07/18/2026
There have been a few things happening in the past couple of weeks. Mostly good things, but a few hiccups. As to be expected.
The incentive plan is not working. At all. He just can't manage to make himself go to groups. I get it. His depression is really bad, perhaps in part due to the increased demand for him to do groups. He does maybe 7 per week. This includes 2-3 showers in the week. We're seeing the opposite effect of what was expected. It's been hard on him, and I see him just giving in and agreeing to whatever they want. Still, he can't do those things.
I've been confused about the group system. So, I had some email back and forth with the administrator. Sometimes it's not easy to communicate via email. But I also like to have a written record of what is discussed. Our recent thread was very difficult. She was vague and I had to keep asking for clarification. That's just me. I need to know answers to what I'm asking, even if it takes several ways of asking my questions.
The main thing I needed to know was what activities were counted as points. It's not only groups. I had to ask for specifically so I'd understand. When she told me he had 'earned' seven points, including 2 showers, I was stunned. I know he goes to workout group three days a week. She said he took two showers and those count as points. I remembered that several months ago I was told that one-to-one meetings with staff counted as points, too. So if that's true, he only met with staff twice that week? Som**hing is off.
I asked her about the CBTp training. She said that was only once a week. She said he'd greet staff when he walked by them but that didn't count as a point. Duh. Of course it wouldn't. Finally, I stopped the back and forth.
A couple days later, I ran into her as I was leaving the facility. She's discouraged that the incentives aren't working, too. I suggested (for the second time) that he might respond to a token economy system. One in which he could see an immediate reward, like a ticket, or a coin, or som**hing tangible that he could exchange for an item at the end of the week. She said she'd think about trying it.
This was good, since she had previously told me they can't do that there because that's not how real life works. They train patients in real-life skills. I don't like that. Creativity is much more valuable. And he may never be in a typical "real life" place. Meet him where he is, right?
I asked her about the tokens a few days later. She said they couldn't give him 'daily treats' and even if they could she didn't think it would motivate him. Wow. She knows the outcome before it happens? (pardon my facetiousness). I corrected her that we hadn't talked about 'treats' but rather tokens he could use at the end of the week. I'm not sure she understands. She says he just needs to try harder.
To me, it seems like he's just too depressed. I email his doctor to ask for a phone call. For years, I've wanted my FM back on Lamictal. He takes Depakote now and has refused Lamictal. Long ago, Lamictal was an amazing med for him. It worked quickly and he was much more clear-headed. We had real conversations! Unfortunately, an inpatient doc changed him from Lamictal to Depakote. My FM has refused to change ever since. He says Depakote is made by aliens, so he HAS to take it.
Thank goodness for this doc! He didn't even wait to have a conversation with me. He sent in an order to switch him to Lamictal right away! He likes the suggestion! My concern, at that point, was how my FM would feel having that med change without being told about it. He could feel betrayed. He could get angry. Who knows. I asked the doc to make sure he was informed and that he agreed. There is a psychiatric intern working with the doctor and she has connected well with my FM. She explained it to him and he agreed! Yes!
On my Wednesday visit with him, the nurse asked for my help. He was refusing his monthly injection, and she thought I might be able to help. I tried, but he refused. He said the shot hurts and he didn't want to take it. That all stems for a time several years ago when a nurse gave him the injection and really did hurt him arm. He had a knot in it for some time after. A few months later, I was doing the injections myself because of his phobia of riding in moving vehicles. When I opened the package, I saw that there was a short needle for the arm and a longer needle for the gluteal muscle. Aha! That nurse used the longer needle in his arm! That's the only possible explanation. Yesterday, he took the shot. Thank goodness!
Also, on the Wednesday visit, we had an impromptu meeting with him clinician. My FM really wants to come home. He doesn't understand why he can't. He gets in this frame of mind every once in a while. I talked with him and listened to him and tried to help him understand. His clinician didn't say much but she listened and interjected a couple of times. I felt good about having her in the meeting so she could get to know how my FM and I communicate. It was very helpful, but he was still very sad that he can't come home yet. I totally understand. But he needs to be much more stable before we get close to that happening.
I asked the clinician how often he receives the CBTp. She said three times a week. I was told he only went once a week. She looked perplexed and said she'd find out. I hope it's three times a week. I don't think once a week could help much. So maybe a communication issue? That is so often an issue with his treatment providers.
There is a rehab physical therapist at this facility. He emailed me earlier this week to see what I thought about him taking my FM with him and a few others to a local park to play frisbee golf. Yes please! He mentioned that my FM would have to do a couple of groups to get the privilege of going on the outing. Come on! It's not a privilege. It's therapy. Treatment.
I jumped the gun on that one. Today, I got an email from the Rehab PT. He took my FM out to the park today. Just the two of them. They talked about motivation to step up the next level. His lack of engagement in groups. And he said they'll be making this a regular weekly thing. Great news! My FM said he really enjoyed it, too. Nice!
So, mostly good things. Med change that I'm very optimistic about. An outing to a park! Accepting his injection. Lots of wins!