I’ve been reading Irvin Yalom’s “The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients,” and I’ve found it helpful as a newer therapist. The book shares his experience as an existential therapist and the importance of the therapeutic relationship. So let’s back up a little bit and start by explaining who the author Irvin Yalom even is. As I found out on his website, Dr. Yalom is both a medical doctor and a psychiatrist, and he ended up writing a textbook on existential therapy in 1980 even though there weren’t any classes on the topic. Let that sink in. He wrote a textbook on a subject that wasn’t being taught in schools at the time! How bold is that? He is currently a Professor Emeritus of Psychiatry at Stanford University and has been since 1994.
All of this is to say that Yalom is more than qualified to speak on therapy in general as well as his own experience as an existential therapist. So now you might be asking, what exactly is existential therapy? Existential therapy focuses on the conflict that arises when we confront the givens of our human existence: Death, Isolation, Meaning/Purpose, and Freedom/Responsibility. Yalom advises therapists to increase their sensitivity to existential issues rather than trying to devote themselves solely to becoming existential therapists. This is because Yalom has “never considered existential psychotherapy to be a discrete, freestanding ideological school” (2017, p. xvii).
To Share or Not to Share?
Now to the interesting stuff! What does Yalom actually say about the therapy process? What should therapy look like? Yalom argues that “the effective therapist should never try to force discussion of any content area: therapy should not be theory-driven but relationship-driven” (2017, p. xvii). This really resonated with me because this is an excellent way of explaining my own approach to therapy. I never want therapy to feel like I’m a stuffy professor lecturing my client on CBT principles or grounding techniques. I want to be genuine, and I want my client to know that just because I’m the therapist doesn’t mean that I’m somehow immune to the struggles that all human beings face. Now that doesn’t mean that I share my life story with my clients, but I do share my imperfections with them. For example, when a client talks about being a people pleaser, I might ask them if that causes them to be indecisive around other people because of my own experience of being a people pleaser.
I will say though that as a therapist you need to be extremely careful when it comes to how much, how often, or why you are sharing things with clients. When I ask clients about their previous therapy experiences, a lot of clients complain about how much their last therapist would share with them about their own personal problems and how uncomfortable it was for them to help their therapist through their problems instead of it being the other way around. A therapist needs to put the client first and it can be hard at times to censor yourself but therapy needs to be focused entirely on the client.
The therapeutic relationship is incredibly unique, it’s rare to be in a relationship that is entirely one-sided but that’s what therapy is. The client is the sole focus which is why therapy is different than talking things out with a friend or family member. As a therapist, this takes some time to get used to because it’s only naturally that we want to share ourselves with others because that’s how virtually every other interaction with others is like. I’ve caught myself in session wanting to jump in and tell them how what they’re saying reminds me of something going on in my own life when I realize that it has nothing to do with therapy or what we are actually talking about or working on. Part of the therapist role is directing the session and keeping both people on track, which can be difficult with a client you could see yourself being friends with if you had met in other circumstances.
Being a therapist can be difficult at times, but the client should always come first. Before sharing something personal in session you should be checking in with yourself about why you feel the need to share this information. Anything you share should be related to helping your client reach their therapeutic goals. If you can’t explain to the client why this is relevant to their therapy, then you probably shouldn’t be sharing that with them. Now that all being said, I do think there are times when it is okay to share something personal with your client.
I think that it’s important to balance being a real person with being a therapist in session. Therapists should not be unloading their problems with a client, but I do think that small mentions of shared struggles can be extremely helpful. Most of the clients I see think of themselves as suffering alone and being misunderstood by their loved ones and peers, so when I share similar struggles with them (like that I’m a people pleaser too), it might help them realize that it is completely normal to feel that way and that they’re not alone.
The Therapeutic Relationship
I agree with Yalom’s statement about therapy being relationship-driven and not theory-driven. Research has shown that having a strong therapeutic bond is one of the most important factors in treatment outcomes, regardless of therapeutic style (Lambert & Barley, 2001). Which makes sense when you think about it, of course a client is going to struggle to make progress if they don’t respect or trust their therapist.
A therapist can do well if the client sees them only as a respected professional, but I have personally found that clients appreciate seeing a therapist who is a person first and foremost. Thankfully the therapy profession has moved away from being the emotionless professional who sits back writing notes as you tell them your life story. You can still find remnants of this outdated form of therapy but I would say that most therapists nowadays bring some form of their own personality and personal experiences with them in session.
As I stated above, we need to be mindful of what and how much we share with our clients but the therapeutic relationship can be strengthened when the client feels like they can relate to their therapist. When the therapist can be seen as a real person who isn’t perfect, it can empower the client to see themselves in a more honest light. Most of my clients are really hard on themselves and tend to see others more honestly as human beings who make mistakes but struggle to have the same compassion for themselves. I try to help clients realize the importance of being comfortable making mistakes or not living up to expectations by sharing my humanity with them.
I think Yalom said it best: “I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between ‘them’ (the afflicted) and ‘us’ (the healers)” (2017, p. 8). I love this! Just because I studied mental health counseling and they gave me a degree, doesn’t mean that I’m somehow better than my clients or don’t make mistakes. I’m just Jess, a human being who also struggles to achieve their goals. There is no one on Earth who is perfect or better than anyone else and hate it when people try to pretend that money or a job title means they have become better than someone with less money or a different job.
In the end, we are all just people so let’s start treating each other with respect 🙂
Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361. https://doi.org/10.1037/0033-3188.8.131.527
Yalom, I. D. (n.d.). Biography. Irvin D. Yalom, MD. Retrieved April 29, 2022, from https://www.yalom.com/biography
Yalom, I. D. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.