We all went quiet. You won’t get today back.
What a chilling idea. We knew that our supervisor was trying to tell us something important. But we didn’t have time to think about it.
Speed is about time, but it’s also closely related to endurance and effort. The faster the speed, the thinking goes, the less endurance or effort required. Patience, on the other hand, requires endurance and effort. It’s defined as “the bearing of provocation, annoyance, misfortune, or pain without complaint, loss of temper, irritation, or the like.” Of course, much of life is made up of provocation, annoyance, misfortune, and pain; in psychology, patience might be thought of as the bearing of these difficulties for long enough to work through them. Feeling your sadness or anxiety can also give you essential information about yourself and your world.
But while I was down in that basement rushing toward licensure, the American Psychological Association published a paper called “Where Has All the Psychotherapy Gone?” It noted that 30 percent fewer patients received psychological interventions in 2008 than they had ten years earlier and that since the 1990s, the managed-care industry—the same system that my medical-school professors had warned us about—had been increasingly limiting visits and reimbursements for talk therapy but not for drug treatment. It went on to say that in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians—nearly twice what they spent on research and development.
Of course, it’s a lot easier—and quicker—to swallow a pill than to do the heavy lifting of looking inside yourself. And I had nothing against patients using medication to feel better. Just the opposite; I was, in fact, a strong believer in the tremendous good it often did in the right situations. But did 26 percent of the general population in this country really need to be on psychiatric medications? After all, it wasn’t that psychotherapy didn’t work. It was that it didn’t work fast enough for today’s patients, who were now, tellingly, called “consumers.”
There was an unspoken irony to all of this. People wanted a speedy solution to their problems, but what if their moods had been driven down in the first place by the hurried pace of their lives? They imagined that they were rushing now in order to savor their lives later, but so often, later never came. The psychoanalyst Erich Fromm had made this point more than fifty years earlier: “Modern man thinks he loses something—time—when he does not do things quickly; yet he does not know what to do with the time he gains except kill it.” Fromm was right; people didn’t use extra time earned to relax or connect with friends or family. Instead, they tried to cram more in.
One day, as we interns begged to be given more new cases despite our full caseloads, our supervisor shook her head.
“The speed of light is outdated,” she said dryly. “Today, everybody moves at the speed of want.”
Indeed, I sped through. Before long, I completed my internship, passed my board exams, and moved upstairs into an airy office with a view of the world around me. After two false starts—Hollywood, medical school—I was ready to begin a career I felt passionate about, and my being older also gave it a sense of urgency. I had taken a circuitous route, arriving late to the game, and though now I could finally slow down and appreciate the hard-won fruits of my labor, I still felt as rushed as I had in my internship—this time, I felt rushed to enjoy it. I sent out an email announcement introducing my practice and did some networking. After six months, I had a smattering of patients, but then the number seemed to plateau. Everyone I spoke to was having a similar experience.
I joined a consultation group for new therapists, and one night, after we’d discussed our cases, the conversation turned to the state of our practices—were we imagining things, or was our generation of therapists doomed? Somebody said she had heard about branding specialists specifically for therapists, professionals who could help to bridge the gap between the culture’s need for speed and ease and what we were trained to do.
We all laughed—branding consultants for therapists? How ludicrous. The influential therapists of the past that we admired would be turning in their graves! But secretly, she got my attention.
A week later, I found myself on the phone with a branding consultant for therapists.
“Nobody wants to buy therapy anymore,” the consultant said matter-of-factly. “They want to buy a solution to a problem.” She made some suggestions about positioning myself for this new marketplace—even proposing that I should offer “text therapy”—but the whole thing made me uncomfortable.
Still, she was right. The week before Christmas, I got a call from a man in his early thirties about coming in for therapy. He explained that he wanted to figure out whether to marry his girlfriend, and he hoped we could “resolve this” quickly because Valentine’s Day was coming up and he knew he had to produce a ring or she’d bail. I explained that I could help him with clarity but couldn’t guarantee his timeline. It was a big life question, and I didn’t know anything about him yet.
We set up an appointment, but the day before he was to come in, he called and told me he’d found someone else to help sort things out. She’d given him a guarantee that they’d resolve the issue in four sessions, which would meet his Valentine’s Day deadline.
Another patient who genuinely wanted to find a life partner told me that she was going through people on the dating apps so fast that several times she had contacted a guy only to have him reply that they’d already met. She’d actually spent an hour having coffee with this person, but she was cycling through her options so quickly that she couldn’t keep track.
Both of these patients were examples of, as my supervisor had put it, “the speed of want”—want in the sense of a desire. But I also began to think of the term slightly differently, as referring to the other sort of want—a lack or deficit.
If you’d asked me when I started as a therapist what most people came in for, I would have replied that they hoped to feel less anxious or depressed, to have less problematic relationships. But no matter the circumstances, there seemed to be this common element of loneliness, a craving for but a lack of a strong sense of human connection. A want. They rarely expressed it that way, but the more I learned about their lives, the more I could sense it, and I felt it in many ways myself.
One day at my new practice, in the long lull between patients, I found a video online of MIT researcher Sherry Turkle talking about this loneliness. In the late 1990s, she said, she had gone to a nursing home and watched a robot comfort an elderly woman who had lost a child. The robot looked like a baby seal, with fur and large eyelashes, and it processed language well enough to respond appropriately. The woman was pouring her heart out to this robot, and it seemed to follow her eyes, to be listening to her.
Turkle went on to say that while her colleagues considered this seal robot to be great progress, a way to make people’s lives easier, she felt profoundly depressed.
I gasped in recognition. Just the day before, I’d joked to a colleague, “Why not have a therapist in your iPhone?” I didn’t know then that soon there would be therapists in smartphones—apps through which you could connect with a therapist “anytime, anywhere . . . within seconds” to “feel better now.” I felt about these options the way Turkle felt about the woman with the robotic seal.