- Paperback: 320 pages
- Publisher: Harper Perennial; 1 edition (May 12, 2009)
- Language: English
- ISBN-10: 0061719617
- ISBN-13: 978-0061719615
- Product Dimensions: 5.1 x 0.8 x 8.1 inches
- Shipping Weight: 5.6 ounces (View shipping rates and policies)
- Average Customer Review: 4.7 out of 5 stars See all reviews (314 customer reviews)
- Amazon Best Sellers Rank: #5,687 in Books (See Top 100 in Books)
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The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients Paperback – May 12, 2009
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“[Yalom’s] wise ideas are perfectly accessible.” (Publishers Weekly)
“An absorbing guide” (Boston Globe)
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.
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Top Customer Reviews
Irv Yalom's "open letter to a new generation of therapists and their patients" speaks to three essential aspects of myself: the psychotherapist, the human being, and the writer.
As a psychotherapist I am validated for thinking outside the traditional boxes and challenged to keep learning with every client I see. Yalom offers everything from specific suggested questions to ask clients to the wisdom of his experience such as "therapy should not be theory-driven, but relationship-driven," and "though the physicality of death destroys us, the idea of death can save us."
As a human being I am reminded that there is seldom --- if ever --- only one valid explanation for how we become who we are. And I am enlightened by Yalom's reminder of Paul Tilich's list of four "ultimate concerns" --- death, isolation, meaning, and freedom.
As a writer I am thoroughly entertained by how Yalom puts a sentence together. For instance, speaking of the importance of dream interpretation in therapy, he writes, "Pillage and loot the dream, take out of it whatever seems valuable, and don't fret about the discarded shell."
Most of all, as I close my now well-worn, underlined and dog-eared copy of Irv Yalom's new book, I am inspired by the man and the psychotherapist who has been, and remains, a hero of mine. (I suppose Irv would consider that literary transference.)
Bottomline: great book for therapists and non-therapists alike.
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.
But it left me with questions for the author (and some serious reservations)--never a good feeling at the end of a book.
On the one hand, I appreciate that his training was to remain distant from patients where, as he described it, even helping an elderly woman put on a coat would be frowned on. I appreciate that, through experience with real-life patients, he realized the importance of establishing warmth, an interpersonal connection, a -human- relationship with patients rather than a distant "psychiatrist-as-remote-God-like" figure.
However, reading many of the chapters here, I couldn't help but think some of the therapy methods he describes could be too intimate and too seductive with his patients. I kept feeling that it would be very easy to act like this and wind up crossing the line--or being misunderstood--in a therapy setting. Sexual attraction (and, as he says, even unconsummated love that is mutually felt) is a recurrent theme in so many stories he shares from his practice.
There seemed to me to be much too much emphasis on talking about the therapist-patient relationship each week. Dr. Yalom writes, over and over, that he realizes he is far more important to his patients, personally, than they are to him. And yet he also seemed to intentionally intensify their feelings for him in the course of therapy, giving example after example of how he pushed them to share dreams about him, fantasies about him, etc. Where there was conflict between what he felt and what they felt, the solution was often to focus on how they were thinking and feeling erotically and/or emotionally about him. When a patient describes how she bonded with her husband when they jointly laughed at something she quoted Yalom saying, he resents the shared jokes about him with her husband, and reminds her that the three of them are in a relationship "triangle".
At least in this retelling, its unclear that this intense emotional intimacy with patients is genuinely best for the patient.
I'm not saying there's any sexual misconduct. In fact, Yalom clearly says that a therapist should never, ever become sexually involved with a patient as it is "a serious betrayal and does great harm to both". He is unequivocal about this and says it is better to even see a prostitute than violate the patient's trust. Nevertheless, putting an outright physical relationship aside, I do feel his methods/remarks as he describes them here, often seem very "seductive" in the broader sense, especially as so many women seek treatment with him for their relationship issues (including loneliness, marital and sexual problems, and low self-esteem).
Its possible that being on first-name basis with a therapist who routinely discloses himself and his personal feelings about you--and who says and shows that he cares about you personally--may be therapeudic. But as recounted in this book it sometimes seems ...a potentially inappropriate pattern with female patients. (I'm also interested that his bi-monthly "leaderless" support group that has met for years consists of 11 psychologists/psychiatrists--ALL of whom are men. Ironic, given his intimate and seductive approach to female patients in therapy, how that "missing" female psychiatrist regularly might be just the right person to offer HIM feedback).
Yalom does quote a renowned psychotherapist who bluntly questions his methods, saying, "Doesn't the intense personal intimacy you have with patients interfere with their ability to terminate treatment?" A great question, and one that, imo, he should have worrying about a great deal more than he shows here.
Anyway, I liked the idea that an emotionally engaged therapist can help a patient more than a distant one. He tells a good story, the short chapters are a bit brave style-wise and serve the reader well. I liked how he revisited Freud in a positive way, reminding us of the historical context of his insights and achievement.
I recommend this book, but with a discussion group. Otherwise, it leaves too many questions about the advisability of intentionally building relationships of intense intimacy and dependency with patients. Alone, it left me with too many unresolved questions and criticisms. As the focal point of group/class discussion, however, it would be perfect.