Unstable, Abusive Teen Refusing Therapy

By Kristina Randle, Ph.D., LCSW

Q. My 13y/o dau has ultra-rapid cycling bipolar,ADHD,& ODD. She has been on several new generation anti-psych since she was 8. With little success. Also in combo with mood stabil and stimulants (at the lowest dose). Due to severe weight gain(40lbs/yr) and continued instability she was taken off Abilify 5mg a month ago. She now is taking Lamictal, Topamax, Concerta. She is still unstable. She is physically and emotionally abusive with her 11y/o brother and I. Very destructive, oppositional, refuses to leave the house and can’t be left alone due to her behavior. She only sees her Dad every other weekend and does not behave this way at his house. He thinks she could not have possibly done the things she has done at home. She can be a very loving, helpful child. Until she snaps. On occasion she been delusional. What usually sets her off is telling her no for anyhing or to please wait. Her reaction is atypical. Screaming at the top of her lungs, biting, kicking, pulling your hair, throwing things, breaking down doors. Afterward she claims not to remember and you will find her hiding somewhere(under the bed, in a corner, the closet). Due to her increased violence with her brother and I her Dad asked her to stay with live for a while. She comes here every other weekend and is still violent. I am trying to avoid committing her. How do I get her to cooperate with therapy? Will it help while she is so unstable? I miss her terribly and want her to get better.

A. Your daughter’s behavior changes when she is in your presence. She behaves acceptably at her father’s house and she is out of control when she is with you. You need to investigate this difference in her behavior and what accounts for it. Perhaps her father is parenting her in a way that he is able to keep her calm and stable. You need to find out what he is doing and why there is a discrepancy in her behavior.

Secondly, you should strongly consider family therapy. Since you and her father are separated but have the shared responsibility of raising a child who has severe behavioral issues, it would be helpful for the family to meet regularly with a therapist. Family therapy allows you to tackle this problem as a family (i.e. we are all in this together) as opposed to trying to force your daughter into individual therapy where the focus would be on her behavior only. She may be willing to attend family therapy if she sees that everyone in the family would be participating and not just her. A family therapist could also help you and your ex understand why your daughter behaves appropriately in his presence but not in yours.

If her behavior gets too out of control, you may have to consider sending her to a residential living facility but first try family therapy. It could really be helpful. Thanks for writing. Please take care.

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Last reviewed: By John M. Grohol, Psy.D. on 29 Sep 2008

APA Reference
Randle, K. (2008). Unstable, Abusive Teen Refusing Therapy. Psych Central. Retrieved on November 26, 2014, from http://psychcentral.com/ask-the-therapist/2008/09/29/unstable-abusive-teen-refusing-therapy/