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. —RICHARD BENTALL, Journal of Medical Ethics, 1992

We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same.

No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We’ll

We are mirrors reflecting mirrors reflecting mirrors, showing one another what we can’t yet see.

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. 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.

In this room, I’m going to see you, and you’ll try to hide, but I’ll still see you, and it’s going to be okay when I do.

A supervisor once likened doing psychotherapy to undergoing physical therapy. It can be difficult and cause pain, and your condition can worsen before it improves, but if you go consistently and work hard when you’re there, you’ll get the kinks out and function so much better.

Because therapists know that at first, each patient is simply a snapshot, a person captured in a particular moment. It’s like a photo of you taken from an unfortunate angle and with a sour expression on your face. There might also be a photo in which you’re glowing, caught opening a present or mid-laugh with a lover. Both are you in that fraction of time, and neither is you in your entirety.

We sort through the snapshots, and before long it becomes apparent that these seemingly discrete images all revolve around a common theme,

“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.”

Grief, not surprisingly, can resemble depression, and for this reason, until a few years ago, there was something termed the bereavement exclusion in our profession’s diagnostic manual. If a person experienced the symptoms of depression in the first two months after a loss, the diagnosis was bereavement. But if those symptoms persisted past two months, the diagnosis became depression. This bereavement exclusion no longer exists, partly because of the timeline: Are people really supposed to be done grieving after two months? Can’t grief last six months or a year or, in some form or another, an entire lifetime?

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

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. Women tend to confide in friends or family members, but when men tell me how they feel in therapy, I’m almost always the first person they’ve said it to.

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 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. One day, as we interns begged to be

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.