One of my patients gave me her copy of Lori Gottlieb’s book Maybe You Should Talk to Someone. I read it over the holiday break and found it engaging. I particularly related to two ideas that Gottlieb discussed: how to help patients “edit their stories” within the therapeutic milieu of dyadic coconstruction and how we psychotherapists can manage our personal upheavals to avoid inflicting them unwittingly on our patients.

As Gottlieb pointed out, a patient’s presenting problem is sometimes just the tip of the iceberg. For example, one of my adult twin patients began her treatment blaming her twin sister for her unhappiness and despair. She told me that her sister belittled her, tried to make her feel bad, competed with her, resented her happiness, and wanted her to be overweight so the twin could feel superior. Over many months of treatment, my patient and I uncovered a more complicated and nuanced story that elucidates the genesis of her self-loathing and rage. An emotionally and physically abusive mother severely traumatized my patient to such an extent that she repeatedly found herself in similar combative relationships. When we first began exploring her horrific upbringing, she often stopped to ask me “Can you really hate your mother?” or “Is it okay to be jealous?” She projected many intolerable feelings onto her twin because she did not yet understand the profound emotional brutality of her abusive childhood. As Gottlieb attested, our role as therapists is to amplify patients’ stories and bring greater context, dimension, and nuance to an ever-unfolding narrative. This process unfolds within the coconstructed relationship between the therapist and her patient.

To demonstrate how psychotherapists practice self-care, Gottlieb shared some aspects of her treatment with her own psychotherapist and how their journey together helped her sort out her feelings about an unexpected, abrupt abandonment by a man she planned to marry. She related that she compartmentalized her personal despair, heartbreak, and anxiety to stay present with her patients. Many people ask how I remain consistent and reliable for my patients. I reply that being in therapy myself for many years taught me how to manage my ups and downs. The relationship my therapist and I coconstructed over the years helped me feel understood and remain self-regulated and tranquil.

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