What distinguishes good therapy from not-so-good therapy? What to do to make each session as alive as possible? Guest writer Victor Yalom explains. Madison Keys, tennis and therapy.

Welcome to the January edition and may 2025 be a year of success and well-being.

In SAVVY, guest writer Victor Yalom, Ph.D. previews his new Masterclass video and answers, "What distinguishes good therapy from not-so-good therapy? What to do to make each session as alive as possible?"

In SKILLS, he offers SKILLS Tips on "How to help clients engage in an internal discover process so they discover new things about themselves? What exactly can therapists do to speed up this process?

In SOUL, Madison Keys, a USA tennis player won her first Grand Slam tournament January 25, 2025 after over a decade of trying. She credits therapy for helping her look at herself and stop self-defeating “internal talk” that allowed this particular first big win.

When I was in my specialty psychiatry training in the 1970s and starting my psychiatric career in the 1980s, Irvin Yalom, M.D., was the psychiatrist leader who taught us so much about group psychotherapy. His son, Victor Yalom, Ph.D. has among many things, spent the past three decades making training videos of master therapists through the company he inadvertently created, Psychotherapy.net.

Victor writes that he “finally stepped up to the plate to create a Masterclass in Advanced Psychotherapy Skills where my colleague Orah Krug and myself demonstrate and teach some of the most powerful ideas we’ve learned over the years.” In the first volume of this series, they address: How to help clients engage in an internal discover process so they discover new things about themselves? What exactly can therapists do to speed up this process?

I invited Victor to share a little of this first volume for this month’s Tips and Topics. All the content is Victor’s, but I have edited it to fit Tips and Topics’ format and style. (See below for a special discount to readers of Tips and Topics.)

Tip 1

What distinguishes good therapy from not-so-good therapy?

In my 3rd year of college I entered my first extended course of therapy, and I lucked out to be assigned through the school counseling center with a warm, compassionate, and down-to-earth therapist named Britt.

It was comforting and helpful to meet with Britt, but what really stands out to this day was the frequent occurrence of coming out of a session with a slightly new take on how I experienced myself, or thought about my problems. These were issues I had mulled over incessantly since my early teens, that time moving from childhood to adolescence, where my emotional state became much more fraught. This frequent experience in therapy seemed quite incredible to me: how could I uncover in a single session things that I had tried and failed to tackle on my own for a good decade or so?

This always stayed with me, and remains in my mind today what distinguishes good therapy from not-so-good therapy:

• Is something new actually happening?
• Is the client coming out of each session with some ever-so-slightly new experience?
• Is there a sense of aliveness in the session? Or are they just telling the same old story, or intellectually analyzing their problems without a sense of discovery or freshness?

As my mentor James Bugental put it, borrowing from an old Memorex commercial (an audiotape manufacturer—I know this dates both him and myself), “Is it live, or is it on tape?” Or as Frieda Fromm-Reichman famously said, “A patient needs an experience, not an explanation.”

Tip 2

What can we do as therapists to make each session as alive as possible?

• The goal is to maximize the likelihood that clients will come out with even a small nugget of something new.
• Note I say “small nugget” because therapy in real life, as opposed to Hollywood renditions, rarely have single “aha” moments that change the course of our clients’ lives.
• But a bunch of small nuggets can add up over time!

Tip 3

Help clients engage in an internal discover process so they discover new things about themselves.

What exactly can therapists do to speed up this process?

• One of the most important things we do as therapists is helping clients explore their inner subjective world to discover new things about themselves, versus simply reporting about themselves.
• This includes--but is not limited to--a focus on their emotions.
• Asking “How do you feel?” is a start, but for most clients it’s just not enough. You need to follow up repeatedly, giving more specific direction.

SKILLS

Victor then goes on to give some SKILLS Tips on How to help clients engage in an internal discover process so they discover new things about themselves? What exactly can therapists do to speed up this process?

Tip 1

Give clients more specific direction in their internal discover process.

Asking “How do you feel?” is a start, but here are some tips to help you help your clients go deeper:

You can start with general questions or prompts such as: 

• Take a minute just to check inside and see what you notice. 
• As you think about X (whatever client is talking about), do you notice any feelings or sensations? 
• Go slow, just turn your attention inward and see if you notice any feelings, thoughts, images, memories...or anything else.
• Sometimes it helps to close your eyes, if you’re comfortable with that.
• Just take a deep breath or two and focus on how that feels.
• What comes to mind as you imagine that? (This may tend to elicit more cognitive responses--that’s ok, we are helping them explore their full range of inner experiences including thoughts).

Then you can support them in continuing their inner “search process” with nudges such as: 

• Keep going, see what comes next into your awareness. 
• Stay with that feeling of sadness.
• Don’t rush your way through it; give yourself time to sit with it. 
• Just stay with that sensation and see what you notice next. 
• Just take a minute to check back inside right now and see what else is stirring.
• You've just told me some important things. Now just take a moment to notice what’s happening inside you right now.  Again, there could be feelings, images, memories, bodily sensations, thoughts.  
• You don’t need to speak in full sentences.  Even a word or two can help get the ball rolling. (This can be helpful when clients have a hard time getting started).
• And? (This is simple, and can be powerful, conveying to your clients that there is aways more.)

Tip 2

Pay attention to how clients present themselves versus what they are talking about.

Process comments bring the attention to how clients present themselves versus what they are talking about, and they can be very helpful in assisting clients to tune in to their inner experiences.

This can include bringing attention to:

• facial expressions
• body language
• tone of voice
• implied relationship with therapist, and more.

Content is the topic being discussed (e.g. relationship or work issues), whereas process is the way in which the client communicates.

Note that we don’t normally make process comments in everyday life, so it may feel awkward or even intrusive at first.

• Try to give yourself permission to try these out, and like anything else, you’ll get better and more at ease over time.
• Practicing with a friend or colleague is a great way to start developing your skills in making process comments.

Process comments can focus on facial expressions:

• I notice you’re smiling as you say that.
• It looks like there’s some sadness (or tenderness) in your eyes.
• You’re holding your head very high, with a little smile on your face.
• You seemed to grimace just there.
• I can see a softness in your face.
• Your face changed a little as you said that.

Or on body language:

• You sort of shrunk down in your seat.
• You’re tightening your fists.
• A big sigh there!
• I notice you keep looking away.
• Your knees are bouncing.
• You’re holding yourself tightly.
• Your breath seems very constricted.

Or on voice:

• Your voice just got very soft.
• You sound angry.
• It sounds like you’re asking a question.
• You keep pausing as you speak.
• You’re telling me about something really awful, but your voice is flat.

Or on implied relationship with the therapist:

• You keep looking to me as if you want my approval.
• You really want me to understand what you’ve gone through.
• You keep interrupting me.
• You’d really like me to tell you what to do.

Tip 3

Be creative and take risks! Use your intuition and creativity to find ways to help clients go deeper.

Here are some ways of helping your clients understand the need to spend some more time exploring their inner world, so that you can assist them. It helps to be open-hearted and spontaneous as well. How can you ask your clients to be present and take risks if you aren’t willing to do the same?

• Try using role-plays to have them talk with different parts of themselves.
• Analogies can be helpful in explaining why they need to focus inward for more than 10 seconds before giving up or looking to you for an answer.
• If your client is a computer programmer, you can say, “If someone asks you to debug a program, but only lets you look at the code for 10 seconds, I imagine you wouldn’t be able to do much.”
• Likewise to a car mechanic, you can say, “If someone brings you their car, but shuts the hood 10 seconds after you’ve opened it, how can you possibly do your job?”

More about and from Victor Yalom

I hope you find these ideas helpful! If so, and you want to learn more, please do check out my Masterclass in Advanced Psychotherapy Skills. where you’ll see these ideas demonstrated with actual therapy sessions. This link will give Tips and Topics readers a $30 discount.

Victor Yalom, PhD

SFpsychologist.com (info on psychotherapy, metal sculptures and more)

Founder, Psychotherapy.net (over 400 training videos, plus blogs and articles)

Want something lighter? Check out my Psychotherapy Cartoons

With thanks to James Bugental, who graciously taught me many of these ideas and skills. You can see videos and related writings on Psychotherapy.net. Plus here are two books of his I’d recommend:

Psychotherapy Isn't What You Think: Bringing the Psychotherapeutic Engagement into the Living Moment.  

The Art of the Psychotherapist: How to Develop the Skills that Take Psychotherapy Beyond Science. This is his classic text, a more comprehensive (but denser) presentation of his ideas. Don’t try to read it quickly!

SOUL

Madison Keys is a 29-year-old American tennis player. She showed a lot of promise in tennis and was told since she was about 11 or 12 that she would one day be a great tennis player and a champion. Madison first turned professional at the age of 14 in 2009.

For over a decade, she worked hard to live up to the expectation of winning at least one Grand Slam Tournament. She got so close several times but it never happened; until January 25, 2025 at the Australian Open Tennis Tournament.

Even if you aren’t a tennis fan, her post-win Press Conference is full of helpful tips about mental health, the value of psychotherapy and how Madison overcame her self-defeating “internal talk.” If you don’t have time for all 17 minutes, check out at least the first three minutes.

Here is my paraphrase of the insights and shifts in thinking and behavior that Madison highlighted:

• The talk of her becoming a champion one day was initially encouraging. But as the years wore on with no ultimate success for all her hard work, that expectation became a stress and burden that actually prevented reaching her goal.
• When she was able to detach from that expectation and accept that she was still a successful good person even if she never wins a Grand Slam, this freed her up to actually win.
• The stress of living up to everyone else’s expectations interfered with her ability to be “in the moment” and connect her body and mind and just play tennis joyfully and effectively.
• She learned to not stress about what you can’t control.
• While she had done sports therapy, she had to get “low” enough to realize she needed to look in the mirror at herself and do therapy to “feel better,“ not just “perform better.”
• Madison learned that two things can happen at the same time: Feeling nervous but also performing and executing your skills in the moment.

You would enjoy hearing Madison explain all this herself. Good therapy really works.

UNTIL NEXT TIME

Thank you for joining us this month. See you in February.

David