All grown up, but still fighting? Why more siblings are turning to therapy, together

The Science of Siblings is a series exploring the ways our siblings can influence us, from our money and our mental health all the way down to our very molecules. We'll be sharing these stories over several weeks.

For decades, patients came to psychotherapy to wrestle with a seemingly fixed cast of main characters: Father and mother. Daughter and son. Spouse. Lover. Boss. Rival.

Siblings sometimes came up, of course. But all too often they appeared as minor characters, lurking in the wings.

Now the emotional influence of siblings on our long-term development is beginning to draw more attention, and some therapists report that more siblings are seeking professional help, as adults, with ongoing conflicts or resentments.

Karen Gail Lewis has specialized in sibling therapy for decades. As she nears 80, she is focused on sharing what she has learned with other therapists. That was the impetus behind her new book, Sibling Therapy: The Ghosts from Childhood that Haunt Your Clients' Love and Work.

In childhood, sibling interactions can be fundamental to shaping who we are, Lewis says. Although parents are extremely influential, siblings are peers, with whom we practice skills of loving and fighting.

"In those early years, you either learn — or you don't learn — to argue and resolve. To use your power more effectively or not. To resolve fights, to tattle," Lewis says. "You learn all the skills that you need for living with another."

Brett, 52, and his sister Mandie, 49, underwent therapy with Karen Lewis after an argument during Christmas in 2019 led to months of them not speaking. (NPR has agreed to identify the siblings in this story by their first names so they can speak frankly about the therapeutic process.)

Brett describes the first few sessions with Mandie as emotionally "pretty rough." But he says after six sessions they not only had repaired their rift, but developed new, healthier ways to interact as adults.

"The fact that you had to go back to things [from] when you were six, seven, eight, nine years old, to get to things you're dealing with in your forties and fifties," Brett says, "it's pretty surprising that there's a connection. But there was."

As adults, strong sibling relationships can affect our emotional well-being and mitigate loneliness in midlife — and help us navigate the aging and death of parents, and eventually, ourselves.

"In the normal course of life, you will have your siblings longer than your friends. You'll certainly have them longer than your partner and longer than your parents. So if you can keep them close enough to be a loving support of you, you're going to be in better shape," says Geoffrey Greif, a professor at the University of Maryland School of Social Work and co-author of the book Adult Sibling Relationships.

Until recently, sibling relationships, particularly among adult siblings, were understudied by family therapists and researchers. That's changing, but purposely entering therapy with a sibling, to repair or strengthen that relationship, is still not as common as, say, individual or couples therapy.

"People just don't perceive those relationships as needing the type of attention and tending one might bring to a spouse or child," says Kelly Scott, a therapist and Director of Supervision and Training for Tribeca Therapy in New York City. "Relating to our siblings is like, 'You're stuck with me. We're always going to be family. You can't ever actually leave me.' "

While that's technically true (you can't divorce a sibling), experts say taking that bond for granted is risky.

'Every sibling has different parents'

There isn't a lot of research about sibling estrangement, but one study of German siblings found 28 percent reported at least one "episode" of estrangement (defined as either lack of contact or of emotional closeness). The reasons for sibling conflict vary, but common ones include parental favoritism (in childhood and adulthood), disputes over caregiving and childhood abuse by parents or siblings.

What triggered the 2019 argument between Brett and Mandie was something banal, ordinary and irrelevant, both of them say. But they went almost a year without speaking. Brett sent a long email, but Mandie says she couldn't even bring herself to read it, much less reply.

"It wasn't that he was being hurtful. It was [that] the whole thing just was painful. And I was going through so much already with COVID," says Mandie, an emergency medicine doctor in Wisconsin.

Brett lives in California and works in business. Both siblings are married and have kids. As Mandie continued to rebuff him, Brett says he realized they might need professional help.

"There was a disagreement, but it was much deeper than that," he says. "There were things that had been smoldering from a family perspective for a while."

Eventually Mandie agreed that if Brett found a therapist and set up the appointment, she would attend. "I said, 'I have a lot of walls that are built up, and I don't know how this will go. But I'll show up,' " she says.

They had five or six sessions with Karen Gail Lewis. They talked about their childhood, and while both agreed that their family had been close, and that their mom was pretty terrific, they recalled different dynamics with their parents.

"I felt that my parents treated him differently than me. They're harder on me," Mandie says.

Growing up, Brett says he wasn't aware of what Mandie was describing in therapy, but now, as an adult, he listened. "It doesn't matter whether it was right or wrong, it's the way she felt about it," Brett says. "So it's real and I had to deal with that."

The way Mandie and Brett surfaced their different experiences of being parented is important in sibling work, according to Kelly Scott. "Every sibling has different parents. Every sibling has a different upbringing."

Recognizing that emotional truth is as important as discussing the shared memories and bonds, Scott says.

Geoffrey Greif agrees that each sibling has a different perspective on how they were parented: "You can't raise all your children exactly the same. You can't be exactly fair all the time. Someone's going to need more."

Siblings also experience family events (divorce, deployment, fluctuations in income) at different ages, with different reactions and capacities for coping. In a survey of hundreds of adult siblings, Greif found that sibling relationships are characterized by a mixture of affection, ambivalence and ambiguity. Affection was present for most, with 64% describing themselves as good friends with at least one other sibling, and 45% calling a sibling their "best friend."

But ambivalence is also common: Siblings can love each other but also feel competitive or jealous or annoyed with each other. Finally, Gieif found that sibling relationships are often pervaded by ambiguity — uncertainty or doubt about the other's motivations or decisions.

"The other part of ambiguity is 'They don't know who I am today. They still treat me like I'm 16.... They just don't get me and I don't get them, maybe.' "

Stuck in 'crystallized roles'

For Mel and her younger sister Liz, the therapeutic breakthrough came from identifying their different childhood "roles" and finding new ways to relate.

"There were things that we just assumed about each other," Liz says. "We would say, 'Oh, well, Mellie's this way and she's always this way. Or, I'm this way and I'm always this way.' And we had just said it for so long, that we almost wouldn't allow ourselves to grow and admit more complicated feelings."

Mel, 51, is married and has two "wonderful, brilliant" sons with autism and ADHD. She's a paralegal and advocate for kids with special needs.

Liz, 45, doesn't have kids — but she works as a pediatric occupational therapist.

During the pandemic, Mel's sons were struggling under lockdown. They were isolated and had trouble paying attention during family Zoom sessions. Liz offered resources and professional expertise, but she still felt pressure to do more: facilitate the family Zooms, keep her aging parents connected to their grandsons, support her sister and generally put on a happy face.

Until one day, when Liz found she just couldn't do that emotional labor anymore. "I just kind of shorted out," Liz recalls. "I kind of freaked out a little bit and said, 'I don't want to talk to anybody right now. I need a break.' And subsequently, that upset my sister."

For Mel, her sister's withdrawal felt intensely painful. "I was also having a lot of emotions about the world, feeling that the world was rejecting my boys and my family," Mel recalls. "I felt like it was hurting them to have people come in and out of their lives."

And Mel couldn't understand why Liz — her beloved sister — had shut down. "I just didn't know who she was, who she really was," Mel recalls, "And I just didn't know how to have a relationship with her moving forward."

Liz, for her part, bristled at the implication that she had somehow failed her nephews or family. "It, to me, was a huge slap in the face. Because it's like 'Well, nothing I do is good enough, and nobody's acknowledging what I'm doing, you know?' "

They didn't speak for months, and when the holidays came around, just being together felt awkward and strained. But eventually, over email, they decided to try therapy.

Growing up in California, their mom had been physically and emotionally abusive, both sisters say, though most of the abuse was directed at Mel. In therapy, they discussed the "roles" they had come to play in the family: Mel, the family's "black sheep," remembers constantly trying to protect her little sister Liz, who was cast as the family's "golden child."

Although Liz says she avoided much of the abuse, she felt pressured to show up as "the happy one, the giving one, the together one, [the] person who will always help in a time of need." Until the pandemic, that is, when she says she hit a wall: "It wasn't working for me. It was damaging for me," Liz says.

These childhood roles can vary, says Sibling Therapy author Karen Gail Lewis. "The troublemaker, the funny one, the responsible one, the irresponsible one," she says, naming just a few.

The roles aren't necessarily bad, she adds. "The problem comes if it doesn't fit, and if it gets crystallized."

For Liz and Mel, identifying these family roles in therapy was just the start. The hard part was recognizing the complex feelings hidden behind the roles, Liz says.

"I didn't want to explore it," Liz says. "I mean, I already felt so horrible about it, right? I didn't want to delve into it." But they did. They talked about the resentment and jealousy over who got abused and who avoided it, over which sister always seemed to get things wrong and which always seemed to do things right.

"We were in these roles and that's not who my sister is," Mel said. "She's a real person. She's not a porcelain fairy or whatever."

The painful distance between them melted away. "I feel so much closer to her," Mel says. "I feel like I have my sister back."

Liz says she felt unburdened, freed from invisible duties and obligations. Things are also better with their parents, who agreed to attend a few sessions with their daughters.

Because of therapy, Mel realized she sometimes avoided communicating directly with Liz and instead used their parents as go-betweens. "In hindsight that was stupid. But I would use our parents to communicate about certain things or feelings back and forth, and things would get skewed."

A sibling relationship put to the ultimate test

As their therapy drew to a close, Mandie and Brett also found their communications had opened up. They even decided to try another vacation together, and it went well.

But then came some terrible news. Their mom had a bad cough, and had gotten a CT scan. She wanted Mandie, the ER doctor, to take a look at it. "Literally that one day I knew that it was a death sentence," Mandie recalls. "And so I had to call Brett and tell him."

Their mom was diagnosed with pancreatic cancer, and it had spread to the lungs. Brett flew out to see his parents and Mandie, and the four sat down to talk. Mandie led the conversation, explaining the clinical challenges to come, and suggesting changes they would have to make to their parents' home, to prepare.

"I was seeing the next couple of months in a whole different perspective than the other three," Mandie says. It was a deeply uncomfortable conversation for Brett. "It was hard because I'm thinking like a doctor and he's thinking like a son."

Brett left the meeting upset, but Mandie followed up later.

"I said 'Brett, that was the hardest moment of our lives, the four of us right there,' " Mandie says. "I think we were able to actually listen to each other and not just close off and shut off."

The illness was swift, just four months. Brett lived far away, but made frequent visits and helped with the caretaking duties. They were especially careful about making sure each of them spent as much time as possible with their mom, without getting in each other's way, while also balancing jobs and families. It took logistics and patience and communication.

Their mother sometimes called Brett and Mandie her "baby birds." That long period when they were estranged, back in 2020, had been painful for her. "She was very aware that we did therapy, and very aware it could have been a totally different situation," Mandie recalls.

"If we hadn't gone through the therapy we went through, we would never have given her the love and the wonderful last four months that she had with us. I think she died happy, knowing that her baby birds were happy in a nest together again."

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