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“Maybe You Should Talk to Someone” interview with Lori Gottlieb

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I knew for a few years that I needed to go to therapy, but it wasn’t until 2020 that I made it happen. It seemed like the process would take energy and investment that, when combined with work and daily distractions, felt too overwhelming to fit into my busy lifestyle. So I pushed it off until I couldn’t anymore.

The book that made me excited about therapy

I had done all the exploratory activities to get myself comfortable with the idea and the investment in therapy; I listened to podcast hosts nonchalantly discuss their own therapy experiences and heard friends share “aha” moments from sessions. Then I read “Maybe You Should Talk To Someone,” which was a vicarious entry-point.

In it, psychotherapist Lori Gottlieb takes us through an anthology of therapy sessions with her patients — a Hollywood producer; a young newlywed with a terminal illness; a twenty-something with dissatisfying relationships; an isolated senior citizen — as well as her own sessions. An unexpected life event has upended Gottlieb’s life, and she finds herself in the role of patient — sitting on the couch of another therapist.

While the specifics change, most of the people in Gottlieb’s book are dealing with the big fears and questions that feel relatable in day-to-day life.

Her own struggles with these themes, frankly, made therapy seem infinitely more approachable to me. I realized that, rather than laying on a couch and rehashing my childhood every week, (as Gottlieb herself told me below), therapy looks more like getting “a really good second opinion from someone who’s not already in your life.” 

Besides being a page-turner, Gottlieb’s book is warm, wise, and approaches vulnerable topics in her own life with the same unapologetic candor that she allows her patients in their sessions. And, thanks to the dual-lens of being a clinician and patient, we get a bit of a birds-eye view of themes in therapy — like why we don’t treat our mental struggles as responsibly as our physical ones. 

Without going to an appointment, Gottlieb’s book let me see what therapy was like — and even experience some of those same “aha” moments — from the comfort of my couch.

Even though I felt too busy to pursue therapy at the time, the book’s warm description of the process was the first real step in getting me through the (virtual) door. 

Ultimately, it was the pandemic’s upheaval that “helped” me prioritize going. I had decamped from my home in New York and unpacked my things in an eerily irrelevant childhood bedroom in Minnesota. Some of my loved ones fell sick; some stayed sick. I took on caregiver roles at home and new obligations at work. By the summer, I had never been more overwhelmed, but armed with the insight I had after reading “Maybe You Should Talk To Someone,” I decided to talk to someone. The book wasn’t the reason I went to therapy, but its portrait of how good a “second opinion” could feel, and the effects it could have on your life — combined with everything else — made me more excited about trying it.

I learned that therapy is worth it, even if it’s all remote.

For me, and for many, finding a therapist felt Sisyphean. Even with the privilege of insurance, a dependable salary, and full support from my then-partner, I still needed to research psychologists, check with their offices about coverage, budget, and attend virtual consultations from the privacy of my scorching car just to get started. 

But if there’s one thing I’d tell someone from the other side of the hassle of finding a therapist, it’s that it is worth it. Even if variables like a pandemic or political unrest remain unchanged, talking to someone has helped me feel both more relaxed and in control of my responses. I can open up about my fears and find direction, so when the world “resumes,” I have a better idea of what I’d like out of it. And it’s a blessing to be able to confide in someone who only touches my life in this one specific, intimate way — it gives me permission to be radically honest.  

I asked Lori Gottlieb, author of “Maybe You Should Talk To Someone,” to debunk myths about therapy and answer common questions about accessing it.

Lori Gottlieb isn’t just the bestselling author of “Maybe You Should Talk To Someone,” she’s also a psychotherapist and The Atlantic’s “Dear Therapist” columnist. While I recommend reading her book if you’re struggling with the idea of going to therapy, you’ll also find some thoughts below that could help you take the leap. In our conversation, Lori shared insight about why we do or don’t go to therapy; who needs it and when; what we should do while we’re there, and how to make the most out of remote sessions. 

What are some of the biggest misconceptions around therapy?

One of the obstacles to seeking therapy is a misunderstanding of what therapy really is. According to Gottlieb, some people believe you “go into therapy, talk about your childhood every week, and never leave… And that doesn’t feel like progress. It feels like bringing up painful things, and then leaving.”

On the contrary, Gottlieb says, most therapy takes place outside of your appointment. “If someone is struggling with something and they go home and come back the next week without having made changes out in the world based on our discussion, then they’re wasting their time,” she says. “Therapy is about how you apply what we talk about in that hour to the six days of the week that you’re not there.” Instead of solely dissecting the past, a good therapist will encourage you to ask what you’re doing right now to create a different future. 

Is remote therapy as effective as in-person therapy?

While remote therapy clearly has limitations like important body language left out of frame, “there are ways in which online therapy can be incredibly intimate — in ways that don’t happen in the office,” Gottlieb says. “There’s sort of a leveling; Everybody is sort of going through the same thing [right now].” For instance, in remote sessions, Gottlieb has been able to pick up on things that seem tangential — like a cello in the background — that are actually related to the sessions, even if the patient has never mentioned them before.

It can also help increase access, now and in the future, for people who can’t get to a therapist’s office or who are therapy-curious but hesitant to try. 

What if your problems don’t feel big enough for therapy?

If you’re having unusual but infrequent chest pains, you’d probably want to get them checked out. The same rules should apply to our mental health.

“Because of how we treat our emotional health, some people don’t come to me until they’re having the equivalent of an emotional heart attack,” Gottlieb says. “By then, it’s harder to treat, because we have to work with where you are now and then get you back to your baseline — and then get you to a new place. And you don’t have to suffer unnecessarily for so long.” 

What if you have no idea what to start talking about?

If you’re feeling discomfort or hesitation, you should mention it. 

“That can be a great way [to get started],” Gottlieb says. “If you’re able to say right away, ‘this feels really weird for me, I’ve never done this, I’m not really sure how to do this,’ that’s an ongoing conversation with the therapist — and it will really help.” 

What should you look for in a therapist?

Gottlieb says therapists likely won’t challenge you frequently in the first session, but passive “uh-huh”s and nodding aren’t helpful; unconditional validation for your version of events is what you can already get from friends.

Instead, Gottlieb recommends asking yourself at the end of your first session whether or not you felt understood — as much as one can be in 50 minutes — and whether or not you believe this person will challenge you. 

“Do you feel like, ‘this person kind of got me, and this person is going to hold up that mirror to me?'” If so, Gottlieb says that’s when she’d recommend going back for a second session. “It doesn’t mean you’re in therapy with them yet. And if, after a few sessions, you think, ‘this is feeling good’, then consider yourself in therapy with them. [But,] you can change at any time.” 

What if you tried one session and didn’t click with your therapist at all?

Every study shows that the most important factor in the success of your therapy is your relationship with your therapist,” Gottlieb says. And while she notes that many factors are important in choosing a therapist, the relationship with your therapist “matters more than the modality they’re using, the number of years of training they have, their theoretical orientation.”

According to Gottlieb, one reason newcomers don’t stay in therapy after one session with one therapist is they view therapy as a binary choice: “Either I’m in therapy with this person, or I don’t go to therapy.” Instead of focusing on finding a therapist that feels right, people can write off therapy altogether. 

That’s why Gottlieb encourages you to see the first session as a consultation. You aren’t in therapy with this person yet.  

What if you’re too busy or overwhelmed to start therapy right now?

“There’s so much care-taking going on, but [caregivers] are not caring for themselves. It sounds sort of like an entitled, privileged thing — but it’s mandatory,” Gottlieb says.

If you don’t feel like you have enough time, Gottlieb suggests taking stock of your day; do you find yourself scrolling through Instagram or Twitter for at least an hour one day of the week? If so, it may serve you better in the long-term to spend that time with a therapist. 

You should also see a return on your investment that makes you feel less busy. “[Going to therapy] will make you feel like you have more time,” Gottlieb says. “You are going to get coping strategies.”

What if you don’t have insurance or can’t afford therapy?

Most metropolitan areas have low-fee or no-fee mental health clinics that have a price tier based on your ability to pay. You could be charged $0 per session or $20 per session — it depends on your financial situation. According to Gottlieb, it’s where many therapists now in private practice first trained — including herself. Typically, you can call 211 for information about local mental health resources. You can also try online therapy through local clinics or apps.

If you’re a student, you may also be able to connect with free or low-cost therapy through your university. And, if you have the bandwidth, you can also reach out to therapists with out-of-budget prices to ask about pro-bono or sliding scale (price based on income) options. Even if they aren’t offering free sessions, they may be able to send you referrals of therapists who meet your needs.

How do you know that you’re getting the most out of your sessions?

“[A successful patient-therapist relationship] is about being honest with yourself,” Gottlieb says. “If you’re honest with yourself, then you’ll be honest with your therapist.” 

That may mean working on a more nuanced perspective. “The stories we tell our therapists are very much our perception of how those stories went,” she adds. “The more we get clarity about that, the more we can broaden the story and see things that we hadn’t seen before — that’s really helpful for us in order to move forward.” 

Gottlieb says progress will look different for each person, but there are some general milestones.

“If you notice yourself doing things differently than you did a month ago, that’s progress,” she says. “If you notice yourself being less impulsive and reactive, or you notice the stories that you’re telling yourself — the “I’m unlovable” or “nothing works out for me” or “I’m not good enough for that” —  are evolving, that’s all part of the progress.”

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