You simply cannot ignore Yalom. Every psychologist can benefit from reading his work regardless of their clinical approach, so did I.
I love the way he writes and how this book is structured. There are 85 chapters in total and each “chapter” consists of no more than a handful pages. He addressed many practical issues that all therapist have encountered and struggled with—therapeutic relationship, boundary, disclosure, transparence, dream, death, and more. You can easily pick up a few pages here and there and you will be amazed by how many reflections this book would evoke. These thoughts will stay with you for a few days and then you find them resurfacing during therapy sessions. Of course, not all chapters apply and not all psychologists find his approach sensible, this book still has abundant treasures to offer!
A few things really “hit” me and I am very aware how they have transformed me and my practice.
1. It is the therapeutic relationship that heals. 2. Let your client matter to you. 3. Process the here and now. 4. Create a new therapy for each client.
Whether as a new therapist or a human being, I always ask myself this question: which is more important, being or doing? I have been trained in CBT, which means two things: (1) therapeutic alliance and collaborative work, and (2) skills training, such as thought record, behavioural experiments, exposures, cognitive reconstructing. What often puzzles me is that the client does not “take in” the skills and returns empty-handed. I also find it difficult to balance two urges from inside of me: one is to explore and validate their experiences, and the other is to teach skills and problem-solve. In a way, there is part of me who wants to be a listener but part of me desires to be a coach. CBT believes, or what I have been trained to believe, all the client needs is the right tools and the capacity and motivation to use such tools to address their symptoms. As a therapist, my job is to sell, teach, and help my clients master a variety of cognitive and behavioural tools. Therapeutic relationship is important, but only in preparation for such training to take place.
I do not fully agree with this approach and sometime I feel that the therapeutic relationship, or love as I would label it, is far more important than skills training. When I heard others telling me that I don’t have enough skills to deal with some issues, I felt ridiculed—no one can be perfectly trained, but with love and faith, one can learn and even develop all the skills that are needed to help the client. Training in clinical psychology is not about skills either, it is by thousands of hours of learning and practicing that one thinks like a psychologist, acts like a psychologist, and most importantly, becomes a psychologist. On this point, I am in total agreement with Yalom. What heals in psychotherapy is not the skills training, it is the supportive, transparent, and caring relationship that empower the client to confront and deal with their own difficulties. To do so, one must have complete faith in the following two: (1) we all need care from others, and (2) we are capable of providing this care. It is not what you do, but who are you. The reason is also simple—if you don’t let your client matter to you, they will know.
A big block as a clinician was my fear and hesitance to process the here and now, i.e., what is happening in the therapy room between me and my client. I felt that a strict boundary needs to be maintained and I should not let my client access my internal processing. What a fool I was! Processing the here and now has been proved to be of tremendous help since I started implementing it last week. My client appreciates my efforts in paying attention to what they felt and my curiosity in knowing what they thought. By attending and labeling their emotions, my client made important disclosures, which not only improved rapport but also accelerated treatment. From my perspective, I was able to be more spontaneous, transparent, and effective, and by doing so, I provided a model to my client in terms of how to deal with one’s emotions and interpersonal relationships.
The last point is so true that I do not feel the need to defend it. Every client deserves a new therapy. By labeling us as a CBT therapist or psychoanalyst, it gives us a sense of security and some control over therapy process. But does it benefit our clients? Whether it is psychoanalysis, interpersonal therapy, CBT, DBT, or existential therapy, they all need to be client centred. We are not the expert to give them a solution that we think will work the best for them. Instead, it is by working together on building a solution for them and them only that treatment outcomes can be sustainable. How do I love this book!