Sunday, April 09, 2006

Sandra Left This Week

Sandra was discharged this week to a group home. At her discharge party Sandra said: “I never thought I’d see this day. I was sure I would end up in jail.”

The thing that helped Sandra the most was probably just sticking with her. Sticking with her despite all the staff she assaulted, all the windows she broke, all the furniture she destroyed.

But what helped us stick with her? It was the emphasis on relationships, the staff who could say, “we love Sandra. She is such a special girl” despite all the outbursts and difficulty. Staff was able to see the goodness in her because they understand trauma, and know that her agitation was a symptom, her disregulated emotions were a result of Post Traumatic Stress Disorder, that she was not defiant or bad and that she was doing the best she could. They saw that the center of her distress was relationships, her need for closeness and her fear of closeness, her struggles within her connection to her mother and her family.

It helped Sandra when we took seriously that she could not stand to be in her room alone for “Quiet Hour”- she was not “being manipulative” or “just looking for attention” she was actually experiencing flashbacks.

It helped Sandra when we converted our unit to a Dialectical Behavioral Therapy unit ( and began to teach her specific skills of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. She began actively learning and practicing these skills.

It helped Sandra when as a result of converting to DBT we learned and began practicing distress tolerance skills, so we could get through a crisis, remain calm, stay mindful, and not make it worse.

And as we watch this courageous young lady hug the people she has come to trust, cry and say goodbye, and head out to create new connections and a new future, we know that it has all been more than worthwhile.

1 comment:

Michael Stein said...

Patricia - thanks for the link in your blogroll! I'll return the favor. Very nice approach you've taken here - over and over again showing how the additional time and effort of your approach is really less expensive than the cost of inadequate treatment.