Yalom observes that sexual relationships between therapists and patients tend to be extremely damaging for both parties. Both professionally and morally, engaging in sexual relationships with clients is never acceptable. Yalom laments that, like many professions, psychotherapy has been tainted by the inappropriate behavior of some therapists, causing many professionals to follow rigid rules about session time, eliminating all touching, never using people’s first names, or even video-taping every session. While Yalom rejects these rules himself since they feel inhumane, he acknowledges the extreme importance of never developing a sexual relationship with patients and implores all therapists to follow this rule.

It is very common for people to experience distress or existential crises around particular dates, such as the anniversary of losing their spouse. People may even subconsciously react to significant anniversaries without being immediately aware of them. Yalom points to typically distressing life-stages, such as people outliving their parents’ age, milestone birthdays, or wedding or divorce anniversaries. Understanding the persistence of anniversary-related distress can help therapists predict their patients’ needs and feelings.

When patients feel anxious before, during, or after therapy with regard to their sessions, therapists should explore this with them. By understanding which aspects of therapy make the patient anxious, the therapist can address their concerns and ensure that they feel therapy is a safe space.