The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients

by Irvin Yalom

Overview

Anyone interested in psychotherapy or personal growth will rejoice at the publication of The Gift of Therapy, a masterwork from one of today's most accomplished psychological thinkers.

From his thirty-five years as a practicing psychiatrist and as an award-winning author, Irvin D. Yalom imparts his unique wisdom in The Gift of Therapy. This remarkable guidebook for successful therapy is, as Yalom remarks, "an idiosyncratic mélange of ideas and techniques that I have found useful in my work. These ideas are so personal, opinionated, and occasionally original that the reader is unlikely to encounter them elsewhere. I selected the eighty-five categories in this volume randomly guided by my passion for the task rather than any particular order or system."

At once startlingly profound and irresistibly practical, Yalom's insights will help enrich the therapeutic process for a new generation of patients and counselors.

Product Details

ISBN-13:	9780062297266
Publisher:	HarperCollins Publishers
Publication date:	05/21/2013
Sold by:	HARPERCOLLINS
Format:	eBook
Pages:	320
Sales rank:	59,312
File size:	713 KB

About the Author

Irvin D. Yalom, M.D., is the author of Love's Executioner, Momma and the Meaning of Life, Lying on the Couch, The Schopenhauer Cure, When Nietzsche Wept, as well as several classic textbooks on psychotherapy, including The Theory and Practice of Group Psychotherapy, considered the foremost work on group therapy. The Professor Emeritus of Psychiatry at Stanford University, he divides his practice between Palo Alto, where he lives, and San Francisco, California.

Read an Excerpt

Chapter One

Remove the Obstacles to Growth

When I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney's Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree.

"Just as an acorn develops into an oak..." What a wonderfully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient's path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient.

I remember a young widow with, as she put it, a "failed heart" -- an inability ever to love again. It felt daunting to address the inability to love. I didn't know how to do that. But dedicating myself to identifying and uprooting her many blocks to loving? I could do that.

I soon learned that love felt treasonous to her. To love another was to betray her dead husband; it felt to her like pounding the final nails in her husband's coffin. To love another asdeeply as she did her husband (and she would settle for nothing less) meant that her love for her husband had been in some way insufficient or flawed. To love another would be self-destructive because loss, and the searing pain of loss, was inevitable. To love again felt irresponsible: she was evil and jinxed, and her kiss was the kiss of death.

We worked hard for many months to identify all these obstacles to her loving another man. For months we wrestled with each irrational obstacle in turn. But once that was done, the patient's internal processes took over: she met a man, she fell in love, she married again. I didn't have to teach her to search, to give, to cherish, to love -- I wouldn't have known how to do that.

A few words about Karen Horney: Her name is unfamiliar to most young therapists. Because the shelf life of eminent theorists in our field has grown so short, I shall, from time to time, lapse into reminiscence -- not merely for the sake of paying homage but to emphasize the point that our field has a long history of remarkably able contributors who have laid deep foundations for our therapy work today.

One uniquely American addition to psychodynamic theory is embodied in the "neo- Freudian" movement -- a group of clinicians and theorists who reacted against Freud's original focus on drive theory, that is, the notion that the developing individual is largely controlled by the unfolding and expression of inbuilt drives.

Instead, the neo-Freudians emphasized that we consider the vast influence of the interpersonal environment that envelops the individual and that, throughout life, shapes character structure. The best-known interpersonal theorists, Harry Stack Sullivan, Erich Fromm, and Karen Horney, have been so deeply integrated and assimilated into our therapy language and practice that we are all, without knowing it, neo-Freudians. One is reminded of Monsieur Jourdain in Molière's Le Bourgeois Gentilhomme, who, upon learning the definition of "prose," exclaims with wonderment, "To think that all my life I've been speaking prose without knowing it."

The Gift of Therapy. Copyright © by Irvin Yalom. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

First Chapter

Chapter One

Remove the Obstacles to Growth

When I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney's Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree.

"Just as an acorn develops into an oak..." What a wonderfully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient's path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient.

I remember a young widow with, as she put it, a "failed heart" -- an inability ever to love again. It felt daunting to address the inability to love. I didn't know how to do that. But dedicating myself to identifying and uprooting her many blocks to loving? I could do that.

I soon learned that love felt treasonous to her. To love another was to betray her dead husband; it felt to her like pounding the final nails in her husband's coffin. To love another as deeply as she did her husband (and she would settle for nothing less) meant that her lovefor her husband had been in some way insufficient or flawed. To love another would be self-destructive because loss, and the searing pain of loss, was inevitable. To love again felt irresponsible: she was evil and jinxed, and her kiss was the kiss of death.

We worked hard for many months to identify all these obstacles to her loving another man. For months we wrestled with each irrational obstacle in turn. But once that was done, the patient's internal processes took over: she met a man, she fell in love, she married again. I didn't have to teach her to search, to give, to cherish, to love -- I wouldn't have known how to do that.

A few words about Karen Horney: Her name is unfamiliar to most young therapists. Because the shelf life of eminent theorists in our field has grown so short, I shall, from time to time, lapse into reminiscence -- not merely for the sake of paying homage but to emphasize the point that our field has a long history of remarkably able contributors who have laid deep foundations for our therapy work today.

One uniquely American addition to psychodynamic theory is embodied in the "neo- Freudian" movement -- a group of clinicians and theorists who reacted against Freud's original focus on drive theory, that is, the notion that the developing individual is largely controlled by the unfolding and expression of inbuilt drives.

Instead, the neo-Freudians emphasized that we consider the vast influence of the interpersonal environment that envelops the individual and that, throughout life, shapes character structure. The best-known interpersonal theorists, Harry Stack Sullivan, Erich Fromm, and Karen Horney, have been so deeply integrated and assimilated into our therapy language and practice that we are all, without knowing it, neo-Freudians. One is reminded of Monsieur Jourdain in Molière's Le Bourgeois Gentilhomme, who, upon learning the definition of "prose," exclaims with wonderment, "To think that all my life I've been speaking prose without knowing it."

The Gift of Therapy. Copyright © by Irvin Yalom. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

Table of Contents

	Introduction
	Acknowledgments
Ch. 1	Remove the Obstacles to Growth	1
Ch. 2	Avoid Diagnosis (Except for Insurance Companies)	4
Ch. 3	Therapist and Patient as "Fellow Travelers,"	6
Ch. 4	Engage the Patient	11
Ch. 5	Be Supportive	13
Ch. 6	Empathy: Looking Out the Patient's Window	17
Ch. 7	Teach Empathy	23
Ch. 8	Let the Patient Matter to You	26
Ch. 9	Acknowledge Your Errors	30
Ch. 10	Create a New Therapy for Each Patient	33
Ch. 11	The Therapeutic Act, Not the Therapeutic Word	37
Ch. 12	Engage in Personal Therapy	40
Ch. 13	The Therapist Has Many Patients; The Patient, One Therapist	44
Ch. 14	The Here-and-Now - Use It, Use It, Use It	46
Ch. 15	Why Use the Here-and-Now?	47
Ch. 16	Using the Here-and-Now - Grow Rabbit Ears	49
Ch. 17	Search for Here-and-Now Equivalents	52
Ch. 18	Working Through Issues in the Here-and-Now	58
Ch. 19	The Here-and-Now Energizes Therapy	62
Ch. 20	Use Your Own Feelings as Data	65
Ch. 21	Frame Here-and-Now Comments Carefully	68
Ch. 22	All Is Grist for the Here-and-Now Mill	70
Ch. 23	Check into the Here-and-Now Each Hour	72
Ch. 24	What Lies Have You Told Me?	74
Ch. 25	Blank Screen? Forget It! Be Real	75
Ch. 26	Three Kinds of Therapist Self-Disclosure	83
Ch. 27	The Mechanism of Therapy - Be Transparent	84
Ch. 28	Revealing Here-and-Now Feelings - Use Discretion	87
Ch. 29	Revealing the Therapist's Personal Life - Use Caution	90
Ch. 30	Revealing Your Personal Life - Caveats	94
Ch. 31	Therapist Transparency and Universality	97
Ch. 32	Patients Will Resist Your Disclosure	99
Ch. 33	Avoid the Crooked Cure	102
Ch. 34	On Taking Patients Further Than You Have Gone	104
Ch. 35	On Being Helped by Your Patient	106
Ch. 36	Encourage Patient Self-Disclosure	109
Ch. 37	Feedback in Psychotherapy	112
Ch. 38	Provide Feedback Effectively and Gently	115
Ch. 39	Increase Receptiveness to Feedback by Using "Parts,"	119
Ch. 40	Feedback: Strike When the Iron Is Cold	121
Ch. 41	Talk About Death	124
Ch. 42	Death and Life Enhancement	126
Ch. 43	How to Talk About Death	129
Ch. 44	Talk About Life Meaning	133
Ch. 45	Freedom	137
Ch. 46	Helping Patients Assume Responsibility	139
Ch. 47	Never (Almost Never) Make Decisions for the Patient	142
Ch. 48	Decisions: A Via Regia into Existential Bedrock	146
Ch. 49	Focus on Resistance to Decision	148
Ch. 50	Facilitating Awareness by Advice Giving	150
Ch. 51	Facilitating Decisions - Other Devices	155
Ch. 52	Conduct Therapy as a Continuous Session	158
Ch. 53	Take Notes of Each Session	160
Ch. 54	Encourage Self-Monitoring	162
Ch. 55	When Your Patient Weeps	164
Ch. 56	Give Yourself Time Between Patients	166
Ch. 57	Express Your Dilemmas Openly	168
Ch. 58	Do Home Visits	171
Ch. 59	Don't Take Explanation Too Seriously	174
Ch. 60	Therapy-Accelerating Devices	179
Ch. 61	Therapy as a Dress Rehearsal for Life	182
Ch. 62	Use the Initial Complaint as Leverage	184
Ch. 63	Don't Be Afraid of Touching Your Patient	187
Ch. 64	Never Be Sexual with Patients	191
Ch. 65	Look for Anniversary and Life-Stage Issues	195
Ch. 66	Never Ignore "Therapy Anxiety,"	197
Ch. 67	Doctor, Take Away My Anxiety	200
Ch. 68	On Being Love's Executioner	201
Ch. 69	Taking a History	206
Ch. 70	A History of the Patient's Daily Schedule	208
Ch. 71	How Is the Patient's Life Peopled?	210
Ch. 72	Interview the Significant Other	211
Ch. 73	Explore Previous Therapy	213
Ch. 74	Sharing the Shade of the Shadow	215
Ch. 75	Freud Was Not Always Wrong	217
Ch. 76	CBT Is Not What It's Cracked Up to Be ... Or, Don't Be Afraid of the EVT Boogeyman	222
Ch. 77	Dreams - Use Them, Use Them, Use Them	225
Ch. 78	Full Interpretation of a Dream? Forget It!	227
Ch. 79	Use Dreams Pragmatically: Pillage and Loot	228
Ch. 80	Master Some Dream Navigational Skills	235
Ch. 81	Learn About the Patients's Life from Dreams	238
Ch. 82	Pay Attention to the First Dream	243
Ch. 83	Attend Carefully to Dreams About the Therapist	246
Ch. 84	Beware the Occupational Hazards	251
Ch. 85	Cherish the Occupational Privileges	256
	Notes	261

Editorial Reviews

If the future of psychotherapy lies in psychopharmaceuticals and the short-term therapies stipulated by HMOs, argues Yalom, then the profession is in trouble. Yalom, the recipient of both major awards given by the American Psychiatric Association, professor emeritus of psychiatry at Stanford and the author of both fiction and nonfiction volumes about psychotherapy, writes this book in response to that crisis. Based on knowledge gained from his 35 years of practice, the resulting book of tips (a "gift" for the next generation of therapists) is an enlightening refutation of "brief, superficial, and insubstantial" forms of therapy. Yalom, who references Rilke and Nietzsche as well as Freud's protege Karen Horney and the founder of client-centered therapy, Carl Rogers, describes therapy as "a genuine encounter with another person." He suggests that therapists avoid making DSM IV diagnoses (except for insurance purposes), since these "threaten the human, the spontaneous, the creative and uncertain nature of the therapeutic venture." He also encourages psychotherapists to use dream analysis, group therapy and, when appropriate, wholly inventive forms of treatment. Traditionalists will probably squirm at some of his suggestions (particularly "Revealing the Therapist's Personal Life" and "Don't Be Afraid of Touching Your Patient"). Other tips, though, such as "Never Be Sexual with Patients" are no-brainers. Although the book dies somewhat in the second half, and not much here is new, the wise ideas are perfectly accessible. (Jan.) Forecast: Yalom has explored many of these ideas before. His followers will certainly be charmed, and newcomers patients as much as therapists may be won over by his openness and tender tone. Copyright 2001 Cahners Business Information.

Publishers Weekly

These two books defend the professional treatment of psychological problems by listening and responding in the Freudian manner, and they deplore the current dominance of neuroscience, pharmacology, and behaviorism. In Why Psychoanalysis?, French psychoanalyst, historian, and critic Roudinesco refers to our "depressive society" and our loss of subjectivity in the era of individuality. She fiercely defends Freud against "fanatical" opponents, even claiming that he was not antifeminist. Roudinesco will appeal to scholars of Freud and Jacques Lacan, of whom some knowledge is assumed. Unfortunately, though Roudinesco wants psychoanalysis to be a science, she often waxes polemical when a clear, objective evaluation of Freud is needed. For that, a general audience will be better served by Elio Frattaroli's Healing the Soul in the Age of the Brain (LJ 8/01). For a more readable presentation of the cultural nexus of psychiatry, Julian Leff's The Unbalanced Mind (LJ 11/15/01) is outstanding. In The Gift of Therapy, Yalom (psychiatry, emeritus, Stanford) writes for both the professional and the lay reader a good idea, since educated consumers help bring professionals into the real world. He favors some self-disclosure by therapists, home visits, meeting with significant others, nonsexual touching, and time for reflection on each session. In 85 short chapters, he presents little pearls of ideas shaped from 35 years in practice. Yalom's view that the therapist is also healed in the process reminds this reviewer of James P. Carse's philosophy. Yalom's latest is essential for therapy trainers and fine for general libraries with psychology and self-help collections. For a general selection of this respected psychiatrist's earlier work, including fiction, consider The Yalom Reader (Basic Bks: Perseus, 1998). E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC Copyright 2001 Cahners Business Information.

Library Journal

Having reached his 70th year, Yalom (psychiatry, Stanford U.) worries about where the next generation of effective psychotherapists will be trained, noting that the big medical corporations are primarily interested in pushing medicine. He advises students against sectarianism and suggests a therapeutic pluralism in which effective interventions are drawn from several different therapy approaches. He does not include an index. Annotation c. Book News, Inc., Portland, OR (booknews.com)

An absorbing guide

Boston Globe