Maybe You Should Talk to Someone

by Lori Gottlieb

The eminent Swiss psychiatrist Carl Jung said this: “People will do anything, no matter how absurd, to avoid facing their own souls.” But he also said this: “Who looks inside, awakes.”

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.

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.

I think about patients who present ideal scenarios and insist that they can only be happy with that exact situation. If he didn’t drop out of business school to become a writer, he’d be my dream guy (so I’ll break up with him and keep dating hedge-fund managers who bore me). If the job wasn’t across the bridge, it would be the perfect opportunity (so I’ll stay in my dead-end job and keep telling you how much I envy my friends’ careers). If she didn’t have a kid, I’d marry her. Certainly we all have our deal-breakers. But when patients repeatedly engage in this kind of analysis, sometimes I’ll say, “If the queen had balls, she’d be the king.”

I’m in a state of shock mixed with bewilderment. I don’t understand how this has never come up. How do you sleep soundly next to a person and plan a life with her when you’re secretly grappling with whether to leave? (The answer is simple — a common defense mechanism called compartmentalization. But right now I’m too busy using another defense mechanism, denial, to see it.)

There’s a popular saying, a paraphrase of a Robert Frost poem: “The only way out is through.” The only way to get to the other side of the tunnel is to go through it, not around it. But I can’t even picture the entrance right now.

Right now it’s all about one foot, then the other. That’s one thing I tell patients who are in the midst of crippling depression, the kind that makes them think, There’s the bathroom. It’s about five feet away. I see it, but I can’t get there. One foot, then the other. Don’t look at all five feet at once. Just take a step. And when you’ve taken that step, take one more. Eventually you’ll make it to the shower. And you’ll make it to tomorrow and next year too. One step. 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.

He’s trying to determine what’s known as my attachment style. 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.

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.

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.

start to stew again on the drive to the office. By the time I pull into my building’s parking garage, I’m thinking about the fact that not only has Boyfriend wasted two years of my life, but now I’m going to have to deal with the fallout by going to therapy, and I don’t have time for any of this because I’m in my forties now and half my life is over and … oh my God, there it is again! Half my life is over. I’ve never said that to myself or anyone else before. Why does it keep popping up? You’re grieving something bigger, Wendell had said.

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.

Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed.

Why would we choose a profession that requires us to meet unhappy, distressed, abrasive, or unaware people and sit with them, one after the other, alone in a room? The answer is this: 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. So therapists listen, suggest, nudge, guide, and occasionally cajole our patients to bring other snapshots into view, to shift their experience of what’s happening inside and around them. We sort through the snapshots, and before long it becomes apparent that these seemingly discrete images all revolve around a common theme, one that might not have been in our patients’ fields of vision when they decided to come in.

One morning, as I drone on about Boyfriend, Wendell scoots to the edge of his couch, stands up, walks over to me, and, with his very long leg, lightly kicks my foot. Smiling, he returns to his seat. “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? I think about why I might be obsessively Google-stalking Boyfriend despite how bad I know it makes me feel. Is it a way to stay connected to Boyfriend and his daily routine, even if it’s only one-sided? Maybe. Is it a way to numb out so I don’t have to think about the reality of what happened? Possibly. Is it a way of avoiding what I should be paying attention to in my life but don’t want to? Earlier, Wendell had pointed out that I’d kept my distance from Boyfriend — ignoring clues that would have made his revelation less ...

“I 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. We’re both quiet for a while, then I get up and move farther away, about midway between positions A and B. I can breathe again. I think of a Flannery O’Connor quote: “The truth does not change according to our ability to stomach it.” What am I protecting myself from? What do I not want Wendell to see?

“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.”

Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth.

There is a continuing decision to be made as to whether to evade pain, or to tolerate it and therefore modify it.

Wendell explains that my pain feels like it’s in the present, but it’s actually in both the past and the future. Therapists talk a lot about how the past informs the present — how our histories affect the ways we think, feel, and behave and how at some point in our lives, we have to let go of the fantasy of creating a better past. If we don’t accept the notion that there’s no redo, much as we try to get our parents or siblings or partners to fix what happened years ago, our pasts will keep us stuck. 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...

Finally, there it was, looking just like the images I’d seen in a book the night before, but as I stood there, my own brain inches from Mr. Sanchez’s, I felt a sense of awe. Everything that made this man himself — his personality, his memories, his experiences, his likes and dislikes, his loves and losses, his knowledge and abilities — was contained in this three-pound organ. You lose a leg or a kidney, you’re still you, but lose a part of your brain — literally, lose your mind — and who are you then?

well-known essay “Welcome to Holland.” Written by Emily Perl Kingsley, the parent of a child with Down syndrome, it’s about the experience of having your life’s expectations turned upside down: When you’re going to have a baby, it’s like planning a fabulous vacation trip — to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The flight attendant comes in and says, “Welcome to Holland.” “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around … and you begin to notice that Holland has windmills … and Holland has tulips. Holland even has ...

Whenever I hear about saintly parents, I get suspicious. It’s not that I’m looking for problems. It’s just that no parent is a saint. Most of us end up being the “good-enough” parents that Donald Winnicott, the influential English pediatrician and child psychiatrist, believed was sufficient to raise a well-adjusted child. Even so, the poet Philip Larkin put it best: “They fuck you up, your mum and dad, / They may not mean to, but they do.”

But personality disorders lie on a spectrum. 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.

The answer to an unasked question is always no,

Generally what happens between therapist and patient also plays out between the patient and people in the outside world, and it’s in the safe space of the therapy room that the patient can begin to understand why. (And if the dance between therapist and patient doesn’t play out in the patient’s outside relationships, it’s often because the patient doesn’t have any deep relationships — precisely for this reason. It’s easy to have smooth relationships on a surface level.)