Therapy is about self-understanding and taking responsibility to change your own life.
The therapist does not give instructions but guides you to understand and change yourself, not others.
The therapist's role isn't being better at life than the patients. Instead they provide objectivity, insights from other cases, and a safe space.
Clinical psychologists are therapists. Psychiatrists focus more on medication.
Therapy changes relationships with the past. You can't alter it but can accept it, and make the most of the present.
Expecting family, friends, or partners to rectify the past will leave you stuck.
"In therapy we aim for self-compassion (Am I human?) versus self-esteem (a judgment: Am I good or bad?)."
"It's impossible to get to know people deeply and not come to like them."
Insights to the life of being a therapist:
Therapists often feel uncomfortable seeing patients outside work. Patients may feel surprised catching a glimpse of the therapist's imperfect life, and therapists have lost patients because of this.
Due to confidentiality, therapists have to grief alone when a patient dies.
Therapists often let calls go to voicemail because they don't want patients to feel unwanted if there's not enough time to talk.
Patients sometimes walk out of therapy, especially in couples therapy.
Patients may skip appointments to punish or express anger at the therapist.
Therapists often sit close to the door in case things escalate.
Therapists will sometimes not know what to say.
Therapists have a harder time finding a therapist for themselves as they need to find someone they don't already know in their professional network.
You may need to try several therapists before you find the right one. Try using PsychologyToday.com.
Research shows the connection to the therapist is more important than their credentials.
"What brings you here today?" That's how the author, a therapist, starts each first session. The answer to the question is the presenting problem, which could be grief, panic attacks or just feeling stuck, but it's rarely the real issue.
A patient named John seemed to have straightforward problems like insomnia and stress at work, but he didn't reveal his real problems to the author until almost six months later, which involved tragic events from childhood and adulthood that led him to be unable to grieve or trust.
Patients often start therapy clinging to unhelpful narratives about their problems.
"Part of getting to know yourself is to unknow yourself -- to let go of the limiting stories you've told yourself about who you are so that you aren't trapped by them, so you can live your life and not the story you've been telling yourself about your life."
We often aren't aware of our real problem, so we repeat patterns causing unhappiness. Identifying feelings lets us respond to them healthily, but ignoring them leaves us lost, and suppressing them risks unexpected eruption.
When the author sought therapy herself after a painful breakup, she arrived with her own narrative.
She thought she was anxious and depressed because her ex was a "selfish sociopath" for suddenly leaving her because he didn't want to live with her son.
In her first sessions, she tried to prove this narrative, recounting her ex's questionable behavior. She wanted her therapist, Wendell, to validate it so she could make sense of the breakup.
Wendell refused, seeing it as avoidance. Like many patients, her simplistic narrative kept her from examining her deeper issues.
Losses have layers -- the surface loss and the deeper meaning. A breakup is rarely just about the other person. It also represents failure, rejection, betrayal, fear of the unknown, and unmet expectations.
The five stages of grief (denial, anger, bargaining, depression and acceptance) were originally developed for terminal patients accepting death. Applied more widely, expecting people to reach "acceptance" can make them feel worse. The key to improvement is integrating the loss -- maintaining a bond with the loss yet still fully living on.
We naturally want to feel positive, so we try to put up defenses when we delve into issues during therapy that could bring us pain. Part of the therapist's job is to see through the defenses to the real, concealed problems.
The author fixated on her ex's flaws to avoid deeper issues after their breakup.
Her therapist noticed a clue -- she lamented her life being "half over." He realized she was grieving more than just the lost relationship. On a deeper level, she was distraught about loneliness and death itself.
"Anger is the go-to feeling for most people because it's outward-directed -- angrily blaming others can feel deliciously sanctimonious. But often it's only the tip of the iceberg, and if you look beneath the surface, you'll glimpse submerged feelings you either weren't aware of or didn't want to show: fear, helplessness, envy, loneliness, insecurity. And if you can tolerate these deeper feelings long enough to understand them and listen to what they're telling you, you'll not only manage your anger in more productive ways, you also won't be so angry all the time."
Lack of human connection is a common underlying issue in therapy.
The author's own fear of isolation rose when her relationship ended. She is scared that with middle age looming, she would not find love again.
Human touch reduces blood pressure and stress, elevates moods, and strengthens immune systems. Infants deprived of touch can die, whereas regular touch in adulthood correlates with extended lifespans.
"We all have a deep yearning to understand ourselves and be understood. When I see couples in therapy, often one or the other will complain, not 'you don't love me' but 'you don't understand me.'"
Forging a bond with the therapist helps patients heal since the sessions offer intimate conversations often lacking in modern life. The therapist helps to reframe the patient's narratives so they can progress in feeling better.
Lack of purpose or meaning is a common underlying issue in therapy.
The author struggled with the obligation of a book contract. She felt an overwhelming sense of anxiety because of her lack of connection to the book's topic.
Recognizing the project's disconnect to her, she faced the risk of losing her identity and purpose tied to writing. Eventually, she chose to forgo the contract, returning the advance, and wrote Maybe You Should Talk to Someone, a book far more meaningful to her.
Lack of freedom or feeling trapped is a common underlying issue in therapy.
The author's decision to break her book contract addressed the issue of feeling confined.
Julie, a young professor diagnosed with terminal cancer, confronted a situation beyond escape. Despite her fate, Julie chose to embrace life -- taking risks and seeking new experiences like joining a band, going on a game show, and working as a grocery store cashier.
Julie's transformation emphasizes the power of choice even in dire situations.
"The inability to say no is largely about approval-seeking -- people imagine that if they say no, they won't be loved by others. The inability to say yes, however -- to intimacy, a job opportunity, an alcohol program -- is more about lack of trust in oneself. Will I mess this up? Will this turn out badly? Isn't it safer to stay where I am?"
We can find purpose and choose our responses in even the most challenging circumstances, as Viktor Frankl shows in Man's Search for Meaning depicting his experiences as a Holocaust survivor.
Internal resistance to change often stems from a comfort found in familiarity, even within unhealthy and destructive patterns.
Charlotte struggles with alcohol dependency and a pattern of toxic relationships. Despite her efforts to break these cycles, she continued with her pattern of alcoholism and detrimental partners.
Growing up, Charlotte's parents frequently verbally abused each other. Her tumultuous upbringing shaped her understanding of love and relationship, associating it with anxiety and instability. As a result, she is drawn to unhealthy relationships.
If an addict recovers, the people around her may unconsciously undermine it, since the status quo has a "troubled person" they're used to.
At the outset of therapy, Charlotte spoke monotonously about everything and appeared completely emotionally detached, a condition known as alexithymia.
Repression of negative feelings leads to unresolved emotions, surfacing in unhealthy behaviors (e.g., drinking) or physical symptoms (e.g., loss of appetite, ulcers, panic attacks).
Many people can't identify or express their feelings because they were discouraged to do so by their parents or society (particularly affects men).
Emotional liberation happens when patients openly express buried emotions, whether through vocal admissions, tears, or heartfelt letters, allowing individuals to confront suppressed aspects and begin the journey of resolution.
A reaction like crying or exclaiming how you feel should not be considered as a "break down" but as a breakthrough.