My niece is struggling

[W_W]

Hi there,
New to forum, 1st post.
My recently socially transitioning 22year old niece is struggling significantly with life and her inability to regulate her emotions. She has been previously diagnosed with both ASD and ADHD and during a hospital stay last year following a meltdown/self harm incident, it was suggested BPD. Despite her anger, anxiety and depression, she often misses her therapy appointments provided for her by her mother and flatly refuses any emotional regulation medication even though this has in particular given her significant relief for the short periods when she did take some medication.
She has high resentment and fury towards her mother with whom she still lives and either ignores or yells at her. The source of her fury towards her mother is unclear to us, but very real for her.
She has no job, no real friends outside of online, and rarely leaves the house except to buy food.
I as her aunt seem to be the only person she speaks to and trusts. I live interstate and we have always been very close and I have now become the person she turns to for some kind of advice or simply to try and talk her down. Whilst I am glad she feels she has someone she can trust, being her only person takes a significant toll on my own mental health.
I suppose my question is, how can we help someone who seems to not want to help themselves? Her mother is obviously at her wits end and feels like she is living with someone who hates her. Her husband is going through cancer treatment just now and whilst is incredibly supportive, obviously has his own challenges just now.
Sorry for the length of this post, is longer than I intended it to be.
Thanks for listening.

[js friend]

Hi W_W

Your post really resonated with me as I also have a family member who Iam really close to and has shared things with me that she would never have shared with her own parents so I wonder if it may help if  you tried speaking to her about trying therapy again.
She must want to do it herself and not feel forced, but the time may be right for her now as she is dealing with so much stress from her father illness which is probably also intensifying her feelings of abandonment and anger towards her mother (mother is now most of her energy on caring for her father) It would also take some of the stress off you too. I would make the therapy more about getting help for the stress and anxiety more than the anger at this point and then just see where it goes from there. Coming from someone that she respects and trusts may put a different spin on it

[CC43]

Hi there WW,

What you describe about your niece sounds exactly what my stepdaughter (diagnosed with BPD) went through, save for the ADHD/ASD diagnosis.  She also skipped various therapy appointments at first, when she wasn't committed to working on her issues, and this was incredibly frustrating as well as expensive.

Right now your niece is hurting.  She probably feels "stuck" with her mom, but really she's miserable because she's lost all her friends, doesn't have a job, doesn't study and doesn't have a "real" life outside her parental home, save for social media.  In my stepdaughter's case, social media made holing up in her room somewhat entertaining, enabling her to tolerate rotting in bed all day and night for months on end, ruminating endlessly about how horrible her life is.  Meanwhile, social media fed her FOMO, as she witnessed her peers moving on with life--graduating, getting jobs, having romances, moving into apartments, travelling, partying--while she felt incredibly stuck, like a child.  I think that triggered rages towards her parents and siblings, blaming them for all her woes, because she just couldn't take responsibility for carving out an adult's life for herself, as it seemed too scary and hard for her fragile emotions to handle.  Your niece's sense of self is probably very fragile, too--she doesn't really know who she is and what she wants to become, let alone how to get out of the hole she's dug for herself.  She has the emotional skills of a child, and yet she's facing an adult's world now.  She probably feels very alone, scared and lost.  She might feel so much pain that to cope, she begins to feel numb.  And when she sits around doing nothing all day and night, eventually she feels like she's nothing.  She likely feels like a victim, which is a negative, self-destructive identity, as she thinks that everyone else is the problem, not her.  Accordingly, she thinks that everyone else needs to change, and not her, which might make her resistant to therapy.  It's all very depressing indeed.

I think she's lucky to have you right now.  Having someone she trusts to talk to is very valuable.  I'd caution, however, not to be surprised if one day you trigger her, and she lashes out at you, too, just like she's lashed out at everyone else important in her life.  You can't control this, so I'd say, hope for the best, but prepare yourself for that eventuality, understanding that a hate-text or blocking you are classic BPD behaviors.

Having said that, if you do have a dialogue with your niece, you might be able to help her, simply by being an ally and appearing to be on her side.  I'd say, you might approach conversations with curiosity, and try to refrain from judgment.  She might interpret advice and suggestions as meddling, controlling, judgmental or condescending.  (My stepdaughter characterized most people as being "abusive" and/or "condescending," which basically reflected her victim attitude and her preoccupation with feeling like a child.)  So maybe you emphasize questions, and let her take the lead in talking.  With my stepdaughter, this was actually really hard to do, because she's not much of a conversationalist, and she often acted passive-aggressively.  But if conversation topics were in her areas of interest--make-up, TV, clothes--she'd open up a little.  She responded to compliments:  "You look really pretty today, I love how you've done your makeup."  Then maybe I could continue with a little chit-chat:  "Did you get outside and see how sunny it was today?"  And if she mentioned she went to therapy, I might say something encouraging, like, "Well, it's fantastic you're being so responsible with keeping your appointments.  It must be nice to work with a professional."  My stepdaughter latched onto the idea that therapists were professionals, as in, only they could possibly comprehend the extent of her pain.  Generally speaking, she was more open to taking advice from doctors than loved ones.  So if you saw an opening with your niece, you might say something like, "You know, once when I was struggling with my mental health, I found that talking with my therapist was really helpful--as a professional, she really understood where I was coming from, and she helped me navigate through a rough patch in my life."  I guess what I'm saying is, if you have the opening, underscore the normalcy of therapy, and that it's more about helping someone feel better than about making judgments or diagnoses.  If she gets defensive and responds with, "Are you saying I'm messed up and I need therapy?" or "You're saying I'm a mental case!" maybe you try to turn it into a question, "Do you think it's worth a try to see if therapy might help someone feel better, if they're hurting?"

[Methuen]

Coming from someone that she respects and trusts may put a different spin on it

Maybe.  This would  never be the case with my mother.  I was so supportive with  my mom. But just starting the topic meant I got knocked off the pedestal, and painted black. That was almost 20 years ago.

I'd caution, however, not to be surprised if one day you trigger her, and she lashes out at you, too, just like she's lashed out at everyone else important in her life.  You can't control this, so I'd say, hope for the best, but prepare yourself for that eventuality, understanding that a hate-text or blocking you are classic BPD behaviors.

Yes.  It is helpful to know this can happen, so that if/when it does, you understand in advance that it's the disease, and nothing you did/said.