What to read before starting therapy.
Congrats on an excellent decision, by the way
It’s a Monday at 11:45 a.m., so I’m in bed with my laptop. Dr. S is at home, too, seated in front of a window, branches raking the pane. We’re floating heads on each other’s screens.
“The next newsletter—you know that newsletter I’m doing?—is about therapy.”
“I forget,” she says, “am I allowed to read it? I want to read this one.”
“Sure. I’m struggling with it. There are too many books about this.”
“Well, what do you think people should know?” she asks.
“That therapy isn’t what they think?”
“What do people think? What did you think?”
“I guess like how it is in movies, like an expressionless person nudging tissues toward you, or a bearded Austrian with a couch.”
“I think you’re watching the wrong movies. Robin Williams in Good Will Hunting? He’s not like that. Ordinary People?”
“I’ve never seen Ordinary People.”
“Oh, you should.”
So, that afternoon I watch Ordinary People. The therapist smokes a lot, prods and retreats, urges baby Timothy Hutton to stop bullshitting. He shows up to the office in the wee hours when Timothy is in crisis, and, after hearing why, gives him a fatherly hug. I wonder if Dr. S would hug me, assuming we’re ever in the same room again. Would she take my call at 2 a.m.? I get confused: Was she saying to watch this because Judd Hirsch is a great therapist, or just that he’s not the poker-faced enigma or Freud clone I’d described? Maybe she just likes the movie.
Sometimes in therapy I worry things are going over my head. Sometimes they are, either because we get into abstract territory, or I’m still processing the last thing she said as she says something new. But it’s okay. Whatever the subject—this maladaptive impulse, that illogical thought—it will recur. After the tenth time I do something self-defeating, I’ll realize we’ve spoken several times about how to avoid it. That’s one thing to know: Therapy is about accrual.
As such, it takes a while. I haven’t seen her in person for two years, but I’ve been Dr. S’s patient for almost eight.
One night in May 2014, I sat beside my friend, P—a psychoanalyst, older than me, born in Italy—at a reading. We chatted, waiting for the author to begin. P was mid-sentence talking about a book when I felt gathering heat behind my eyes. Nothing had sparked the tears, but also everything had, my whole flailing life. As people filed in around us, I wept like a child.
“I’ve been struggling lately,” I said—just the previous twenty years or so.
“Jesus, you are not okay,” P said, horrorstruck; in ten years of close friendship, she’d never seen me cry. “We will find you someone,” she said. “Do not worry, my Katie.” Outside, I said I felt like a dead person pretending to be alive. “That’s depression,” P said, gesturing wildly like Italians do. “Why did you not tell me, dingus?” (Our mutual nickname, which in her accent becomes “ding-goose.”) I said this was me telling her—that I felt little joy or hope, was certain no one loved me, that I couldn’t blame them. I suppose I’d let her see because she, imbued with the twin authorities of age and Jung, was best positioned to drag me out of my inertia.
Paradoxically, I’d avoided therapy because of how dire my state had become. My self-loathing had metastasized, guilt and rage eating every organ, and I thought a therapist would recoil at how bad I’d let things get, like when the dentist lays into you for failing to floss times a thousand. I’d settled for a GP who prescribed an antidepressant at a comically low dosage.
But now things were bad. So, I let P arrange a session with a therapist and professor recommended by her supervisor. Dr. S, I was told, had a sterling reputation and took no insurance.
“I can’t afford that,” I said weakly.
“Fuck these insurances,” P said. “You need someone real.”
The narrow waiting area was lamplit and silent, and Dr. S retrieved me in sturdy heels and a pencil dress, her generous smile evaporating the image of her I’d constructed on the way over: sober, imperious, eager to judge. She seemed like a cool aunt, or the kind of neighbor who always waves. And yet, in her homey office, white noise machine purring, I told her none of the real reasons I’d come: that I was no longer able to live around my depression as if it didn’t exist, which, after years of white-knuckling, was terrifying; that I knew I couldn’t stay in my marriage but also couldn’t leave it; that I was drifting steadily from the life I wanted and couldn’t seem to fight the current. Instead, I fed her fluff—my stressful job, a toxic friend, the second novel I couldn’t fix. All true, but all beside the point.
I worried aloud about the money part. “Oh,” Dr. S said. “Well, I use a sliding scale.”
“Why?”
She cocked her head. “Because why should I only treat rich people?”
I went once a week. I left the marriage, bad friend, and job. I felt I could handle life so long as Dr. S was the scaffolding around it—if I encountered an unwieldy problem or feeling, we’d tinker under the hood and make it okay. It felt good. It felt safe.
“But dingus, do you love her?” P kept asking.
Was I supposed to? Dr. S was nice. She was kind and wise and well-read and sardonic. She watched all the same TV shows I did. She was easy to talk to and had astute insights—the kind that pin you to your chair as you reframe what you thought you knew. But that was the whole idea, right? So, to me, Dr. S was like a doctor or professor; a functionary, one whose influence was felt and whose personality I enjoyed but with whom I never expected or wanted genuine intimacy. Our work might seem intimate, the way a doctor sees you naked or a professor sees the mechanisms of your mind, but it wasn’t real.
Dr. S, too, would pose versions of P’s question. If I said I felt let down, she asked if she had ever let me down. If I was angry, she asked if I’d ever been angry with her. Finally, she came out with it: “How do you feel about me?” she asked. “It’s not that I’m vain—it really does matter.”
I seize with shame to recall my answer: “I feel nothing about you,” I said—on numerous occasions. I was telling the truth, sort of; if I looked only to the parts of me most anesthetized against emotion, it wasn’t a lie. Any deeper and things got murky. What did love mean in this context? What could it mean? She wasn’t my friend; I paid her. (Not much, but still.) I was her job. I tried to prove this to her, to articulate this obvious hole in her logic, the reason I didn’t love her and could never love her:
“I don’t know you!” I cried. “I tell you stuff, it only goes one way!”
Dr. S shook her head gravely. “You do know me,” she said. “You know how I see the world, what I think is important. You might not know some biographical details, but you know me.”
The rightness of this thawed something. I let her be a person. I addressed her by name in emails instead of the empty “Hey there!” I’d leaned on. I asked questions about her, after fearing for years that she’d refuse to answer—an outcome that would’ve felt like intolerable rejection. (She’s married with grown kids, loves Paul Simon and flowers and travel, disdains Dr. Melfi for putting a table between herself and her patients, and always makes two soups on Thanksgiving.)
Then we reached the turning point, the event that divides our work into before and after: Dr. S saved my life. It sounds mawkish if you don’t know how literally I mean it.
Nine months in, mired in a weekslong low, I confessed that I’d given some thought to doing something terrible, irreversible. She’d asked the session prior if I was having such thoughts, and I had assured her I wasn’t.
Dr. S’s expression darkened. “So, you lied to me.”
I think I apologized. I hope I did.
Her tone sagged with something unfamiliar. “And if you’d gone through with it? What would that have meant for me?”
“Well, professionally I’m sure it would’ve felt like a failing…”
“Don’t do that,” she said. “You know damn well that’s not what I mean.”
There was a long pause. And in it, I finally understood what the unfamiliar thing in her voice had been: sorrow, and anger born of that sorrow. It was the sound of love.
“It would have made you very sad,” I said.
“I would have been devastated,” she said.
Time was up. (Another thing to know: For better or worse, the session always ends.)
“Well, I’ll tell you this much,” she said, “we’re not dicking around with a little Wellbutrin anymore. And I have to insist that you start coming twice a week.”
I did, for years. I saw, and still see, a psychiatrist Dr. S recommended, who put me on proper meds. Life became brighter, lighter, reliably even. It was like having a cataract removed. For the first time in my adult life, I could see.
A long while later, Dr. S asked if her response that day had been okay, if it was too little or too much. I told her the truth: It was just right.
These days, Dr. S and I talk about my dreams (“when the subway went through Beyonce’s apartment, did she react?”), or my son (“you get a million chances,” she says when I worry that I’ve failed him), or what I’ll do for money when print journalism finally dies. We talk more and more about aging, my creeping dread that my life may already be half over. (“I don’t like your math,” she tells me.) Recently she said, “In the end, the resource that everyone wants more of isn’t money, but time,” and I think about that every day. If therapy were a marriage, we’d be in our settled, middle-aged epoch of comfort and quiet, with a bevy of shared references and a general expectation of smooth sailing. Some Mondays I tell her, “Nothing’s happened, I have nothing interesting for you.”
“Good!” she always says.
Now I must end this piece, which is tricky: I don’t have an ending yet, in life or in prose. Are Dr. S and I closer to the beginning of our time together, or to its conclusion? I don’t know. She likes to say that “hams get cured, dogs get fixed.” You’ll never be all better. So, what does it mean, then, to be finished with therapy? I don’t know, and it frustrates me. A surgeon reattaches your severed foot and calls it a day. But a therapist helps in a way you may have trouble even articulating, and much of the work is done by you—you’re sewing on your own foot as someone gently questions your approach, asking you to describe how it came off in the first place.
Whenever Dr. S asks about our eventual end, I run down a litany of baggage I haven’t yet dumped on her doorstep: Can’t you see I’m still a mess?! I used to think my panic about our parting indicated that it wasn’t yet time. But more and more I think it indicates that goodbyes are very hard. Which is one last thing to know: If you find the right person, therapy carries a steep surcharge. After spending early sessions terrified of being seen, you’ll spend latter ones pre-mourning the loss of those eyes upon you. Grief, it’s been said, is the tax we pay on love. And though I didn’t know it, that was what I went to Dr. S to learn: how to love, whatever the cost.
As you gear up to go spelunking in your psyche, I hope these books will ease and aid your journey. I hope your insurance doesn’t give you any guff. I hope you join me in becoming an irritating proselytizer who quotes their therapist at dinner parties. And I wish you the best of luck, my dinguses, with all the learning and unlearning ahead.
1.
Author: Stephen Grosz
Book; Nonfiction (2014)
In addition to being a precise and engaging writer, Grosz is a psychoanalyst who’s logged 50,000 hours with patients. (We’ll set aside the dizzying taxonomy of clinicians and disciplines—psychoanalyst versus psychotherapist, etc.—other than to say that analysis can involve years of four to five sessions per week, which likely explains Grosz’s tally.) This moving and meditative book is the result. Its candor is at times startling; the reader is given strikingly intimate glimpses of Grosz’s patients. We see their feints and denials, how they hide and withdraw and mislead, mostly without meaning to, and we see their quiet triumphs, too, the moments when they let go of their fears and take risks, rethink, grow. A theme hums beneath each narrative, becoming more insistent with each page, and that theme is blindness to the self, the astounding degree to which we remain ignorant of our motives and desires. Let this blindness be the premise from which you start. Let your task be not to get “better,” not yet. Let it be first to understand.
2.
Couch Fiction: A Graphic Tale of Psychotherapy
Author: Philippa Perry Artist: Junko Graat
Book; Graphic Novel (2010)
In any session (or conversation, really), countless systems are operating simultaneously: the talk itself, the interior monologue of both parties, the unconscious shifts each person makes to mirror the other, the tapestry of associations informing their perceptions, and on and on. Add to that the therapist’s strategic drawing out of the patient, informed by years of training and experience, and the patient’s subtle acts of resistance—obfuscating, deflecting, digressing—and you’ve got a bubbling stew of subtext. This graphic novel’s ingenious format (you see the spoken words and private thoughts of both parties, all at once) portrays this curious dance both comprehensibly and compellingly—it’s a narrative feat.
Extra Credit: If you like hanging out at the nexus of graphic novels and psychology (or just enjoy very good books), treat yourself to the searching and contemplative illustrated memoirs of Alison Bechdel. Her most beloved work is of course Fun Home (2007), and with good reason—but her meta-memoir of her relationship with her mom, Are You My Mother? (2013), is also marvelous, drawing heavily on revelations Bechdel had while undergoing analysis.
3.
Author: Lorrie Moore
Short story; originally published in the New York Times (1993), revised and republished (as “Four Calling Birds, Three French Hens”) in Birds of America (1998), and anthologized in On the Couch: Great American Stories About Therapy (1999)
In this droll tale (which you can read in full via the link), grief-ridden Aileen seeks help after the loss of her cat, Bert. “I have a death-of-a-pet situation,” she barks at prospective therapists. “How long does it take for you to do those?” After several explain that it doesn’t work that way, Aileen finds Sidney, who specializes in “Christmas specials.” As he puts it, “You feel better by Christmas, or your last session’s free.” (This chat takes place on December 1.)
Sometimes Sidney falls asleep mid-session, and Aileen must clap to wake him, but when he’s conscious, she tells him of Bert’s fine qualities, and of her guilt about prolonging his end with medical interventions—“all that metallic and fluorescent voodoo.” Aileen assures her loved ones that her intense grief isn’t, as they suggest, “really” about something else—and as far as the reader can tell, that’s true. I mention this because therapy can inspire a weird strain of imposter syndrome; we think we’re allowed to go only if we have a problem that desperately needs solving. Not so! You can go because you’re about to become a parent and want to reinforce your emotional reserves, or because you have a sneaking suspicion that you’re carrying around an old hurt and wish to investigate it. You can go because you’d like to know yourself better.
As Aileen’s husband says, “Life is a long journey across a wide country. Sometimes the weather’s good. Sometimes it’s bad. Sometimes it’s so bad your car goes off the road.” You can go to therapy when it’s barely sprinkling, or even when it’s a sunny 72 degrees. You don’t have to—nor should you—wait until you’re skidding on black ice.
4.
Psychoanalysis: The Impossible Profession
Author: Janet Malcolm
Book; Nonfiction (1981)
I don’t reread books, but I’ve read this three times. (Before this last go, it’d been a while—inside, I found notes I took in poetry class on September 28, 2004.) Like much of Malcolm’s work, it’s juicy; no small feat for what’s ostensibly a rundown of psychoanalytic approaches. But that rundown turns out to be flecked with more absurdity than you might imagine, and the prose is irresistibly sly, and it all results in a surprisingly fun read.
Malcolm hangs her story on a pseudonymous psychoanalyst from New York, and, through his sessions with patients, discusses the principles that guide his work. Meanwhile, the analyst himself is struggling with personal issues that two years-long analyses haven’t remedied; he’s now considering a third go, and a wisp of judgment (three times?!) haunts the book. But Malcolm’s greatest accomplishment is her rendering of the always-changing, somewhat fractious world of psychoanalysis—the disagreements between disciplines, the roiling revisions and re-revisions of canonical theories, the sects that congeal around particular thinkers. If you’re going into therapy thinking of every practitioner as some enlightened being who’s above reproach, this book will disabuse you of that notion pretty quickly.
In addition to saucy insider info, the book also offers a thoroughly readable briefing on therapy’s theoretical underpinnings. You don’t need to know that stuff—you won’t be quizzed at your first session—but it can be helpful to have a sense of what, say, transference is, or sublimation, or object relations theory. I’ve found that knowing things like this helps me make sense of revelations and emotions that arise in therapy—and reassures me that I’m not the only person ever to do self-defeating stuff in this or that way.
5.
Author: Judith Rossner
Book; Fiction (1983)
The title of this intricate, scrupulously drawn novel refers to the month in which therapists traditionally take leave. (Actually, the practice is less ubiquitous now; this book is only a year younger than me, which makes it pretty old.) The novel zeroes in on a single patient and her therapist, cataloguing their sessions in obsessive detail. The patient, Dawn Henley—Rossner must be a fan of The Eagles?—is a flinty, stunning teenager who sees Lulu, the therapist, only at her parents’ urging. But soon, Dawn grows so dependent on Lulu that August’s looming separation fills her with dread. The annual gearing up for, tolerating of, and recovering from that month apart imposes a rhythm on their four-year therapeutic relationship, which eventually sees Dawn through her depression and into a promising adulthood. The novel stays laser focused on their talks—instructive for a newbie!—with glimpses of Lulu’s life outside the office but never Dawn’s, in a curious recreation of a therapist’s limited vantage: To them, you can only ever be the you that you’ve explained into being, session by session.
The book’s big twist is that Lulu is as much a mess as Dawn, flinging herself through life with little direction or sense. But Dawn shifts something in Lulu, intrigues her, stays with her as she goes about her days. Personally, as someone who struggled early on to imagine her therapist as a living being with a life outside that room—like when little-kid-you assumed your teacher lived at school—I relished the peek into a clinician’s human, fallible existence. It makes the alchemy of therapy somehow more extraordinary that, ultimately, you’re both just people. The deep dive into Lulu’s private life puts one in mind of the question every patient has at some point—what does my therapist think of me?—and evokes the weirdly scandalous notion that even as they’re having an effect on you, you might be having an effect on them, too.
6.
Author: David Lodge
Book; Fiction (1993)
What to do when you have everything but aren’t happy? What’s the half-life of regret? Can you ever fully recover from ancient pains? These and other thorny questions lie at the center of this delightfully odd novel, which follows listless screenwriter Tubby Passmore on his quest to discover the cause of his midlife angst and apparently psychologically afflicted knee. The narrative unfolds in three parts: first, Tubby’s diary, sparked by a session with his therapist; second, a series of monologues in which folks in his orbit discuss Tubby (spoiler alert, you find out later that Tubby wrote those, too); and third, a mini memoir by Tubby that finally locates the source of his woe. It’s that second part that’s intriguing for our purposes, because it wryly simulates the tyranny of our own perceptions. Just as we’re prisoners of Tubby’s vision of the world, despite believing that what we’re seeing is objective, so too are we captive to the distorted lens of our neuroses—at least, that is, until someone helps us learn to question the view.
Next time: What to read if you think you want to write a novel…