6/10 (Buy it on Amazon)

Short Summary

After a breakup with her boyfriend, a therapist goes to therapy. She needed someone to talk to in order to process her feelings about her break up, and also needed someone to help her through her process of healing after the breakup. She also weaves the narratives of her clients into the story of her finding meaning after her long-time relationship. In doing so, she depicts how life can be messy sometimes and imparts onto the reader principles that therapists use to help their clients get out of bad relationships, bad life situations, and even help them confront some of the things that they tell themselves to hold themselves back from becoming their idealized version of themselves. By interweaving her story with those of her clients, it makes for an interesting read which imparts many life lessons onto the viewer. The reason I gave this a 6/10 was because I was going to read a fiction book after a non-fiction book and it seemed as though this read like a non-fiction book (which it was), but I didn’t realize it at the time.

Lessons Learned

I learned a lot from this book about how people change their viewpoints in therapy, and how your worldview can be expanded by learning about the loss of other people. I learned how therapists help people confront their own mortality and their actions. I also learned how we could think about change and the actions that we must take in order to confront it. There are a lot of events in life that we don’t fully process until years later, and it’s important that we look at those events with the help of someone else trained to guide someone through the harsh experience of confronting change. In this book, the author helped me confront with sobering questions about myself, like how I will act when I age, how I will understand the loss of loved ones, and how to deal with my own mortality. However, she does so through anecdotes and funny nicknames. For example, she deals with loneliness through an artist named Rita who has come to terms with her broken family and finds new friends to live with and an art hobby which she makes her living out of, and Julie, the terminal cancer patient who, at 33, is coming to terms with her diagnosis. It is a wonderful, and warm book which will make you want to hug your loved ones, and talk with them openly about some of the questions that the book poses.


We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same.

Like in those National Geographic Channel shows that capture the embryonic development and birth of rare crocodiles, I want to capture the process in which humans, struggling to evolve, push against their shells until they quietly (but sometimes loudly) and slowly (but sometimes suddenly) crack open.

We’ll talk with almost anyone about our physical health (can anyone imagine spouses hiding their reflux medication from each other?), even our sex lives, but bring up anxiety or depression or an intractable sense of grief, and the expression on the face looking back at you will probably read, Get me out of this conversation, pronto.

Most big transformations come about from the hundreds of tiny, almost imperceptible, steps we take along the way.

What people don’t like to think about is that you can do everything right—in life or in a treatment protocol—and still get the short end of the stick. And when that happens, the only control you have is how you deal with that stick—your way,

You need to meet with a few before you find the right one. That’s because clicking with your therapist matters in a way that it doesn’t with other clinicians (as another therapist said :” It’s not the same as choosing a good cardiologist who sees you maybe twice a year and will never know about your massive insecurity”). Study after study shows that the most important factor in the success of your treatment is your relationship with the therapist, your experience of” feeling felt.” This matters more than the therapist’s training, the kind of therapy they do, or what type of problem you have.

For the past couple of years, Boyfriend and I had been in constant contact throughout our days, had said good night every bedtime. Now what was he doing?How had his day gone?Did his presentation at work go well?Was he thinking about me?Or was he glad to have gotten the truth off his chest so he could go search for somebody who was kid-free ?

Attachment styles are significant because they play out in people’s adult relationships too, influencing the kinds of partners they pick (stable or less stable), how they behave during the course of a relationship (needy, distant, or volatile), and how their relationships tend to end (wistfully, amiably, or with a huge explosion). The good news is that maladaptive attachment styles can be modified in adulthood—this, in fact, is a lot of the work of therapy.

He knows what all therapists know : That the presenting problem, the issue somebody comes in with, is often just one aspect of a larger problem, if not a red herring entirely.

In idiot compassion, you avoid rocking the boat to spare people’s feelings, even though the boat needs rocking and your compassion ends up being more harmful than your honesty. People do this with teenagers, spouses, addicts, even themselves. Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed.

People often mistake numbness for nothingness, but numbness isn’t the absence of feelings; it’s a response to being overwhelmed by too many feelings.

I once heard creativity described as being the ability to grasp the essence of one thing and the essence of some very different thing and smash them together to create some entirely new thing. That’s what therapists do too. We take the essence of the initial snapshot and the essence of an imagined snapshot and smash them together to create an entirely new one.

“Your feelings don’t have to mesh with what you think they should be,” he explained.” They’ll be there regardless, so you might as well welcome them because they hold important clues.” How many times had I said something similar to my own patients?But here I feel as if I’m hearing this for the first time. Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth.

things we protest against the most are often the very things we need to look at.

There is a continuing decision to be made as to whether to evade pain, or to tolerate it and therefore modify it.

We tend to think that the future happens later, but we’re creating it in our minds every day. When the present falls apart, so does the future we had associated with it. And having the future taken away is the mother of all plot twists.

Everything that made this man himself—his personality, his memories, his experiences, his likes and dislikes, his loves and losses, his knowledge and abilities—was contained in this three-pound organ. You lose a leg or a kidney, you’re still you, but lose a part of your brain—literally, lose your mind—and who are you then ?

After Julie learned that she was dying, her best friend, Dara, wanting to be helpful, sent her the well-known essay” Welcome to Holland.” Written by Emily Perl Kingsley, the parent of a child with Down syndrome, it’s about the experience of having your life’s expectations turned upside down

We think we make bucket lists to ward off regret, but really they help us to ward off death. After all, the longer our bucket lists are, the more time we imagine we have left to accomplish everything on them. Cutting the list down, however, makes a tiny dent in our denial systems, forcing us to acknowledge a sobering truth:Life has a 100 percent mortality rate. Every single one of us will die, and most of us have no idea how or when that will happen. In fact, as each second passes, we’re all in the process of coming closer to our eventual deaths. As the saying goes, none of us will get out of here alive.

that point, though, I was thirty-three years old, with two more years of medical school, at least three years of residency, maybe a fellowship after that—and I knew that I wanted a family. The more I saw the effects of managed care up close, the less I could imagine myself taking the years-long risk of finishing my training and then trying to find out if it was possible to concoct the kind of practice I wanted while also being a writer.

We are afraid of being hurt. We are afraid of being humiliated. We are afraid of failure and we are afraid of success. We are afraid of being alone and we are afraid of connection. We are afraid to listen to what our hearts are telling us. We are afraid of being unhappy and we are afraid of being too happy (in these dreams, inevitably, we’re punished for our joy). We are afraid of not having our parents ’ approval and we are afraid of accepting ourselves for who we really are. We are afraid of bad health and good fortune. We are afraid of our envy and of having too much. We are afraid to have hope for things that we might not get. We are afraid of change and we are afraid of not changing. We are afraid of something happening to our kids, our jobs. We are afraid of not having control and afraid of our own power. We are afraid of how briefly we are alive and how long we will be dead. (We are afraid that after we die, we won’t have mattered.) We are afraid of being responsible for our own lives.

I haven’t told Wendell about the book-I’m-not-writing because every time I think about it, I’m filled with panic, dread, regret, and shame. Whenever the situation pops into my head (which is constantly; as Fitzgerald put it,” In a real dark night of the soul, it is always three o’clock in the morning, day after day”), my stomach tightens and I feel paralyzed.

“Too many parents make life hard for their children by trying, too zealously, to make it easy for them.”

At the same time, I empathize with John because his reaction is common. Whenever one person in a family system starts to make changes, even if the changes are healthy and positive, it’s not unusual for other members in this system to do everything they can to maintain the status quo and bring things back to homeostasis.

Anger is the go-to feeling for most people because it’s outward-directed—angrily blaming others can feel deliciously sanctimonious. But often it’s only the tip of the iceberg, and if you look beneath the surface, you’ll glimpse submerged feelings you either weren’t aware of or didn’t want to show:fear, helplessness, envy, loneliness, insecurity. And if you can tolerate these deeper feelings long enough to understand them and listen to what they’re telling you, you’ll not only manage your anger in more productive ways, you also won’t be so angry all the time.

“I’m reminded,” he begins,” of a famous cartoon. It’s of a prisoner, shaking the bars, desperately trying to get out—but to his right and left, it’s open, no bars.” He pauses, allowing the image to sink in.” All the prisoner has to do is walk around. But still, he frantically shakes the bars. That’s most of us. We feel completely stuck, trapped in our emotional cells, but there’s a way out—as long as we’re willing to see it.”

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment.

The average life expectancy in the United States now hovers around eighty, and it’s becoming common to live into one’s nineties, so what happens to these sixty-year-olds ’ identities during the decades they still have left?With aging comes the potential to accrue many losses : health, family, friends, work, and purpose.

It turns out that most of us aren’t aware of how we actually spend our time or what we really do all day until we break it down hour by hour and say it out loud.

It wasn’t that she didn’t respect psychiatrists; it was that psychiatry today tends to be more about the nuances of medication and neurotransmitters than the subtleties of people’s life stories—all of which she knew I knew.

In movies, therapist silences have become a cliché, but it’s only in silence that people can truly hear themselves. Talking can keep people in their heads and safely away from their emotions. Being silent is like emptying the trash. When you stop tossing junk into the void—words, words, and more words—something important rises to the surface. And when the silence is a shared experience, it can be a gold mine for thoughts and feelings that the patient didn’t even know existed.

The internet can be both a salve and an addiction, a way to block out pain (the salve) while simultaneously creating it (the addiction). When the cyber-drug wears off, you feel worse, not better. Patients think they want to know about their therapists, but often, once they find out, they wish they hadn’t, because this knowledge has the potential to contaminate the relationship, leaving patients to edit, consciously or not, what they say in their sessions.

What most people mean by type is a sense of attraction—a type of physical appearance or a type of personality turns them on. But what underlies a person’s type, in fact, is a sense of familiarity. It’s no coincidence that people who had angry parents often end up choosing angry partners, that those with alcoholic parents are frequently drawn to partners who drink quite a bit, or that those who had withdrawn or critical parents find themselves married to spouses who are withdrawn or critical.

remember in medical school how hard it was for us students to accept that somebody had died and that there was nothing else we could do, to have to be the person to” call it” —to say aloud those dreaded words Time of death… I look at the clock—3:17.

It always amazes me that someone can walk into a room as a stranger and then, after fifty minutes, leave feeling understood, but it happens nearly every time.

Everyone wages this internal battle to some degree:Child or adult?Safety or freedom?But no matter where people fall on those continuums, every decision they make is based on two things : fear and love. Therapy strives to teach you how to tell the two apart.

As we hunkered down in that basement, doing our charts by hand and searching for reception on our phones, we didn’t realize that upstairs, a revolution was under way, one of speed, ease, and immediate gratification. And that what we were being trained to offer—gradual but lasting results that required some hard work—was becoming increasingly obsolete.

You won’t get today back. What a chilling idea. We knew that our supervisor was trying to tell us something important. But we didn’t have time to think about it.

“Modern man thinks he loses something—time—when he does not do things quickly; yet he does not know what to do with the time he gains except kill it.”

“The speed of light is outdated,” she said dryly.” Today, everybody moves at the speed of want.”

If you’d asked me when I started as a therapist what most people came in for, I would have replied that they hoped to feel less anxious or depressed, to have less problematic relationships. But no matter the circumstances, there seemed to be this common element of loneliness, a craving for but a lack of a strong sense of human connection. A want. They rarely expressed it that way, but the more I learned about their lives, the more I could sense it, and I felt it in many ways myself.

The four ultimate concerns are death, isolation, freedom, and meaninglessness.

Here people procrastinate or self-sabotage as a way to stave off change—even positive change—because they’re reluctant to give something up without knowing what they’ll get in its place.

“Everything can be taken from a man but one thing:the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

If you’re used to feeling abandoned, if you already know what it’s like for people to disappoint or reject you—well, it may not feel good, but at least there are no surprises; you know the customs in your own homeland. Once you step into foreign territory, though—if you spend time with reliable people who find you appealing and interesting—you might feel anxious and disoriented. All of a sudden, nothing’s familiar.

She’s become hyper-present. When people delude themselves into believing they have all the time in the world, she’s noticed, they get lazy.

“Wouldn’t it be nice to be one of those people who doesn’t overthink anything, who just goes with the flow—who lives the unexamined life ?” I remember saying that there was a difference between examining and dwelling, and if we’re cut off from our feelings, just skating on the surface, we don’t get peace or joy—we get deadness.

The inability to say no is largely about approval-seeking—people imagine that if they say no, they won’t be loved by others. The inability to say yes, however—to intimacy, a job opportunity, an alcohol program—is more about lack of trust in oneself.

There’s no hierarchy of pain. Suffering shouldn’t be ranked, because pain is not a contest.

You get through your pain by accepting it and figuring out what to do with it. You can’t change what you’re denying or minimizing. And, of course, often what seem like trivial worries are manifestations of deeper ones.

“It’s like the eggs,” I say, and he nods in recognition. I once told Wendell that Mike, my colleague, had said a while back that when we feel fragile, we’re like raw eggs—we crack open and splatter if dropped. But when we develop more resilience, we’re like hard-boiled eggs—we might get dinged up if dropped, but we won’t crack completely and spill all over the place.

The day before he said this, I had been told by my eye doctor that I had developed presbyopia, which happens to most people in their forties. As people age, they become farsighted; they have to hold whatever they’re reading or looking at farther away in order to see it clearly. But maybe an emotional presbyopia happens around this age too, where people pull back to see the bigger picture : how scared they are to lose what they have, even if they still complain about it.

“Every laugh and good time that comes my way feels ten times better than before I knew such sadness.”

Irvin Yalom, the psychiatrist, wrote that it was” far better that a patient make progress but forget what we talked about than the opposite possibility (a more popular choice for patients)—to remember precisely what was talked about but to remain unchanged.”

Every hour counts for all of us, and I want to be fully present in the therapy hour I spend with each one.

I thought about how many people avoid trying for things they really want in life because it’s more painful to get close to the goal but not achieve it than not to have taken the chance in the first place.

Every person you’ve been close to lives on somewhere inside you. Your past lovers, your parents, your friends, people both alive and dead (symbolically or literally)—all of them evoke memories, conscious or not. Often they inform how you relate to yourself and others. Sometimes you have conversations with them in your head; sometimes they speak to you in your sleep.

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