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

by Yalom, Irvin D.

• ISBN13: 9780066214405
• ISBN10: 0066214408
• Format: Hardcover
• Copyright: 2002-01-01
• Publisher: HarperCollins Publications

Summary

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 of nonfiction and fiction, 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.

Author Biography

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

Table of Contents

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

Excerpts

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

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 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
An Open Letter to a New Generation of Therapists and Their Patients. Copyright © by Irvin Yalom. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

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Excerpted from The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients by Irvin D. Yalom
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