<p>My daughter, a freshman has had a tough semester that seems to be a continuation of issues she had during high school. We managed to keep it fairly under control when she was home and we thought they were simply a combination of boredom and immaturity. She was at a very competitive high school and we believed that being in a more collaborative environment such as her college would allow her to overcome some of these issues. Unfortunately that hasn’t been the case. </p>
<p>To summarise my daughter seems to suffer from anxiety issues and has for about 4 years. She fears being alone, is anxious around people, seems to be unhappy most of the time, and has an almost obsessive need to be in a relationship with a boy. She simply can’t function unless she is in constant contact with a boy and even then the exchanges are usually frought with more anxiety, self doubt, and/or jealousy. This then leads to some unhealthy behaviour and more anxiety. It all reached a head this week, with an act of self harm. She is thankfully physcially ok at the moment and is en route home from college and should be back by tomorrow.</p>
<p>She has clearly sent out a very loud cry for help. My question is “where do we go from here”? </p>
<p>How do we evaluate and choose a therapist?
How do we know what is the best treatment for her condition?
What questions should we/she ask during the initial evaluation?
Should we get a second opinion?
What is a standard length of therapy?
Should we keep her home spring semester or try to use her school’s counseling services?</p>
<p>I’m really at a lose here as to how we do what is best for our daughter? I’m sure we aren’t the only parents on CC to face this situation so any guidance is most appreciated.</p>
<p>I found a therapist for my daughter when she was young and I felt experiencing undue stress over my husband’s illness with cancer, so I started by asking our pediatrician for some names, then I asked a few very close friends, and she had sort of an initial “interview” that lasted about 1/2 hour and was meant to determine if there was a fit. One therapist was sort of cold, the other was much friendlier and warmer, so it was a pretty easy choice. The therapist wants to take on patients they believe will be open with them, feel comfortable talking about their feelings, and where they think they can be of help. My daughter was much younger than your daughter, but some of this would apply. She may need a psychologist and a psychiatrist (who would prescribe something to lessen the anxiety then the psychologist would do talk therapy where she’d discuss what made her anxious and see if she could learn new ways to respond). Many friends have had very good results with social workers instead of psychologists. Good luck. She’s lucky to have you looking out for her.</p>
<p>I like the book, The Everything Parent’s Guide to Children with Anxiety. There are other books in this series, and other good series. David Burns has a workbook called “10 steps to self-esteem”, and a newish book whose title I forget at the moment, that use cognitive therapy to identify and challenge distorted thinking. </p>
<p>Most therapists, including psychiatrists, begin training with adults. Learning child and family therapy can be an additional 1-2 years. So, I’d ask the T if they have specialty training, and what % of their practice includes young adults.</p>
<p>During vacation, she could see a local T 2x/week or more, and then follow through at school or with a T in college town. Therapy doesn’t need to be linear. It can be intense in the beginning. Having a good relationship with the T is important.</p>
<p>Sorry to hear of your situation. Believe me, you are not alone. It is a good idea to start with the pediatrician for recommendations for those who treat adolescents. Our dr. recommended someone who specialized in grief therapy so I did not feel like that would be the best possible solution since our D’s issues were similar to your D’s without boyfriend stuff. I asked a friend who is a therapist (MSW) if she could recommend someone and she gave me 2-3 names and I checked our insurance plan for those names and the kinds of patients that they treated. My D wanted a female so I would ask your D if that mattered. I was told that sometimes you might need to try several for a “good fit”. Hopefully, you can get her in right away and the thearpist should be able to help you and her decide if she should go back to school. My D told me almost nothing about what was said other than she now knew how to breathe a different way when she was anxious. </p>
<p>Also, I found it helpful to drive her to therapy and keep the radio off on the way home. She rarely said much but I could tell she was digesting was had been said. Wish you the best.</p>
<p>I agree with Class’s advice. Since you need to evaluate over the Holidays to make a decision about next term, I would suggest that you find a provider who can also prescribe meds. or at the least is in a clinic with a psychiatrist or NP. Another place to begin is with your insurance company. You can call them and there will be someone to triage you by giving you a few names and numbers. They will also have a website where you can put your zipcode in and see who practices in your area. Because of your daughters age the therapist will not be able to talk with you unless she gives specific and written permission. Often the therapist will let the client know that they will inform the parents if there is anything of danger to note. This does not include, however, general drugs or alcohol unless it is life threatening.
If she does take medication and has enough time to see the results she might be able to return to school. Without an evaluation it is difficult to know if it is wise that she return. Using the college services can work–look at their website and see what their credentials are. Otherwise, you can proceed as above but in the college’s area. Your D can get a medical leave for next semester and could make up the classes at home and over the summer as another option. Very good thoughts being sent your way.</p>
<p>Thank you for the responses so far. I appreciate the thought about seeing if my daughter would prefer a female. That was a great idea. </p>
<p>We did manage to find a few places, one through our Paediatrician and one through the insurance company website. Both are groups that have both Licensed Social Workers, Pyschologists, and MD’s as part of the practice. One offers both residential and intensive out patient therapy services with the other only out patient therapy. We were able to get appointments next Monday / Tuesday so hopefully after the assessments we’ll see what they suggest.</p>
<p>I guess I’m still so in the dark about how we evalutate the advice they give us as to her treatment? What things should we ask them about their credentials or track record and therapy methods? We simply just want what is best for our daughter and I feel so unprepared to judge what is the right course of action. </p>
<p>I feel like for so many years her father and I have just thought this was something she’d grow out of or she’d simply grow tired of acting this way…it dawned on me after the last few days that our daughter just needs help and neither she nor we are able to provide the treatment she needs by ourselves</p>
<p>But at least she’s started the journey to recovery.</p>
<p>Thank you all again for the on-going support.</p>
<p>You say she self-harmed, and to me that’s a big deal when it comes to what you’re looking for in therapy. First of all, it’s suggests there <em>may</em> be an underlying diagnosis such as borderline personality disorder (which also fits very well with her fear of being alone and need for romantic attachment). So if I were you I’d want to make sure whoever she sees is experienced in diagnosing and treating various disorders instead of just, say, assuming all unhappy people have as “simple” a diagnosis as depression. I say this because, if she does have borderline personality disorder, a specific form of therapy called dialectical behavioral therapy is much more successful than other treatments, and many therapists have no clue how to do it. </p>
<p>Even aside from the possibility of some more complicated diagnosis, make sure the therapist is comfortable with treating someone who has harmed/does harm herself. A lot of therapists find that challenging.</p>
<p>You also want to find out how the therapists describe what they do. Cognitive behavioral therapy? Psychotherapy? Then research whatever they say.</p>
<p>Also, consider involving a psychiatrist in addition to therapist in case your daughter ends up needing meds.</p>
<p>How far are you from her college? If she will need ongoing therapy while at school, you will need to consider this as well. Is it possible for her to come home for this therapy or, if she is returning to the college and it’s not close enough, maybe looking for someone nearer to the school might be an option. OR perhaps the person near to your home can help you with this. Often there is a need for ongoing therapy and finding someone near the college (if it’s a hike away from home) maybe something to consider.</p>
<p>What’s important is that she “connect” with the therapist, not necessarily that you have that connection. We had an issue where we thought our dau’s counselor was super- but it turned out to be the wrong match for her. </p>
<p>You can ask the college- they refer kids so often and should know people who works well with this age group. ANd, if the first isn’t right, absolutely try another. </p>
<p>We found that our pediatrician simply had a list of suggested names- with no real knowledge of them. The goal is to find a counselor who “knows” teens and college-age kids, understands the pressures and thought patterns, as well as the psychological side- and how to talk to kids, how to draw out info and work toward success. Someone who just happens to also see kids may not have this level of skill and understanding. Good luck.</p>
<p>Your daughter is in a crisis. Would you ask an Emergency Room doctor for their credentials or track record? </p>
<p>My point is that your daughter needs help right now. I would go with what the doctors recommend unless they came across as totally incompetent or drunk. If you feel confident in the doctors, then great and look up their recommendations. If not, then I’d start looking for a longer term solution but I would go with the short term solution for now. </p>
<p>I think it’s wonderful that you are taking this all so seriously but it is easy for people who do not have anxiety to dismiss it or minimize it. Those of us with anxiety also become very good at hiding it until a crisis. Thank goodness you’re listening to your daughters cry for help, she’s lucky to have such good parents.</p>
<p>We have gone through similar times with our son. Mainly anxiety/depression and thoughts of harming self (some of his decisions could probably be classified as such).</p>
<p>When this all started he was lucky and found a counselor on campus that was absolutely great and he worked with an off campus psychiatrist for any meds needed. Unfortunately, that wonderful young man moved on then it became a trial and error process. Some of the people who sounded great based on referrals and credentials were a total misfit with him. All I can say is if the first doesn’t work out (given a little time), don’t give up and keep looking—therapy is a very intimate process and the “chemistry” between patient and therapist is so very important.</p>