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

Though the physicality of death destroys us, the idea of death may save us.

Life as a therapist is a life of service in which we daily transcend our personal wishes and turn our gaze toward the needs and growth of the other. We take pleasure not only in the growth of our patient but also in the ripple effect—the salutary influence our patients have upon those whom they touch in life.

love obsession often serves as a distraction, keeping the individual’s gaze from more painful thoughts.

Sometimes I simply remind patients that sooner or later they will have to relinquish the goal of having a better past.

As long as he denies his own agency, real change is unlikely because his attention will be directed toward changing his environment rather than himself.

I often feel caught in a dilemma: on the one hand I wish to be more natural with you and yet, on the other hand, because I feel that you’re easily wounded and that you give my comments inordinate power, I feel I must consider my wording very, very carefully.

If you make a mistake, admit it. Any attempt at cover-up will ultimately backfire. At some level the patient will sense you are acting in bad faith, and therapy will suffer. Furthermore, an open admission of error is good model-setting for patients and another sign that they matter to you.

Look out the other’s window. Try to see the world as your patient sees it.

The establishment of an authentic relationship with patients, by its very nature, demands that we forego the power of the triumvirate of magic, mystery, and authority.

We humans appear to be meaning-seeking creatures who have had the misfortune of being thrown into a world devoid of intrinsic meaning. One of our major tasks is to invent a meaning sturdy enough to support a life and to perform the tricky maneuver of denying our personal authorship of this meaning. Thus we conclude instead that it was "out there" waiting for us. Our ongoing search for substantial meaning systems often throws us into crises of meaning.

if we hope for more significant therapeutic change, we must encourage our patients to assume responsibility—that is, to apprehend how they themselves contribute to their distress.

The path to decision may be hard because it leads into the territory of both finiteness and groundlessness—domains soaked in anxiety.

Psychotherapy is a demanding vocation, and the successful therapist must be able to tolerate the isolation, anxiety, and frustration that are inevitable in the work.

Abraham Lincoln is reputed to have said that if he had eight hours to cut down a tree, he’d spend several of these hours sharpening his ax.

The therapist's worldview is in itself isolating. Seasoned therapists view relationships differently, they sometimes lose patience with social ritual and bureaucracy, they cannot abide the fleeting shallow encounters and small talk of many social gatherings.

Friendship between therapist and patients is a necessary condition in the process of therapy - necessary, but not, however, sufficient. Psychotherapy is not a substitute for life but a dress rehearsal for life, In other words, though psychotherapy requires a close relationship, the relationship is not an end - it is a means to an end.

Beginning therapists must learn that there are times to sit in silence, sometimes in silent communion, sometimes simply while waiting for patients' thoughts to appear in a form that they may be expressed.

We cannot avoid this responsibility, this freedom.

Perhaps the real therapy occurred at the deathbed scene, when they moved into honesty with the revelation that they were fellow travelers, both simply human, all too human.

Heidegger spoke of two modes of existence: the everyday mode and the ontological mode. In the everyday mode we are consumed with and distracted by material surroundings - we are filled with wonderment about how things are in the world. In the ontological mode we are focused on being per se - that is, we are filled with wonderment that things are in the world.

I often urge patients to project themselves into the future and to consider how they can live now so that five years hence they will be able to look back upon life without regret sweeping over them anew.

Perhaps you can help me locate some of my own blind spots.” This is another one of those phrases that have taken up lodging in my mind and that I often make use of in my clinical work.)

[T]echnique has a different meaning for the novice than for the expert. One needs technique in learning to play the piano but eventually, if one is to make music, one must transcend learned technique and trust one's spontaneous moves.

I believe "technique" is facilitative when it emanates from the therapist's unique encounter with the patient. [E]very course of therapy consists of small and large spontaneously generated responses or techniques that are impossible to program in advance.

We need to go even further: the therapist must strive to create a new therapy for each patient.

It is sad to think of being together with others for so long and yet never to have let them matter enough to be influenced and changed by them. I urge you to let your patients matter to you, to let them enter your mind, influence you, change you—and not to conceal this from them.

Given this, the act of revealing oneself fully to another and still being accepted may be the major vehicle of therapeutic help. Others may avoid intimacy because of fears of exploitation, colonization, or abandonment; for them, too, the intimate and caring therapeutic relationship that does not result in the anticipated catastrophe becomes a corrective emotional experience. Hence, nothing takes precedence over the care and maintenance of my relationship to the patient, and I attend carefully to every nuance of how we regard each other.

When I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney’s Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree. “Just as an acorn develops into an oak …” What a wonderfully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient’s path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient.