I found the second part of this book, which deals with existential psychotherapy, the most interesting. It is based on Existential Psychotherapy(2), which Yalom tells us was 4 years in the writing and twice as long in the reading. Somehow I got through a first-rate psychiatric residency program and an academic career without knowing what the term "existential" really means. Perhaps this was because, as Yalom tells us, the term "defies succinct definition" and because "existential" has been used by colleagues as a false sophistication. Instead of plain ordinary anxiety and depression, for example, the pseudosophisticate refers to existential anxiety and existential depression, in many instances without knowing its meaning themselves, thereby enhancing resistance to the concept. Yalom comes as close as anybody can to explaining the term and its usefulness in the practice of psychotherapy, using meaningful clinical examples. He tells us that it is a dynamic approach to therapy that focuses on concerns rooted in the individual’s existence. It deals with four ultimate concerns—death, freedom, isolation, and meaninglessness. Yalom implies that the perceived amorphous nature of existentialism is based on the fact that its approach cuts across categories and clusters in a novel manner. He says that "the clinician will find the language psychologically alien" and that "the existential position cuts below the subject-object cleavage and regards the person not as a subject who can, under the proper circumstances, perceive external reality but as a consciousness who participates in the construction of reality." He explores life-death interdependence, death anxiety and the lack of attention paid to it in psychotherapy theory and practice, and fundamental defenses against death. He says that death awareness opens only one facet of existential therapy. It helps us understand anxiety. To arrive at a fully balanced therapeutic approach, however, one must examine the other concerns—freedom, isolation, and meaninglessness.