Further questions about residential placement for daughter with medical/death anxiety

[Dadof2kids3cats]

Hello again. Following up on my post earlier today with a couple of other questions....the day before our daughter L was hospitalized, we spoke with her psychiatrist, who said that the main reason for L to spend some time in a hospital or residential setting would be so that she would be in a safer and less stressful place while her providers tried a medication change. My impression is that she thought that L would be able to work on ERP and any other appropriate therapies while living at home (perhaps in a PHP) if/when her condition was a little more stable, and that we should be looking primarily to medication changes to get us to that point. Certainly at the moment it does not seem like she would be ready to deal with ERP now. What do those of you with relevant experience think about this? Certainly it will also be easier to find her a residential placement if we are not specifically looking for one with a specialization in OCD.

Another possibility is that she might go directly into a PHP without a period in residential. L says she at present would LIKE to have a residential placement where she would have less freedom to make bad OCD-driven choices, but she may have an idealized picture of what that is likely to be like. I'm struck that there seem to be a lot of bad reports about residential programs (although perhaps more about programs for teens with substance abuse disorders rather than adults with MH problems) and am somewhat concerned about her going into one, and especially if it is too far away for us to see her often.

On the other hand, three possible advantages of residential placement are that (a) if L's symptoms get even worse while changing meds, that could be overwhelming for my wife and me, (b) given the nature of L's compulsions, being in a residential placement would provide a significant level of "response prevention" even without explicit ERP--she would not be able to take herself to the ER or urgent care, she would not be able to check her blood pressure or O2 saturations repeatedly, etc. (We might be able to provide some of this if she is at home--e.g. taking Uber off of her phone, getting our BP cuff and pulse oximeter out of the house--but it would likely be more difficult and more stressful for us.) (c) more generally, as parents it is difficult for us not to accommodate or reassure L when she is in distress, even if we all know that this is bad for her in the long run--this should be much easier for care providers who are not family members. We'd welcome any thoughts about how much weight to give any of these considerations from anyone with relevant experience (or professional knowledge.) Thanks.

[Zen108]

I haven't done PHP or residential, but I have read of places that do offer it for OCD. Rogers is one such place. Can you ask your daughter's psych which would he best? I'd hesitate to choose residential first. Perhaps, PHP first to see if it helps.

[Zen108]

It sounds like she needs better medication management first. Until there's a med(s) that can calm her and lower her anxiety, I don't see how she could do ERP. At least, that's why my GP told me.

[Dadof2kids3cats in reply to Zen108]

Thanks so much for your comments! We have also been thinking that in the short run she will probably not be ready for ERP, so that if we are looking for a residential placement, it would not have to be OCD-specific. FWIW, the main reason that she WANTS a residential placement is that she figures that it would make it difficult-to-impossible for her to carry out most of her compulsions--so if/as she is continuing to have anxiety spikes, there would be an element of response prevention built into her circumstances, but that would not require the availability of formal ERP.

[SCC1 in reply to Zen108]

I totally agree!

[Zen108]

I understand why your daughter would think that, and never having been in residential I can't say she'd be wrong. But if your daughter does residential at the wrong place she could develop mental compulsions as a way to cope with not being able to do them physically. I know that for me after a triggering or traumatizing event, the rumination is hell. I don't have an easy answer as I am currently seeking someone different for medication management. OCD is a sneaky beast.

[Natureloverpeace]

The level of care needed is based on the severity of the OCD. Just a heads up, there are therapists who claim they are OCD specialists, and who mean well, but they don’t have the specific training to treat OCD. If L needs residential OCD treatment then a residential treatment program for OCD would be appropriate. They would also be able to provide appropriate medication management. There are only a handful of residential OCD treatment programs in the United States. You can learn more about them at iocdf.org and click on Find Help.

[Sallyskins]

I think it's a mistake to say that your daughter will not be ready for ERP. It is difficult to do, but it's good to make a start on it. The alternative is letting the OCD take greater hold of her.

If she can go at her own pace, then she can make progress. It's painful, but it does get easier, and bit by bit she can get her life back.

It's important to stretch yourself with ERP just enough to make a difference. An analogy occurs to me: I once injured my shoulder so badly that any movement was agony. It ached from neck to wrist and there was a ten week wait for physiotherapy. I phoned them and asked if there was anything I could do in the meantime. They said to stretch it gradually. I did, and the relief was immediate. The physiotherapy, when I got it, was painful too, but it sorted it out.

In the same way, just a little stretching with ERP can have dramatic results. It's no good just waiting until she's ready - the OCD simply gets worse. And the more ERP she does - going at her own pace - the more she will be ready to do more.