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

by Lori Gottlieb

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. To help John, I’m going to have to figure out what his loss would be, but first, I’m going to have to understand mine. Because right now, all I can think about is what my boyfriend did last night. The idiot!

Therapists, of course, deal with the daily challenges of living just like everyone else. This familiarity, in fact, is at the root of the connection we forge with strangers who trust us with their most delicate stories and secrets. Our training has taught us theories and tools and techniques, but 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. Of all my credentials as a therapist, my most significant is that I’m a card-carrying member of the human race.

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. Often, though, people carry around the belief that the majority of their problems are circumstantial or situational—which is to say, external. And if the problems are caused by everyone and everything else, by stuff out there, why should they bother to change themselves? Even if they decide to do things differently, won’t the rest of the world still be the same?

If this portrait sounds skewed, it is. There are many ways to tell a story, and if I’ve learned anything as a therapist, it’s that most people are what therapists call “unreliable narrators.” That’s not to say that they purposely mislead. It’s more that every story has multiple threads, and they tend to leave out the strands that don’t jibe with their perspectives. Most of what patients tell me is absolutely true—from their current points of view. Ask about somebody’s spouse while they’re both still in love, then ask about that same spouse post-divorce, and each time, you’ll get only half the story.

I almost smile at the preposterousness of this. What I really need just hours into this breakup is for somebody to sit with me in my pain, but I also know how helpless it feels to watch a friend suffer and do nothing to fix it. Sitting-with-you-in-your-pain is one of the rare experiences that people get in the protected space of a therapy room, but it’s very hard to give or get outside of it—even for Jen, who is a therapist.

They may not be able to imagine their depression lifting anytime soon, but they don’t need to. Doing something prompts you to do something else, replacing a vicious cycle with a virtuous one. 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. Both parties have the well-being of the patient in mind but often work at cross-purposes in the service of a mutual goal. As calmly as possible,

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. He knows that pushing aside emotions only makes them stronger, but that before he goes in and destroys somebody’s defense—whether that defense is obsessing about another person or pretending not to see what’s in plain sight—he needs to help the patient replace the defense with something else so that he doesn’t leave the person raw and exposed with no protection whatsoever. As the term implies, defenses serve a useful purpose. They shield people from injury … until they no longer need them.

Above all, I didn’t want to fall into 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. 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.

“Ouch!” I say reflexively, even though it didn’t hurt. I’m startled. “What was that?” “Well, you seem like you’re enjoying the experience of suffering, so I thought I’d help you out with that.” “What?” “There’s a difference between pain and suffering,” Wendell says. “You’re going to have to feel pain—everyone feels pain at times—but you don’t have to suffer so much. You’re not choosing the pain, but you’re choosing the suffering.” He goes on to explain that all of this perseverating I’m doing, all of this endless rumination and speculation about Boyfriend’s life, is adding to the pain and causing me to suffer. So, he suggests, if I’m clinging to the suffering so tightly, I must be getting something out of it. It must be serving some purpose for me. Is it?

somebody walks into your office for the very first time, scans the room, and then plops down right there, even though you’re going to be sitting just inches away?” “They do,” Wendell says simply. I think about the tissue box that Wendell had tossed to me and how he kept it on the table next to position B because, it occurs to me now, most people must sit there. “Oh,” I say. “Should I move?” Wendell shrugs. “It’s up to you.” I get up and sit down perpendicular to Wendell. I have to adjust my legs to the side so that they don’t touch his. I notice a bit of gray at the roots of his dark hair. The wedding ring on his finger. I remember asking Caroline to refer me—or my “friend”—to a married male therapist, but now that I’m here, I realize it doesn’t really matter. He hasn’t sided with me or declared Boyfriend a sociopath. I adjust

can’t sit here,” I say. Wendell asks why, and I tell him I don’t know. “Not knowing is a good place to start,” he says, and this feels like a revelation. I spend so much time trying to figure things out, chasing the answer, but it’s okay to not know.

I said with a straight face that I didn’t want revenge, that I didn’t hate Boyfriend, that I wasn’t angry, just confused. Wendell listened but said he wasn’t buying it. Obviously, I did want revenge, I did hate Boyfriend, I was furious. “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.

Maybe, in ways he didn’t realize, I reminded him too much of his parents or ex-wife or the woman he once mentioned who had hurt him deeply in graduate school. “I made a decision never to go through anything like that again,” he had said early in our relationship. I’d asked him to explain more, but he didn’t want to talk about it, and I, colluding with his avoidance, didn’t push it. Wendell, though, has been asking me to look at the ways we avoided each other by hiding behind romance and banter and plans for our future. And now I’m in pain and creating my own suffering—and my therapist is literally trying to kick some sense into me.

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

Changing our relationship to the past is a staple of therapy. But we talk far less about how our relationship to the future informs the present too. Our notion of the future can be just as powerful a roadblock to change as our notion of the past. In fact, Wendell continues, I’ve lost more than my relationship in the present. I’ve lost my relationship in the future. 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. But if we spend the present trying to fix the past or control the future, we remain stuck in place, in perpetual regret. By Google-stalking Boyfriend, I’ve been watching his future unfold while I stay frozen in the past. But if I live in the present, I’ll have to accept the loss of my future. Can I sit through the pain, or do I want to suffer? “So,” I say to Wendell, “I guess I should stop interrogating Boyfriend—and Google-stalking him.” He smiles indulgently, the way one would at a smoker who announces that she’ll quit cold turkey but doesn’t realize how overly ambitious that is. “Or at least try,” I say, backtracking. “Spend less time on his future, more on my present.” Wendell nods, then pats his legs twice and stands. The session is over but I want to stay. I feel like we just got started.

She felt horrible even having these thoughts, but she couldn’t deny them either. “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.

It wasn’t until I became a parent that I could truly understand two crucial things about therapy: The purpose of inquiring about people’s parents isn’t to join them in blaming, judging, or criticizing their parents. In fact, it’s not about their parents at all. It’s solely about understanding how their early experiences inform who they are as adults so that they can separate the past from the present (and not wear psychological clothing that no longer fits). Most people’s parents did their absolute best, whether that “best” was an A-minus or a D-plus. It’s the rare parent who, however limited, deep down doesn’t want his or her child to have a good life. That doesn’t mean people can’t have feelings about their parents’ limitations (or mental-health challenges). They just need to figure out what to do with them.

I ask when he has peace. “Walking the dog,” he says. “Until Rosie started acting out. That used to be peaceful.” I think about how he doesn’t want to bring the dream into this room. Could it be that this room has become something of a sanctuary for him, away from his job, wife, kids, dog, the world’s idiots, and the ghost of his mom that appears in his sleep? “Hey, John,” I try. “Are you feeling

“Or I could just leave a pair of boxing gloves at the door so you could hit yourself with them all session. Would that be easier?” Wendell smiles, and I feel myself take in some air, let it out, relax into the kindness. I flash on a thought I often have when seeing my own self-flagellating patients: You are not the best person to talk to you about you right now. There is a difference, I point out to them, between self-blame and self-responsibility, which is a corollary to something Jack Kornfield said: “A second quality of mature spirituality is kindness. It is based on a fundamental notion of self-acceptance.” In therapy we aim for self-compassion (Am I human?) versus self-esteem (a judgment: Am I good or bad?).

Therapy is hard work—and not just for the therapist. That’s because the responsibility for change lies squarely with the patient. If you expect an hour of sympathetic head-nodding, you’ve come to the wrong place. Therapists will be supportive, but our support is for your growth, not for your low opinion of your partner. (Our role is to understand your perspective but not necessarily to endorse it.) In therapy, you’ll be asked to be both accountable and vulnerable. Rather than steering people straight to the heart of the problem, we nudge them to arrive there on their own, because the most powerful truths—the ones people take the most seriously—are those they come to, little by little, on their own. Implicit in the therapeutic contract is the patient’s willingness to tolerate discomfort, because some discomfort is unavoidable for the process to be effective.

Except that I was—as a patient, that is. What makes therapy challenging is that it requires people to see themselves in ways they normally choose not to. A therapist will hold up the mirror in the most compassionate way possible, but it’s up to the patient to take a good look at that reflection, to stare back at it and say, “Oh, isn’t that interesting! Now what?” instead of turning away.

John has gone over this with me before so I’m not sure what the urgency is about today. Initially he had lobbied Margo to see a therapist (“So she can complain to him”) but once she started going, John often told me that this “idiot therapist” was “brainwashing” his wife and “putting crazy ideas in her head.” My sense has been that the therapist is helping Margo gain more clarity about what she will and will not put up with and that this exploration has been long overdue. I mean, it can’t be easy being married to John. At the same time, I empathize with John because his reaction is common. 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 and bring things back to homeostasis.

His expression is sad instead of angry now. 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.

Of course, anger serves another function—it pushes people away and keeps them from getting close enough to see you. I wonder if John needs people to be angry at him so that they won’t see his sadness. I start to speak, but somebody yells

As the late psychotherapist John Weakland famously said, “Before successful therapy, it’s the same damn thing over and over. After successful therapy, it’s one damn thing after another.” I know that therapy won’t make all my problems disappear, prevent new ones from developing, or ensure that I’ll always act from a place of enlightenment. 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. 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 understood his frustration. 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. When you stop tossing junk into the void—words, words, and more words—something important rises to the surface. And when the silence is a shared experience, it can be a gold mine for thoughts and feelings that the patient didn’t even know existed. It’s no wonder that I spent an entire session with Wendell saying virtually nothing and simply crying. Even great joy is sometimes best expressed through silence, as when a patient comes in after landing a hard-won promotion or getting engaged and can’t find the words to express the magnitude of what she’s feeling. So we sit in silence together, beaming. “I’m listening for whatever you have to say,” I told John.

Of course, I thought. Unavailable. Just Charlotte’s type. Charlotte, in fact, had used that same expression every time she mentioned the Dude. He’s so my type. 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.

They have an uncanny attraction to people who share the characteristics of a parent who in some way hurt them. In the beginning of a relationship, these characteristics will be barely perceptible, but the unconscious has a finely tuned radar system inaccessible to the conscious mind. It’s not that people want to get hurt again. It’s that they want to master a situation in which they felt helpless as children. Freud called this “repetition compulsion.” Maybe this time, the unconscious imagines, I can go back and heal that wound from long ago by engaging with somebody familiar—but new. The only problem is, by choosing familiar partners, people guarantee the opposite result: they reopen the wounds and feel even more inadequate and unlovable.

Until then, every time she meets an available guy who might love her back, her unconscious rejects his stability as “not interesting.” She still equates feeling loved not with peace or joy but with anxiety. And so it goes. Same guy, different name, same outcome.

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.

Since our Skype call the day after Margo had insinuated that she might leave, things between them had calmed down. As John described it, he tried to listen more. He tried to get home from work earlier. But really, it seemed to me that he was, as he said, “appeasing her,” whereas what she likely wanted was the very thing John and I struggled with together: his presence.

I kept it to myself because I wanted to avoid being a woman suspected of having a wandering uterus. And then there was this: On one of our early dates, when Boyfriend and I were in the midst of infatuation and had hours-long conversations about anything and everything, he mentioned that before meeting me, he’d gone on a few dates with a woman he really liked but when he’d learned that she had some difficulty with her joints that made it hard for her to go hiking, he’d stopped seeing her. I asked him why. After all, she didn’t have an acute illness; it sounded more like a common case of arthritis, and we were middle-aged, after all. Besides, Boyfriend wasn’t even a hiker. “I don’t want to have to take care of her if she gets really sick one day,” he said over our shared dessert. “If we’d been married for twenty years and then she got sick, that’s different. But why get into it knowing she’s already sick?” “But any of us could get sick,” I said. At the time, I didn’t think I fell into that category. I thought that whatever I had was temporary (a bug of some sort) or treatable (a thyroid imbalance). Later, as my Medical Mystery Tour got under way, my denial turned into magical thinking: As long as I don’t have a diagnosis, I can postpone telling Boyfriend the extent of it—indefinitely, and maybe forever—if it turns out that nothing’s wrong after all. He knew (sometimes) that I was having tests done and wasn’t feeling “myself,” but I also explained away a lot of my fatigue the...

I remember Rita’s earlier proclamation: Love is pain. The Myron situation has upended her so because when her heart that had been in a decades-long deep freeze finally began to thaw with Myron in her life, she had tasted hope and then lost it. It occurs to me now that when Rita first came to see me, she was desperate not just because she would be turning seventy in a year, as she reported then, but because Myron’s disappearance had made her wonder the same thing I was wondering when I first saw Wendell: Had the man who’d just left been the “end of the line,” as I’d put it—the last chance at love? Rita, too, has been grieving something bigger. But now the kiss has presented another crisis for Rita—possibility. And that may feel even more intolerable to her than her pain.

Charlotte believes she’s been hit with a wave of “bad karma.” It seems as if, every other week, there’s another crisis—a traffic violation, an incident with her sublet—and while at first I felt bad for her and tried to help her cope, 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.

Taped up next to my files is the word ultracrepidarianism, which means “the habit of giving opinions and advice on matters outside of one’s knowledge or competence.” It’s a reminder to myself that 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. When I first started out, though, occasionally I’d feel pressure to give advice of the benign (or so I believed) sort. But then I realized that people resent being told what to do. Yes, they may have asked to be told—repeatedly, relentlessly—but after you comply, their initial relief is replaced by resentment. This happens even if things go swimmingly, because ultimately humans want to have agency over their lives, which is why children spend their childhoods begging to make their own decisions. (Then they grow up and plead with me to take that freedom away.)

Everyone wages this internal battle to some degree: Child or adult? Safety or freedom? But no matter where people fall on those continuums, every decision they make is based on two things: fear and love. Therapy strives to teach you how to tell the two apart.

She’d had to parent herself, and her younger brother too. Children, however, don’t like having to be hyper-competent. So it’s not surprising that Charlotte wants me to be the mother for her now. I can be the “normal” parent who safely and lovingly drives the car, and she can have the experience of being taken care of in a way she never has before. But in order to cast me in the competent role, Charlotte believes she has to cast herself as the helpless one, letting me see only her problems—or, as Wendell once put it in relation to what I do with him: “seduce me with her misery.” Patients often do this as a way to ensure that the therapist won’t forget about their pain if they mention something positive. Good things happen in Charlotte’s life too, but I rarely hear about them; if I do, it’s either in passing or months after they occurred.

But at least I don’t have cancer, Julie thought as she left the hospital she knew so well by then. This time, she’d been there for a “normal” problem for people her age. Lots of people miscarried in those early weeks, her obstetrician explained. Julie’s body had been through a lot. “It’s just one of those things,” her doctor had said. And for the first time in her life, Julie, who had always lived in the land of rational explanations, was content with this answer. After all, every time the doctors had a reason for something, the reason was devastating. Fate, bad luck, probability—any of those seemed like a welcome respite from a dismal diagnosis. 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.

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.

I try to wrap my mind around this paradox: self-sabotage as a form of control. If I screw up my life, I can engineer my own death rather than have it happen to me. If I stay in a doomed relationship, if I mess up my career, if I hide in fear instead of facing what’s wrong with my body, I can create a living death—but one where I call the shots. Irvin Yalom,

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

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 concern: freedom, and all the existential difficulties that freedom poses for us. On the surface, it’s almost laughable how much freedom I have—if, as Wendell pointed out, I’m willing to walk around those bars. But there’s also the reality that as people get older, they face more limitations. It becomes harder to change careers or move to a different city or marry a different person. Their lives are more defined, and sometimes they crave the freedom of youth. But children, bound by parental rules, are really free only in one respect—emotionally. For a while, at least, they can cry or laugh or have tantrums unselfconsciously; they can have big dreams and unedited desires. Like many people my age, I don’t feel free because I’ve lost touch with that emotional freedom. And that’s what I’m doing here in therapy—trying to free myself emotionally again. In a way, this midlife crisis may be more about opening up than shutting down, an expansion rather than a constriction, a rebirth rather than a death. I remember when Wendell said that I wanted to be saved. But Wendell isn’t here to save me or solve my problems as much as to guide me through my life as it is so that I can manage the certainty of uncertainty without sabotaging myself along the way.

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.

“He won’t change, will he?” she says. “He may not want to change,” I say gently. “And your father might not either.” 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. This is a familiar scenario in therapy. A patient’s boyfriend doesn’t want to stop smoking pot and watching video games on weekends. A patient’s child doesn’t want to study harder for tests at the expense of doing musical productions. A patient’s spouse doesn’t want to travel less for work. Sometimes the changes you want in another person aren’t on that person’s agenda—even if he tells you they are.

Every relationship is a dance. The Dude does his dance steps (approach/retreat), and Charlotte does hers (approach/get hurt)—that’s how they dance. But once Charlotte changes her steps, one of two things will happen—the Dude will be forced to change his steps so that he doesn’t trip and fall down, or he’ll simply walk off the dance floor and find somebody else’s feet to stomp on. Charlotte’s first drink after four months