How does a therapist know what to believe?

And do they need to figure out what is the truth behind what they are being told? i ask because my niece, my sister’s daughter, has decided to talk to a therapist about her issues, and she has told my sister what she said to the therapist, and they are heavily…shall we say shaded? statements. My sister is upset by this and wants to be able to set the record straight. She doesn’t feel her daughter will be adequately helped if they therapist takes these statements at face value.

Here are the facts: Their house is messy. My sister is a huge procrastinator on things, and we were brought up to not throw away anything that could be useful (Depression-era mom who grew up poor). So there is a lot of clutter. And my sister had a lot of hobbies and interests that related to her teaching job, so there are materials for school as well. So the dining room table, the last time I was there, is stacked with mail and magazines and cookbooks and fabric and bills and owner’s manuals and newspapers and everything. When there is a desperate need to straighten up, they have a tendency to shove it all into a box and shove it in the spare bedroom.

My niece is a photographer. Her dad, when he was living there, had all sorts of tools and computers stuff and DVDs, and he took very little with him when he moved in with his boyfriend. My nephew took very little of his stuff when he went into the miltary, so there are games and toys and books and clothing still in his room. My niece builds props for her photography jobs, and leaves the residue all over the house…one day it is cut-up pieces of cardboard, the next day you’ll come home to glitter and paint everywhere. Clothing strewn about. The bathroom is a clutterfest of makeup and hairtools and wet towels…and all this from a girl who rarely bathes and infrequently brushes her teeth.

No one helps clean up, and my sister is overwhelmed. Over the past few years, she has dealt with her husband sort-of coming out as gay, leaving the home, and moving across town, though he stops by every day to pick up the lunch she makes him. Then she got diagnosed with breast cancer, and had to go through the surgery and chemo with very little assistance from husband and kids. Oh, the daughter would make a big show of helping in front of her friends and on Facebook, but when push came to shove…not so much. My sister’s health then took a hit from some bursitis and arthritis issues that were exacerbated by the chemo, and she now can barely walk and uses a scooter to get around while she teaches at a very stressfilled high-school. She’s hoping for a total knee replacement this summer if she can lose some weight. Their finances are rocky, what with two households being supported, and their house is older and things keep needing repairs. In the last two weeks they have had to replace a toilet and the subflooring in one bathroom AND buy a new refrigerator.

So. Lots of background to let you visualize the situation. Untidy, cluttered, aging house, little help from her daughter, criticism from the husband, ill-health…but my sister is not a hoarder. She is more than willing to sort through boxes of stuff, send things off to Goodwill, have garage sales, throw trash away…she just is exhausted and physically limited. She rented a storage space to meet her husband’s ultimatums about clearing through stuff, but she can’t physically carry heavy boxes down the steps to the car and into the storage locker, and the son and daughter will rarely take a load over for her…in fact, her daughter has taken almost all the storage boxes she bought and used them for her photography studio.

What my sister will not do, and I support her in this, is just load up boxes and take them to the dump without going through them. That is her family’s “solution” to the problem…just throw all your stuff away, Mom, because nothing of yours matters to us. But in those boxes are tax papers, family photos, savings bonds, recipes, bills, financial records, the paperwork for the house and the cars and medical records she needs for making her insurance claims…it’s not trash. She steadfastly refuses to let them just “hire a dumpster and clean everything out”. She leaves for work at 6am everyday, teaches a full day, and then usually has either doctor’s appointments or grading and classroom prep to do for the next day, and her daughter demands that she run errands for her. She falls asleep the minute she sits down at night most nights. And some nights she has to deal with her daughter flying into rages and having emotional meltdowns…hence the therapist.

Which brings us full circle to the daughter telling the therapist that my sister has OCD and refuses to throw away a single piece of paper. Gee, darling niece, what is in the bags of trash my sister painfully drags to the curb each week? She told the therapist my sister is a hoarder…this from a girl who had a month’s worth of half-filled drink cups in her room and has a fit if my sister tries to go in her room to clean them out before bugs get in them. My sister is just so worried that the therapist is going to believe these heavily edited statements and not get the real situation. My sister readily admits that her house is not in a fit state, and that she procrastinates, and that she is way behind on cleaning through and organizing. But she also deals with coming downstairs at 5 am and finding a sink full of dishes and food that her daughter has created during the night and left behind, after my sister has stayed up late to clean the kitchen.

My sister has set up an appointment to see, at long last, her own therapist. I’ve been urging her to do this for years, ever since her husband started sort-of coming out. Instead, she has called me nearly every single morning and most nights to cry on my shoulder and vent. Between her family issues and the horrible high-schoolers she has to deal with, I start my mornings with doom and gloom that I can’t fix. i told her if she is concerned about what her daughter is telling the therapist, maybe she should ask for joint sessions.

So what does a therapist do? Will they accept my niece’s statements about my sister’s “problems” at face value and base their diagnosis of the source of my niece’s issues on something that is just not true? My daughter had friends who had mothers who DID have true OCD, and dealing with that can mess a girl up. But that is NOT what my niece has had to deal with at home. Clutter, yes. Hoarding and OCD? No. A mother who has been too lenient about requiring her child clean up after herself? Yes. A family in financial and emotional stress? Yes.

Sorry this is so long. I guess I needed to vent, too!

Depending on the therapist’s method, it probably doesn’t matter what they think is true or factual; what matters is addressing what the patient says they believe. In this instance, the niece can hardly expect the therapist to fix her mom’s issues, only the niece’s. That said, I’d wager that if the mom asked for a joint session w/ the niece, the therapist wold be happy to oblige. Family commitment to a patient’s therapy is usually welcomed.
Tldr - the therapist likely doesn’t care what the facts are.

Correct. Unless it’s a matter of danger to the client or someone else- i.e., the daughter tells the therapist that she fell down the stairs a few months ago and broke her foot because there was stuff piled up all over the place, and the stuff is still there and she’s scared it’ll happen again so she sleeps on the floor in the living room rather than go up to her bedroom- the therapist is far more focused on the presenting issues of the client, not the client’s mom.

How old is the daughter? The therapist may take the statements more seriously if she’s a minor and is saying things like “there isn’t enough food in the house, and what is there is moldy and bug-ridden because my mom won’t clean,” but if the daughter is an adult, chances are the therapist will be more focused on dealing with the daughter’s issues than with the condition of the home.

I agree that offering to do a joint session is a good idea, but not to defend herself/the situation; rather to address the issues of lack of communication/support/helping everyone to see their role in the situation. If she goes in there with the idea that she MUST defend herself from the EVIL LIES that her daughter is telling the therapist, then it becomes a she-said, she-said situation, sets up animosity, and likely will derail the therapy.

Moved MPSIMS --> IMHO.

Once your niece has done her complaining about her mom, and feels that she has been heard, the therapist will try to get her to focus on her own emotions and behavior. It is hard knowing that someone is complaining about you to their therapist, but your sister will just have to let that go. In your description, she sounds very defensive, which is probably making the tension between them much worse.

kittenblue you seem to love your sister very much, and she seems to need it and deserves it but I can see where it’s frustrating to be the sounding-board when you can’t change things.

I’m not clear on what your niece’s issues are. A messy house? A chaotic environment can contribute to a chaotic emotionl state (niece doesn’t bathe regularly or brush her teeth) but surely that’s not all, not enough to require therapy? And given the financial situation, who’s paying for the visits?

I think therapists work with their client’s own personal “truth” and not “the” truth, and recognize symptoms (from whatever source—denial, refusing responsibility etc.) when they see them. Your sister’s not going to be visited by the “It’s not fair!” police but a joint session could help all around.

I relate enough to various points in your sister’s story to offer an Internet (total stranger, I know) type of “Friendship.” I know that’s weird and I’ve never made myself vulnerable like that before but, I think I could benefit also from such an exchange. (Just throwing that out there. Disregard if it’s too strange.)

I hope the therapy, or at least the questioning of the status quo, helps bring about some progress in the family dynamic.

Some thoughts:

  1. Your niece may actually see things in your sister that you do not see.

  2. No therapist worth his or her salt is going to diagnosis a third party based on second-hand information. They may validate what the patient says (“Wow, it sucks that your mother is like this!”), but that’s different from believing everything they say.

  3. When it gets right down to it, it’s the niece’s therapy, not anyone else’s. Including yours. What she says in there should stay there. (This is what I would say to your niece.)

  4. Therapist are not totally stupid (sometimes!) And patients start revealing a lot of themselves over time. So while at first the therapist may take what the patient says at face value, over time the bullshit will become apparent and the therapist will call them on it (if they are good).

  5. One’s perception of reality is their reality.

For the sake of your own mental health, I think you’d be better off disengaging from this level of involvement with your sister’s conflict with her daughter. Be supportive, but not to the point of taking multiple calls per day. And encouraging your sister to get counseling is a great idea. And family therapy for all of them probably wouldn’t hurt, given the upheavals they’ve been through.

Beyond that, I think you’re too invested in taking your sister’s side. To some extent, you’re just not able to know what’s true, because you didn’t live their home life for all the years that they did. You may see places where your niece’s memory is misleading, but you may not be in a position to know it when your sister’s memory is incomplete. Ultimately, anyway, I think the therapist is likely to be less interested in sorting through everything that happened in the past than in developing ways for the family to live together more harmoniously now.

Family conflicts like this take years to develop, and there’s usually some level of problematic behavior on both sides, particularly as between parent and child. To an outsider, it may look like your niece is modeling behavior she learned from her parents: She doesn’t clean up her clutter, like her mother and her father. She leaves projects lying around unfinished – precisely what you say her mother also does. It’s improper of her to make unreasonable demands on her mother, but it’s less surprising when she sees how her father is still leaning on your mother to get his lunch made for him daily, even after he walked out. Notice how when you talk about your sister, you recognize that her behaviors are partly the product of how she was raised by her own mother; it works the same way for your niece.

Your sister may not be a hoarder, but she’s exhibiting some of the same behaviors that hoarders do. Important papers shoved into boxes with inconsequential stuff, such that none of it can now be thrown away. Hobby projects left out and set aside. Rental of a storage unit to store clutter rather than throwing away stuff like newspapers, DVDs, and cookbooks. She may be especially overwhelmed by her health problems now, but you also say that she’s always been this way, because of how her own mother behaved. Whether or not a particular label fits, that’s a high-stress environment, both for your sister to live with and for your niece to grow up in.

Try to spare a little sympathy for your niece as well as your sister. Whatever the reasons, she’s grown up unhappy. Her mother is suddenly very sick. Her father has suddenly blown up the household. Her brother is suddenly gone. Her aunt (and here I’m going to push you a bit) hates her for having grown up to be the person her parents seem to have raised her to become. It sounds like no one has any time for her. That can be a recipe for rage and breakdown. The niece melts down to your sister, and then your sister melts down to you.

You obviously love your sister very much, and I think you’re doing her a kindness by insisting that she needs to see someone professionally trained to help with the chaos that’s erupted in her life and the blowback from her daughter’s therapy.

Your sister needs to stop asking, what happens in your niece’s therapy session is your niece’s business.

Depending on the relationship her accounts of what she said may also not be true, if you ask me what my shrink and I talk about my answer to your completely out of line question may well be “your constant masturbation at the kitchen table while I am trying to eat, yes, my therapist believes you have your hand down your pants 24/7 bwahahaha”.

There are many situations where not knowing the entire truth means a therapist is less effective than they could be. There are also many situations where worrying too much about knowing the truth will make therapy less effective.

My reading is that there is a possibility of hoarding as well. Tom Tildrums post is excellent.

Otara

That was an enormous WTF moment for me too. Dude’s a grown man, with his own place to live. He can make his own damn sandwich (I can’t fathom the mental processes where he believes traveling to pick up his lunch is somehow more time- and cost-effective than spending five minutes in his own kitchen, which makes me suspect it to be a control issue), and sis can simply inform him in a neutral tone that she doesn’t have time for that anymore next time he shows up, because that seems to be the god’s honest truth.

In therapy, facts of events are usually less important than facts of emotions and reactions. A good therapist will be less concerned about what exactly happened, than how the person is coping with it. An experienced therapist will understand that they can draw no conclusions before completing several sessions and start seeing the patterns, and they’re savvy to people relating their stories in the way that makes themselves look better than everyone else. They know there will be skew. And skew such as “mom is universally horrible and I am universally the poor, put upon daughter who does no wrong” is pretty easy to spot. Lack of grey area is a dead giveaway.

… and severe health and emotional issues will only exacerbate any hoarding tendencies there. I know when I had to deal with ill parents, a dying parent, and major health issues for both my spouse and I over the course of about 3-4 years my house went from “cluttered” to “you have a problem here”. A big part of it is simply not having help to deal with it. Too often people “solve” this problem with “throw it all out” which does not address the root causes of how this came to be. I realize that for some people hiring a dumpster is soooo much easier than actually helping someone to order/clean up their house and giving them assistance when they are fighting a severe illness, but I’m not convinced it’s the best solution in most cases. These people saying “throw it all out” - where any of them around to help when she was fighting cancer? Any why is she still making lunch every day for an ex-husband/separated spouse who has moved out? He can get his own damn lunch!

This right here. It’s classic hoarder behavior, along with insisting that they do too throw stuff away and the clutter is really everyone else leaving their stuff around while her stuff isn’t that bad, it’s just that there’s nowhere to put it with everyone else’s mess, etc.

Tom speaks the truth. You aren’t helping her by listening to her woes, or at least not nearly as much as a therapist would.

The lunch thing drives me right up the wall, and I have told her on numerous times that if it were me, I’d tell him to get his own damn lunch, since all it seems to be to me is an opportunity for him to come in and criticize (she isn’t there when he stops by, so there is no time to explain “I had the livingroom all picked up but Daughter had her friends over after I went to bed and they worked on props until 3 am and left a mess”) but she refuses. I can sort of see her point: she still is trying to deal with the fact that her marriage of over 25 years was just a huge sham, and she really isn’t ready to face starting a new sort of life. By still doing wifely things for him, she hopes that when he gets over this “phase” he may move back in. It keeps him coming by and part of the household, and he hasn’t said, “Hey, I can get my own lunch” either. And occasionally when she is home when he stops by they can talk about household stuff. She does not yet see that she deserves a new life…she just wants to stay married until one of them dies. She has no interest in a new relationship, she can’t deal with the upheaval of a divorce and the financial impact of that…they are just slowly sliding into a new reality, and she just can’t cope with it all.

I don’t think my sister asks her daughter what she is saying…she volunteers it, or it comes out when she has a meltdown. I know I need to detach, but it’s very hard when I know my sister has no one there she can talk freely to…she has no close friends at the moment (her good friend died a couple years back) and all her other friends are from their church. She doesn’t feel she can “out” her husband to them, so she has just pulled away. I am truly the only person she feels she can cry with. I’m hoping once she starts talking to her own therapist in a few days, I will get a break. I’ve tried to get her to reach out to organizations for straight wives of gay men, but she hasn’t followed through, yet. Becky, maybe you can PM me… I just feel I can’t isolate my own sister anymore than she already is. She needs to feel that someone is on her side, somewhere.

“So… weren’t you defeated at Waterloo in 1815?”

“Yes.”

“And didn’t you die in 1821?”

“Why do you think I’m so depressed?”

Has she ever lived on her own, or with housemates, or did she go from parents to husband? I realize Americans tend to be into sequential monogamy, but if a relative of mine had found their spouse of 20+ years had been closeted all that time, I’d want my relative to get a good relationship with him or herself before they started looking for a new partner (if ever).

Surprisingly, of all of us kids, my sister was the only one who lived on her own after college, and was always dating, though her husband was her first “real” relationship that I can recall. I’m five years younger than her and I had already gotten married straight out of college and had a baby three years later by the time she got married at age 30. Our older brother lived at home until he got married at 40…and he’s the only one still happily married!