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

Therapist and author Irvin D. Yalom wrote The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients in 2001. Yalom, a psychiatrist and psychotherapist with over three decades of experience, distills his wisdom in this book, which is written as an open letter to the younger generation of therapists. He offers advice on the therapist-patient dynamic, on effectively showing empathy and support, and on focusing on the present moment during therapy. Yalom’s accessible prose and insightful lessons have earned The Gift of Therapy praise from fellow psychologists as well as literary critics.

This guide refers to the Kindle edition of this book, which was published in 2013.

Content Warning: The source text and this guide mention mental health issues, including suicidal ideation and substance use disorders.

Summary

Yalom says that his intention behind writing The Gift of Therapy is to pass down the knowledge he has gleaned from his decades of experience as a psychotherapist. He is an existential psychotherapist who helps individuals understand how they are affected by existential issues. He urges therapists to avoid needlessly labeling their patients with particular diagnoses, and he says therapists must instead regard patients as nuanced and unique individuals.

As an existential therapist, Yalom believes that many of the issues that patients seek help with are rooted in fundamental existential problems, such as the fear of death and the meaninglessness of life. He explains how people’s fear of death and limitations often manifests as other problems, such as difficulties with making decisions. Yalom believes that therapists must help their patients confront the inevitability of death in order to move past these issues. Also, therapists can guide their patients to discover what will give their lives meaning and to pursue it.

Yalom believes that therapists should cultivate a respectful and egalitarian dynamic with their patients, which must be based on empathy and honesty. He wants to do away with the hierarchy in the therapist-patient relationship, instead encouraging therapists to foster trust and model openness to their patients. He advises therapists on how to best provide honest, but gentle, feedback to their patients. He also urges therapists to avoid mythologizing or idealizing themselves; instead, they must maintain transparency and ensure that their patient sees them as humans who can make errors. To this end, Yalom recommends that therapists acknowledge and apologize for any errors they might make.

Another idea that Yalom argues for is the importance of the immediate, present-moment interactions between the therapist and patient during therapy, which he terms the “here-and-now.” He says that the therapist-patient relationship is a social microcosm, and it is therefore a useful window into how the patient relates to other people generally. So, therapists should pay close attention to their patients’ behaviors and emotions during therapy. When therapists explore these dynamics with their patients in real-time, it will help their patients gain greater self-awareness and reflect on how they interact with people outside of therapy. Though Yalom says that patient histories are important, he sees the “here-and-now” of therapy as being equally important.

Yalom recommends that therapists seek therapy themselves as a means of personal and professional development. To be effective therapists, they must be highly attuned to their own feelings, thoughts, and biases, so they must engage in self-reflection. He argues that therapists have a responsibility toward their patients to work on their self-awareness and well-being so they can be fully present for them. He also cautions therapists about the “occupational hazards” that come with the job, namely isolation, burnout, and anxiety. To combat this, they can seek therapy as well as authentic relationships in their own lives. Despite these challenges, he celebrates the positive aspects of working as a therapist, such as the opportunities for introspection and intellectual stimulation. Most of all, Yalom feels that therapists should be proud to extend their compassion and knowledge to others and to continue the long tradition of healing.