“The Gift of Therapy” by Irvin Yalom, MD

Subtitle: An Open Letter to a New Generation of Therapists and Their Patients

Recommended to me by: Rachel Manija

This is a collection of short tips about psychotherapy from a longtime practitioner. I loved his tips about creating a warm, safe, positive relationship with the client and processing the here-and-now of the relationship for clues about how to help the client with external relationships. I loved that he starts with the assumption that he is helping to remove obstacles, because everyone naturally grows and develops given the chance. I loved that he sees himself as a fellow traveler with his clients.

This quote early in the book of German philosopher Arthur Schopenhauer expresses our common expectations that life should go well, and that we’ve done something wrong if it doesn’t, and yet it so often doesn’t.

In early youth, as we contemplate our coming life, we are like children in a theater before the curtain is raised, sitting there in high spirits and eagerly waiting for the play to begin. It is a blessing that we do not know what is really going to happen. Could we foresee it, there are times when children might seem like condemned prisoners, condemned, not to death, but to life, and as yet all uncounscious of what their sentence means.

I found the stated assumption that clients are causing their own problems frustrating and condescending. He overtly says he makes that assumption because that is how he can be effective in helping the client. Reminds me of someone looking for lost keys under the streetlight because they can see better there.

Of course it’s true in many cases, and looking at one’s role in a recurring problem can be a fruitful exploration. He seems to say that it is universally true, and does not acknowledge the work a client may already have done in that arena. Some clients need help to stop blaming themselves. I hear an underlying assumption that clients are broken, despite his starting assertion that growth simply requires the removal of blocks.

I think as a white male doctor he has a lot more experience of agency in his life than a lot of his clients, and he would also naturally discuss in his book the clients who benefited most from his approach. It makes me angry that the book made me question myself again on the topic, and I imagine he had that effect on some clients as well.

He repeatedly brings up the damaging effect on psychotherapy of insurance, “managed care,” lower compensation, less training, and “evidence-based” treatments. This book is a defense of long-term therapy toward profound change.

The book is a quick read. I recommend it as a tool to learn about psychotherapy, although I would not personally benefit from a therapist who followed all these practices.

Available at Powell’s Books.

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