Lori Gottlieb is a psychotherapist in Los Angeles and writes a “Dear Therapist” column for the Atlantic. Her new book (2019), which has been reviewed in a number of recent publications, is a classic “insider” series of reflections on her therapy stories working with clients and her sessions with her own psychotherapist.
Alex Kuczynski, in the May 12, 2019 New York times Book Review, summarizes Gottlieb’s book as “an irresistibly candid and addicting memoir about psychotherapeutic practice as experienced by both the clinician and the patient”. “Gottlieb explores her patients’ inner demons – a young newlywed diagnosed with terminal cancer, an older women who finds life meaningless and intends to commit suicide on her next birthday, a self- absorbed Hollywood producer, a woman stuck in a cycle of alcoholism and damaging relationships – and simultaneously peers into her own psyche with Wendell, a middle-aged, cardigan sporting psychotherapist.” This is a fine summary, yet the book is also about much more. As a psychotherapist and someone who reads the history of and current trends in psychotherapy, I am familiar with Gottlieb’s many insights and references. But she is such a terrific story-teller and explainer, that I was hooked by her style and presentation and at times, read as if I was a beginner to determine how the book might be understood outside the field of psychotherapy. For example, she explains a number of very insider terms, such as transference and countertransference, within a case story context that most anyone could grasp. She also sprinkles in various insider facts while staying with the story flow and without becoming didactic. On page 19, “(Fun fact: the countries with the most therapists per capita are, in descending order, Argentina, Austria, Australia, France, Canada, Switzerland, Iceland, and the United States.)” I have explanations for a number of these country stats and will discuss them later. Gottlieb also says, on page 37, “About three-fourths of clinicians who do therapy (as opposed to research , psychological testing, or medication management) are women.” This is a fun fact that I intend to look into later.
On page 47, she explains the notion of a “presenting problem”: Referring to her therapist, Wendell, she says, “He knows what all therapists know: That the presenting problem, the issue somebody comes in with, is often just one aspect of a larger problem, if not a red herring entirely. He knows that most people are brilliant at finding ways to filter out the things they don’t want to look at, at using distractions or defenses to keep threatening feelings at bay. He knows that pushing aside emotions only makes them stronger, but before he goes in and destroys somebody’s defense- whether that defense is obsessing about another person or pretending not to see what is in plain sight – he needs to help the patient replace the defense with something else so that he doesn’t leave the person raw and exposed with no protection whatsoever. As the term implies, defenses serve a useful purpose. they shield people from injury … until they no longer need them. It’s in this ellipsis that therapists work.” This is one of the best explanations available.
Another well-known fact among psychotherapists, but not necessarily well-known to people who have not been in therapy, Gottlieb mentions on page 36, “Study after study shows that the most important factor in the success of your treatment is your relationship with the therapist, your experience of ‘feeling felt’. This matters more than the therapist’s training, the kind of training they do, or what type of problem you have. “
Here is an example of how Gottlieb teaches us without seeming didactic:
“Carl Jung coined the term “collective unconscious” to refer to the part of the mind that holds collective memory, or experience that is common to all humankind. Whereas Freud interpreted dreams on the “object level”, meaning how the content of the dream related to the dreamer in real life (the cast of characters, the specific situations), in Jungian psychology, dreams are interpreted on the “subject level”, meaning how they relate to common themes in our collective unconscious.” (p.128)
Gottlieb sought out Wendel, her own therapist, essentially because of her being abandoned by a long-time boyfriend. She describes a session and the potency of Wendell’s intervention:
” ‘Are you ready to start talking about the fight you’re in?’ Wendell asks. “‘ You mean the fight with boyfriend?’ I begin.” ” ‘ Or with myself – ‘ ” “‘No , your fight with death.’ Wendell says.”
“For a second I’m confused, but then I flash to my dream about running into Boyfriend at the mall. Him: ‘Did you ever write your book?’ Me: What book? Him: ‘ the book about your death’. Oh.My.God.
“I have a feeling that Wendell has been storing up this question, waiting for just the right moment to float it out there. Therapists are always weighing the balance between forming a trusting alliance and getting to the real work so the patient doesn’t have to continue suffering. From the outset, we move both slowly and quickly, slowing the content down, speeding up the relationship, planting seeds strategically along the way. As in nature, if you plant the seeds too early, they won’t sprout. If you plant too late, they might make progress, but you’ve missed the most fertile ground. If you plant at just the right time, though, they’ll soak up the nutrients and grow. Our work is an intricate dance between support and confrontation.” (p.154)
This inside reflection on the therapy process is one of the very best descriptions I have read. Whether one is a therapist, a patient in therapy or someone intrigued with how therapy might work, this description puts the reader into the room and in the relationship.
Later in the book Gottlieb comments on our current variety of distractions in the U.S.: “The second people felt alone, I noticed, usually in the space between things – leaving a therapy session, at a red light, standing in a checkout line, riding the elevator – they picked up devices and ran away from that feeling.” She then mentions another well-known point about psychotherapy, but one which can bear repeating, particularly in our over- technologised and over stimulating social environments wherein loneliness and aloneness are exacerbated by avoiding authentic encounters and relationships with others. She writes, “The therapy room seemed to be one of the only places left where two people sit in a room together for an uninterrupted fifty minutes. Despite its veil of professionalism, this weekly I-thou ritual is often one of the most human encounters that people experience.” (p.260)
This quote acts as an appropriate lead-in for my next few posts, which will review and interrogate some of Irv Yalom’s works as well as his recent autobiography, “Becoming Myself: a Psychiatrist’s Memoir”. (2019)