Maybe You Should Talk to Someon - Lori Gottlieb Page 0,11
wore last night.
I brace myself and glance down. My top says NAMAST’AY IN BED. Julie is looking at me, waiting for an answer.
Whenever I’m not sure what to say in the therapy room—which happens to therapists more often than patients realize—I have a choice: I can say nothing until I understand the moment better, or I can attempt an answer, but whatever I do, I must tell the truth. So while I’m tempted to say that I do yoga and that my top is simply a casual T-shirt, both would be lies. Julie does yoga as part of her Mindful Cancer program, and if she starts talking about various poses, I’d have to lie further and pretend that I’m familiar with them—or admit that I lied.
I remember when, during my training, a fellow intern told a patient he would be out of the clinic for three weeks, and she asked where he was going.
“I’m going to Hawaii,” the intern said truthfully.
“For vacation?” the patient asked.
“Yes,” he replied, even though, technically, he was going for his wedding, which was to be followed by a two-week island honeymoon.
“That’s a long vacation,” the patient remarked, and the intern, believing that sharing the news of his wedding would be too personal, decided instead to focus on the patient’s comment. What would it be like for her to miss three weeks of sessions? What did her feelings about his absence remind her of? Both of which might be fruitful avenues to explore, but so would the patient’s indirect question: Since it’s neither summer nor a holiday season, why are you really taking three weeks off? And sure enough, when the intern returned to work, the patient noticed his wedding ring and felt betrayed: “Why didn’t you just tell me the truth?”
In retrospect, the intern wished he had. So what if a patient learned that he was getting married? Therapists get married and patients have reactions to that. Those can be worked through. Loss of trust is harder to repair.
Freud argued that “the physician should be impenetrable to the patient, and like a mirror, reflect nothing but what is shown to him.” Nowadays, though, most therapists use some form of what’s known as self-disclosure in their work, whether it’s sharing some of their own reactions that come up during the session or acknowledging that they watch the TV show that a patient keeps referring to. (Better to admit that you watch The Bachelor than to feign ignorance and slip up by naming a cast member the patient hasn’t mentioned yet.)
Inevitably, though, the question of what to share gets tricky. One therapist I know told a patient whose child was diagnosed with Tourette’s syndrome that she, too, had a son with Tourette’s—and it deepened their relationship. Another colleague treated a man whose father had committed suicide but never revealed to the patient that his own father had also committed suicide. In each situation, there’s a calculation to make, a subjective litmus test we use to assess the value of the disclosure: Is this information helpful for the patient to have?
When done well, self-disclosure can bridge some distance with patients who feel isolated in their experiences, and it can encourage more openness. But if it’s perceived as inappropriate or self-indulgent, the patient will feel uncomfortable and start to shut down—or simply flee.
“Yes,” I tell Julie. “It’s a pajama top. I guess I put it on by mistake.”
I wait, wondering what she’ll say. If she asks why, I’ll tell the truth (although not the specifics): I wasn’t paying attention this morning.
“Oh,” she says. Then her mouth twitches the way it does when she’s about to cry, but instead, she starts laughing.
“I’m sorry, I’m not laughing at you. Namast’ay in Bed . . . that’s exactly how I feel!”
She tells me about a woman in her Mindful Cancer program who’s convinced that if Julie doesn’t take yoga seriously—along with the famous pink ribbons and the optimism—her cancer will kill her. Never mind that Julie’s oncologist has already informed her that her cancer will kill her. This woman still insists it can be cured with yoga.
Julie despises her.
“Imagine if I walked into yoga wearing that top and—”
Now she’s laughing uncontrollably, reining it in and then bursting out with another round. I haven’t seen Julie laugh once since she learned she was dying. This must be what she was like in what she calls “B.C.” or “Before Cancer,” when she was happy and healthy and falling in love with her soon-to-be husband.