The Gift of Therapy

An office visit for even a simple condition like hypertension may be routine to a physician, but patients, in the back of their mind, may fear the implications of the doctor's assessment for the length of their life or changes in their lifestyle. Existential concerns are never far from a physician's daily business, yet we receive little formal instruction in how to use the doctor-patient relationship to talk with patients about issues like death and life meaning in a helpful way. While Yalom's intended audience is the young psychotherapist, physicians of any specialty will find both the existential theme and his reflections on the healing relationship quite relevant to their own practices. The Gift of Therapy is a brief work written as a series of 2- to 3-page tips of the trade, with a tone somewhere between that of an informal memoir and off-the-cuff teaching on morning rounds with a seasoned psychiatrist. It is peppered with brief clinical examples invariably on point, as well as well-distilled literary references. The first 40 mini-essays address the therapeutic relationship, stressing how Yalom works by keeping the content in the moment rather than analyzing past conflicts. The next 10 sections describe how he discusses the issues of death, freedom, and life meaning with patients. Seven sections are devoted to working with dreams, and the remainder of the book is composed of miscellaneous observations and advice on the conduct of therapy with its joys and hazards. A work of this nature is brief by necessity, but it would have been helpful to include a discussion on isolation, since he lists it among the 4 existential life concerns and since it is an integral part of the experience of physical or mental illness. The Gift of Therapy is not an exposition of theory or philosophy—it is meant as a high-yield, practical guide to building healing relationships with patients. Yalom has done a service by demystifying the act of engaging with patients about their ultimate concerns in the moments of great life transition that we physicians are privileged to share with them.