The Gift of Therapy
by Irvin Yalom, M.D.
Reviewed by Suzanne M. Retzinger, Ph.D.
Waiting for my brother to complete his three-hour dialysis, I browsed the bookshelf provided for the waiting. I came across Love's Executioner and read it for the first time. I had read Yalom's Theory and Practice of Group Psychotherapy text in grad school - like all requirements. Now he grabbed me by the shoulders and forced me to listen - inspired, I had to read more and found The Gift of Therapy (2003, Perennial edition; 263 pages $12.95).
Yalom is the first, of many that I've read on the therapeutic relationship, who doesn't "talk" about the therapeutic relationship - but "shows" it - a path for the bold to venture, a real connection between therapist and patient. My interest in his work lies in his openness about his own feelings and how he uses them therapeutically. Nothing, he says, "takes precedence over care and maintenance of my relationship to the patient,... and how we regard each other." Most patients come to therapy starving for intimacy, their conflicts being precisely in this area - and it is the therapeutic relationship, itself, that creates change.
For this reason, the "blank screen" model is far from what Yalom sees as effective patient therapist relationship; he sees therapist opaqueness as counterproductive. Because of the alienated nature of many clients' lives, the here and now space between therapist and patient is what matters. It's about the space that we create with our clients and how we use that space - "the betweenness". Yalom spells out 3 levels of therapist transparency that can be productive or not, asking of each, "is this disclosure in the best interest of the client?".
Standardization, he believes, renders therapy less effective, threatening therapist spontaneity. Therapy is a journey - and in Yalom's view the therapist and client are "fellow travelers". Whatever relationship there is, we build together with our clients. Be "prepared to go wherever the patient goes" - The long brown path before me leading wherever I choose (Walt Whitman - Song of the Open Road).
The relationship is key - I know - I've heard this from the beginning: in school, supervision, exam study courses, yatta, yatta, yatta. But at the same time I hear "don't get too close", or "reveal anything about yourself", "god forbid you touch a client" - a double message - the unspoken message: hold your nose, close your eyes, use a 10-foot pole. In my first career - research - I learned to jump in with all I have - open my eyes, my ears and each and every sense, throw away that pole. Yalom breathes life into therapy by attending to the inbetweens, the emotions that arise in this space and discussion of this process with the patient.
Western culture is awash in alienation; therapy is a process that can renew intimacy for those who choose this path. It is a "dress rehearsal for life", says Yalom. Affect and analysis are altering sequences, microcosms of our patients' lives that must be examined for lasting change to occur. Feelings, thoughts, words along with their analysis are not taboo; they are the stuff of intimacy. We must not confuse intimacy with sex, Yalom says. Sex is always inappropriate with clients, intimacy is not.
Yalom expresses his concern with the direction the mental health field has taken. With the growing alienation in our world, people are becoming less important. Even in our profession we see fewer sessions provided by HMO's, medication in place of human contact, focus on technique, fear of intimacy because of lawsuits. In this age of pharmaceuticals, HMOs, and lawsuits, is the relationship being lost? This book (as well as his others) is a wakeup call, a reminder for us all - the experienced as well and the novice - that we are in the business of healing relationships and not to loose them in the shuffle.
Since that first day at the dialysis center where I found Love's Executioner, I've read much of what Yalom has written. It's not only the brilliance of what he writes that draws me in, but the way he writes that touches me. His books are "serious, down to earth, and pulse with levity and life".
Yalom's book The Gift of Therapy is a gift to therapists past, present, and future. Like Yalom, we need to `show' and not `tell' our clients the road to connectedness. My hope is that this, and other works like this, will not be lost in a world so desperately in need of human connection.
