Introduction
Lori Gottlieb's "Maybe You Should Talk To Someone" offers a unique and intimate look into the world of therapy from two perspectives - that of a therapist and that of a patient. As a practicing therapist herself, Gottlieb found herself in need of therapy after experiencing a personal crisis. This dual role allowed her to gain profound insights into the therapeutic process, which she shares through her own story and the stories of four of her patients.
The book explores the complexities of human nature, the ways we often blind ourselves to our own problems, and the transformative power of therapy. It delves into the deepest fears that underlie many of our issues and examines how we can confront and overcome them. Through engaging storytelling and relatable experiences, Gottlieb invites readers to reflect on their own lives and consider the potential benefits of therapy.
The Nature of Presenting Problems
When patients first come to therapy, they often present what they believe to be their main issue - the "presenting problem." However, Gottlieb reveals that these initial problems are usually just the tip of the iceberg. The real, underlying issues are often much deeper and more complex.
Take John, a television scriptwriter who came to Gottlieb complaining of insomnia, marital conflicts, and work stress. On the surface, these seemed like straightforward issues. John thought he just needed some tips for better sleep and a chance to vent about his wife and coworkers. But as therapy progressed, it became clear that John's problems stemmed from much deeper sources.
John had experienced significant trauma in his life. His mother died in a car accident when he was just six years old. Later in life, in a tragic coincidence, John was involved in a car accident that killed his own six-year-old son. These devastating losses had left John with unresolved grief and an inability to be vulnerable with others. His presenting problems were merely symptoms of these deeper issues.
This pattern is common in therapy. Patients often come in with what they perceive as their main problem, but through the therapeutic process, they discover that their issues run much deeper. The job of a therapist is to help patients uncover these underlying problems and work through them.
The Power of Narratives
When people begin therapy, they don't just bring their problems - they bring entire narratives they've constructed around these problems. These narratives are often unhelpful, simplifying complex issues and projecting blame outward rather than encouraging introspection.
Gottlieb experienced this firsthand when she sought therapy after a painful breakup. She came to her therapist, Wendell, with a clear narrative: her ex-boyfriend was a "goddamn motherfucking selfish sociopath," and her emotional turmoil was solely the result of his actions. She spent her initial sessions trying to convince Wendell of the validity of this narrative, hoping for external validation that would allow her to make sense of her pain and move on.
However, Wendell recognized this narrative for what it was - a defense mechanism. By focusing all her energy on vilifying her ex-boyfriend, Gottlieb was avoiding confronting her deeper issues. Her fixation on this narrative was preventing her from addressing the real reasons why this breakup had affected her so profoundly.
This tendency to create and cling to simplistic narratives is common among therapy patients. These narratives serve as a form of self-protection, shielding us from painful truths about ourselves or our situations. However, they also hinder growth and healing. A key part of the therapeutic process involves challenging these narratives and helping patients construct more helpful, nuanced understandings of their experiences.
Defense Mechanisms in Therapy
One of the main challenges in therapy is that humans naturally resist confronting painful emotions and unflattering truths about themselves. This resistance often manifests as defense mechanisms - psychological strategies that people unconsciously employ to protect themselves from anxiety, emotional pain, or threats to self-esteem.
In Gottlieb's case, her defense mechanism was her fixation on her ex-boyfriend's faults. By spending all her time in therapy sessions ranting about him, she was avoiding deeper, more painful topics. This is a common tactic - deflecting attention away from one's own issues by focusing on the perceived faults of others.
Other common defense mechanisms include:
- Denial: Refusing to accept reality or facts.
- Rationalization: Creating false but seemingly rational explanations for behaviors.
- Projection: Attributing one's own unacceptable thoughts or emotions to others.
- Displacement: Redirecting emotions from their original source to a less threatening target.
A skilled therapist must be able to recognize these defense mechanisms and gently guide the patient past them. This often involves picking up on subtle clues or seemingly offhand comments. For instance, Wendell noticed that during one of Gottlieb's rants about her ex-boyfriend, she made a passing comment about her life being "half over." This clue helped him realize that Gottlieb's distress wasn't just about the breakup, but also about her fears of mortality and aging.
Recognizing and working through these defense mechanisms is crucial for making progress in therapy. It allows patients to confront the real issues underlying their presenting problems and begin the work of healing and growth.
The Fear of Death
One of the most fundamental fears that often underlies many psychological issues is the fear of death. This fear can manifest in various ways and is often not immediately apparent, even to the person experiencing it.
In Gottlieb's case, her fear of death was intertwined with her reaction to her breakup. On one level, she was grieving the death of the future she had envisioned with her ex-boyfriend - the marriage and life together that would now never happen. But on a deeper level, she was grappling with her own mortality.
Prior to her breakup, Gottlieb had been experiencing mysterious health symptoms that no specialist could diagnose. This brush with unexplained illness had brought her face-to-face with her own mortality in a way she had never experienced before. The breakup, coming on the heels of this health scare, amplified her fears about aging and death.
The fear of death is a universal human experience, but it's one that we often push to the back of our minds in our day-to-day lives. However, certain life events - like illness, loss, or significant life changes - can bring this fear to the forefront. When this happens, it can trigger a range of emotional and psychological responses that might seem unrelated on the surface.
Recognizing the role that death anxiety plays in our psychological landscape is crucial for both therapists and patients. It allows for a deeper understanding of seemingly unrelated issues and can open up new avenues for healing and growth.
The Importance of Human Connection
While the fear of death might seem like the ultimate human fear, there's another that rivals it in intensity: the fear of isolation. Humans are inherently social creatures, and the need for connection is deeply ingrained in our psychology. The loss or lack of meaningful human connections can be profoundly distressing and is often at the root of many psychological issues.
This is vividly illustrated through the story of Rita, an elderly patient of Gottlieb's who had been socially isolated for about a decade. Rita's loneliness was so acute that she started getting regular pedicures just to experience some form of human touch. Her case might seem extreme, but it highlights a common underlying issue that brings many people to therapy: a lack of meaningful human connection.
Even people who aren't physically isolated can experience this sense of disconnection. John, the TV scriptwriter, was surrounded by colleagues at work and had a family at home, but his inability to communicate openly left him feeling profoundly alone. Similarly, Gottlieb's own fear of isolation contributed to the intensity of her reaction to her breakup. As she approached middle age, she feared she might never find another romantic partner.
The therapeutic relationship itself plays a crucial role in addressing this need for connection. The therapy session provides a rare space in our busy, technology-driven world for uninterrupted, face-to-face human interaction. Over time, the connection between therapist and patient can become a powerful tool for healing, helping the patient feel understood and providing a model for healthy relationships outside of therapy.
Moreover, recognizing the importance of human connection often leads patients to take steps to build or rebuild relationships in their lives. For someone like Rita, this might involve reaching out to estranged family members or joining community groups. For others, it might mean learning to be more vulnerable and open in existing relationships.
The Search for Meaning
Another fundamental human need that often brings people to therapy is the search for meaning. A life that feels meaningless can be as distressing as one filled with pain or fear. This search for meaning was at the heart of Gottlieb's own struggle with her book contract.
When Gottlieb began therapy, she was grappling with a book contract that came with a substantial advance. While this might seem like a positive thing, it had become a source of intense anxiety for her. She found herself unable to write the book, despite the legal and financial obligation to do so. Through therapy, she realized that her writer's block stemmed from a deeper issue: the book project felt meaningless to her.
The topic of the book - helicopter parenting - didn't resonate with her on a personal level. She couldn't connect with the material, and as a result, the project felt empty and unfulfilling. This lack of meaning was paralyzing her creatively.
However, not writing the book posed its own crisis of meaning. If she failed to deliver on this contract, she feared she might never get another one. For Gottlieb, writing wasn't just a job - it was part of her identity and a source of purpose in her life. The prospect of losing that was deeply unsettling.
This dilemma highlights how central the need for meaning is to our psychological well-being. We need to feel that our actions, our work, and our lives have some greater purpose or significance. When we lose that sense of meaning, it can trigger profound distress and even depression.
Ultimately, Gottlieb made the difficult decision to break her contract and return the advance. This was a risky move, but it freed her to pursue writing projects that felt meaningful to her - including the book that these insights are based on. Her story illustrates how sometimes, finding meaning requires taking risks and making difficult choices.
The search for meaning is a common theme in therapy. Many patients find themselves grappling with questions about their purpose in life, the significance of their work, or the value of their relationships. Helping patients explore these questions and find sources of meaning in their lives is often a crucial part of the therapeutic process.
The Quest for Freedom
Closely related to the search for meaning is the quest for freedom. Many therapy patients feel trapped in some way - by circumstances, by relationships, by their own fears or habits. Regaining a sense of freedom is often key to recovery and growth.
For Gottlieb, feeling trapped by her book contract was a major source of distress. For Rita, it was feeling stuck in her social isolation, afraid to seek out new relationships for fear of being hurt again. John felt trapped by his grief and his inability to be emotionally vulnerable. And Julie, a college professor diagnosed with terminal cancer, initially felt trapped by her diagnosis.
Julie's case is particularly instructive. While she couldn't escape the reality of her cancer, she found freedom in how she chose to face it. Instead of crumbling under the weight of her diagnosis, she decided to use the time she had left to take risks and pursue experiences she'd always held back from. She joined a band, went on a game show, and even took a job as a grocery store cashier - all things she would never have done before her diagnosis.
Julie's story highlights an important truth: even in the most dire circumstances, we still have the freedom to choose how we respond. This idea, central to existential psychology, suggests that recognizing and exercising our freedom to choose is crucial for mental health and personal growth.
However, exercising this freedom isn't always easy. Many people, even when presented with the opportunity to make positive changes in their lives, find themselves resistant to doing so. This resistance to change is a common challenge in therapy, and understanding it is crucial for both therapists and patients.
Resistance to Change
One of the most frustrating aspects of human psychology - both for individuals trying to improve their lives and for therapists trying to help them - is our tendency to resist change, even when we know it would be good for us. This resistance often keeps people stuck in unhealthy patterns of behavior or thought.
Charlotte, a 25-year-old patient of Gottlieb's, exemplified this resistance to change. Despite recognizing that her drinking was problematic and that she consistently chose unhealthy romantic relationships, Charlotte seemed unable to break these patterns. No matter how many times she resolved to quit drinking or to avoid toxic men, she found herself falling back into old habits.
This resistance to change often stems from the comfort of familiarity. Even when our habits or situations are unhealthy or painful, there's a certain security in their familiarity. The prospect of change, even positive change, can feel threatening because it introduces uncertainty.
In Charlotte's case, her propensity for unhealthy relationships had roots in her childhood. Growing up with parents who fought constantly, she had come to associate love with anxiety and conflict rather than peace and happiness. As a result, she was unconsciously drawn to men who recreated this familiar dynamic, even though it was harmful to her.
This association had become so ingrained that Charlotte felt a mysterious lack of chemistry with emotionally stable men who might have been better for her. The very stability that would have been healthy felt alien and uncomfortable to her.
Charlotte's story illustrates how our resistance to change can be deeply rooted in our personal histories and unconscious associations. Breaking free from these patterns often requires not just conscious effort, but also a deep exploration of the underlying reasons for our behaviors.
Overcoming this resistance to change is often one of the main challenges in therapy. It requires patience, persistence, and a willingness to sit with the discomfort that comes with challenging long-held patterns and beliefs.
The Importance of Emotional Expression
One of the key breakthroughs in therapy often comes when patients are able to access and express emotions they've long kept buried. Many people, either consciously or unconsciously, suppress their emotions, especially negative ones like fear, anger, or grief. This emotional suppression can manifest in various ways, from seeming emotionless to engaging in self-destructive behaviors.
Charlotte, for instance, initially presented as almost emotionless in therapy. She spoke about everything, from positive experiences to traumatic events, in the same monotone voice. This wasn't because she didn't have emotions, but because she had difficulty identifying and expressing them - a condition known as alexithymia.
While Charlotte's case might seem extreme, many people struggle with some degree of emotional disconnection. This is especially true when it comes to deep, painful emotions like the fear of death or loneliness. It's natural to want to avoid these feelings, and many people develop various strategies to do so, from engaging in defense mechanisms to self-medicating with substances like alcohol.
However, suppressed emotions don't simply disappear. They continue to influence our thoughts and behaviors, often manifesting in unconscious ways or even as physical symptoms. That's why a crucial part of therapy involves helping patients access and express these buried emotions.
The moment of breakthrough often comes when a patient finds a way to openly express these long-suppressed feelings. For Charlotte, it was finally admitting that her emotional detachment "feels like shit." For Rita, it was writing a heartfelt letter to her estranged children. For Julie, it involved shouting expletives to express her anger at her cancer diagnosis. And for both Gottlieb and John, it meant allowing themselves to cry and fully feel their grief.
These moments of emotional expression might feel like "breaking down," but they're actually moments of "breaking open." By letting down their guard and allowing themselves to fully feel and express their emotions, patients take a crucial step towards freedom and healing.
This emotional release doesn't instantly solve all problems, but it marks a turning point. Once patients are able to acknowledge and express their true feelings, they can begin to work through them in a meaningful way. It's often the beginning of real change and growth.
The Therapeutic Relationship
Throughout the book, Gottlieb emphasizes the importance of the relationship between therapist and patient. This relationship is not just a means to an end, but a crucial part of the healing process itself.
The therapy room provides a unique space in our modern world - a place for uninterrupted, face-to-face human interaction focused entirely on understanding and helping one person. Over time, the bond that forms between therapist and patient can become a powerful force for change.
This relationship serves multiple purposes:
It provides a safe space for patients to explore their thoughts and feelings without fear of judgement.
It offers patients the experience of being truly seen and understood, which can be profoundly healing, especially for those who have felt isolated or misunderstood.
It serves as a model for healthy relationships, demonstrating qualities like empathy, boundaries, and honest communication.
It allows for the experience of transference, where patients project feelings or expectations onto the therapist, providing valuable insights into their relationship patterns.
It provides a consistent, reliable presence in the patient's life, which can be particularly important for those dealing with instability or loss.
Gottlieb's own experience as a patient allowed her to fully appreciate the power of this relationship from both sides. She describes how her sessions with Wendell became a anchor in her life, providing stability and insight during a tumultuous time.
However, she also emphasizes that the therapeutic relationship is not a one-way street. Therapists, too, are impacted by their patients. They learn from them, are moved by their stories, and often find their own views and understanding expanded through their work.
This mutual impact is part of what makes therapy so powerful. It's not just about a professional dispensing advice, but about two humans connecting and growing together.
The Ongoing Journey of Growth
One of the key messages of Gottlieb's book is that personal growth and healing are ongoing processes. There's no magical moment where all problems are solved and all wounds are healed. Instead, therapy - and life - is about continual learning, adapting, and growing.
This is illustrated through the stories of Gottlieb's patients. While each of them experiences significant breakthroughs and improvements, their stories don't end with neat, tidy resolutions. Instead, we see them continuing to work on themselves, applying what they've learned in therapy to new challenges and situations.
John, for instance, makes great strides in processing his grief and learning to be more emotionally open. But this doesn't mean he never struggles with these issues again. Instead, he now has better tools to handle them when they arise.
Similarly, Gottlieb's own journey doesn't end when she resolves the immediate crisis that brought her to therapy. Instead, she continues to apply the insights she gained to new situations in her life and work.
This ongoing nature of personal growth is both challenging and liberating. On one hand, it means there's no finish line where all our problems disappear. On the other hand, it means that we always have the opportunity to learn, grow, and improve, no matter our age or circumstances.
Gottlieb encourages readers to view their own lives through this lens. Rather than seeing challenges or setbacks as failures, we can view them as opportunities for growth. And rather than expecting to reach a point of perfect mental health or happiness, we can focus on continual small improvements and moments of insight.
Conclusion
"Maybe You Should Talk To Someone" offers a deeply human look at the process of therapy and personal growth. Through her own story and those of her patients, Gottlieb illustrates the complexities of the human psyche and the transformative power of self-reflection and emotional honesty.
The book highlights several key insights:
- Our presenting problems are often not our real, underlying issues.
- We all construct narratives about our lives, but these narratives can sometimes hold us back.
- Defense mechanisms often prevent us from confronting our true feelings and issues.
- Many of our problems stem from fundamental human fears - of death, isolation, meaninglessness, and lack of freedom.
- Resistance to change can keep us stuck in unhealthy patterns, even when we know better.
- Emotional expression is crucial for healing and growth.
- The therapeutic relationship itself is a powerful tool for change.
- Personal growth is an ongoing journey, not a destination.
Gottlieb's work invites readers to apply these insights to their own lives. Whether or not we're in therapy, we can all benefit from greater self-reflection, emotional honesty, and willingness to confront our fears and challenges.
The title of the book, "Maybe You Should Talk To Someone," is more than just a suggestion to seek therapy (although Gottlieb certainly sees value in professional help). It's also an invitation to open up more generally - to friends, family, or even to ourselves through journaling or meditation. The act of articulating our thoughts and feelings, of making the internal external, is a powerful tool for understanding and growth.
Ultimately, Gottlieb's book is a testament to the resilience of the human spirit and our capacity for change and growth. It reminds us that no matter how stuck we might feel, there's always the possibility of writing a new chapter in our life story. And sometimes, that new chapter begins with the simple act of talking to someone.