Stephen Grosz: On the psychoanalyst's couch - the most common problems in the consulting room

Psychoanalyst Stephen Grosz's book, 'The Examined Life', has been a surprise bestseller. Its success demonstrates our need to understand and to be understood, he tells Katie Law

Are you worried you're in the wrong job? Frustrated that you can't get that promotion? Lonely at home even though you're in a stable relationship? Concerned that you're drinking, working or eating too much? These are the types of problems familiar to most of us, and the issues that psychoanalyst and therapist Stephen Grosz hears about every day. Seeing patients for up to five hours each a week at his north London practice – where he offers the option of sitting in a chair or lying on his couch – the 61-year-old American, who was born in Indiana but has lived here for many years, acts as a kind of mind detective, listening to his patients' stories, collecting the clues, often coaxing them into talking about bits of their lives they don't want to, then analysing the evidence. He doesn't always have a clear or obvious solution, and he sometimes comes up with surprising answers.

Grosz's The Examined Life: How We Lose and Find Ourselves was a surprise hit when published a year ago, one of those word-of-mouth bestsellers, shifting more than 30,000 copies in hardback and dominating the bestseller lists for months. It's now in paperback. It's the distillation of his mental sleuthing over the past 25 years, written in spare, gripping prose, with each case study a short story, compellingly narrated, often ending on a cliffhanger. He is writing a second book, Seven Obstacles to Love, about the problems of achieving intimacy in relationships.

I've come to his rooms – where he lives above the shop with his wife, Nicola Luckhurst, and their two young children – to spend an hour with him, slotted between his other appointments, but this time it's him, not me, who's going to be lying on the couch. Yet I find myself feeling immediately seduced by his mellifluous voice, calm manner and apparently sincere interest in everything I say. In fact, I want to tell him all about my problems. As I examine why this might be, I'm struck by the simple truth that runs through The Examined Life. "This book is about our desire to talk, to understand and be understood. It's also about listening to each other, not just the words, but the gaps in between. What I'm describing here isn't a magical process. It's something that is part of our everyday lives," he writes in the introduction. And Grosz, it strikes me, is the most brilliant listener I've ever met. These are the most common problems he encounters in his consulting rooms:

Graduates who expect too much from a job

Young professionals often struggle to know what kind of work they should do, especially given unemployment levels and genuine external problems. They get depressed. "You may have skills but you don't know quite where to put yourself. I see some really bright graduates, who are clever, knowledgeable and sometimes have postgraduate degrees. But there isn't the position there they expected or perhaps their course had trained them to be an academic yet now they find they have to make their way in the world." Grosz tries to help people discover things about themselves they may be unaware of. "People might be talented but choose a career that isn't going to work. It's often to do with adapting to reality, seeing yourself clearly."

The problems of self-medication

The most difficult problem for any analyst is the professional who self-medicates. "People may be depressed, so they overeat, overdrink, overwork, over-exercise, watch porn, go to prostitutes or something as a way to keep their problems at bay. Alcohol and drugs do anaesthetise the pain, until your life falls away and then they don't. People will come to me when their own anti-depressant system is unravelling and they want me to help them make it work again but, as an analyst, it's about pulling the problems apart. Sometimes I have to say that they have to come off it or go into AA."

Parents who overpraise their children

Multi-tasking has made us more distracted and a result is that we lavish indiscriminate praise on our children. Partly a reaction against the culture of parental criticism of previous generations, this praise is often delivered with the same indifference. "The hard work is to take a child, or a friend or colleague or ourselves into our mind. To be properly present, to be involved and curious. You don't need to praise a small child for the picture she is drawing, but you might ask why she is using so much of a certain colour. Confidence is given when a child believes they are worth thinking about."

The professional who can't get a promotion

People complain about their work and personal life but can't identify why. They have a good job, but it's in a "conciliatory" role, say, a PA or as an adviser to someone else. They want a promotion but are anxious about changing jobs. This may be true in their personal life, too. They'll see friends getting on and feel stuck, but won't commit: to marriage, to children, whatever. "After a while, I'll realise that in their personal life they are never the father or the mother, they're always the child. So they're refusing at an unconscious level to make that step up. They may not see that the way they argue with their boss is the way they argued with their mum."

The couple who can't be intimate

According to Grosz, equality is impossible in any relationship. "There's always one person who washes the dishes more than the other or who buys the toothpaste, and if one person is more successful or earns more, there will be envy, even if it's unconscious," he says. And while two people are separate entities, when they form a couple, the couple becomes a third, other entity. "There are expectations about money, how the couple will live, what schools their children will go to, which all relate to their individual histories. Consciously, the couple want the same thing, but unconsciously they don't, and it all sits on this volcano of sexuality, which is passionate and by its nature wants to dominate, control, own, not share and have."

The false hope of closure

Most of us are led to hope that, after a certain period of time, we will "get over" a tragic event, be it bereavement, divorce, or other kind of loss. Many suffer even more as a result of failing to "get closure". This is a fantasy, Grosz says, and worse, it's a tyranny of expectation, which can lead us to more depression and despair. "My experience is that closure is an extraordinarily compelling fantasy of mourning," he says. "Because grief can surprise and disorder us."

Grosz appears at The Independent Bath Literary Festival on 2 March (