A Therapist’s-Eye View: Organizers and Therapists Working Together

Kathy Bacon-Greenberg, PhD, Clinical Psychologist

A patient of mine, someone I’ll call Sandy, worked with me for a number of years. She grew tremendously in her self-confidence and was promoted to a very responsible position, but could never let an organizer into her apartment to help her with her significant clutter problem. If you have such a client, and he or she has allowed you into the house or apartment, your client has already crossed a great barrier — the shame of letting someone in. And, that someone is you! Your client has let you into a previously private space that has, at least for some, been the source of great shame. Since you don’t have a client unless this threshold has been crossed, it may not have occurred to you. But it is truly something to take note of, privately to yourself, or maybe with your client, by offering congratulations on the bravery, trust, and hope that has been expressed in letting you enter that cluttered space.

A therapist, on the other hand, never actually sees the chaos, the clutter, the mess. As Sandy said to me, "When all I have to do is tell you about all the stuff, it’s more manageable; it's less real; the whole thing is a little more under my control." While we as therapists are intimately knowledgeable about our patients' fears, fantasies, hurts, triumphs, sleeping and waking dreams, we do not see the actual real-world counterparts: the mess, the husband, the friend, etc. And, importantly, the patient does not have to bear the shame and anxiety of being with us as we see the state of affairs they have created or let accumulate. You, on the other hand, have been let in on the "scene of the crime."

By now, I hope you are feeling some real pride about the confidence and trust that your most challenging clients have given you. It is just this trust that needs to be protected in any collaborative effort you might undertake with a client's therapist. When I work with another therapist, for instance a couples' therapist with whom I share a patient, I begin by asking the patient how he or she feels about the two therapists talking to each other. Some patients hold tremendous (sometimes to a fault!) respect for the therapist and say, in essence, "Whatever you think is best..." Some are adamant that they do not want two professionals conferring about them, and many fall in the great continuum between these two views.

Even with someone who takes the whatever-you-think-is-best approach, I think it pays to engage in a little exploration. You might want, at the very least, to highlight their quick compliance by saying something like, "Wow! That was fast...do you want to think about it?" What you don’t want is compliance from a client's sense of obligation, which can easily be followed by resentment. Obligated compliance won’t serve your working relationship with your client and also does nothing to promote the independence and purposefulness that you are trying to build in these overwhelmed and stalemated clients.

In contrast, the client who refuses your request for collaboration with a therapist should be respected in this view, at least at the outset. What this person is saying is that he or she is keeping unmanageable feelings in check — at least somewhat — by showing some mess (emotional) to a therapist and other mess (actual stuff) to an organizer. Ultimately, of course, this person would benefit from braving the anxiety of bringing these two worlds together, but to push for this prematurely risks damaging the valuable relationship you’ve built and, possibly, losing the client altogether. The same light touch is probably the best approach for making a referral to a therapist if your client isn’t yet engaged in any talking therapy.

I can think of one exception to what this. If you are at your wit’s end with a difficult client — if the client, the client’s family, or the mess itself begins to feel like more than you can handle — then different guidelines apply. At this point, you may want to make a conversation with the client’s therapist, or entrance into therapy, a condition for your continued involvement. As I’m sure you are well aware, a severe clutter or hoarding problem is usually a symptom of significant emotional distress and your intuition about a situation that is over your head is definitely a warning worth heeding.

So, what about a client who is engaged in some form of talk therapy and who is willing to have you confer with the therapist? Should you get the number and make the call? Well, perhaps, but the collaboration may bear more fruit over the long haul of your relationship with your client if you do a little more “prep” work. Once you have an agreement that you and your client’s therapist will talk, there are some basic questions that are useful to ask your client:

1. What are you hoping will come from our talking? (here you can learn about unrealistic expectations)
2. Are there things you’d like me to be sure to tell your therapist?
3. Are there things you’d like me to ask your therapist?
4. Are there things that you want me to be sure that I do not tell your therapist?**
5. Would you like to hear from one or both of us regarding what we talked about? (A tactful yet truthful summary is typical)

**This is a crucial question to protect all three of you (the organizer, the therapist, and the patient/client) from getting ahead of what can be managed emotionally. Remember that your client may not want the therapist brought in immediately. These restraints need not be permanent; you can revisit these questions periodically if you continue to confer with the therapist. Proceeding slowly — with your client as a consultant to the pace — will do the most to ensure a lasting and productive relationship for everyone. You are also modeling a step-by-step, modulated approach (as in, we can take this collaboration little by little), something that your more disturbed clients sorely need in facing the overwhelming task of their clutter/hoarding reduction.

Once you have made it through all these steps, what about the actual collaboration? In many ways, this, too, is a relationship that will evolve and be created by you and your client’s therapist. It will depend on your respective personalities, professional styles and backgrounds, and on the particular client you are sharing. It is likely that, if you had two different clients seeing the same therapist, your relationship with that therapist would be somewhat different when discussing each client.

Since the collaboration is a relationship, I can’t give you a blueprint, but I can suggest a rough outline and alert you to common pitfalls. If you’ve taken a few minutes to go over the five questions I mentioned above (don’t hesitate to jot down the answers as your client speaks — it will aid you in accurately conveying the information and simultaneously let your client know how seriously you take him or her and the project you are tackling together), then you have a good outline for your consult with the therapist. If you add a list of questions of your own, then you will have plenty of material to get a conversation started. In terms of frequency, this, too, is a matter to be developed between the two of you, while making the client’s comfort level paramount. Some therapists enjoy talking to adjunct collaborators; others may have tight schedules or for personal reasons prefer to keep consults short or infrequent. However, if you are truly concerned or overwhelmed, you should make your feelings known when you leave the message. Ongoing collaborative consultations may be a matter of taste or preference for both professionals, but again, if your intuition tells you that there is cause for alarm, don’t hesitate to pay attention to your built-in "early alert system."

Finally, I’d like to offer a few words on the common pitfalls that can occur when two professionals confer. There are the problems that the two of you could inadvertently create and then the problems that your client can create, since there is now a triangle. The major caution I have for the two professionals is that you both take care not to engage in something that veers close to a gossip-fest. While this possibility may seem remote to you at this point, the frustration of trying to help and relate to very disturbed individuals can cause us all to be less than our most professional selves! I have seen well- trained psychologists cross this line more than once. Try for an empathic stance, working together to best understand the hurdles facing the person you are both trying to help. Of course, a little humor in the expression of your frustration never hurts either!

I mentioned that the three of you now constitute a triangle...to make sense of this caution, think about the potential jealousies in a three-way friendship or the classic problems of triangles in families. When there are three people in a relationship, there are always the twin problems of fear and temptation — fear that the other two will team up and exclude the third, and simultaneously, the temptation to be the first to initiate a twosome so as not to be left out in the cold! You may be thinking that this is just for the immature among us, but it seems to be part of being human. The best we can do is to be aware of it and try to navigate the sometimes rocky seas. In a collaboration such as we are discussing, your client may begin to complain to you about his or her therapist, hoping to enlist your sympathies about something that is going on in their work. Your job is only to listen empathically and then gently direct the problem back to its source. In almost every situation, the following is the simplest and best response, "That sounds difficult/confusing/painful, have you told X (therapist) how you feel about it? I bet he/she would like to know how you feel and I’m sure the two of you can work it out." In other words, in no instance should you get involved in their misunderstandings or other issues. It may feel very nice in the moment to have your client confide in you, but it will almost always backfire eventually if you try to get involved. Simultaneously, if the therapist mentions something your client has said about you, you can correct any ways that you were misquoted — this is common — and then ask the therapist to have your client bring it up with you. If you see the client first, you can certainly bring it up, as in, "I was talking to X and he/she mentioned that you’d said ___; let’s talk about it now and I hope in the future you’ll be able to tell me about any ways that I upset you."

One final note of caution: confidentiality must be protected. This means that whatever you and the therapist discuss is not to be repeated outside the small society of the three of you. In addition, it is important that any conversation between you and the therapist be held in a way that it is not overheard. If you meet in a private space or speak on the phone from one office to another, there is not much concern. If you meet in a public space, you must be sure that you speak in low tones, that you are not in a restaurant with closely spaced tables, and that you both agree not to refer to the client/patient by name. You would not want your waiter or neighbor to be the cousin, friend, boss, or employee of the individual you are discussing! Finally, I'm not in favor of such chats taking place via email, but if you find this to be the best method of communication, then be very sure that you both avoid all names and other identifying information.

I think that the relatively new professionalization of organizers will be a big help to those of us working with talk therapy. We can certainly learn from each other and together provide better support and intervention for some very isolated and previously unreached and totally overwhelmed people.