Lori Gottlieb is a practicing psychotherapist, an advice columnist, and a human being who, a few years ago, found herself in need of therapy. She writes about her own search for help — as well as several of her most memorable clients — in her fascinating, entertaining, and best-selling book Maybe You Should Talk to Someone. Below is her full conversation with host Mary Laura Philpott for this episode of NPT’s A Word on Words.
Mary Laura Philpott: Lori, I am fascinated by your career path. Can you tell us a little bit about what you were seeking, step by step, as you made your way to where you are now?
Lori Gottlieb: Yeah, so I’ve had this career that has looked at story and the human condition from different perspectives. I started off working in the entertainment business. I worked in film development and then I moved over to NBC where I worked on television shows. And when I was working at NBC, one of the shows that I was assigned to was ER and on ER we had an actual ER physician who was our consultant to make sure that the trauma bay scenes were choreographed accurately and to make sure that the show really reflected life in an emergency room.
I spent a lot of time doing research. And I say “research,” you know, in quotes because really I was in love with the experience of being in the ER. I think that when people come to an emergency room, it’s always a point of inflection. Nobody expects to be there. And the consultant on the show kept saying to me, you know, I think you like it better here than you like your day job — maybe you should go to medical school. I laughed at him, because I was a French major in college and I had this great job working in television and that wasn’t something that I had ever considered. And yet that is what I did. So I went to Stanford.
When I was in medical school there was a lot of talk about this new landscape of the healthcare system, which was managed care. I had this fantasy of being the family doctor who would guide people through their lives. And it seemed like that would be really hard to do in this new environment. And at the same time, I was writing about my experiences in medical school. And so I left to become a journalist so that I could help to tell other people’s stories. And I’m still a journalist. But after about ten years of being a journalist, I had a baby. As those parents who are seeing this know, it’s a new experience, where you don’t have a lot of adult contact during the day. And so the UPS guy would come and I would detain him, you know, with all kinds of questions, every time he made baby deliveries. He got to the point where he would back away to his big brown truck to avoid me. He didn’t even ring the doorbell anymore.
I realized I needed to do something about the situation, so I called up the dean at Stanford and I said, okay, maybe I should come back and do psychiatry. And she said, you know, if you do psychiatry, a lot of it is medication management. You’re going to be prescribing Celexa in 15-minute intervals. You should get a graduate degree in clinical psychology and then you can do the work that you want to do. So that was exactly what I did!
Now I feel like my job as a therapist is very much related to my jobs beforehand, especially my job as a writer, because I feel like I’m an editor sitting in that chair. I feel like I’m helping people edit these faulty narratives that they come in with and to really look at the story that they’re telling and ask what is the story that would help them navigate through their lives in a better way.
Philpott: It’s all been about editing life stories. I’m curious, at what point in your life did you feel qualified to give advice? Is that something you felt qualified to do once you had a certain amount of training or once you had lived long enough? Or were you like Lucy on Charlie Brown, out there giving advice to the kids on the playground?
Gottlieb: So I have this word taped up in my office: ultracrepidarianism. I love that word. It means the habit of giving advice or opinions outside of one’s knowledge or competence.
And I have it there because it reminds me that as a therapist I can help people to figure out what they want to do, but I can’t make their life choices for them. So often I’ll see people in therapy and I’ll think, Oh, this is what I would do in that situation. But that doesn’t necessarily mean that’s what they should do — because it’s their life to live.
And it’s interesting, because I also write an advice column called “Dear Therapist” for the Atlantic, and then I have a new podcast coming out for iHeart radio that Katie Couric is producing. And even in those venues, I’m not really giving advice. It’s not like, here’s what you should say to your mother-in-law. It’s more about, I want you to consider what might be happening for you when you interact with your mother-in-law, I want you to consider another perspective. Broadening the story, as we’ve been talking about, right? So it’s kind of like, what is the information that you’re not looking at as you tell this story through a very narrow lens? I think that helps people to figure out what they want to do in a way that is much deeper than just, here’s what you should say. I think the problem gets resolved in a longer term way than it would if I just said, “Here’s what you do in this situation.” Then people would need to come back every time they have an issue and say, “What’s your advice?” I want people to be able to trust themselves, to be able to figure out what they should do in their own situations.
Philpott: It’s a really important distinction. I re-learn it every time I go to my therapist and say, give me homework, tell me what to do. And she says, no, no, no, it’s not that simple. OK, let’s talk about your book, Maybe You Should Talk to Someone. How do you write about your patients while still honoring the confidentiality of the patient/therapist relationship? Are there legal or philosophical or creative hurdles that you have to clear in order to do that?
Gottlieb: There are all kinds of hurdles! Legal, creative, ethical, philosophical. First of all, obviously, I had to get permission from the patients, but in terms of how I selected them, I didn’t want to choose anybody that I was currently seeing in any way. I felt like it had to be clean. It couldn’t be someone that I was going into session with and then writing about.
And then in terms of the people that I chose, I wanted to choose people who seemed very different from one another on the surface. And I say that about all five of us, including myself, that we all seem like very different people with very different histories, different issues that we’re coming in with. And yet underneath at all, at our core, we are so similar. And I think the reader has that experience, too, of saying, “I’m like that, too.” No matter whose story it is, even if they don’t on the surface seem like that patient.
There were certain patients where I felt like maybe they would have made a good story, but I didn’t want to ask them because I felt there would be clinical repercussions that I didn’t want to get involved in. For example, maybe a patient is someone who always needed to please me. If I ask them and maybe they didn’t want to be in the book, they would say yes anyway, and I didn’t feel like that was a good person to ask. Maybe there’s a person who would feel like, oh, I’m the favorite patient — look, you picked me. So I was very careful about who I picked.
Philpott: I would totally want to be the favorite patient who got picked.
Gottlieb: Right? I know a lot of people do. In fact, I didn’t tell any of my patients that I was writing the book. Then I went off on book tour and just said, I’m going to be out on such-and-such dates, here’s who’s on call for me, I’ll see you on this date. When I came back, several people came in and sat down on my couch and said, “So… I read your book.” Which is really funny. Some people said, “I kept reading thinking I was going to be in it, and I was disappointed when I wasn’t.”
Philpott: You include pieces of your own life in your writing sometimes — certainly in this book, not necessarily in your other writing. What is your response when people say to you, “Oh, you must feel so exposed writing about yourself.” I hear that sometimes. Do you actually feel exposed or do you feel like you’ve kept back a lot of your private life from your writing?
Gottlieb: I feel like I did a lot of writing about myself before I even knew that I would become a therapist, because I was a writer for so long before that. And I very much wanted to write about psychology and culture through the lens of my own experience. Knowing that I’d become a therapist, I think that I probably wouldn’t have chosen to put so much out there. Not because I’m embarrassed about anything that I put out there. But simply because it’s a lot of information and people can Google you. I think with this book I was very aware, obviously eyes wide open — I’m a therapist in private practice and I’m writing about myself.
What was interesting is that this wasn’t the book I was supposed to be writing at first. I had written this piece for the Atlantic called “How to Land Your Kid in Therapy” — why our obsession with our kids’ happiness might be dooming them to unhappy adulthoods — and that piece spread like wildfire. Publishers wanted me to write that book. I didn’t want to write that book, but I ended up getting a book contract. I called it “the miserable, depression-inducing happiness book” — because I was starting out as a therapist, and I felt like, okay, what I was writing about couldn’t capture the nuances of the human condition in all of their beauty, all of their pain, all of their joy that I was seeing in the room. And so ultimately I decided to bring readers into the therapy room, with this book, Maybe You Should Talk to Someone. I thought maybe three people would read it, but to me this was the book about the human condition.
This was the book where I felt I had so much to say that would resonate with people and help them to see themselves differently, to help them to change their lives, that it would be a transformative experience for those three people who would read it. So I kind of let it rip. I was like, I’m just gonna be really, really honest. And the people in the publishing house really liked it and they kept seeing themselves in it and they were giving it to people and I thought, oh man, maybe like three hundred people will read this? And so I had this momentary hesitation then about, you know, maybe I should clean myself up a little bit, maybe more people will read this than I anticipated, but I decided not to.
And I’m so glad that I decided not to because I feel like that’s the reason that so many people are reading this. It’s a year out and it’s still on the New York Times bestseller list. And I feel like it’s really resonating with people because I didn’t clean myself up. I think when we talk about how much do we reveal as writers, it’s not about TMI. It’s about, what is important for me to share that serves this story? What is relevant that the reader needs to know in this moment? I need to take my mask off and I need to reveal, but I don’t go the other way either. You don’t just really, really say everything.
It’s kind of like self-disclosure in the therapy room. If I ever disclose something — and it’s so rare that I will, but if I ever do — I want to know, how does this serve the patient in this moment? And so when I’m revealing something as a writer, it’s, how does this serve the reader in this moment?
Philpott: I agree 100%. Everything you share has to serve the book. So — when people write into the Dear Therapist column or approach you in some way, are there some basic core themes that come up again and again in their questions, some elemental human concerns that never go away?
Gottieb: Yeah. I feel like there can be almost a taxonomy of the human condition in the kinds of of categories that people write in about. There are sort of age-old problems. I also think there are very modern-day problems that have come up because of the ways that we live in the world today. Some of the ones that are very universal are about, how can I love and be loved? What do I do with the things that I can’t change? How do I deal with regret? How do I deal with all kinds of grief and loss — questions that are about mortality even though they don’t seem on the surface to be about mortality. And they’re really about, how do I live with intention? How do I deal with the fact that I have a limited time on this planet — and am I making the best use of my time on this planet? I’ve wasted all this time, what do I do now? How do I find meaning and purpose? I always like to say that when I’m in the therapy room, I’m listening for the music under the lyrics. And I think that as a columnist, I listened for the music, the lyrics, and I address the music in my column.
Philpott: I love that. You write in this book about the point in your life when you realized your own need to see a therapist. And I hope you’ll forgive me if this is a silly question, but why can’t a trained therapist be her own therapist? Why does it take someone else?
Gottlieb: We all have blind spots. I think it’s almost like we’re zoomed in so closely to our own lives. And when you zoom out, you know… if you’re looking at a picture and you’re zoomed in so closely, it looks like a bunch of pixels, and then you zoom out and you’re like, ohhhh, that’s the part I hadn’t seen. So I feel like therapy is almost like getting a really good second opinion on your life.
I write in the book about the difference between idiot compassion and wise compassion. Idiot compassion is what we do with our friends, how we back them up unconditionally. They say, you know, my partner did this or my boss did this or whatever, and we say, “Yeah, that’s terrible, you were so right.” And that doesn’t help us see anything about our own role in the situation. A therapist offers wise compassion, which means that they hold up the mirror to you so that you can see yourself in a way that maybe you haven’t been willing or able to do. And I think that’s the same thing when you’re dealing with your own issues, right? We need someone to hold up that mirror for us so that we can see ourselves more clearly.
Philpott: There’s always some processing time between when we have these conversations and when these spots air on television, so who knows what state the world is going to be in when people see this. But I’m wondering if perhaps, on behalf of our viewers, I could ask for a little free therapy and get your take on what you would tell people who feel scared or uncertain or like they’ve lost control of what’s going on in their lives.
Gottlieb: I had an opinion piece in the New York Times about this idea that we feel like we can’t laugh or experience joy during this time. I was talking about how so many people are saying to me, “Oh, you must be so drained talking about people’s issues right now, given that everybody is experiencing such collective grief and loss and anxiety.” I said, actually, you know, we’re laughing a lot in these sessions now. I think that surprises people. It’s what I talk about in the book, which is that you can experience two very opposing kinds of emotions at the same time. And they can sit alongside one another and coexist quite nicely. So you can feel anxiety and at the same time you can say, I’m laughing with my partner or my child or my friends — I’m experiencing all of this loss right now and I’m cooking a meal right now. And that feels good.
In the book I write about how there’s no hierarchy of pain. Pain is pain, and suffering is suffering. And so often someone will try to minimize their pain because they almost feel embarrassed about it. They’ll say, you know, “Yeah, it was a miscarriage, but I didn’t lose an eight year old child.” Or, “It was a breakup, but it wasn’t a divorce of a 20-year marriage.” I think we’re doing the same thing right now in the pandemic, which is we’re saying, if it’s not loss of life, loss of health or loss of a job, we almost feel like we can’t talk about the fact that, you know, your child is not going to get to go to their college graduation and they’ve worked so hard for this, or you’re losing the daily things of life that mean so much to you.
Philpott: I could not agree more.
Gottlieb: Right? So everybody is experiencing a recalibration right now. And this isn’t the grief Olympics. We don’t need to compare our losses to other people’s for them to be valid. And so I think that when people are able to say, I’m experiencing one thing and I’m experiencing another thing and my experience is my experience and I don’t need to compare it to other people’s experiences, that’s really helpful. The “both/and” is also like: my son is home doing remote learning right now and I am so happy to see him. He’s 14 and he doesn’t talk to me as much about school stuff when he’s at school every day. And being a boy, you know, I don’t get a lot of info, and now I’m seeing his days and just catching him in the hallway or being able to have lunch with him. I get so much more, deeper time with him. And yet the circumstances under which I’m seeing him are, of course, horrible. So that’s the both/and thing.
Philpott: We’re capable of so many emotional truths at the same time. I was just telling a friend the other day, you know, you’re not betraying people who have lost bigger things when you mourn the little things that you’ve lost. There’s all sorts of sad.
Gottlieb: I think it’s really important for people to keep in mind, and not just during the pandemic — even as we emerge from this to be able to hold those things at the same time.
Philpott: Lori, thank you so much for doing this from your home.
Gottlieb: Oh, it was my pleasure. I always love talking with you.
This transcript has been edited slightly for length and clarity.
Lori Gottlieb Recommends:
The Tennis Partner, Abraham Verghese
Love’s Executioner, Irvin Yalom
The Immortal Life of Henrietta Lacks, Rebecca Skloot
About Lori Gottlieb
Lori Gottlieb is a psychotherapist and author of the New York Times bestseller Maybe You Should Talk to Someone, which is being adapted as a television series. In addition to her clinical practice, she writes The Atlantic’s weekly “Dear Therapist” advice column and contributes regularly to The New York Times and many other publications. Her recent TED Talk is one of the top 10 most watched of the year. A member of the Advisory Council for Bring Change to Mind and advisor to the Aspen Institute, she is a sought-after expert in media such as The Today Show, Good Morning America, CBS This Morning, CNN, and NPR’s “Fresh Air.”