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

by Lori Gottlieb

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains—that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.

“There’s something likable in everyone,” and to my great surprise, I found that she was right. It’s impossible to get to know people deeply and not come to like them.

life happens and therapy helps us confront our demons when they pay a visit. And visit they will, because everyone has demons—big, small, old, new, quiet, loud, whatever. These shared demons are testament to the fact that we aren’t such outliers after all. And it’s with this discovery that we can create a different relationship with our demons, one in which we no longer try to reason our way out of an inconvenient inner voice or numb our feelings with distractions like too much wine or food or hours spent surfing the internet (an activity my colleague calls “the most effective short-term nonprescription painkiller”).

One of the most important steps in therapy is helping people take responsibility for their current predicaments, because once they realize that they can (and must) construct their own lives, they’re free to generate change.

“If the queen had balls, she’d be the king.” 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.

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?

Doing something prompts you to do something else, replacing a vicious cycle with a virtuous one.

subjective litmus test we use to assess the value of the disclosure: Is this information helpful for the patient to have?

the trap that Buddhists call idiot compassion—an apt phrase, given John’s worldview. 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.

we’re imagining them down the line. We do this not just on that first day but in every single session, because that image allows us to hold for them the hope that they can’t yet muster themselves, and it informs how the treatment unfolds.

I’m curious about

I was game. I didn’t want to lose the person behind the diagnosis.

If he spends any time at all with his emotions, they likely overwhelm him, so he projects them onto others as anger, derision, or criticism.

job to help me edit my story. All therapists do this: What material is extraneous? Are the supporting characters important or a distraction? Is the story advancing or is the protagonist going in circles? Do the plot points reveal a theme?

Therapists delve into a mind rather than a brain, and we can see from the subtlest gesture or expression if we’ve hit a nerve. But unlike neurosurgeons, we gravitate toward the sensitive area, pressing delicately on it, even if it makes the patient feel uncomfortable.

The late reporter Alex Tizon believed that every person has an epic story that resides “somewhere in the tangle of the subject’s burden and the subject’s desire.”

(Our role is to understand your perspective but not necessarily to endorse it.)

What are we afraid of? We are afraid of being hurt. We are afraid of being humiliated. We are afraid of failure and we are afraid of success. We are afraid of being alone and we are afraid of connection.

We are afraid of being responsible for our own lives.

“The cardinal rules of good parenting—moderation, empathy, and temperamental accommodation with one’s child—are

Happiness (t) = w0+ w1 γt−j CRj+ w2 γt−j EVj+ w3 γt−j RPEj

Which all boils down to: Happiness equals reality minus expectations. Apparently, you can make people happy by delivering bad news and then taking it back

Anger is the go-to feeling for most people because it’s outward-directed—angrily blaming others can feel deliciously sanctimonious. But often it’s only the tip of the iceberg, and if you look beneath the surface, you’ll glimpse submerged feelings you either weren’t aware of or didn’t want to show: fear, helplessness, envy, loneliness, insecurity. And if you can tolerate these deeper feelings long enough to understand them and listen to what they’re telling you, you’ll not only manage your anger in more productive ways, you also won’t be so angry all the time.

PEACE. IT DOES NOT MEAN TO BE IN A PLACE WHERE THERE IS NO NOISE, TROUBLE, OR HARD WORK. IT MEANS TO BE IN THE MIDST OF THOSE THINGS AND STILL BE CALM IN YOUR HEART.

Therapists don’t perform personality transplants; they just help to take the sharp edges off. A patient may become less reactive or critical, more open and able to let people in. In other words, therapy is about understanding the self that you are.

quote from Einstein: “No problem can be solved from the same level of consciousness that created it.” I’ve always felt that made sense, but, like most of us, I also believe that I should be able to think my way out of my problem by going over and over how I thought myself into it.

If we have a choice between believing one of two things, both of which we have evidence for—I’m unlovable, I’m lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations (the everyone’s-life-is-better-than-mine station, the I-can’t-trust-people station, the nothing-works-out-for-me station) instead of moving the dial up or down? Change the station. Walk around the bars. Who’s stopping us but ourselves?

Therapists are always weighing the balance between forming a trusting alliance and getting to the real work so the patient doesn’t have to continue suffering.

at the top of their games in terms of skill, knowledge,

“The opposite of depression isn’t happiness, but vitality.”

Why would people do this to themselves? Because the pull toward that feeling of “home” makes what they want as adults hard to disentangle from what they experienced as children. They have an uncanny attraction to people who share the characteristics of a parent who in some way hurt them.

I’ve had to resist the temptation to jump in and set her straight too quickly when she plops down in her chair, tells a meandering anecdote, and finishes with a demand couched in a question:

Therapist is spelled the same way as the rapist. It’s a common joke in the therapy world. I smiled. “I wonder if you’re trying to tell me that sometimes it’s hard to be here.” I’ve certainly felt that with Wendell, especially when his eyes seem to bore into me and there’s no place to hide. By day, therapists hear people’s secrets and fantasies, their shame and their failures, invading the spaces they normally keep private. Then—boom—the hour’s over. Just like that. Are we emotional rapists?

He may be resistant to acknowledging it now, but I welcome his resistance because resistance is a clue to where the crux of the work lies; it signals what a therapist needs to pay attention to. During training, whenever we interns felt frustrated by resistant patients, our supervisors would counsel, “Resistance is a therapist’s friend. Don’t fight it—follow it.” In other words, try to figure out why it’s there in the first place.

This felt like a classic example of projective identification. In projection, a patient attributes his beliefs to another person; in projective identification, he sends them into another person. For instance, a man may feel angry at his boss at work, then come home and say to his spouse, “You seem angry.” He’s projecting, because the spouse isn’t angry. In projective identification, on the other hand, the man may feel angry at his boss, return home, and essentially insert his anger into his partner, actually making the partner feel angry. Projective identification is like tossing a hot potato to the other person. The man no longer has to feel his anger, since it’s now living inside his partner.

Projective identification

I’m not sure what to do or even where to look. If I look right at her, will she feel self-conscious? If I look away, will she feel ignored? Should I say something to engage with her or wait for her to finish crying?

People with conversion disorder aren’t faking it—that’s called factitious disorder. People with factitious disorder have a need to be thought of as sick and intentionally go to great lengths to appear ill. In conversion disorder, though, the patient is actually experiencing these symptoms; it’s just that there’s no identifiable medical explanation for them. They seem to be caused by emotional distress that the patient is completely unconscious of.

“somatic symptom disorder.”

conversion disorders tend to be more prevalent in cultures with strict rules and few opportunities for emotional expression.

My symptoms were as nebulous as emotional suffering appeared to outsiders.

I kept it to myself because I wanted to avoid being a woman suspected of having a wandering uterus.

because the truth comes with a cost: the need to face reality.

gradually I noticed that we’d stopped doing any therapy at all. And how could we? By focusing on one external calamity after another, Charlotte has been distracting herself from the real crises in her life—the internal ones. Sometimes “drama,” no matter how unpleasant, can be a form of self-medication, a way to calm ourselves down by avoiding the crises brewing inside.

I don’t tend to give prescriptive advice. One of the things that surprised me as a therapist was how often people wanted to be told what to do, as if I had the right answer

ultracrepidarianism, which means “the habit of giving opinions and advice on matters outside of one’s knowledge or competence.”

every decision they make is based on two things: fear and love. Therapy strives to teach you how to tell the two apart.

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.

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

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.

“Avoidance is a simple way of coping by not having to cope.”