I called the pdoc earlier this week to say, "hey, Sissy is having some serious issues." He bumped up her monthly appt to this morning.
We talked for some time. We went over therapy strategies. We reviewed the standards: hurting self, hurting others, seeing or hearing things, talking to people not there, hyper sexual or religious, want to die, sleeping, eating, toileting, school and then ... home life.
choices, choices, choices. pdoc agrees with us and the therapy team, it's a matter of choice, not medication or disability. There's no pill to fix this. It's up to Sissy. Pdoc said to her, "If you don't pull your stuff together and start making the good choices, I will send you back to the hospital. you can not behave this way at home. You can not treat your family like this."
Which is what the therapy team has told her. Which is what we've told her. Which she continues to pretend she's never heard. Therapist came this afternoon and we rehashed it all some more and Sissy still sitting at the table, tongue hanging out, staring into space, ignoring us all. I watched her therapist get completely exasperated with her and I just laughed. "Yep. Now you know why we're so put out with her. It's ridiculous. She simply doesn't care."
Therapist said, "I just don't even know what to do at this point! She has NO response to us telling her she'll go back to the hospital! NONE!"
and The Dad and I just nodded our head and said, "yep. we know."
It's up to Sissy. We tweaked her lamictal a smidge and are changing when she doses her intuniv to help her sleep better (her sleep walking and talking is pretty bad right now) and the doc said if she gets worse in her rage or starts talking about suicide to call and he'll up the resperidal. Pdoc is also going to make some of the diagnoses official and fax the report to school in an attempt to nail down a medical IEP.
We're going to switch to CBTs to try to put it in her face that it's her choice to change and we're going to make her "rewards" be temporary. In other words, if she wants TV today, she must bathe properly TODAY. Tomorrow will start it all over. No TV if no proper hygiene. period. It's behavior modification with a short term, temporary reward. We'll also begin implementing a two tier consequence system. Consequence for the infraction and if she escalates or lies, then consequence that too. pdoc said to give her two choices (love and logic) make your bed by 8 am or get no computer time. you pick. He said to keep saying "the choice is up to you. only YOU can control the outcome."
but she's heard all of this and more in one way or another for four years worth of therapy. I'm not thinking it's going to have any affect. After that, there's nothing more that we need to do or change. It's up to Sissy now. I don't WANT her back at RTC but that's not a choice I get to make for her at this point. It's a choice SISSY will be making for herself, harsh words her therapist concluded today's session with.