Katie Couric: What inspires a therapist to write a book about HER experiences with her own therapist?
Lori Gottlieb: There are two main themes in the book. One is that we grow in connection with others, and the other is that we’re more the same than we are different. And so along with my patients’ lives, I wanted to show the other side of a therapist’s life, the human side. Each of the patients I write about look very different on the outside, but there are aspects of each of them that I identify with, and so I felt it would be disingenuous to present myself as the expert up on high who doesn’t struggle with the same universal questions about what it means to love and be loved, what we do with the past so we don’t feel trapped by it, how we grow and change even though change can be so hard. And then there’s the fact that we all have blind spots, ways of shooting ourselves in the foot without even realizing it. As a therapist, I hold up a mirror to people and say, “Let’s look at your reflection. Let’s look at how you might be getting in your own way.” I can see other people’s blind spots clearly because I have the vantage point of being outside their lives. But it’s very hard to see our own, and I wanted to show my humanity in this way, too. I always say that my most significant credential as a therapist is that I’m a card-carrying member of the human race. Without this humanity, I’d be useless to my patients.
Katie: Do you think therapy is still a taboo subject for a lot of people?
Lori: I think there’s still stigma attached to therapy because we don’t place value on our emotional health the way most of us do with our physical health. If you notice that something’s feeling “off” with your body, you’ll probably go get that checked out by your doctor before you have, say, a heart attack. But if something feels “off” emotionally, people tend to ignore that. They try to pretend the feelings aren’t there, but feelings don’t go away just because they’re inconvenient. In fact, the more you try to suppress them, the bigger they get, and what might happen is that you’ll wait until you have the equivalent of an emotional heart attack before you call a therapist. And then it’s harder to treat than it would have been if you’d gone to talk to a therapist earlier on. But stigma prevents many people from calling. I think this has to change, and we can do that by talking more openly about therapy in the way we talk freely about going to our internist or chiropractor.
Katie: You talk about your patients in the book…some with very serious problems, like the newlywed with breast cancer and others with problems that seem small in comparison. But you’ve come to realize that everyone’s problems are important. How so?
Lori: There’s no hierarchy of pain. Suffering shouldn’t be ranked, because pain is not a contest. Spouses often forget this, upping the ante on their suffering—I had the kids all day. My job is more demanding than yours. I’m lonelier than you are. Whose pain wins—or loses? But pain is pain. When I first started seeing Julie, a newlywed with breast cancer, I imagined that it would be hard going from hearing about her CT scans and tumors to listening to “So, I think the babysitter is stealing from me” and “Why do I always have to initiate sex?”You think you have problems? I worried I’d say in my head.But it turned out that being with Julie made me more compassionate. Other patients’ problems mattered too: their betrayal by the person who’d been trusted to watch their child; their feelings of shame and emptiness when rejected by their spouses. Underneath these details were the same essential questions Julie had been forced to face: How do I feel safe in a world of uncertainty? How do I connect? Seeing Julie called forth in me an even greater sense of responsibility to my other patients. Every hour counts for all of us, and we don’t live a good life by diminishing our pain. Women, especially, tend to apologize for their pain. “I’m sorry,” they’ll say as they start crying, as if their pain is something to apologize for.
Katie: A lot of people go to therapy because of a traumatic life event…but that’s just the trigger. Do people usually discover there’s something much deeper they haven’t dealt with?
Lori: Often the issue that someone comes in with is a sign of a struggle or pattern that got the person into that circumstance in the first place. It generally has to do with how people relate to themselves or to others. A person might carry around a faulty narrative such as I’m unlovable or nothing ever works out for me or I’m not the problem, my partner/parent/child is the problem. And so we work on these stories, and in doing so, I’m listening for the music under the lyrics. What’s going on with this person underneath the presenting issue that has led to the current situation–and how can I help them change that?
Katie: As a therapist, was it hard to choose someone who could treat you? How did you resist critiquing yours and instead focus on your own problems?
Lori: It was almost comically hard because while I know many wonderful therapists, the relationship in the therapy room needs to be its own, distinct and apart. I’m friendly with, refer patients to, go to conferences with, or otherwise associate with numerous therapists in town. So while I was surrounded by therapists, my predicament was a bit like that Coleridge line “Water, water, everywhere/Nor any drop to drink.” But I did get a good referral. My friend who’s a therapist said, “You need to go someplace where you’re not being a therapist,” meaning, where I didn’t have to hold it all together, but it’s hard being the patient. Sometimes my therapist would say something and I’d think, “Hmm, I wouldn’t have done it that way.” But you can’t be a backseat driver in your own therapy. You have to let go.
Katie: I always want my therapist to like me and feel a lot of pressure to be entertaining. How can people like me get out of that trap?
Lori: A therapy session isn’t a cocktail party: I’m not expecting to be entertained with fabulous stories. What makes therapy interesting is seeing people at their most human and figuring out how I can help them to grow. The patients who don’t hold our attention are the ones who won’t share the details their lives or let us know how they really feel, who avoid answering our questions or go off on tangent after tangent when we try to focus them, who launch into repetitive stories every time, leaving us scratching our heads: Why are they telling me this? What significance does this have for them? If a patient is droning on, we try to help them see how they’re talking around the very reason they came to see us. In other words, there’s a difference between telling me how hurt you are when your partner rejects you and telling me yet another story about how awful your partner is without telling me anything about you. When I was doing my training, a supervisor said, “There’s something likable about everyone” and I thought, Well, probably not everyone. But she was right. The people I don’t feel that way about are the people who don’t let me get to know them, who don’t give me the opportunity to see their humanity. They’re so afraid that if they show the truth of who they are, they won’t be likable. And it’s the opposite: The funny stories get boring very quickly. But let me really see you, and I’ll feel like you’re the most fascinating person in the world.
How do you feel about all the technology that’s making therapy more accessible for people? Now you can text a therapist and get advice. Is that a good thing for people who may not be able to afford traditional therapy? (It’s 59 dollars a week!)
Lori: One of my colleagues said of Skype therapy, “It’s like doing therapy with a condom on.” Therapy is one of the few places nowadays where you can sit face-to-face with another person for fifty minutes straight with no distractions–nothing pinging or beeping, no screens hanging over your heads in a restaurant–and just be present. You can hear each other breathe. There’s an energy between two people who share the same physical space that doesn’t exist when mediated by technology, even technology like Skype where you can see the other person. And therapists don’t really give the kind of advice you might get on text. But therapy also isn’t accessible to everyone, and the more ways people have of reaching out and getting help, the better. In my weekly “Dear Therapist” column for The Atlantic, I provide a way of looking at the letter writer’s problem from a different perspective that I hope can be useful to that person. So while it’s not the way things might go in the therapy room, it’s still beneficial perhaps in the way that these other modes of reaching out to a therapist can be.
