Thursday, September 1, 2011

4 Nuggets from Yalom’s “The Gift of Therapy”

Have you read the book  The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (P.S.) by Irvin Yalom?

The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (P.S.)
I loved this book because it has so many wonderful gems of therapeutic wisdom.

Four nuggets of advice you may appreciate:

Be Authentic and Admit to Mistakes

When you make a mistake with a client, acknowledge it. According to Yalom, any attempt at covering the error up will only backfire because the client will ultimately sense that you are not being upfront with her/him. Hence, it will have a negative impact on the therapy.

Conversely, admitting to the error is setting a positive role model for the client and an indication that he/she matters to you (an important ingredient of a good therapeutic relationship).

Develop "Here and Now" Rabbit Ears

It is important to develop "here and now" rabbit ears because the interpersonal problems of a client will inevitably appear within the here and now of the therapeutic relationship.

To illustrate, if a client is demanding or judgmental or maladaptive interpersonally in another way, the client will exhibit these traits in his/her relationship with the therapist.

What To Do When Your Client Is Crying

Contrary to what you do as a friend (attempt to console and help your friend regain control and stop crying), Yalom recommends that a therapist encourage the client to plunge deeper so as to assist the client in exploring their emotions.

Yalom eloquently suggests asking the client, "If your tears had a voice, what would they be saying?"

Beware of Professional Hazards

Isolation is one professional hazard. Therapists often neglect their personal lives; our work becomes our life. Living with the possibility of a patient committing suicide and a malpractice lawsuit are two additional stresses that are rather catastrophic.

To avoid being alone and having some support in addressing these issues, Yalom recommends that therapists participate in weekly or once every other week group meetings with other therapists.

There are many additional sage pieces of advice that you may wish to follow and/or read....

Do any of the four nuggets that I've described speak to you? What thoughts/comments come to your mind?

You May Also Enjoy:
Self-Care for Mental Health Professionals
Social Work Vs. Psychology and a Taste of Hypnotherapy
Innovation in Social Work
Family/Couples Therapy - Improving Relationships


  1. Beware of Professional Hazards is a big one for me. There are times when I can get busy being busy doing the work, but the real work is self care and community. Yalom is definitely an interesting and provocative guy!

  2. It's great that you are aware of this, Mozart.

    This is a big one in general for all of us in the helping professions.

    The mere fact that you have such great awareness of this suggests you are likely to do the requisite self-care along the way and/or be alert to signs when you are overstressed so as to prevent yourself from ever getting too overwhelmed :)

    Yes, there are a few things that Yalom has mentioned doing that I would not necessarily feel comfortable doing...

  3. I have this book, but have not yet read it. These are great gems for sure!I especially like the first...sometimes you can make a mistake and it is important to own up to it. This happened to me in my internship and I was glad that I said something and brought it out in the open. Made a huge difference going forward with the therapeutic alliance.

  4. Thanks so much, Sharon, for sharing which gem you liked most and how you have already applied it in your work with patients.

    Your experience serves as evidence that being upfront truly plays a key role in establishing the therapeutic alliance with a client.

  5. I don't know this particular book of his, but I have read a lot of his earlier work.

    All of what he says resonates with me. I heard him speak many years ago at one of the Evolution of Psychotherapy conferences--I liked him instantly and it was wonderful to meet someone who's work I had read and studied.

    Authenticity in clinical work is essential, and that includes acknowledging mistakes.

    I am a huge believer in working with what shows up in the hear and now, individually and in groups. The process oriented group therapy groups I ran were some of the most powerful change experiences my clients had ever had.

    I also have had a lot of success in giving the body a voice: asking what tears would say, what the tension in your stomach would say if it had a voice, etc. I don't recall learning this from Yalom's early work though--I actually learned that technique in my EMDR training with Francine Shapiro.

    However, going deeper into feelings only works if a client is at a place to handle it. Some people may not have sufficient affect regulation skills to tolerate that kind of work. So one needs to have a clear sense for who you're working with and where they are in terms of their ability to tolerate affect.

    Thanks for sharing the nuggets of wisdom with us, Dorlee!

  6. How wonderful that you had the opportunity to hear Yalom speak!

    The "here and now" concept is very interesting and was brought back to life for me in my Gestalt was the concept of giving the body a voice...As I'm learning more about the different techniques, I am seeing that often times there are overlaps of concepts and ideas but with tweaks.

    I hear you about the concern and care that needs to be taken with regards to delving deeper into a person's feelings (via giving the body a voice for example). It makes total sense and in fact, I felt that I needed to exercise care with this myself because the work we were doing in my Gestalt class was very experiential....

    There were a number of students who broke down in class...they seemed to be ok; that is, they recuperated and rebalanced themselves but that takes a particular type of strength, vulnerability etc. to be able to go that deep into your feelings in a group/class forum.

    And how cool that you obtained your EMDR training with Francine Shapiro, the mother of EMDR!

    Thanks so much for sharing some of your interesting experiences as well as your expert guidance, Nancy :)

  7. This was an excellent post with a lot of information. So true-- "Isolation is one professional hazard. Therapists often neglect their personal lives; our work becomes our life."

    "Contrary to what you do as a friend (attempt to console and help your friend regain control and stop crying), Yalom recommends that a therapist encourage the client to plunge deeper so as to assist the client in exploring their emotions." Yes! A difficult thing to do sometimes as we are all human and are sometimes very touched emotionally by our clients sadness. My thought is that it is important to make sure our clients are ready for such an exploration and have the tools or coping skills to deal with more intensive feelings that may come up in this exploration of feelings. A therapist should be very careful of that-- Sometimes consoling might be the right choice until the client is ready to go deeper. It can be tricky. We certainly don't want our clients to leave our office and have no way of dealing with feelings that may come up and have that client fragment. It really is a balance, in which we need to make sure our client is ready for such an exploration. Sometimes preparation and timing in therapy is very important.

    Loved. Loved. Loved this posting!!! A wealth of information!

  8. Thanks so much, Laurel, for your enthusiastic feedback as well as for the wisdom you shared...

    Similar to what Nancy said above, you too are expressing the need to exercise caution in how/when one explores a client's feelings so as not to cause a client to get unbalanced.

    As I'm thinking about it, I do not recall Yalom raising this concern, even in a different "story" or example in this particular book. I'm not sure whether he assumed this was a given or whether this would be taken care of in supervision.

    With much appreciation,

  9. HI Dorlee:

    I know this post has been up for ages, but I just stumbled upon you via Tamara Suttle at Private Practice from the Inside Out. I love Yalom. It's true I don't agree with every suggestion, but he embodies an authenticity in his work that should instruct us all about how to really "show up" in our work. I think that ability to be very focused in session with a client must include both careful attention to our client and to ourselves. Our clients affect us. Part of our job is to be able to understand what part of these responses are just about us, and what part is about them. The part that is about them provides important information about the client and how they operate, affect others, and what they might need. Taking care of our emotional needs is like getting regular service to our car. We are the instruments of change - you have to keep the machines tuned up! For me, Yalom speaks to how to show up authentically in a way that takes care of the client and the therapist. Thanks so much for the reminders of his great nuggets.

  10. Hi Amy,

    Thanks so much for stopping by and sharing your thoughtful reflections about Yalom's work :)

    You raise a very important point - how we must be fully present and mindful in our work so as to not only hear what our clients are saying but to also be able to correctly the emotions that they are eliciting in us (whether it is objective or subjective countertransference).

    I also love your analogy of our self care to the service of a car... This reminds me of Mary Jo Barrett's approach in . She essentially argues that in light of the critical role that self care plays in maintaining our body/instrument of therapy, it would be unethical for us to neglect this component.

    Thanks again for taking the time to share your thoughts. I hope to see you again soon!