Why You Should Run, Not Walk, Into Talk Therapy

Almost everyone I know is or has been in psychotherapy. Individual, group, couples, all of the above. This is not only because I am myself a clinical psychologist with a lot of clinical psychologist friends, but also because I live in New York City, where people see therapists like they go to the gym. In the New York that I inhabit, things have changed little since the mid 1960s, when, as Jonathan Engel recorded in his 2008 book American Therapy, two buildings on one corner of the Upper East Side of Manhattan housed as many psychoanalysts as the states of Minnesota, Oregon, Delaware, Oklahoma, Vermont, Wisconsin and Tennessee combined.

So accustomed to these environs I became that it was something of a shock to my system when, during the one-year internship that I did at Brooklyn’s Kings County Hospital at the end of graduate school, I was faced with the truth that outside of Manhattan and the innermost corners of its outer boroughs, people thought that talking to a psychologist was suspect. Shameful even. This reminisced of familiar to me—I did, after all, originate Somewhere Else—but still I had to recalibrate. “I’m not crazy,” seemed to be the rallying cry of the medical patients whose bedsides I’d been sent to in order to assess whether they were struggling emotionally with their illnesses.

“Psychologists aren’t just for crazy people,” I learned to say during that particular rotation at Kings County, never without great discomfort. (I felt like a 1980s television pitchman. “Orange juice—it’s not just for breakfast anymore.” Nobody bought that either.) I reluctantly delivered my line at bedsides, and then, too, at the beginning of each oncology support group I co-led weekly with another psychology intern. Even people undergoing treatment for cancer—cancer!—found it just barely acceptable to sit with a trained human being in search of help or some solace. Right, I reminded myself, this is what people think. As often as I saw it, it penetrated only slowly, like so much bad news.

Bad news because I knew how lives could play out without therapy. Helen, a patient I’d begun seeing at the hospital’s outpatient mental health clinic, was just one example. In her early sixties, she’d been terribly depressed all her life, a condition she related quite appropriately to having been left by her parents at an early age. Raised around cousins who teased her mercilessly for being unwanted, her only friend as a child, she recounted, had been a large doll. During Helen’s initial session with me—her first-ever visit with a therapist—she told me tearfully that when she’d recently been discharged from the medical hospital, no one had cared even enough to come to pick her up. She’d waited in the rain for hours before finally boarding a city bus.

“Who had you called to come get you?” I asked, because something just didn’t feel right.

“No one,” she replied puzzled, unable to see the obvious role she’d played in authoring, like a play, her latest experience of abandonment.

During our year together, I’d hear dozens of similar stories. Helen had lived her whole life re-enacting her early trauma, over and over and then over yet again until her sense of herself as an unlovable creature was almost all that was left of her. Without a therapist to help attach meaning to this compulsive repetition, she’d had no choice but to keep it up, despite its great cost to her objective well-being.

In her many years of over-determined suffering, was Helen extreme? My experience in practice, not to mention life, has taught me not. Not in the least. Today, a handful of years past my internship and in private practice, I see versions of Helen walk into my office on a regular basis. Men and women sit down on my long leather couch. They describe to me how they have been living, and begin to allow that it just might not make so much sense.

Of course it always makes perfect sense. Our most self-defeating ways come to us honestly, in attempt to protect ourselves from truths we fear too horrible to bear (in Helen’s case, she’d chosen proving herself innately reject-able to mourning the fact that her parents had problems that had nothing to do with her). The failure to develop other modes of feeling and thinking and behaving becomes the problem. We all leave our families of origin eventually, though some manage it only quite literally.

In the end we get just one life. Many of its outcomes are probably out of our control. But—and this is what I’ve learned that far too few people realize—there is also one that isn’t. Our psychological wellness, or more to the point its opposite, is hardly something that has to be left to chance, to the luck of the draw. If this sounds like something you might benefit from thinking more about, a good psychotherapist is not hard to find.