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

This book drove home the fact that therapists are human and not necessarily humane. Irvin's (we're on a first name basis) humor and especially his insights where he, this accomplished psychiatrist, reveals himself to be no different than you or I honestly made me feel much better about myself. It was the best therapy session I ever had!

Psychiatry residency is challenging in a different way than other medical specialties. Medical school prepares you for the medical aspects of psychiatry, specifically the neuroscience and pharmacology. But for therapy, medical schools barely touch on it. Things that help are being in therapy yourself, or having at least been in therapy, as well as seeking out really good supervision. Good books help too. But picking up those first couple patients is scary and the PGY-2 year is too exhausting to spend hours and hours reading up on the art of therapy. Yalom's "The Gift of Therapy" was given to me by one of my chief residents during my PGY-2 year and was very helpful. I've since had time to read more of Yalom's works and have enjoyed many of his therapeutic tales as well as his group therapy primer, but for where I was at that time, "The Gift of Therapy" was just what the doctor ordered. The key is extremely short chapters. It's a book that can be by the bedside (or stuffed in a white coat pocket if that's your style) and read just a couple of pages at a time. Some chapters focus on nuts-and-bolts everyday issues but what is particularly helpful are the chapters that give the flavor of the process. Many of the chapters help to reinforce the `it's all grist for the mill' notion, that there are few true mistakes, that almost anything you do in therapy creates opportunities and provides data on how the patient reacts and relates. This is an important concept and also, for me, alleviated some of the anxiety of being a new therapist. It's much better to approach outpatients with enthusiasm as opposed to angst, and no doubt patients can feel that difference as well. I also very much appreciate Yalom's attitude about not adhearing to a particular model or modality of therapy, but the recognition that different situations call for different approaches, that flexibility is the greatest tool for the therapist. Nothing turns me off more than hearing analysts knock cognitive behavioral therapy or vice versa, just to pick an obvious example. Before my medicine days, I studied Anthropology, and it was this very same kind left me bored and disenchanted. The majority of people's energy went into "deconstructing" other people's ideas rather than contributing something positive and helpful. Yalom emphasizes that certain discrete symptoms are best treated with CBT type approaches, some questions call for an existential approach, sometimes analytic techniques are best, and so on. Especially in training, the focus should be on acquiring as many tools as possible, staying flexible, and maintaining an open mind. He also models the importance of continually refocusing on the here-and-now and counter-transference. These may be rudiments, but early on in training it can't be overemphasized. Especially coming from a western medical model, these fundamental concepts tend not to come naturally. So this book is exactly what you need as a PGY-2: good, l

Twenty years ago when I read Irvin Yalom's Theory and Practice of Group Psychotherapy, I knew that I wanted to be a psychotherapist. These 20 years later, reading The Gift of Therapy, I am reminded that I made an excellent choice.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.