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

by Lori Gottlieb

So many of our destructive behaviors take root in an emotional void, an emptiness that calls out for something to fill it.

Say what you will about the wonders of technology, but screen-to-screen is, as a colleague once said, “like doing therapy with a condom on.”

Whenever one person in a family system starts to make changes, even if the changes are healthy and positive, it’s not unusual for other members in this system to do everything they can to maintain the status quo

I don’t know what to do with this information, so I do what therapists are taught to do when we’re having a complicated reaction to something and need more time to understand it. I do nothing—for the moment.

feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them. But if we push them away the second they appear, often we end up veering off in the wrong direction,

love can often look like so many things that don’t seem like love.

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:

There’s a magnet that somebody stuck on the refrigerator in our office’s kitchen: 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.

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.

I remember a quote from Einstein: “No problem can be solved from the same level of consciousness that created it.”

You are your own jailer.

“Insight is the booby prize of therapy” is my favorite maxim of the trade, meaning that 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.

While suicidal thoughts—known as suicidal ideation—are commonplace with depression, most people respond to treatment and never act on those hopeless impulses. In fact, it’s as patients begin to get better that the risk for suicide increases.

men commit suicide three times more often than women)?

As Andrew Solomon wrote in The Noonday Demon: “The opposite of depression isn’t happiness, but vitality.”

It’s the most common refrain I hear from single women of all ages: Dating sucks.

We marry our unfinished business.

It’s well documented that touch is important for well-being throughout our lifetimes. Touch can lower blood pressure and stress levels, boost moods and immune systems. Babies can die from lack of touch, and so can adults (adults who are touched regularly live longer). There’s even a term for this condition: skin hunger.

He joked that dating a therapist was like dating a CIA agent. I laughed and said that being a therapist sometimes felt more like having an affair with your entire caseload, past and present, simultaneously. We’re always pretending not to know the people we know most intimately.

In movies, therapist silences have become a cliché, but it’s only in silence that people can truly hear themselves. Talking can keep people in their heads and safely away from their emotions. Being silent is like emptying the trash.

If something isn’t working, do something different,

What most people mean by type is a sense of attraction—a type of physical appearance or a type of personality turns them on. But what underlies a person’s type, in fact, is a sense of familiarity. It’s no coincidence that people who had angry parents often end up choosing angry partners, that those with alcoholic parents are frequently drawn to partners who drink quite a bit, or that those who had withdrawn or critical parents find themselves married to spouses who are withdrawn or critical.

It’s a common belief that people’s sex lives reflect their relationships, that a good relationship equals a good sex life and vice versa. But that’s only true sometimes.

In projection, a patient attributes his beliefs to another person; in projective identification, he sends them into another person.

Sometimes when people don’t show, they do it to punish the therapist and send a message: You’ve upset me. And sometimes they do it to avoid not just the therapist but themselves, to avoid confronting their shame or pain or the truth they know they need to tell. People communicate through their attendance—whether they’re prompt or late, cancel an hour beforehand, or don’t show up at all.

I remember in medical school how hard it was for us students to accept that somebody had died and that there was nothing else we could do, to have to be the person to “call it”—to say aloud those dreaded words Time of death

(If you ever want proof that what people present online is a prettier version of their lives, become a therapist and Google your patients.

It takes a while to hear a person’s story and for that person to tell it, and like most stories—including mine—it bounces all over the place before you know what the plot really is.

What makes night within us may leave stars. —Victor Hugo

in medical school, we students suffered from “medical students’ disease.” This is an actual phenomenon, documented in the literature, in which medical students believe that they’re suffering from whatever illnesses they happen to be studying.

conversion disorder. This is a condition in which a person’s anxiety is “converted” into neurologic conditions such as paralysis, balance issues, incontinence, blindness, deafness, tremors, or seizures. The symptoms are often temporary and tend to be related (sometimes symbolically) to the psychological stressor at its root.

People with factitious disorder have a need to be thought of as sick and intentionally go to great lengths to appear ill.

hysteria, from the Greek word for “uterus.”

as a therapist, I can come to understand people and help them sort out what they want to do, but I can’t make their life choices for them.

“It’s like this. I’ll give them a haircut, and they’ll come back the next time and say they want something different. ‘Why?’ I’ll ask. ‘Was something wrong with the last one?’ No, they say. The last one was fabulous! They just want something different. So I give them the exact same haircut but they think it’s different. And they love it.”

This was grief: You laugh. You cry. Repeat.

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.

Every day is another loss of something she took for granted until it was gone, like what happens to the couples I see who take each other for granted and then miss each other when the marriage seems to be dying.

Recently in my consultation group, Andrea had said that while we need to hold hope for our patients, we have to hope for the right thing.

You won’t get today back.

If we create the space and put in the time, we stumble upon stories that are worth waiting for, the ones that define our lives.

as the writer Philip K. Dick put it, “Strange how paranoia can link up with reality now and then.”

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

Irvin Yalom, the scholar and psychiatrist, often talked about therapy as an existential experience of self-understanding, which is why therapists tailor the treatment to the individual rather than to the problem.

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

our awareness of death helps us live more fully—and with less, not more, anxiety.

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.

Losing somebody you love is such a profoundly lonely experience, something only you endure in your own particular way.

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.

the intersection of psychology and philosophy, or what he called logotherapy,