Maybe You Should Talk to Someone

by Lori Gottlieb

  “This is the counseling you want?” Wendell asks.

  I nod. Given the earlier fiasco, I imagine he’s being extra-careful in how he responds.

  “What can I tell you that will be useful to you?” he asks.

  I think about this. He can’t answer my question about whether Margo has the appointment before mine or even say if he’s aware that we’re talking about Margo. He can’t tell me if the fact that I see his patient’s husband is new information or if he’s known all along. He can’t tell me what Margo may or may not have said about me. And I know if I were ever to say anything about John, Wendell would handle it professionally and we’d talk about it in the moment. Maybe I want his advice on whether I did the right thing by telling him about the situation.

  “Do you ever wonder if I’m a good therapist?” I ask instead. “I mean, given all you’ve seen in here?” I remember my earlier “Do you like me?,” but this time I’m asking something different. Then I was saying, Do you love me as a child, love my neshama? Now I’m saying, Can you picture me as an adult, as a competent grownup? Of course, Wendell has never seen me do therapy, has never supervised my work. How can he have any opinion at all on the matter? I start to say this but Wendell stops me.

  “I know you are,” he says.

  At first I don’t understand. He knows I’m a good therapist? Based on wha—oh! So Margo thinks things are getting better with John.

  Wendell smiles. I smile. We both know what he can’t tell me.

  “I have one more question,” I say. “Given the situation, how do we lessen the awkwardness?”

  “Maybe you just did,” he says.

  And he’s right. In couples therapy, therapists talk about the difference between privacy (spaces in people’s psyches that everyone needs in healthy relationships) and secrecy (which stems from shame and tends to be corrosive). Carl Jung called secrets “psychic poison,” and after all of the secrets I’ve kept from Wendell, it feels good to have this final secret out in the open.

  I don’t ask for counseling again because the truth is that Wendell has been counseling me from day one, in the sense that therapy is a profession you learn by doing—not just the work of being a therapist, but also the work of being a patient. It’s a dual apprenticeship, which is why there’s a saying that therapists can take their patients only as far as they’ve gone in their own inner lives. (There’s much debate about this idea—like my colleagues, I’ve seen patients reach heights I can only aspire to. But still, it’s no surprise that as I heal inside, I’m also becoming more adept at healing others.)

  On a practical level, too, I’ve taken Wendell’s lessons straight to my office.

  “I’m reminded of a cartoon of a prisoner, shaking the bars . . .” I said to John early on, in a Hail Mary attempt to help him see that the “idiot” he was talking about that day wasn’t his jailer after all.

  When I got to the punch line—the bars are open on each side—John smiled for a second in what seemed like recognition but then batted it back at me. “Oh, give me a break,” he said, rolling his eyes. “Do other patients actually fall for this?” But he was the outlier. The intervention has worked beautifully with everyone else.

  Still, the most important skill I’ve learned from Wendell is how to remain strategic while also bringing my personality into the room. Would I kick a patient to make a point? Probably not. Would I sing? I’m not sure. But I might not have yelled “Fuck!” with Julie had I not seen Wendell be so utterly himself with me. In internships, therapists learn how to do therapy by the book, mastering the fundamentals the way you have to master scales when learning to play piano. For both, once you know the basics, you can skillfully improvise. Wendell’s rule isn’t as simple as “There are no rules.” There are rules, and we’re trained to adhere to them for a reason. But he has shown me that when rules are bent with thoughtful intention, it broadens the definition of what effective treatment can be.

  Wendell and I don’t talk about John or Margo again, but a few weeks later, as I settle into my chair in the waiting room, Wendell’s door opens and I hear a male voice. “So this time next Wednesday?”

  “Yes, see you then,” replies Wendell, then his door clicks shut.

  Past the screen, a guy in a suit slips out the door to the hall. Interesting, I think. Maybe the woman before me ended her therapy, or maybe she was Margo, and Wendell engineered the switch to protect my privacy in case Margo eventually figured it out. I don’t ask, though, because it doesn’t matter anymore.

  Wendell was right: The awkwardness had disappeared. The secret was out, the psychic poison diluted.

  I’d gotten all the counseling—or was it therapy?—I needed.

  50

  Deathzilla

  It’s ten minutes before Julie’s session, and I’m mainlining pretzels in our suite’s kitchen. I don’t know when our last session will be. If she’s late, I think the worst. Should I check on her between sessions or let her call if she needs me (knowing she has trouble asking for help)? Should therapists’ boundaries be different—looser—with terminally ill patients?

  The first time I saw Julie at Trader Joe’s, I’d been reluctant to get in her line, but every time after that, if I happened to be there when she was, Julie would wave me over and I’d happily go. If my son was with me, he’d get an extra sheet of stickers and a high five. And when Julie wasn’t there anymore, he noticed.

  “Where’s Julie?” he asked, scanning the counters for her as we approached the checkout. It wasn’t that I wouldn’t talk about death with him—a close childhood friend of mine had died of cancer a few years before, and I had told Zach the truth about her illness. But because of confidentiality, I couldn’t reveal more about Julie. One question would lead to another, to lines I couldn’t cross.

  “Maybe she changed days,” I said, as if I knew her only as the clerk at Trader Joe’s. “Or maybe she got another job.”

  “She wouldn’t get another job,” Zach said. “She loved her job!” I was struck by his response: even a young child could tell.

  Without Julie there anymore, we’ve been going in Emma’s line—the woman who offered to carry Julie’s baby. Emma also gives him extra stickers.

  But back at my office, waiting for Julie to arrive, I ask the same question Zach did: “Where’s Julie?”

  There’s a word we use for the end of therapy: termination. I’ve always found it to be oddly harsh-sounding for what’s ideally a warm, bittersweet, and moving experience, much like a graduation. Generally, when the therapy is coming to an end, the work moves toward its final stage, which is saying goodbye. In those sessions, the patient and I consolidate the changes made by talking about “process and progress.” What was helpful in getting to where the person is today? What wasn’t? What has she learned about herself—her strengths, her challenges, her internal scripts and narratives—and what coping strategies and healthier ways of being can she take with her when she leaves? Underlying all this, of course, is how do we say goodbye?

  In our daily lives, many of us don’t have the experience of meaningful goodbyes, and sometimes we don’t get goodbyes at all. The termination process allows someone who has spent a great deal of time working through a significant life issue to do more than simply leave with some version of “Well, thanks again—see ya!” Research shows that people tend to remember experiences based on how they end, and termination is a powerful phase in therapy because it gives them the experience of a positive conclusion in what might have been a lifetime of negative, unresolved, or empty endings.

  Julie and I have been preparing for another kind of termination, though. We both know that her therapy won’t end until she dies; I made her that promise. And our process lately has consisted of more and more silence, not because we’re avoiding saying something, but because this is how we’re facing each other most honestly. Our silences are rich, our emotions swirling in the air. But the silences are also about her declining state. She has less energy, and talking can take a
toll. Jarringly, Julie looks healthy, if thin, on the outside, which is why so many people have trouble believing that she’s dying. Sometimes I do too. And in a way, our silences serve another purpose: They give us the illusion of stopping time. For fifty blissful minutes, we’re both granted a respite from the outside world. She feels safe here, she told me, not having to worry about people worrying about her, having their own feelings.

  “But I have feelings about you too,” I said the day that Julie brought this up.

  She thought about this for a second and then said simply, “I know.”

  “Would you like to know what they are?” I asked.

  Julie smiled. “I know that too.” And then we went back to silence.

  Of course, between the silences, Julie and I have also been talking. Recently, she said she was thinking about time travel. She’d heard a radio show about it and shared a quote she loved, a description of the past as “a vast encyclopedia of calamities you can still fix.” She’d memorized it, she said, because it made her laugh. And then it made her cry. Because she’ll never live long enough to have this list of calamities that other people acquire by the time they reach old age—relationships they’d want to mend, career paths they’d want to take, mistakes that they’d go back and “get right” this time.

  Instead, Julie has been time-traveling to the past to relive parts of her life that she’s enjoyed: birthday parties as a child, vacations with her grandparents, her first crush, her first publication, her first conversation with Matt, one that lasted until dawn and still hasn’t ended. But even if she were healthy, she said, she’d never want to travel to the future. She wouldn’t want to know the plot of the movie, to hear the spoilers.

  “The future is hope,” Julie said. “But where’s the hope if you already know what happens? What are you living for then? What are you striving for?”

  I immediately thought of a difference between Julie and Rita, between young and old, but flip-flopped. Julie, who was young, had no future but was happy with her past. Rita, who was old, had a future but was plagued by her past.

  It was that day that Julie fell asleep in session for the first time. She dozed off for a few minutes, and when she woke up and realized what had happened, she made a joke, out of embarrassment, about how I must have been time-traveling while she was sleeping, wishing I were someplace else.

  I told her I wasn’t. I was remembering hearing what must have been the same show she’d heard on the radio, and I was thinking about an observation made at the end of that segment—that we’re all time-traveling into the future and at exactly the same rate: sixty minutes per hour.

  “Then I guess we’re fellow time travelers in here,” Julie said.

  “We are,” I said. “Even when you’re resting.”

  Another time Julie broke our silence to tell me that Matt thought she was being a Deathzilla—going crazy with the death-party planning, the way some brides become over-the-top Bridezillas with their weddings. She’d even hired a party planner to help carry out her funeral-party vision (“It’s my day, after all!”), and despite his initial discomfort, Matt was now fully onboard.

  “We planned a wedding together and now we’re planning a funeral together,” Julie said, and it has been, she told me, one of the most intimate experiences of their lives, full of deep love and deep pain and gallows humor. When I asked what she wanted that day to be like, first she said, “Well, I’d rather not be dead that day,” but failing that, she didn’t want it to be all “sugarcoated” and “cheery.” She liked the idea of a “celebration of life,” which the party planner told her was all the rage nowadays, but she didn’t like the message that came with it.

  “It’s a funeral, for God’s sake,” she said. “All these people in my cancer group say, ‘I want people to celebrate! I don’t want people to be sad at my funeral.’ And I’m like, ‘Why the fuck not? You died!’”

  “You want to have touched people and for them to be affected by your death,” I said. “And for those people to remember you, to keep you in mind.”

  Julie told me that she wanted people to keep her in mind the way she keeps me in mind between sessions.

  “I’ll be driving, and I’ll panic about something, but then I’ll hear your voice,” she explained. “I’ll remember something you said.”

  I thought about how I did this with Wendell—how I’d internalized his lines of questioning, his way of reframing situations, his voice. This is such a universal experience that one litmus test of whether a patient is ready for termination is whether she carries around the therapist’s voice in her head, applying it to situations and essentially eliminating the need for the therapy. “I started to get depressed,” a patient might report near the end of treatment, “but then I thought of what you said last month.” I’ve had entire conversations in my head with Wendell, and Julie has done the same with me.

  “This might sound crazy,” Julie said, “but I know that I’ll hear your voice after I die—that I’ll hear you wherever I am.”

  Julie had told me that she’d begun thinking about the afterlife, a concept she insisted that she didn’t completely believe in but nonetheless contemplated, “just in case.” Would she be alone? Afraid? Everyone she loved was still alive—her husband, her parents, her grandparents, her sister, her nephew and niece. Who would keep her company there? And then she realized two things: first, that her babies from her miscarriages might be there, wherever “there” was, and second, that she was coming to believe that she would hear, in some unknowable spiritual way, the voices of those she loved.

  “I would never say this if I weren’t dying,” she said shyly, “but I include you in those I love. I know you’re my therapist, so I hope you don’t think it’s creepy, but when I tell people that I love my therapist, I really mean I love my therapist.”

  Though I’d come to love many patients over the years, I’d never used those words with any of them. In training, we’re taught to be careful with our words to avoid misinterpretations. There are many ways to convey to patients how deeply we’ve come to care about them without getting into dicey territory. Saying “I love you” isn’t one of those ways. But Julie had said she loved me, and I wasn’t going to stand on professional ceremony and reply with a watered-down response.

  “I love you too, Julie,” I said to her that day. She smiled, then closed her eyes and dozed off again.

  Now, as I stand in the kitchen waiting for Julie, I think about that conversation and about the ways I know that I’ll hear her voice too, long after she’s gone, especially at certain times, like while shopping at Trader Joe’s or folding laundry and seeing that pajama top with NAMAST’AY IN BED in the pile. I’m saving that top not to remember Boyfriend anymore, but to remember Julie.

  I’m still munching on pretzels when my green light goes on. I pop one more into my mouth, rinse my hands, and breathe a sigh of relief.

  Julie’s early today. She’s alive.

  51

  Dear Myron

  Rita is carrying an artist’s portfolio, a large black case with nylon handles that’s at least three feet long. She’s begun teaching art at the local university, the one from which she would have graduated had she not dropped out to get married, and today she brought in her own work to share with her students.

  Her portfolio holds sketches for the prints that she’s selling on her website, a series based on her own life. The images are visually comical and even cartoonish, but their themes—regret, humiliation, time, eighty-year-old sex—reveal their darkness and depth. She’s shown me these before, but now when Rita reaches into her portfolio, she takes out something else: a yellow legal pad.

  She hasn’t spoken to Myron since the kiss more than two months ago—has avoided him, in fact, going to a different class at the Y, ignoring his knocks on her door (she uses the peephole for screening purposes now, not for spying on the hello-family), going into stealth mode when moving about the building. She’s been taking time to craft a letter, obsessi
ng over every line. She tells me she has no idea if her words make sense anymore, and after reading it again this morning, she’s not convinced she should send it at all.

  “Can I read it to you before I make an absolute fool of myself?” she asks.

  “Of course,” I say, and she places the yellow pad on her lap.

  I can see her handwriting from where I’m sitting—not the specific letters, but the shapes. An artist’s handwriting, I think. Gorgeous cursive, the loops perfectly formed but with an added flair. It takes her a minute to start. She breathes in, sighs, almost begins, breathes in, and sighs again. Finally, she speaks.

  “‘Dear Myron,’” she reads off the page, then looks up at me. “Is that too formal—or too intimate, perhaps? Do you think I should start with ‘Hi’? Or just the more neutral ‘Myron’?”

  “I think if you worry too much about the details, you might miss the big picture,” I say, and Rita makes a face. She knows that I’m talking about more than her salutation.

  “All right, then,” she says, looking back at the lined pad. Still, she grabs a pen, crosses out the word dear, then takes a breath and begins again.

  “‘Myron,’” she reads. “‘I’m sorry for my inexcusable behavior in the parking lot. It was completely uncalled for, and I owe you an apology. I certainly owe you an explanation, and you deserve one. So I’m going to give you that here, and then I’m sure you’ll be done with me.’”

  I must have made a sound—an involuntary mmm—because Rita looks up and asks, “What? Too much?”

  “I was thinking about the prison sentence,” I say. “I was just noticing that you’re assuming Myron abides by your same punishment system.” Rita thinks about that, crosses something out, then continues reading.