Lori Gottlieb: Understanding Pain, Therapeutic Breakthroughs, and Keys to Emotional Health

Lori Gottlieb’s Journey

• Started working in the entertainment business after college 
  • Worked in film development, then moved to network television at NBC
  • Worked on shows like ER and Friends
• Spent time in a real ER with a physician consultant for the show ER 
  • Realized she enjoyed the human stories and inflection points in people’s lives
• Decided to go to medical school at Stanford 
  • Wanted to guide people through their lives and have long-​​term relationships with patients
  • Felt the new medical model with managed care was not conducive to her goals
  • Began writing about her experiences in medical school
  • Eventually left medical school to become a journalist and author
• Later became a psychotherapist, seeing individuals and couples in her practice in Los Angeles 
  • Wrote the book “Maybe You Should Talk to Someone”
  • Writes the weekly “Dear Therapist” column for The Atlantic
  • Has a podcast called “Dear Therapists” with co-​​host Guy Winch
  • Gave a TED Talk about how changing our stories can help us change our lives

Lori Gottlieb’s journey to becoming a psychotherapist was non-​​linear, starting in the entertainment business and then going to medical school. She was drawn to the human stories and inflection points in people’s lives, which led her to eventually become a therapist. In addition to her practice, she writes, speaks, and hosts a podcast about helping people navigate their struggles and grow as individuals.
Lori Gottlieb’s Journey

• Left medical school to become a journalist 
  • Felt she could help people tell their stories through writing
  • Worked as a journalist for 10 years
• After having a baby, desired more social interaction 
  • Called the Dean at Stanford Medical School about returning for psychiatry
  • Dean suggested getting a graduate degree in clinical psychology instead
• Became a therapist, helping people change their stories 
  • Feels like an editor, helping people edit their faulty narratives

Medical School Experience

• Anatomy class with cadavers 
  • Emotional experience, humanizing the cadavers
  • Respect for the cadavers and their families’ donations
  • Ceremony at the end to express gratitude

Courage to Leave Medical School

• Less risk-​​averse at that point in life 
  • Felt she only had one life to live and wanted to make choices that wouldn’t impact others
• Believed in listening to the inner voice and trusting oneself 
  • Helps clients in therapy find their own answers

Career Changes

• Left a job at NBC to pursue medical school
• Left medical school to become a freelance journalist
• Left journalism to become a therapist with an infant
  Pursuing Passions and Facing Mortality
• Decisions to change career paths were not impulsive, but well-thought-out 
• Sunk cost fallacy: people argue that time and effort invested in a career should not be abandoned 
  • Counterargument: focus on what you want to do for the rest of your life, not what you’ve done in the past
• Julie’s story: young woman diagnosed with treatable breast cancer 
  • Came to therapy for support as a newlywed going through cancer treatment
  • Later diagnosed with a rare, aggressive, and incurable cancer
  • Asked therapist to stay with her until she died, wanted to separate therapy from the “cancer world”
  • Made unconventional choices in her life, despite others thinking she was crazy
  • Emphasized living life intentionally and being aware of the gift of life
    Trader Joe’s and Squeegeeing: Finding Joy in Simple Tasks
• Woman with terminal illness wanted to work at Trader Joe’s 
  • Enjoyed the energy and connection with customers
  • Wanted to make people’s day better, even for a moment
• Doctor wished for time to squeegee windshields at a gas station 
  • Found satisfaction in the tangible, brief interaction with customers
  • Both examples show the desire for simple, meaningful tasks in life

Therapy: Dealing with Difficult Patients

• John: abrasive, unlikable, insulting 
  • Kept people at a distance to avoid confronting his pain
  • Grew the most in therapy as he learned to communicate and face his pain
• People often make judgments about others without knowing their full story 
  • John becomes a character that readers care about by the end of the book

Counseling vs. Therapy

• Counseling: short-​​term, focused on specific issues
• Therapy: deeper, long-​​term exploration of emotions and behaviors 
  • Not about instant gratification or providing answers
  • Helps patients access their own knowledge and make informed decisions
  • Therapists must resist the temptation to tell patients what to do
    Lori Gottlieb’s Experience with a Patient Named John
• John came to therapy presenting with sleep disturbance and blaming “idiots” for making his life difficult 
• John was initially resistant to opening up and being vulnerable in therapy
• Lori Gottlieb, the therapist, worked to build a relationship with John and create a safe environment for him to share his feelings
• John eventually broke open and revealed deep pain and vulnerability
• Lori noticed differences in how men and women approach therapy and vulnerability 
  • Men often struggle with mixed messages about emotional availability and vulnerability
  • Women may have already shared their feelings with a few close people before therapy
• Lori emphasizes the importance of the relationship between therapist and patient for successful therapy

The Importance of the Therapist-​​Patient Relationship

• Studies show that the most important factor in the success of therapy is the relationship between the therapist and the patient
• This relationship matters more than the therapist’s training, modality, or years of experience
• Building trust and creating a safe space for vulnerability is crucial for therapeutic progress
  Therapy and Personal Growth
• Therapy can help individuals rewrite their personal stories 
  • Gain new perspectives and interpretations of events
  • Manage remorse, regret, and self-forgiveness
• Change happens gradually, then suddenly 
  • Lasting change requires multiple steps and maintenance
  • Understanding that setbacks are part of the process
• Therapeutic relationship is crucial for progress 
  • Goal is to have moments of connection in each session
  • Develop trust and understanding between therapist and client
• Personal growth and transformation can happen at any age 
  • Never too late to seek help and make changes in one’s life
  • Requires commitment and willingness to face challenges
    Loneliness and Therapy
• Loneliness can lead to a false sense of self 
• Therapy can provide a safe space for individuals to be themselves
• Building trust and connection with a therapist can take time

Therapists Learning from Each Other

• Therapists can learn from their own therapists and apply those lessons to their practice
• Example: Wendell’s metaphor of the open prison bars, encouraging patients to take responsibility for their lives

Discussing Suicide in Therapy

• Important to assess for suicide when a patient is depressed or mentions it
• Asking about suicide does not plant the idea in their head, but rather provides an opportunity for open discussion
• One of the biggest risk factors for suicide is feeling isolated

Common Issues in Therapy

• Relational issues (romantic, familial, work, etc.) and relationship to self
• Therapy can provide a second opinion on one’s life from an unbiased perspective

Humor and Self-​​Deprecation in Therapy

• Recognizing the ridiculousness of human behavior can be both humorous and relatable
• Therapists can acknowledge their own flaws and experiences to connect with patients

Change and Uncertainty

• Humans often resist change due to fear of uncertainty
• Moments of unwanted change can lead to transformative experiences

Rita’s Story

• Rita is an isolated individual with estranged adult children and failed marriages
• She gives the therapist an ultimatum to help her find a reason to live by her 70^th birthday
• Rita’s story highlights the importance of human connection and physical touch
  The Importance of Touch and Connection
• People are routinely touched during the day in various ways 
  • Hugging, shaking hands, high fives, etc.
• Touch is important for connection and feeling a part of the human race

Rita’s Struggles

• Felt regret for mistakes as a parent and in relationships
• Lived with a sense of isolation and lack of connection
• Had a fear of joy (cherophobia) due to childhood experiences with an inconsistent mother
• Sabotaged potential connections in her adult life

Rita’s Letter to Myron

• Reveals her shame and past mistakes
• Shows her vulnerability and desire for connection
• Asks if Myron can tolerate and accept her despite her past actions

Choosing Patients for the Book

• Author chose patients she was no longer seeing in therapy
• Ensured patients gave permission for their stories to be included
• Avoided including patients who may feel pressured to please or be the “star patient”
• Patients’ reactions to the book showed they felt cared for and understood by the author
  The Importance of Emotional Health
• Emotional health is often undervalued compared to physical health 
• People often ignore emotional discomfort until it becomes a crisis
• Emotional health issues can cause collateral damage to relationships
• Therapy is focused on the present and making changes for a better future
• Insight alone is not enough; changes must be made in the real world
• Investing in emotional health has a high return on investment (ROI) for improving the quality of life

Misconceptions about Therapy

• Therapy is not just talking about childhood or past experiences
• It is not just downloading the problem of the week
• Insight is the first step, but real change must be made in the person’s life
• Therapy is like physical therapy; exercises must be done outside of sessions for improvement
• The ultimate goal of therapy is to improve the quality of a person’s life

Lori Gottlieb’s Work

• Author of “Maybe You Should Talk to Someone”
• Hosts the podcast “Dear Therapists”
• Writes the column “Dear Therapist” for The Atlantic