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

00:00:00.000 Hey everyone, welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.740 here's today's episode. My guest this week is Lori Gottlieb. Lori is a psychotherapist and author of

00:00:55.740 the New York Times bestselling book, Maybe You Should Talk to Someone, a book that I've read

00:01:00.040 twice. And basically the second time I read it was right after the first time I read it,

00:01:03.600 but more on that in a moment. She also writes a weekly column in the Atlantic titled Dear

00:01:08.700 Therapist. Lori also has a new podcast, Dear Therapists, that's plural, hosted by Lori and

00:01:15.500 her friend Guy Winch. Their podcast allows you to sit in on some of the intimate, raw, and

00:01:20.840 transformative sessions as they guide patients through the everyday challenges of daily life

00:01:25.840 while offering the kind of behind the scenes insights into what makes us all humans. Dear

00:01:31.880 Therapists is out right now and you can find it on iHeartRadio app, Apple Podcasts, or wherever you

00:01:37.740 get your podcasts. And I can tell you right now, I am absolutely jazzed to be listening to this

00:01:42.600 because my discussion with Lori was riveting. And as I mentioned earlier, her book is really what

00:01:49.220 kind of got its hook into me. So the second I finished reading Lori's book, which I basically read

00:01:53.940 in a matter of days, I went back to rereading it. And then I reached out to Lori and said,

00:01:59.440 hey, sorry, you don't know me from Adam, but I'd really love to sit down and have this interview with

00:02:03.500 you. Now, in this episode, we talk about her journey in terms of how she became a psychotherapist.

00:02:08.640 And also we go through a lot of the stories in her book. Now, I think we together make a very good

00:02:13.420 effort not to spoil anything because my intention is that those of you that have not read this book

00:02:18.160 will actually go out and get it. I think it is on the short list of books that one should read this

00:02:22.940 year, regardless of your interest in mental health, emotional health. If you have any interest

00:02:28.560 in living a better life, I think this is a book for you. In this discussion, we pull out some of

00:02:32.940 the backstories and we dig into some of the nuance a little bit more. And I think honestly, those of you

00:02:38.080 that have read the book are going to get a lot out of it. And again, those that haven't certainly will.

00:02:42.580 And I hope it encourages those of you that haven't to go out and read it. This is an episode for

00:02:47.200 anyone who cares about what it means to live a better life, to live a more fulfilling life,

00:02:51.540 to live a happier life, to suffer less, and to kind of understand the nature of the human condition.

00:02:57.960 I think Lori is a fantastic writer and I think she's also a great speaker. And I think you're

00:03:02.360 going to enjoy this episode a lot. So without further delay, please enjoy my conversation with

00:03:07.180 Lori Gottlieb. Lori, thank you so much for making time to chat today. I know how busy you

00:03:17.140 are both clinically and in terms of you're outside of clinical activities. So it means a lot.

00:03:22.680 Well, thank you for having me. I'm really glad to have this conversation.

00:03:25.980 I have wanted to sit down with you and I was hoping it could have been done in person,

00:03:30.860 but obviously given the circumstances, it can't. From the moment I finished reading your book the

00:03:35.460 first time, which is to say I've read it more than once, which I think speaks to how much it impacted

00:03:40.760 me. And it's my hope that either people listening to this podcast who haven't read it will

00:03:44.980 certainly go out and read it. And even people who have read it might go back and reread it with

00:03:49.140 sort of a keener eye to, I think, the beauty of the book. So maybe for folks who haven't read it,

00:03:53.960 let's just start with kind of an explanation of this beautiful narrative that you managed to do

00:03:58.440 so poetically where you kind of weave your story in that with a group of patients. But tell folks a

00:04:05.180 little bit about who you are and what you do for a living and what it means for you to be both a

00:04:09.580 patient and a therapist. Sure. So I guess starting with maybe you should talk to someone with the

00:04:15.680 book. In the book, I follow four very seemingly different patients as they go through their

00:04:23.520 struggles. And then there's a fifth patient in the book who is me as I go through my own struggle

00:04:30.220 and go to see my own therapist. And really it's when I say seemingly different people, what I mean is

00:04:37.660 that on the surface, I think the people may not look like the reader, but by the end of the book,

00:04:44.360 I think everybody says, I saw myself in every single one of these patients. And I include myself

00:04:50.100 as one of the patients. And I think that really it's a book about the human condition. And it's a

00:04:54.860 book about how we're all more the same than we are different and how we grow in connection with others.

00:05:00.940 And I think that that is really what I'm trying to do in all of the work that I do is try to

00:05:07.140 really help people to see that. So you asked about what I do more generally. So I'm a psychotherapist.

00:05:14.440 I have a practice in Los Angeles. I see individuals, I see couples. I think what I do is an incredible

00:05:21.720 privilege to be able to sit with people as they go through their lives and try to transform and grow

00:05:29.920 as people. And I write the weekly Dear Therapist column for The Atlantic. And starting in the end

00:05:37.420 of July, I have a new podcast coming out that actually Katie Kirk is producing for iHeart. And

00:05:42.820 it again is about people and their struggles and how we can sort of help them. So I think in all of

00:05:49.540 the work that I do, whether it's, I did a TED talk recently about how changing our stories can help us

00:05:55.300 change our lives. And I think that what I really love about what I do is that no matter what lens

00:06:01.760 through which I'm doing it, whether it's a column or a podcast or a TED talk or a book or my practice,

00:06:07.300 I'm really dealing with, I think, what makes us most human at our core.

00:06:12.820 And we'll make sure to link to obviously the TED talk. And once your podcast is out,

00:06:16.720 what's the title of it, by the way?

00:06:18.300 Dear Therapists, plural. My Atlanta column is Dear Therapists, singular.

00:06:21.880 There are two of us, Guy Winch, who you might also know from his TED talks. He is my co-host on the

00:06:27.260 podcast.

00:06:28.440 Awesome. Okay. Well, we'll make sure we point people in that direction. Let's talk a little

00:06:31.760 bit about how you got here. You and I do share one odd thing in common, which is we at least spent

00:06:38.060 time at the same medical school, though I don't think we overlapped. So you have kind of an

00:06:42.920 interesting circuitous route to where you got having started off making television, winding your way

00:06:50.520 through an experience you had there in the ER to medical school. Give folks a bit of a sense of

00:06:56.200 that journey. Yeah. So I took a really non-linear path to becoming a therapist. And in retrospect,

00:07:03.700 I think it actually seems quite linear. But when you look at it from the perspective of not having

00:07:08.260 lived it yet, people, I always said at the time, I'm either very versatile or very confused,

00:07:12.740 which was my way of saying, I know it sounds crazy what I'm doing. After college, I started working

00:07:17.300 in the entertainment business. First, I was working in film development, and then I moved

00:07:22.320 over to network television and I started working at NBC. When I got to NBC, it happened to be the

00:07:30.120 year that two, what were to become very successful shows were about to premiere. One was called ER

00:07:35.760 and the other was called Friends. And I really loved both of those shows because even a sitcom,

00:07:43.780 I think, really said a lot. I think it's like reading a good novel where there are deep psychological

00:07:48.820 truths kind of hidden behind the sort of entertaining part of the book. And I think the same thing was

00:07:54.620 true with ER and Friends. They were so successful because they really did strike a chord emotionally with

00:08:00.400 people. And what was really interesting about ER was we had a consultant who was an ER physician,

00:08:06.200 and he was making sure that everything was accurate on the show. And I spent some time in the ER with

00:08:13.280 him. And the more time I would spend there, he would say, I think you like it better here than you like

00:08:18.100 your day job. You should go to medical school. And I thought he was nuts because first of all, I was a

00:08:23.600 French major as an undergrad. But I was also very kind of mathy and sciencey, but that wasn't where

00:08:29.880 I focused my academic career. And the other part of it was that there was something that really

00:08:35.620 resonated with me about being in the real ER, which was, I think that we were telling these very

00:08:41.420 rich human stories on the show ER. But it's another thing when someone like a real person walks in and

00:08:50.120 nobody comes to an ER because they expected something to happen. It's always an inflection

00:08:54.940 point in some way in someone's life. And so what happens when someone comes in and they say,

00:08:59.620 oh, you know, I have headaches. And then you do a scan and you're like, oh, you have a brain tumor.

00:09:04.560 That's crazy. Like how quickly your life can change. And so I was really interested in those

00:09:10.320 inflection points in people's lives. And so that's why he kept saying to me, I think you really want to

00:09:14.680 go to medical school. And so I did. I went up to Stanford. I had to take all the classes,

00:09:19.400 do all the prerequisites, take the MCAT, do all of that. And when I got there, it was up in Palo

00:09:26.660 Alto. It was Silicon Valley right before it was the first big boom before the first bust.

00:09:34.240 And a lot of my professors were saying there's this new thing called managed care. And I was very

00:09:39.400 clear from the very beginning that I really wanted to kind of guide people through their lives. I wanted

00:09:44.420 to have those relationships, those long-term relationships with my patients over time.

00:09:49.140 And it seemed like the new medical model was not going to be conducive to that. I wasn't interested

00:09:54.680 in research. I really liked the clinical side. A lot of people were like leaving to do .com types of

00:09:59.180 things. And so a lot of people were saying, you know, why are you doing this? And I started writing

00:10:03.980 when I was up there at medical school and I was writing about my experiences. And I actually left

00:10:10.340 medical school to become a journalist because I felt like I could really delve into people's stories

00:10:16.140 and help them to tell their stories through writing. And so I did that and I still do that. I'm still

00:10:22.680 a journalist when I still write, but I did that exclusively for about 10 years. And then I had

00:10:29.080 my baby and it was really interesting because I loved what I did as a journalist, but it's not the

00:10:36.000 kind of thing where you have a lot of social interaction. You're doing a lot of writing and

00:10:40.320 doing a lot of phone interviews and things like that. And so I really wanted adult conversation

00:10:46.060 during the day. And so the UPS delivery person would come. I had a million deliveries with a new

00:10:51.120 baby and I would detain him and I would try to have conversations with him. And he hated that. And he

00:10:55.560 would like back away to his big brown truck to get away from me. Eventually started tiptoeing to my door

00:11:00.120 and putting the packages down very gently. So I would not even open the door. And so I knew I needed

00:11:05.900 to do something. So I called up the Dean at Stanford Medical School. I used to run her

00:11:09.680 mother-daughter book groups. And so I knew her pretty well. And I said, maybe I should come back

00:11:13.480 and do psychiatry. And she knew me well from our relationship there. And she said, you are welcome

00:11:18.720 to come back, but do you really want to go through internship and residency and all of that with a

00:11:22.740 baby, with a toddler to do psychiatry where most people do medication management and they see patients

00:11:27.740 in these 15 minute intervals and they're prescribing antidepressants and anti-anxiety medication.

00:11:32.620 She said, maybe you should get a graduate degree in clinical psychology.

00:11:35.900 And do the kind of deeper, more intensive work that you are interested in. And it sounds

00:11:41.080 very obvious in retrospect, but at the time it was like this aha moment of, oh, wow, that

00:11:46.440 was brilliant. And so that's exactly what I did. And so that's how I had this hybrid career

00:11:50.820 where I feel like I went from telling people stories as a journalist to helping people to change

00:11:57.720 their stories as a therapist. And I feel like a lot of what I do in the therapy room when I'm

00:12:03.860 sitting in that chair is I feel like I'm as much an editor as I am a therapist, because I really feel

00:12:10.080 like what I'm doing is people are coming in. They're telling me we're all unreliable narrators.

00:12:14.500 They're telling me a faulty narrative. They're telling me a narrative that is keeping them stuck.

00:12:18.160 And I'm there to help them edit this story. So I feel like the path might seem a little bit

00:12:24.160 circuitous, but I feel like the whole time I was always interested in story and the human

00:12:29.860 condition. I just looked at it through in different ways. So interesting. When you were

00:12:34.820 in medical school, were they still doing anatomy in the trailers? Yeah, actually. When were you there?

00:12:41.480 Yeah. So my anatomy, I was a freshman in 97 or freshman med student in 97. So we must have been

00:12:47.640 only off by a year or two, right? I came in 99. Yeah. Yeah. So you were only two years after me.

00:12:53.760 They were still in the trailers. So it's funny when I was reading your book and you were describing

00:12:58.960 that because that's a really intense experience for anybody coming into medical school. I was also

00:13:04.860 not a pre-med, but whether you're a pre-med or not coming in the first quarter, it's you dive right

00:13:10.440 into that ocean of dissecting that cadaver. That cadaver becomes your best friend with your partner.

00:13:15.240 It's you and one other person that are paired at the hip and you're going through everything.

00:13:20.120 And I don't know if you felt this experience, but there were certain parts of dissections that I

00:13:25.160 found staggeringly tough. And the hand was one of them. I think looking at people's fingers

00:13:31.260 was really hard. And it's also where I saw the most heterogeneity across the cadavers.

00:13:37.640 When you were dissecting a heart, you could show your heart to your neighbor's heart. You could see

00:13:42.700 there was different pathology, but a heart's a heart, but a hand, boy, you could tell a lot about

00:13:47.240 a person by their hands. I agree. I would think that the hand is so revealing. And you think about

00:13:53.040 what we use our hands for. When I was dissecting the hands, I remember thinking, whose hands did

00:13:58.220 this person hold? Who did this person hug? What did the person do with their hands? And you could

00:14:02.940 see on certain cadavers, there would be like nail polish still on there. And so you got a sense of

00:14:09.340 someone's personality by what they chose. They wore rings on their fingers and you could see like a

00:14:15.360 suntan line of where they had worn their rings. It was, yeah, I think the hand is very human. There were

00:14:20.900 other parts too, though, I think. Do you remember when we were dissecting, we did the head near the

00:14:26.480 end. And that was the hardest part, I think. Their lids were closed and then they had something over

00:14:33.020 them. Do you remember? They had like a little shield over them. And that was to get us used to the idea

00:14:39.040 of opening up this person who is a person and remembering that they are a person. It's like this

00:14:44.820 balance between remembering that they're a person and then also being able to separate yourself enough

00:14:51.100 to be able to do the work. Because if all you thought about was they're a person, it would be

00:14:55.980 extremely difficult to cut them open in the ways that we had to and kind of almost dehumanize them.

00:15:03.920 And so I remember doing the head, doing the face. The face was so hard.

00:15:08.760 Yeah. And I remember my cadaver was a male. And I remember really being observant of the length of

00:15:14.640 his stubble and realizing what it implied about the timing of his last shave and things like that.

00:15:20.820 And I just agree. I thought it was a very emotional experience that at times you had the privilege of

00:15:27.300 just being so far into the pancreas that you could forget for a moment what you were doing. But then

00:15:32.760 you had so many moments where you were pulled back into that human element. And I can honestly say,

00:15:39.660 and I don't know if you can say this, but in my class, I don't recall one instance of any of my

00:15:44.740 classmates doing anything that felt disrespectful. I really felt like there was a remarkable both

00:15:50.360 camaraderie amongst us as classmates, but also just camaraderie with the cadavers. I think the families

00:15:56.920 of those people would be proud of what their family members did in terms of the donation and how

00:16:03.340 we as students learned from it. Oh, absolutely. And I think that at Stanford,

00:16:08.740 they did a beautiful job of making sure. And I think there was a reason that that was one of the

00:16:13.040 first classes that we had to take because you from the get-go developed this. They really made clear

00:16:20.060 to you that when you see people that you have the utmost respect for them, that you treat them

00:16:26.680 in the most human way possible. And that started with these cadavers. Remember that we had that

00:16:32.180 ceremony. Did you guys have that at the end where we wrote notes and we thanked them? And it was like

00:16:38.260 this very spiritual moment of really sharing our gratitude for them having donated their bodies and

00:16:46.220 let us learn so that we can help people, but for through what we've learned by opening them up and

00:16:51.560 seeing inside. And so it was really such an act of generosity for them and their families to say,

00:16:56.920 yes, we trust you young medical students to treat my loved one with the utmost respect as you learn

00:17:04.700 and do this. You've told the story in one way, but there's another dimension I'm just curious about,

00:17:10.680 which is the courage it took to leave, which is you glossed over what it took to get into medical

00:17:16.000 school. But I think, let's be honest, for a French major to then take the necessary courses,

00:17:22.140 to then take the MCAT and not just take it, but ACE it and then get into one of the hardest medical

00:17:28.320 schools to get into in the country and get through it. You get through this first quarter of semester

00:17:33.200 and you're doing well, but then to be at this crossroads and say, wait a minute, is this the

00:17:38.680 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,

00:17:43.700 I don't think it is. I'm going to walk away. How did you handle that?

00:17:49.040 It's interesting because I think that at that point in my life, I was less risk averse than maybe

00:17:55.400 I've become. And so I think as a parent, it's a different equation that you're looking at.

00:18:01.540 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

00:18:06.760 young woman who goes on her honeymoon and she comes back and she's diagnosed with cancer. And it's about

00:18:12.320 sort of our relationship as she goes through this. And she said to me at one point, and I write about

00:18:18.260 this in the book where she says, why do people need a terminal diagnosis to really pay attention

00:18:22.800 to what they want to do in their lives? We shouldn't need that. And it occurred to me that

00:18:27.040 we all have a terminal diagnosis. Life has a hundred percent mortality rate, and that's not

00:18:31.300 just for other people. And so I think we don't know how or when we're going to die. None of us really

00:18:36.300 does unless we actually have some kind of terminal diagnosis right now. And so I feel like I had some

00:18:42.780 sense of that at a young age. I don't know why I didn't have early exposure to death. There was just

00:18:48.240 this sense of, I only get to live once. This is the time before I have a family when I'm free to make

00:18:54.100 the choices that I want to make and they won't impact other people. And so I just did, I sort of went

00:18:59.600 into that place of knowing inside that I think we all have that is very quiet in most of us. We don't listen

00:19:06.360 to it. All that noise outside about what we should do or what's the practical thing that usually drowns

00:19:12.660 out that voice inside that takes us to that place of knowing. And I'm not trying to get all woo-woo.

00:19:17.520 I don't, I feel like we all have this place where we trust ourselves, where we know something,

00:19:21.720 we have information. So many times people come to therapy and they're like, tell me what to do.

00:19:25.980 And what I want to help them do is find the answer inside because it's there. They just can't hear it yet.

00:19:31.780 And they have a better answer than I do for them. And so I think back then when I was

00:19:36.460 thinking about leaving medical school, I mean, even thinking about like who would leave that job

00:19:40.200 at NBC, who's going to leave that job with friends in ER, who's going to leave medical school to become

00:19:45.300 a freelance journalist. That's not the path. And then to have a really successful career as a

00:19:50.760 freelance journalist and really be thriving. And then to say, you know what, I'm going to go and

00:19:55.900 start over and go to grad school with an infant and then go become a therapist. I think there was

00:20:02.320 always just this sense of I'm drawn to this and I'm not going to hold myself back from it.

00:20:08.380 They weren't impulsive decisions, by the way. It wasn't like I woke up one day and I decided this.

00:20:12.580 It was, I thought about them for a while before I actually made those moves. So when I was in

00:20:16.520 medical school, it wasn't like I woke up one day and said, you know what, I think I'm doing this

00:20:20.520 writing. I'm really liking this writing. I'm really liking the relationships and telling these stories.

00:20:24.180 I'm going to do that. It was over a course of two years when I was thinking about maybe I should

00:20:30.380 go do this other thing. I mean, I ask in part because I wanted to contrast it with the experience

00:20:35.980 I had, which was ultimately leaving medicine altogether in, I think, 2006. And it had the

00:20:43.080 same sorts of elements in that there was a group of people around who understandably, I think,

00:20:47.680 succumbed to a bit of the narrative, a sunk cost, which is between medical school and residency,

00:20:52.380 you've now put 10 years into this endeavor. It's crazy for you to walk away before you actually

00:20:59.160 start your career and all the other arguments that come with it. But I'll never forget one of

00:21:03.220 the people who really was the most encouraging was an attending at Hopkins. His name was Peter

00:21:08.260 Pronovost, who's gone on to do some really amazing things within ICU safety. And he handed me a copy of

00:21:13.780 a Joseph Campbell book. There was the line in there about a hero being the one who had the courage to

00:21:19.540 pursue his own bliss. That's the thing that really stuck with me. And I think you're right.

00:21:23.320 It's like, in the end, it took me four months to make that decision to leave. It wasn't an impulse,

00:21:28.660 but in the end, as silly and as unreasonable as it appeared to everybody else, I had no qualms about

00:21:35.860 it and I never looked back. And ultimately I did come back to medicine, albeit in a completely

00:21:39.760 different capacity. But it's interesting to hear that the part you said that resonates the most with

00:21:44.540 me are two things. One, the answer is usually inside of us. It just takes us a while to figure

00:21:48.900 it out. Sometimes you as a great therapist, I think can help the prodding. The second thing

00:21:54.200 that really resonates with me is what you said about Julie. Well, you didn't describe her by name,

00:21:58.540 Julie, but we'll get to Julie's story, which is when people would argue to me this sunk cost,

00:22:04.020 which is you've already put 10 years into this. At the time I was 33. I said, well, I think that's

00:22:10.080 the faulty logic. I mean, the reality of it is I'm 33 right now. I'm going to work for another 40

00:22:16.100 years. So shouldn't I just work on what I want to do for the next 40 years, as opposed to what I'm

00:22:22.880 destined to do based on the last 10 years? Like it just struck me as the wrong argument. Now, whether

00:22:27.980 I had 40 more years to work or not is irrelevant. And Julie's story will teach us that you don't know

00:22:34.560 if you're going to have 40 years left, you might have one year left. You should be doing exactly what

00:22:38.400 you want to be doing. But I guess maybe with that, I want to talk a little bit about Julie.

00:22:43.240 Can you tell folks a little bit about how this woman came into your life? And I guess we should

00:22:46.900 caveat this for people to understand. I'm going to be using the names that you use in the book,

00:22:51.540 which are not their real names. We'll talk about this, the way you've written about them, which have

00:22:55.820 enough of the details stripped out. So I don't want people thinking we are having discussions about

00:23:01.760 patients that are violating their confidentiality. But if it's okay with you, I'd like to just talk

00:23:06.580 about them as the way they're written about. Yeah, absolutely. I just wanted to also just

00:23:10.500 say something about what you just so beautifully said about this idea of sunk costs that I remember

00:23:16.380 that at a certain point when I was going back, so I was in my late thirties when I was going back to

00:23:23.400 grad school to become a therapist. And I remember a lot of people saying, you're going to be 40.

00:23:30.080 And I said, but I'm going to be 40 anyway. Whether I'm doing what I want or something that I'm not

00:23:35.480 interested in doing, I'm going to become 40 and turn 40. So shouldn't I turn 40 and be doing

00:23:40.820 something that I want to do as opposed to I'm turning 40 and I'm doing the thing that I'm really

00:23:45.600 successful at, but I feel like it's not enough. So I think that that logic is very faulty when people

00:23:51.620 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

00:23:57.020 years looking back and saying, wow, I could have done that thing when I was 37, but I waited until I

00:24:02.460 was 50 and now I'm really sad that I didn't do it. So let me talk a little bit about Julie.

00:24:08.240 Yeah. Let's introduce people to Julie. How did this really wonderful woman come into your life?

00:24:13.720 So Julie came to me because she was this young woman who had just gotten married to the love of

00:24:20.720 her life. And she had a career that she loved and she had wonderful family and friends. She had a

00:24:27.320 really good life. And she went on her honeymoon. She and her new husband had been together for a

00:24:34.720 while and they decided that they would want to start a family right away. And so she came back

00:24:39.520 and she felt like something funky in her breast. And she thought, well, maybe I'm pregnant. That's

00:24:43.460 what they were hoping. And it turned out she wasn't pregnant, that she had breast cancer, but it was a

00:24:48.900 very treatable form of breast cancer. And all of her doctors reassured her, you're going to be fine.

00:24:54.020 You'll go through this treatment. The treatment will be unpleasant, but you will be fine and you

00:24:59.260 will move on and you will live your normal life after this. And so she came to me not because she

00:25:05.660 was dying, but because she just wanted to get some support as a newlywed going through cancer. And she

00:25:10.560 was very funny. She'd say things like, what should I say in my thank you cards? Like, thank you for the

00:25:14.680 bowl. I use it to throw up in after chemo. She had that very sort of wry sense of humor, but she was

00:25:20.040 just this very warm, lovely person and very real. She wasn't the cancer patient who's the saint. She

00:25:26.260 really didn't want to go through this. She wasn't the pink ribbons and the optimism. That was not the

00:25:31.580 approach that would work for her. So she specifically came to me because I had zero experience with this.

00:25:36.660 And so she said to her doctor, I want to go to somebody who's not on the quote unquote cancer team.

00:25:42.080 I don't want to be part of the cancer world, especially since my prognosis is so positive. I just want

00:25:47.500 some support as a newlywed going through an illness. There's a funny story you tell about how

00:25:53.100 she's totally put off by the yoga instructor who's explaining to her that her entire prognosis

00:25:59.360 is a function of how compliant she is with the yoga routine. Yes. Yeah. She hated that whole idea.

00:26:06.160 It's your attitude. It's doing the yoga. It's all in your mind. And so we went through that time

00:26:12.940 together and then she went back to her life and we said goodbye. And it's always interesting as a

00:26:17.420 therapist to say goodbye to people, because that's our goal. Our goal is to have people leave us.

00:26:22.760 It's a terrible business model, but it's very rewarding emotionally. And she left and that was

00:26:28.520 that. And, you know, occasionally I would think about her and wonder if they'd gotten pregnant and

00:26:32.320 those kinds of things. And six months after she left, I got a voicemail from her. She had had her

00:26:38.160 sign-off scan, which was going to clear her to go ahead and get pregnant. And instead they found

00:26:44.860 another form of cancer, it was unrelated, they believe to the breast cancer. And it was a very

00:26:50.380 rare, aggressive form of cancer in a different part of her body. And they said there was no cure

00:26:55.960 and that she had somewhere between one and 10 years to live, which of course the difference between one

00:27:02.820 and 10 years is enormous. She was in her early thirties. She came into my office and told me this.

00:27:08.440 And she said to me, will you stay with me until I die? I would like to say that the reaction was

00:27:14.640 that I hugged her and we cried together. And I said, of course I will, but that is not what

00:27:19.320 happened. I actually hesitated because I had no experience doing that with someone her age going

00:27:26.260 through this. And I wanted her to have the experience of doing it in a way that whatever

00:27:31.640 right meant for her, I wanted it to be done right. And I didn't want to screw it up for her because

00:27:35.560 she was only going to get one shot at this. And she said, no, specifically the same reason that

00:27:41.080 she came to me earlier was she said, I really want to do this with you. I really want to do this

00:27:45.440 separate from all of the sort of cancer world, which I'm already going to be very ensconced in.

00:27:51.480 And so I said, I would, and I kept that promise to her. And she included in that, by the way,

00:27:56.880 was that I had to go to her funeral. That was part of the deal that I made with her,

00:28:01.200 that she insisted that I make with her, that I agreed to. And it was this very

00:28:05.040 transformative experience because again, I think I always kind of had death sitting on one shoulder

00:28:11.180 when I was younger and not in a morbid way, but actually in a really inspiring way, which is

00:28:16.120 be aware, be aware of the gift of your life today. When you wake up, be intentional about how you want

00:28:24.600 to live your life. What are your priorities and are you living those? But I think it was another thing

00:28:28.980 to go through this with someone and to get really attached to them as I did to Julie, and then to watch her

00:28:34.660 and be inspired by her again, not because she was a saint, because what I loved about her was she was

00:28:38.940 so real and raw and honest about what this experience was like, but because she made choices that

00:28:46.560 everybody thought were crazy. And she said, no, this is what I want to do. She was this person who had

00:28:51.880 always ticked off all the boxes. She did everything by the book and she did it all right. And she did it

00:28:56.500 all well and her life was humming along smoothly. And then this hit and she was like, here are some

00:29:03.040 things I want to do. I know it sounds crazy, but this is what I want to do. And we all thought she

00:29:06.720 was crazy. And what was interesting was one of the things she wanted to do was she was a professional

00:29:12.080 and a very successful one. And she said, she was in Trader Joe's one day and she said, I love the way

00:29:17.000 the cashiers interact with the people in the store and that they have these moments of connection that

00:29:23.940 they just give them balloons and they ring the bell and there's energy in the place. And for that

00:29:28.860 moment, you're doing something tangible. You're tangibly making someone's day better, even if it's

00:29:33.780 for a minute. And she said, that's what I want to do. And her husband said, wait a minute, you're

00:29:37.840 dying. You have a terminal illness and that's how you want to spend your time. He thought she was crazy.

00:29:43.720 I thought she was crazy. But I also wondered, are we saying this because we think she's making a bad

00:29:49.700 choice? Or are we saying this because we're jealous? Are we saying this because we're actually,

00:29:54.300 we envy the fact that she is not chicken shit like the rest of us to do something so bold that

00:30:02.020 everybody else thinks is crazy. And so I think in some ways there was this lesson of maybe she's

00:30:07.320 doing something that the rest of us, because we don't have that gun to our heads, we do, but we don't

00:30:13.040 realize it, that she's doing something that we wish we had the courage to do.

00:30:16.680 It's funny. I remember that part so well for a couple of reasons. One, the first time I ever

00:30:21.680 went to Trader Joe's because I grew up in Canada was when I actually went to medical school. And

00:30:25.560 then I discovered this place and I'm like, I'm obsessed with Trader Joe's. And I could sort of

00:30:29.920 understand exactly why that's the place Julie would want to go and work. It is such an amazing

00:30:35.760 environment. And then the other thing that kind of resonated with me when I read the story was

00:30:40.020 I remember thinking even in medical school and into residency, I wish I could just have

00:30:46.460 half a day a week to squeegee windshields at a gas station. It gives me so much pleasure.

00:30:53.560 And I have this whole technique on how I squeegee. I'm actually very good at it. If I'm going to allow

00:30:57.340 myself to be a little bit immodest, there's a real technique to it. It's so satisfying to clean

00:31:02.740 a windshield. And I was like, how can I figure out a way to integrate my medical career with at least

00:31:07.880 some squeegee time per week?

00:31:10.380 And have you done it?

00:31:11.660 No. I remember even bringing this up to my friends and family at my medical school graduation party.

00:31:17.120 And everybody looked at me like I had seven heads. Can you just shut up? Like, what are you

00:31:22.020 stop talking about squeegeeing? But I was like, look, I'm not saying I'm going to be a full-time

00:31:26.020 squeegee guy, but I want to at least do some squeegeeing because it is so satisfying. And to

00:31:32.240 your point, it's very tangible. It's a very brief interaction with a person who comes in and

00:31:36.740 their windshield, they can barely see out of it. And five minutes later, it's like, perfect. So I

00:31:42.400 think Julie's story just resonates so much on so many levels about living, right? It's what you said.

00:31:47.260 It's a story about early death, but it's actually a story about life.

00:31:53.060 Well, that's the thing I think people would say, isn't it depressing treating someone like that?

00:31:57.340 Isn't it hard? And of course it was hard, but you know what? I looked forward to her sessions

00:32:02.360 more so than maybe some others because there was so much vitality in those sessions because she was

00:32:09.900 bringing so much energy into those sessions. I don't mean like sometimes she was exhausted and

00:32:15.040 she would sleep, but even then there was so much about taking off the mask, about stripping down to

00:32:20.980 the essentials that feels invigorating and just getting rid of the performative aspects of lives,

00:32:27.280 the pretense, all of that. And just saying, this is who I am. Can you hear me? Can you understand me?

00:32:33.940 And this is how I want to manifest myself in the world. I think there was something about those

00:32:39.000 sessions that just felt so much more real than I think what some of us deal with on a daily basis.

00:32:46.280 I'm not minimizing what other people were dealing with. I'm saying that I don't think that the rest of

00:32:51.260 us really let go in the way that Julie let go. And I think there's a lot that we can learn from

00:32:55.800 Julie's story in the book. Well, if Julie's story in some ways is the one that where life is taken

00:33:03.660 too quickly, the two stories that resonated with me the most were John and Rita, because in them,

00:33:09.440 I both saw such a cycle of shame for different reasons, but just an unbelievable cycle of sort of

00:33:18.260 punishment, self-punishment and this shame cycle. I'd like to maybe start with John and just,

00:33:24.000 I think you actually open your book with, I think John, it shows up in the very first chapter.

00:33:29.320 He's a guy that I think on the surface, most people would not like. I think that's a safe

00:33:35.480 statement, correct? Yeah. He is very abrasive, very unlikable. He is very insulting to me in the very

00:33:47.000 first session. He is already insulting me, but he doesn't realize he's insulting me. Although I should say

00:33:52.140 on some level he must, but he sort of jokes around and his jokes are very insulting. I mean,

00:33:58.660 I guess that's the best word to describe it. I mean, look, he refers to you as his mistress.

00:34:03.320 He's totally derogatory in every way imaginable. Yeah. He's always putting me down.

00:34:07.660 Right, right, right. The only thing he gives you is he doesn't refer to you as a complete idiot,

00:34:12.800 which is what he refers to everybody else as. That's the only quarter you have is you're not a full

00:34:17.040 idiot. Yeah. Yeah. But you know, the jury was out. He wasn't sure yet. And you know, I think the thing

00:34:23.600 is though, people say, well, why would you even treat him given how he treated you in that first

00:34:26.940 session? Why would you take him on as a patient? And what I always say to people is that these are

00:34:33.280 the people that I think are the people who grow the most in therapy, because what they're doing is

00:34:39.600 we use our behaviors to speak something, to communicate something that we can't do with

00:34:47.240 words. So we take the unspeakable and we convert it into a behavior to communicate something. And

00:34:52.820 what he was communicating was, I'm going to keep everybody at a distance. I'm going to be so

00:34:56.740 obnoxious. And he had what we might call narcissistic traits. So he thought very highly of himself and

00:35:02.140 not so highly of other people, which was really a defense. And he was somebody who was saying,

00:35:09.360 I have this unspeakable pain and I'm going to keep everybody at a distance so that they don't

00:35:13.360 get near my pain, because if they get near my pain, I might have to look at it. So those aren't the

00:35:17.380 words he used, but that's what his behavior was doing. So I knew that there was going to be something

00:35:21.980 there that we were going to uncover together and that he was going to eventually start to talk about

00:35:27.300 and that that would give him freedom. That would liberate him from the shackles, the emotional shackles

00:35:32.940 that were constraining him. But I had no idea what it was. And as you can see, the way I write it in the

00:35:38.800 book is exactly how it happened in life in terms of when that revelation came to me and how it came

00:35:43.480 to me. And I was so just gobsmacked by that. And I think the reader is too. And I think that he

00:35:51.940 becomes, I think people talk about the people. I think that people find themselves in every single

00:35:57.200 person in the book. They see themselves in every single person. But I also think that there's something

00:36:02.600 about John and how it makes them think about the ways that we make judgments about people when we

00:36:08.940 first meet them, and then how much we could come to love them if we really knew who they were.

00:36:15.240 And I think that's what happens with John. People love him. By the end of the book, everybody just,

00:36:19.280 how's John? How's he doing? Everybody cares about him.

00:36:23.340 At the outset, you referred to therapy. In the book, you actually have an entire

00:36:27.280 short chapter dedicated to the differentiation between counseling and therapy. Give folks a bit

00:36:33.160 of a sense of what that is, because I think what we're really talking about here is the deep therapy.

00:36:38.520 Yeah. So I think that a lot of people, especially today, where we have instant gratificationitis,

00:36:44.500 we don't have a lot of patients. And so I think that a lot of people, I know I wrote a piece for

00:36:50.120 the New York Times Magazine about this. It was called What Brand Is Your Therapist? And it was about how

00:36:53.360 people are sort of branding themselves as these people. Four sessions, and you'll have an answer,

00:36:57.560 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

00:37:02.740 there to keep you there for life. We are very much about, you're coming in, we want to be very aware

00:37:07.820 of the purpose of what you're doing here and make sure that you're getting what you need to leave.

00:37:13.060 But it's also not, I remember I had this guy call me before the holidays once, and he said,

00:37:18.120 I need to know by Valentine's Day whether or not to propose to my girlfriend, because she'll leave me if I

00:37:22.640 don't propose by Valentine's Day. And so it was like December, right? So we'd have like six weeks

00:37:29.320 or something. And he said, so I need to know that I'll have an answer by then. And I said, listen,

00:37:33.200 I can help you get clarity, but I don't know anything about you yet. I don't know what your

00:37:36.920 history is. I don't know what the issue is. I don't know that you will have clarity in six weeks.

00:37:42.640 So I can't guarantee that. And so he made an appointment, but then he called me back later and

00:37:46.580 canceled it and said, I found somebody who could guarantee that for me, which is just insane.

00:37:50.680 I think he wants to make an informed decision, not just a decision. But I really feel like people

00:37:56.180 want instant gratification. They want me to have answers for them. And I have this

00:38:00.900 word taped up in my office, ultra-crepidarianism, which means the habit of giving advice or opinions

00:38:06.620 outside of one's knowledge or competence. And it reminds me that people are always saying,

00:38:10.920 what should I do? And I don't know what they should do. I know what I would do in that situation,

00:38:16.140 but just because I would do a certain thing, I'm not living their life for them. So I don't know

00:38:20.560 what they should do. They have to, again, access that place of knowing, and that's what I can help

00:38:25.160 them do. So it's very tempting as a therapist when someone keeps sort of like going in circles and

00:38:30.100 ending up in the same place to kind of just be like, just do this. You feel like, oh, I just want

00:38:35.620 to tell them, but I actually need them to come to their own conclusion about what they should do.

00:38:39.040 So going back to John, I was thinking about this as you were talking a moment ago. I think for the

00:38:45.080 purpose of the people who haven't read the book, maybe we won't get into the details. My hope is

00:38:49.560 that everybody who is listening to this, who has not read the book is going to order it ASAP and do

00:38:54.620 what I did, which is the first reading of this is you're not putting it down and you're in tears at

00:38:59.200 the end of it. But let's go back to some of the stuff that I think we can get into without the

00:39:03.660 spoiler alerts. First off, what gave you, I don't want to say the confidence, but for lack of a better

00:39:09.920 word, Lori, what gave you the confidence to say, A, I don't know how long this guy is going to be an

00:39:15.580 abusive jerk, but I can weather this out and I can eventually get him to break open. And two, what

00:39:23.800 gave you sort of in your own experience? I don't see one thing that is lost on me a little bit as a

00:39:31.620 reader is where were you in your experience level? Was John like the 10th guy that showed up like

00:39:38.380 this, that you'd taken care of, or was this the hardest case you'd ever seen as case one?

00:39:43.840 Definitely not the hardest case. I mean, I think that when people present for therapy,

00:39:47.900 they're not at their best. That's why they came. So they're not doing as well as maybe they normally

00:39:53.120 do. For John, it was clear that there was this characterological piece where this is how he

00:39:58.380 interacted in the world in all spheres, professional, personal, his marriage, his kids,

00:40:02.980 at work, however. I think the thing about John was I don't know that I had confidence. I felt like

00:40:11.780 I knew how to work with him, but you never know what's going to happen with people. And that's

00:40:15.460 what's so surprising about my job is that going back to medical school, it's like, you know,

00:40:19.500 that if you do this surgery, there's a this percent chance if you do it well, that it's going to be

00:40:24.260 successful. Therapy is very different. It depends so much on the people and what's going on and mostly

00:40:32.660 the relationship that's going on. All these studies will tell you if you look them up, that the most

00:40:38.040 important factor in the success of someone's therapy is the relationship that you have with

00:40:42.920 your therapist. It matters more than the training the therapist has, than the modality that they're

00:40:48.020 using, than the number of years of experience. Not that those things don't matter, they absolutely do.

00:40:52.380 But the thing that matters the most is that relationship. So my goal was to, and what we

00:40:58.660 do in therapy is that the relationship in the room is a microcosm for the relationships that they will

00:41:03.480 have outside. So I wanted to create that environment in the room. You see in the book, I work very much

00:41:09.760 in the here and now with him of what's going on between us. And he fights that tooth and nail.

00:41:13.860 He hates that. He does not want anyone to get close with him. In fact, one of our first sessions

00:41:18.220 wasn't, I think the very first one. I can't remember, but we're sitting there and we're

00:41:22.720 doing therapy and he's always getting his texts and he's doing his texts. And then like the light

00:41:27.600 goes on, which shows another patient is there and he looks over it and he says, Oh, it was his lunch.

00:41:33.080 He had ordered lunch to come into our therapy session without asking, just here's my lunch.

00:41:39.860 What I did was we ended up having these Chinese chicken salads, which is what he liked for lunch.

00:41:44.040 And we would have them together. I wasn't hungry at all. Like at the time of his appointment,

00:41:47.060 I'd already eaten lunch, all of that. But, but I would just like have a few bites. It was this glue

00:41:51.280 for us. It was a way of just connecting with him. I would say another thing about treating John is

00:41:56.140 that, and this is going to be a gross generalization, but I've noticed these differences

00:42:00.600 between men and women and how they interact in therapy. And I would say that I have so much

00:42:05.600 compassion for men because I think that when somebody first presents for therapy, I'm looking at not

00:42:10.380 only what's not working in their lives, which is what they're telling me about, but I'm also

00:42:14.600 scanning for strengths. And one strength that everybody has is they made the call. They decided

00:42:19.800 to come in. So I'm not just asking, why are you here? But I want to know why now, why this day,

00:42:25.160 this week, this month, are you here when maybe this has been going on for a long time? What made

00:42:29.740 you call? That's a strength. So there's something in them that says change has to happen. Often what

00:42:35.100 happens is they say, I want something to change, but what they mean is I want someone else or something

00:42:39.120 else to change. They don't realize that they are going to need to change, but that's okay.

00:42:42.980 Let me ask you about that, Laurie. How often do you find that people come to you because they have

00:42:49.740 hit a relative rock bottom and they acknowledge that? Meaning there is a pain that is so great,

00:42:57.280 it is clear to them that they play some role in that versus they're coming to you thinking everybody

00:43:05.620 around me is acting badly or crazy and I just need help to cope with their pathology. What's the

00:43:12.820 relative balance of those? It's very mixed. I would say you get both. Maybe you get more of the,

00:43:19.460 I'm having trouble in my life because of my partner, my boss, my parents, my sibling, my whomever,

00:43:25.160 more than, hey, I know that I have a problem and I want to change. But you do get that too. I think

00:43:32.020 that it's revealed sort of over time and as that relationship between the therapist and the patient

00:43:36.660 really develops and there's a trust there. And I think that's what happens with, there's a saying,

00:43:42.100 I remember one of my colleagues had said, before diagnosing someone with depression, make sure they

00:43:46.860 aren't surrounded by assholes. So it's like there are difficult people in the world and I acknowledge

00:43:51.020 that. Obviously people are dealing with difficult people, but what is their role? What is their response

00:43:55.740 to those difficult people? Do you need to be in that relationship? If so, and you want to be in that

00:44:00.060 relationship, what is your role in exacerbating the difficulty in that relationship? But I was going to say about men and

00:44:06.300 women, which I think is important in John's case, is that the fact that men land in therapy and the

00:44:11.300 fact that they're willing to talk to you, especially a female therapist. And John, by the way, came to me

00:44:15.600 because he said I was a nobody and he didn't want to run into any of his Hollywood industry colleagues

00:44:21.020 in the waiting room. So it was not a positive reason that he came to me. But what was interesting

00:44:26.200 was that I think, you know, and I also see a lot of couples and if I'm seeing a heterosexual couple

00:44:30.280 and usually the woman will say something to the man, like, I really want to get to know you.

00:44:36.020 I want you to share your inner life with me. I feel like we're not connected. I can't reach you.

00:44:40.120 And then he like really opens up to her and maybe he starts crying. Maybe he starts crying a lot.

00:44:45.360 And she looks at me like a deer in headlights. Like on the one hand, I didn't feel safe when

00:44:50.020 you weren't sharing with me, but I don't feel safe when you're crying either. So there's this

00:44:54.300 mixed message that men get. In John's case, he really felt like he had to be the rock in his family.

00:44:59.080 And I won't sort of get into the details because it reveals in the book, but he really felt like if he

00:45:03.160 became vulnerable, he showed his pain that the whole house of cards would fall down, the whole

00:45:07.280 family would collapse because he had to be the strong one. And a lot of men feel that. And so

00:45:12.560 men will come into therapy and they'll say something to me eventually, like, I've never told anyone this

00:45:17.140 before. And then I sit back and I wait. And what they tell me feels so mild. And even if they have

00:45:24.620 a good marriage and they have good friends, they felt like they couldn't tell anyone this. They

00:45:30.560 couldn't be vulnerable with anyone. They have so much compassion for them. Women will come in and

00:45:35.880 eventually they'll get to that point where they'll say, I've never told anyone this before, except for

00:45:40.480 my mother, my sister, and my best friend. So they've told one to three people already, but they feel

00:45:46.380 like they haven't told anyone. And then the thing that they haven't told anyone, there is something

00:45:51.140 about it that feels like I can see why they maybe were a little reluctant to share that. It feels very,

00:45:56.500 very private. And so I think it's really hard for men that on the one hand we're, and I'm raising a

00:46:01.700 boy, right? So I think that on the one hand we tell boys at a certain point and we tell men, we want

00:46:08.660 you to be really emotionally available. We want you to feel your feelings. We want you to have the

00:46:13.760 freedom to feel the way that women do, to feel whatever you feel and for that to be okay. And on

00:46:19.080 the other hand, we don't really, because we don't really create the space for them. There's a lot of

00:46:24.220 shame around that. And we do shame that. And even in ways like in that couple situation where

00:46:28.660 somebody says, I want you to do this and then you do it. And then she's like scared because you're

00:46:34.180 crying. Yeah. And I think the other kind of shame in John's life is the circumstances that get him

00:46:40.520 into your office. Obviously are not the presenting circumstances. He presents with something quite

00:46:45.500 benign. If I recall, it was basically sleep disturbance. Yeah. He says he has insomnia and it's

00:46:50.340 because of all the quote idiots that are making his life very difficult.

00:46:54.660 But you're absolutely right. I don't think you get through the end of John's story and it actually

00:46:59.820 happens quite abruptly. So it's sort of two thirds of the book. We're going along with John. I think

00:47:06.620 as readers, assuming there is something lurking beneath the surface that explains this, there's one

00:47:14.380 moment when, as you put it, it's breaking down versus breaking open and he fully breaks open in the

00:47:22.220 most unexpected way. How were you able to control your own emotions there? I don't know how long you'd

00:47:28.660 been seeing John at that point. I don't think that is clear in the book in terms of real time, but

00:47:33.640 obviously you had just an interpersonal affection for him. How is it for you to see somebody who has had

00:47:42.240 such a shield, has had so much armor and you are the only person that is now witnessing the complete

00:47:50.280 destruction of that armor such that the real John can come out? Yeah. Well, there were a bunch of

00:47:57.800 misdirects that I think sort of prepared me not for what ultimately comes out, but just felt a lot of

00:48:03.620 empathy for him. It's revealed very early in the book, so this does not spoil anything, that his mother

00:48:08.880 had died when he was young. She had been hit by a car and she was a teacher and she was trying to

00:48:13.960 save a student from getting hit by a car and he was six years old and him feeling like it was sort of

00:48:19.840 his fault because he wanted her to rush home and he missed her and him kind of carrying the burden of

00:48:26.420 that and not really being able to talk to anybody about that and his family dealing with the death by

00:48:31.460 like, let's move on, let's move on. And so I felt like I could see glimpses of him and who he really

00:48:37.560 was and the younger him and the more tender parts of him. And so when this happened, though, I was

00:48:41.980 really blindsided when I found out what was the other piece of it. And I did tear up and he calls

00:48:48.080 me on it. He's like, oh my God. He goes back into his kind of defended place and makes some kind of

00:48:52.980 sarcastic remark about the fact that I was tearing up because you have very human reactions as a

00:48:59.120 therapist. And it was an incredibly sad, tragic, moving story. And I don't think anybody could sit

00:49:07.240 in that room with him and not cry. I don't know how someone would. You'd have to be a robot.

00:49:11.940 And we're not robots. And there's really two pieces to it, Laurie. There's the story, which is sad,

00:49:18.840 but then there's him. And I actually think of these as two slightly different pieces.

00:49:24.260 I actually find the latter slightly more painful as the reader. And I, I would guess that as a

00:49:31.260 therapist, you're even more attached to the latter, which is the journey of this guy who has carried

00:49:38.680 the weight of the world on his shoulders, which is his family, his work, his career, his, again,

00:49:45.660 this armor that he's had to wear. And there's now this one moment where it all comes crumbling down

00:49:52.460 and you kind of realize, well, look, there's some good to this, which is when something breaks

00:49:58.160 so completely, there's actually an opportunity to put it together in a different form,

00:50:02.000 but it's also really messy. It is. And I think that's going back to what we were talking about

00:50:07.320 at the beginning, the story part of sort of rewriting the story. So he had this story in his

00:50:11.960 head of this is the story. And this is the story that I've been telling myself. And this is why he

00:50:16.680 really can't sleep and what he dreams about and what keeps him up at night. And it's that story

00:50:22.160 that needs some nuance to it. It needs to have another perspective to it. So I think sometimes

00:50:29.400 we get so ossified in the story, our story becomes so ossified that there's no room for sort of any

00:50:36.020 other interpretation of events. And all roads in his story led to he's a horrible person. And that just

00:50:45.060 wasn't the case. So it was really about how do you manage your remorse? How do you manage regret?

00:50:52.860 And then how do you also forgive yourself? Which I think is really hard. How do we forgive ourselves?

00:50:59.040 What does that look like? So much of the time, like in Rita's story, which we can maybe talk about

00:51:03.280 later, but she has these adult children who are estranged from her and she really wants their

00:51:08.240 forgiveness and they don't want to have anything to do with her. And what I said to her is you need

00:51:13.440 to be the mother to them now that they need and not try to get a redo from them and not try to get

00:51:19.120 a pardon from them. And the person that you need the forgiveness from is yourself. You need to come

00:51:23.860 to terms with what you did in order to be the kind of mother that they need now. And I think the same

00:51:29.200 thing with John, where it's about how do you forgive yourself for being human? What do we do

00:51:34.060 with that? Like, what is the sentence for this crime? Is it life in prison? Is it the death sentence?

00:51:39.040 Because basically a lot of people will give themselves the death sentence, which is basically

00:51:42.720 they're alive, but they're not living because they don't feel like they deserve to have any pleasure,

00:51:46.660 any joy in life. And so they sabotage any joy that might come their way because unconsciously

00:51:51.400 they don't realize that, I mean, subconsciously they don't realize that what they're doing is they're

00:51:55.460 making sure that they are punishing themselves, that they are giving themselves that jail

00:51:58.680 sentence or that death penalty. You actually ask Rita that question point blank. And I do want to

00:52:04.320 come to Rita. I want to spend a lot of time on her because I think, again, both her story and John's

00:52:09.840 story, at least through the lens that I look at things are so similar. I mean, the extent of self

00:52:16.140 loathing, just the complete and utter lack of self compassion. I can very much relate to this by the

00:52:21.980 way. So it's probably not an accident that those resonate. So let's kind of go back to John a little

00:52:26.280 bit to the notion of what does the recovery look like? I mean, I think John's story is also one of

00:52:32.320 the most hopeful stories to me because he's almost a caricature of a phenotype of a person that you just

00:52:40.580 think is beyond hope. Like the narcissistic. Well, I didn't think that. I can see why the reader would

00:52:47.500 think that. Yeah. Absolutely. Right. Like in general, but to your point of how readers will have in some

00:52:53.660 ways the biggest emotional response to that, because we know how much we judge that phenotype.

00:52:58.900 We know that the sarcastic, snappy, jerk. Condescending. Condescending and narcissistic.

00:53:07.720 Like that's just not a phenotype that generates much affection, right? No. And everyone knows a John.

00:53:12.420 Everyone knows some of them. Everybody knows a John. And not a lot of us walk around. There's not a lot

00:53:17.140 of love loss for the Johns. Your story suggests, no, actually, this is not a terminal condition.

00:53:24.340 Well, right. I mean, I think that people, there's so much room for people to grow and change and

00:53:29.740 transform. And even with Rita, who's about to turn 70, people always say, you know, is it too late when

00:53:35.480 you live so much of your life this way? It's really never too late. And I think, again, that's what's so

00:53:40.680 hopeful about when people land in my office is that's a triumphant moment that they got there.

00:53:45.920 They came and they said, I'm ready. They don't know what they're ready for yet, but they're ready.

00:53:51.220 And when you describe it this way, Lori, coupled with what you said a few minutes ago,

00:53:56.180 it probably does speak to the fact that you, through some connection, were able to get John

00:54:03.260 to keep coming back. And whether it's the fact that you humored his obnoxious behavior with a cell

00:54:08.420 phone, that you let him order lunch every time he showed up and just act in a certain goofy way

00:54:14.640 was enough to keep him coming back. It's so funny. When I reread your book the second time,

00:54:21.440 I'm doing it with the highlighter and the post-it notes and stuff. And there's a line that I'm not

00:54:25.340 going to quote directly because I can't remember it at the second, but it to me is one of the most

00:54:29.180 profound at the very end of your book, which is, look, change happens very slowly and then it

00:54:34.280 happens very quickly. There's something to that effect.

00:54:36.000 Change happens gradually, then suddenly. Yeah.

00:54:37.860 Yes. Yeah. You say it much better than I do. Well, I don't think any story in the book illustrates

00:54:44.100 that probably more than John's though. I think, I can't remember if you were writing about it yourself

00:54:47.900 or about John. I can't actually recall now that I think about it, which patient you were more

00:54:52.100 referring to. I mean, I think it refers to all of them because I think with all of them, I think

00:54:56.800 there's this look at new year's resolutions or Nike's just do it. When we say, okay, we're going to

00:55:01.400 just change. Sometimes that works in the short term, but if you really want lasting change,

00:55:06.360 there's a chapter in the book called how humans change. And it outlines all the steps that we go

00:55:11.100 through that we're not even aware of in preparation for the change. And so it's a process.

00:55:16.460 The most important step in change is actually not making the change, but the last step,

00:55:21.700 which is called maintenance. And it's how do you maintain the change? So once you make the change

00:55:26.480 and you've done like five steps to get to that place of even taking action, the action step,

00:55:30.980 and then it's how do you maintain it? And people really misunderstand that step because they think,

00:55:37.580 well, if I go back to my old ways, even once, it's like, look at people on diets. They go on a diet

00:55:44.080 and they're like, oh, I ate the cake. So the diet's over. No, it's just, that's part of that stage is

00:55:50.660 maintenance. You're going to go back. It's not going to be linear in that way. And so people need to know

00:55:55.160 that so that they realize this is just part of the process of change. And then you could just go back

00:55:59.620 to the change and yes, you'll screw up again and that's okay.

00:56:03.380 But I think there's something about getting to that. Like the way I pictured it in these

00:56:09.540 breakthroughs, especially with Rita and John was the way I would imagine a stonemason working with

00:56:15.200 a piece of stone, which is you're hitting, you're hitting, you're hitting, you're hitting,

00:56:19.020 you're hitting. There's a thousand strikes and nothing happens. And on the 1000th and first strike,

00:56:26.220 the stone breaks. But the reality of it is it's all the strikes that came before,

00:56:31.300 but the stone had comes back to, I think what you're saying, which is just getting John and

00:56:37.040 Rita to show up and having that relationship, even if it felt like in the moment, my God,

00:56:42.160 we're making no progress. This guy is still just as much of a jerk today as he was six months ago.

00:56:47.740 He's still ordering the salads. He's still making fun of the shoes I'm wearing. He's still doing all of

00:56:52.700 these things. He's still on the surface. I thought we were making progress. So it's kind

00:56:57.820 of like most big transformations come about from the dozens or even hundreds of tiny,

00:57:03.680 almost imperceptible steps that we take along the way. So when I would have those, I would have a

00:57:08.720 moment of connection. My goal in every session with John was to have a moment of connection with

00:57:13.880 him every session. And that was going to be laying the groundwork for what these changes were.

00:57:19.420 And if he could connect with me even for a moment and you see it, it's like one little piece of the

00:57:24.340 session where we have a moment of connection, then he immediately gets rid of me every time he can't

00:57:29.520 tolerate it. That's okay. But we have that moment of connection. And so I know that our relationship

00:57:35.240 is developing. And that's why in that moment when he leaves and doesn't come back, when there's that

00:57:39.860 rupture, I really thought he was not going to come back. I didn't know. And then the way that played

00:57:46.040 out was kind of interesting. You can see that that was all about the relationship and how

00:57:50.320 I tried to use the glue of the relationship to give him enough space so he wouldn't feel pressure

00:57:56.160 to come back, but to also give him enough of a taste of what we had because I know he craved it.

00:58:02.340 He was so incredibly lonely, even though he was surrounded by people and people admired him in

00:58:07.780 his work. He was very well known. He had this family, had these kids. He was the loneliest person

00:58:13.420 because he was just living in his own world and putting this person out there, this false self

00:58:20.860 to kind of maintain things. So he only could really be him in our therapy sessions and he could only do

00:58:26.620 it for maybe two minutes tops, but that's okay. That was enough to kind of get him to see how

00:58:32.800 liberating that is. I think that's an interesting and important distinction you make that I think I've

00:58:37.660 probably failed to fully appreciate, which is it's that you had months and months or years and years

00:58:44.340 of two minutes of connection every week. That was actually a linear glue that held together. I mean,

00:58:50.020 his respect for you was growing as those connections I suspect were happening. And I mean, there's no way

00:58:58.700 he could have finally got to where he got with you without all of that. And of course it begs the

00:59:04.140 question. You talk about your therapist, because again, you're one of the patients in here, your

00:59:08.200 therapist, Wendell, who also comes across as the wisest human ever. Never a wasted word comes out of

00:59:16.000 Wendell's mouth, right? It's like, he's so brilliant. He's so wise, but we have no idea if the John Wendell

00:59:22.900 thing would have ever worked out, right? I mean, did you find yourself thinking those things? Because I

00:59:27.860 know you talk a lot about how, when you're on Wendell's couch, you can't help, but think, okay,

00:59:32.820 what would I be doing here? Were you ever doing the reverse? What would Wendell be doing with John

00:59:37.620 in this situation or with Rita in that situation? Oh, absolutely. The thing about Wendell was that

00:59:42.360 when I came to him, so I was a relatively new therapist and he had been doing this for a much

00:59:46.860 longer time. And I was relatively new because I had all these other careers. So we weren't that far

00:59:51.260 apart in age, but we were very far apart in experience. And so I learned so much from him and I

00:59:57.640 would just steal things from him. I would take his metaphors. I would use them. There was this one

01:00:03.520 that I use, I still use to this day all the time. I think so many times people come to therapy and

01:00:08.200 they feel trapped by their circumstances or they say, you know, this person is making it so I can't

01:00:13.300 do this, or this circumstance makes it so I can't do this. And at one point I was doing that. And he

01:00:18.120 said to me, you remind me of this cartoon and it's of a prisoner shaking the bars, desperately trying

01:00:23.960 to get out. But on the right and the left, it's open, no bars. And so why don't we just walk around

01:00:29.880 the bars? Why is it preferable to us to shake the bars and say, I'm a victim. I can't do this. This

01:00:35.500 isn't available to me. And it's because if we walk around the bars, we're free, but then we have to

01:00:41.120 take responsibility for our own lives. And a lot of us would rather blame other people or other

01:00:46.460 circumstances for why we can't have happiness or joy or meaning or whatever it is in our lives

01:00:51.300 than to say, oh, now I'm responsible for that. And if it doesn't work out, that's on me.

01:00:55.960 You even bring that image into your TED talk. It's one of the images you integrate very beautifully

01:01:00.360 into that talk. Yeah. Yeah. I think it just, it resonates with people because I think when you

01:01:05.020 realize, wait a minute, the bars are open, people get, they're both elated and frightened at the same

01:01:11.620 time. Yeah. I want to talk a little bit about suicide as an introduction to Rita. You write something

01:01:19.540 very interesting in the, one of the latter chapters, you write about these two types of

01:01:24.920 suicide. There's the group of people that are depressed because they're thinking is, Hey,

01:01:31.740 I once had a really nice life, but then something has gone wrong. Something has gotten in the way of

01:01:36.640 that. It could be the death of a loved one. It could be some horrible circumstance and there's

01:01:41.900 nothing they have to look forward to. And then the other type is the person who just feels life is

01:01:46.320 barren. There's nothing to look forward to. And you talk about Rita falling into the second

01:01:49.780 category. How often do you see patients who at one point or another in your relationship with

01:01:55.860 are truly contemplating ending their life? I would say it's not terribly common that it happens,

01:02:04.000 but percentage wise, I would say people can be very depressed, but in terms of really,

01:02:10.220 so you have to assess for suicide whenever somebody is depressed or whenever somebody brings it up or you

01:02:14.940 bring it up. And you have to bring it up. That's the thing. I think a lot of people feel like I

01:02:19.840 don't want to bring up suicide because that will plant the idea in their head. No, that is so wrong.

01:02:24.780 You see this with teenagers a lot. The parents are so afraid. I don't know. I don't want to mention

01:02:29.860 anything to my kid. My kid seems really depressed, but I don't want to ask about suicide. Ask about

01:02:35.000 suicide because a lot of times people feel like they can't talk about it or to relief for them,

01:02:40.580 for someone to give voice to those feelings that they might be having,

01:02:44.280 that they feel like they can't share with anyone. So a lot of, one of the biggest risk factors,

01:02:49.100 of course, for suicide is feeling of isolation, this feeling of being completely alone in the

01:02:53.400 world. And if you can't share that, you're really alone in the world. If you're under experiencing

01:02:58.180 such pain and you can't share it. I think a lot of people that I see, obviously there will be,

01:03:03.640 sometimes people are very depressed. What I see most of in my practice are sort of like relational

01:03:08.080 issues. And by that, I don't just mean romantic relational issues. I mean, there's something going on at

01:03:12.700 work or there's something going on with a parent or there's something going on with an adult child

01:03:16.400 or there is something going on with a sibling or their romantic relationship or the relationship

01:03:21.620 mostly to themselves. So there's usually like the relationship to self, their life is not going the

01:03:26.920 way that they had expected it to go or something is not working and they don't know what. And I feel

01:03:32.860 like in that sense, therapy is like getting a really good second opinion on your life from somebody who is

01:03:38.620 not in your life. So I think that the value of therapy is that the people in your life, they're

01:03:44.120 too close to the situation. And so if you really want a good second opinion on your life, go to a

01:03:49.600 therapist who can look at you from the perspective of not having all that other information yet and

01:03:55.120 being able to see, well, what is going on right here, right now? It's a very different kind of

01:03:59.380 assessment. And I should say, by the way, as we talk about John's story and Rita's story and all of

01:04:03.700 this, I should say the book is actually very funny. And a lot of people find it and not funny at the

01:04:08.600 expense of patients, but funny in the sense that humans are ridiculous. And I mean that in the

01:04:13.580 most compassionate way, that I think that we as humans, we say one thing and we do another all the

01:04:20.340 time. And I think that's funny, the ways that we act, the ways that we try to protect ourselves,

01:04:25.020 which actually don't protect us, they make things less safe. The ways that we try to be heard or seen

01:04:32.440 often backfire because we're doing it in a way that ensures that we're not going to be heard or seen.

01:04:36.680 The way that we kind of chase after some kind of meaning or joy is often we're doing the exact

01:04:42.500 thing that will basically guarantee our own unhappiness, but we don't realize that. And so I think

01:04:47.160 there's something very humorous because it's so relatable that often we self-sabotage in ways that

01:04:52.300 we aren't even aware of and that are so common. So yes, there obviously there are some, I would say,

01:04:59.160 very sad moments in the book, but I think ultimately it's a very sort of inspiring book.

01:05:05.380 And I think that watching these people go through this, I think gives people an idea that maybe

01:05:10.480 they can do that too. Well, I would agree. There are definitely moments in there where

01:05:15.140 you're howling. And a lot of it is, at least for me, the recognition that I would do that or say that

01:05:20.680 or have done that or said that. And of course you do something very elegant, which is by bringing

01:05:26.260 yourself in as a peer, not as a superior, like you're very self-deprecating in the right kind of way,

01:05:32.380 I think, which is even just acknowledging your own foibles and just your own. Again, I don't want

01:05:40.920 to give away too much of the book, but just, it all starts with a pretty simple premise, right? You

01:05:46.460 and your boyfriend break up. You just need a couple sessions to get through it, right? I mean, like what

01:05:50.720 could possibly be going on? You just probably, you need like four sessions to get through it, right?

01:05:54.980 That was the thinking. Yeah. When you look back at that, have you ever played the game of what if

01:06:01.860 you and boyfriend didn't break up? What if you and boyfriend are still limping along? You've never

01:06:07.820 met Wendell. You've never gone through this journey. Who is Lori today? I think a very different person.

01:06:13.840 I think that those moments in life when you feel like, wow, you really didn't want something to happen

01:06:19.580 are often the moments when something really transformative is about to happen. And so,

01:06:25.720 so many times I think that that's why we stay with like the safe thing. That's why going back to

01:06:30.080 change, why change is so hard is because we cling to the familiar. We cling to what we know. And so,

01:06:35.500 even if you're making a really positive change, sometimes we fight that because we don't like

01:06:41.760 uncertainty. Humans don't like uncertainty. And so we go into this place of, I know what I have now.

01:06:46.860 It may not be very good, but at least I know it. And if I do this other thing, I go into this place

01:06:52.200 where it's like going to a country where you don't speak the language. You don't know a person there.

01:06:56.660 You don't know the customs or the mores and you kind of feel a little bit lost. So at least you'll

01:07:01.460 stay in your country where it's safe, but maybe not what's best for you. Now, going back to Rita,

01:07:07.260 who's, I think her story is, as I said now a couple of times, I guess, probably the one that touched me

01:07:13.380 the most along with John's. You already alluded to this. She shows up. She's, I think, just shy of

01:07:19.540 her 70th birthday and she's kind of given you an ultimatum. What's that ultimatum? And that's a

01:07:24.440 pretty unusual ask of a therapist. Yeah. So Rita is somebody who, she's one of the

01:07:31.220 most isolated people that I had ever seen. She has adult children who are estranged from her,

01:07:38.740 who don't talk to her. She has some marriages that didn't work out. She lives alone in this

01:07:43.980 little apartment. She never really leaves or does anything. She goes and gets pedicures.

01:07:49.740 She tells me only because, not that anyone will ever see them, but because that's the only time

01:07:55.620 that someone will touch her. We talk about skin hunger and how important that is, that we need

01:08:00.340 physical touch. And just in the course of a day, I'm not even talking about romantic touch,

01:08:04.480 but in the course of a day, think about how many times we are touched normally. You hug your

01:08:09.360 friend, hello. You kiss somebody on the cheek. You shake hands with somebody. You high five them.

01:08:14.860 The barista at Starbucks hands you your latte and you touch hands. We just are routinely touched

01:08:20.300 during the day in little ways. She was just not touched at all. And so she would just go get these

01:08:26.260 pedicures. That was the only time she would be touched. She lived with this incredible

01:08:30.820 sense of regret because she did make significant mistakes as a parent, which is why her children

01:08:36.520 were not talking to her. And she also made mistakes in her relationships. And she felt

01:08:42.920 like she had nothing to live for. And she said, if things don't get better by my 70th birthday,

01:08:46.340 she was 69. She said, then I don't want to live anymore. I wasn't too alarmed by that because I felt

01:08:52.820 that first of all, she's very clear that she's not going to do that. She wants something to change.

01:08:56.700 That's why she's here. If she wanted to kill herself, she just would have. And I did assess

01:09:00.620 for that. But she was very clear that I'm going to give this a year and then we'll see what happens.

01:09:04.780 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

01:09:10.640 have her join the human race again, was to get her connected somehow in the world. And she did not

01:09:17.700 want to do that in any of the ways that I suggested. It was sort of like Goldilocks. This idea is to this,

01:09:22.440 this idea is not enough, this, this one's not, you know, there was nothing that would work.

01:09:27.040 And then through the work that we did together, I think she started to see possibility, even though

01:09:32.420 she wasn't ready to admit it. And when it did happen, that things started to change for her

01:09:37.540 a little bit or could have changed for her. Of course, she sabotaged that right away. She had

01:09:40.640 what we call cherophobia, which is chero is the Greek word for joy and phobia, of course, is fear. And so

01:09:47.780 she had a fear of joy. And a lot of people who grow up in situations where they felt like they were

01:09:52.780 robbed of their joy, a very suspicious joy. They don't trust it. It's almost like anytime her

01:09:58.880 mother who was very kind of distant, anytime her mother would approach her and be sort of like a

01:10:03.280 normal mother, she would get very excited about when she was young. And then the mother would go

01:10:06.600 back to being distant. So her joy would always get taken away. The other shoe would always drop.

01:10:10.640 So she never trusted joy, connection, those kinds of things. So when that did present to her in her

01:10:17.660 adult life, she did everything she could to ruin it. Which is heartbreaking to watch. It's so painful

01:10:24.760 to watch. It is the slowest, most upsetting train wreck imaginable. And it's a very different

01:10:31.300 experience from the frenetic pace of John's destruction, right? These are totally different

01:10:38.640 paces of pain. Well, right. So John would actively distract and Rita would do it in a very passive way.

01:10:45.700 So this gentleman comes along, Myron, who really seems like a wonderful opportunity for Rita to

01:10:56.480 enter the final 20 or 30 years of her life, depending on how long she's going to live. He would check all

01:11:02.540 the boxes by any metric. And as you describe it, the extent to which she self-sabotages is something you

01:11:11.240 could only see in a movie. You couldn't imagine a person in real life could go to the lengths to

01:11:17.120 sabotage the way she does. But then there's something that you give us an insight into through

01:11:24.500 Rita. I actually, I would say was one of the two most moving parts of the book, which is the letter

01:11:30.880 she wrote to Myron. Because that's when her shame really comes out. And that's when you understand

01:11:38.000 what maybe even you as the therapist or me as the reader can't fully appreciate is just how she

01:11:46.300 feels about herself because she feels that way about herself. How could she tolerate anybody loving

01:11:53.680 her? Well, how could anyone love her? She basically, it was like warnings on a drug here. If you take this

01:12:00.420 drug, here's what you might encounter. She was basically saying, full disclosure, you should know who I am.

01:12:08.000 Because you don't know what you're getting into. You don't know the monster that I was. You don't

01:12:13.220 know who I was. And you're going to find out, you're going to learn this. And that's going to be so

01:12:17.460 painful because you will leave. You will not want to be with me when you learn this. So I'm going to

01:12:21.320 tell you now so you understand why we can't be together. Yeah. I don't know. I mean, I love for you,

01:12:27.420 if you feel it's reasonable to read part of that letter, because I find it so powerful. But at the same time,

01:12:33.320 I was like, you know, maybe we should just let the reader read that letter. I'd give this your call,

01:12:36.900 Lori, what do you think? Sure. I mean, I can read part of it. I think it's pretty long, but do you

01:12:41.480 remember where it is? It's on page 359. Okay. And I'll let you read from it, whatever you think

01:12:48.000 conveys the point. But it's a beautiful letter in the sense that she's just so open and you can tell

01:12:54.280 like, it's sort of her life story. And again, I think it's the fact that she comes into your office

01:12:59.020 and reads this to you. She is opening up to you and reading this letter to you and seeking

01:13:05.460 your advice of, on the one hand, she's basically saying, look, this is a letter I've written to

01:13:10.600 give Myron. But she's also, I think, being more transparent and direct with you through this letter

01:13:16.860 than she'd ever been before. Yeah. I think what she's saying is, can you tolerate me to me? Do you

01:13:25.220 think I'm a monster? It's so painful to see her do that. And what I really like about the work that

01:13:30.200 I do, and I think that the reason that readers are responding to these stories in the book is because

01:13:35.080 they're so nuanced, like life. They are life. And there's no easy answer. So on the one hand,

01:13:42.260 what she did is reprehensible. And on the other hand, there are so many understandable reasons,

01:13:48.700 even if they're not excusable reasons, but they're understandable for why she did what she did.

01:13:55.280 And so there are both sides of that. And how do you sort of ethically, morally deal with these kinds

01:14:00.960 of issues where you have lots of feelings about it yourself? And as a parent, I had a lot of feelings

01:14:06.420 about it. I couldn't help but think, wow, what if someone had done that to my child? What would I have

01:14:11.760 done in that situation? You always think, I would get out of there. I would protect my child. Her first

01:14:16.940 has been started drinking and became an alcoholic and became a very abusive alcoholic to her and to

01:14:22.900 the children. And she did not leave for a lot of reasons that make sense in the context of who she

01:14:28.400 was in her 20s and what her life was like and in her 30s. But there's both sides of that. And yet,

01:14:34.700 I don't think she's a monster at all. But I can understand why her kids do. So there was both sides

01:14:39.540 of that. I'll come sort of midway into the letter. So she says, what you don't know, Myron,

01:14:45.180 what even my second and third husbands didn't fully know is that their father, my first husband,

01:14:49.960 Richard, drank. And when he drank, he hurt our children, my children, sometimes with words,

01:14:55.500 sometimes with his hands. He would hurt them in ways I can't get myself to write here. Back then,

01:15:00.580 I would scream at him to stop pleading. And he would yell back at me. And if he was very drunk,

01:15:05.640 he'd hurt me too. And I didn't want the children to see that. So I would stop. You know what I did

01:15:10.420 instead? I would go into the other room. Did you read that, Myron? My husband would be hurting my

01:15:16.800 children and I would go in the other room. And I would think about my husband, you are ruining them

01:15:22.080 forever, hurting them beyond repair. And I would know that I was ruining them too. And I would cry

01:15:27.520 and do nothing. So that's part of what she reveals to him. And yet, when you meet her in the book,

01:15:34.340 and as I met her, she's such a lovely person. And so how do you reconcile that person with the

01:15:41.620 person she is at her core, the person before she became so damaged by her own experiences that she

01:15:47.900 damaged other people because of it? And I think those are the complicated questions that we ask

01:15:52.360 in life. And maybe they're not as heightened as this situation, but I think that there are ways in

01:15:56.740 which it relates to our lives nonetheless. How many of the patients that you've written about in this

01:16:01.780 book are you still in contact with through a therapeutic relationship?

01:16:06.540 Right. So one of the things that was really important to me was when I was choosing the

01:16:10.360 stories for the book that I did not choose anybody that I was currently seeing. Because even though I

01:16:15.760 was writing about events that maybe took place five years earlier, I didn't feel like I could see

01:16:20.060 someone and do the work with them and then leave and then write about something that had happened

01:16:24.420 between us. So I did make sure of that. And I also made sure that when I was thinking about who to ask

01:16:30.800 for permission, because I asked everybody for permission, obviously, there were certain stories

01:16:35.040 that I felt I really wanted to tell, but I didn't even ask or include them. Because I felt like in

01:16:40.400 one case, the person always kind of wanted to be my star patient. Like, do you like me the best kind

01:16:46.420 of like sibling rivalry, which a lot of us feel with our therapist. I felt that with my therapist,

01:16:50.640 too. I'd walk through the waiting room on the way out. And I think, oh, he probably likes her better

01:16:54.600 than me. I'm so not a fun session. And she looked like so nice and put together. And so this one

01:17:01.600 patient I felt, by virtue of my asking, if I could include the story in the book, that would reinforce

01:17:06.120 that notion, which I didn't think would be really clinically useful for that person. And in another

01:17:10.760 case, there was a person who often would try to please other people. And I felt like if I asked that

01:17:16.560 person if I could use her story, she would say yes, even if she was not really sure she wanted to say yes.

01:17:22.020 And so I didn't want to put her in that position. So I did not include her story or asked for

01:17:27.420 permission. And so it's interesting, the reaction to the people whose stories I included, because I

01:17:32.740 did not show them the manuscript beforehand, I just got their permissions. And afterward, what they all

01:17:38.180 said to me in different words, was something that moved me so much, which was, I knew that you cared

01:17:44.020 about me when we were doing our work together. But I didn't realize the depths of it, that I would think

01:17:52.660 about them between sessions, I would wonder if I should say this instead of that, when they didn't show up, I

01:17:58.420 thought this, or I worried about this. And it's sort of like, just how much on a human level, they infuse

01:18:05.180 themselves 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.

01:18:12.620 But what I mean is that you can't help but be affected by the people that you see. And so I think

01:18:18.040 that they were very, very moved by how strongly I felt about them, and how much I thought about them

01:18:24.080 in the context of what was going on between us.

01:18:27.660 Do you have a sense, you talked about this a couple of times, that obviously your goal is to

01:18:31.860 help people, to get people out the door or leave the nest in a way. Do you have a sense when someone is

01:18:36.600 at that point, and they're leaving your care, at least in that sort of more structured way,

01:18:41.340 what the predictors are of the people who are going to enter that maintenance phase, that fifth

01:18:45.600 and final change of behavior, and be successful, do the work, versus people who are going to struggle

01:18:52.020 without the regular support. I'll be honest with you, I ask this partially through a selfish lens,

01:18:57.620 as I sort of try to imagine where, what my therapeutic tail looks like in the relationships I

01:19:03.920 have with my therapists, right? Which is like, when do the crutches come off? When do the training

01:19:08.240 wheels come off? What does the long tail of this look like in terms of how much support I'll need

01:19:12.980 the rest of my life? Because I do, I probably should have said this at the outset, Lori, but

01:19:17.120 I think the work that you're doing, and I think the work that anybody who's really involved in the

01:19:21.760 care of emotional health and mental health, I just don't think there's enough of an appreciation in the

01:19:26.680 medical community of how important this is. And I think it's very easy for people to say,

01:19:31.580 that trauma surgeon saved my life. Because it's very tangible. You got hit by a car or

01:19:36.720 hit by something, and in that moment, your life was saved. And it's, you have that tumor,

01:19:41.420 and it got cut out, and it's the difference between life and death. And it's very easy to say,

01:19:45.040 that doctor saved my life. But I think when the story of my life is going to be told,

01:19:50.160 the people who are going to have literally saved my life are going to be the people who helped me with

01:19:55.820 my mental health. And I just, I don't think that can be overstated. And I think that that

01:20:01.680 represents the greatest single opportunity to reduce suffering on this planet is through this.

01:20:08.020 Absolutely. It's so interesting when you were just making the comparison with physical health

01:20:12.960 and surgery, and we both did medical school. And so I think it's interesting that when you look at the

01:20:18.120 way our culture looks at physical health versus emotional health, first of all, they separate them as if

01:20:23.260 they're not intertwined in some way, which of course they are. But then the other part of it is that if

01:20:27.580 something feels off in your body, something feels not right, you're having some discomfort. Let's

01:20:32.020 say you're having some discomfort in your chest. You're probably going to go to a cardiologist before

01:20:36.340 you have a massive heart attack. You're going to get it checked out. What is this discomfort? I need to

01:20:40.700 get it checked out. If people are having some kind of emotional discomfort, they often will say,

01:20:46.420 well, I have a roof over my head and food on the table, and I'm just sort of plugging along,

01:20:51.200 and the sadness or this anxiety or these relational difficulties or whatever, this feeling of

01:20:55.540 offness, whatever it is, this feeling of discomfort, it's not that bad. They minimize it. It's like I

01:21:01.400 talk in the book about the hierarchy of pain, that we feel like there's this hierarchy of pain,

01:21:05.500 and that you compare your pain, like it's like the pain Olympics. And if you don't have like a nine or a

01:21:10.600 10, right, it doesn't matter. But it does. So what happens is people don't go to get it checked out

01:21:16.080 until it gets really bad. They're having the equivalent of an emotional heart attack. And now

01:21:21.820 they land in my office. And so the problem with that is that, first of all, you've suffered

01:21:26.820 unnecessarily for all of that time that you were feeling the discomfort, and you didn't need to. And

01:21:32.720 secondly, it's harder to treat right now, because now you're in this crisis phase. And if you would

01:21:37.840 come earlier, we could have dealt with it in a different way, and you could have avoided a lot of

01:21:43.120 the suffering. The change would have happened much more easily. Now we're sort of like digging

01:21:46.680 out of the hole. And there's a third thing I would add to that, Laurie, which is the collateral

01:21:50.840 damage is also worse. So if you're sitting there with a bum knee that you kind of ignore for 10 years

01:21:58.340 too long, it's a tragedy for all the reasons you've described, but it probably hasn't hurt other people

01:22:05.040 as much as if you spend 10 years in depression. So if you spend 10 years as Rita or 10 years

01:22:13.120 especially as John, it's almost like the more people you're around, the more potential you have

01:22:18.420 for collateral damage as you wait to get to that emotional heart attack.

01:22:23.020 Yes, yes. Even Charlotte in the book, who is this young woman in her 20s who keeps kind of

01:22:28.360 hooking up with the wrong guys, including eventually someone from the waiting room,

01:22:32.040 which is very ill-advised. I don't mean they're hooking up in the waiting room, by the way. We don't

01:22:36.140 have that kind of exciting office, but they meet in the waiting room. The collateral damage of all of

01:22:41.240 the sort of destruction around relationships that happens until she really kind of sees what's

01:22:45.120 going on. And she also has some other issues that she is working out. And so, yeah, I mean,

01:22:50.400 I think that's what happens. And so when you look at how we sort of place value on taking care of our

01:22:56.400 physical health, and then we devalue our emotional health, we feel like it's like going to yoga. It's

01:23:01.340 like, yeah, maybe I'll go to the gym, or maybe I'll go to yoga, or maybe I'll eat right. Those are

01:23:05.100 important things, right? They're important. But we don't realize, wait a minute, if you aren't

01:23:10.180 emotionally healthy, you need to actually get help for it. You need to get it checked out. You

01:23:15.360 need the support. So when you talk about what these endings look like, first of all, it's getting

01:23:18.940 people there is number one. And realizing, no, it's not just like a navel-gazing activity for

01:23:25.080 people who have nothing better to do. Our emotional health matters. The other piece of it is that when

01:23:31.720 you're there, I think what I wanted to really do in the book was to really look at these misconceptions

01:23:36.860 around what therapy is. Because I think a lot of people don't come to therapy because

01:23:40.240 they have a lot of ideas about therapy that just aren't accurate. So one idea that they

01:23:45.320 have is that you go to therapy, and you talk about your childhood ad nauseum, and you never

01:23:49.240 leave that model of therapy. That's just not what therapy is. It's very much focused in the

01:23:53.720 present. And yes, we will look at maybe how a story from your past is living inside of you

01:24:00.080 and is getting in your way. And also, what are your blind spots and those kinds of things.

01:24:05.040 But we really want to see, what are you doing in the present so that you can have a better

01:24:08.320 future? That's how therapy is oriented. And I think the other thing, the other misconception

01:24:12.200 is that you're going to come to therapy, you're going to download the problem of the week,

01:24:15.860 you're going to leave, you're going to come back, you're going to download the problem of

01:24:18.420 the week. That's not therapy. We like to say that insight is the booby prize of therapy,

01:24:23.380 meaning you can have all the insight in the world. But if you don't make changes out in the

01:24:27.180 world, the insight is useless. So if someone comes in and they're like, I got into this argument

01:24:30.880 with my partner, and here's what happened, and blah, blah, blah, blah, blah about that, right?

01:24:34.100 And then maybe they have some insight about it, but they leave and they come back the next week

01:24:38.600 and they say, now I understand why I got into that argument with my partner. And I'll say,

01:24:43.000 great, did you do something different? Well, no, but now it's like, well, okay, that's a good first

01:24:48.720 step. But then what are you going to do differently? It's like going to physical therapy. If you go to

01:24:53.200 physical therapy, and you just go and you don't do the exercises at home that you need to do in between,

01:24:59.020 you're not going to improve. Nothing's going to change. It's not going to feel better,

01:25:02.560 ultimately. I would even take it one step further, which is the exercises you do in

01:25:07.060 physical therapy or in the gym, even if you're doing them at home, are not for the sake of the

01:25:11.740 exercise. It's for the activity of life. So it's like you don't sit there and do the leg extension

01:25:18.140 for the sake of the leg extension. You're doing it so that when you walk up the stairs or down the

01:25:21.980 stairs, you can actually do that. And I think that's really the point of the therapy, as you said,

01:25:26.820 is it's great to have those insights because I think being able to observe and pause is a great

01:25:33.480 first step. But yeah, none of it matters if it doesn't translate to the ultimate metric,

01:25:38.200 which is improving the quality of a person's life. And in that sense, like I said, I don't think there

01:25:43.760 is a greater ROI that a person can make than investing in their emotional health because without

01:25:50.780 it, all of the other things don't matter. The good news is these are not mutually exclusive.

01:25:54.920 We should be pursuing them all. But I think a book like yours has done, I think, just a great

01:26:01.340 service along with many other wonderful books that I've talked about over the years in terms of

01:26:06.480 really getting people to think about this through the lens of something that every person would

01:26:11.280 probably benefit from on some level, some more than others. And I know I'm staring at the clock

01:26:16.740 closely because I know we are literally one minute away from you having to go. And I want to honor that

01:26:22.400 promise to keep you to exactly that time. So I can't thank you enough both for making the time

01:26:27.080 today, Lori, but more importantly, much more importantly for writing this book.

01:26:30.820 Oh, thank you so much for the conversation. I so enjoyed every minute of it.

01:26:34.980 Lori, again, we'll make sure we link to the TED Talk for folks. Anybody who has not read the book,

01:26:40.440 we'll obviously link to it all over the place. But in case you missed it, the title is Maybe You

01:26:44.900 Should Talk to Someone. Your podcast, by the time this podcast comes out, people will be able to find

01:26:50.740 your podcast. And remind me, it's Dear Therapists, plural, correct? Yes. And your column, Dear

01:26:57.180 Therapist, singular, is where you've been writing for some time. Is that at the Atlantic? That's

01:27:02.000 every Monday at the Atlantic, yeah. Great. I think that's a pretty good list of where people can find

01:27:07.700 you and hopefully they're going to become lifelong fans. Well, I welcome the connection with all of

01:27:13.460 the people who connect, however they connect. That's the point of all the work that I do.

01:27:17.440 Thanks so much, Lori. Thank you so much.

01:27:21.820 Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper

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The Peter Attia Drive - August 03, 2020

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

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