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

by Lori Gottlieb

Whatever the problem, it generally “presents” because the person has reached an inflection point in life.

If you go through life picking and choosing, if you don’t recognize that “the perfect is the enemy of the good,” you may deprive yourself of joy.

But I understand where these responses come from. It boils down to fear—of being exposed, of being found out. Will you spot the insecurities that I’m so skillful at hiding? Will you see my vulnerabilities, my lies, my shame? Will you see the human in my being?

I’ve always been drawn to stories—not just what happens, but how the story is told. When people come to therapy, I’m listening to their narratives but also for their flexibility with them. Do they consider what they’re saying to be the only version of the story—the “accurate” version—or do they know that theirs is just one of many ways to tell it? Are they aware of what they’re choosing to leave in or out, of how their motivation in sharing this story affects how the listener hears it?

Attachment

After a bunch of empathetic Mmms, Wendell asks a question: “Is this a typical breakup reaction for you?” His tone is kind, but I know what he’s getting at. He’s trying to determine what’s known as my attachment style. Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in people’s adult relationships too, influencing the kinds of partners they pick (stable or less stable), how they behave during the course of a relationship (needy, distant, or volatile), and how their relationships tend to end (wistfully, amiably, or with a huge explosion). The good news is that maladaptive attachment styles can be modified in adulthood—this, in fact, is a lot of the work of therapy.

“I know that you feel caught by surprise,” Wendell says. “But I’m also interested in something else you said. Half your life is over. Maybe what you’re grieving isn’t just the breakup, though I know this experience feels devastating.” He pauses, and when he speaks again, his voice is softer. “I wonder if you’re grieving something bigger than the loss of your boyfriend.”

He knows what all therapists know: That the presenting problem, the issue somebody comes in with, is often just one aspect of a larger problem, if not a red herring entirely. He knows that most people are brilliant at finding ways to filter out the things they don’t want to look at, at using distractions or defenses to keep threatening feelings at bay.

You’re grieving something bigger, Wendell had said.

“Welcome to Holland.” Written by Emily Perl Kingsley, the parent of a child with Down syndrome, it’s about the experience of having your life’s expectations turned upside down:

She told me that for a long while, Dara would say, “I didn’t sign up for this!” and catalog all the ways in which her life had been irrevocably changed. She and her husband would never have cuddles and carpools and reading stories before bed. They would never have a child who would grow into an independent adult. Dara would look at her husband, Julie said, and think, He’s an amazing father to our son, but she couldn’t help contemplate the amazing father he would have been to a child who could fully interact with him. She couldn’t help the sadness that would descend when she let herself think about the kinds of experiences they wouldn’t be able to have with their child, ever.

“Do you think I’m a bad person?” she’d ask, and I’d assure her that everyone who comes to therapy worries that what they think or feel might not be “normal” or “good,” and yet it’s our honesty with ourselves that helps us make sense of our lives with all of their nuances and complexity. Repress those thoughts, and you’ll likely behave “badly.” Acknowledge them, and you’ll grow.

He can’t fix my broken relationship. He can’t change the facts. But he can help because he knows this: We all have a deep yearning to understand ourselves and be understood. When I see couples in therapy, often one or the other will complain, not “You don’t love me” but “You don’t understand me.” (One woman said to her husband, “You know what three words are even more romantic to me than ‘I love you’?” “You look beautiful?” he tried. “No,” his wife said. “I understand you.”)

Who I was when my son was an infant is different from who I am in sessions now,

In therapy, she learned that the mystery she was trying to solve was larger than whether or not her father committed suicide. It was also the mystery of who her father was when he was alive—and who she became as a result of that.

Honesty is stronger medicine than sympathy, which may console but often conceals. —Gretel Ehrlich

Men tend to be at a disadvantage here because they aren’t typically raised to have a working knowledge of their internal worlds; it’s less socially acceptable for men to talk about their feelings. While women feel cultural pressure to keep up their physical appearance, men feel that pressure to keep up their emotional appearance.

John’s eyes have darted down and to the side, which is what usually happens with someone when what I’m saying touches someplace vulnerable, and I’m glad. It’s impossible to grow without first becoming vulnerable.

Often when patients see our humanity, they leave us. Soon after

By the time Charlotte got to the end of this story, she was sobbing, which was unusual for her. Charlotte generally betrays little, if any, real emotion—her face is a mask, her words, diversions. It’s not that she’s hiding her feelings; it’s that she can’t access them. There’s a word for this kind of emotional blindness: alexithymia. She doesn’t know what she’s feeling or doesn’t have the words to express it. Praise from her boss will be reported in a monotone, and I have to probe . . . and probe . . . and probe, until I finally get to a hint of pride. A sexual assault in college—she was drinking, found herself at a party in a strange dorm room, naked, in a bed—will be reported in that same monotone. A retelling of a chaotic conversation with her mom will sound like she’s reciting the Pledge of Allegiance. Sometimes people can’t identify their feelings because they were talked out of them as children. The child says, “I’m angry,” and the parent says, “Really? Over such a tiny thing? You’re so sensitive!” Or the kid says, “I’m sad,” and the parent says, “Don’t be sad. Hey, look, a balloon!” Or the child says, “I’m scared,” and the parent says, “There’s nothing to be worried about. Don’t be such a baby.” But nobody can keep profound feelings sealed up forever. Inevitably, when we least expect it—seeing a commercial, for instance—they escape.

The Speed of Want After completing my traineeship year, I began

“You’ll turn thirty or forty or fifty anyway, whether your hours are finished or not,” she said. “What does it matter what age you are when that happens? Either way, you won’t get today back.” We all went quiet. You won’t get today back. What a chilling idea. We knew that our supervisor was trying to tell us something important. But we didn’t have time to think about it.

There was an unspoken irony to all of this. People wanted a speedy solution to their problems, but what if their moods had been driven down in the first place by the hurried pace of their lives? They imagined that they were rushing now in order to savor their lives later, but so often, later never came. The psychoanalyst Erich Fromm had made this point more than fifty years earlier: “Modern man thinks he loses something—time—when he does not do things quickly; yet he does not know what to do with the time he gains except kill it.” Fromm was right; people didn’t use extra time earned to relax or connect with friends or family. Instead, they tried to cram more in.

“Nobody wants to buy therapy anymore,” the consultant said matter-of-factly. “They want to buy a solution to a problem.” She made some suggestions about positioning myself for this new marketplace—even proposing that I should offer “text therapy”—but the whole thing made me uncomfortable.

The four ultimate concerns are death, isolation, freedom, and meaninglessness. Death, of course, is an instinctive fear that we often repress but that tends to increase as we get older. What we fear isn’t just dying in the literal sense but in the sense of being extinguished, the loss of our very identities, of our younger and more vibrant selves. How do we defend against this fear? Sometimes we refuse to grow up. Sometimes we self-sabotage. And sometimes we flat-out deny our impending deaths. But as Yalom wrote in Existential Psychotherapy, our awareness of death helps us live more fully—and with less, not more, anxiety. Julie, with the “wacky” risks she’s been taking, is a perfect example of this. I never paid attention to my own death until I embarked on the Medical Mystery Tour—and even then, Boyfriend allowed me to distract myself from my fears of extinction, both professional and actual. But he also offered me an antidote to my fear of isolation, another ultimate concern. There’s a reason that solitary confinement makes prisoners literally go crazy; they experience hallucinations, panic attacks, obsessional behavior, paranoia, despair, difficulty with focus, and suicidal ideation. When released, these people often struggle with social atrophy, which renders them unable to interact with others. (Perhaps this is simply a more intense version of what happens with our increasing want, our loneliness, created by our speedy lifestyles.) And then there’s the third ultimate ...

Uncertainty, I’m starting to realize, doesn’t mean the loss of hope—it means there’s possibility. I don’t know what will happen next—how potentially exciting! I’m going to have to figure out how to make the most of the life I have, illness or not, partner or not, the march of time notwithstanding. Which is to say, I’m going to have to look more closely at the fourth ultimate concern: meaninglessness.

I want to say that what John sees in me isn’t pity at all—that it’s compassion and empathy and even a kind of love. But John doesn’t let anyone touch or be touched by him, which leaves him alone in already isolating circumstances. Losing somebody you love is such a profoundly lonely experience, something only you endure in your own particular way.

“You’re so focused on being a good dad,” I say to John, “but maybe part of being a good dad is allowing yourself the full range of human emotions, of really living, even if living fully can sometimes be harder than not. You can feel your feelings privately, or with Margo, or here with me—you can let them out in the adult sphere—and doing that might allow you to be more alive with your kids.

given some air in your household and not tucked away in a box in the proverbial attic.” John shakes his head. “I don’t want to be like Margo,” he says. “She cries at the slightest things. Sometimes it seems like she’ll never stop crying, and I can’t live that way. It seems like nothing has changed for her and at some point, you have to make a decision to move on. I’ve chosen to move on. Margo hasn’t.” I picture Margo sitting on the couch near Wendell, hugging my favorite pillow and telling him how alone she feels in her pain, how she’s bearing it all herself while her husband is in his closed-off world. And then I think about how alone John must feel, watching his wife’s pain and not being able to bear the sight of it. “I know it looks that way,” I say finally. “But I wonder if part of why Margo is like this is that she’s been doing double duty. Maybe all of this time, she’s been crying for both of you.” John’s forehead furrows, then he looks down at his lap. A few tears land on his black designer jeans, slowly at first, then quickly, like a waterfall, faster than he can wipe them, and finally he stops trying. These are the tears he’s been holding in for the past six years. Or maybe more than thirty.

Fu Lin

Through his tears, John says that this is exactly what he didn’t want to happen, that he didn’t come here to have a breakdown. But I assure him that he’s not breaking down; he’s breaking open.

In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this: Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance

Of course, therapists aren’t persuaders. We can’t convince an anorexic to eat. We can’t convince an alcoholic not to drink. We can’t convince people not to be self-destructive, because for now, the self-destruction serves them. What we can do is try to help them understand themselves better and show them how to ask themselves the right questions until something happens—either internally or externally—that leads them to do their own persuading.

Whereas Freud believed that people are driven to seek pleasure and avoid pain (his famous pleasure principle), Frankl maintained that people’s primary drive isn’t toward pleasure but toward finding meaning in their lives.

He wrote, “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.”

Rereading these notes, I thought of my conversations with Wendell. Scribbled in my grad-school spiral were the words Reacting vs. responding = reflexive vs. chosen. We can choose our response, Frankl was saying, even under the specter of death. The same was true of John’s loss of his mother and son, Julie’s illness, Rita’s regrettable past, and Charlotte’s upbringing. I couldn’t think of a single patient to whom Frankl’s ideas didn’t apply, whether it was about extreme trauma or an interaction with a difficult family member. More than sixty years later, Wendell was saying I could choose too—that the jail cell was open on both sides. I particularly liked this line from Frankl’s book: “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 tell Wendell about the time I was in college on the East Coast, missing home and unsure if I wanted to stay there. My father heard the pain in my voice and got on a plane and flew three thousand miles to sit with me on a park bench across from my dorm, in the cold winter weather, and just listen. He listened to me for two more days, and I felt better, and he went home. I haven’t thought about this in years.

Did his father ever tell him he was proud of him, not despite his rejecting the family business and carving out his own path but because of it?

Most important, Erikson’s stages continue throughout the entire lifespan, and each interrelated stage involves a crisis that we need to get through to move on to the next. They look like this: Infant (hope)—trust versus mistrust Toddler (will)—autonomy versus shame Preschooler (purpose)—initiative versus guilt School-age child (competence)—industry versus inferiority Adolescent (fidelity)—identity versus role confusion Young adult (love)—intimacy versus isolation Middle-aged adult (care)—generativity versus stagnation Older adult (wisdom)—integrity versus despair

The eighth stage is where people Rita’s age generally find themselves. Erikson maintained that, in later years, we experience a sense of integrity if we believe we have lived meaningful lives. This sense of integrity gives us a feeling of completeness so that we can better accept our approaching deaths. But if we have unresolved regrets about the past—if we think that we made poor choices or failed to accomplish important goals—we feel depressed and hopeless, which leads us to despair.

There’s a term for this irrational fear of joy: cherophobia (chero is the Greek word for “rejoice”). People with cherophobia are like Teflon pans in terms of pleasure—it doesn’t stick (though pain cakes on them as if to an ungreased surface). It’s common for people with traumatic histories to expect disaster just around the corner. Instead of leaning into the goodness that comes their way, they become hypervigilant, always waiting for something to go wrong. That might be why Rita still fumbled for tissues in her purse even though she knew a fresh box was beside her on the table. Better not to get used to a full box of tissues, or a surrogate family next door, or people purchasing your art, or the man you’re dreaming about giving you a big fat kiss in the parking lot. Don’t delude yourself, sister! The second you get too comfortable—whoosh!—it will all go away. For Rita, joy isn’t pleasure; it’s anticipatory pain.

Why do parents do this? Often, they envy their children’s childhoods—the opportunities they have; the financial or emotional stability that the parents provide; the fact that their children have their whole lives ahead of them, a stretch of time that’s now in the parents’ pasts. They strive to give their children all the things they themselves didn’t have, but they sometimes end up, without even realizing it, resenting the kids for their good fortune.

Forgiveness is a tricky thing, in the way that apologies can be. Are you apologizing because it makes you feel better or because it will make the other person feel better? Are you sorry for what you’ve done or are you simply trying to placate the other person who believes you should be sorry for the thing you feel completely justified in having done? Who is the apology for? There’s a term we use in therapy: forced forgiveness. Sometimes people feel that in order to get past a trauma, they need to forgive whoever caused the damage—the

“You,” I say. I point out to her that pain can be protective; staying in a depressed place can be a form of avoidance. Safe inside her shell of pain, she doesn’t have to face anything, nor does she have to emerge into the world, where she might get hurt again. Her inner critic serves her: I don’t have to take any action because I’m worthless. And there’s another benefit to her misery: she may feel that she stays alive in her kids’ minds if they relish her suffering. At least somebody has her in mind, even in a negative way—and in this sense, she’s not completely forgotten.

The humanistic psychologist Carl Rogers practiced what he called client-centered therapy, a central tenet of which was unconditional positive regard. His switch from using the term patient to client was representative of his attitude toward the people he worked with. Rogers believed that a positive therapist-client relationship was an essential part of the cure, not just a means to an end—a groundbreaking concept when he introduced it in the mid-twentieth century. But unconditional positive

According to Julie, here are a few things not to say: Are you sure you’re dying? Have you gotten a second opinion? Be strong. What are your odds? You need to be less stressed. It’s all about attitude. You can beat this! I know somebody who took vitamin K and was cured. I read about this new therapy that shrinks tumors—in mice, but still. You really have no family history of this? (If Julie did, the person asking would feel safer; it could be explained by genetics.) The other day, someone told Julie, “I knew a woman who had the same kind of cancer as you.” “Knew?” Julie said. “Um, yes,” the person replied sheepishly. “She, uh, died.”

at various difficult times: You can still have another child. At least he lived a long life. She’s in a better place now. When you’re ready, you can always get another dog. It’s been a year; maybe it’s time to move on. To be sure, these comments are meant to comfort, but they’re also a way of protecting the speakers from the uncomfortable feelings that somebody else’s bad situation stirs up. Platitudes like these make a terrible circumstance more palatable for the person saying the words but leave the person experiencing the adversity feeling angry and alone.

“What do you wish people would say?” I ask. Julie thinks about this. “They can say, ‘I’m so sorry.’ They can say, ‘How can I be helpful?’ Or ‘I feel so helpless but I care about you.’” She shifts on the couch, her thinner frame not quite filling out her clothes. “They can be honest,” she continues. “One person blurted out, ‘I have no idea how to say the right thing here,’ and I was so relieved! I told her that before I got sick, I wouldn’t have known what to say either.

All of this, no matter how mundane, delights her to no end. She’s become hyper-present. When people delude themselves into believing they have all the time in the world, she’s noticed, they get lazy.

“If I write this book,” she says, “maybe I’ll say that the best responses I’ve gotten have been from people who were genuine and didn’t edit themselves.” She looks at me. “Like you.” I try to remember what I’d said when Julie told me she was dying. I remember feeling uncomfortable the first time, devastated the second. I ask Julie what she remembers me saying. She smiles. “Both times you said the same thing, and I’ll never forget it, because I wasn’t expecting that from a therapist.” I shake my head. Expecting what? “You spontaneously said, in this quiet, sad voice, ‘Oh, Julie’—which was the perfect response, but it’s what you didn’t say that meant the most. You teared up, but I figured that you didn’t want me to see it, so I didn’t say anything.”

“It’s like we’ve done therapy on steroids,” Julie said of everything that had happened since we met. “Like the way Matt and I say that we’re doing our marriage on steroids. We have to cram it all in as quickly as possible.” Julie realized, when she talked about cramming it all in, that if she was pissed off about having such a short life, it was only because it had been such a good one. Which is why, in the end, after several drafts and revisions, Julie decided to keep her obituary simple: “For every single day of her thirty-five years,” she wanted it to read, “Julie Callahan Blue was loved.” Love wins.

Sometimes when a new patient comes in, I ask not just “What brings you here?” but “What brings you here now?” The now is the key. Why this year, this month, this day, have you decided to come talk to me? It seemed like the breakup was my answer to “Why now?” but underneath it was my stuckness and my grief.