Maybe You Should Talk to Someone: A Therapist, Her Therapist, and Our Lives Revealed

by Lori Gottlieb

Nothing is more desirable than to be released from an affliction, but nothing is more frightening than to be divested of a crutch. —James Baldwin

I’m dealing with my pain the way I suspect John has been dealing with his: by covering it up.

As a therapist, I know a lot about pain, about the ways in which pain is tied to loss. But I also know something less commonly understood: that change and loss travel together. We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same.

whirring beneath our hard-earned expertise is the fact that we know just how hard it is to be a person. Which is to say, we still come to work each day as ourselves—with our own sets of vulnerabilities, our own longings and insecurities, and our own histories.

No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We’ll talk with almost anyone about our physical health (can anyone imagine spouses hiding their reflux medication from each other?), even our sex lives, but bring up anxiety or depression or an intractable sense of grief, and the expression on the face looking back at you will probably read, Get me out of this conversation, pronto.

Most big transformations come about from the hundreds of tiny, almost imperceptible, steps we take along the way.

An interesting paradox of the therapy process: In order to do their job, therapists try to see patients as they really are, which means noticing their vulnerabilities and entrenched patterns and struggles. Patients, of course, want to be helped, but they also want to be liked and admired. In other words, they want to hide their vulnerabilities and entrenched patterns and struggles. That’s not to say that therapists don’t look for a patient’s strengths and try to build on those. We do. But while we aim to discover what’s not working, patients try to keep the illusion going to avoid shame—to seem more together than they really are.

In idiot compassion, you avoid rocking the boat to spare people’s feelings, even though the boat needs rocking and your compassion ends up being more harmful than your honesty. People do this with teenagers, spouses, addicts, even themselves. Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed.

People often mistake numbness for nothingness, but numbness isn’t the absence of feelings; it’s a response to being overwhelmed by too many feelings.

“Your feelings don’t have to mesh with what you think they should be,” he explained. “They’ll be there regardless, so you might as well welcome them because they hold important clues.” How many times had I said something similar to my own patients? But here I feel as if I’m hearing this for the first time. Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth.

The things we protest against the most are often the very things we need to look at.

There is a continuing decision to be made as to whether to evade pain, or to tolerate it and therefore modify it.

We tend to think that the future happens later, but we’re creating it in our minds every day. When the present falls apart, so does the future we had associated with it. And having the future taken away is the mother of all plot twists.

Everything that made this man himself—his personality, his memories, his experiences, his likes and dislikes, his loves and losses, his knowledge and abilities—was contained in this three-pound organ. You lose a leg or a kidney, you’re still you, but lose a part of your brain—literally, lose your mind—and who are you then?

When you’re going to have a baby, it’s like planning a fabulous vacation trip—to Italy.

One day Julie told me that she’d begun to notice how often in casual conversation people talked about the future. I’m going to lose weight. I’m going to start exercising. We’re going to take a vacation this year. In three years, I’ll get that promotion. I’m saving to buy a house. We want to have a second baby in a couple of years. I’ll go to my next reunion in five years. They plan.

therapy is about understanding the self that you are. But part of getting to know yourself is to unknow yourself—to let go of the limiting stories you’ve told yourself about who you are so that you aren’t trapped by them, so you can live your life and not the story you’ve been telling yourself about your life.

you can have all the insight in the world, but if you don’t change when you’re out in the world, the insight—and the therapy—is worthless.

In the fifth century BC, however, Hippocrates noted that aromas didn’t seem to be working for this malady, which he had named hysteria, from the Greek word for “uterus.” Accordingly, the treatment for hysterical women went from aromas and spices to exercise, massages, and hot baths. That lasted until the beginning of the thirteenth century, at which point there was thought to be a connection between women and the devil. The new treatment? Exorcism.

Finally, in the late 1600s, hysteria came to be thought of as related to the brain rather than the devil or the uterus. Today, there’s still debate on how to think about symptoms for which we can’t find a functional explanation. The current ICD-10 lists “conversion disorder with motor symptom or deficit” as a dissociative disorder (and includes the word hysterical in its subtypes), whereas the DSM-5 classifies conversion disorder as a “somatic symptom disorder.”

Interestingly, conversion disorders tend to be more prevalent in cultures with strict rules and few opportun...

The second people felt alone, I noticed, usually in the space between things—leaving a therapy session, at a red light, standing in a checkout line, riding the elevator—they picked up devices and ran away from that feeling. In a state of perpetual distraction, they seemed to be losing the ability to be with others and losing their ability to be with themselves. The therapy room seemed to be one of the only places left where two people sit in a room together for an uninterrupted fifty minutes.

The four ultimate concerns are death, isolation, freedom, and meaninglessness.

I think about how it’s the not knowing that torments all of us. Not knowing why your boyfriend left. Not knowing what’s wrong with your body. Not knowing if you could have saved your son. At a certain point, we all have to come to terms with the unknown and the unknowable. Sometimes we’ll never know why. “Anyway,”

“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

I get ready for … I don’t know what. Something bad to happen. A tornado to enter the room and alter our connection in some intangible but irreparable way. I wait for everything to feel distant, different, changed between us. But instead, the opposite happens. It feels as though the storm came in, passed through the room, and left not ruins but a clearing in its wake. I feel lighter, relieved of a burden. Sharing difficult truths might come with a cost—the need to face them—but there’s also a reward: freedom. The truth releases us from shame.

too often people feel pressured to forgive and then end up believing that something’s wrong with them if they can’t quite get there—that they aren’t enlightened enough or strong enough or compassionate enough. So what I say is this: You can have compassion without forgiving. There are many ways to move on, and pretending to feel a certain way isn’t one of them.

Your misery doesn’t change their situation. You can’t lessen their misery by carrying it for them inside you. It doesn’t work that way.

There’s no hierarchy of pain. Suffering shouldn’t be ranked, because pain is not a contest.