When it comes to our physical health, most of us don't hesitate to seek help when something's wrong. Things like broken bones, burns, and concussions usually result in a visit to the doctor. But when it comes to our emotional health, well, that's a different story.

People don't come to therapy until they're having the equivalent of an emotional heart attack.

That's psychotherapist and writer Lori Gottlieb.

We don't have this hierarchy of pain. With our physical health, we don't say, oh, I fell down and broke my wrist, but I don't have stage four cancer, so I'm just going to let my wrist hang out there and I'm not going to get a cast. And we have a very different attitude about emotional health.

Lori suggests that we could all be happier if we didn't wait for crisis to strike. And that therapy is a powerful tool that might help. Now, look, we've all heard time and time again that true happiness comes not from money or even external success, but rather from within. And I really believe there's truth in that. But it's also true that many of us could use a little help getting there. And that's where therapy comes in.

But here's the issue. A lot of people are unsure about therapy. According to Pew Research, nearly a third of Americans surveyed said they'd only be somewhat comfortable talking to a therapist about their own mental health. It could be that people are concerned about the cost. Others may just be skeptical. Whatever the reason, uncertainty about what therapy is and how it works, that's real. And as someone who's never been to therapy before, I had a lot of questions as well.

So today we're going to explore how therapy could help you achieve happiness, whether you're facing challenges or simply seeking to enrich your life. Also, what exactly is the science behind therapy? How does it work? And here is a provocative question. Should everyone be in therapy? I'm Doctor Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.

Can you just spend a minute telling us how you define what therapy actually is? Because I think a lot of people who are listening, they see it in TV, they see it in the movies. But I imagine, like with a lot of medicine as well, it's not always accurate. What is therapy?

There are so many misconceptions about therapy, and I think that often prevents people from going. So one misconception about therapy is that you're going to go in, you're going to download the problem of the week, and you're going to leave. And you're basically just complaining and getting validated for your complaints. And that is not what therapy is. We like to say that insight is the booby prize of therapy, that you can have all the insight in the world, but if you don't make changes out in the world, the insight is useless. So one misconception is that all therapy takes place in therapy. Most therapy takes place in the week between sessions, where you are actually taking what you've learned and doing something different.

So we like to talk about the difference between idiot compassion and what is compassion. Idiot compassion is again what we often do with our friend. So you tell your friend the story that you maybe would have told your therapist. Like, can you believe that my partner did this, or my sibling did this? And we say, yeah, you're right, they're wrong. You know, we we just we support our friend's story, but we're all unreliable narrators. We are all telling a story from our very specific perspective, and we're leaving out the things that maybe don't make us look so good or that we're just not seeing. Because of course, we're just looking through our own very narrow lens. But at therapy, you get wise compassion where we hold up a mirror to you and we help you to see something about your role in the situation and in the relationship that maybe you haven't been willing or able to see. And that's really helpful. It's almost like getting a second opinion on your life from someone who's not already in your life.

That is really wise. I can see why you are someone who practices wise compassion.

And I think that the reason that people don't maybe go to therapy is because there's this idea that things have to be really bad before you go to therapy. Right. If you're feeling sad or you're feeling anxious, you're having trouble in a relationship. We say, well, I have a roof over my head and food on the table, so I have no reason to complain or be sad or be anxious or so what if I'm having trouble in my relationship? And people don't come to therapy until they're having the equivalent of an emotional heart attack.

We'll be right back.

You know, it's interesting, Lori. I've been talking a lot to preventive doctors lately. For example, preventive neurologists. And to your point, I think one of the things that they say is we kind of live in a sick care system more than a health care system that, even when it comes to our physical health, people aren't really doing things to maintain as much as really addressing the problem when it gets to some sort of crisis point. Who, who should be doing therapy? When should they be coming in?

'So I always say to people that if you're asking yourself if you should go to therapy, that's your inner therapist telling you you should go to therapy. People feel like the threshold has to be so high in terms of preventative emotional well-being. I think that's really important. So, for example, I have a lot of couples who come to me before they get married and they're coming not because they have any problems. They're at the the best possible place in their relationship. They're so happy. They're so excited. And the reason that they're coming is because they want to learn how to talk about things. So it's not necessarily the issues to talk about that they want to learn how to talk about things because things will inevitably come up. We might talk about things like money. And let's talk about what you guys have discussed in terms of how you might handle your money. Let's talk about sex. Let's talk about your families, because you are blending two different families when you get married and in-laws and parents and siblings and your friends and your separate friend groups. Let's talk about whether you want to have children and if so, how are you thinking about how many you might want to have and who might be taking care of them and and how that might work. So all of these things are things that most couples do without going to therapy. First. They just do it and then they come in when the problems arise. Like, well, I didn't know that you thought that. I didn't know that that was the expectation. I didn't know it was going to work this way. So that's a great example of preventative therapy. And those couples tend to do really well, but they get so much flack out in the world like, oh, you must have a lot of that's not a good sign for your marriage that you're going to therapy and you're not even married yet. Because people assume that they're coming because they have problems, but they're coming because they're learning how to have some hard conversations that are going to come up in the course of their marriage.

This idea that the sort of stigma I think that you're, you're alluding to there, has that changed over your the time that you've been practicing? I mean, I feel like I hear a lot of people who are much more open about discussing going to therapy. If I'm just out in social situations, it'll come up just as part of normal conversation. I don't feel like that happened ten, 15 years ago. I'm I'm in my mid 50s now, but, what what is your experience?

There are two sides to this. One is that yes, more people are talking about therapy. And I think because of Covid, a lot of people realized it's okay to talk about emotional health, whereas I think before they might have been reticent to do that. So a lot more people started talking about mental health is important. It's it's as important as physical health. And they're not discrete entities. Your physical health affects your mental health. Your mental health affects your physical health. It's all health. On the other hand, I think that what social media has done is it has taken what people consider therapeutic terms and misused that. So now if you look on social media, everybody is having their boundaries violated, everybody is being gaslit. Everybody is in relationship with a narcissist. If somebody is, you know, problematic, that's a great word people use cut them off, which is not what would happen in therapy. Therapy is really a much more nuanced conversation. And people are misusing these words so much. And I think that it's actually hurting people's mental health, because now people don't know how to be relational. They're just they're sort of getting that idiot compassion that we were talking about. But on social media, like, can you believe what this person did? This person's a narcissist. And then everyone's like, yeah, that person's a narcissist. And in therapy you'd be having a very different conversation about that. And that's not to say that there aren't difficult people out there. We have the saying before diagnosing someone with depression, make sure they aren't surrounded by assholes. So, you know, there are definitely difficult people out there. But then the question is, how do you navigate that and how do you navigate that in an adult, mature way? Not in a very reactive way.

If you had to say, here is the goal of therapy. And I don't want to overly simplify here, Lori, but is it to make you happy or is it to make you saner? Is it to make you more balanced, give you more clarity? How would you describe it?

I think at the end of the day, what most of us want, our primal need is to love and be loved, and so many things get in the way. So I think that what therapy helps people do is navigate through the world in a more relationally healthy way. And so someone might come in for a discreet problem, like, you know, it might be I'm having trouble in this relationship. Whether it's a work relationship or a friend relationship or family relationship or a romantic relationship. But it could also be I'm feeling depressed or I'm feeling anxious, and usually that there's some component of the depression or the anxiety that is related to not having enough meaningful connection in their lives. So how can we help them navigate through the world in a way where they will have more meaningful connections, where they will have more purpose and just feel, again, a sense of, I think, intentionality about their lives instead of just going through life and then saying, I don't really know what I'm doing, I don't really know why I'm here. And I know that sounds a little bit like, woowoo, almost. But I think that when we think about life has a 100% mortality rate, and that's not just for other people. That is truly 100% right? That we need to understand that we're not here forever, and we have choices about what we do every single day and how we live our lives. So it's not about being happy per se. I think that people who chase happiness, that sort of a recipe for disaster. I think that people who are looking for meaning and connection, which of course brings us happiness, is why people come to therapy.

You know, if patients come to the office to see me. You know, I get a pretty good idea if someone's coming in for a herniated disc or brain tumor, how likely I am to be successful in addressing the issue. What about you with therapy?

Yes, I would say maybe not the first session, but certainly after the first few.

And what is it that you're looking for?

'Part of it has to do with readiness. So is the person ready to self-reflect. Is the person ready to make some changes? Is the person... Why is the person here? What is their goal? I think another misconception about therapy is that people think you're just sort of freeform talking and there aren't goals. And from the very beginning, as a therapist, I am thinking about what are they hoping to get out of this experience. What is the through line here so that we know whether we're on track and we know whether we've met certain goals? And I think that the people that are hard to help are the people who don't want to do the work, don't want to self-reflect, don't want to make change out in the world, want to blame other people. You know, everybody comes into therapy because they want something to change. That's why they're there. But often what they want to change is someone else or something else. And I get that. I went into therapy the same way, you know, that's why I wrote about in my book, I follow four patients in Maybe You Should Talk To Someone. I follow their stories, but I put myself as the fifth patient in the book because I wanted people to see that I do the same things when I go to therapy. I think it's really human. But I also think that, you know, how open are you? How willing are you to consider another perspective if you're just going to keep thinking about your situation in the same exact way, then why are you in therapy? Right?

You said it's not necessarily a goal of therapy to make you happier, but rather to make you feel like you can be loved, that you can love in society. Do people, though, report being happier when they go through therapy? Do they report elevated mood?

Yes. And I, the reason I hesitate is that nobody's happy all the time. That's just not realistic. So that the term happy, do they experience joy more? Yes. Are they generally more content in their lives? Do they feel less stressed, less sad, more able to manage when things don't go well? Less reactive when they're in a situation that maybe is relationally difficult for them. More able to find sort of inner peace? Yes. And I think that that shouldn't be underestimated. I think that when people say, you know, oh, I just want to be happy... All of the things that I just described bring you happiness.

We're going to take a short break here. But when we come back, Lori explains how therapy can actually change your brain and maybe, just maybe, get you closer to achieving happiness.

Neurologically, we are wired from very early on. And what we're doing in therapy is we're changing the wiring.

We'll be right back. I don't know if you've looked at the story of what's really happening in someone's brain, call it their mind when someone goes through therapy. But do you think about this from a mechanism standpoint, like why does therapy work?

I'm really interested in the science, and I think that therapy is both a science and an art. You can know all the science, but if you don't know how to use what I like to call timing and dosage in terms of how do you deliver a message to somebody, how do you help them to see something differently? How much do you say at one moment? And at what point which session are you going to do it in, and what moment in the session are you going to do it? Timing and dosage is crucial and there's an art to that.

But I think when we look at sort of neurological pathways, when people have trauma, for example, and there's immediately there's a pathway that forms between sort of stimulus and response. And it's like if you think about streets, it's like that becomes a major highway. And what we want to do is look at when they come to therapy later in life. What we want to do is we want to look at all the roads that never got paved. A great example of this might be somebody has a really hard time being around, someone who is calm and supportive of them, and, you know, they feel like that's what I really want. But then when they're around that person, they're like, yeah, that person's boring, or I don't really like that person.

Let's say you grew up with a father who drank and was very inconsistent with you, and a mother who was depressed and was also inconsistent because when she was depressed, she wasn't there. But when she wasn't depressed, she was very present. So love means to you... You know, someone who's inconsistent now in terms of that's outside of your awareness. You don't think that that's what love means to you. You think I'm going to find someone who's really consistent. I'm going to find someone who doesn't have an addiction. I'm going to find someone who's not depressed. And you go out in the world. And who are you attracted to all the time? Someone who ultimately, you know, they might not have the same exact thing, but they might be someone who's like, when my father drank a lot, he yelled, so what is it? What happened? You're attracted to someone who yells, and you don't even realize that when you first meet them. So it's kind of like your unconscious is saying like, oh, you look familiar. Come closer, because that's the highway of love for you.

And so what we want to do is... It's interesting, right? And so then what happens is they go out with someone who's not like that and they say, yeah, really nice person, but I just wasn't attracted to him or her. And so what we want to do is we want to kind of help them be around people like that more. So we get that road paved a little bit more. It's like an unpaved road, and we want to help them find out that there are other routes that they can take so that when they are around different kinds of people, that neurologically, what's going to happen is they're going to go down one of those roads, it's getting more paved, and they're not going to take that highway anymore. And that highway because it's not being used anymore. It's going to atrophy a little bit and they're not going to immediately go down that highway. So I'm mixing tons of metaphors here, but the point is that neurologically we are wired from very early on. And what we're doing in therapy is we're changing the wiring.

I have friends of mine who they would describe their childhoods as difficult. And a lot of times they want to sort of confront some of those memories, as painful as they may be. And I'm not the expert here, but but I, I have sometimes questioned the value of that. But if life were infinite, maybe we'd be having a different conversation. But I think to myself, sometimes pain is just pain. Why? Why bring it up again? Does it have value?

It has value when you are trying to understand how the past is informing the way you move through the world in the present. It does not have value if you're just recycling the pain. You know, I think that a lot of people kind of revisit the past ad nauseum because they have this fantasy that they can change it. You know, they know they can't.

Hmhm.

'So I like to say that, we need to let go of the fantasy of having a better childhood in order to have a better adulthood. And once we let go of the fantasy that we can change what happened by talking about it and talking about it and talking about it, then we can say, okay, let me look at how that informs some of the ways that I move through the world. Some of the ways that I limit myself. Let's say you're someone who self-sabotages. Let's say you're someone who has trouble in relationships. Let's say that you're someone, you know, who does all these things that are just not helpful to you. Well, some of that is informed by the stories that you were told about yourself when you were younger. You're not good enough. You'll never amount to anything. You're so sensitive. You know. Oh, your sister's the pretty one.

Wow.

You know, whatever. Whatever the stories are, we all have stories that were told to us. But what we don't realize as children is that those stories were much more about the storyteller than they were about us. So the reason that somebody told you that story has much more to do with their own mental health challenges, than it has to do with you. And so I think that what we're doing in therapy is we're not just sitting there talking about the past in the pain. We're touching on that. And sometimes we're letting people feel the pain for the first time, because they were never really allowed to feel it. But then we're saying, okay, what do we do with this? What does that have to do with the present, so you can have a different future. And that is, again, I keep talking about misconceptions in therapy. Therapy is very present and future oriented. People think it's all about the past. It's only about the past in so much as how is the past holding you back from the present in the future?

You know, I'm curious. You know, again, just drawing the analogy to medicine. Sometimes you do one thing for someone's health and it's going to have all these sort of ripple effects, some of which are hard to predict. So we were talking about our kids before we started the podcast, and we have kids around the same age. So one of my daughters is she's a real student, you know, she's a sort of a STEM kid. Probably wants to follow the kind of work that you and I do. She's really hard on herself. Really, really hard on herself. And as a result, can sometimes I think, be hard on others as well. And there are times when her mom, my wife and I, we'll look at each other and say, like, do you know, do we intervene? Because on one hand, it's really fueling to her. I mean, I think it's part of the reason she's so successful in school is because of this, this, this being hard on herself. On the other hand, I worry that it may border into pathology. And I don't know what to do sometimes. And I and I'm just curious, like when you are thinking of your, your patients, if you're addressing a particular thing, could it be not harmful necessarily, but taking away another superpower of theirs or something that's an attribute of theirs?

'So in terms of what your daughter does, there's this, I think idea that a lot of people have that if you are really hard on yourself, that somehow that's going to make you more successful. You know, if you self-flagellating if you are a taskmaster, that's going to make you more successful. And by the way, in the short term, sometimes it does. But in the long term, most people burnout. They can't sustain that level of stress. And what they come to realize is that when you have self-compassion, you actually hold yourself more accountable.

So let me give you an example. I had a patient come in and she was so hard on herself. And like you said, that also makes you critical of others because you feel like you have these standards. And so I said to her, listen, the person that you talk to most in the course of your life is yourself. So most people, if you say to them, who is the person that you talk to most in the course of your life? They might say, oh, it's my partner, it's my parent, it's my sibling, it's my best friend. No, we have... It's like a radio station playing in the background or like having the TV on in the background. And that is the voice that we hear the most. We talk to ourselves all day long, and what we say to ourselves isn't always kind or true or useful. And those three criteria together are so important because people think, well, if it's kind, it's not true, right? Like, is that idiot compassion? No. So it has to be kind and true and useful.

'So I said to her, listen, I want you to go home, and I want you to listen to how you talk to yourself. And I want you to write down what you say and come back next week and we'll talk about it. And she was very skeptical of this whole exercise, but she went home. She did it. She comes back the next week. And she of course, because she's a perfectionist. She had like done the assignment perfectly and she'd written down everything and she starts to read and she said, I am such a bully to myself. I had no idea. And an example was she was she was typing an email and she made a mistake in the email. It was a small typo, and the voice in her head immediately said, "you're so stupid." She did not realize she spoke to herself that way. "You're so stupid. So this is not the path to success and achievement. This is the path to. "I am so afraid of making a mistake that I'm never going to go outside of my comfort zone. I'm always going to do things that I already know that I'm good at. If I do something that that is a mistake, I'm not going to be able to focus on what led to the mistake or how I can do better next time because I'm so bathed in shame." So I think that we all have to ask ourselves these questions. Is it kind? Is it true? Is it useful? And once we start doing that with ourselves and having self-compassion, with accountability, we start to treat other people in the same way.

For people who are listening, Lori, and they may think, look, I this is fascinating. I am therapy curious. Let's say that. Where should they start? And let me add as well. Like talking to you, you are obviously really good at what you do. And I'm not just saying that because you're on this podcast. But like any profession, I'm sure there are good therapists and maybe not as good or not as good for that individual. Maybe like being therapy curious, but then also finding the right person because I imagine that relationship is is of paramount importance.

You're right. Study after study shows that the most important factor in the success of someone's therapy is their relationship with their therapist. It matters more than the number of years of experience they have, the modality they're using, by the way, both of which are important. It's that the relationship is more important. So those other things have to be there in terms of, you know, they have to be well trained and they have to use a modality that is helpful for you. But if those two things are true and the relationship isn't clicking, you're not going to have a good outcome.

So I think when people go to a first session, they need to really look at "how do I feel coming to this person." And I always say that if they're leaving the session, it's not about am I going to go to therapy or am I not going to go to therapy because that therapist might not have been the right fit for you. So ask yourself two things one, did I feel like this person gets it, and different people or, you know, that's a very subjective question to ask yourself, but it's kind of like when you meet someone, you know, like whether they kind of get you or don't get you. So as much as someone can understand you in a first session, like, do I feel like they kind of get it? And that's that's a really important chemistry question to ask yourself. That's about the chemistry. And the other question is, did this person say something or ask something that made me pause for a second and think about something in a different way? We aren't going to challenge people too much in a very first session, but I think that you want to know that you're going to somebody who is going to help you to grow.

I think it's pretty clear that therapy holds tremendous potential for anyone seeking greater joy, greater connection, fulfillment. And honestly, that's probably most of us, if not all of us. As Lori emphasized, therapy does require you to show up and then do the work outside of sessions to really dig down deep and be vulnerable in finding the right guide that can make all the difference. And as she said, it's probably worth it because remember, the longest relationship you'll ever have is the one with yourself and investing time and care in that relationship. Well, that can lead you toward lasting happiness.

Now, before we go, I wanted to share some more thoughts from all of you about how you chase life. Today's comes from Katie.

'For most of my life, chasing life for me was moving to different countries, finding out what makes us different or what makes us similar. Finding out things I could learn from them. But lately, and for the foreseeable future, what I do to chase life is to get to know my family or get to re-know my family. What makes us different, what makes us similar, and what I can learn from them.

'Katie, thank you so much for sharing that. Relationships with family - they can be one of the sweetest things about living this life. And just as therapy helps us understand ourselves and our relationships better, taking the time to reconnect with loved ones can be profoundly healing and also can bring us happiness. That's certainly true for me.

Coming up next week, we'll explore exercise and why movement might make you happier.

Moving your body seems to open people up to new perspectives, with an increased sense of optimism and confidence that the situation is not hopeless.

We'll see you next Tuesday.

Chasing life is a production of CNN audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer. Dan Dzula is our technical director, and the executive producer of CNN Audio is Steve Licktieg, with support from Jamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker, Amanda Sealy, and Nadia Kounang of CNN Health and Katie Hinman.