The key ideas

The Gift of Therapy

Irvin D. Yalom, 2002

Why do people who are close so often see the same road in completely different ways? Irvin Yalom gathered thirty-five years of practice into a letter to young therapists, and it became a book about how to be truly present for another person. You will learn why labels are dangerous, how to look out of someone else’s window, and what the thought of death can teach you.

Who it is for

For anyone who wants to understand the people close to them more deeply, speak more honestly, and look at the big questions of life more calmly: death, loneliness, meaning and freedom.

Sometimes I simply remind patients that sooner or later they will have to give up hope for a better past.

A letter that fell into other hands

Imagine that a letter written to someone else has fallen into your hands. An older doctor is writing it to young colleagues, and it is about the hardest part of their work: how to be with a person who is suffering. You are not going to treat anyone, but with every page you notice that the letter is about you too. About your quarrels and friendships, about fears that are not customarily spoken aloud, and about how hard it is to truly hear another person.

This is how Irvin Yalom’s book “The Gift of Therapy” is built. Yalom, an American psychiatrist and professor at Stanford University, worked with people for more than thirty-five years. He became one of the creators of the approach known as existential psychotherapy. In 2002 he gathered the essentials of his practice into 85 short chapters of advice and addressed them to a new generation of therapists and to their patients.

The central idea of the book is simple and unfamiliar. According to Yalom, a person is changed not by clever techniques or wise interpretations, but by the relationship between two people, if it is honest and alive. Behind many of our anxieties, he believes, stand four core concerns common to everyone: death, loneliness, the search for meaning, and freedom. No one is exempt from them, and that includes the person sitting in the therapist’s chair.

Six lessons from this letter lie ahead. Why we are all fellow travelers. What a label does. How to look out of someone else’s window. What to do with what is happening between people right now. What the thought of death teaches. And why one day you will have to give up hope for a better past. This is not a book about how to treat others. It is about how to be truly with them. Let’s begin.

Fellow travelers on one road

One of Yalom’s patients was being treated for cancer. Chemotherapy had taken her hair, and she was ashamed of her head. It mattered to her to know whether her doctor found her repulsive, and she asked for some sign. Yalom answered that no, not at all. Then he asked whether he might touch her hair. For both of them it became a warm moment, after which it became easier to breathe.

There is no technique in this scene. There is only one person who allowed another to see that they matter to him. Yalom notes that people rarely remember a therapist’s clever explanations later on. Far more often they remember the support and the plain human words.

One chapter of the book is titled “The Therapist and Patient as Fellow Travelers.” Yalom writes that everyone, the therapist included, is bound to learn not only the joy of life but also its unavoidable darkness: losses, illness and death. That is why he does not want to divide people into those who suffer and those who treat them. For him the therapist is not a guide who reached the summit long ago and waves from above, but a companion walking the same road.

From this come his rules. A mistake must be admitted: in Yalom’s view, any attempt to hide it will sooner or later turn against you. Once he told a patient about his own dreams, in which he had been helpless. He wanted her to see that he too had difficulties, and that he was not above her but beside her.

This idea is easy to take into everyday life. When a friend is in trouble, you want to play the one who has figured everything out and hand over a ready-made piece of advice. But what a person usually needs is not an answer from above, but someone who will sit down beside them and honestly say: I am scared of this too, let’s think about it together.

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About the author

Irvin D. Yalom is an American psychiatrist, professor emeritus at Stanford University and one of the founders of existential psychotherapy. He is the author of textbooks on group therapy and of the novels “When Nietzsche Wept” and “Love’s Executioner.”

All books by this author: Irvin D. Yalom

Terms from the book

  • Empathy
  • existential psychotherapy
  • chemotherapy
  • Horney: Karen Horney (1885–1952), a German-American psychoanalyst. She believed that a person has a built-in drive to grow, and that neuroses get in the way of that growth.
  • diagnosis: A medical judgment about what disorder or illness a person is suffering from. Yalom considers it necessary in serious conditions, but in ordinary therapy he sees a risk that it narrows one’s view of the person.
  • microcosm: A small world in which a large one is reflected, as in a drop of water. For Yalom, this is the name for the therapist’s room, where a person behaves as they do with people in their life.
  • Heidegger: Martin Heidegger (1889–1976), a German philosopher who wrote a great deal about time, death and what it means to exist.
  • ontological: Relating to being as such. In Heidegger this names the mode in which a person thinks not about the things around them but about the very fact of their own existence.

All terms

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