Is She Failing at Therapy?

Everything therapist Lori Gottlieb says about Annie’s problem is eminently sensible. Annie is in therapy. Her company offers to pay for counseling and she has taken up the offer. She has spoken with her therapist about her work situation and the talks have helped her.

Now, she is anguished because she chokes up every time she wants to speak about her marriage. So, Gottlieb offers a set of instructions about how to open up to one’s therapist. All of them are sensible.

And yet, she is missing an essential point. Or, in fact, two essential points. See if you can see what they are:

I've taken advantage of it and have finally started seeing a counselor to address my anxiety and depression, which have worsened since moving halfway across the country for this job. Together we've come up with strategies to fix some of the aspects of my work environment that make me most anxious, and now I'm much calmer and happier at work.

However, I've been unable to talk with her about my relationship with my spouse,

which caused my anxiety and depression to spike even before the move and new job.

Every time I try to bring this up, I start crying and am literally unable to say words until I switch to a different topic.

I think part of this reluctance is the result of growing up in a divorced household and feeling like any marital strife is an unforgivable personal failing. I’m especially frustrated because I believe she could help me work through these issues, as everything she's suggested so far has made a noticeable improvement in my life.

I feel like I'm failing at therapy by not talking about my "real" problems with my counselor. How can I get over this mental block? Should I break things off and try again in a few months so I don't waste her time?

Allie

Denver, Colo.

Gottlieb ignores two salient points. First, the sessions are taking place within a work context. It makes sense that Annie feels comfortable talking about work matters. Nothing especially strange about that. If she believes that she is duty bound to use the sessions to talk about work, then bringing up marital difficulties might be outside the scope of treatment. She might feel this way without knowing that she feels this way. For all I know the therapist is completely engaged in conversations about work and less interested in non-work matters.

The second point is, Gottlieb places the onus entirely on Annie. She does not even hint that the therapist has some responsibility for the state of affairs. There are two people in any conversation. It is grossly unfair to suggest that the fault lies only with Annie. The fault more likely lies with the therapist. A good and competent therapist, upon seeing that her patient is breaking down, will ask what the problem is. She will question and probe the issue. She will not simply sit back and wait for the patient to be more forthcoming.

In addition, any conversation includes a myriad of subtle gestural clues. As you are conversing with someone  you are reading these clues. Depending on how sensitive you are, you will tailor your remarks accordingly. If a mere hint at a marital difficulty causes a therapist to grimace, the patient might justly choose to stop discussing the issue.

It is wrong for Annie to think that she has a mental block. In the most obvious case, a therapist can inquire as to her married life. A therapist can ask some questions. A therapist ought not to leave a woman crying and sputtering in her office without showing the minimum degree of interest. If the therapist does not show such concern, then clearly Annie is getting the message that the therapist believes that the topic is out of bounds.