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

When I agreed to review this book, I did not know it was a “how to” book, which would have made me reluctant to accept such an assignment. I had already read two of Yalom’s books, his novels When Nietzsche Wept (1) and the double entendre Lying on the Couch (2). I found both entertaining and knew that the author is a good writer, so I was curious to see how he fared when delving into an area that I have been immersed in all my professional life.

My initial reaction to his book was extremely ambivalent. Maybe it could serve as a primer for beginning clinicians, but what use would it be for seasoned veterans? Was it not somewhat pretentious for a person who has not graduated from a psychoanalytic institute, as the author admits, to advise analysts? (I will return to this topic later.)

Yalom says that his guidebook is “an idiosyncratic melange of ideas and techniques.… These ideas are…personal, opinionated and occasionally original.” In 85 short chapters he addresses the patient-therapist relationship, techniques to deal with specific clinical phenomena, how to relate to patients in general, and many other facets of the analyst’s conduct to further therapeutic progress and to release the patient’s developmental potential in a nonjudgmental, autonomy-promoting atmosphere.

My initial ambivalence progressively diminished as I kept reading, because I realized that what Yalom is describing in his highly personal experiences is not particularly idiosyncratic or, at least, it should not be. He is advocating courtesy, a respect for the patient and the patient’s illness, as well as simple common sense.

Although a professor of mine once said, “Common sense is often more common than sense,” Yalom’s suggestions are based on compassion, wisdom, experience, and scholarship. He has a wide eclectic vista, which is also a reflection of the different analysts he had, who ranged in orientation from classical to more interpersonal.

My initial defensive response abated as I realized that Yalom is implicitly sending a very important message, perhaps a plea, that we regain our senses as psychiatry is succumbing to organic reductionism. Psychiatry has lost its mind, but Yalom’s orientation emphasizes a return to humanistic from mechanistic perspectives.

I must say, however, that some, not many, of Yalom’s ideas and actions are difficult for me to accept. This is to be expected because he is writing about personal style and we all have our preferences or quirks based on our character and personal history. For example, he states that during a session, he touches the patient in a nonerotic fashion—a handshake or a pat on the shoulder. He sometimes presents hypothetical problems, and he has certain opinions about personal disclosure. He likes to interview family members and spouses. Many of these maneuvers strike me as potentially manipulative and minimizing the adaptive significance of the patient’s attitudes and behavior.

Perhaps my few objections are based on my opinion that Dr. Yalom is too eclectic, but he is an expert in whatever area he is engaged in. Returning to the author’s admission that he never was certified by a psychoanalytic institute, I do not think this means he is not an analyst. In fact, I believe he is an unusually talented psychoanalyst and teacher. Chapter 75, which discusses Freud in five short pages, describes psychoanalysis. It is the best summary I have ever read, and only a master clinician and scholar could have written it.

As must be evident, my initial ambivalence has dwindled to almost zero, and I would recommend this book to all clinicians, because even readers with some objections will be forced to reexamine their perspectives and honestly examine their modi operandi. I hope this review will overcome the reluctance of the potential reader who might be deterred as I was initially.