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

by Lori Gottlieb

It’s not uncommon for patients to go through an entire session talking about this or that, only to spill something important in the last ten seconds (“I think I’m bisexual,” “My biological mother found me on Facebook”).

It’s not that I’m worried she’ll start to dress exactly like me (as one of my patients did).

“What do I say when I hear all their problems?” he asked. “Right. Do you try to give them advice, add your two cents?” “None of that,” he said. “Then what?” “‘Just be,’” he said. “What?” “I tell them, ‘Just be.’” “That’s what you say?” I started laughing. I imagined saying that in my office. You’ve got problems? Just

“Maybe everything they complain about isn’t actually a problem! Maybe it’s fine the way it is. Maybe it’s even great, like their haircut. Maybe they’d be happier if they didn’t try to change things. Just be.”

“It’s like those ‘would you rather’ games we played at slumber parties as kids,” she says today. “Would you rather die in an airplane crash or a fire? Would you rather be blind or deaf? Would you rather smell bad for the rest of your life or smell bad things for the rest of your life?

Now when her computer crashed or a pipe burst in the kitchen, she’d say, It’s just one of those things.

The phrase made her smile. It could work both ways, she decided. How many times do good things inexplicably come our way too? Just the other day, she told me, some random person walked into Trader Joe’s with a homeless woman who’d been sitting in the parking lot and said to Julie, “See that woman over there? I told her to buy herself some food. When she gets to the register, come find me and I’ll pay the bill.” Relating the story to Matt after work, Julie shook her head and said, It was just one of those things.

When the doctors first presented this news, Julie and Matt, sitting side by side in vinyl chairs in a doctor’s office, burst out laughing. They laughed at the earnest gynecologist, and then the next day they laughed at the solemn oncologist. By the end of the week, they had laughed at the gastroenterologist, the urologist, and the two surgeons they consulted for second opinions.

At another appointment, Julie said, “I don’t know, Doc. What’s the point of keeping my vagina if we remove my colon and I’ve got a bag of poop attached to my body? Not exactly an aphrodisiac.” Matt and Julie laughed then too.

When Julie told me this, I remembered how I had burst out laughing when Boyfriend said he didn’t want to live with a kid under his roof for another ten years. I remembered the patient who laughed hysterically when her beloved mother died, and another who laughed when he learned that his wife had multiple sclerosis. And then I remembered sobbing in Wendell’s office for entire sessions, the way my patients had and the way Julie had for the past few weeks. This was grief: You laugh. You cry. Repeat.

“Well, sure, the vows say ‘in sickness and health’ and ‘for better or worse’ and all that, but that’s kind of like clicking okay to the terms and conditions when you download an app or sign up for a credit card. You don’t think any of that is going to apply to you.

Julie nods. “I feel guilty for putting him through this and jealous that he gets a future,” she says, adjusting a pillow behind her back. “And then I feel guilty for being jealous.”

Julie’s crying again. “Sorry,” she says. Almost every woman I see apologizes for her feelings, especially her tears. I remember apologizing in Wendell’s office too. Perhaps men apologize preemptively, by holding their tears back.

She goes on to name all the things she wishes she’d appreciated more before she got sick: Her breasts, which she used to think weren’t perky enough until she had to give them up; her strong legs, which she often thought were too thick, even though they served her well in marathons; her quiet way of listening, which she feared some might find boring. She’s going to miss her distinctive laugh that a boy in fifth grade called “a squawk,” a comment that somehow stuck like a burr inside her for years until that laugh made Matt glance her way in a crowded room and then make a beeline for her to introduce himself.

Then I feel the tears well up. Laughter to tears—grief. I’m going to miss Julie and I’m having a hard time with this myself. Sometimes the only thing to do is yell, “Fuck!”

a revolution was under way, one of speed, ease, and immediate gratification.

After all, it wasn’t that psychotherapy didn’t work. It was that it didn’t work fast enough for today’s patients, who were now, tellingly, called “consumers.”

“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.

circuitous

smattering

Somebody said she had heard about branding specialists specifically for therapists, professionals who could help to bridge the gap between the culture’s need for speed and ease and what we were trained to do.

If you’d asked me when I started as a therapist what most people came in for, I would have replied that they hoped to feel less anxious or depressed, to have less problematic relationships. But no matter the circumstances, there seemed to be this common element of loneliness, a craving for but a lack of a strong sense of human connection. A want. They rarely expressed it that way, but the more I learned about their lives, the more I could sense it, and I felt it in many ways myself.

I don’t know where to start. Lately I’ve been anxious about pretty much everything. Even little things like making small commitments have left me paralyzed. I’ve become cautious, afraid of taking risks and making mistakes because I’ve made so many already and I fear I won’t have time to clean up the mistakes anymore.

I remember something I learned during my internship: “Avoidance is a simple way of coping by not having to cope.”

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

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!

Still, the way he loved his wife was different from the way he loved his kids. If his love for his wife was romantic and warm, his love for his kids was like a volcano.

precocious!”

I don’t smile. I bring him back by waiting.

It’s the not knowing that torments John. 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.

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.

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.

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.

Contemplation is rife with ambivalence.

People often start therapy during the contemplation stage.

Here people procrastinate or self-sabotage as a way to stave off change—even positive change—because they’re reluctant to give something up without knowing what they’ll get in its place.

The hiccup at this stage is that change involves the loss of the old and the anxiety of the new.

The goal, of course, is to get to the final stage, maintenance, which means that the person has maintained the change for a significant period. That’s not to say that people don’t backslide, like in a game of Chutes and Ladders.

Charlotte squeezes her lips together, as if considering a possibility that had never occurred to her before. After all of her efforts to try to get these men to love her the way she wants to be loved, she can’t change them because they don’t want to change.

Every relationship is a dance.

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.

This.

“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.”

We can choose our response, Frankl was saying, even under the specter of death.

“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.”

So I pull back, ignoring the fact that therapists are trained to listen for what patients aren’t saying.

I remember feeling a twinge of envy when I saw that photo, not because I was envious of his wife but because they seemed to have the kind of relationship I wanted for myself—with someone else.

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.

dirge,

Soon Rita was teaching art to Sophia and Alice, ages five and seven, and often joined the “Hello, family” for, well, family dinner.

She seemed to be stuck in what the psychologist Erik Erikson termed despair.