#122 - Lori Gottlieb: Understanding pain, therapeutic breakthroughs, and keys to enduring emotional health

Hey everyone. Welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in depth content. If you want to take your knowledge of this space to the next level, at the end of this episode I'll explain what those benefits are. Or if you want to learn more now, head over to peterattiamd.com subscribe Now without further delay. Here's today's episode. My guest this week is Lori Gottlieb. Lori is a psychotherapist and author of the New York Times best selling book maybe youe Should Talk to Someone a a book that I've read twice and basically the second time I read it was right after the first time I read it. But more on that in a moment. She also writes a weekly column in the Atlantic titled Dear Therapist. Lori also has a new podcast, Dear Therapists, that's plural. Hosted by Lori and her friend Guy Winch. Their podcast allows you to sit in on some of the intimate, raw and transformative sessions as they guide patients through the everyday challenges of daily life while offering the kind of behind the scenes insights and into what makes us all humans. Dear Therapists is out right now and you can find it on iHeartRadio app, Apple Podcasts or wherever you get your podcasts. And I can tell you right now I am absolutely jazzed to be listening to this because my discussion with Lori was riveting and as I mentioned earlier, her book is really what kind of got its hook into me. So the second I finished reading Lori's book, which I basically read A Matter of Days, I went back to rereading it and then I reached out to Laurie and said, hey, sorry you don't know me from Adam, but I'd really love to sit down and have this interview with you. Now in this episode we talk about her journey in terms of how she became a psychotherapist and also we go through a lot of the stories in her book. Now I think we together make a very good effort not to spoil anything because my intention is that those of you that have not read this book will actually go out and get it. I think it is on the short list of books that one should read this year. Regardless of your interest in Mental health, emotional health. If you have any interest in living a better life, I think this is a book for you. In this discussion, we pull out some of the backstories and we dig into some of the nuance a little bit more. And I think, honestly, those of you that have read the book are going to get a lot out of it. And again, those that haven't certainly will. And I hope it encourages those of you that haven't to go out and read it. This is an episode for anyone who cares about what it means to live a better life, to live a more fulfilling life, to live a happier life, to suffer less, and to kind of understand the nature of the human condition. I think Laurie is a fantastic writer, and I think she's also a great speaker, and I think you're going to enjoy this episode a lot. So without further delay, please enjoy my conversation with Lori Gottlieb. Lori, thank you so much for making time to chat today. I know how busy you are, both clinically and in terms of your outside of clinical activities, so it means a lot.

Well, thank you for having me. I'm really glad to have this conversation.

I have wanted to sit down with you, and I was hoping it could have been done in person, but obviously, given the circumstances, it can't. From the moment I finished reading your book the first time, which is to say I've read it more than once, which I think speaks to how much it impacted me. And it's my hope that either people listening to this podcast who haven't read it will certainly go out and read it, and even people who have read it might go back and reread it with sort of a keener eye to, I think, the beauty of the book. So maybe for folks who haven't read it, let's just start with kind of an explanation of this beautiful narrative that you managed to do so poetically, where you kind of weave your story in that with a group of patients, but tell folks a little bit about who you are and what you do for a living and what it means for you to be both a patient and a therapist.

Sure. So I guess starting with maybe you should talk to someone with the book. In the book, I follow four very seemingly different patients as they go through their struggles. And then there's a fifth patient in the book who is me as I go through my own struggle and go to see my own therapist. And really, when I say seemingly different people, what I mean is that on the surface, I think the people may not look like the reader, but by the end of the book, I think everybody says, I saw myself in every single one of these patients. And I include myself as one of the patients. And I think that really, it's a book about the human condition, and it's a book about how we're all more the same than we are different and how we grow in connection with others. And I think that that is really what I'm trying to do in all of the work that I do is try to really help people to see that. So you asked about what I do more generally. So I'm a psychotherapist. I have a practice in Los Angeles. I see individuals, I see couples. I think what I do is an incredible privilege to be able to sit with people as they go through their lives and try to transform and grow as people. And I write the weekly Dear Therapist column for the Atlantic. And starting in the end of July, I have a new podcast coming out that actually Katie Couric is producing for iHeart. And it again is about people and their struggles and how we can sort of help them. So I think in all of the work that I do, whether it's. I did a TED Talk recently about how changing our stories can help us change our lives. And I think that what I really love about what I do is that no matter what lens through which I'm doing it, whether it's a column or a podcast or a TED Talk or a book or my practice, I'm really dealing with, I think, what makes us most human at our core.

And we'll make sure to link to, obviously, the TED Talk. And once your podcast is out, what's the title of it, by the way?

Dear Therapists, Plural. My Atlantic column is Dear Therapist Singular. There are two of us. Guy Winch, who you might also know from his TED Talks, he is my co host on the podcast.

Awesome. Okay, well, we'll make sure we point people in that direction. Let's talk a little bit about how you got here. You and I do share one odd thing in common, which is we at least spent time at the same medical school, though I don't think we overlapped. So you have kind of an interesting circuitous route to where you got. Having started off making television, winding your way through an experience you had there in the ER to medical school. Give folks a bit of a sense of that journey.

Yeah, so I took a really non linear path to becoming a therapist. And in retrospect, I think it actually seems quite linear. But when you look at it from the perspective of not having Lived it yet people. I always said at the time, I'm either very versatile or very confused, which was my way of saying, I know it sounds crazy what I'm doing. After college, I started working in the entertainment business. First I was working in film development, and then I moved over to network television and I started working at NBC. When I got to NBC, it happened to be the year that two what were to become very successful shows were about to premiere. One was called ER and the other was called Friends. And I really loved both of those shows because even a sitcom, I think, really said a lot. I think it's like reading a good novel where there are deep psychological truths kind of hidden behind the sort of entertaining part of the book. And I think the same thing was true with ER and Friends. They were so successful because they really did strike a chord emotionally with people. And what was really interesting about ER was we had a consultant who was an ER physician, and he was making sure that everything was accurate on the show. And I spent some time in the ER with him, and the more time I would spend there, he would say, I think you like it better here than you like your day job. You should go to medical school. And I thought he was nuts, because, first of all, I was a French major as an undergrad, but I was also very kind of mathy and sciencey, but that wasn't where I focused my academic career. And the other part of it was that there was something that really resonated with me about being in the real er, which was, I think, that we were telling these very rich human stories on the show er. But it's another thing when someone, like a real person walks in and nobody comes to an ER because they expected something to happen. It's always an inflection point in some way in someone's life. And so what happens when someone comes in and they say, oh, you know, I have headaches. And then you do a scan and you're like, oh, you have a brain tumor. That's crazy. Like, how quickly your life can change. And so I was really interested in those inflection points in people's lives. And so that's why he kept saying to me, I think you really want to go to medical school. And so I did. I went up to Stanford. I had to take all the classes, do all the prerequisites, take the mcat, do all of that. And when I got there, it was up in Palo Alto. It was Silicon Valley right before it was the first big boom, before the first bust and a Lot of my professors were saying there's this new thing called managed care. And I was very clear from the very beginning that I really wanted to kind of guide people through their lives. I wanted to have those relationships, those long term relationships with my patients over time. And it seemed like the new medical model was not going to be conducive to that. I wasn't interested in research. I really liked the clinical side. A lot of people were like leaving to do.com types of things and so a lot of people were saying, you know, why are you doing this? And I started writing when I was up there at medical school and I was writing about my experiences and I actually left medical school to become a journalist because I felt like I could really delve into people's stories and help them to tell their stories through writing. And so I did that and I still do that, I'm still a journalist and I still write. But I did that exclusively for about 10 years and then I had my baby. And it was really interesting because I loved what I did as a journalist. But it's not the kind of thing where you have a lot of social interaction, you're doing a lot of writing and doing a lot of phone interviews and things like that. And so I really wanted adult conversation during the day. And so the UPS delivery person would come. I had a million deliveries with a new baby and I would detain him and I would try to have conversations with him and he hated that and he would like back away to his big brown truck to get away from me. Eventually started tiptoeing to my door and putting the packages down very gently so I would not even open the door. And so I knew I needed to do something. So I called up the dean at Stanford Medical School. I used to run her mother daughter book groups and so I knew her her pretty well and I said maybe I should come back and do psychiatry. And she knew me well from our relationship there and she said, you are welcome to come back but do you really want to go through internship and residency and all of that with a baby, with a toddler to do psychiatry where most people do medication management and they see patients in these 15 minute intervals and they're prescribing antidepressants and anti anxiety medication. She said maybe you should get a graduate degree in clinical psychology and do the kind of deeper, more intensive work that you are interested in. And it sounds very obvious in retrospect, but at the time it was like this aha moment of oh wow, that was brilliant. And so that's exactly what I did. And so that's how I have this hybrid career where I feel like I went from telling people stories as a journalist to helping people to change their stories as a therapist. And I feel like a lot of what I do in the therapy room when I'm sitting in that chair is I feel like I'm as much an editor as I am a therapist, because I really feel like what I'm doing is people are coming in, they're telling me we're all unreliable narrators. They're telling me a faulty narrative. They're telling me a narrative that is keeping them stuck, and I'm there to help them edit this story. So I feel like the path might seem a little bit circuitous, but I feel like the whole time I was always interested in story and the human condition. I just looked at it through in different ways.

So interesting. When you were in medical school, were they still doing anatomy in the trailers?

Yeah, actually. When were you there?

Yeah. So my anatomy, I was a freshman in 97 or freshman med student in 97. So we must have been only off by a year or two, right?

I came in 99. Yeah.

Yeah. So you were only two years after me. They were still in the trailers. So it's funny, when I was reading your book and you were describing that, because that's a really intense experience for anybody coming into medical school. I was also not a pre med, but whether you're a pre med or not coming in the first quarter, you dive right into that ocean of dissecting that cadaver. That cadaver becomes your best friend with your partner. It's you and one other person that are paired at the hip, and you're going through everything. And I don't know if you felt this experience, but there were certain parts of dissections that I found staggeringly tough, and the hand was one of them. I think looking at people's fingers was really hard. And it's also where I saw the most heterogeneity across the cadavers. When you were dissecting a heart, you could show your heart to your neighbor's heart. You could see there was different pathology. But a heart's a heart, but a hand. Boy, you could tell a lot about a person by their hands.

I agree. I think that the hand is so revealing. And you think about what we use our hands for. When I was dissecting the hands, I remember thinking, whose hands did this person hold? Who did this person hug? What did the person do with their hands? And you could see on certain cadavers, there would be, like, nail polish still on there. And so you got a sense of someone's personality by what they chose. They wore rings on their fingers, and you could see, like, a suntan line of where they had worn their rings. It was. Yeah. I think the hand is very human. There were other parts, too, though, I think. Do you remember when we were dissecting, we did the head near the end, and that was the hardest part. I think their lids were closed, and then they had something over them. Do you remember? They had, like, a little shield over them. And that was to get us used to the idea of opening up this person who is a person and remembering that they are a person. It's like this balance between remembering that they're a person and then also being able to separate yourself enough to be able to do the work. Because if all you thought about was they're a person, it would be extremely difficult to cut them open in the ways that we had to and kind of almost dehumanize them. And so I remember doing the head, the. Doing the face. The face was so hard.

Yeah. And I remember my cadaver was a male. And I remember really being observant of the length of his stubble and realizing what it implied about the timing of his last shave and things like that. And I just agree. I thought it was a very emotional experience that at times you had the privilege of just being so far into the pancreas that you could forget for a moment what you were doing. But then you had so many moments where you were pulled back into that human element. And I can honestly say, and I don't know if you can say this, but in my class, I don't recall one instance of any of my classmates doing anything that felt disrespectful. I really felt like there was a remarkable Both camaraderie amongst us as classmates, but also just camaraderie with the cadavers. I think the families of those people would be proud of what their family members did in terms of the donation and how we, as students, learned from it.

Oh, absolutely. And I think that at Stanford, they did a beautiful job of making sure. And I think there was a reason that that was one of the first classes that we had to take because you, from the get go, develop this. They really made clear to you that when you see people that you have the utmost respect for them, that you treat them in the most human way possible. And that started with these cadavers. Remember that we had that ceremony. Did you guys have that at the end where we wrote notes and we thanked them and it's like this very spiritual moment of really sharing our gratitude for them having donated their bodies and let us learn so that we can help people through what we've learned by opening them up and seeing inside. And so it was really such an act of generosity for them and their families to say, yes, we trust you young medical students to treat my loved one with the utmost respect. As you learn and do this, you've.

Told the story in one way, but there's another dimension I'm just curious about, which is the courage it took to leave, which is you glossed over what it took to get into medical school. But I think, let's be honest, for a French major to then take the necessary courses, to then take the mcat and not just take it, but ace it, and then get into one of the hardest medical schools to get into in the country and get through it. You get through this first quarter a semester and you're doing well, but then to be at this crossroads and say, wait a minute, is this the path that's going to take me to where I want to go? And then to kind of have the courage to stop and say, I don't think it is, I'm going to walk away. How did you handle that?

It's interesting because I think that at that point in my life I was less risk averse than maybe I've become. And so I think as a parent, it's a different equation that you're looking at. What's so strange to me is I don't know why this was. But in my book I write about, I'm seeing this young woman who goes on her honeymoon and she comes back and she's diagnosed with cancer. And it's about sort of our relationship as she goes through this. And she said to me at one point, and I write about this in the book, where she says, why do people need a terminal diagnosis? To really pay attention to what they want to do in their lives. We shouldn't need that. And it occurred to me that we all have a terminal diagnosis. Life has 100% mortality rate and that's not just for other people. And so I think we don't know how or when we're going to die. None of us really does unless we actually have some kind of terminal diagnosis right now. And so I feel like I had some sense of that at a young age. I don't know why I didn't have, I didn't have early Exposure to death. There was just this sense of, I only get to live once. This is the time before I have a family, when I'm free to make the choices that I want to make and they won't impact other people. And so I just did. I sort of went into that place of knowing inside that I think we all have that is very quiet in most of us. We don't listen to it. All that noise outside about what we should do or what's the practical thing that usually drowns out that voice inside that takes us to that place of knowing. And I'm not trying to get all woo woo. I don't. I feel like we all have this place where we trust ourselves, where we know something, we have information. So many times people come to therapy and they're like, tell me what to do. And what I want to help them do is find the answer inside, because it's there. They just can't hear it yet. And they have a better answer than I do for them. And so I think back then when I was thinking about leaving medical school, I mean, even thinking about, like, who would leave that job at NBC, who's going to leave that job with friends in er, who's going to leave medical school to become a freelance journalist, that's not the path. And then to have a really successful career as a freelance journalist and really be thriving, and then to say, you know what, I'm going to go and start over and go to grad school with an infant and then go become a therapist. I think there was always just this sense of, I'm drawn to this and I'm not going to hold myself back from it. They weren't impulsive decisions, by the way. It wasn't like I woke up one day and I decided this. It was. I thought about them for a while before I actually made those moves. So when I was in medical school, it wasn't like I woke up one day and said, you know what? I think I'm doing this writing. I'm really liking this writing. I'm really liking the relationships and telling these stories. I'm going to do that. It was over a course of two years when I was thinking about maybe I should go do this other thing.

I mean, I ask in part because I wanted to contrast it with the experience I had, which was ultimately leaving medicine altogether in, I think, 2006. And it had the same sorts of elements in that there was a group of people around who understandably, I think, succumbed to a bit of the narrative. A sunk cost which is between medical school and residency. You've now put 10 years into this endeavor. It's crazy for you to walk away before you actually start your career and all the other arguments that come with it. But I'll never forget one of the people who really was the most encouraging was an attending at Hopkins. His name was Peter Pronovost, who's gone on to do some really amazing things within ICU safety, and he handed me a copy of a Joseph Campbell book. There was the line in there about a hero being the one who had the courage to pursue his own bliss. That's the thing that really stuck with me. And I think you're right. It's like, in the end, it took me four months to make that decision to leave. It wasn't an impulse. But in the end, as silly and as unreasonable as it appeared to everybody else, I had no qualms about it, and I never looked back. And ultimately, I did come back to medicine, albeit in a completely different capacity. But it's interesting to hear that the part you said that resonates the most with me are two things. One, the answer is usually inside of us. It just takes us a while to figure it out. Sometimes you, as a great therapist, I think, can help the prodding. The second thing that really resonates with me is what you said about Julie. Well, you didn't describe her by name, Julie. But we'll get to Julie's story, which is when people would argue to me, this sunk cost, which is, you've already put 10 years into this. At the time, I was 33, I said, well, think that's the faulty logic. I mean, the reality of it is I'm 33 right now. I'm going to work for another 40 years. So shouldn't I just work on what I want to do for the next 40 years as opposed to what I'm destined to do based on the last 10 years. Like, it just struck me as the wrong argument. Now, whether I had 40 more years to work or not is irrelevant. And Julie's story will teach us that. You don't know if you're going to have 40 years left. You might have one year left. You should be doing exactly what you want to be doing. But I guess maybe with that, I want to talk a little bit about Julie. Can you tell folks a little bit about how this woman came into your life? And I guess we should caveat this for people. Understand I'm going to be using the names that you use in the book, which are not their real Names will talk about this the way you've written about them, which have enough of the details stripped out. So I don't want people thinking we are having discussions about patients that are violating their confidentiality. But if it's okay with you, I'd like to just talk about them as the way they're written about.

Yeah, absolutely. I just wanted to also just say something about what you just so beautifully said about this idea of sunk costs, that I remember that at a certain point when I was going back. So I was in my late 30s when I was going back to grad school to become a therapist, and I remember a lot of people saying, you're going to be 40. And I said, but I'm going to be 40 anyway, whether I'm doing what I want or something that I'm not interested in doing, I'm going to become 40 and turn 40. So shouldn't I turn 40 and be doing something that I want to do as opposed to, I'm turning 40 and I'm doing the thing that I'm really successful at, but I feel like it's not enough. So I think that that logic is very faulty. When people say, but you've put so much into this, it's like, that's right. And I don't want to waste a lot of years looking back and saying, wow, I could have done that thing when I was 37, but I waited until I was 50, and now I'm really sad that I didn't do it.

Yeah. Yeah.

So let me talk a little bit about Julie.

Yeah. Let's introduce people to Julie. How did this really wonderful woman come into your life?

So Julie came to me because she was this young woman who had just gotten married to the love of her life, and she had a career that she loved, and she had wonderful family and friends. She had a really good life. And she went on her honeymoon. She and her new husband had been together for a while, and they decided that they would want to start a family right away. And so she came back and she had felt like something funky in her breast. And she thought, well, maybe I'm pregnant. That's what they were hoping. And it turned out she wasn't pregnant, that she had breast cancer, but it was a very treatable form of breast cancer. And all of her doctors reassured her, you're going to be fine. You'll go through this treatment. The treatment will be unpleasant, but you will be fine, and you will move on and you will live your normal life after this. And so she came to Me, not because she was dying, but because she just wanted to get some support as a newlywed going through cancer. And she was very funny. She'd say things like, what should I say in my thank you cards? Like, thank you for the bowl. I use it to throw up in after chemo. You know, like, she had that very sort of wry sense of humor. But she was just this very warm, lovely person and very real. She wasn't the cancer patient who's the saint. She really didn't want to go through this. She wasn't the pink ribbons and the optimism, that was not the approach that would work for her. So she specifically came to me because I had zero experience with this. And so she said to her doctor, I want to go to somebody who's not on the quote, unquote cancer team. I don't want to be part of the cancer world, especially since my prognosis is so positive. I just want some support as a newlywed going through an illness.

There's a funny story you tell about how she's totally put off by the yoga instructor who's explaining to her that her entire prognosis is a function of how compliant she is with the yoga routine.

Yes, yes. She hated that whole idea of it's your attitude, it's doing the yoga, it's all in your mind. And so we went through that time together, and then she went back to her life and we said goodbye. And it's always interesting as a therapist to say goodbye to people because that's our goal. Our goal is to have people leave us. It's a terrible business model, but it's very rewarding emotionally. And she left, and that was that. And, you know, occasionally I would think about her and wonder if they had gotten pregnant and those kinds of things. And six months after she left, I got a voicemail from her. She had had her sign off scan, which was going to clear her to go ahead and get pregnant. And instead they found another form of cancer. It was unrelated, they believe, to the breast cancer. And it was a very rare, aggressive form of cancer in a different part of her body. And they said there was no cure and that she had somewhere between one and 10 years to live. Which, of course, the difference between one and 10 years is enormous. She was in her early 30s. She came into my office and told me this, and she said to me, will you stay with me until I die? I would like to say that the reaction was that I hugged her and we cried together. And I said, of course I will, but that is not what happened. I actually hesitated because I had no experience doing that with someone her age going through this. And I wanted her to have the experience of doing it in a way that whatever right meant for her, I wanted it to be done right. And I didn't want to screw it up for her because she was only going to get one shot at this. And she said no. Specifically. The same reason that she came to me earlier was she said, I really want to do this with you. I really want to do this separate from all of the sort of cancer world, which I'm already going to be very ensconced in. And so I said I would. And I kept that promise to her. And she included in that, by the way, was that I had to go to her funeral. That was part of the deal that I made with her that she insisted that I make with her, that I agreed to. And it was this very transformative experience because, again, I think I always kind of had death sitting on one shoulder when I was younger. And not in a morbid way, but actually in a really inspiring way, which is be aware. Be aware of the gift of your life today. When you wake up, be intentional about how you want to live your life. What are your priorities, and are you living those. But I think it was another thing to go through this with someone and to get really attached to them, as I did to Julie, and then to watch her and be inspired by her again, not because she was a saint, because what I loved about her was she was so real and raw and honest about what this experience was like, but because she made choices that everybody thought were crazy. And she said, no, this is what I want to do. She was this person who had always ticked off all the boxes. She did everything by the book, and she did it all right, and she did it all well. And her life was humming along smoothly. And then this hit, and she was like, here are some things I want to do. I know it sounds crazy, but this is what I want to do. And we all thought she was crazy. And what was interesting was one of the things she wanted to do was she was a professional and a very successful one. And she said she was in Trader Joe's one day, and she said, I love the way the cashiers interact with the people in the store and that they have these moments of connection that they just give them balloons and they ring the bell and there's energy in the place. And for that moment, you're doing something tangible. You're tangibly making someone's day better. Even if it's for a minute. And she said, that's what I want to do. And her husband said, wait a minute, you're dying, you have a terminal illness and that's how you want to spend your time? He thought she was crazy. I thought she was crazy. But I also wondered, are we saying this because we think she's making a bad choice, or are we saying this because we're jealous? Are we saying this because we're actually. We envy the fact that she is not chicken shit like the rest of us to do something so bold that everybody else thinks is crazy. And so I think in some ways there was this lesson of maybe she's doing something that the rest of us, because we don't have that gun to our heads. We do, but we don't realize it, that she's doing something that we wish we had the courage to do.

It's funny, I remember that part so well for a couple of reasons. One, the first time I ever went to Trader Joe's because I grew up in Canada was when I actually went to medical school. And then I discover this place and I'm like, I'm obsessed with Trader Joe's. And I could sort of understand exactly why that's the place Julie would want to go and work. It is such an amazing environment. And then the other thing that kind of resonated with me when I read the story was I remember thinking, even in medical school and into residency, I wish I could just have half a day a week to squeegee windshields at a gas station. It gives me so much pleasure. And I have this whole technique on how I squeegee. I'm actually very good at it. If I'm going to allow myself to be a little bit immodest, there's a real technique to it. It's so satisfying to clean a windshield. And I was like, how can I figure out a way to integrate my medical career with at least some squeegee time per week?

And have you done it?

No. I remember even bringing this up to my friends and family at my medical school graduation party. And everybody looked at me like I had seven heads. Can you just shut up? Like, what are you. Stop talking about squeegeeing. But I was like, look, I'm not saying I'm going to be a full time squeegee guy, but I want to at least do some squeegeeing because it is so satisfying. And to your point, it's very tangible. It's a very brief Interaction with a person who comes in and their windshield, they can barely see out of it. And five minutes later, it's, like, perfect. So I think Julie's story just resonates so much on so many levels about living. Right. It's what you said. It's a story about early death, but it's actually a story about life.

Well, that's the thing I think people would say, isn't it depressing treating someone like that? Isn't it hard? And of course it was hard. But you know what? I looked forward to her sessions more so than maybe some others, because there was so much vitality in those sessions, because she was bringing so much energy into those sessions. I don't mean, like, sometimes she was exhausted and she would sleep. But even then, there was so much about taking off the mask, about stripping down to the essentials. That feels invigorating and just getting rid of the performative aspects of lives, the pretense, all of that. And just saying, this is who I am. Can you hear me? Can you understand me? And this is how I want to manifest myself in the world. I think there was something about those sessions that just felt so much more real than, I think, what some of us deal with on a daily basis. I'm not minimizing what other people were dealing with. I'm saying that I don't think that the rest of us really let go in the way that Julie let go. And I think there's a lot that we can learn from Julie's story in the book.

Well, if Julie's story in some ways is the one that. Where life is taken too quickly. The two stories that resonated with me the most were John and Rita. Because in them, I both saw such a cycle of shame, for different reasons, but just an unbelievable cycle of sort of punishment, self punishment, and this shame cycle. I'd like to maybe start with John and just. I think you actually open your book with. I think John shows up in the very first chapter. He's a guy that I think, on the surface, most people would not like. I think that's a safe statement, correct?

Yeah. He is very abrasive, very unlikable. He is very insulting to me. In the very first session, he is already insulting me, but he doesn't realize he's insulting me. Although I should say on some level, he must. But he sort of jokes around, and his jokes are very insulting. I mean, I guess that's the best word to describe it.

I mean, look, he refers to you as his mistress. He's Totally derogatory in every way imaginable.

Yeah, he's always putting me down.

Right, right, right. The only thing he gives you is he doesn't refer to you as a complete idiot, which is what he refers to everybody else as. That's the only quarter you have, is you're not a full idiot.

Yeah, but, you know, the jury was out. He wasn't sure yet. And, you know, I think the thing is, though, people say, well, why would you even treat him, given how he treated you in that first session? Why would you take him on as a patient? And what I always say to people is that these are the people that I think are the people who grow the most in therapy, because what they're doing is we use our behaviors to speak something, to communicate something that we can't do with words. So we take the unspeakable and we convert it into a behavior to communicate something. And what he was communicating was, I'm going to keep everybody at a distance. I'm going to be so obnoxious. And he had what we might call narcissistic traits. So he thought very highly of himself and not so highly of other people, which was really a defense. And he was somebody who was saying, I have this unspeakable pain, and I'm going to keep everybody at a distance so that they don't get near my pain. Because if they get near my pain pain, I might have to look at it. So those aren't the words he used, but that's what his behavior was doing. So I knew that there was going to be something there that we were going to uncover together and that he was going to eventually start to talk about, and that that would give him freedom, that would liberate him from the shackles, the emotional shackles that were constraining him. But I had no idea what it was. And as you can see, the way I write it in the book is exactly how it happened in life in terms of when that revelation came to me and how it came to me. And I was so just gobsmacked by that. And I think the reader is, too. And I think that he becomes. I think people talk about the people. I think the people find themselves in every single person in the book. They see themselves in every single person. But I also think that there's something about John and how it makes them think about the ways that we make judgments about people when we first meet them, and then how much we could come to love them if we really knew who they were. And I think that's what happens with John. People love him. By the end of the book, everybody just, how's John? How's he doing? Everybody cares about him.

At the outset, you referred to therapy in the book. You actually have an entire short chapter dedicated to the differentiation between counseling and therapy. Give folks a bit of a sense of what that is. Because I think what we're really talking about here is the deep therapy.

Yeah. So I think that a lot of people, especially today, where we have instant gratification, itis. We don't have a lot of patience. And so I think that a lot of people I know. I wrote a piece for the New York Times Magazine about this. It was called what brand is your therapist? And it was about how people are sort of branding themselves as these people. Four sessions and you'll have an answer. Whatever it is, that's not what we do. And by the way, the other thing that we don't do is we're not there to keep you there for life. We are very much about, you're coming in. We want to be very aware of the purpose of what you're doing here and make sure that you're getting what you need to leave. But it's also not. I remember I had this guy call me before the holidays once, and he said, I need to know by Valentine's Day whether or not to propose to my girlfriend, because she'll leave me if I don't propose by Valentine's Day. And so, you know, it was like December, right? So we'd have like six weeks or something. And he said, so I need to know that I'll have an answer by then. And I said, listen, I can help you get clarity, but I don't know anything about you yet. I don't know what your history is. I don't know what the issue is. I don't know that you will have clients clarity in six weeks. So I can't guarantee that. And so he made an appointment, but then he called me back later and canceled it and said, I found somebody who could guarantee that for me, which is just insane. I think he wants to make an informed decision. Not just a decision, but I really feel like people want instant gratification. They want me to have answers for them. And I have this word taped up in my office. Ultracrepidarianism, which means the habit of giving advice or opinions outside of one's knowledge or confidence. And it reminds me that people are always saying, what should I do? And I don't know what they should do. I know what I would do in that situation. But just because I would do a certain thing, I'm not living their life for them. So I don't know what they should do. They have to, again, access that place of knowing, and that's what I can help them do. So it's very tempting as a therapist when someone keeps sort of like going in circles and ending up in the same place to kind of just be like, just do this. You feel like, oh, I just want to tell them, like. But I actually need them to come to their own conclusion about what they should do.

So, going back to John, I was thinking about this as you were talking a moment ago. I think for the purpose of the people who haven't read the book, maybe we won't get into the details. My hope is that everybody who is listening to this, who has not read the book is going to order it ASAP and do what I did, which is the first reading of this is you're not putting it down and you're in tears at the end of it. But let's go back to some of the stuff that I think we can get into without the spoiler alerts. First off, what gave you. I don't want to say the confidence, but for lack of a better word, Laurie, what gave you the confidence to say a, I don't know how long this guy is going to be an abusive jerk, but I can weather this out and I can eventually get him to break open? And two, what gave you sort of in your own experience? I don't see. One thing that is lost on me a little bit is, as a reader, is where were you in your experience level? Was John like the 10th guy that showed up like this that you'd taken care of, or was this the hardest case you'd ever seen as case one?

Definitely not the hardest case. I mean, I think that when people present for therapy, they're not at their best. That's why they came. So they're not doing as well as maybe they normally do. For John, it was clear that there was this characterological piece where this is how he interacted in the world, in all spheres, professional, personal, his marriage, his kids at work. However, I think the thing about John was, I don't know that I had confidence. I felt like I knew how to work with him. But you never know what's going to happen with people. And that's what's so surprising about my job, is that going back to medical school, it's like, you know that if you do this surgery, there's A this percent chance, if you do it well, that it's going to be successful. Therapy is very different. It depends so much on the people and what's going on, and mostly the relationship that's going on. All these studies will tell you, if you look them up, that the most important factor in the success of someone's therapy is the relationship that you have with your therapist. It matters more than the training the therapist has, than the modality that they're using, than the number of years of experience. Not that those things don't matter. They absolutely do. But the thing that matters the most is that relationship. So my goal was to. And what we do in therapy is that the relationship in the room is a microcosm for the relationships that they will have outside. So I wanted to create that environment in the room. You see in the book, I work very much in the here and now with him, of what's going on between us. And he fights that tooth and nail. He hates that. He does not want anyone to get close with him. In fact, one of our first sessions wasn't, I think, the very first one, I can't remember. But we're sitting there and we're doing therapy, and he's always getting his texts, and he's doing his texts. And then, like, the light goes on, which shows another patient is there, and he looks over it and he says, oh, it was his lunch. He had ordered lunch to come into our therapy session without asking, just, here's my lunch. What I did was we ended up having these Chinese chicken salads, which is what he liked for lunch, and we would have them together. I wasn't hungry at all. Like, at the time of his appointment, I had already eaten lunch, all of that, but. But I would just, like, have a few bites. It was this glue. For us, it was a way of just connecting with him. I would say another thing about treating John is that. And this is going to be a gross generalization, but I've noticed these differences between men and women and how they interact in therapy. And I would say that I have so much compassion for men, because I think that when somebody first presents for therapy, I'm looking at not only what's not working in their lives, which is what they're telling me about, but I'm also scanning for strengths. And one strength that everybody has is they made the call, they decided to come in. So I'm not just asking, why are you here? But I want to know why now? Why this day, this week, this month, are you here when maybe this has been going on for a long time. What made you call that's a strength? So there's something in them that says change has to happen. Often what happens is they say, I want something to change, but what they mean is, I want someone else or something else to change. They don't realize that they are going to need to change, but that's okay.

Let me ask you about that, Laurie. How often do you find that people come to you because they have hit a relative rock bottom and they acknowledge that, meaning there is a pain that is so great it is clear to them that they play some role in that, versus they're coming to you thinking everybody around me is acting badly or crazy, and I just need help to cope with their pathology. What's the relative balance of those?

It's very mixed. I would say you get both. Maybe you get more of the. I'm having trouble in my life because of my partner, my boss, my parents, my sibling, my whomever. More than, hey, I know that I have a problem and I want to change. But you do get that, too. I think that it's revealed sort of over time and as that relationship between the therapist and the patient really develops. And there's a trust there. And I think that's what happens with. There's a saying. I remember one of my colleagues had said before, diagnosing someone with depression, make sure they aren't surrounded by assholes. So it's like, there are difficult people in the world. And I acknowledge that. Obviously, people are dealing with difficult people, but what is their role? What is their response to those difficult people? Do you need to be in that relationship? If so, and you want to be in that relationship, what is your role in exacerbating the difficulty in that relationship? But I was going to say about men and women, which I think is important in John's case, is that the fact that men land in therapy and the fact that they're willing to talk to you, especially a female therapist. And John, by the way, came to me because he said I was a nobody and he didn't want to run into any of his Hollywood industry colleagues in the waiting room. So it was not for positive reason that he came to me. But what was interesting was that I think. And I also see a lot of couples, and if I'm seeing a heterosexual couple, and usually the woman will say something to the man, like, I really want to get to know you. I want you to share your inner life with me. I feel like we're not connected. I can't Reach you. And then he, like, really opens up to her, and maybe he starts crying, maybe starts crying a lot. And she looks at me like a deer in headlights. Like, on the one hand, I didn't feel safe when you weren't sharing with me, but I don't feel safe when you're crying either. So there's this mixed message that men get. In John's case, he really felt like he had to be the rock in his family. And I won't sort of get into the details because it reveals in the book, but he really felt like if he became vulnerable, if he showed his pain, that the whole house of cards would fall down, the whole family would collapse because he had to be the strong one. And a lot of men feel that. And so men will come into therapy and they'll say something to me eventually, like, I've never told anyone this before. And then I sit back and I wait, and what they tell me feels so mild. And even if they have a good marriage and they have good friends, they felt like they couldn't tell anyone this. They couldn't be vulnerable with anyone. They have so much compassion for them. Women will come in, and eventually they'll get to that point where they'll say, I've never told anyone this before except for my mother, my sister, and my best friend. So they've told one to three people already, but they feel like they haven't told anyone. And then the thing that they haven't told anyone, there is something about it that feels like I can see why they maybe were a little reluctant to share that. It feels very, very private. And so I think it's really hard for men that on the one hand, we're. And I'm raising a boy, right. So I think that on the one hand, we tell boys at a certain point, and we tell men. We want you to be really emotionally available. We want you to feel your feelings. We want you to have the freedom to feel the way that women do, to feel whatever you feel and for that to be okay. And on the other hand, we don't really. Because we don't really create the space for them. There's a lot of shame around that. And we do shame men. And even in ways like in that couple situation where somebody says, I want you to do this, and then you do it, and then she's, like, scared because you're crying.

Yeah. And I think the other kind of shame in John's life is the circumstances that get him into your office obviously are not the presenting circumstances. He presents with something quite benign. If I recall, it was basically sleep disturbance.

Yeah. He says he has insomnia and it's because of all the idiots that are making his life very difficult.

But you're absolutely right. I don't think you get through the end of John's story. And it actually happens quite abruptly. So it's sort of two thirds of the book we're going along with John, I think, as readers, assuming there is something lurking beneath the surface that explains this. There's one moment when, as you put it, it's breaking down versus breaking open. And he fully breaks open in the most unexpected way. How were you able to control your own emotions there? I don't know how long you'd been seeing John at that point. I don't think that is clear in the book in terms of real time. But obviously you had just an interpersonal affection for him. How is it for you to see somebody who has had such a shield, has had so much armor, and you are the only person that is now witnessing the complete destruction of that armor such that the real John can come out?

Yeah, well, there were a bunch of misdirects that I think sort of prepared me not for what ultimately comes out, but just felt a lot of empathy for him. It's revealed very early in the book, so this does not spoil anything, that his mother had died when he was young. She had been hit by a car, and she was a teacher and she was trying to save a student from getting hit by a car. And he was 6 years old. And him feeling like it was sort of his fault because he wanted her to rush home and he missed her. And him kind of carrying the burden of that and not really being able to talk to anybody about that. And his family dealing with the death by, like, let's move on, let's move on. And so I felt like I could see glimpses of him and who he really was and the younger him and the more tender parts of him. And so when this happened, though, I was really blindsided when I found out what was the other piece of it. And I did tear up. And he calls me on it. He's like, oh, my God. He goes back into his kind of defended place and makes some kind of sarcastic remark about the fact that I was tearing up. Because you have very human reactions as a therapist. And it was an incredibly sad, tragic, moving story. And I don't think anybody could sit in that room with him and not cry. I don't know how someone would. You'd have to be A robot, and we're not robots.

And there's really two pieces to it, Laurie. There's the story, which is sad, but then there's him. And I actually think of these as two slightly different pieces. I actually find the latter slightly more painful as the reader. And I would guess that as a therapist, you're even more attached to the latter, which is the journey of this guy who has carried the weight of the world on his shoulders, which is his family, his work, his career, his. Again, this armor that he's had to wear. And there's now this one moment where it all comes crumbling down, and you kind of realize, well, look, there's some good to this, which is when something breaks so completely, there's actually an opportunity to put. Put it together in a different form. But it's also really messy.

It is. And I think that's going back to what we were talking about at the beginning, the story part of sort of rewriting the story. So he had this story in his head of, this is the story, and this is the story that I've been telling myself. And this is why he really can't sleep and what he dreams about and what keeps him up at night. And it's that story that needs some nuance to it. It needs to have another perspective to it. So I think sometimes we get so ossified in the story, our story becomes so ossified that there's no room for sort of any other interpretation of events. And all roads in his story led to, he's a horrible person, and that just wasn't the case. So it was really about, how do you manage your remorse? How do you manage regret? And then how do you also forgive yourself? Which I think is really hard. How do we forgive ourselves? What does that look like so much of the time, like in Rita's story, which we can maybe talk about later, but she has these adult children who are estranged from her, and she really wants their forgiveness, and they don't want to have anything to do with her. And what I said to her is, you need to be the mother to them now that they need and not try to get a redo from them and not try to get a pardon from them. And the person that you need the forgiveness from is yourself. You need to come to terms with what you did in order to be the kind of mother that they need now. And I think the same thing with John, where it's about, how do you forgive yourself for being human? What do we do with that? Like, what is the sentence for this crime, is it life in prison? Is it the death sentence? Because basically a lot of people will give themselves the death sentence, which is basically, they're alive, but they're not living because they don't feel like they deserve to have any pleasure, any joy in life. And so they sabotage any joy that might come their way because unconsciously they don't realize that. I mean, subconsciously they don't realize that what they're doing is they're making sure that they are punishing themselves, that they are giving themselves that jail sentence or that death penalty.

You actually ask Rita that question point blank. And I do want to come to Rita. I want to spend a lot of time on her because I think, again, both her story and John's story, at least through the lens that I look at, things are so similar. I mean, the extent of self loathing, just the complete and utter lack of self compassion. I can very much relate to this, by the way. So it's probably not an accident that those resonate. So let's kind of go back to John a little bit to the notion of what does the recovery look like? I mean, I think John's story is also one of the most hopeful stories to me because he's almost a caricature of a phenotype of a person that you just think is beyond hope. Like the narcissistic.

Well, I didn't think that. I can see why the reader would think that.

Yeah, absolutely. Right. Like in general. But to your point of how readers will have in some ways the biggest emotional response to that, because we know how much we judge that phenotype. We know that the sarcastic, snappy, jerk, condescending, Condescending and narcissistic, like, that's just not a phenotype that generates much affection. Right?

No. And everyone knows a John. Everyone knows someone like that.

Everybody knows a John. And not a lot of us walk around. There's not a lot of love, loss for the Johns your story suggests. No, actually, this is not a terminal condition.

Well, right. I mean, I think that people. There's so much room for people to grow and change and transform. And even with Rita, who's, you know, about to turn 70, people always say, you know, is it too late? When live so much of your life this way, it's really never too late. And I think, again, that's what's so hopeful about when people land in my office is that's a triumphant moment that they got there, they came and they said, I'm ready. They don't know what they're ready for yet, but they're ready.

And when you describe it this way, Laurie, coupled with what you said a few minutes ago, it probably does speak to the fact that you, through some connection, were able to get John to keep coming back. And whether it's the fact that that you humored his obnoxious behavior with a cell phone, that you let him order lunch every time he showed up and just act in a certain goofy way was enough to keep him coming back. It's so funny. When I reread your book the second time, I'm doing it with the highlighter and the post it notes and stuff, and there's a line that I'm not going to quote directly because I can't remember it at the second, but it to me is one of the most profound at the very end of your book, which is, look, change happens very slowly and then it happens very quickly. There's something to that effect.

Change happens gradually, then suddenly. Yeah.

Yes, you say it much better than I do. Well, I don't think any story in the book illustrates that. Probably more than John's, though. I think I can't remember if you were writing about it yourself or about John. I can't actually recall, now that I think about it, which patient you were more referring to.

I mean, I think it refers to all of them because I think with all of them, I think there's this look at New Year's resolutions or Nike's. Just do it. When we say, okay, we're going to just change, Sometimes that works in the short term, but if you really want lasting change, there's a chapter in the book called How Humans Change. And it outlines all the steps that we go through that we're not even aware of in preparation for the change. And so it's a process. The most important step in change is actually not making the change, but the last step, which is called maintenance. And it's how do you maintain the change? So once you make the change and you've done like five steps to get to that place of even taking action, the action step, and then it's how do you maintain it? And people really misunderstand that step because they think, well, if I go back to my old ways, even once, it's like, look at people on diets. They go on a diet and they're like, oh, I ate the cake, so the diet's over. No, it just. That's part of that stage is maintenance. You're going to go back, it's not going to be linear. In that way. And so people need to. To know that, so that they realize this is just part of the process of change. And then you could just go back to the change and, yes, you'll screw up again, and that's okay.

But I think there's something about getting to that. Like the way I pictured it in these breakthroughs, especially with Rita and John, was the way I would imagine a stone mason working with a piece of stone, which is, you're hitting, you're hitting, you're hitting, you're hitting, you're hitting. There's a thousand strikes and nothing happens. And on the 1,000th and first strike, the stone breaks. But the reality of it is, it's all the strikes that came before, but the stone had. Comes back to, I think, what you're saying, which is just getting John and Rita to show up and having that relationship, even if it felt like in the moment, my God, we're making no progress. This guy is still just as much of a jerk today as he was six months ago. He's still ordering the salads. He's still making fun of the shoes I'm wearing. He's still doing all of these things. He's still. On the surface.

I thought we were making progress. So it's kind of like most big transformations come about from the dozens or even hundreds of tiny, almost imperceptible steps that we take along the way. So when I would have those, I would have a moment of connection. My goal in every session with John was to have a moment of connection with him every session. And that was going to be laying the groundwork for what these changes were. And if he could connect with me, even for a moment, and you see it, it's like one little piece of the session where we have a moment of connection, then he immediately gets rid of me every time. He can't tolerate it, that's okay. But we have that moment of connection. And so I know that our relationship is developing. And that's why in that moment, when he leaves and doesn't come back, when there's that rupture, I really thought he was not going to come back. I didn't know. And then the way that played out was kind of interesting. You can see that that was all about the relationship and how I tried to use the glue of the relationship to give him enough space so he wouldn't feel pressured to come back, but to also give him enough of a taste of what we had, because I know he craved it. He was so incredibly lonely, even though he was surrounded by people, and people admired him and his work. He was very well known. He. He had this family, had these kids. He was the loneliest person because he was just living in his own world and putting this person out there, this false self, to kind of maintain things. So he only could really be him in our therapy sessions, and he could only do it for maybe two minutes, tops. But that's okay. That was enough to kind of get him to see how liberating that is.

I think that's an interesting and important distinction you make that I think I've probably failed to fully appreciate, which is it's that you had months and months or years and years of two minutes of connection every week. That was actually a linear glue that held. I mean, his respect for you was growing as those connections, I suspect, were happening. And, I mean, there's no way he could have finally got to where he got with you without all of that. And, of course, it begs the question, you talk about your therapist, because, again, you're one of the patients in here. Your therapist. Therapist Wendell, who also comes across as the wisest human ever. Never a wasted word comes out of Wendell's mouth, right? It's like, he's so brilliant, he's so wise, but we have no idea if the John Wendell thing would have ever worked out, right? I mean, did you find yourself thinking those things? Because I know you talk a lot about how when you're on Wendell's couch, you can't help but think, okay, what would I be doing here? Were you ever doing the reverse? What would Wendell be doing with John in this situation or with Rita in that situation?

Oh, absolutely. The thing about Wendell was that when I came to him, so I was a relatively new therapist, and he had been doing this for a much longer time, and I was relatively new because I had had all these other careers. So we weren't that far apart in age, but we were very far apart in experience. And so I learned so much from him, and I would just steal things from him. I would take his metaphors. I would use them. There was this one that I use, I still use to this day, all the time, I think. So many times people come to therapy and they feel trapped by their circumstances, or they say, you know, this person is making it so I can't do this, or this circumstance makes it so I can't do this. And at one point, I was doing that, and he said to me, you remind me of this cartoon. And it's of a prisoner shaking the bars, desperately trying to get out. But on the right and the left, it's open. No bars. And so why don't we just walk around the bars? Why is it preferable to us to shake the bars and say, I'm a victim. I can't do this. This isn't available to me. And it's because if we walk around the bars, we're free. But then we have to take responsibility for our own lives. And a lot of us would rather blame other people or other circumstances for why we can't have happiness or joy or meaning or whatever it is in our lives than to say, oh, now I'm responsible for that. And if it doesn't work out, that's on me.

You even bring that image into your TED Talk. It's one of the images you integrate very beautifully into that talk.

Yeah, Yeah. I think it just. It resonates with people because I think when you realize, wait a minute, the bars are open, People get. They're both elated and frightened at the same time.

Yeah. I want to talk a little bit about suicide. As an introduction to Rita, you write something very interesting. In one of the latter chapters, you write about these two types of suicide. There's the group of people that are depressed because their thinking is, hey, I once had a really nice life, but then something has gone wrong. Something has gotten in the way of that. It could be the death of a loved one. It could be some horrible circumstance, and there's nothing they have to look forward to. And then the other type is the person who just feels life is barren, there's nothing to look forward to. And you talk about Rita falling into the second category. How often do you see patients who at one point or another in your relationship with, are truly contemplating ending their life?

I would say it's not terribly common that it happens, but percentage wise, I would say people can be very depressed. But in terms of. Really. So you have to assess for suicide whenever somebody is depressed or whenever somebody brings it up or you bring it up. Right. And you have to bring it up. That's the thing. I think a lot of people feel like, I don't want to bring up suicide because that will plant the idea. Idea in their head. No, that is so wrong. You see this with teenagers a lot. The parents are so afraid. I don't know. I don't want to mention anything to my kid. My kid seems really depressed. But I don't want to ask about suicide. Ask about suicide, because a lot of times people feel like they can't talk about it or it's a relief for them for someone to give voice to those feelings that they might be having that they feel like they can't share with anyone. So a lot of. One of the biggest risks factors of course, for suicide is feeling of isolation. This feeling of being completely alone in the world. And if you can't share that, you're really alone in the world. If you're under experiencing such pain and you can't share it. I think a lot of people that I see, obviously there will be sometimes people are very depressed. What I see most of in my practice are sort of like relational issues. And by that I don't just mean romantic relational issues. I mean, there's something going on at work, or there's something going on with a parent, or there's something going on with an adult child, or there is something going on with a sibling or their romantic relationship or the relationship mostly to themselves. So there's usually like the relationship to self. Their life is not going the way that they had expected it to go or something is not working and they don't know what. And I feel like in that sense, therapy is like getting a really good second opinion on your life from somebody who is not in your life. So I think that the value of therapy is that the people in your life, they're too close to the situation. And so if you really want a good second opinion on your life, go to a therapist who can look at you from the perspective of not having all that other information yet and being able to see, well, what is going on right here, right now. It's a very different kind of assessment. And I should say, by the way, as we talk about John's story and Rita's story and all of this, I should say the book is actually very funny. And a lot of people find it, and not funny at the expense of patients, but funny in the sense that humans are ridiculous. And I mean that in the most compassionate way that I think that we as humans, we say one thing and we do another all the time. And I think that's funny. The ways that we act, the ways that we try to protect ourselves, which actually don't protect us, they make things less safe. The ways that we try to be heard or seen often backfire because we're doing it in a way that ensures that we're not going to be heard or seen. The way that we kind of chase after some kind of meaning or joy is often we're doing the exact thing that will basically guarantee our own unhappiness. But we don't realize that. And so I think there's something very humorous because it's so relatable that often we self sabotage in ways that we aren't even aware of and that are so common. So yes, there, obviously there are some, I would say very sad moments in the book, but I think ultimately it's a very sort of inspiring book. And I think that watching these people go through this, I think gives people an idea that maybe they can do that too.

Well, I would agree. There are definitely moments in there where you're howling. And a lot of it is, at least for me, the recognition that I would do that or say that or have done that or said that. And of course you do something very elegant, which is by bringing yourself in as a peer, not as a superior. Like you're very self deprecating. Deprecating in the right kind of way, I think, which is even just acknowledging your own foibles and just your own. Again, I don't want to give away too much of the book, but just it all starts with a pretty simple premise, right? You and your boyfriend break up. You just need a couple sessions to get through it, right? I mean, what could possibly be going on? Probably you need like four sessions to get through it, right?

That was the thinking. Yeah.

When you look back at that, have you ever played the game of what if you and boyfriend didn't break up? What if you and boyfriend are still limping along? You've never met Wendell, you've never gone through this journey. Who is Laurie today?

I think a very different person. I think that those moments in life when you feel like, wow, you really didn't want something to happen are often the moments when something really transformative is about to happen. And so, so many times I think that that's why we stay with like the safe thing. That's why going back to change, why change is so hard, is because we cling to the familiar. We cling to what we know. And so even if you're making a really positive change, sometimes we fight that because we don't like uncertainty. Humans don't like uncertainty. And so we go into this place of I know what I have now, it may not be very good, but at least I know it. And if I do this other thing, I go into this place where it's like going to a country where you don't speak the language, you don't know a person there, you don't know the customs or the mores, and you kind of feel a little bit lost. So at Least you'll stay in your country where it's safe. But maybe not what's best for you.

Now, going back to Rita, who's. I think her story is, as I said now a couple times, I guess, probably the one that touched me the most, along with. With John's. You already alluded to this. She shows up, she's, I think, just shy of her 70th birthday. And she's kind of given you an ultimatum. What's that? Ultimatum. And that's a pretty unusual ask of a therapist.

Yeah. So Rita is somebody who. She's one of the most isolated people that I had ever seen. She has adult children who are estranged from her, who don't talk to her. She has some marriages that didn't work out. She lives alone in this little apartment. She never really leaves or does anything. She goes and gets pedicures, she tells me, only because. Not that anyone will ever see them, but because that's the only time that someone will touch her. We talk about skin hunger and how important that is, that we need physical touch. And just in the course of a day, I'm not even talking about romantic touch, but in the course of a day, think about how many times we are touching. Normally you hug your friend hello, you kiss somebody on the cheek, you shake hands with somebody, you high five them, the barista at Starbucks hands you your latte and you touch hands. We just are routinely touched during the day in little ways. She was just not touched at all. And so she would just go get these pedicures. That was the only time she would be touched. She lived with this incredible sense of regret because she did make significant mistakes as a parent, which is why her children were not talking to her. And she also made mistakes in her relationships. And she felt like she had nothing to live for. And she said, if things don't get better. By my 70th birthday, she was 69. She said, Then I don't want to live anymore. I wasn't too alarmed by that because I felt that, first of all, she's very clear that she's not going to do that. She wants something to change. That's why she's here. If she wanted to kill herself, she just would have. And I did assess for that. But she was very clear that I'm going to give this a year and then I'm going to see what happens. So I felt like I have some time to kind of see what we can do here. And my main goal with her was to have her join the human race again. Was to get her connected somehow in the world. And she did not want to do that in any of the ways that I suggested. It was sort of like Goldilocks. This idea is to. This. This idea is not enough. This. This one's not. You know, there was nothing that would work. And then through the work that we did together, I think she started to see possibility, even though she wasn't ready to admit it. And when it did happen that things started to change for her a little bit, or could have changed for her, of course, she sabotaged that right away. She had what we call cherophobia, which is chero is the Greek word for joy. And phobia, of course, is fear. And so she had a fear of joy. And a lot of people who grow up in situations where they felt like they were robbed of their joy are very suspicious joy. They don't trust it. It's almost like anytime her mother, who was very kind of distant, anytime her mother would approach her and be sort of like a normal mother, she would get very excited about when she was young, and then the mother would go back to being distant. So her joy would always get taken away. The other shoe would always drop. So she never trusted joy, connection, those kinds of things. So when that did present to her in her adult life, she did everything she could to ruin it, which is heartbreaking to watch.

It's so painful to watch. It is the slowest, most upsetting train wreck imaginable. And it's a very different experience from the frenetic pace of John's destruction. Right. These are totally different paces of pain.

Well, right. So John would actively distract and Rita would do it in a very passive way.

So this gentleman comes along, Myron, who really seems like a wonderful opportunity for Rita to enter the final 20 or 30 years of her life, depending on how long she's going to live. He would check all the boxes by any metric. And as you describe it, the extent to which she self sabotages is something you could only see in a movie. You couldn't imagine a person in real life could go to the lengths to sabotage the way she does. But then there's something that you give us an insight into through Rita. I actually, I would say was one of the two most moving parts of the book, which is the letter she wrote to Myron, because that's when her shame really comes out. And that's when you understand what maybe even you as the therapist or me as the reader, can't fully appreciate is just how she feels about herself, because she feels that way about herself. How could she tolerate anybody loving her?

Well, how could anyone love her? She basically, it was like warnings on a drug here. If you take this drug, here's what you might encounter. She was basically saying, full disclosure. You should know who I am. Because you don't know what you're getting into. You don't know the monster that I was. You don't know who I was. And you're going to find out. You're going to learn this, and that's going to be so painful because you will leave. You will not want to be with me when you learn this. So I'm going to tell you now so you understand why we can't be together.

Yeah. I don't know. I mean, I'd love for you, if you feel it's reasonable to read part of that letter, because I find it so powerful. But at the same time, I was like, you know, maybe we should just let the reader read that letter. I'd give this your call, Laurie. What do you think?

Sure. I mean, I can read part of it. I think it's pretty long, but do you remember where it is?

It's on page 359.

Okay.

And I'll let you read from it. Whatever you think conveys the point. But it's a beautiful letter in the sense that she's just so open and you can tell, like it's sort of her life story. And again, I think it's the fact that she comes into your office and reads this to you. She is opening up to you and reading this letter to you and seeking your advice of. On the one hand, she's basically saying, look, this is a letter I've written to give Myron. But she's also, I think, being more transparent and direct with you through this letter than she'd ever been before.

Yeah. I think what she's saying is, can you tolerate me? To me, do you think I'm a monster? It's so painful to see her do that. And what I really like about the work that I do, and I think that the reason that readers are responding to these stories in the book is because they're so nuanced. Like life, they are life, and there's no easy answer. So on the one hand, what she did is reprehensible, and on the other hand, there's so many understandable reasons, even if they're not excusable reasons, but they're understandable for why she did what she did. And so there are both sides of that. And how do you Sort of ethically, morally deal with these kinds of issues where you have lots of feelings about it yourself. And as a parent, I had a lot of feelings about it. You know, I couldn't help but think, wow, what if someone had done that to my child? What would I have done in that situation? Like, you always think, like, I would get out of there. I would protect my child. Her first husband started drinking and became, you know, an alcoholic and became a very abusive alcoholic to her and to the children. And she did not leave for a lot of reasons that make sense in the context of who she was in her 20s and what her life was like and in her 30s. But there's both sides of that. And yet I don't think she's a monster at all. But I can understand why her kids do so. There was both sides of that. I'll come sort of midway into the letter. So she says, what you don't know, Myron, what even my second and third husbands didn't fully know is that their father, my first husband, Richard, drank. And when he drank, he heard our children, my children, sometimes with words, sometimes with his hands. He would hurt them in ways I can't get myself to write here. Back then, I would scream at him to stop pleading, and he would yell back at me. And if he was very drunk, he'd hurt me, too. And I didn't want the children to see that. So I would stop. You know what I did instead? I would go into the other room. Did you read that, Myron? My husband would be hurting my children. And I would go in the other room and I would think about my husband. You are ruining them forever. Hurting them beyond repair. And I would know that I was ruining them, too. And I would cry and do nothing. So that's part of what she reveals to him. And yet, when you meet her in the book, and as I met her, she's such a lovely person. And so how do you reconcile that person with the person she is at her core, the person before she became so damaged by her own experiences that she damaged other people because of it. And I think those are the complicated questions that we ask in life. And maybe they're not as heightened as this situation, but I think that there are ways in which it relates to our lives nonetheless.

How many of the patients that you've written about in this book are you still in contact with through a therapeutic relationship?

Right. So one of the things that was really important to me was when I was choosing the stories for the book that I did not choose Anybody that I was currently seeing. Because even though I was writing about events that maybe took place five years earlier, I didn't feel like I could see someone and do the work with them and then leave and then write about something that had happened between us. So I did made sure of that. And I also made sure that when I was thinking about who to ask for permission, because I asked everybody for permission, obviously there were certain stories that I felt I really wanted to tell, but I didn't even ask or include them because I felt like, in one case, the person always kind of wanted to be my star patient. Like, do you like me the best? Kind of like, sibling rivalry, which a lot of us were feel with our therapist. I felt that with my therapist too. I'd walk through the waiting room on the way out and I'd think, oh, he probably likes her better than me. I'm. I'm so not a fun session. And she looked, like, so nice and put together. And so this one patient, I felt by virtue of my asking if I could include the story in the book, that would reinforce that notion, which I didn't think would be really clinically useful for that person. And in another case, there was a person who often would try to please other people. And I felt like if I asked that person if I could use her story, she would say yes, even if she was not really sure she wanted to say yes. And so I didn't want to put her in that position. So I did not include her story or ask for permission. And so it's interesting, the reaction to the people whose stories I included, because I did not show them the manuscript beforehand. I just got their permissions. And afterward, what they all said to me in different words was something that moved me so much, which was, I knew that you cared about me when we were doing our work together, but I didn't realize the depth of it that I would think about them between sessions. I would wonder if I should say this instead of that. When they didn't show up, I thought this, or I worried about this. And it's sort of like just how much on a human level they infused themselves in into my life. And I don't mean that I carry my patients around with me and I don't have a life of my own. But what I mean is that you can't help but be affected by the people that you see. And so I think that they were very, very moved by how strongly I felt about them and how much I thought about them in the context of what was going on between us.

Do you have a sense, you talked about this a couple of times, that obviously your goal is to help people, to get people out the door or leave the nest in a way. Do you have a sense when someone is at that point and they're leaving your care, at least in that sort of more structured way, what the predictors are of the people who are going to enter that maintenance phase, that fifth and final change of behavior, and be successful? Do the work versus people who are going to struggle without the regular support? I'll be honest with you. I ask this partially through a selfish lens as I sort of try to imagine what my therapeutic tale looks like in the relationships I have with my therapists, which is like, when do the crutches come off? When do the training wheels come off? What does the long tail of this look like in terms of how much support I'll need the rest of my life? Because I do. I probably should have said this at the outset, Laurie, but I think the work that you're doing, and I think the work that anybody who's really involved in the care of emotional health and mental health, I just don't think there's enough of an appreciation in the medical community of how important this is. And I think it's very easy for people to say that trauma surgeon saved my life, because it's very tangible. You got hit by a car or hit by something, and in that moment, your life was saved, and you have that tumor and it got cut out. And it's the difference between life and death. And it's very easy to say that doctor saved my life. But I think when the story of my life is going to be told, the people who are going to have literally saved my life are going to be the people who helped me with my mental health. And I just. I don't think that can be overstated. And I think that that represents the greatest single opportunity to reduce suffering on this planet is through this.

Absolutely. It's so interesting when you were just making the comparison with physical health and surgery, and we both did medical school. And so I think it's interesting that when you look at the way our culture looks at physical health versus emotional health, first of all, they separate them as if they're not intertwined in some way, which of course they are. But then the other part of it is that if something feels off in your body, something feels not right, you're having some discomfort. Let's say you're having some discomfort in your chest, you're probably going to Go to a cardiologist before you have a massive heart attack. You're going to get it checked out. What is this discomfort? I need to get it checked out. If people are having some kind of emotional discomfort, they often will say, well, I have a roof over my head and food on the table and just sort of plugging along and the sadness or this anxiety or these relational difficulties or whatever, this feeling of offness, whatever it is, this feeling of discomfort, it's not that bad. They minimize it. It's like I talk in the book about the hierarchy of pain that we feel like there's this hierarchy of pain and that you compare your pain like it's like the pain Olympics. And if you don't have like a 9 or a 10, right, it doesn't matter, but it does. So what happens is people don't go to get it checked out until it gets really bad. They're having the equivalent of an emotional heart attack. And now they land in my office. And so the problem with that is that, first of all, you've suffered unnecessarily for all of that time that you were feeling the discomfort and you didn't need to. And secondly, it's harder to treat right now, now, because now you're in this crisis phase. And if you would come earlier, we could have dealt with it in a different way and you could have avoided a lot of the suffering. The change would have happened much more easily. Now we're sort of like digging out of the hole.

And there's a third thing I would add to that, Laurie, which is the collateral damage is also worse. So if you're sitting there with a bum knee that you kind of ignore for 10 years too long, it's a tragedy for all the reasons you've discovered, but it probably hasn't hurt other people as much as if you spend 10 years in depression. So if you spend 10 years as Rita or 10 years, especially as John, it's almost like the more people you're around, the more potential you have for collateral damage as you wait to get to that emotional heart attack.

Yes, yes. Even Charlotte in the book, who is this young woman in her 20s who keeps kind of hooking up with the wrong guys, including eventually someone from the waiting room, which is very ill advised. I don't mean they're hooking up in the waiting room, by the way. We don't have like that kind of exciting office, but they meet in the waiting room. The collateral damage of all of the sort of destruction around relationships that happens until she really Kind of sees what's going on and she also, you know, has some other issues that she is working out. And so, yeah, I mean, I think that's what happens. And so when you look at how we sort of place value on taking care of our physical health and then we devalue our emotional, we feel like it's like going to yoga. It's like, yeah, maybe I'll go to the gym or maybe I'll go to yoga or maybe I'll eat. Right. Those are important things, right? They're important. But we don't realize, wait a minute. If you aren't emotionally healthy, you need to actually get help for it. You need to get it checked out, you need the support. So when you talk about what these endings look like, first of all, it's getting people there is number one. And realizing, no, it's not just like a navel gazing activity for people who have nothing better to do. Our emotional health matters. The other piece of it is that when you're there. I think what I wanted to really do in the book was to really look at these misconceptions around what therapy is because I think a lot of people don't come to therapy because they have a lot of ideas about therapy that just aren't accurate. So one idea that they have is that you go to therapy and you talk about your childhood ad nauseam and you never leave that model of therapy. That's just not what therapy is. It's very much focused in the present. And yes, we will look at maybe how a story from your past is living inside of you and is getting in your way. And also what are your blind spots and those kinds of things. But we really want to see what are you doing in the present so that you can have a better future. That's how therapy is oriented. And I think the other thing, the other misconception is that you're going to come to therapy, you're going to download the problem of the week, you're going to leave, you're going to come back, you're going to download the problem of the week. That's not therapy. We like to say that insight is the booby prize of therapy. Meaning you can have all the insight in the world, but if you don't make changes out in the world, the insight is useless. So if someone comes in and they're like, I got into this argument with my partner and here's what happened and blah, blah, blah, blah, blah about that, right? And then maybe they have some insight about it, but they Leave. And they come back the next week and they say, now I understand why I got into that argument with my partner. And I'll say, great. Did you do something different? Well, no, but now it's like, well, okay, that's a good first step, but then what are you going to do differently? It's like going to physical therapy. If you go to physical therapy and you just go and you don't do the exercises at home that you need to do in between, you're not going to improve, nothing's going to change. It's not going to feel better.

Ultimately, I would even take it one step further, which is the exercises you do in physical therapy or. Or in the gym, even if you're doing them at home, are not for the sake of the exercise. It's for the activity of life. So it's like you don't sit there and do the leg extension for the sake of the leg extension. You're doing it so that when you walk up the stairs or down the stairs, you can actually do that. And I think that's really the point of the therapy, as you said, is it's great to have those insights, because I think being able to observe and pause is a great first step. But, yeah, none of it matters if it doesn't translate to the ultimate metric, which is improving the quality of a person's life. And in that sense, like I said, I don't think there is a greater ROI that a person can make than investing in their emotional health, because without it, all of the other things don't matter. The good news is these are not mutually exclusive. We should be pursuing them all. But I think a book like yours has done, I think, just a great service, along with many other wonderful books that I've talked about over the years in terms of really getting people to think about this through the lens of something that every person would probably benefit from on some level, some more than others. And I know I'm staring at the clock closely because I know we are literally one minute away from you having to go, and I want to honor that promise to keep you to exactly that time. So. So I can't thank you enough both for making the time today, Laurie, but more importantly, much more importantly for writing this book.

Oh, thank you so much for the conversation. I so enjoyed every minute of it, Laurie.

Again, we'll make sure we link to the TED Talk for folks. Anybody who has not read the book will obviously link to it all over the place. But in case you missed it, the title is maybe you should talk to someone. Your podcast. By the time this podcast comes out, people will be able to find you your podcast and remind me it's Dear Therapists plural, correct?

Yes. Yes.

And your column Dear Therapist Singular is where you've been writing for some time. Is that at the Atlantic?

That's every Monday at the Atlantic, yeah.

Great. I think that's a pretty good list of where people can find you and hopefully they're going to become lifelong fans.

Well, I welcome the connection with all of the people who connect, however they connect. That's the point of all the work that I do.

Thanks so much Laurie.

Thank you so much.

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Sam.