What John doesn’t know is that I’m reeling from last night, when the man I thought I was going to marry unexpectedly called it quits. Today I’m trying to focus on my patients (allowing myself to cry only in the ten-minute breaks between sessions, carefully wiping away my running mascara before the next person arrives). In other words, I’m dealing with my pain the way I suspect John has been dealing with his: by covering it up.
As a therapist, I know a lot about pain, about the ways in which pain is tied to loss. But I also know something less commonly understood: that change and loss travel together. We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same. To help John, I’m going to have to figure out what his loss would be, but first, I’m going to have to understand mine. Because right now, all I can think about is what my boyfriend did last night.
The idiot!
I look back at John and think: I hear you, brother.
Wait a minute, you might be thinking. Why are you telling me all this? Aren’t therapists supposed to keep their personal lives private? Aren’t they supposed to be blank slates who never reveal anything about themselves, objective observers who refrain from calling their patients names—even in their heads? Besides, aren’t therapists, of all people, supposed to have their lives together?
On the one hand, yes. What happens in the therapy room should be done on behalf of the patient, and if therapists aren’t able to separate their own struggles from those of the people who come to them, then they should, without question, choose a different line of work.
On the other hand, this—right here, right now, between you and me—isn’t therapy, but a story about therapy: how we heal and where it leads us. Like in those National Geographic Channel shows that capture the embryonic development and birth of rare crocodiles, I want to capture the process in which humans, struggling to evolve, push against their shells until they quietly (but sometimes loudly) and slowly (but sometimes suddenly) crack open.
So while the image of me with mascara running down my tear-streaked face between sessions may be uncomfortable to contemplate, that’s where this story about the handful of struggling humans you are about to meet begins—with my own humanity.
Therapists, of course, deal with the daily challenges of living just like everyone else. This familiarity, in fact, is at the root of the connection we forge with strangers who trust us with their most delicate stories and secrets. Our training has taught us theories and tools and techniques, but whirring beneath our hard-earned expertise is the fact that we know just how hard it is to be a person. Which is to say, we still come to work each day as ourselves—with our own sets of vulnerabilities, our own longings and insecurities, and our own histories. Of all my credentials as a therapist, my most significant is that I’m a card-carrying member of the human race.
But revealing this humanity is another matter. One colleague told me that when her doctor called with the news that her pregnancy wasn’t viable, she was standing in a Starbucks, and she burst into tears. A patient happened to see her, canceled her next appointment, and never came back.
I remember hearing the writer Andrew Solomon tell a story about a married couple he’d met at a conference. During the course of the day, he said, each spouse had confessed independently to him to taking antidepressants but didn’t want the other to know. It turned out that they were hiding the same medication in the same house. No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We’ll talk with almost anyone about our physical health (can anyone imagine spouses hiding their reflux medication from each other?), even our sex lives, but bring up anxiety or depression or an intractable sense of grief, and the expression on the face looking back at you will probably read, Get me out of this conversation, pronto.
But what are we so afraid of? It’s not as if we’re going to peer in those darker corners, flip on the light, and find a bunch of cockroaches. Fireflies love the dark too. There’s beauty in those places. But we have to look in there to see it.
My business, the therapy business, is about looking.
And not just with my patients.
A little-discussed fact: Therapists go to therapists. We’re required, in fact, to go during training as part of our hours for licensure so that we know firsthand what our future patients will experience. We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others.
But then we get licensed, people come to seek our counsel and . . . we still go to therapy. Not continuously, necessarily, but a majority of us sit on somebody else’s couch at several points during our careers, partly to have a place to talk through the emotional impact of the kind of work we do, but partly because life happens and therapy helps us confront our demons when they pay a visit.
And visit they will, because everyone has demons—big, small, old, new, quiet, loud, whatever. These shared demons are testament to the fact that we aren’t such outliers after all. And it’s with this discovery that we can create a different relationship with our demons, one in which we no longer try to reason our way out of an inconvenient inner voice or numb our feelings with distractions like too much wine or food or hours spent surfing the internet (an activity my colleague calls “the most effective short-term nonprescription painkiller”).
One of the most important steps in therapy is helping people take responsibility for their current predicaments, because once they realize that they can (and must) construct their own lives, they’re free to generate change. Often, though, people carry around the belief that the majority of their problems are circumstantial or situational—which is to say, external. And if the problems are caused by everyone and everything else, by stuff out there, why should they bother to change themselves? Even if they decide to do things differently, won’t the rest of the world still be the same?
It’s a reasonable argument. But that’s not how life generally works.
Remember Sartre’s famous line “Hell is other people”? It’s true—the world is filled with difficult people (or, as John would have it, “idiots”). I’ll bet you could name five truly difficult people off the top of your head right now—some you assiduously avoid, others you would assiduously avoid if they didn’t share your last name. But sometimes—more often than we tend to realize—those difficult people are us.
That’s right—sometimes hell is us.
Sometimes we are the cause of our difficulties. And if we can step out of our own way, something astonishing happens.
A therapist will hold up a mirror to patients, but patients will also hold up a mirror to their therapists. Therapy is far from one-sided; it happens in a parallel process. Every day, our patients are opening up questions that we have to think about for ourselves. If they can see themselves more clearly through our reflections, we can see ourselves more clearly through theirs. This happens to therapists when we’re providing therapy, and it happens to our own therapists too. We are mirrors reflecting mirrors reflecting mirrors, showing one another what we can’t yet see.
Which brings me back to John. Today, I’m not thinking about any of this. As far as I’m concerned, it’s been a difficult day with a difficult patient, and to make matters worse, I’m seeing John right after a young newlywed who’s dying of cancer—which is never an ideal time to see anyone, but especially not when you haven’t gotten much sleep, and your marriage plans have just been canceled, and you know that your pain is trivial compared to that of a terminally ill woman, and you also sense (but aren’t yet aware) that it’s not trivial at all because something cataclysmic is happening inside you.