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

“Our training [as therapists] 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.” 

Even though patients are initially strangers whose life is unknown to a therapist, all professionals will utilize their experience and expertise to lay the groundwork for future analysis: Because all humans share the fact of living, a therapist is just another human who knows how life works a little bit better than others. The author emphasizes the therapists’ humanity in performing their job successfully.

“Every day, our patients are opening up questions that we have to think about for ourselves. If they can see themselves more clearly through our reflections, we can see ourselves more clearly through theirs [...] We are mirrors reflecting mirrors reflecting mirrors, showing one another what we can’t yet see.” 

Lori Gottlieb’s central thematic image is that human interactions (and especially in therapy) are a series of reflections through which humans learn about others and themselves. Without this process of mirroring (which in psychology indicates the subconscious need of any person to imitate and replicate gestures, attitudes, and patterns of other people in their environment), a person cannot function within society. As the therapist learns about the patient, she also picks up the patient’s signals and reflects them back in a process that makes psychoanalytic work possible.

“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.” 

In a form of instruction, the author reminds us that our existence is a series of individual steps that amount to a journey. If we attempt to grasp the immensity of life’s decisions, we often lose the courage to act. By focusing on individual tasks, like connecting the dots, we perform life’s demands before they paralyze us. 

“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.” 

For things to get better, they most frequently need to get worse, and it is through perseverance and commitment that we can attain our goals. As in physical therapy (or exercise), people often abandon the process if it seems like they are not progressing fast enough or without obstacles; these obstacles push us to break the boundaries and achieve progress. 

“There’s a myth that therapists are trained to be neutral, but how can we be? We’re humans, not robots. In fact, instead of being neutral, we therapists strive to notice our very un-neutral feelings and biases and opinions (what we call countertransference), so that we can step back and figure out what to do with them. We use, rather than suppress, our feelings to help guide the treatment.” 

Transference (as described by father of psychoanalysis, Freud, this term denotes that patients spontaneously redirect the feelings they have towards people in their lives onto a therapist) and countertransference allow therapists to consider their own feelings, while helping patients deal with theirs. Suppressing natural reactions would not be beneficial for either the therapist or the patient, but taking an objective look at them helps therapists find the appropriate attitude in therapy.  

“I once heard creativity described as being the ability to grasp the essence of one thing and the essence of some very different thing and smash them together to create some entirely new thing. That’s what therapists do too. We take the essence of the initial snapshot and the essence of an imagined snapshot and smash them together to create an entirely new one.” 

The author again uses analogy to underscore the resourceful nature of therapy. By comparing therapy to a definition of creativity, she emphasizes that the first impression of how patients present themselves needs to join their fantasy self-image to allow for a new, healthier, more objective picture to emerge. Utilizing the harsh-sounding verb “smash” implies the process is difficult yet essential.  

“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.’” 

This quote creates a literary image by relating an event descriptively, using dialogue and an anecdotal tone. By kicking Lori’s foot, Wendell crosses the boundary of therapist-patient relationship deliberately to make a point: There is a difference between pain and suffering. When we choose to suffer, we choose to stay within a condition that does not offer us healing nor progress. Wendell’s kick shatters Lori’s self-indulgent “wallowing” and pushes her towards a healthier response to her pain. 

“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).” 

Examining a patient’s childhood is one of the staples of psychoanalytical therapy. Freud’s belief that the way parents deal with a child’s limitless desires determines later development was the foundation of many later theories on the influence of childhood on adult psychology. In this quote, the author emphasizes that therapists use childhood events to help patients divest themselves from the burden of acquired patterns and beliefs through refocusing on the present moment (the child-self versus the adult-self).

“Normally I wouldn’t do this, but therapy isn’t by the numbers. We need professional boundaries, but if they’re too open, like an ocean, or too constricting, like a fishbowl, we run into trouble. An aquarium seems just right. We need space for spontaneity—which is why when Wendell kicked me, it was effective. And if John needs some distance between us in the form of food to feel comfortable talking to me right now, so be it.” 

Lori is now in the role of therapist who chooses to break the boundaries with her patient John, to get him to open more. Gottlieb examines how finding the proper balance in approaching the patient—with defined boundaries but room for spontaneity—helps the therapist find the best approach to each patient. Using the phrase “by the numbers,” she indicates that there is danger in doing therapy in a manner that does not adapt to individual patients.  

“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.” 

As in previous quotes, Gottlieb gradually reveals the essential characteristics of therapy for readers who might have no concept of what it entails. Therapy holds the patient responsible while allowing them to be vulnerable, which is crucial in the process of a patient finding his or her way through a crisis. It combines support and subtle guidance towards a better understanding of self. 

“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.” 

People adopt patterns of behavior throughout their lives, and these patterns influence the way they react to new situations. Therapy helps patients reshape the narrative of their life in places where it becomes dysfunctional for the self or for others around them. Thus, we “unknow” ourselves—we cancel the restrictive self-image we have created over time and become more open to new interpretations of events, which helps us develop a healthier response to life.

“Given the public’s visceral reactions to aging bodies, it’s no wonder old people don’t get touched much.

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. 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.” 

Gottlieb utilizes the example of her older patient to explore touch starvation. She emphasizes in this quote that prevalent ageism in our society creates an empty space around the elderly, who have the same need to be touched as do babies or people in general. According to statistics, due to technological advances, people in the US often experience skin hunger, because they tend to form and maintain relationships online rather than in person. Gottlieb lists the benefits of touch to underscore how crucial it is to change the situation.

“The internet can be both a salve and an addiction, a way to block out pain (the salve) while simultaneously creating it (the addiction). When the cyber-drug wears off, you feel worse, not better.” 

While the benefits of internet are known and appreciated, people often find themselves alienated from others through personal contact avoidance that occurs once we discover how liberating it can feel to hide behind the screen. The healthy way, although hard, is to face the pain and deal with it, and the technological revolution has created many ways to distract us from real feeling, which leaves us with additional psychological issues.  

“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.” 

Gottlieb offers poignant examples for how much our learned patterns determine our behavior: We tend to misread what we know as what we like, even though this is often not the case. Often, we feel a sense of attachment to behaviors that we have experienced in the past (often in childhood), because we recognize them on a subconscious level, and this tricks us into believing they are attractive, even when they are destructive. Therefore, it is important to understand how the mechanism works so that we can avoid being charmed by things that are bad for us.  

“She hated the fact that she was almost seventy and still analyzing interactions with men with the same obsessiveness she had in college. She hated feeling like a girl with a crush, foolish and helpless and confused. She hated trying on outfits one after the other, discarding this one, replacing it with that one, her bed littered with evidence of her insecurity and overinvestment.” 

Through an analysis of her patient Rita’s feelings, the author underlines one of life’s important truths: Regardless of our age, we maintain levels of insecurity concerning interpersonal relations, especially those of a romantic kind. Some self-doubts are hard-wired within our brains and keep us feeling fresh, nervous, and alive, even though they often present themselves as anxiety. Only by embracing life’s unpredictability can we (and Rita) learn to be thrilled by it, instead of paralyzed. 

“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.” 

We often have strong opinions about other people’s behavior and choices, and we often presume that they will benefit from being told how to react or what to do. Additionally, some people show us that they want us to tell them how to behave because that would free them from taking responsibility for their actions. In both cases, however, it is important to let people work their course of action for themselves. Therapists can guide and support, but they must not prescribe or dictate the patient’s actions.  

“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.” 

This quote offers insight into the division of gender roles in our society. In a patriarchy, women learn from an early age that they are “more emotional” than men, who are “more rational.” Therefore, women must learn to navigate this accepted truth, and one of the ways is to feel they have to either hide their emotions or apologize for showing them openly, as if they somehow offend others. Men also must learn to hide their feelings, because it is often unacceptable for men to be emotional, and especially cry in front of others. Though these ideas have waned in modern times, the consensus still perceives showing raw emotions as weak and unseemly, which is damaging for the psyche.  

“To avoid distraction, I’d suggest turning off their phones during sessions, which worked well, but I noticed that before patients even reached the door at the end of the session, they’d grab their phones and start scrolling through their messages. Wouldn’t their time have been better spent allowing themselves just one more minute to reflect on what we had just talked about or to mentally reset and transition back to the world outside?” 

Gottlieb ponders the decrease of attention span caused by the constant use of cell phones, which increasingly serve as lifelines to the rest of the world. The time right after therapy sessions is important because it gives the patient the space to contemplate what they have said and shared, and by eliminating it by immediately going back to their phones, the patients can fail to gain significant insight into their psychological state. 

“I particularly liked this line from Frankl’s book: ‘Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.’” 

In quoting renowned Austrian psychiatrist Viktor Frankl, Gottlieb connects her thoughts to his in what is known in literature as silent partnership (borrowed from economics, the term was coined by literary theorist and philosopher Slavoj Žižek, and it implies the communication of two writers through their texts even though they have no direct links). She uses the quote to emphasize that although various stimuli dictate our automatic reactions, we have the power to choose our response. This means that while reactions are quick and sometimes hurtful, responses should be measured and thoughtful. This is a healthy way to avoid conflict.

“I point out to her that pain can be protective; staying in a depressed place can be a form of avoidance. Safe inside her shell of pain, she doesn’t have to face anything, nor does she have to emerge into the world, where she might get hurt again.” 

Even negative stimuli (like pain) can become defense mechanisms. Once we get used to feeling pain, the alternative seems too unpredictable, because it is pain we are used to—behind it might lurk a bigger pain, or something worse (psychologists refer to this sensation as negative fantasy). Pain blocks other stimuli, so it can become the shell Gottlieb refers to that hides a person from outside reality. Therapists work on showing their patients that negative fantasies only seem protective: They are harmful and not conducive to a healthy psychological life. 

“Sometimes people drop out of therapy because it makes them feel accountable when they don’t want to be. If they’ve started drinking or cheating again—if they’ve done or failed to do something that now causes them shame—they may prefer to hide from their therapists (and themselves). What they forget is that therapy is one of the safest of all places to bring your shame. But faced with lying by omission or confronting their shame, they may duck out altogether. Which, of course, solves nothing.” 

During the process of therapy, there are two main reasons why patients stop attending the sessions: They trick themselves into believing they feel better and that means their problems have vanished, or they do not have the courage to face the therapist (and themselves) if they have behaved in a way they judge as unacceptable. The author reminds the reader that when we confront our fears and our demons, we reduce them in size and see them objectively, and thus conquer them. 

“I think of something else Wendell once said: ‘The nature of life is change and the nature of people is to resist change.’ It was a paraphrase of something he’d read that had resonated with him both personally and as a therapist, he told me, because it was a theme that informed nearly every person’s struggles.” 

This excerpt uses a literary device of describing a quote within a quote within a quote (intertextuality) to emphasize how an idea can become part of many people’s concepts, because it fits with how most people think. The quote in question is axiomatic, dealing with universal human resistance to change (psychological inertia), even though our rational self informs us that everything around us is in the state of flux. 

“I thought about how many people avoid trying for things they really want in life because it’s more painful to get close to the goal but not achieve it than not to have taken the chance in the first place.” 

This quote illuminates the psychological fear of almost succeeding, and the negative fantasy that surrounds most of our endeavors: that we will not fail at once, but close to our goal, which feels unbearable. This fantasy usually prevents us from trying at all, and it gives us the false impression that we are safer for not trying.