Words&Dirt

Summary:

Irvin D. Yalom’s The Gift of Therapy is a guidebook written for people entering the psychotherapy profession. The text’s many concise and enlightening chapters cover a range of topics that unveil Yalom’s therapeutic theory and practice, focusing on his experiences with individual therapy, group therapy, and existential therapy.  Written with tremendous spirit, deep compassion, and candid intelligence, The Gift of Therapy is an essential examination of one of modern life’s most challenging and rewarding vocations.

Key Concepts and Notes:

• This is the first book I’ve read for my graduate program that felt like we were finally getting into the nuts and bolts of how therapy works. I found it extremely helpful and can’t wait to put the lessons contained here into practice.
• A therapist’s primary function, Yalom says, is to “remove obstacles” that stand in the way of a client’s natural growth and healing process (1). It is not within the therapist’s capacity to directly “fix” clients, so the appropriate goal is to help identify and clear out impediments to client autonomy and self-actualization.
• Yalom presents a very egalitarian and nonhierarchical view of the therapist-client relationship, referring to both parties as “fellow travelers” in the mysterious and challenging journey of life. To keep things balanced, he also offers scrupulous analysis of the professional boundaries necessary to form and maintain a strong therapeutic alliance.
• Yalom focuses a lot on the difference between content (the concrete details discussed in therapy) and process (how those details influence the client-therapist relationship). While I occasionally found Yalom’s examples a bit too therapist-focused, I nonetheless see this as a very useful approach. His repeated insistence that “Therapy should not be theory-driven but relationship-driven” resonates strongly with my intuitions about how to pursue a successful therapeutic practice (xviii).
• As an existential therapist, Yalom’s theoretical orientation revolves around four central concerns of human life: (1) Death, (2) Isolation, (3) Meaning, and (4) Freedom. There is no formal structure or programmatic method for delivering existential therapy, and Yalom emphasizes that it can be fruitfully complementary to any other therapeutic modality.
• A critical facilitating component of Yalom’s process is the therapist’s ability to model intelligent and compassionate interpersonal skills that neutralize a client’s defense mechanisms and invite them to reciprocate. The key to ameliorating a client’s social dysfunction is often found by leveraging the “here-and-now” of therapeutic encounters to co-create positive, exploratory, and respectful dynamics that the client can then begin to apply elsewhere.
• Yalom asserts that effective therapy always contains elements of spontaneity and creativity that arise naturally and unexpectedly during sessions. Further, he recommends “shaping the therapy” over time to fit the specific character and needs of each client (35). This makes him naturally skeptical of therapeutic approaches such as cognitive-behavioral therapy and other “empirically validated therapies” that are friendly to the constraints of modern experimental design. In his view, these methods overvalue standardization and manualization, and usually fail to generate long-term change and progress even if they effectively alleviate short-term suffering. I don’t yet have the requisite experience to have a strong opinion on this one way or another.
• I’m not personally very drawn to dream analysis, but I would like to be able to engage in it with clients who express the desire to do so. To that end, I appreciated Yalom’s thoughts on this topic, especially his suggestion to eschew “full interpretation” and instead pragmatically “pillage and loot” a client’s dreams for interpretations and lessons that support personal insight and growth (227-8).

Favorite Quotes:

“Just as an acorn develops into an oak…” What a wonderful 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, with zest for life, caring, loyalty, or any of the myriad characteristics that make us fully human. No, what I had to do was identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient. (1)

Therapists must convey to the patient that their paramount task is to build a relationship together that will itself become the agent of change. It is extremely difficult to teach this skill in a crash course using a protocol. Above all, the therapist must be prepared to go wherever the patient goes, do all that is necessary to continue building trust and safety in the relationship. I try to tailor the therapy for each patient, to find the best way to work, and I consider the process of shaping the therapy not the groundwork or prelude but the essence of the work. (34-5)

Effective therapy consists of an alternating sequence: evocation and experiencing of affect followed by analysis and integration of affect. How long one waits until one initiates an analysis of the affective event is a function of clinical experience. Often, when there is deep feeling involved––anguish, grief, anger, love––it is best to wait until the feeling simmers down and defensiveness diminishes. (71)

Keep in mind that therapy is a deep and comprehensive exploration into the course and meaning of one’s life; given the centrality of death in our existence, given that life and death are interdependent, how can we possibly ignore it? From the beginning of written thought humans have realized that everything fades, that we fear the fading, and that we must find a way to live despite the fear and the fading. Psychotherapists cannot afford to ignore the many great thinkers who have concluded that learning to live well is to learn to die well. (125)

We humans appear to be meaning-seeking creatures who have had the misfortune of being thrown into a world devoid of intrinsic meaning. One of our major tasks is to invent a meaning sturdy enough to support a life and to perform the tricky maneuver of denying our personal authorship of this meaning. Thus we conclude instead that it was “out there” waiting for us. Our ongoing search for substantial meaning systems often throws us into crises of meaning. (133)

Responsibility assumption is an essential first step in the therapeutic process. Once individuals recognize their role in creating their own life predicament, they also realize that they, and only they, have the power to change that situation. (141)

We crave the comfort of absolute truth because we cannot bear the desolation of a purely capricious existence. As Nietzsche put it, “Truth is an illusion without which a certain species could not survive.” Anointed, as we are, with an inbuilt solution-seeking, gestalt-filling need, we cling tenaciously to the belief that explanation, some explanation, is possible. It makes things bearable, it anoints us with a sense of control and mastery.

But it is not the content of the intellectual treasure trove that matters but the hunt, which is the perfect therapy mating task, offering something to each participant: Patients bask in the attention paid to the most minute details of their life, and the therapist is entranced by the process of solving the riddle of a life. The beauty of it is that it keeps patient and therapist tightly connected while the real agent of change––the therapeutic relationship––is germinating. (175-6)

Not only does our work provide us the opportunity to transcend ourselves, to evolve and to grow, and to be blessed by a clarity of vision into the true and tragic knowledge of the human condition, but we are offered even more.

We are intellectually challenged. We become explorers immersed in the grandest and most complex of pursuits––the development and maintenance of the human mind. Hand in hand with patients, we savor the pleasure of great discoveries––the “aha” experience when disparate ideational fragments suddenly slide smoothly together into coherence. Other times we are midwife to the birth of something new, liberating, and elevating. We watch our patients let go of old self-defeating patterns, detach from ancient grievances, develop a zest for living, learn to love us, and, through that act, turn lovingly to others. It is a joy to see others open the taps to their own founts of wisdom. Sometimes I feel like a guide escorting patients through the rooms of their own house. What a treat it is to watch them open doors to rooms never before entered, discover new wings of their house containing parts in exile––wise, beautiful, and creative pieces of identity. (258)

Rating: 9/10