If you’ve never been to a therapist, you might wonder what people get out of talking once a week to a near stranger about their struggles in life.

Plenty, it turns out.

Therapists guide people through some of the most personal and painful experiences of their lives, helping them overcome depression, live with loss, and stop self-destructive behavior (among other issues). But, while the results of therapy are often impressive, the process can seem mysterious—even miraculous—when you don’t understand what’s happening in the room.

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Enter Lori Gottlieb’s new book, Maybe You Should Talk to Someone. Gottlieb, an experienced psychotherapist and author of The Atlantic’s weekly “Dear Therapist” advice column, gives readers front-row access to what goes on in therapy by following the narratives of four of her clients. We see how she approaches her interactions with them, using her empathy, skill, and humanity to encourage their healing and growth. At the same time, she shares her own life struggles that led her to seek therapy herself, helping to illuminate the difficulties of adapting to loss and the power of human connection.

Part memoir, part advocacy for the profession, the book is not only profound but also a gripping read. I spoke with Gottlieb recently about what therapists actually do and how we can all relate better to our emotions.

Lori Gottlieb, MFT

Jill Suttie: Why did you want to write this book?

Lori Gottlieb: I was originally supposed to be writing a book about happiness, but writing the happiness book was making me miserable. Believe me, the irony wasn’t lost on me! Every day when I sat down to write it, I felt depressed—what I was writing about couldn’t capture all of the richness and nuances of what I was seeing as a therapist. Eventually, I cancelled that book contract and decided to just do what I wanted to do, which was bring [readers] into the therapy room.

JS: Many people think of therapists as akin to medical doctors—people who diagnose and offer advice. But your book speaks to the importance of listening more and letting people struggle to find their own answers. Why that approach?

LG: We all have answers within ourselves, but sometimes we need a guide to help us find them. That’s what the best therapy does: It gives you agency over your own life. So many times, people come in and they say, “Tell me what to do.” And that’s not very helpful, because we want to help you learn to trust yourself, to understand why some of the choices you’ve made before haven’t worked out the way you wanted them to. What are your blind spots? What are the ways you keep shooting yourself in the foot?

So many times, people will make choices that basically guarantee their unhappiness. And they don’t see that they’re doing that. So, they feel like they can’t make decisions for themselves. But what they need is someone to help them see themselves more clearly so that they can make better decisions.

JS: You write a lot about listening to what’s not being said and slowing down the process in the therapy room. Why is that important?

LG: We don’t get enough of that in the outside world—to just have someone listen to us. So, when people think about what therapists do, it sometimes seems like a superhuman feat.

Or course, therapists are not just listening. There are so many misconceptions about therapy that I was trying to get rid of in this book; one of them is that a therapist is just going to listen to you and then you leave. That’s not true—it’s a very active process. We’re making eye contact; we’re letting silences breathe. We’re letting people pause, so they can hear themselves think and let themselves feel—something people normally cover up with words or a phone or a screen. The relationship between the therapist and the client is an extremely rich, emotional experience.

JS: Several of your clients seem to be punishing themselves for past mistakes or wrongdoing. What’s the role of self-compassion in moving out of this pattern?

LG: Self-compassion is important, because the one thing we all struggle with is being kind to ourselves. I asked one client to write down everything she said to herself over the course of a few days and bring it back to me, and she was embarrassed to read it. She said, “Oh my god! I didn’t know that I talked to myself like this! I am such a bully!” If we ever talked to our friends like that, we’d never have any friends. We’re so hard on ourselves.

That doesn’t mean that we shouldn’t take responsibility for things that we need to change or for things we wished we’d done differently or that are just flat-out wrong. It’s a combination of accountability and vulnerability: You want to be able to say that this is something you want to change or you wish you hadn’t done, but also say, “What can I learn from this experience, and how can I take responsibility without beating myself up?” You will gain a lot more and grow a lot more from the experience if you don’t self-flagellate while you’re taking responsibility for it.

JS: Many of your clients are also grieving loss, though not always a loss of life. Could you talk a little about the role of grieving in therapy?

LG: We experience loss throughout life, whatever that may look like. And it may be something literal like a death, but it could also be the death of a dream or the loss of a narrative we wanted for our lives. What happens so often is that people minimize their grief; they feel like if it isn’t something tangible, like death, it’s not worth our attention. But that’s not true.

There’s a myth in our culture about Elisabeth Kübler-Ross and her stages of grieving—like we’re going to go through these stages of grieving and then get to a place of acceptance or closure. Grief doesn’t work like that—it’s integrated into the fabric of our lives. When people have feelings of grief, they may want to get rid of them. But I try to help people live with the loss, to acknowledge it and not get submerged by it—to integrate it into the joy and other things in their life. That’s what’s most helpful.

JS: One of the clients you describe in the book, John, seems to be narcissistic; he’s putting you down, being rude and disagreeable. How were you able to find empathy or compassion for him?

Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed (Houghton Mifflin Harcourt, 2019, 432 pages)

LG: I think of people’s behaviors as a way of protecting themselves from something threatening or painful. So, in his case, his behaviors were all about pushing people away. When he’s being very abrasive and insulting and difficult to like, I know that’s a barrier he puts up to the world. There’s going to be something else underneath to explain why he’s behaving in such an off-putting way. I don’t take that personally, because I know he’s finding a way to cope in the only way he knows how.

Out in the world, we take so many people’s behavior personally, but it’s often really about them and the ways they’re managing whatever struggles they’re going through. People’s behavior is data—it gives you information about them. In John’s case, it gave me information about him: There’s some pain he’s experiencing. I don’t know what it is yet; I don’t know if he’ll ever tell me what it is. But there’s something very painful, and this is how he’s coping with it.

JS: If you could wave a magic wand and change our society so people are less likely to need therapy, what would you change?

LG: Lack of connection. No matter what people come in with, there’s an underlying sense of loneliness, disconnection—even if they have friends and family or are surrounded by people. I think people are feeling a lot of depression and anxiety because they aren’t being nurtured by connection. We’ve lost that sense of community that used to be so inherent—at least in my parents’ generation—where you had neighborhoods, and you’d go outside and kids would play. I’m not idealizing the past, but I think the one thing the past did have was a greater sense of organic community.

Nowadays, because we move around so much, we don’t necessarily put down roots in the same way. And each family becomes its own little silo. We aren’t just in each other’s lives organically. Then add technology to that, and people are not having many “I/thou” interactions, where you make eye contact and you’re not distracted by your phone on the table pinging or dinging or vibrating or by the screen on the wall in the restaurant. We lose that unstructured downtime, where we might run into people and get in a conversation or go take a walk. I’m not anti-technology, but I think that people feeling disconnected contributes to a lot of the low-lying depression and anxiety I see.

JS: If readers were to take away one lesson from your book, what would you want it to be?

LG: There’s a great Joseph Campbell quote that comes to mind, where he says that life is a wonderful opera, except that it hurts. I love that quote, because I feel like people need to understand that we are more the same than we are different. We all go through very similar things, even though we imagine that our lives are very different from others’ lives.

With my book, I tried to say, “Come on in and visit for a little while. I want to connect with you, the reader, and I want you to connect with me and with the people I’m going to tell you about.” I hope doing so will inspire them to connect with the people in their own lives in a different way…in a more fulfilling way. I want people to realize that when you connect with others, everybody feels better.

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