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.

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.

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.

even when he thought about telling me, he didn’t know how to bring it up because of how far in we were already and how angry I’d likely be.

“Will you stay with me until I die?” Julie asked, and though my instinct was to do what people tend to do whenever somebody brings up death, which is to deny death completely (Oh, hey, let’s not go there yet. Those experimental treatments might work), I had to remember that I was there to help Julie, not comfort myself.

Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in people’s adult relationships too, influencing the kinds of partners they pick (stable or less stable), how they behave during the course of a relationship (needy, distant, or volatile), and how their relationships tend to end (wistfully, amiably, or with a huge explosion). The good news is that maladaptive attachment styles can be modified in adulthood — this, in fact, is a lot of the work of therapy.

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.

“You know what I love about Rosie?” he says. “She’s the only one who doesn’t ask things of me. The only one who isn’t, in one way or another, disappointed with me — or at least, she wasn’t before she bit me! Who wouldn’t love that?”

In time, they find out that they aren’t at war after all, that the path to peace is to call a truce with themselves. Which is why when people first come in, 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.

He says that I want Boyfriend to explain himself to me — and that he is explaining himself to me — but that I keep going back because his explanation isn’t what I want to hear.

Wendell says that if I’ve been taking such copious notes during our phone calls, I probably haven’t been able to listen to Boyfriend, and if my goal is to be open to understanding his perspective, that’s hard to do when I’m trying to prove a point rather than have an interaction in earnest.

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.

think of a Flannery O’Connor quote: “The truth does not change according to our ability to stomach it.”

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.”

at some point in our lives, we have to let go of the fantasy of creating a better past.

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.

People with borderline personality disorder are terrified of abandonment, but for some, that might mean feeling anxious when their partners don’t respond to texts right away; for others, that might mean choosing to stay in volatile, dysfunctional relationships rather than being alone.

Diagnosis has its usefulness. I know, for example, that people who are demanding, critical, and angry tend to suffer from intense loneliness. I know that a person who acts this way both wants to be seen and is terrified of being seen.

That’s why for many people the pain of a divorce is only partially about the loss of the other person; often it’s just as much about what the change represents — failure, rejection, betrayal, the unknown, and a different life story than the one they’d expected. If the divorce happens at midlife, the loss might involve coping with the limitations of knowing someone and being known again with the same degree of intimacy.

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.

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.

Fitzgerald put it, “In a real dark night of the soul, it is always three o’clock in the morning, day after day”),

“Too many parents make life hard for their children by trying, too zealously, to make it easy for them.”

“The cardinal rules of good parenting — moderation, empathy, and temperamental accommodation with one’s child — are simple and are not likely to be improved upon by the latest scientific findings.”

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.

there’s a difference between a criticism and a complaint, how the former contains judgment while the latter contains a request.

When he opens his eyes again, we sit there for a while, saying nothing, two therapists comfortable together in a long silence. I lean back and luxuriate in it, and I think about how I wish everyone could do this more in daily life, simply be together with no phones, laptops, TVs, or idle chitchat. Just presence. Sitting like this makes me feel relaxed and energized at the same time.

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. From the outset, we move both slowly and quickly, slowing the content down, speeding up the relationship, planting seeds strategically along the way.

Often people talk about suicide not because they want to be dead but because they want to end their pain. If they can just find a way to do that, they very much want to be alive.

With aging comes the potential to accrue many losses: health, family, friends, work, and purpose.

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

But it’s a deep human need. 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.

or was she going to break it off on Sunday so that she’d have the structure of Monday’s workday to help her stay the course?

often, not mentioning it makes it bigger, the elephant in the room, and acknowledging the encounter feels like a relief.

“That year was a crash course in biking and love,” Wendell’s mother later remarked. “You take a risk, you fall down, and you get back up and do it all over again.”

therapy was the perfect setup for somebody like Charlotte, a person who craved connection but also avoided it.

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.

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.”

“The speed of light is outdated,” she said dryly. “Today, everybody moves at the speed of want.”

I can tell that John’s feeling what therapists call flooded, meaning that his nervous system is in overdrive, and when people feel flooded, it’s best to wait a beat.

The person needs a few minutes for his nervous system to reset before he can take anything in.

In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM)

Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance

Contemplation is rife with ambivalence. If pre-contemplation is denial, contemplation might be likened to resistance.

Here, the person recognizes the problem, is willing to talk about it, and isn’t opposed (in theory) to taking action but just can’t seem to get herself to do it.

Sometimes the changes you want in another person aren’t on that person’s agenda — even if he tells you they are.

He wrote, “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.”

Reacting vs. responding = reflexive vs. chosen.