50 Tips for Counselors: A Compilation of Irvin Yalom’s Advice

Fifty Tips for Counselors:

A Compilation of Irvin Yalom’s Advice

Renee Baker, Ph.D.

The following is a list of tips and tidbits I consolidated from Irvin Yalom’s book The Gift of Therapy – An Open Letter to a New Generation of Therapists and Their Patients (Perennial first edition, 2003).  The book is terrific and I recommend reading it.  This list below is not comprehensive, but provides a nice quick reference of things to remember.  Yalom works from an existential and interpersonal framework – people fall into despair because of relationships that do not satisfy or due to the harsh facts of the human condition.  The tips follow the sequence of the book – material is paraphrased excepting direct quotes which are his.   See also 50 More Tips, coming soon.

  1. “Therapy should not be theory driven, but relationship driven” (p. xviii)
  2. Karen Horney influenced Yalom with the notion that the human being has an inbuilt propensity towards self-actualization.  The job of the therapist is then to identify and remove obstacles, the rest following from the innate tendency of the client to grow.
  3. Avoid diagnosis as “diagnosis is counterproductive in the everyday psychotherapy of less severely impaired patients.” (p. 4) Why?  Therapy is an unfolding where the therapist gets to know the client over time…a diagnosis is limiting and can act as a self-fulfilling prophecy.
  4. Think of your clients as fellow travelers, rather than dividing into healers and the afflicted – we are all in this together and no person has immunity to the tragedies of existence.
  5. The relationship with the client should take top priority.  Each hour, check in with the client on the therapist-client relationship – how are we doing today?
  6. Be generous with sharing your positive thoughts and feelings about clients, but be genuine and avoid empty compliments.
  7. Have accurate empathy for your clients – they benefit immensely from being fully seen and understood.
  8. Use the here and now to help clients learn empathy themselves, asking clients how their statements and actions might affect others, not forgetting to include yourself, the therapist.
  9. Share your thoughts or dreams of your clients with them, if productive.  “Let your patients matter to you, to let them enter your mind, influence you, change you – and not conceal this from them.” (p. 28)
  10. Share your errors and acknowledge it directly – admit mistakes – it is good model setting.  “Therapist disclosure begets patient disclosure.” (p. 29).”
  11. Invent a new therapy for each client and allow choices to flow spontaneously rather than following any standardized protocols.  Transcend technique and trust one’s spontaneous moves.
  12. “Recall the fundamental therapy principle that all that happens is grist for the mill.” (p. 36)
  13. Learn from clients and make it a point to check in with them to see what is helpful about the therapy process.
  14. Demonstrate your willingness to your client to enter into a deeply intimate relationship with them.  “Therapists must show the way to patients by personal modeling.” (p. 40)
  15. Self exploration should continue throughout life, including entering therapy at various stages of life.
  16. There is an inequality in the therapeutic relationship – the teacher has many students and the students have but one teacher.
  17. Use the here and now as a major source of therapeutic power – it refers to the events of the therapeutic hour and to what is happening here in this office and relationship.
  18. The importance of using the here and now is based upon assumptions of the importance of interpersonal relationships and the idea of therapy as a social microcosm.  Our interpersonal environment influences us and our self image is formulated to a large degree based upon what we perceive important figures in our lives appraise us to be.  “The interpersonal problems of the patient will manifest themselves in the here-and-now of the therapy relationship.” (p.48)
  19. You must develop here-and-now rabbit ears noting that every person reacts differently to the same stimulus. “Each patient has a different internal world and the stimulus has a different meaning to each.” (p.50).
  20. Find here-and-now equivalents of dysfunctional behavior regarding interpersonal interactions a client is concerned about.
  21. Working in the here-and-now is concrete compared to an abstract or historical focus.  “Therapy is energized when it focuses on the relationship between therapist and patient.” (p. 64)
  22. Use your own feelings as precious and valuable information.  If a client bores you for example, then they may likely bore others as well.  Use that.  Say to the client, “I notice I have been feeling disconnected from you, somewhat distanced…is your feeling similar?…let’s try and understand what is happening.” (p. 66)
  23. Frame here-and-now comments carefully such that they are caring and acceptable to clients.
  24. Sometimes comment on the current moment’s experience and other times note it for reference later.
  25. “Effective therapy consists of an alternating sequence: evocation and experiencing of affect followed by analysis and integration of affect.” (p. 71)
  26. Check in with your client as to how the relationship between you and them is going – each therapy hour – how are you working together, how are you relating. (p. 72)
  27. When clients happen do describe times of deception in their lives, use the opportunity to inquire as to the lies they may have told you or what they may have concealed, perhaps out of shame. (p. 74)
  28. Forget the blank screen model of the ideal therapist (i.e. remaining neutral and disengaged) – “it is a better model to think of understanding the pats in order to apprehend the present therapist-patient relationhnship.”  Become engage, disclose, as disclosure begets disclosure. (p. 76-82)
  29. Three types of needed disclosure: the full disclosure of mechanism of therapy, a discretionary sharing of here and now feelings, and a cautionary and well-timed disclosure of personal life.
  30. Comfort your clients who feel all alone in their therapy, that they are the only one with such problems, by “welcoming them to the human race” – that we all have our closets full.  (p.97).
  31. Clients may resist you being human and resist your disclosure.  You may need to tell them you can’t help them if they continue to not see you as human and as omniscient. (p. 100)
  32. Avoid the “crooked cure” – a sudden radical improvement based upon magic – emanating from an illusory view of the power of a therapist.   Explain it was them, not the therapist, who is the magician, who had really helped themselves. (p. 103)
  33. Question whether we can take our clients farther than we have gone ourselves.  Nietzche expresses an opposing view: “Some cannot loosen their own chains, yet can nonetheless redeem their friends.” (p. 104)
  34. It is commonplace for therapists to be helped by their clients.  Jung said therapy worked best when the “patient brought the perfect salve for the therapist’s wound and that if the therapist doesn’t change, then the patient doesn’t, either” (p. 107).  Harry Stack Sullivan said if the therapist develops more anxiety than the client, the client becomes the therapist.
  35. Self-disclosure is an absolutely essential ingredient in psychotherapy – no client profits without revelation. (p. 109).  A disclosure has content and process.  Content is the stuff revealed and process is the disclosure act itself.  Vertical disclosure refers to in-depth disclosure about the content.  Horizontal disclosure is disclosure about the act of disclosure itself.  (p. 109-111)
  36. The Johari Window is a four quadrant window of self-knowledge. If the knowledge is known to our self and others, it is public. If it is known to our self and not others, it is secret. If it is not known to our self yet it is known to others, it is blind. If it is not known to self and also not to others, it is unconscious.  It is the blind self that therapists target, helping clients see themselves as others see them.  Especially useful in group therapy, using here and now experiences. (p. 112-114).
  37. Give feedback gently.  If we focus on our own feelings, we are less likely to evoke defensiveness – our own feelings cannot be challenged.  Introduce the idea that you wish to be closer to the client, to know them better, yet the behavior in question distances me and may distance others.
  38. Increase receptiveness to feedback by referring to “part” of a person.  “Part of you” wants to live.  “Part of you” disagrees.
  39. Strike when the iron is cold – give feedback to clients about a behavior when they are behaving differently. (p. 120).
  40. Confront the topic of death and our defenses based on denial of death – cope with the awareness of death – that learning to live well is to learn to die well.  The idea of death may save us – we reprioritize our values and trivialize the trivia.
  41. Heidegger spoke of two modes of existence – the everyday mode and the ontological mode.  The first we are consumed with material surroundings and are filled with wonderment with how things are in the world. The second we are focused on being per se, we are filled with wonderment that things are in the world. (p. 127)
  42. Talk about death directly and matter-of-factly.  When did you first become aware of death?  With whom did you discuss it?  How did adults respond to your questions?  What deaths have you experienced?  How have your attitudes changed about death?  Strong fantasies/dreams about death?  Some preoccupied with sex have been exposed to a great threat of death.
  43. 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 – that it was “out there” waiting for us.  One-third of Jung’s of clients came for therapy to find meaning.
  44. In finding meaning, may ask: What do you want on your tombstone epitaph?  Schopenhauer said that willing is never fulfilled – as soon as one wish is satisfied, another appears…every human life is tossed backward and forward between pain and boredom.  The Buddha taugh that the question of meaning in life is not edifying and one should immerse oneself into the river of life and let the question drift away.  (p.135-136)
  45. There are four ultimate concerns or facts of existence – death, isolation, meaninglessness and freedom – that when confronted evoke deep anxiety.  We are in the deepest sense, responsible for ourselves and as Sarte put it, we are the authors of ourselves.
  46. Help clients assume responsibility.  If they see their problems as outside of themselves, then we can commiserate, help them adapt or attain equanimity, or teach them to be more effective at altering their environment. If we hope for a therapeutic change, then we must encourage our clients to assume responsibility – that a client must see themselves as having a role in the sequence of events.  “We have to look at your role, even if it is minor, because that is where I can offer the most help”.  Take advantage of here and now data.
  47. Never or almost never make decisions for a client – we work with unreliable data, biased by the client.  Caveat – physical abuse situations – may need to discourage clients from returning to abusive settings.
  48. Making decisions for clients, especially ones they do not wish to do, is a good way to lose clients – they drop out of therapy.  Decisions are the “via regia” (royal road) into existential bedrock, the realm of freedom, responsibility, choice, regret, wishing and willing.  To settle for preemptive advice forgoes the opportunity for existential exploration.
  49. Decisions are expensive for they demand renunciation and cut us off from other possibilities.  We are required to reduce our limitations and relinquish our myth of personal specialness, unlimited potential, imperishability, and immunity to biological laws.
  50. We help clients by dealing with difficult decision dilemmas by helping them assume responsibility and exposing them to the resistance of choosing.  Sometimes, one can facilitate an awareness by giving advice by prescribing certain behaviors – not to take away a client’s choice, but to shake them up into becoming aware of a certain behavior pattern.  (150-154)
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