“Maybe You Should Talk to Someone:” A Second Opinion
I was excited to read Lori Gottlieb’s book, “Maybe you Should Talk to Someone.” As a psychologist and therapist in therapy (off and on), a memoir-style book about a therapist (in therapy) is right up my proverbial alley. Candidly, however, I was disappointed. Not only does the book portray therapists as good-natured, but slightly self-righteous, know-it-alls, it does nothing to minimize the “ick factor” associated with psychotherapy in general.
While Gottlieb does a fine job of “pulling back the curtain” and letting readers see the inner workings of psychotherapy and the psychotherapist’s mind, her book does little to dispel the unhelpful myths and misconceptions surrounding the therapy process.
Take, for instance, several notable cringe-worthy “ick” moments. In both the book and in subsequent media interviews, Gottlieb repeatedly compares psychotherapy to “pornography,” in that “everyone does it, but nobody talks about it.” She also reveals that one of her more challenging patients refers to her as his “hooker,” (jokingly, of course) but in her attempt to characterize him as a narcissist this detail is simply unnecessary. She also tells a dying patient that she loves her, which the author defends in the context of treatment, but still – personally, made me uncomfortable. And, at one point, Gottlieb admits to asking her own therapist, “Do you like me?” after spending a considerable amount of time describing how attractive she thought he was.
O.M.G. Stop.
Aside from these images casting therapists in a less-than-flattering light, and promoting therapy in the same romanticized and sensationalized way that all media tends to do, Gottlieb’s book does something potentially even more harmful. It does nothing to dispel the notion of psychotherapy as a self-indulgent privilege, a “paid friendship,” effective only for those with the means to access it and the intellectual capacity for deep self-reflection.
Now, don’t get me wrong. This is not a criticism of Gottlieb’s writing style – she is a fantastic story-teller – nor is it a criticism of her as a therapist – she is clearly gifted and loves her work. She articulates extremely well the complexities of human motivation and readiness for change, and the difficulties we all face as we confront our vulnerabilities. But the story she tells does little to challenge the outdated idea that “just talking” about our problems will somehow fix them.
Modern-day psychotherapy is an active, goal-driven, outcomes-measured, collaborative, structured, and effective process because its emphasis is less on talking and more on doing. We work. We roll up our sleeves. We identify the root of the problem quickly and start applying creative solutions, all in the service of learning and growth. Change begins immediately.
I am a strong proponent for creating more informed consumers of mental health care, discussing what is effective and scientifically supported for which conditions. Equipping individuals with the right information to pursue the right kind of treatment with the right provider. Expanding access through accurate information.
I am also deeply committed to reducing the stigma attached to seeking mental health treatment and minimizing barriers to quality care. Disparity still exists, and as long as the media continue to portray therapy as “just talking,” insurers will remain reluctant to pay. Thousands upon thousands of individuals who don’t look like Gottlieb’s clientele/audience who would benefit from the work will never have access to it. There are very effective, non-medication treatments available for serious and pervasive clinical problems, like anxiety, depression, and substance use that could benefit people who may be reluctant to seek it out. This is why the myths and misconceptions surrounding the therapeutic change process are so damaging and for whom the effects will be felt for generations. If I were the author, I would be careful not to directly or indirectly promote outdated ideas about mental health issues that further shame and isolate those who experience them.
All in all, I would love to create a world where we can have open and routine conversations about therapy and how it works, and in doing so, eliminate barriers to treatment for all those who would benefit. I commend Gottlieb for giving us a place to start. The publicity and interest this book has generated certainly moves the needle, but we still have a long way to go.
