Maybe You Should Talk to Someone is a memoir by Lori Gottlieb, an author and therapist, about a particularly difficult time in her life—a time when she sought out therapy herself—and common struggles that people have. Lori’s own story is interwoven with the stories of some of her patients, all of which relate to Lori’s issues in some way.
The story begins with Lori getting dumped by her boyfriend. The problem, according to him, is that Lori has a young son and he doesn’t want to live with a kid in the house anymore—his own children are older and will be leaving for college soon.
Lori completely breaks down. She had planned to spend the rest of her life with this person, and now she’s grieving not only the relationship, but also the life she thought she’d have. Lori is in her 40s and wonders whether she’ll ever be able to find another romantic partner.
At first Lori tries to tough it out, but after a couple of weeks, she realizes that she’s not recovering. She’s suffering from anxiety and forgetfulness, and she’s obsessing over her ex, even going so far as to stalk him on Google and social media. She finally seeks out a therapist for, she thinks, a few weeks of crisis management in order to get back on her feet.
Lori ends up seeing an eccentric therapist named Wendell Bronson. At first she tries to cast her ex in as bad a light as possible, hoping Wendell will confirm that he’s a bad person and Lori was deeply wronged. Instead, over many sessions, Wendell coaxes out the deeper issues Lori is facing: the fear of death and the search for meaning in her life.
Lori eventually reveals that she has more problems than just the breakup. She’s also suffering from a mysterious illness that causes painful rashes, muscle tremors and weakness, and a variety of other symptoms. No doctor so far has been able to diagnose her—one test suggests that it may be an autoimmune condition called Sjogren syndrome, but the results aren’t conclusive.
On top of that, she’s accepted a contract to write a book about happiness, but she hasn’t been able to write it. She’s already taken a significant advance on the book, which she’ll have to pay back if she breaks the contract, and her agent has warned her that if she doesn’t write this book, she might never be contracted to write another. Lori feels trapped, but Wendell says she reminds him of a cartoon character he once saw: a man behind bars, rattling them, apparently trying to escape, but never noticing that there are no walls around him. He means that Lori is the one trapping herself.
It turns out that all of these problems are related. Lori’s advancing age and her strange condition are making her think about death. She doesn’t know if her disease is fatal and, if so, how long it will take to kill her. As a result, she can’t commit to spending what time she has on a book that isn’t meaningful to her.
John is one of Lori’s patients. He’s a bigshot in the TV industry who suffers from anger issues and thinks everyone he meets—including his wife—is stupid. The only things he seems genuinely fond of are his two daughters and the family dog. His issues echo Lori’s sense of loss and her fear of letting others hurt her.
John first comes to Lori because he’s having trouble sleeping. He’s abrasive and rude, and he openly breaks Lori’s rules about therapy: He uses his cell phone during sessions and orders food to eat while they’re talking. He’s emotionally distant, insulting and blaming everyone except himself for his problems. Lori eventually realizes that this is a defense mechanism: If everything is someone else’s fault, then John doesn’t have to do the hard work of looking inward and changing himself.
It takes months of work, but eventually Lori learns that John used to also have a young son named Gabe. Gabe was killed in a car accident that John alternately blamed himself and his wife for, though it turned out the driver who hit them was drunk. Since then, John has tried to repress his feelings and keep working to support himself and his family. While he’s been highly successful professionally, it’s taken a heavy toll on his emotional state and his family life.
By the end of therapy, John has begun to open up with Lori and with his family. He used to forbid any mention of Gabe at home, but now he and his wife have had some cathartic conversations about their son. They’ve also started attending couples therapy.
There’s still more work for John and Lori to do, but he’s made huge improvements and seems to be on the right track to recover. His major revelation is that he doesn’t always have to be one thing or another: He doesn’t always have to be the good guy or the bad guy, and he doesn’t always have to be happy or grieving. Everything comes and goes, including happiness, and the important thing is to accept whatever each moment brings.
Julie is a young woman who learned she had cancer shortly after getting married. While at first the treatment seemed to be working and her disease went into remission, it soon came back. This time, doctors gave her one to five years to live. She’s depressed because she feels like her life is ending right as it was about to truly start. Her problems echo Lori’s fears of mortality and living a meaningless life.
At first, Julie is angry at the unfairness of her situation. Through her sessions with Lori, she eventually makes peace with the fact that nobody knows how his or her life will turn out or even how long it will be. She comes to appreciate what she still has: a loving husband, many close friends, her strength, and a sound mind—for however long they last—and even Lori, her therapist.
With Lori’s encouragement, Julie creates a bucket list for herself; not just a list of things she’d like to do “someday,” but a short, achievable plan for the rest of her life. With death looming over her, Julie—who has always been a cautious and careful planner—discovers a newfound spontaneity and zest for life.
One of the most surprising things Julie does is take a part-time job at Trader Joe’s. After seeing how the cashiers are able to connect with their customers and have immediate, concrete impacts on their lives (by talking with them and bagging groceries), Julie realizes that she wants that for herself. Though her husband, and even Lori, think the idea is ridiculous, she does it anyway and is very happy working there.
As Julie’s disease progresses, doctors have to remove more and more of her organs to buy her more time. She compares it to a twisted game of Would You Rather, a children’s game where the player is presented with two unappealing situations and forced to choose between them. Julie recalls that, as a child, she had broken the rules by choosing neither. In fact, “I choose neither” had been her yearbook quote in high school. Unfortunately, this time “neither” isn’t an option—she has to choose between her body parts and her life.
During one of her last sessions, Julie talks about the plans she’s made for her funeral. She likes the idea of celebrating her life, but while many people in her cancer support groups say that they don’t want people to be sad at their funerals, Julie rejects that idea. Instead, she wants people to remember and mourn her so she knows that she mattered. During that same session, she talks about all the things she misses—that cancer has taken from her—and all the things she’ll miss when she’s dead. She starts cursing and asks Lori to scream obscenities as a sort of final catharsis. Though it’s extremely unorthodox, Lori joins her.
Julie passes away shortly after that, peacefully in her home. Lori goes to her funeral, which is attended by hundreds of people from all different parts of Julie’s life. Even though she’d died very young, Julie had a remarkable impact on the people around her. One of the last things Julie had asked was whether Lori would remember her; even years later, while writing Maybe You Should Talk to Someone, she still does.
Rita is a woman in her 60s who is several times divorced, estranged from her children, and in despair because she thinks it’s too late to turn her life around. During their first session together, she tells Lori that if her life doesn’t improve within a year, she’s planning to end it. Her problems echo Lori’s fears of mortality and loneliness.
Rita’s first husband was an abusive alcoholic, and her greatest regret is failing to protect their kids from him. Similarly, the children have never forgiven her for the way they were raised. She lives alone in a small apartment, where she spends her days painting, napping, and watching TV. She is intensely jealous of the happy family across the hall.
Lori initially encourages Rita to try reaching out and connecting with people, romantically and otherwise. Rita tries using Tinder for a while, but she is disgusted by the aging bodies of the men in her age group. Lori continues trying to get her to reach out to people, though even Lori isn’t sure what kind of new life Rita will be able to make for herself at this point. This issue parallels Lori’s uncertainty about her own advancing age and whether she’ll be able to find another romantic partner at this point in her life.
Rita eventually confesses that there had been a man named Myron in her life, and she’d been very fond of him. He’d even created a website for her to show off her art. However, their relationship had been purely platonic. Right as Rita was considering bringing up romance with Myron, he’d gotten together with another woman he met online. Rita immediately cut off all contact with him, and that incident was what drove her to seek out therapy.
Over time, Rita becomes friends with the family across the hall. Their children are enthralled by her artwork, and with the parents’ help, Rita adds an online store to her website to sell her creations.
At around the same time, Myron’s relationship with the other woman ends because he realizes that he doesn’t enjoy spending time with her the way he did with Rita. He tries to reestablish contact, but Rita storms off.
Aside from Myron, Rita seems to be getting everything she wanted: She now has companionship, and she’s creating art for people who appreciate it—and her. However, she’s showing signs of cherophobia: fear of joy. She explains that she’s always waiting for something to go wrong, like it always has in the past. She’s psychologically unable to let herself be happy.
The next major step Rita takes is writing a letter to Myron talking about her past in detail, and explaining why she reacted the way she did. She’s sure that once Myron knows who she “really” is—in other words, who Rita thinks she is—he’ll be disgusted and abandon her. Lori asks Rita whether the letter is really for Myron, or if it’s what she wants to say to her children. The answer is that it’s both.
Similar to how John is able to reconnect with people after opening up about his son Gabe, Rita’s cathartic reading of the letter drops some of her defenses and lets her make meaningful connections again. Myron doesn’t abandon her, and they end up together.
Rita also eventually makes contact with most of her children again. By giving up the need for forgiveness and trying to create new relationships with her children instead of fixing the old ones, she’s been able to reconnect with all but the youngest—he’s still too angry to let her back into his life, and Rita must accept that that might never change.
However, far from the depressed, suicidal woman she’d been at the beginning of the book, Rita manages to create a happy and fulfilling life for herself, even though she’s already pushing 70. Though she will always have some pain and some regrets, she has learned to accept her life for what it is and to appreciate and enjoy the good things without smothering them in despair.
Charlotte is a young woman with a drinking problem and a history of getting into bad relationships. She finds herself attracted to emotionally unavailable people and always ends up getting hurt. Charlotte’s connections to Lori’s issues are perhaps the least obvious of all her patients; however, her relationship struggles and her inability to get emotionally invested in healthy people and habits echo Lori’s painful breakup and search for meaningful work.
These problems are evident throughout the book as Charlotte has an on-again, off-again fling with another patient she sits with in the waiting room. The Dude, as she calls him, strings her along for months. He repeatedly breaks up with, then gets back together with, another woman, leaving Charlotte to get hurt over and over.
Charlotte also has a habit of asking Lori for advice about every little problem she has, from what she should do about an upcoming presentation to whether she should call a doctor about an injured toe. Lori believes this habit, and Charlotte’s relationship problems, are the result of having had an unsettled home life. Her parents were often absent, and when they were around, they frequently drank and fought with each other.
This had two major effects on Charlotte’s psyche: First, she had to act like an adult long before she was ready, and Lori thinks she’s trying to compensate for that by acting like a helpless child now; second, she subconsciously associates love with anxiety and uncertainty. That’s why she’s always attracted to people who end up hurting her, and when she meets a man with the qualities she claims to want—emotional stability and reliability—she doesn’t feel a “spark.”
However, perhaps the strangest thing about Charlotte is that she seems to think her real addiction isn’t to alcohol or emotionally distant men, but to therapy. Lori comes to realize that it’s because therapy is a perfect setting for someone like Charlotte, who both craves and fears human connection. She’s able to open up freely while in therapy, but at the end of her hour she always gets to leave.
After months of treatment, Charlotte makes two significant steps: She asks Lori to recommend an outpatient alcohol abuse treatment program, and she asks to move her appointment time so she won’t be sitting with The Dude. By the end of the book, though there’s still more work for Charlotte and Lori to do, she is sober and seemingly ready for healthier relationships.
The most important thing Lori learns during her time with her own therapist, Wendell, is how to accept uncertainty. She doesn’t know what her disease is, she doesn’t know how long she’ll live, and she doesn’t know if she’ll ever find someone to spend her life with—and that’s okay. Not knowing doesn’t mean she has to despair; it means she can hope and savor every moment she has, however many moments that may be.
Eventually she decides to break her book contract, and she accepts that she’ll have to spend a long time paying back the advance. Shortly after, she starts writing another book about her recent experiences; she’s not contracted to write this one but feels compelled to do so because it’s a meaningful and important topic to her. That book will eventually become Maybe You Should Talk to Someone.
In the final scene of the book, Lori leaves Wendell’s office after their last session together. She notices that the nearest crosswalk signal has changed so she can cross. However, instead of rushing to catch it, she notices that it’s a beautiful day out and takes a minute to just enjoy the sun. This shows that she’s finally living fully in the moment and enjoying life for what it is, instead of constantly dreading the future.
Maybe You Should Talk to Someone is a memoir by Lori Gottlieb, a therapist and author. She tells the story of a bad breakup and the midlife crisis it led to.
After her breakup, Lori finds herself spiraling into depression and despair. She eventually seeks therapy herself, where she realizes that her issues are much deeper than the end of a relationship.
Though she thinks she’s just there for some crisis management to deal with the breakup, Lori eventually realizes that she’s facing several of the fundamental fears that all humans share: mortality, loneliness, freedom, and futility. At the root of it all is uncertainty—Lori’s plan for the rest of her life has fallen apart. She doesn’t know what will happen next, and that terrifies her.
Lori’s struggles are mirrored by those of some of her patients, whose stories and issues are interwoven with her own. In dealing with her patients, Lori gets insight into her own life. She brings many of these insights to her therapist, and together they are able to work through Lori’s problems and help her to accept uncertainty in life.
By the end, Lori is able to shift her perspective—instead of regarding uncertainty with dread, now she can regard it with hope. Instead of fearing what might go wrong, she can now look forward to what might go right.
Many people don’t realize it, but therapists also go to therapy. It’s a requirement during training, but many continue to see other therapists while practicing. They will especially seek out help during difficult times in their lives, such as, in Lori’s case, a bad breakup.
A key point of this story is that therapists are humans too. In fact, that’s one of the main reasons they can be effective: They go through many of the same struggles as their patients. Therapists can use their shared experiences to forge meaningful connections with their patients. However, they must be careful what they share, so as to remain trustworthy and competent in the patient’s eyes.
Sharing too much, or the wrong thing, could make the patient lose faith in the therapist. Imagine if a therapist mentioned, for example, that she’d gotten a DUI; the patient’s view of the therapist would change, likely for the worse. On the other hand, in some situations, sharing that information could actually strengthen the relationship—say, if the patient is also struggling with alcoholism.
Whatever the case, the single most important thing for a therapist is to be honest. Even a little white lie can damage trust if discovered, and damaged trust is very hard to repair. However, when combined with the need to be seen as competent and collected, this means that therapists often find themselves toeing a difficult line when the conversation turns toward their own lives.
Unfortunately, there’s still a powerful stigma around mental health issues. For example, one of Lori’s colleagues lost a patient when that patient happened to see the colleague crying in Starbucks after getting some bad news. He didn’t feel comfortable seeing a therapist who had problems of her own, and he cut off their sessions.
As another example, Lori once had a husband and wife couple who were both hiding their antidepressants, because each didn’t want the other to know they were taking them. This phenomenon is almost unique to mental health issues like anxiety and depression—people don’t tend to hide other types of meds, or think less of people for taking them.
Because of that stigma, many people Lori meets outside the office become uncomfortable when they learn that she’s a therapist. She compares therapy to pornography: Both involve a type of exposure, both have the potential to be either exciting or uncomfortable, and both have millions of customers—many of whom hide the fact that they are customers.
People also tend to be afraid that Lori will see through their defenses and expose their inner insecurities and vulnerabilities. That concern isn’t entirely unfounded; breaking down people’s defenses and forcing them to examine themselves is the entire point of therapy.
Many people believe that their problems are all because of circumstances or because of other people. It can be a useful defense mechanism; if their problems aren’t their fault, then there’s no need to change themselves. However, while it’s true that there are a lot of difficult people in the world, we cause our own problems far more often than we’d like to admit—something that’s true of Lori as well.
Lori acknowledges almost immediately that, as a writer and a human being, she can sometimes be an unreliable narrator who’s responsible for more of her own problems than she cares to admit.
Lori speaks in terms of narrators and stories because she’s always had an interest in them. In fact, before becoming a therapist, she worked in movies and then the TV industry as a writer. When working on the medical drama E.R., she became fascinated by medical work, and she eventually quit her job to go to med school.
Lori knew she wanted to do something where she could form a real bond with her patients. Unfortunately, most medical fields had moved—or were in the process of moving—to a less personal, more “assembly-line” style of treatment. The focus was on maximizing how many patients doctors could see per day, rather than making meaningful connections with their clients. This growing disconnect between doctors and patients eventually led her to leave medical school as well.
Lori’s interest in people and their stories eventually led her to therapy work. The dean of Lori’s old medical school gave her the idea—Lori had originally called to float the idea of going into psychiatry, but the dean said that was a terrible idea. Lori wouldn’t be happy just prescribing pills to her patients, and going through medical school and residency as a new mother would be a nightmare.
(Shortform note: The nuances between psychiatry and psychology are often a matter of some confusion. The main difference is that psychiatrists are trained in how to use and prescribe various medications, while psychologists are focused entirely on talk therapy and similar treatments.)
Clinical psychology was the perfect opportunity for Lori to connect with and help people, while still leaving her time to spend with her young child. Being a therapist would also give her the flexibility to continue her writing career.
In fact, therapists are a bit like editors, helping patients to rewrite their stories. In that sense, it was a perfect match with Lori’s writing skills. Therapists look for important characters and recurring themes in patients’ lives. They help determine whether the “main character” (that is, the patient) is making progress or just spinning his or her wheels.
There’s often some kind of grief at the heart of a patient’s issue, but there may be a lot of built-up stories to work through before finding it. On top of that, people are often unreliable narrators—two people recounting the same event might tell wildly different stories.
For example, Lori tells people the story of her sociopathic ex-boyfriend who strung her along for two years, knowing the whole time that he didn’t want to live with a child. The boyfriend might have a very different take on the events. However, we never get to hear his side of the story, because Lori doesn’t know it either.
Even when the stories aren’t overtly biased, people are bound to forget or omit details that they deem unimportant or uncomfortable. Therefore, it’s also part of a therapist’s job to dig out those details.
The issue that drives a person to seek therapy is the presenting problem. The presenting problem may be a major traumatic event, or simply a feeling that something is wrong. However, in therapy, the presenting problem is often a mask for a deeper issue, usually relating to grief, loss, or fear.
Lori has just broken up with her long-term boyfriend, whose name is not given. This is her presenting problem. The boyfriend left because of Lori’s 8-year-old son—his own kids will be moving out soon, and he doesn’t want to be tied down anymore once that happens.
He says he loves Lori and wants to be with her, but the kid is a deal-breaker. He thought he could come to terms with it, but after two years of dating, they were starting to talk about moving in together, and he realized that he didn’t want that.
Lori is reminded of patients who insist that they can only be happy in extremely specific scenarios, like if their dream job wasn’t quite so far away, or the person they’re madly in love with had a different career (or, in this case, didn’t have a kid). Perfect can be the enemy of good—by waiting for this perfect scenario that will never happen, they’re denying themselves the happiness they could have had.
As a therapist herself, one might expect Lori to immediately seek out help after this upsetting event. However, she tries to go on with life as normal—placing one foot in front of the other, as she often tells her patients to do.
Unfortunately, she’s not able to continue as normal. Two weeks later she’s suffering from forgetfulness and anxiety and obsessing over her now-ex boyfriend. One of Lori’s friends suggests that she should see a therapist, and Lori knows her friend is right.
However, finding the right therapist is tricky under normal circumstances and doubly so for another therapist. Many studies have shown that the single most important thing in treatment is how well you connect with your therapist; but therapists have to stringently avoid any conflicts between their personal and professional lives. That means that, in addition to finding somebody they “click” with, they also have to find someone they have no previous connection to. Not even a friend of a friend is acceptable—the two must be complete strangers.
Lori contacts a colleague—an associate, not a friend—to get a referral. She specifies, without saying that she’s the patient, that she wants a male therapist who’s married and has children. In short, she wants someone like her ex-boyfriend.
In Lori’s mind, if someone like that is as outraged by her ex’s decision as Lori is, it will prove that she’s “right” and he was “wrong.” In fact, Lori is quite certain her new therapist will confirm that her ex-boyfriend is a sociopath.
After considering and rejecting a number of possible therapists, she settles on one named Wendell Bronson, who meets all of her criteria. She makes an appointment with Wendell, saying that she just needs a few weeks of treatment for crisis management in order to get back on her feet.
Many people’s lives don’t pan out the way they expected—an unexpected change in Lori’s life was the inciting incident for this entire book.
Welcome to Holland is a well-known essay about learning to be happy with what you have, even if it wasn’t what you expected. The premise is that a fictional person who was supposed to be going on vacation to Italy somehow wound up in Holland instead. That person now has two choices: either spend the whole vacation upset that Holland isn’t Italy, or explore and enjoy Holland for what it is.
One of Lori’s patients, Julie, was diagnosed with terminal cancer shortly after getting married. A friend of Julie’s sent her Welcome to Holland in hopes of encouraging her to make the most of what she has. However, the essay enraged Julie, who demanded to know what good there could possibly be in her situation.
When Julie brings this up during treatment, Lori acknowledges that the friend was probably trying to help, but that Julie’s reaction to it is understandable and valid. Later, Welcome to Holland comes up again in Julie’s treatment, after she’s processed her anger about it.
Julie now understands that almost nobody’s life goes exactly as planned, and there will always be people whose lives seem better—or worse—than one’s own. For example, the friend who sent her the essay in the first place has a severely autistic child. Taking care of the child has completely drained her friend both emotionally and financially. Julie isn’t sure whether she’d want to trade places with that friend.
With this new understanding and acceptance, Lori and Julie begin making her an “itinerary” for her time in “Holland.” They plan on Julie having 10 years to live, which they acknowledge is optimistic, but say they can adjust the schedule as needed. Julie starts making a bucket list—but not just to have one, as many people do. She makes a relatively short, attainable list of goals and immediately sets out to accomplish them.
Chronologically, this all happened before Maybe You Should Talk to Someone began. However, after the breakup with her boyfriend, Lori begins thinking about the essay again. She has a similar reaction to Julie, wondering what good there could possibly be in being single—again—in her 40s.
At first, Lori feels guilty about comparing her situation to Julie’s, but she remembers that a key point in therapy is you shouldn’t judge your pain based on the pain of others. In other words, your pain isn’t invalid just because someone else has it worse. This also reflects Julie’s discussion about whether she’d want to trade places with her friend. Really, the question is irrelevant—Julie isn’t this other woman, and all she can do is deal with the life she has.
Lori has her first appointment with Wendell to start sorting out her own story. She finds that Wendell and his office are a bit strange: Perhaps oddest of all, his office doesn’t have the usual therapist’s chair, just two couches arranged in an L shape.
Lori sits as far from Wendell as possible, right at one tip of the L. She’s later surprised to learn that many people choose to sit right at the corner of the L, with Wendell just across from them (on the other couch).
Wendell doesn’t open with the usual questions, he just sits and waits for Lori to speak. Like many patients, Lori tries to appear more in control than she is. Patients are, of course, looking for help, but they also want people to think well of them, so they often try to hide their struggles. However, she soon breaks down and tells Wendell about the breakup while crying uncontrollably.
Lori is in her 40s now, and she’s lamenting the fact that half her life is over and she’s back to being single. While explaining what happened, she tries to cast her ex in the worst possible light. She explains all about his history of avoidant behavior (trying to ignore problems instead of confronting them), and she repeatedly asks Wendell to confirm that what her ex had done was wrong.
Wendell doesn’t do this. Instead, he notes that it’s odd she knew so much about her ex’s patterns of avoidance and was still blindsided. He also suggests that she may be grieving something bigger than simply a failed relationship.
However, Lori isn’t ready to confront deeper issues yet. She goes back to talking about her ex. Wendell allows this, knowing that they have to build trust and understanding before they can address the underlying problems. Lori’s next several sessions go much the same way.
She’s contacted her ex several times looking for answers, and she comes to her therapy sessions with detailed notes about the conversations. She claims to be trying to understand how it had happened, what had led to the completely unexpected breakup.
During these sessions Lori barely gives Wendell a chance to speak. When he’s able to get a word in, he notes that Lori claims to want answers, but she keeps contacting the ex-boyfriend because she’s not getting the answers that she wants to hear. He also points out that if she’s taking such copious notes while talking to her ex, she can’t possibly be listening to him—and she’s not listening to Wendell, either.
Finally, during one session Wendell interrupts Lori by kicking her foot. He jokingly says that since she seemed to be enjoying suffering so much, he thought he’d help with it. Later, in a more serious moment, he asks Lori to be kind to herself while she’s in his office.
Eventually, Lori realizes that her behavior is a defense mechanism. She wonders why she’s obsessing about her ex-boyfriend even though she knows it’s painful—what is she defending herself from?
She now recognizes that she’d also been using avoidant behavior herself during the relationship, ignoring a lot of clues that might have made the seemingly sudden breakup less shocking. For example, her ex frequently seemed annoyed by children in public places, would run errands rather than go with Lori to her son’s basketball games, and made his brother and sister-in-law stay at a hotel rather than bringing their kids to stay at his house.
Similarly, Lori now realizes that she’s been avoiding her real feelings about the breakup and her ex. She’s been saying that she isn’t mad, that she doesn’t want revenge, and that she doesn’t hate her ex. However, she now realizes that none of that’s true.
She’s been trying to have the feelings she thinks she should have, rather than the ones she’s actually experiencing. Lori remembers that she frequently tells her own patients not to judge their feelings, but simply to notice them.
Lori now understands that she isn’t just mourning the end of a relationship, she’s mourning the loss of the future she thought they’d have together. She’s having such a hard time moving on because the loss of her boyfriend was really the loss of the life she’d planned. She’s also afraid that, at her age, she might never find another romantic partner. In losing her relationship, Lori is subconsciously feeling that she’s lost her last chance at a happy life with a loving husband.
Now that Lori understands what her actual issues are, she and Wendell can begin working to correct them.
Can you think of a time, recent or not, when your life didn’t go the way you’d planned or hoped?
How did you respond to that situation?
Can you think of one good thing, however insignificant it might seem, that came out of that unexpected situation? What is it?
Part 2 of the book reveals more of Lori’s backstory, and why the breakup sent her spiraling the way it did. Lori’s deeper, hidden issues are paralleled by the issues of several patients she treats, which allows her to write in greater detail and from other perspectives about common problems people face.
This part begins with Lori at a weekly get-together with her colleagues. They’re discussing a particularly troublesome patient of Lori’s, a young woman named Becca who suffers from abandonment issues.
Their sessions invariably run in circles, with Becca completely unwilling to open up to Lori. Though they’ve been meeting for months, Becca has made no noticeable progress. However, when Lori asks Becca why she keeps coming back if she’s not seeing the results she wants, Becca accuses Lori of abandoning her just like everyone else.
Finally, Lori’s colleagues convince her to stop seeing Becca. Lori can’t help someone like Becca, who’s unwilling to examine herself.
Lori says that the most difficult kind of patients are the ones, like Becca, who keep coming but never change. Ironically, when she discusses these events with Wendell, he implies that she is exactly the same kind of patient: She talks endlessly about her ex-boyfriend, never about her own issues, and therefore can’t make any progress. This is a major turning point for Lori, when she’s able to see herself behaving exactly like Becca and realize that she needs to make some changes.
One of Lori’s patients, a young woman named Holly, tells her about a dream she had where she took revenge on a girl who had ignored and pretended not to know her in high school, even though they had several classes together. Holly felt embarrassed and ostracized every time this other girl pretended not to know who she was—in her dream, Holly turned the tables and pretended not to know the other girl, as she was recounting all the classes they’d had together and all the years they’d known each other.
While Holly found the dream very satisfying, Lori sees it as a sort of pre-confession. Dreams can often point to our deepest fears and worries, sometimes things that we aren’t aware of ourselves. For example, Holly might be experiencing a deep-seated fear of embarrassment or feeling left out.
Shortly after that, Lori has a pre-confession dream of her own. She dreams that she’s going clothes shopping when she bumps into her ex, who’s looking for something for his new girlfriend. Lori asks how old the new girlfriend is, and she is pleased to hear that she’s turning 50—not only is she not the 25-year-old Lori had imagined, she’s actually even older than Lori.
Lori then catches a glimpse of herself in the mirror and realizes that in this dream she is, indeed, very old; in her 80s or 90s at least. After she sees herself in the mirror, her ex asks her whether she’d ever finished writing her book. When she asks what book, he says he means the one about her death. Then Lori wakes up.
Haunted by her dream, Lori admits to her therapist Wendell that there’s another problem she’s been avoiding: She’s contracted to write a book, and she has already accepted an advance for it, but she hasn’t been writing it.
Lori sees herself not just as a therapist, but as a writer too—it’s a key part of her self-image and she can’t give it up. Her agent has warned her that if she doesn’t fulfill this contract, she probably won’t get another—that is, she won’t be a writer anymore. Also, Lori has already spent the advance money, which she would have to return if she breaks the contract.
The book Lori’s supposed to be writing is about happiness but, ironically, thinking about it now fills her with anxiety and guilt. Lori’s unable to write because she doesn’t feel a meaningful connection to the material—what she would be able to put into a book and cite research for would barely scratch the surface of what she wanted to say.
Lori had a previous offer—for a substantial amount of money—to write a book about helicopter parenting, which she turned down for the opposite reason; she felt the topic had been done to death, and the world didn’t need yet another book about helicopter parenting. However, now she feels that she made a mistake and should have written it, so she wouldn’t have needed to take on the happiness book. In both cases, she couldn’t write the books because they didn’t feel meaningful.
Lori feels trapped, but Wendell says he’s reminded of an old cartoon: a character behind bars, shaking them, apparently trying to escape, but there are no walls around him. The character hasn’t noticed that he’s not trapped, because he hasn’t looked for other ways out.
Wendell leads Lori through an exercise where she imagines herself as that character. She vividly pictures herself trapped in that cell, shaking the bars, begging to be let out. In Lori’s imagination, the cell represents her future possibilities, or the lack of them: No loving relationship, no ability to write the happiness book, no way to get out of writing it, no hope for anything but a stagnant, miserable life.
However, then Lori imagines herself looking to the side and seeing that there are no walls on this awful cell. She takes a few hesitant steps around the bars. She starts to walk, and then to run, and she notices that there are no prison guards chasing her. There never were any guards; she’s been free to leave all along, to find what she truly wants instead of staying trapped in a prison of her own making.
Lori immediately feels a great weight lift. This is the first major breakthrough in her treatment. However, both she and Wendell know that it’s only the first step—she now understands that she’s the one trapping herself, but what she does with that insight is up to her.
As mentioned earlier, one of Lori’s main concerns is that she’s now middle-aged. While the end of her life is hopefully still far in the future, she’s subconsciously starting to think about it. Two of her clients are also confronting death—however, they are facing it much more immediately and in very different circumstances. One of these is Julie, the cancer patient from Part 1.
Meanwhile, Julie has been working on her bucket list and decides that she wants to work as a cashier at Trader Joe’s. She sees how the cashiers are able to interact and connect with their customers; they make immediate, concrete improvements to the customers’ days by bagging their items and chatting with them. Both Lori and Julie’s husband think this idea is absurd, but Julie gets a weekend job at Trader Joe’s anyway.
One day while Lori is shopping, she winds up in Julie’s checkout line and finds that Julie is extremely happy there. Lori wonders whether she and Julie’s husband had secretly been jealous of Julie’s certainty about what she wanted and her determination to do it even though others told her not to.
The second patient confronting death is Rita, a woman in her late 60s. Rita’s profoundly unhappy with her life and the decisions she’s made. She’s divorced several times over, estranged from her children, and retired from a job she never liked. In their first session, she tells Lori that she thinks she’s past help, but wants to try one more time. She says that if her life hasn’t improved within a year, she’s planning to end it. Rita also confesses that hearing the happy family across the hall from her apartment makes her extremely angry.
Rita spends her days alone at home painting, napping, or watching TV. Her only regular contact comes from exercise classes at the local YMCA and the pedicures that she gets just to feel a human touch. Lori encourages her to try reaching out and making new connections. Rita starts using a dating app, but she says she’s disgusted by the bodies of the men in her age group. Rita seems to have a tendency to self-sabotage, always finding reasons why anything that might be good for her won’t work out.
Despite Rita’s struggles, Lori encourages her to keep trying to make connections, romantic or otherwise. However, privately, Lori isn’t sure what kind of new “family” Rita will be able to make for herself at this point. This parallels Lori’s struggles in her own life and her uncertainty about finding a new romantic partner and creating a new family of her own.
Two of Lori’s other patients mirror her relationship issues and inability to feel emotionally connected to her writing.
One of the patients is John, a workaholic TV industry executive. He has anger issues and explodes at the smallest provocation. He also thinks people are “idiots” and tends to push others away. In John’s sessions with Lori, he is pushy, insulting, and rude. He also breaks many of the “rules” of therapy, texting and emailing during his sessions and ordering food to be brought to the office. He blames his problems on everyone else, including his wife. His go-to explanation for everything is that he’s surrounded by idiots.
In John, Lori sees a twisted reflection of the life she’d planned with her ex-boyfriend: He’s married, but he and his wife are clearly unhappy together. In fact, his wife has talked about leaving due to his anger issues and lack of emotional availability. However, John does seem genuinely fond of his two daughters and his dog. Lori thinks that might be a gap in his emotional defenses that she can use to make progress with him.
At first Lori is frustrated with John, but after a few sessions she recognizes his pattern: He blames others so that he doesn’t have to take responsibility for his own problems. Even when he takes Lori’s advice by trying to pay attention to his wife and put his work down at the end of the day, he says he’s only doing it to appease his wife—then blames her for still being unhappy with him. During this time, Lori also learns that John lost his mother when he was only six years old. She believes that he never properly processed that loss, and it might be the reason for his emotional distancing.
After about six months of therapy, John comes in extremely upset and angry that his wife wanted to get their older daughter a cell phone. He can’t or won’t explain why this upsets him so much, but he keeps repeating that it’s stupid for a girl her age to have her own phone.
While ranting about how stupid the idea—and his wife—are, he lets slip the name Gabe. When Lori asks who Gabe is, John answers that Gabe is his son. He leaves the session immediately after. The next week John doesn’t show up for his session, and he calls shortly after his scheduled time to say he’s quitting therapy.
Lori doesn’t know exactly why John decided to leave, but she says she’s not ready to quit on him quite yet. This is the end of John’s involvement in this part of the book.
Charlotte, another patient of Lori’s, came to the clinic because she’d been feeling anxious, although nothing had happened to make her feel that way.
Charlotte tends to fall for unstable, emotionally unavailable men, even though she claims to want somebody who’s dependable and sincere. When she goes on a date with someone who has the qualities she claims to be looking for, she inevitably says that there was no connection.
Lori believes that Charlotte subconsciously associates anxiety and instability with love, due to growing up in a household where her parents fought frequently. When she’s with someone who doesn’t make her anxious, she interprets that as a lack of a “spark” between them.
There’s also her drinking problem, which she has tried—so far unsuccessfully—to address. During one of her sessions she tells Lori, apparently without realizing the irony in it, that she had gotten drunk the night before because she was mad at herself for skipping that night’s Alcoholics Anonymous meeting.
Perhaps the strangest thing about Charlotte is that she believes her real addiction isn’t to alcohol but to therapy. While many patients stay in touch with their therapists between sessions, especially if there’s a major development or a crisis, Charlotte seems to do so obsessively. She emails Lori about inconsequential things or sends her funny pictures several times a week. She’s also “quit” her treatment and come back to it several times, just like an alcoholic does with drinking.
She once came back to therapy after getting a DUI, totaling her car, and breaking her arm. Then she admitted that her real problem might be alcohol, not therapy. However, a year later, she was still drinking.
Lori thinks this “therapy addiction” may be a result of Charlotte’s simultaneous desire for, and fear of, genuine human connection. Because of those contradictory feelings, therapy is the perfect setting for someone like Charlotte—she gets to open up to someone whose job is to understand and talk to people, but at the end of the session, she always gets to leave.
Lori has similar issues to Charlotte’s, though not to the same extent. She constantly holds parts of herself back from Wendell, which impedes her recovery. She also got into her crisis in the first place because she was hurt by an emotionally unavailable man.
In this part of the book, Lori’s patients each deal with a crisis of some kind. The crises are necessary for their eventual recovery (or, in Julie’s case, making peace with her mortality). Meanwhile, Lori makes some significant breakthroughs in her own treatment and finds a way to move forward.
Rita calls Lori for an emergency session, where she admits that there actually is a man in her life—or there was, until recently. A man named Myron had recently moved into her apartment complex, and the two had become close friends. However, the relationship had been completely platonic.
Right when Rita had been considering talking to Myron about romance, he had met someone else on Tinder. Rita stopped talking to him after that, and that was when she began therapy with Lori.
Myron’s Tinder relationship didn’t work out because he realized that he loved Rita and didn’t feel the same way about this new woman. He tried to rekindle his friendship with Rita, and he kissed her. Rita slapped him and ran away, then called Lori for this emergency session. Lori believes that Rita is afraid, or otherwise unable, to let herself hope she could be happy again.
In another session some time later, Rita repeats that her life is hopeless, and that it’s too late for her to change. This is especially frustrating to Lori, who can see that Rita has been making great changes and progress lately. However, people are often not accurate judges of their own lives.
After a near-collision in her apartment hallway while carrying art supplies, Rita became friends with the family across the hall and frequently joins them for dinner. The children were enthralled by Rita’s artwork, and the parents encouraged her to sell it. Myron had previously made Rita a website to display her work, and now this other family helped her add a store to it so she could sell her work.
In short, Rita has genuine connections, is making and selling art to people who appreciate it, and seems to have everything she claimed to want. However, she still seems to be in despair over her “wasted life.”
Lori wonders whether Rita is suffering from cherophobia: the fear of joy. Rita confirms that she’s waiting for everything to go wrong, like it always does. She also believes that she deserves to be unhappy for all the mistakes she’s made with her own family: for being absent so much of the time and not protecting her children from their abusive father. Rita’s children have never forgiven her, and it seems clear that she hasn’t forgiven herself either.
Lori muses that it’s possible to have compassion without forgiveness; to understand another’s pain without excusing what that pain made him or her do. In fact, this is exactly what Lori needs to do with her ex-boyfriend—while she might never forgive him for breaking up with her so suddenly, she can understand and come to terms with it, even if only so she can move on with her own life.
Rita thinks if her new friends and fans knew who she really was—that is, who Rita thinks she is—they’d abandon her in disgust. Lori asks what Rita thinks an appropriate “sentence” would be for her “crimes,” and Rita answers that she deserves life in prison. Lori replies that that’s exactly what Rita’s giving herself.
However, unlike locking away dangerous criminals, Rita’s suffering only benefits one person: herself. If she convinces herself that she’s hopeless and deserves to suffer, that frees her from the need to examine herself and make real changes. She has to first accept that she can be happy again, and even more importantly, that she deserves to be happy again.
The Eight Stages of Life
In the mid 1900s, psychologist Erik Erikson developed eight stages of psychosocial development: key points in a person’s life that have powerful impacts on the psyche and personality. Each stage comes with a crisis that the person must face before moving on to the next. For example, an infant is learning how to develop trust; the crisis for that stage of life is whether he or she is able to trust others or not. The eight stages are:
Infant: trust vs. distrust—at this stage the infant is almost totally helpless and is completely dependent upon his or her caregivers. Whether those caregivers provide reliable and adequate care for the infant will have a large impact on his ability to trust people later in life.
Toddler: independence vs. doubt—the child is beginning to discover his own abilities, but if overly criticized or coddled during this time, he may come to doubt his self-sufficiency.
Preschooler: drive vs. guilt—the child will start interacting with others, inventing various forms of play and asking many questions. However, if these tendencies are repressed or if the child is treated as a nuisance, he may develop feelings of guilt around “bothering” others.
School age: competence vs. incompetence—for perhaps the first time, the child's skills are being rigorously developed and tested in a controlled environment. His self-esteem will depend in large part on whether he is seen as competent, and encouraged or discouraged by peers and adults.
Adolescent: identity vs. confusion—at this stage the child is starting to develop a sense of personal identity; who he is, what he wants to do, and how he views himself as a member of society. If he isn’t able to establish a clear role—such as a person who doesn’t know what he wants to do when he grows up—this can lead to confusion about his identity throughout his life.
Young adult: intimacy vs. loneliness—the person is beginning to think about forming long-term, intimate bonds with people other than family members (not only romantic bonds, although those can be important as well). If the person shies away from commitment or fears intimacy, it can lead to an isolated and lonely life. (Shortform note: Lori is right around the end of this stage age-wise, so the breakdown she has after breaking up with her boyfriend may be her intimacy vs. loneliness crisis.)
Middle age: creativity vs. stagnation—the person experiences a growing desire to leave something behind that will outlast him or her. This could be a great scientific discovery, a famous book, or even a child. Someone who doesn’t feel accomplished, or doesn’t believe that he’s left a mark on the world, may experience a lack of connection to or interest in the world around him.
Old age: ego integrity vs. despair—as the end of life approaches, the person looks back at what he or she has done (or not done). Someone who is satisfied with his life will feel what Erikson calls integrity: acceptance of his life as a whole, and a sense of completeness. This is often expressed as someone who has “done all he wanted to do.” On the other hand, someone like Rita who regrets her mistakes and doesn’t feel accomplished will feel bitterness and despair as the end of life draws nearer.
People around Rita’s age are generally in the final stage, torn between satisfaction at the lives they’ve lived and despair at the mistakes they’ve made. It remains to be seen whether Rita can move from despair to integrity.
Charlotte has come to her last few sessions with a seemingly endless string of misfortunes. These ranged from having her wallet stolen, to dropping a weight on her foot, to getting into a fender bender while leaving work. Charlotte says she’s suffering from bad karma, but Lori suspects she’s using all of these incidents to distract herself from her real problems.
Charlotte keeps asking Lori what she should do about each of these situations, but therapists don’t tend to give that kind of advice. The problem with prescriptive advice is that, if it doesn’t work or doesn’t get the full results the patient wants, she can then blame the therapist for it. Not only is it helpful for patients to solve their own problems, but resentment toward one’s therapist could make further progress more difficult.
However, even though she knows all of that, Lori has asked Wendell similar questions during her own sessions. She subconsciously assumes Wendell is just a more competent person than she is, even though she has the background and experience to know that therapists aren’t “better” than other people.
A little later, Charlotte brings up the fact that a silly commercial about a dog driving her puppy around in a car made her cry. She cries again telling Lori about the commercial. This is especially exceptional because Charlotte displays alexithymia: the inability to connect with and express her emotions.
Between the endless requests for advice and her reaction to the commercial, Lori believes that Charlotte is trying to compensate for her inattentive parents. Her parents were frequently absent, and they were drunk when they were around. Charlotte had to act like an adult too early, and she may be acting helpless now in order to experience the childhood she never had.
Two months pass, and Charlotte finally asks if Lori knows a good outpatient treatment program for alcohol abuse. She attends the program Lori recommends and stops drinking entirely during that time. There are noticeable improvements in Charlotte’s memory, energy, and motivation.
However, she is still struggling with relationships, most notably with a man she sits with in the waiting room. She’s been attracted to him for months, but he’s been stringing her along that whole time. He keeps breaking up and then reconnecting with his girlfriend, hurting Charlotte every time it happens.
During one session, Charlotte finally admits that he’s never going to change—and neither are her parents. Lori replies that they might not want to change, and Charlotte won’t be able to force them to. She can’t control other people, only her own thoughts and actions.
Charlotte asks if she can change her appointment time to avoid sitting with this man. This is something Lori suggested a long time ago, but Charlotte wasn’t ready to act on it until now. Overall, Charlotte shows remarkable improvement in this part of the book.
How People Change
Charlotte making this change—ironically, as a result of recognizing that the people around her would never change—makes Lori think about the stages of change as laid out by psychologist James Prochaska in the 1980s. This model has five stages:
Pre-contemplation: You’re not even thinking about making a change yet. This could also be seen as denial, refusing to even acknowledge that you have a problem.
Contemplation: You now recognize that you have a problem and are—in theory—ready to do something about it. However, you haven’t yet started taking action. This is the stage when many people seek therapy, because they know that something’s wrong but feel powerless to change it on their own.
Preparation: At this point you’re not yet ready to make the needed change, but you’re getting yourself ready to. This could mean researching how others have dealt with your situation, looking for support groups, or any number of ways that you could ready yourself for a major change.
Action: The action stage is when you finally make the change you’ve been thinking about—quit drinking, start going to the gym, or what have you.
Maintenance: The final stage is to maintain the change. This is more difficult than it sounds—there are plenty of triggers, or reminders of the old behavior, that may cause you to backslide. However, by this point you should have the proper tools and support to get back on track.
Interestingly, Charlotte went through this same process with her drinking. When she first came to Lori’s office she wouldn’t even admit that she had a drinking problem (pre-contemplation). After getting a DUI, she started thinking about making changes, but wasn’t ready to commit to an alcohol-free lifestyle (contemplation). However, after a while she started doing research on various methods of controlling or limiting her drinking, without having to give it up entirely (preparation). Eventually, she asked Lori to recommend a good treatment program (action). Now, she’s in the final stage of maintenance, which for her means staying sober.
As far as her tendency to fall for unavailable, hurtful men goes, changing her therapy session to get away from the man in the lobby would seem to indicate that she’s moved into the fourth phase, action. From here on, her therapy will be focused on the fifth stage, maintenance.
Julie’s cancer has continued to progress, and she may only have a year or so left to live. It’s spread throughout her body, and doctors have to keep removing parts of her to keep her alive a bit longer.
Julie compares this process to the kids’ game “Would You Rather?” wherein a person is presented with two unappealing options and has to pick one. As a child, she broke the rules and chose neither. In fact, that was her high school yearbook quote: “I choose neither.” Now, though, her choice is between losing more of her organs or dying. “Neither” isn’t an option. It becomes a question of how much of herself she’s willing to give up.
Julie’s disease is also taking a heavy toll on her husband Matt. She hadn’t thought about it until one night when he snapped that he wished they could have one night off from cancer. He immediately apologized and wished he could take it back, but the words were already out there. Though it upset her at the time, more importantly this incident made Julie realize that she’s not the only one suffering, and that Matt will still be suffering after she’s gone.
Julie says that she wants to help Matt find a new wife. She was inspired by a story from one of her cancer support groups of a woman who made her husband promise to go on one date with a close friend of his after the wife’s funeral. He did, and now the two are married.
Lori is initially surprised, and a bit repulsed, by the idea. She thinks it sounds like masochism on Julie’s part to help her husband meet another woman. However, she soon accepts that the idea is coming from a place of love, and that Julie just wants to make sure Matt will be okay. This isn’t the first time that Julie’s had an idea that sounds strange, but ends up being the best thing for her—remember her part-time job at Trader Joe’s.
In another session, Julie and Lori discuss all the best and worst responses that Julie’s had to her diagnosis. The worst come from well-meaning people who fall back on empty platitudes, like assuring her that there’s a reason behind everything, or assuring her that she’ll make it through when Julie knows full well that she won’t. The best are the genuine responses, the ones that express support and love, even if the person doesn’t quite know what to say.
Lori and Julie have also been working on her obituary together. After considering a lot of different options and what to say about the people she’s leaving behind, they settled on a simple message just saying that she was loved for every day of her life.
Despite her newfound spontaneity and appreciation for life, Julie still likes to make plans. She is approaching the end of her life as prepared as possible, both emotionally and practically.
A month after leaving therapy, John unexpectedly calls Lori back and makes an appointment. At that appointment, he finally tells Lori about Gabe, his son: John reveals that Gabe died in a car accident when he was six.
John had just landed his first major project at his TV studio, and he was constantly working even while at home. He called his cell phone a blessing, because it let him spend time with his family and still be in contact with his work. However, John’s wife said that she didn’t want him to be working while he was with his family. The phone became a point of contention between them.
They went on a family vacation to Legoland, a three-day trip during which John promised he would only use his phone “if someone died.” He gave those same instructions to his coworkers: They were only to contact him if somebody died.
Two hours into the drive to Legoland, John’s phone rang. He asked if his wife would at least check who was calling, in case it was an actual emergency, but she angrily refused. Finally, John reached for the phone himself. During that short time, an SUV swerved into their lane and struck their car, killing Gabe. The rest of the family survived. The phone call turned out to be a wrong number. Incidentally, this background also helps explain why John was so angry about his daughter getting a phone.
John says that he came back to therapy because he had a dream that caused him to wake up screaming. This upset his wife, who went into the bathroom to cry. John, however, says that he can’t afford to do that—either wake up screaming or run away to cry. He feels that he needs to stay strong for his children.
Lori now understands why John is so emotionally unavailable. He’s spent years repressing his emotions, both about Gabe’s death and about his own mother’s death when he was six. He also tries to force himself to believe that he can’t be hurt anymore because he’s somehow special and just surrounded by idiots. This is effectively the opposite of Rita’s defense mechanism—she doesn’t need to change because she’s hopeless; he doesn’t need to change because he’s perfect.
Lori suggests that it might be healthier for the entire family if they were able to talk about Gabe and to grieve naturally. Even while protesting that he can’t afford to be a weepy basket case, John begins to cry.
He complains that this is exactly what he came to therapy to avoid: He didn’t want to break down. Lori suggests that instead of breaking down, perhaps he’s finally breaking open. This is the most truthful John has been with himself—or anyone else—in years, and it’s an excellent step forward for him.
Considering the need to be truthful with one’s therapist—and oneself—Lori reveals to Wendell that on top of everything else, she’s been suffering from a mysterious illness. This unknown disease causes painful rashes, fatigue, and muscle tremors and weakness. She’s visited numerous doctors, but none have been able to piece her symptoms together into a diagnosis. She calls her ongoing search for answers her “Medical Mystery Tour,” but even though she gave it a lighthearted name, she’s terrified of not knowing what’s wrong with her.
While discussing her illness, she also mentions that her ex had said on their first date that he’d stopped dating another woman because she was sick and he didn’t want to get stuck taking care of her. That was one major reason she had hidden her symptoms and her numerous tests from him—another example of Lori being in denial about their doomed relationship because if the disease progressed, then sooner or later it would become impossible to hide. If the boyfriend held true to his pattern, he would have abandoned her over the disease if he hadn’t left because of the child.
One specialist believed that Lori’s symptoms were the result of anxiety, a condition called conversion disorder: so called because the patient’s anxiety is “converted” into physical symptoms. Conversion disorder is the modern name for hysteria, or any number of other absurd diagnoses given to women throughout history (such as “wandering uterus”).
Furthermore, many of her lab tests and scans came back with results that were not consistent with conversion disorder. Effectively, the doctor gave a diagnosis of “women are crazy,” and Lori was rightfully offended by it. However, at the same time, she’s trying not to admit to anyone—even herself—that something is really medically wrong with her, and she doesn’t know what.
Lori has hidden her symptoms and testing from everyone, and she admits that she’s been in denial about the disease herself.
When Lori tells Wendell about the disease that nobody’s been able to diagnose, he says that what she’s really afraid of is uncertainty. Since she doesn’t know what her disease is, she doesn’t know whether it’ll prove fatal, or what impacts it might have on her life going forward.
This uncertainty doesn’t just apply to her illness, but also to her fears that she won’t find a new partner, her anxiety about her writing career, and her advancing age. Wendell believes that Lori has been trying to cope with that uncertainty by sabotaging herself.
Wendell points out that she stayed in a relationship she knew was doomed, she is ignoring the book she should either write or break her contract for, and she has tried to hide her symptoms from everybody, even herself. Even though the situation she’s created isn’t the one she wants, it’s one that she has control of—at least for now. Eventually, of course, she’ll have to either write her book or cancel her contract, and the disease will progress however it does.
In addition to uncertainty, Lori is also dealing with several fundamental human concerns. The four fundamental concerns all people share are mortality, loneliness, freedom, and futility. The psychiatrist Irvin Yalom wrote about these in his book Existential Psychotherapy.
Lori is concerned about death due to her illness and what she perceives as her advancing age. Yalom wrote that being aware of death, rather than trying to ignore its inevitability, helps people to live fuller, less anxious lives. Lori sees Julie, the cancer patient, as an example of how to live fully while being aware of your own death.
Lori’s ex distracted her from her fears about death, while also solving her concerns about loneliness, at least temporarily. However, ignoring one’s own mortality isn’t an effective way to cope with that anxiety. Now that her distraction is gone, Lori has to face this issue herself.
She also explains that she is concerned about her freedom. While she’s free in every practical sense, she misses the emotional freedom she had when she was younger. Children, for example, are completely free emotionally. They can laugh, cry, and scream without any concern for what others might think. Lori says that her therapy—and the entire crisis she’s going through—may be about recapturing that emotional freedom, and opening up instead of shutting down.
She comes to terms with the idea that uncertainty doesn’t have to mean hopelessness; instead, it can mean that there are possibilities she hasn’t considered yet. She doesn’t know what will happen next, or how much longer she has, but she is now determined to make the most of whatever’s left of her life.
To do so, she now has to grapple with the last fundamental concern: futility. Some time after this appointment, Lori finds her old grad school coursework, including her studies about the psychologist Viktor Frankl, whose work was all about how people’s primary drive was to find meaning in their lives.
The part that Lori finds especially relevant is Frankl’s discussion about how the only thing a person will always be able to choose is how to respond to his or her circumstances. There’s a time in between a stimulus and the response to it where a person is able to choose what that response will be.
Lori hasn’t thought about this concept in years, but she sees now how it applies to her and every one of her patients. The trick is finding and using that in-between time to respond, instead of just react—to act deliberately instead of reflexively. For John, this might mean responding to problems with compassion and patience instead of anger and insults. For Charlotte, it may be taking the time to recognize that she’s falling for yet another distant, unavailable man and is bound to get hurt again. For Lori, the trick may be to recognize that uncertainty also carries opportunity—she’s afraid of what might go wrong, but never stops to think about what might go right instead.
(Shortform note: For another powerful take on finding purpose in one’s life, read our summary of Frankl’s Man’s Search for Meaning.)
In between talking about her patients, Lori digresses to share some stories from her time as a therapy intern. These stories are all about appreciating the moment, which is something Lori still struggles with.
Lori and the other interns were always rushing to finish their internships as quickly as possible. They would try to take on more and more cases, even when their schedules were already full, just to get through the required number of hours more quickly. They’d also obsessively track those numbers and plot out how long it would take them to finish, and how old they’d be when it finally happened. Lori, who’d had two false starts to her career already (the TV industry and medical school), was in even more of a hurry than her classmates.
One day, one of the older supervisors overheard them talking about their hours and when they’d be finished with their internships. She told them, basically, that time would pass no matter what they did. What difference did it make when they finished their hours? No matter how hard they worked to get through their internships, they’d only get to live today once. Her point was that they should enjoy what they have, instead of always racing toward something in the future.
It was a lesson that Lori never took to heart. Even after she finished her internship—which she did fairly quickly—and moved into her own office, she now felt pressured to start enjoying her life as soon as possible. She’d found her calling later than she thought she “should have” and was in a hurry to get as much joy and satisfaction as possible out of the rest of her life. Ironically, this pressure she put on herself actually prevented her from enjoying what she had.
Also on the topic of being present and enjoying the moment, Lori shares something she observed both in her patients and from people in general: They were always connected to their phones. As soon as they had a quiet moment where they would be alone with their thoughts, they immediately ran away from that feeling to take comfort in scrolling through social media or checking their emails.
It seemed to Lori that the 50 minutes her patients spent in her office, talking to her without any electronic distractions, was one of the few pure, human moments left in the modern world. Though Lori was at this point struggling to make her practice lucrative, she was totally unwilling to give that up in favor of online or over-the-phone counseling services. That is perhaps the one way in which Lori has always lived in the moment. However, that desire to be present and focused hasn’t bled into other aspects of her life yet.
Lori realizes this all ties back to what she said to Wendell in their first session together, that her life was already half-over. She’s still feeling that same pressure to enjoy life now and, ironically, is totally unable to enjoy life because of it. She’s not able to fully experience the moment because she’s constantly regretting her past decisions or worrying about her future, which from her perspective seems closer every day.
The story now returns to the present day. In spite of—or perhaps because of—her unknown disease, Lori has recently started taking positive steps in her own life as well as helping her patients. She’s shared her condition with some of her friends as well as Wendell, and she has learned to be okay with the uncertainty of it. She’s also finally started working on the book she’s supposed to be writing. She’s about three-fourths of the way through writing the first draft.
While taking a break from writing, Lori realizes that she has an email from her ex-boyfriend. This is the first contact she’s had with him in eight months. She’s nervous to open the email, but for a very different reason than before. Rather than desperately hoping that he’s changed his mind and wants to get back together, she now knows beyond doubt that she’ll reject him if he tries. Though it’s an uncomfortable realization for Lori, and she’s afraid of the unpleasantness of rejecting him, this is proof that she’s moved on from the breakup.
The email ends up being inconsequential gossip about work. Lori is amused and somehow pleased by it. She notes that it’s textbook avoidant behavior; her ex is trying to act like nothing ever happened between them.
However, the trivial email causes Lori to have a revelation: She doesn’t want a meaningless relationship with her ex-boyfriend, and she doesn’t want to write a meaningless book. If mortality and futility are two fundamental concerns that people have, it makes sense that Lori—who has no idea if her disease might prove fatal—doesn’t want to waste some of her unknown remaining time writing a book she doesn’t care about.
She stops writing her book, and instead writes her truth: She wants to cancel the contract. She sends an email to her editor saying so. Even though she’ll have to pay back the advance she got on the contract, which was apparently significant (though we never learn the actual amount), the freedom she now feels is more than worth the money. Recall Wendell’s image of the cartoon character in the cage with no walls; Lori has finally stopped rattling the bars and walked around them instead.
Lori is feeling much better, but she’s thrown off when she gets to Wendell’s office for her appointment. Wendell has been away for a couple of weeks, and in that time the office has been completely redecorated. Wendell, too, looks different, sporting a beard and nicer clothes.
Lori finds him attractive, and for a while this makes her very uncomfortable. However, by the end of the session, she realizes it’s a sign of her improvement: She’s feeling attraction and interest again. In fact, she has a date scheduled for later that evening. Like her patients, Lori is making significant progress.
Think about a change you’d like to make in your own life. Consider the five stages of change from the previous section.
What is the change you’d like to make?
Which stage would you place yourself at in terms of making this change and why?
What’s one way you could move on to the next stage of change?
The fourth and final part of Maybe You Should Talk to Someone brings the stories of Lori’s patients, and Lori’s own treatment, to a close. In this section Julie, Rita, and John all find what they’re looking for in their own ways. Lori, too, gains a better understanding of herself and what caused her to break down the way she did. While the work of healing is ongoing, they’ve all made great progress and have bright futures. The obvious exception is Julie; in her case, the progress and the future belong to her husband and other loved ones.
Charlotte is not heavily involved in this part, except to note that she’s also made significant progress and has begun using the tools she’s learned in treatment to see her through rough spots in her life. Aside from a single one-night relapse, she’s also stayed completely sober. She has another near-crisis where she considers leaving therapy, but she opts to stay in treatment with Lori. While there’s not much detail about her, it’s implied that her treatment is going well and that she’s going to be okay.
Julie is staying in therapy until she dies, but a lot of that therapy is now spent sitting in comfortable silence. Julie feels safe in Lori’s office, away from other people and their feelings about her illness and approaching death.
Julie mentions that she’s hired a party planner to plan her funeral reception. While many people in her cancer support groups say that they don’t want people to be sad at their funerals, Julie rejects that idea. She likes the thought of celebrating her life, but also wants people to grieve her death. She wants to know that she affected people; in other words, that she mattered.
Some time later, Julie passes away—peacefully, in her home, as she’d wanted. Julie herself made the choice that it was time to go. She came to her final round of “Would You Rather,” and decided that she’d rather not lose any more of herself just to stay alive. She stopped eating and died a few days later.
Attending Julie’s funeral puts Lori in a difficult spot professionally. For one thing, doctor-patient confidentiality doesn’t end at death, so Lori can’t say anything about their sessions, not even that she was Julie’s therapist. That could be uncomfortable if anyone asks how they knew each other, leaving Lori to either lie or evade the question.
Furthermore, some people might feel that getting involved in a patient’s personal life—or death, as the case may be—is crossing a line professionally. Recall from Part 1 that there is a powerful stigma around mental health issues, and many people feel uncomfortable around therapists. As a result, usually therapists have to grieve on their own when a patient passes away, even though they may have known the deceased better than anyone else.
However, Lori promised Julie that she’d go. In spite of all the possible complications, she keeps her promise.
Julie’s funeral is attended by hundreds of people. When her husband gets up to speak, he says that Julie wanted to be sure he’d always have love in his life, and that she hoped he’d eventually remarry. She warned him to be honest with the women he dated as he was recovering from her death, but she also hoped that he would eventually find someone to love as deeply as they had loved each other. He returns the sentiment, saying that he hopes Julie finds someone to love wherever she is now.
Leaving the funeral, Lori recalls that Julie had frequently asked if Lori would think about her. In other words, would a part of her survive in Lori? Thinking about this, Lori ponders how at first she’d been worried that being Julie’s therapist would make her insensitive to others’ problems. She imagined herself talking with people having comparatively minor issues, like a spouse who doesn’t initiate sex, and comparing those problems to Julie’s cancer.
However, she found that just the opposite happened: Julie’s situation made Lori aware that everyone’s time is limited, and every hour counts. It was one more thing helping Lori to realize that she wants to be fully present in every moment, including—or perhaps especially—with her patients. Recall one of the fundamental concerns: mortality. The way to cope with mortality is not to ignore it, but to embrace it, and get as much out of life as you can.
Even years later, Lori still thinks about Julie. The clearest evidence is that she’s a major character in Maybe You Should Talk to Someone.
Rita has written a long letter to Myron going into great detail about her past: her abusive husband, how and why she failed to protect her children, and how her children still hate her for it. Rita originally wrote the letter because she was sure that Myron wouldn’t want to be with her once he knew the truth. However, the letter also serves as Rita finally opening herself up completely, similar to how John finally lowered his defenses about his son Gabe.
Rita brings this letter to a therapy session and reads it for Lori. While reading it is extremely painful for Rita, after she’s finished she seems calmer than Lori’s ever seen her. Lori asks whether the letter is really for Myron, or if it’s what Rita wants to say to her children. Though Rita doesn’t respond, she and Lori know that the answer is “both.”
Rita comes in for another session a few days after her birthday—the birthday on which she’d originally planned to kill herself. She and Lori celebrate together, and though this isn’t the end of Rita’s treatment, she’s come a long way toward making peace with herself and her life.
Rita also says that Myron finally responded to her letter after more than a week. It was hard for him to come to terms with this side of Rita, but now he thinks that maybe her difficult past is what makes her so interesting and so loving. Rita and Myron spent the night together after that, and have since become romantic partners.
Sometimes Rita still regrets her past, or is tempted to retreat into her despair, but she draws on what she’s gained from therapy to see her through. Rita continues reaching out to her children, no longer looking for forgiveness, but simply trying to make a connection and move forward as a family. Over time, three of her four children respond. The youngest is, so far, unable to move past his anger. Rita, her three children, and Myron become something of a disconnected, dysfunctional family, but much more of a family than she’s had in decades.
Though her life is far from perfect, Rita now seems to have everything she wanted when she first came into Lori’s office. Most important of all, though she’ll always carry the pain of her mistakes and the knowledge that she can’t fix all of them, Rita is happy. If Rita, who is much older than Lori, can fix her life and find happiness again, then there’s no reason at all why Lori can’t do the same.
John mentions that he’s finally told his wife he’s been attending therapy. She was surprised and angry that he’d been seeing Lori without telling her. She also demanded to know whether he’d gone there to talk about Gabe, their dead son. John is confused and irritated by her reaction. Lori suggests that maybe she was upset because she’d spent so long wanting him to open up emotionally to her, and now she’s learned that he’s been opening up to someone else for months.
John also says that he and his family had finally talked about Gabe, then he starts crying again. He’s tried to keep going ever since Gabe died, locking up his feelings and working like a machine to take care of his family. However, you can’t kill one emotion without killing all of them. By repressing his pain, John has also repressed his joy, and this is why he can’t connect with anyone and why people aggravate him so much. Talking about Gabe has been painful for John, but not as much as not discussing him had been.
John says that they need closure, a way to move on. However, Lori doesn’t think there’s any such thing. When people ask for closure, what they really want is to stop feeling.
People often think they can reach acceptance, the last step in the popular five stages of grief. However, those steps originally referred to terminally ill people learning to accept their own deaths, like Julie had to. In fact, the idea of “acceptance” can be actively harmful to people who are grieving—they think there must be something wrong with them, since they haven’t been able to reach it.
Later, John questions whether he and his wife are right for each other after all. They’ve made each other very unhappy, between John’s crushing work schedule and his wife never seeming satisfied with what he does as a husband and father. He wonders whether they only stayed married because they both wanted to hold the family together after Gabe’s death. Lori suggests instead that maybe each of them wanted to rediscover aspects of themselves that seemed to have disappeared along with their son. She thinks that maybe the two of them can fall in love with each other all over again.
Aside from all of his problems, John has also had moments of happiness like he thought he would never experience again. When playing with his daughter Grace he felt—for a short time—as if everything were normal, like his son Gabe had never died. He brought this up with Lori because he felt that being happy again was somehow betraying Gabe’s memory—how could he ever be happy when his son was dead?
Lori tells John that, just like the body has systems to protect itself and heal from disease and injury, the psyche can also strengthen itself after being damaged. A Harvard study found that people regularly responded to difficult events, such as a divorce or the death of a loved one, better than they expected to. People who thought they would never feel joy again eventually went out and had fun, and people who thought they could never love again got into new relationships and rediscovered a level of intimacy they thought would be impossible.
While things can never go back to how they were before Gabe’s death, it’s absolutely possible—and healthy—for John to recover and continue living his life.
In a later session, John asks whether Lori thinks he’s a jerk. Lori is surprised by the question—it shows uncharacteristic self-awareness and vulnerability on John’s part. This could be a sign that John’s mental immune system is finally working to heal him, but she also wonders if it’s an overcorrection of his previous defense mechanism: Perhaps he’s gone from “I’m good, other people are bad” to “other people are good, I’m bad.”
She responds that she doesn’t think he’s a jerk, but that he sometimes acts like one to protect himself. It turns out that sometimes is a key word for John. It allows him to get out of his black-and-white thought patterns: It’s not that he’s always a good person or a bad one, or that he should always be happy or always be grieving, but that everything—including happiness—comes and goes.
During this same session, John says that things are going better with his family, and that he and his wife have been referred to a couples therapist. Lori encourages this new direction for John and says that he can discuss anything he’s uncomfortable or unsure about in couples therapy with her.
John’s attitude is notably different in this part: Opening up to Lori and his wife has lowered some of his defenses, allowing him to be more emotionally receptive and genuine. Similarly, by opening up about her fears about uncertainty and death, Lori is able to finally confront them and move forward in her life.
While speaking with her therapist Wendell, Lori relates an incident where she and her son blew up at each other because each of them was angry at someone else. Lori had been angry at her mother over a conversation they’d had earlier, while her son had been angry about how some other kids had treated him. This is a classic example of displacement, a defense mechanism where you shift your feelings about a person or situation to a safer target.
There are all kinds of defense mechanisms to deal with anxiety, anger, or distasteful urges. Everyone uses them, often without realizing that they’re doing so. For example, a smoker might say—and truly believe—that his breathing problems are because of allergies or the weather. That would be denial. These are some examples of primitive mechanisms.
Most of the behaviors that Lori’s patients, and Lori herself, have shown were the results of various unhealthy defense mechanisms. John directed his anger and grief at everyone around him, and rationalized that his problems were everyone else’s fault. Charlotte was in denial about her drinking problem and her self-destructive pattern of falling for people who hurt her.
However, there are also healthy defense mechanisms, called mature mechanisms. One classic example is sublimation, where unhealthy or inappropriate feelings and urges are channeled into something constructive. For example, a man who wants to hurt people could get into boxing. Lori could be sublimating her own pain into her therapy work: helping others in order to come to terms with her own problems. Also, Maybe You Should Talk to Someone is, itself, an act of sublimation—turning her painful experiences into something creative.
Remembering the incident with her mother, Lori can recognize now that she’s overbearing and controlling out of love. In fact, Lori sometimes acts the same way with her own child. She knows that eventually her son will leave for college or whatever his future holds, and she wishes both her mother and her son could stay around forever—even though that’s both impossible and unhealthy.
Related to her fears about losing her son are Lori’s ongoing concerns about her medical condition. One of her tests returned a marker for Sjogren’s syndrome, an autoimmune condition, but she doesn’t show the most common symptoms of it. It could be the disease presenting unusually, or it could mean that Lori has something else. The continued uncertainty scares her, as does the thought that she might die young and leave her son alone.
Wendell asks Lori what she’d prefer: being a mother who’s never present because she’s worried about dying, or being a mother who knows her time might be limited and savors each moment with her son as a result. Obviously the second choice is the more desirable one, and Lori acknowledges that her illness has already had this kind of impact on her life. It’s why she gave up on writing a book she didn’t care about, why she started dating again, and why she’s been reaching out to her mother, whom she used to find unbearable.
In another session, Lori tells Wendell that she’s started writing another book. This new book will eventually become Maybe You Should Talk to Someone. The book didn’t come from her agent; she was inspired to write it based on her recent experiences. Unlike the previous book that she couldn’t bring herself to write, Lori feels almost compelled to write this one. She and Wendell both agree that it’s meaningful to her.
Shortly after, the two of them start talking about bringing Lori’s treatment to an end. Lori isn’t quite ready to let go of Wendell, but she agrees that she doesn’t need the weekly therapy anymore. Even when doctor and patient agree that it’s time to end the treatment, therapy doesn’t stop abruptly. There’s a process called termination where the two summarize what they’ve done together. They also have to make sure the patient has the right tools to keep making progress in his or her life.
Eventually, though, Lori has her final session with Wendell. She says that she doesn’t want to consider this goodbye, though—more like an extended pause in their ongoing conversation. She also says that someday, perhaps, she’ll need treatment again and will come back.
As she leaves Wendell’s office for the last time (for now), Lori notices that the nearest crosswalk signal is about to change so she can cross. However, instead of rushing to catch it, she takes a moment to just enjoy the feeling of the sun on her skin. This final image shows how Lori, despite not knowing how much longer she may have to live, now has the ability to live in the moment and fully appreciate life.
Everyone has things they wish they could change about themselves or their lives. Some people spend their whole lives thinking about those changes, or trying to make them—and sometimes, like Rita, they don’t even realize the progress they’ve made.
What’s something about yourself that you wish you could change?
What’s one thing you could do to start making that change?
What will your life look like after that change is made; or, in other words, how will you know that you’ve done it?
Thinking about how you’ll know when you’ve accomplished your goal, what progress have you already made (possibly without realizing it)?