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Norman M.
Norman M., Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
Category: Mental Health
Satisfied Customers: 2568
Experience:  ADHP(NC), DEHP(NC), ECP, UKCP Registered.
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Are there inpatient /outpatient programs available to my 22-yearold daughter, who is strug

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Are there inpatient /outpatient programs available to my 22-yearold daughter, who is struggling with depression, weight issues, and severe body image problems? Right now she is in the bathtub crying and lying water, clothes on, and banging her head on the tub side.
She has seen several therapists but doesn't seem to make any progress with anyone. I have insurance that could cover a portion of the cost.

NormanM :

Hello, I'm Norman. Are you ready to chat?

NormanM :

I see that you are still offline, so I'm going to switch this to Question and Answer mode

There are programs available which would help your daughter, and if you tell me where in the US you live, I shall do some research for you.

In the meantime, I'd like to know too if she is currently taking medication, and if so, what and how much.

Does she take her meds as prescribed each day?

What kind of therapy has she had?

Regards, Norman.
Customer: replied 4 years ago.
She has taken meds while undergoing therapy...usually stayed on them for several months, but eventually went off of them...claimed they weren't helping much and were contributing to weight gain. I don't think she's taken any anti-depressants for 8-12 months.

She has seen 4 different therapists, as I recall. Started with the first one at age 14...only a few weeks. A second woman at about age 17...saw her for about 1 year, at a time when she had been cutting herself. I don't remember if there was another one...
She had a panic-type, stressed out event associated with work and we counseled her to take some time off, if needed. She ended up taking 10 months off work. She began seeing but the most recent, a male psychologist, about 2 years ago. After about 4-6 months she complained about his attitude toward her.

She invited me to one session with him because she said he didn't think she was "trying" hard enough to get better. She has a habit of laughing when nervous, and he misunderstood and said something about her not being serious. When I was at the session, he appeared to me to be completely out of touch with her thinking and feelings. She quit going to him shortly thereafter because of his unsympathetic/non-understanding "judging attitude." Later she went off the meds.

I have tried to help her find another therapist (my insurance) but she won't see a woman (she feels they are judging her body) and she doesn't think male therapists can understand her feelings about herself. (From my reading, I notice some correlation between her symptoms and body dysmorphic dysfunction, as well as anxiety.) She has related having a traumatic experience as a 12-year old, which she won't tell me the details of...I infer from what she says that is was not rape, but was a situation at a teen party where she felt sexually violated in some way.

Once she got very drunk at home, and called the sheriff's office to report the incident. They arrived and talked with her...then me, and reported that she said her parents didn't believe that anything had happened to her. I told the officer that we hadn't known that anything had happened until years later...there wasn't anything we could do at that point. She claimed the person who offended was not known to her...a friend of someone she knew at the party. Had I known, I would have believed...and would have tried to do something about it then. Her memories and beliefs around this incident aren't consistent.

I assume her therapy has all been cognitive behavioral therapy, but I don't know. She is very private about these things and doesn't discuss it with me...since she's an adult, I only know what she volunteers.

She functions for periods of time, but we always come back to body image issues, trouble losing weight, inability to handle stress at work, and self-medicating with regular alcohol after work. She doesn't think she has any problem with alcohol. Tonight, after losing her temper at us about how HOT the weather is, stress at work (we are her regular sounding board, and she verbally dumps her stress on us each night...yes, she is still living with us due to economics) she started crying and got into the bathtub with clothes on, laid down and cryed loudly there for about 45 minutes. She also began banging the side of the tub in a regular pattern. Another 15 minutes went by. I checked on her several times...asked her to get out of the tub.

A few minutes ago she quit crying, straightened herself and took her keys to go out to drive. I tried to delay her...this incident is not completely unusual.
Your daughter is in urgent need of professional help It seems to me that she needs to get back to medication and therapy. If she does not, she is just going to get worse, I'm afraid.

This must be the main thrust of your approach. Get her to accept that there is a problem, that help is available and she needs to take it.

This is a very difficult situation, and to be honest, there is no simple solution.

Until someone with a problem accepts that there is a problem, they won’t do anything about solving it. That’s the first hurdle. The second is convincing them that help is available, and that the should accept it.

Sustained gentle persuasion is at least part of the answer. Just being there to listen, and letting the person know that you are there for them may let them build up enough trust inside themselves to begin to deal with it.

You may not to be able to solve their problem, or for that matter understand how they feel, but just listening and letting them talk can be really helpful.

Getting people to open up can be difficult. It has to be done sensitively so that the person does not feel put down or alienated. A gentle approach like ‘It must be difficult feeling as you do. Perhaps we could talk about it? is often the best start.

Choose your time and place carefully if possible so that the person feels as safe and as comfortable as possible.

Try to make sure that the person feels that you are on their side, and try to use ‘open questions’ – ones that don’t allow a simple “Yes” or “No” answer.

Don’t try to give them solutions, because as they open up and talk, the person begins to find their own solutions.

Good beginnings are:

Where – 'Where did that happen?'

When – 'When did you find out……?'

What – 'What else was happening?'

How – 'How did you feel?'

Can you tell me…….

How are you feeling? This helps to get past the bare facts of a situation, and lets people

begin to look at their inner turmoil.

Don’t push hard or try to tell them what they MUST do – give them space and time to talk.

There are some things you can do, and here are some tips:

What you can say that helps:

I’m here for you – you’re not alone.

What causes these thoughts and feelings is a real illness, and it can be treated..

You may not believe it now, but someday, this will pass and you’ll feel differently.

I care about you and want to help, even if I don’t really understand what you are going through right now, how you feel, and what you’re thinking

Don’t ever give up – just hang on one more minute or hour – whatever you can.

You are important to me. Your life is important to me, and to everybody who knows you

I’d like you to tell me what I can do now to help you.

We can get through this together

Don’t say:

Cheer up- it could be worse

Quit worrying about it – you’ll be fine

Your just imagining it, it’s all in your head.

Everybody feels like this sometimes

You’ll just have to help yourself

I’d have thought you would be better by now.

Get over it and snap out of it.

Grow up and act like an adult.

What’s the matter with you anyway?

You’ll also find some helpful information here:

Also the Samaritan’s web site in the UK here is a mine of useful information which will help you, as is the National Suicide Prevention line (in the USA), which you will find here.

Ultimately, of course, a person can be hospitalized against their will, but only under the strictest of circumstances.

The laws of committal vary from State to State, but in general there are broad similarities.

Committal is a legal means of providing individuals with emergency services and temporary detention for mental health evaluation and treatment when required. It can be voluntary or involuntary.

A voluntary committal is when a person 18 years of age or older, or a parent or guardian of a person age 17 or under, applies for admission to a facility for observation, diagnosis or treatment freely and of their own accord

An involuntary committal is when a person is taken to a facility for involuntary examination.

This can only be done when :

There is reason to believe that he or she is mentally ill and because of his or her mental illness

The person has refused voluntary examination and

The person is unable to determine for himself or herself whether examination is necessary and without care or treatment, and the person is likely to suffer from neglect or refuse to care for himself or herself and such refusal could pose a threat of harm to his or her well being;

and there is a substantial likelihood that without care or treatment, the person will cause serious bodily harm to himself, herself or others in the near future as evidenced by recent behavior.

A person may not be detained for more than 72 hours.

A law enforcement officer may take an individual to a facility for evaluation if he has reason to believe that the individual's behavior meets the statutory guidelines for involuntary examination.

If a person is willing to swear in a Petition for Involuntary Examination that he has personally witnessed an individual causing harm to themselves or others, an "ExParte" for an Involuntary Examination can be made.

A person may not be detained for more than 72 hours on primary committal.

These are general guidelines, and you should get legal advice as to what specifically applies in your State.

If you can tell me where you live, I can check what programs are available in your area.

Customer: replied 4 years ago.
We live in Nevada City, California. It is about 50 minutes to drive to Sacramento. I do not want to have my daughter forced into a facility, but at times when she's been most low, she had indicated a willingness to consider a residential program where she could "get away" for awhile and try to work on her issues. Most programs are for addiction issues first---she hasn't demonstrated a big problem with alcohol. We need someone who can work with her on body dysmorphic dysfunction and possibly therapist told her she thought she could be suffering from PTSD.
Leave this with me please and I'll get back tomorrow. It may take me several hours to sift through the information so please do not expect an immediate response.
The three best options I could find for you are:

I suggest that you have a look at their websites then inteview them thoroughly on the phone before making any decisions. Make sure you write out all the qustions you need to ask beforehand, so that nothing is missed!

Norman M. and other Mental Health Specialists are ready to help you
Is there any other information you need?

If not, would you be so kind as to rate my answer?

Regards, Norman.