Content Warning: The source text and this guide mention mental health issues, including suicidal ideation and substance use disorders.

Irvin D. Yalom reveals that in his old age, he has become more aware of what he would like his legacy to be and that he wrote this book to pass down his knowledge to a new generation of therapists. He laments that therapists of all kinds are under increasing pressure to provide brief, economical sessions, limiting the amount of work they can accomplish with their patients. Nevertheless, he hopes they can adapt his guidance and make it relevant to their therapeutic practices.

Yalom identifies the two main types of therapy he has offered: group therapy and existential therapy. While his group therapy focuses on relationships, his existential therapy helps individuals understand how they are affected by the inherent problems of the human condition, whether consciously or unconsciously. These four major existential concerns are isolation, death, freedom, and finding meaning in life.

He says therapy should be relationship-driven, rather than theory-driven, and therapists shouldn’t force conversations about these existential matters. Instead, they should become more aware of them and bring them up when relevant. Yalom describes the ideal therapist-patient relationship as being egalitarian, and the therapist must be as open and engaged as possible.