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

This acronym refers to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The DSM-IV provides standardized criteria of mental health conditions, and it is used by healthcare professionals as an authoritative guide for diagnosing mental illnesses.

Yalom references this manual in his discussion about diagnosing patients. He says that while making a diagnosis can sometimes be useful, especially to identify brain-based disorders such as schizophrenia or to help patients access insurance, he argues that diagnoses can inadvertently encourage patients to over-identify with that label. Therefore, he discourages therapists from liberally making diagnoses.

Existential psychotherapy is rooted in existential philosophy. It focuses on patients’ reactions to existential concerns, namely: death and mortality; freedom and decision-making; the loneliness of the human experience; and the search for meaning and purpose.

Unlike some other forms of therapy that focus on behavioral change (like Cognitive Behavior Therapy), existential psychotherapy tackles these philosophical life concerns as a way of helping individuals confront the core of their insecurities, anxieties, and other behavioral issues. Existential psychotherapists, such as Yalom, aim to help their patients understand how their problems are, consciously or unconsciously, motivated by these existential issues. Existential psychotherapists believe that their patients will be helped by confronting and acknowledging these anxieties rather than suppressing them.

Yalom uses the term “here-and-now” to refer to the present moment shared between the therapist and patient during therapy. He argues that therapists must focus on the immediate events and experiences during therapy as these can yield valuable opportunities for discussion. This approach allows therapists to examine and discuss emotions, thoughts, and behaviors as they unfold rather than relying on the patient’s history or on a patient’s accounts of their interactions with other people. The “here-and-now” approach reduces patient subjectivity and inaccuracies, and it also allows therapists to develop their insights based on their own observations.

In the context of psychological development, the term “self-actualization” refers to people’s ability to live authentic lives and fulfill their potential. Abraham Maslow, a humanist psychologist, developed a framework known as the “hierarchy of needs,” which described how people can achieve self-actualization or their full potential only after their other, basic needs—such as their need for food, safety, and belonging—are met. Self-actualization includes personal growth, self-awareness, and the pursuit of meaningful goals.

In The Gift of Therapy, Yalom sees self-actualization as the aim of therapy. He agrees with the German psychoanalyst Karen Horney that identifying and removing obstacles to growth is the best way for therapists to help their patients self-actualize. He believes that everyone has their own “in-built propensity” toward growth that will commence once obstacles have been removed (17). These obstacles include existential anxieties and a lack of self-awareness.