What your therapist is thinking about in that therapy session

Chalk it up to the warm, loving therapist, plus your own innate genius. Right?

Not so fast. “Insight is the booby prize of therapy,” Lori Gottlieb writes in her new book, “Maybe You Should Talk to Someone: A Therapist, Her Therapist, and Our Lives Revealed.”

“It’s great if you have it, but if you don’t take that insight and produce change, it’s worthless.”

Gottlieb’s book is perhaps the first I’ve read that explains the therapeutic process in no-nonsense terms while simultaneously giving hope to therapy skeptics like me who think real change through talk is elusive.

The book follows the lives of four very different people in crisis — well, five, if you count Gottlieb herself, whose life has been upended by a breakup with a man who was supposed to be her forever after.

Gottlieb writes the “Dear Therapist” advice column for The Atlantic, and as a yarn spinner she shines; it’s not surprising that before she was a psychotherapist, she was a story development executive in Hollywood. (Eva Longoria has optioned “Maybe You Should Talk to Someone” for a television series.) But Gottlieb’s book is considerably more than an engaging series of case studies. It uses her patients’ crises, and her own, to ask some fundamental questions about what therapy is, and what it can and cannot do for us.

This interview has been edited and condensed.

Q: What is a therapist’s main job?

A: We hold up the mirror so that people can see themselves more clearly, but in a compassionate way. It’s not: “Look at you, shooting yourself in the foot again! What’s the matter with you?” It’s, “Hey, can you see that by doing such and such, here’s how you’re getting in your own way.” The therapy mirror isn’t the unflattering but distorted mirror we usually tend to look in, the one that makes us cringe; it’s a more objective reflection, with no judgment whatsoever. It’s a compassionate mirror.

Q: What is one thing that is not a therapist’s job?

A: The Buddhists call it idiot compassion. It’s what we often do with friends and family — we’re afraid to hold up the mirror to them. We don’t want to upset them, so we tilt the mirror to their liking, telling them what they want to hear and not what they need to hear. But our compassion ends up being more harmful than our honesty would have been.

Wise compassion is what therapists practice when we hold up the mirror and say, “Hey, take a look at your reflection for a second.” We show how much we care by being willing to deliver a compassionate truth bomb.

Q: When you talk about successful therapy, you quote the famed psychotherapist John Weakland: “Before successful therapy, it’s the same damn thing over and over. After successful therapy, it’s one damn thing after another.” Can you explain that a bit?

A: I love that quote. As therapists, we help people see self-defeating patterns that are contributing to their struggles, and once they see why the same thing keeps happening over and over — the same fight with their spouse, the same difficulty with family or bosses at work, the same fear of not being good enough that contributes to repeated rejection — they realize that the reason their lives feel like “Groundhog Day” is because of something they’re doing that they can change or do differently.

Changing these patterns transforms people’s lives. But what we can’t do for people is change the nature of life, which includes hardship. People will always encounter “one damn thing after another” that they can’t control, but they can change their response to it.

Q: I love your description of your own therapist, Wendell, who seems a throwback to another era: “His expression is intense but gentle, a combination of a wise elder and a stuffed animal.” And in fact you make a point about therapy itself, that it’s old-fashioned, kind of a throwback to a different time. What do you mean by that?

A: Our world is moving at such a fast pace, and people who come to me often want things to move very quickly. It’s a very human impulse. Help me not to feel NOW, give me a pill. Which is great; I’m not anti-medication at all. There are people who benefit greatly. But there are also a lot of people for whom medication alone won’t work. People mistake feeling less for feeling better. Therapy teaches you otherwise.

Q: You have a tale in the book that is one of the biggest fears of every psychotherapy patient: being fired by your therapist because you’re a hopeless case.

A: Yeah, I talk about a patient who was constantly saying I was not helping her. I could see exactly why people were pulling away. Everything and everyone disappointed her. The guys in her life were all commitment-phobes and the women were snobs, and the colleagues were blah blah blah — and I was so bored.

Q: OK, I am pretty sure that fear of boring a therapist ensures I’ll never go.

A: Well, I felt like such a failure, but I had trouble breaking up with her. Partly I was worried how she would feel, but it’s also my own ego. You keep thinking, If I can just find the key and unlock this. But sometimes you can’t. And the thing is, she came to me with the issue of having problems with relationships in all areas of her life.

Sometimes the dance you’re doing with your therapist is the dance you’re doing in the rest of the world.

Q: In the midst of your disastrous breakup, you also have some challenging but nonlethal health issues that you discuss — all while treating a patient who is actually dying.

A: You can’t be a therapist and not be oriented toward a core. Without getting morbid, you do focus on mortality. You start thinking about the limited time you have on this planet, and how we generally don’t know how much time we have, and how that very thought drives us to find purpose. What will contribute to my growth, and what to other people’s growth?

The experience of my patient, and my own, made me realize the importance of not wasting time. And one way we waste time — that hopefully therapy addresses — is the constant perseveration, the soundtrack in our heads that makes us mean to ourselves, and makes us make bad decisions. If we can start learning to be kind to ourselves, we save a lot of time on this planet.

Q: How do I ask this delicately? OK, I can’t. This book is very revealing about you. Are you worried that your patients will know too much?

A: (Laughs.) Well, it’s the most revealing and personal book I’ve written — by design. Patients and therapists are at cross-purposes, in a way. We want to help patients function better, but they often want to come across in a certain ideal way, and we want to see them in a more realistic way. And it was the same with me. I want to come across well, too. The first draft, I was nonprotective of myself, then, second draft, I tried to clean myself up. In the cleaning up, I deflavorized the entire story, I took the humanity out of it. My persona was polished. And it was not what being human looks like. It felt disingenuous, making people raw and real and polishing myself. So I stopped cleaning myself up. I feel the vulnerability of doing that, but I got more comfortable with it.

Q: Which raises a question that’s really at the heart of this book. It’s something we all think about, in and out of therapy: Can I be truthful and still be loved?

A: Carl Jung called secrets “psychic poison,” which is apt, because secrets are corrosive and go hand in hand with shame. We have so much shame underlying the truth of who we are, and that’s also why in my book, it takes a while before I really hear my patients’ stories — or my therapist really hears mine. We’re so afraid of the truth that sometimes we even hide it from ourselves.

So I think “Can I be truthful and still be loved?” is the paradox we all live with, both in the therapy room and in our personal relationships. So many people believe that the pretty version of themselves makes them more lovable, so they do everything they can to put that version out there. But what they discover in therapy is that the truth of who they are — warts and all — is what draws people to them. That’s the glue, because in that truth lies connection. I see you. You see me. That’s a delicious feeling.

This article originally appeared in The New York Times.