The View from the Therapist's Chair: A Review of Maybe You Should Talk To Someone by Lori Gottlieb

There’s an old adage in the therapy world that therapists are best equipped to help others walk through difficult experiences when we’ve done our own therapeutic work. It can seem strange to imagine your therapist getting help, but the truth is that many of us do. And when we do, it makes us better at helping others.

Lori Gottlieb is a psychotherapist who entered the field later in life. While she was a therapist in private practice, she ran into her own personal issues and decided it was time for her to seek out therapy for herself.  This is the story of her parallel process: what she was experiencing in her own therapy and personal life and how those were impacted by what was happening in her sessions with her patients.   

As a therapist myself, this book resonated with me deeply.  In some ways, it felt like my own personal diary.  Hearing her walk through her struggles and describe them in clinical language that is familiar to me from grad school helped me to relate even more deeply to the story.  This book reminded me of things I know but often forget about my field of work and practicing psychotherapy.

At the same time, there were elements that were tough and challenged me as a therapist.  Reading this book helped me humbly reconsider the way I approach therapy and run my sessions.

Whether you are currently in therapy, are considering beginning now, or are a therapist who is hoping to begin your own journey through therapy, I’d recommend taking a glance at this book.  Here are a few of my takeaways.

Good therapists are self-aware enough to seek out their own therapy when needed.

We all go through difficulties in life and moments of grief or trauma, including therapists.  Therapists especially need of extra support because we are holding the pain of the stories of the people we help. 

What therapists learn from their own experiences in therapy informs their work with you.  You can often feel it in how they hold themselves in sessions.  In fact, I recommend you ask your therapist if he or she does their own therapy to find out this fact.

Most of our problems boil down to relationships and connection (or lack thereof) with others.

Think about what you seek out help for in therapy.  How many of those issues are directly or indirectly related to relationships?  The therapeutic relationship becomes essential in healing when you realize this fact. 

Your therapist likely genuinely loves and cares for you.  You share a lot of vulnerable parts of your story with them, which invites intimacy.  I feel that way about my own clients.

The therapeutic relationship also provides a corrective process to “repetition compulsion.” Repetition compulsion involves looking to receive love in the same way you did from parents as a child, even though it may have been abusive or harmful, because that feels normal.  Therapy can teach you that it feels good to be cared for and loved in a healthy way.

Good work in therapy is slower than you might expect.

Patience is a skill that is both developed by participating in psychotherapy and also needs to continue developing as healing happens on its own timeline.  You’ll take many small steps toward health over a long period of time.  Gottlieb says, “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.”  Each of those small steps or transformations has a big impact. 

“Most big transformations come about from the hundreds of tiny, almost imperceptible, steps we take along the way.”

— Lori Gottlieb

Don’t be afraid to show your vulnerabilities.

Gottlieb says that patients often put on their best faces in therapy when what psychotherapists want is to see the real, human parts of who you are.  We want to see what’s not working, and that usually means you’ll have to engage with uncomfortable feelings and face the parts you’re hiding in the process. 

In a story Gottlieb shares about her own therapist, she says that his eyes communicate a clear message to her. “In this room I’m going to see you, and you’ll try to hide, but I’ll still see you and it’s going to be okay when I do.”  This is the essence of a strong therapeutic relationship, and it is what I aim for. 

I expect that there will be resistance in therapy: lying, posturing, hiding parts of yourself.  You’re going to be trying to maintain an illusion, and my goal is to break through it.  It’s okay if you resist this process: it can feel vulnerable and uncomfortable. Recognize the resistance when it comes, and be willing to talk about it.

Acceptance is the key to healing.

This book explores the concept of acceptance in depth.  She learns to accept the fact that she doesn’t always know why she does what she does.  Not everything will end with a neat and tidy bow, because that isn’t realistic.  In therapy, you’ll learn how to recognize and accept feelings, including anger, and what lies underneath those emotions.  You’ll come to understand your resistance, avoidance, and hesitancy.

You’ll learn about how you picked up coping mechanisms to survive when you were younger that may no longer be the best choice for you.  What are you using to protect yourself and avoid reality?  Instead of being afraid and denying these things, accept that they are there and be curious about what they have to teach you.

One pattern I notice in clients is that they beat themselves up for feeling pain when they compare their lives to how difficult others have it around the world.  If you have this thought, realize that it is not fair to you and not fair to your experience of pain to compare like this.  Gottlieb repeats several times in this book that, “There is no hierarchy of pain.”  What you’re facing is what you’re facing, and it’s affecting you differently than it would anyone else.  It’s fruitless to compare it to someone else and come up feeling bad about yourself for hurting.

You are the one doing the work of therapy.

Therapy is about a series of small steps you take to heal.  I, or any other therapist for that matter, can’t do this work for you.  It would actually hurt you if I tried.  I can’t save you – you need to learn to come to your own rescue.  I can’t make choices for you, and you’ll find that I often counter requests for advice with further questions.  Giving advice hurts rather than helps: you need to come to your own decisions. 

This book taught me to be more reflective about what happens in my sessions with my clients and to integrate who they are as a person into what causes distress for them.  When I have a good understanding of who is sitting across from me, I can allow them to do the hard work of therapy and simply gently guide them in the direction.

“Rather than steering people straight to the heart of the problem, we nudge them to arrive there on their own, because the most powerful truths – the ones people take the most seriously – are those they come to, little by little, on their own.”

— Lori Gottlieb

And finally, learn to be kind to yourself.

As Gottlieb reminds us, “Most of what we say to ourselves we’d never say to people we love or care about, like our friends or children.  In therapy, we learn to pay close attention to those voices in our heads so that we can learn a better way to communicate with ourselves.” Practice kindness toward yourself by changing the words you use to speak to yourself into ones you might share with a loved one instead.

How to Choose Your Therapist

You’ve finally hit the breaking point.  Whether your sadness and depression are the lowest they’ve ever been, your anxiety has hit a fever pitch, or your marriage feels like it’s crumbling around you, you’ve likely hit rock bottom and are looking for a way out.  The idea of therapy may have popped into your head from time to time, but today you’re at the point where you’re ready to start.

But how do you make a decision about which therapist is the best fit for you?

The process of looking for a therapist is anxiety-inducing by nature. Therapy is stigmatized in the media, and you may only know horror stories of therapists you heard from friends or family.  The hurdle of making the first appointment can feel insurmountable.  Common wisdom says that people wait three to six months after receiving a referral to a therapist before scheduling their first appointment.

Here are a few pointers in your search for a therapist.

Ask for a recommendation.

People you know who have seen therapists are often your best resource for a good counselor.  If your friend has seen a therapist and had a positive experience, this is one of your best indicators that this therapist might click with you.  Ask your family or friends for names of counselors they’ve seen.  Check out the counselor’s website and online presence to get a sense of their voice.  If they have a blog, read some articles to see who they are and if you feel as though you can feel comfortable with this individual.

Look for a therapist who specializes in the issue you’re dealing with.

Often, therapists have a specialty in an area of interest for which they have a unique passion.  For example, my area  of specialty is sex and love addiction, particularly as it relates to women.  Therapists attend events or get additional training in these issues in order to be the best resource for you.  Look at the therapist’s “about” page on their website to learn more about these specialties.

Attend the first session to see if you feel comfortable with the therapist and can grow to trust them.

The first session is a good opportunity to test out your fit with your therapist.  You want to feel connected early on in therapy.  While trust is generally built over time, you can typically get a good sense for the potential to trust in that first session.  If you notice yourself feeling “off” in relationship with your therapist, if you are just staying in therapy to appease them, and especially if you feel as though you are being manipulated by your therapist, then you may want to find someone who is a better fit.

Identify if the counselor has a fundamental curiosity about you and your story.

Therapy is meant to be an exploration of your personal narrative with your counselor acting as a guide to help illuminate additional viewpoints and insights into your life story.  In order for this to happen, your therapist needs to be curious about your story: asking questions, digging deeper, exploring different perspectives on the content you bring to session.

Your therapist should be willing to push your buttons…but not too much.

Your counselor should strive to strike the delicate balance between pushing back against some of the faulty beliefs and behavior patterns in your life in order to encourage you to change, but not doing so until you feel uncomfortable.  You will likely feel slight discomfort as your therapist presses into your issues.  But if you’re feeling too uncomfortable in relationship with your therapist, that may be a sign that they’re not the right fit for you.

Counselors need to make space for their own therapy, practice quality self-care, and set appropriate boundaries.

Many graduate programs require their therapists to be involved in their own personal therapy.  Therapists spend their days hearing the pain and difficulty in others’ stories, and they need a space to receive their own care from a therapist.  You want your therapist to practice what they preach.  They likely won’t be perfect at it, but you want your therapist to set appropriate boundaries and take good care of themselves so that they can be fully present with you and your story.

See if your therapist’s values reflect your own.

As much as therapists try to be neutral, therapists do bring their personalities and their values into their sessions.  If you have a significant role in your identity that feels important to you, look for a therapist who fits with that identity.  For example, if you are a Christian, finding a therapist who is also Christian helps you to connect over those spiritual values.

Ultimately, you want to choose a therapist who is grounded in their own emotions, confident in their practice, and not afraid to refer you to another therapist if needed.

What You Can Expect in Therapy

Imagine with me for a moment that you’ve never been in a traditional classroom before.  Perhaps you’ve been homeschooled your entire life, or you’ve lived in a country that doesn’t have American-style schooling.  You know of others who have been in school, all with mixed results.  You’ve seen school portrayed on television, but you wouldn’t want your experience to be anything close to what’s shown on the screen.

For many people, that is what their views of therapy are like, particularly if they've never attended a therapy session.  You may have a general idea of what therapy is supposed to look like, which is often informed by friends and the media.  Today, I’m hoping to set the record straight.

What should I expect from therapy?

In a basic and traditional sense, psychotherapy involves sitting across from a trained professional (psychologist, counselor, or social worker) who asks questions and offers you tools to improve your mental health.  I like one therapist’s simple explanation of therapy as a place to define the problems that plague you, figure out what can be done to change your situation, deal with the underlying roadblocks that are getting in the way of resolution, and help you gain the confidence and courage to change.

But this basic description barely scratches the surface of what therapy and your therapist can represent in your life.  Therapy is a place to be seen and known and to learn the fundamental truth that you are not alone.  Therapy involves a journey – often arduous and sometimes exhausting, but ultimately rewarding you with the gift of a changed life.

Here are some general ideas about what therapy is:

• Therapy is a place to heal relationally. Wounds happen in relationships, and therefore must be healed in relationship. The relationship you have with your therapist can become one of the most important relationships in your life. Similarly, group therapy can offer a catalyst for healing through interactions with other group members.

• Therapy is intended to be a safe environment for understanding and growth. In the therapy office, you are encouraged to share emotions and experiences that have been painful or difficult. You can talk about the darkest corners of your life, the areas that feel the most private, and know that your therapist not only holds your story in confidence, but also accepts you as you are.

• Therapy is meant to challenge your thoughts, worldview, and patterns. Often, in the course of therapy, you’ll be challenged by your therapist to view patterns of relating or thoughts that are destroying your life. You may be clinging to certain coping strategies, hoping they will eventually work. But as the common adage in Alcoholics Anonymous states, the definition of insanity is doing the same thing over and over again and expecting a different result. Your therapist can provide a fresh set of eyes that offer an alternative perspective. This challenge creates clarity in your values and decisions.

• Therapy is about empowerment. Often, you walk into a therapy office because you feel powerless against your thoughts, behaviors, feelings, or circumstances. Therapy is meant to give you the resources and support to regain confidence in your life.

• Therapy is about acceptance and patience. Healing in therapy will likely take longer than you would wish. Part of therapy is learning to trust the process and grow in patience with the way change happens: slowly over time. An image that represents therapy well is this: you and your therapist are miners in a deep cave. Most of the time it feels like you’re just moving piles of dirt, and your therapist suggests which piles to sift through. Eventually though, in all the sifting, you’ll find glints of something gold.

Similarly, here’s what therapy is not:

• Therapy is not a magical solution, a quick fix, or a guaranteed promise of an outcome. Be wary of therapists who make these types of promises or guarantees. The tools therapists teach are truly meant to bring lasting change to your life and your relationships. However, the biggest factor of what causes change in therapy is your motivation and willingness to put in the work to get there. Implementing skills and tools learned in therapy is crucial in seeing lasting change.

• Therapy is not just getting advice from an expert. As your therapist gets to know you better and understands your life and circumstances, you will be led to explore options for yourself and make your own personal decisions. This often happens over the course of long-term therapy: the more time you and your therapist spend exploring the narratives of your life, the more clear your decisions and next steps will become.

• Therapy is not intended to be a place where you end up more wrecked than healed. It is true that often at the beginning of therapy, you’ll feel a bit worse before beginning to feel better. That is a natural result of talking through painful experiences, both present and past. But if a therapist pressures you to uncover repressed traumatic memories or share beyond what you’re comfortable, that’s a red flag. The point of therapy is to create safety and comfort around talking about those deeper issues, not create further trauma by forcing you to go further than what feels safe.

• Therapy is not a way to blame others for everything that’s gone wrong in your life. The stereotype of therapy is that the blame always falls on the parents for the child’s problems. While childhood and family experiences are part of what’s discussed in therapy, there are many other factors that play a role in mental health issues that affect you today. The goal of therapy is to learn to take responsibility for yourself and the changes you can make so that your actions moving forward reflect a more wholehearted life.

Ultimately, my goal as a therapist is to create a safe environment for you to explore the many facets of your life experience in order to create your more grounded and authentic way of living.