Psychiatrist for tween girl in crisis and advice/support for mom

My daughter has some issues that have escalated recently. Although she has a therapist we recently had a crisis appointment with a cognitive behavioral psychiatrist and she responded very well to the direct and concrete approach.  Her therapist is great but really focuses more on younger kids and I think my daughter has outgrown her.  My daughter is struggling with abandonment issues as an adopted child, emotional regulation difficulties particularly with anger, has some learning differences (and a moderate 504 plan though she’s doing well in school now) and has recently talked of self harm and suicide (hence the crisis intervention).  Given the timing of her most difficult times there is definitely a hormonal component but before treating her for that her doctor recommends an evaluation and treatment plan from a psychiatrist to treat her more holisticly rather than just symptom by symptom. Which I wholeheartedly agree with. So now I need the psychiatrist.  We have Kaiser and because she’s from foster care she also has MediCal.  While of course a covered doctor is ideal, we’re mostly interested in getting her the best care possible and I have family who can likely help with the cost.  We’re in North Berkeley. 

Her issues are private struggles at home—her school, friends and after school programs would be shocked to know of what happens at home sometimes.  So I feel we are at a good point to get her help before things spiral more out of control.  I am a solo mom with a long term, live out boyfriend who is incredibly supportive of both me and my daughter.  And I have my own therapist so I can focus on my daughter during her sessions.  Even with all this support, and everyone telling me I am doing everything right it is so hard and so scary to see my little girl suffer so much and to carry this emotional baggage. So even if you don’t have a recommendation—any encouragement, words of wisdom and especially thoughts from those who have made it to the other side are appreciated.  

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I'm having very similar issues with my son. We had a neuropsych exam done at Clearwater Counselling in Oakland and are now doing therapy there with Talia Kurland. My son really likes her and looks forward to going. He has not that reaction to other therapists that we've seen. Talia is young and has developed a very nice, trusting relationship with my son. We tried the therapist who is known locally as the leading adoption therapist and there was no connection at all. I've found that my son relates much better to younger therapists than to baby boomers at the end of their careers.

We pay out of pocket for this. Unfortunately we have never had any luck with therapists covered by our insurance. In my opinion, you can do a lot of damage by trying to force a relationship with the wrong therapist. You don't want your child to hate therapy and be reluctant to attend. If you can get help to pay for this out of pocket, I'd recommend that. We also told our son that he would have input into the therapist and that our goal was to find someone who he liked. Talia has been great. I've not heard good things about Kaiser mental health services. And the Medi-Cal resources that we've tried to use haven't been great either. Unfortunately the age of the therapist is one of the most important things for the fit with my son and the older the therapist, the less likely there is to be a good fit.

I wanted to write you to tell you I get it. I too am a mom of a tween who was adopted. Have been exactly where you are. So much anger, despair, threats of suicide and running away—and all of it completely invisible to the world outside our home. He behaves like a completely different kid in public. Saves all of his attachment/abandonment rage for his parents. It’s exhausting but I guess, also, maybe encouraging that he has learned how to be socially appropriate and so does not alienate teachers and potential friends. 

I can can recommend Dr Wymes at Kaiser for a psych evaluation. He doesn’t do cognitive behavioral stuff and he’s not a therapist but he did do a great job for us of assessing danger and figuring out diagnosis and meds. Also—he seems to have a lot of experience with adopted kids. He told us things tend to get even worse through the teenage years (sigh...) before they get better, as the normal teenage search for one’s identity re-ignites all the abandonment stuff. 

Best of of luck to you mom. We will get through these years eventually. 

I think I have a pretty good idea of how you are feeling and what it's like to be the parent of a child who is suffering emotionally. Our son entered into a deep depression w/ social anxiety and was suicidal a lot of the time. We found a CBT therapist about a year ago. The CBT person recommended he do the CBT work but also see a psychiatrist. Its been a little less that a year and WHAT A DIFFERENCE it has made. He had to make an effort do the CBT work (visualization, meditation writing, etc) but it paid off. The psychiatrist recommended he should try Fluoxetine, (which we were not in favor of in the beginning) but it REALLY helped. It gave him a break from the depression so he could actually do the CBT work.  By the way Fluoxetine (Prozac) is often recommend for premenstrual dysphoric disorder, which your daughter may or may not have.  I don't mean to imply our son is "happy all the time", but he is himself again, doing well in school, having fun with friends, fighting with his siblings, etc. In his darkest hour (a few weeks into treatment) I did talk to him about my experience with faith, not faith in any particular god or anything, but that sometimes when people are in their darkest hour, faith is the only thing left. We also cried together a few times just hugging and not saying anything. I have faith that you will see your daughter smiling again, brighter than ever!

My child is a little older and will not commit to the work she was recommended to do through her CBT. DBT is another level you might look into.  Exercise is really all she relies on for calmness. While she is the one experiencing all the confusion of this newly diagnosed condition, if I don't remember to take the time to take care of myself and let myself go I can be of no help to anyone.  So my advice is to be good to yourself,  continue to be a great role model and utilize a spa day once in a while. 

Yup, the tween, early teen years have been super hard for my younger adopted daughter, the older one seems to be cruising through though. We tried and are having success with 1000mg of omega fatty acids for mood (recommended by a friend who is a child psychiatrist) and also Sam-e which is sold as a supplement in the US, but prescribed for depression in Europe almost as frequently as Prozac. The other suggestion which Kaiser discouraged was having genomic testing to see what antidepressants would be a good match for her. She had a bad reaction to Adderal for ADHD and I didn’t want to put her through anything like that. She’s been attending a girls’ adoption group and will be going to a small high school with a strong mentoring component. Good luck, pick your battles and love your kid unconditionally.

I am sorry to hear your daughter is struggling.  She has a great support group with you, your boyfriend and the professionals you have ensured she has access to. It is hard to go through this, but know you are doing great. You have support for yourself as well as for her. It's a long haul sometimes, but with continued support for both of you, things will get better. If you think there is a hormonal component, I recommend using the app me v pmdd.Your daughter can easily choose moods, etc to track each month and there is an area to type in a daily journal. The creator of the app encourages positive self talk in the journal to help during the tough times each month. We believe our daughter is suffering from PMDD from 2.5-3 weeks out of the month - anxiety, exhaustion, withdrawal --- each month is a bit different --- some months more mild than others, but way more than PMS. By tracking these moods/emoitions/physical symptoms on the app, we will be able to have a better picture over a few months of what is going on (or not going on if that ends up being the case). The app has helped our daughter track her emotions/physical ailments and thoughts of the day easily. We tried other journaling and it never really got to a point where she would do it every day. The app is simple and helps her remember what to rate each day.  Hopefully, it can help  your daughter too.  Hang in there Mom, you are doing well and all of this hard work and support you are providing her will pay off.  Remember to celebrate the small things, the small wins, when you see them.  Lots of celebration along the way to larger goals helps a lot.  Take care.

First of all I want to say that I am so sorry to hear you are going through this. There is nothing worse than when your child is struggling - you just want to do whatever it takes to make sure she's okay. Second of all, I want you to know that you're not alone. So many of us on here have been through similar things with our kids. It's just that nobody really talks about it because there's so much shame and guilt (did I do something wrong? Did I mess up as a mom?) and so much fear (is she going to be okay? What do I need to do to protect her?). We had a hard time finding a therapist who was a good fit for our family. We wanted someone our daughter liked, but also someone we could work with as parents. We finally chose Dr Rachel Zoffness in Berkeley. Our daughter at the time was also struggling with chronic migraines that were triggered by stress, and Dr Z was a perfect fit. We loved her. I cannot say enough about how much she changed our lives. There are a bunch of good CBT therapists in this area so you can't go wrong. We did a Google search and interviewed a few until we found one we loved. Don't give up and hang in there. This too shall pass!!!