Teen’s extreme verbal abuse & violence: refuses help

For the last several years, my partner and I have been trapped in the nightmare of our now 15 yo’s mental health crisis. We’ve never gotten a clear diagnosis, in part because they have refused to participate in therapy of any kind (and has refused to speak a few years ago when we tried). Anxiety and OCD have been what we’ve been told but I wonder if it could be something else given the extreme behavior we live with. And there are no incentives or threats that could get them to willingly go to therapy.  Our kid would have no problem opening the door to a moving car if we were somehow able to get them into the car to go to therapy. 

My partner and I have met with a therapist for strategies with limited success. We live with episodes of extreme verbal abuse aimed at us (usually sparked by something trivial - currently it is their inability to fall asleep/insomnia), sometimes physical destruction, occasional threats of self-harm and sometimes physical attacks on me. Extremely concerning in these episodes (aside from the yelling and potential of a physical attack) is this almost dissociative “angry condescending adult” way of making demands of me: “You need to get back here right now …I’m holding you accountable…go get this right now…”  It’s a little bizarre. I have called the police during one physical attack but short of taking them to the county hospital, there wasn’t anything police could do. My pediatrician can’t help. And I really don’t know who else to call.

 Are there residential programs that deal with this? Outpatient programs? Do we need a formal diagnosis first? How do you find them? I tried to call a crisis line that had a mobile crisis team but apparently it was only for youth with Medi-cal.  We thought our child’s behavior would subside as they got older but clearly it hasn’t. (But always apologizes the next day). And we can’t live with Dr. Jeckyll/ Mr. Hyde any longer. It seems like there is no help available.  Any advice on how to get appropriate help given the refusal to receive help would be appreciated. Thank you. 

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I'm so sorry you are going through this. You are not alone. Consider reaching out to Willows in the Wind. They were of great support to me when I was going through something similar. Also consider seeing what your local NAMI chapter has to offer, as it sounds like there are significant mental health issues at play.

If substance use is an issue or concern and you'd like someone to talk to, you may message me directly. Substance use (self-medication) eventually became the triggering issue in my situation. After much research and years of working through the problem, I'm well-versed in available support for people who have challenges with substance use.

Take care of yourself. You have a long road ahead of you, and it can get better.

My kid was the same.  It was a nightmare.  Finally, we had to have him transported to a wilderness program and an rtc.  I know how isolated and desparining and terrified you are feeling right now. You should also join a support group like Willows in the Wind willowsinthewind.com  They have info and parents who are going through the same thing, at different points of the process.  You should be talking to your school district about placement and call an educational consultant, if you can afford it, just to see what your options are.  We used Shayna Abrams. FYI, my kid is doing great now so there is a light at the end of the tunnel.  Some kids just lose their minds at this age. Not a pretty picture while its happening, to say the least. Big hug.  Hang in there.    

I understand your situation—have lived it. Your teen sounds very much like they might have oppositional defiant disorder or reactive attachment disorder. No way to know for sure (or to rule out other even scarier diagnosis) without getting help from a psychiatrist or psychologist but since your kid isn't going to go see one, you could at least read up on these diagnosis online and see if it sounds to you like it fits. The other possibility is drug use—Jeckyll/Hyde behavior is pretty common for people who are on a getting high/going through withdrawal loop.

Given what I know of the kinds of issues you're describing this is not the sort of thing a kid just grows out of. Residential treatment centers and wilderness programs are a great idea for buying yourself some time while you work on figuring out what's happening as well as making plans for keeping yourself safe.

Check out willowsinthewind.com.  It's an invaluable resource for meeting other parents dealing with this and for getting advice on what to do next.


We are/have lived through an almost identical situation and I would be more than happy to talk offline about resources out there that we’ve tried (message me). In a nutshell, what turned the tide for us was Wilderness Therapy. At first we were resistant bc there is so much noise on the internet that may or may not have been true with some peoples experiences in the past. Eventually we had no choice- we ran out of options and we were all in crisis. We chose Blue Fire which is full of compassionate, understanding, dedicated therapy professionals. The experience ended up being life changing for all of us. By removing the all the complexities of his current world, we were able to get a clearer understanding of his challenges. But more importantly, he came away with a sense of accountability, an understanding that he can/will do better, and a better self view. He finally “bought in” on the journey and the work he needs to do. It gave him and us a critical foundation for ongoing behavioral health work.


I am so sorry that you and your family are in this situation. I can very much relate, and have felt similarly "trapped" at times over the last few years. The good news is that it will get better--something will catch at some point, and the situation will improve. The bad news is that there's no silver bullet or formula that can make it better. You have to try a bunch of different things, and ultimately, your child will have to decide for themselves that they want to accept help. Many programs that can help have long wait lists and are out of network. I recommend getting on waiting lists, even if you don't think it's a perfect fit. Also, you may be able to get your school district to pay for some services. It sounds like Dialectical Behavioral Therapy (DBT), which focuses on emotion regulation, would help. It sounds like parent coaching could help you figure out what to do. Here are a few resources that have helped my family: 

- Clearwater Clinic (https://www.clearwaterclinic.com/). This is a DBT-based counseling program that offers therapy for teens, skills classes, and parent coaching. Give them a call and they can tell you if they have a combination of services that can help. There are other great DBT programs in Marin and the East Bay, but I haven't had direct experience with them. 

- Team Wonder (https://www.teamwonder.org/). They also have therapy for teens and parent coaching. Their therapists will come to your house to meet with your teen, and if the teen is willing, they'll go for walks, out to coffee, or other outings. Susan Carroll was our wonderful parent coach through Team Wonder.

- Coyote Coast: similar services to Team Wonder, but I'm not sure that they still come to the home. 

- Evolve Treatment Centers: they have short-term residential treatment centers throughout California, as well as intensive outpatient programs. 

- Emergency services: I know you've said that you've called the police before. Your child may need to be hospitalized in order to be willing to get help. If they threaten to harm themselves or others, I would call the police or mental health crisis support (some towns and counties have a separate service). Once in the hospital (usually, there's a 72-hour hold period) your child may be willing to get help.

- Long term residential treatment/wilderness therapy/therapeutic boarding school: there is also the option of having your child involuntarily attend an out-of-state treatment program and have them forcibly transported there. There are some very good programs and some terrible ones. I'm not sure if it's the healthiest dynamic, but you may be able to use the threat of being sent to one of these programs as a way to get your child to comply with a less severe treatment option. (A parent coach can definitely advise on this).

Please feel free to message me if you want more information.

I know how hard this is. That said, there is a reason some kids first contact with the mental health system is through the hospital. If they won’t cooperate with an assessment, the best of horrible options are to let them go to the hospital, where you can insist they be assessed for a variety of mental health conditions. If they were 18, you cannot do even that, so don’t delay. It will suck. But the other options are worse. 

I've been where you are and I am so very sorry.  It is a living nightmare.  It sounds like you have tried everything you can possibly do, and it's time to consider wilderness and/or residential treatment.  I agree that Willow in the Wind is a great resource.  You may also want to join this Facebook for people in your situation.  I found the advice and support in this group to be invaluable: WTRS

Many people use an Educational Consultant to help them find a program that is a good match for their kid's needs.  There is a list of these professionals in the Facebook group I linked.  Locally, I know families who have used David Heckinlively, but they don't need to be local to work with you.

The hardest part for my husband and I to accept was that we would have to send our daughter to another state (Utah) for treatment because our daughter was very therapy resistant, and in California kids can sign themselves out of a program at age 13.  No way my daughter would stay.

We are on the other side of this now, and it was a very hard road, but things are so much better now.  After months of resistance in treatment, she engaged in therapy and learned a lot of skills.  At the same time, my husband and I had a lot of parent coaching and education, and we learned a lot of skills.  It's not perfect and things get rocky sometimes, but we have a shared language for working our way through.  I never thought I would send my child away and it remains the most gut-wrenching, awful thing I have ever done.  But I think it saved my daughter and our family.

Good luck to you and your family.

I’m sorry you are going through this. I’ve experienced something similar with my teen who has OCD, ASD, and anxiety. If you’re looking for local support, Rogers Behavioral Health in Walnut Creek has residential and intensive outpatient treatment for OCD and anxiety. Medication can also help tremendously with OCD, on top of therapy. You don’t say whether your child goes to school or not, but if they do, that’s probably causing tremendous strain on them as they have to combat intrusive thoughts and compulsions while trying to pay attention in class and interact with peers. Making demands of your parents can be part of OCD’s way of providing the child with reassurance. It’s the compulsion side of OCD to keep perceived bad things / threats from happening. What helped us tremendously was pulling our child from school and giving them some time to feel safe. Neither school nor home felt safe to them so we stopped placing demands upon them until they weren’t in total autistic burnout anymore. Then they were willing to get help after that to a more regulated state. I also highly recommend checking out At Peace Parents. Dr. Casey Ehrlich offers tons of resources for parents of PDA kids. Your child fits a lot of the profile and her experience with her own child and strategies that she offers have been a game changer for us. Even if your child is not PDA, a lot of her strategies could help with the anger and resistance you are experiencing. I’ve found that her advice around keeping ourselves in a state of calm while changing our expectations of our kids incredibly helpful. She has a podcast  that I follow too.


And finally, as others have mentioned, Willows in the Wind is another great resource. I wish you and your partner all the best. It’s the hardest, most exhausting thing my husband and I have ever experienced and I’m so relieved to be in a better place. I wasn’t sure we’d get there….but there’s hope.

 I repeat what at least one other has said:  PLEASE connect with National Alliance on Mental Alliance (NAMI)!  There is a VERY active branch in Albany.  A family to family, free 8 wk course is offered, from time to time.  There's even a group of teens living with mental health challenges...Husband & I recently took the 8 wk course for the 2nd time. Very helpful.  "Liz" at the Albany office is a psychologist, as well as hard working NAMI rep. She seems to know everyone and every program that may be of help.---  I have a son with mental health issues. He's not a teen any longer, and I'm not being overwhelmed by his up & down outbursts...My son has said that he appreciates how I set boundaries with him because he scares himself with his raging outbursts.   At one point I realized that while it was a nightmare, it was also a blessing:  I had the opportunity to learn how to relate to my son from a place of calm...and yet also one of wisdom.  One thing that has worked, very basic: when he starts going off (cycling into his crazy loud anger) is I pull over the car & sit quietly.  He either calms down (because I'm not engaging..or he keeps it up) If he doesn't calm, then I tell him something like "Ok, this isn't working so today we're not running errands together (or whatever was our purpose of being in car)" Then I'll turn around and take him home (Or in my case, back to his modest apartment) or, I'll tell him he needs to get out and do some walking.  Yes he gets furious.  That's ok.  I get to practice not being drawn into his screaming.  Try it.  :))=== PS: I wish we'd had the $ to enroll my son in a wilderness program or something...but we didn't. Just as well, because once your kid comes home from such an experience you want to be able to respond to his stop with wisdom, calm and self-respect.

Call 1-800-950-NAMI (6264) M–F, 7 a.m.–3 p.m. PT for free mental health info, referrals and support.
You can zoom the meetings.  

I'm so sorry you're going through this. I have a 10 year PDA son and I just want to echo what another person suggests and if you haven't already, please have a look at Casey Ehrlich's work. Her Instagram posts in particular are really helpful and an easy way to get a lot of information.


Hi - I realize this post is several months old but it showed up in my digest and, having been through what we went through, I want to spread the word to hopefully spare other families some of what we went through. 

Our child acted similarly (rage fits where it seemed like they weren't "there"/"themselves" - lights on but nobody home, and weirdly scripted-sounding comments), not to mention OCD-type behaviors, extreme insomnia, us walking on eggshells ...) and it turned out to be PANS/PANDAS. 

I urge you to at least consider whether to look into PANS/PANDAS. Traditional mental health providers are not often aware of it and do not understand that it takes a different approach to resolve (ibuprofen (anti-inflammatory), antibiotics, steroids, sometimes IVIG) & the usual modalities (talk therapy, SSRIs ...) may not work and might make things worse. 

We lost ~10 yrs due to various misdiagnoses (PDA was one, though the PDA parenting techniques/recommendations were more helpful than most of the advice we got on our journey) and unproductive approaches. The emergency rooms, crisis teams, etc. are not going to be familiar with it so unfortunately that's probably not a great solution.

Here are some resources that might help you figure out whether this might be part of what you're dealing with. Note that while the diagnostic criteria tend to focus on sudden/acute onset, this was not our experience - it came on more subtly. (Two quick and easy things to look at might be: (a) does your child ever have notably dilated pupils? (b) if they take ibuprofen (for a headache or whatever), does that seem to take the edge off for a little while?) Sending support and hope your way ...