Maybe You Should Talk to Someon - Lori Gottlieb Page 0,111

down some food (lunch was always eaten “al desco”) and commiserate about our lack of time. But despite our gripes, our initiation as therapists felt exhilarating—partly because of the steep learning curve and our wise supervisors (who gave us advice like “If you’re talking that much, you can’t be listening” and its variant “You have two ears and one mouth; there’s a reason for that ratio”), and partly because we knew this phase was blessedly temporary.

The light at the end of the years-long tunnel was licensure, when we imagined we could improve people’s lives by doing the work we loved but with reasonable hours and a less frenetic pace. 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.

I’d seen hints of these developments in my patients at the clinic but, focused on my own harried existence, I failed to see the bigger picture. I thought: Of course these people have trouble slowing down or paying attention or being present. That’s why they’re in therapy.

My life wasn’t much different, of course, at least during this phase. The faster I finished my work, the sooner I’d get to spend time with my son, and then the quicker we could do the bedtime routine, the quicker I could get to bed so that I could wake up the next day and hurry all over again. And the quicker I moved, the less I saw, because everything became a blur.

But this would end soon, I reminded myself. Once I finished my internship, my real life would begin.

One day I was in the break room with some fellow interns, and we once again started counting our required number of hours and calculating how old we’d be when we finally got licensed. The higher the number, the worse we felt. A supervisor in her sixties walked by and overheard the conversation.

“You’ll turn thirty or forty or fifty anyway, whether your hours are finished or not,” she said. “What does it matter what age you are when that happens? Either way, you won’t get today back.”

We all went quiet. 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.

Speed is about time, but it’s also closely related to endurance and effort. The faster the speed, the thinking goes, the less endurance or effort required. Patience, on the other hand, requires endurance and effort. It’s defined as “the bearing of provocation, annoyance, misfortune, or pain without complaint, loss of temper, irritation, or the like.” Of course, much of life is made up of provocation, annoyance, misfortune, and pain; in psychology, patience might be thought of as the bearing of these difficulties for long enough to work through them. Feeling your sadness or anxiety can also give you essential information about yourself and your world.

But while I was down in that basement rushing toward licensure, the American Psychological Association published a paper called “Where Has All the Psychotherapy Gone?” It noted that 30 percent fewer patients received psychological interventions in 2008 than they had ten years earlier and that since the 1990s, the managed-care industry—the same system that my medical-school professors had warned us about—had been increasingly limiting visits and reimbursements for talk therapy but not for drug treatment. It went on to say that in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians—nearly twice what they spent on research and development.

Of course, it’s a lot easier—and quicker—to swallow a pill than to do the heavy lifting of looking inside yourself. And I had nothing against patients using medication to feel better. Just the opposite; I was, in fact, a strong believer in the tremendous good it often did in the right situations. But did 26 percent of the general population in this country really need to be on psychiatric medications? After all, it wasn’t that psychotherapy didn’t work. It was that it didn’t work fast enough for today’s patients, who were now, tellingly, called “consumers.”

There was an unspoken irony to all of this. People wanted a speedy solution to their problems, but what if their moods had been driven down in the first