year old daughter, but with SD being a teenager, he’s far more of the “dad” than a substitute mom. And I don’t think he’s equipped to do that at all. SD does lack emotional support.

Is there any point to DH and I doing this family therapy? Does it work? DH is telling them he isn’t interested and won’t pay for it. I know the family dynamic is messed up but I’m not sure any counseling is going to fix it.

How do therapists react to stepmoms who are disengaged? I'm worried I'm going to be pressured to be the substitute mom for SD or say something that makes SD feel even worse. I don't like her. I know that doesn't help her mental condition, but there's nothing I can do to make myself feel differently about her unless her behavior changes.

moeilijk's picture

I truly do not understand any of this. Your DH doesn't give a flying rat's ass about SD, and you care more about being judged by a stranger anyway. There is nothing to be gained by therapy since therapy is not about blame and both you and DH are all about blame.

Just accept things as they are. Your DH is the kind of man who won't be bothered with a kid (or probably anyone) who doesn't measure up, you are the kind of woman who feels burdened by the expectations of others, and SD is screwed. Oh well. Let is go and move on. I wish you well and hope that neither you nor your shared child with DH becomes the target of DH's anger at violated expectations.

completely overwhelmed's picture

DH cares very much about SD – especially her future and how she can possibly function in the world and live independently and be successful in life. I’m not sure I can say he loves her, because he feels highly disrespected by her. In his parents’ culture, love and respect are very much connected.

It’s difficult for him to also understand how SD can be depressed without using chemical imbalances as the reason because his grandparents and great grandparents have had such difficult lives and suffered greatly.

He sees SD as being handed a very easy, comfortable life and she’s so depressed that she wants to kill herself. It’s impossible for him to understand that when he compares it to how much his grandparents suffered and how they responded by enduring and building a life in the US. So he does need something or someone to blame.

He sees SD being disrespectful to those sacrifices her great-grandparents made so she could have such as easy, comfortable life with so many nice things she doesn’t appreciate at all.

SD doesn’t care about any of that or how DH feels or how DH thinks about her. DH's parents were far more harsh raising him and he never tried to kill himself. They never showed him any sort of love and he feels that he is far more Americanized and this has resulted in his daughter wanting to end her life.

moeilijk's picture

All this is just talk. Your DH doesn't show his kid any love either. That doesn't prove anything, except that if you don't show your kids love, they may or may not get depressed and they may or may not build a life for themselves.

Who does your DH think he is? That he had it rough so it's a slap in HIS face if his daughter has problems she can't cope with? I had a boss once who told me that the only employee she felt wasn't taking advantage of calling in sick was the one going through chemo. Are you kidding me? That if your suffering isn't deadly then you are a weakling playing the system?

So anyone who isn't currently being tortured has no excuse for having a bad moment? I am disgusted just imagining how your DH must have dealt with SD as a toddler - what a pathetic, lazy 2 year old who was so self-indulgent as to cry when she fell. Now the problems - and consequences - have gotten bigger along with SD.

Your DH sounds like one of the most selfish, petty men alive.

completely overwhelmed's picture

DH is very affectionate with our 4 year old, but he and SD just don't get along. SD has sensory processing disorder, but she wasn't diagnosed with that until DH got custody 4 years ago. Our BD likes to hug and cuddle and SD doesn't like being hugged and also had issues when she was little with hitting and ramming into people. DH is from a culture where misbehavior is not tolerated. Our BD is very well behaved and adores her daddy. I don't think SD ever has.

One of the things DH has been told by therapists is to respect how SD feels and realize she's allowed to how she feels and he can't change that. But, the therapists are trying to work with her to change her dysfunctional thought patterns. His opinion is that therapists talk out of both sides of their mouth and constantly contradict themselves. They aren't going to get him to change how he feels, especially since he sees Americanized and Westernized kids as being so badly behaved and less successful.

He doesn't see his job to be SD's friend. He wants to prepare her to be successful in life, so if that makes him selfish, then he's selfish. That's what he sees as caring for her. He cares that she can actual function in the world, which a lot of Millennials these days can't.

notsurehowtodeal's picture

The "best practice" for most cases of depression is a combination of "talk therapy" and medication. Medication alone usually does not solve serious cases of depression. Have DH research that on the internet. Shock therapy is being used more often and it is better than it used to be. However, since your SD has so much more than just depression I doubt she would be a good candidate.

Why not try the long distance therapy for a couple of sessions and see how it goes? You can always quit if it is not working.

I have read your previous blogs and it seems one of the problems is DH wants everything done his way. However, his way does not work for SD. She learns differently than he does. He did not pick a boarding school that in any way met his daughter's needs. It seems the boarding school was so wrong for her that it made things worse.

I think DH does try - but not in a way that is helpful. He doesn't seem to really understand her issues, nor does he seem to want to.

It is heart breaking that your DH can't even name one good thing about his daughter. I don't doubt that some of her mental issues are biologically based, but it seems clear that her father's feelings towards her have become part of the problem.

Would he be willing to give a therapeutic boarding school another try? This time he could do lots of research and get recommendations from the people who are currently working with her.

completely overwhelmed's picture

I don't think the therapeutic boarding school is an option right now. There really is a lack of therapeutic boarding schools that deal with both special education and those with psychiatric conditions. The place he sent her to had a residential treatment phase then the student progressed to a less restrictive, lower level of care.

Before DH sent SD away to the boarding school, he called the parents of 3 kids graduated from the place and those kids did fantastic. All are in college or graduated from college and have careers. But they were having issues with doing drugs so the RTC phase was for detox. The goal for SD was to stabilize her meds during that phase and get her to be compliant with the program. But she didn't care and she can stay in bed for days on end and not care about getting up or doing anything at all.

When I emailed her long-time therapist about where SD was being sent, she said it wouldn't work and she was right. But this is all over her head. She's a nice person, but this is beyond what she's capable of dealing with. Her psychiatrist still wants to find the right medications and wants us to get help of a psychiatrist experienced with working with patients with cardiac conditions to determine if she can be prescribed meds that are not recommended for anyone with her heart condition.

DH may have made it seem like SD's major problems where being incredibly disrespectful and disobedient when she spoke to the school's admissions person. When they figured out the scope of the psychiatric problems, they understood they couldn't really deal with her. I'm not sure similar boarding schools like that will be willing to deal with the issues. And every time she's been placed in inpatient, she's sent home with the hopes that she'll do better out-patient because she's getting so little out of it and they need to wait for the meds to work.

completely overwhelmed's picture

I don't think even SD knows what she wants. Certainly it's not a happy family life with me, DH and her half-sister. She acts like she can't stand being around us and doesn't want to be living with us. Some days she wants to see her mom and others she doesn't. But that's not really an option.

She has no goals or plans for the future. Her therapist she's seen for years locally says she freaks out over any discussion of what she wants to do when she turns 18. That's in part due to all of DH telling her if she doesn't do well in high school, she can't get a job. She doesn't like being around people. I don't think there's any possible jobs she could do and she knows that. She's likely never going to graduate from high school, much less college.

notasm3's picture

Not all mental disorders can be cured - even with all the medicine and therapy in the world. Just like not all cancer can be cured.

It's probably not going to end well no matter what. Sad.

Harry's picture

Real mental disorders like this, can not be fixed. They can not change chemical imbalance in the brain. Therapy with people that bad doesn't work. It's the medical Dr. Not knowing what to do.
There best answer is to give them drugs to keep them in a state of a medical dazed. So other people see them as OK , a little off ? But these drugs cause them all kinds of side affect, sleeping all day up all night. No sexual function, can't ship for days. Feel like they just, can't feel anything. Will drink and take other drugs to fell better

Unfortunately, this is going to be a lifelong thing SD is not going to get better, she is going to have good days, weeks and months and going to have many bad years. The really unfortunate part is, that some time in her life SD going to figure out herself that she is unfixable
Can't have a relationship with a partner, can't keep a job, basically can't be normal
That when they lose all hope ant try to kill them selves.
Telling you from experience,

P.S. After they do a few years of this therapy, they know what to say. Them every time you talk to them you get a rehurst thing. Going to try to do better, going to try to go back to school, going to do better Turing the corner etc etc going to take there meds,

Acratopotes's picture

Yes In this case I would go ... DH will attend as well, even if you simply learn how to communicate effectively...

You do not need to say anything, keep quiet but it will be good to hear SD and DH... and answer truthfully when asked a question...

That famous joke question of :" And how does this make you feel" laugh and say I feel with my hands.... I'm only here to help my husband communicating with his daughter and getting her the right help she needs, also I'm here for the daughter to understand her better cause she has all the help in the world but refuse to take it

still learning's picture

DD was in and out of the psych ward several times as a teen. Her father and my mother have serious emotional issues that I think she inherited plus suicidal behavior modeling by exH didn't help either. We did so much family therapy and I didn't see any benefit at the time, but later I realize that it did help. The family therapy sucked and basically DD just ragged on about how much she hated me and how I was the crazy one ruining her life, her dad who didn't attend was always the saint. It was important for DD to know that I was trying my best to understand her and help her through this time. DD did get worse before she got better. I think part of it was age and receding hormones. When DD did therapy alone it did seem to help her more though.

It was a rough 5 years that I went through w/her. I kept going to therapy, taking her to therapy, kept doing whatever it took to keep her afloat. She was on Prozac for years too. She's 22 now, employed, emotionally stable for the most part, and doing very well.

bearcub25's picture

I wish I had some answers as I really feel your pain. My SS is like this. DSO would always say, why don't they just give him a pill and fix him. He has been on meds for 13 years and I have never seen any changes in him at all.

My DSO or BM wouldn't send SS to a good out of state psyche treatment center, they wanted him close. He will be 18 in 5 months and the boy is in no way shape or form ready to live in the real world.

I hope something works for you all. See if you can talk your DH into at least trying the therapy before the shock therapy.

still learning's picture

As bad as my daughter was there is no way I would have allowed shock therapy that would permanately fry brain cells. She'll be 18 soon and many of these kids shape up once they realize their behavior is now on their own shoulders.

completely overwhelmed's picture

The shock therapy is essentially a reset for the brain. It's essentially like turning a computer on and off. It can have very quick results for people with severe depression. I know it sounds terrible, but psychiatric consider it incredibly safe and very effective. If it didn't sound so harsh, it would be far more common because of how effective it is. There have been studies on how much it helps kids with severe depression, but many states restrict the use in minors. If SD didn't have the heart condition, he might be able to find a doctor willing to do it, but there's too many risks and doctors are far too risk averse.

I'm worried what will happen when SD turns 18. When things seem difficult, she panics and she absolutely can't deal. She quits. And she's found a new way to completely quit - killing herself. DH and I don't think she'll figure out she needs to change when she's on her own. She'll find better ways of taking her own life because she can't deal with any sort of challenges.

But if that happens, what's the risk of doing the shock therapy now? What I don't want to happen is DH regret not doing more if SD does succeed in taking her life. That's why I was ok with him spending so much to send her away. And now he thinks the shock therapy is the solution.