The Gift of Yalom (I)
My clinical supervisor very off-handedly mentioned "Yalom" in class one day last year and everyone seemed to know what/who that was. I had no clue. I half-figured it was one of those myriad acronyms for some gimmicky "technique" modern psychology loves, if only for purposes of trade-marking and marketing and thus money-making.
I have been happily rectifying my ignorance since then by reading several of Irvin Yalom's books, starting with his landmark work, which I used for a project in a group therapy class: The Theory and Practice of Group Psychotherapy, which is fascinating and so much better written than any textbook I've read so far in the area. I expect this will be the kind of book I shall return to often in the coming years.
Next up I ordered The Gift of Therapy. It, too, will reward re-reading over the years. It is, in some respects, almost a collection of aphorisms, though most chapters are a little longer than the typical aphorism, and in that regard the subtitle is apt: An Open Letter to a New Generation of Therapists and Their Patients.
The book's 85 chapters are thus seen as something longer than an aphorism but shorter than a really long letter: they are in fact short letters, some of them less than a page, and the longest of them just over six pages. Yalom writes with a light and often charming touch, so these are an easy read.
That is not to say they are flippant in any way. Some of these letters strike me as such obvious counsel that they do not need saying (e.g., ch. 64, "Never be Sexual with Patients"), but clearly they do need saying as sexual abuse by clinicians is by no means unknown even today. One of the startling and disgusting experiences of my undergraduate days was finding out that a professor, whom I really liked, who had taught a class on personality theories, which was one of my favourite classes, was later tried by the College of Psychologists of Ontario and had his license stripped after on-going sexual relationships with several patients, to whom he was later ordered by the courts to pay extensive damages.
Part of the motivation for writing this book, Yalom says in the introduction, is that "our field is in such crisis," in large part because (at least in America under its horrid and rapacious health insurance industry) of the pressure that all therapy be "brief, superficial, and insubstantial." Such pressures (ongoing in 2020, as this letter from Division 39 of the APA shows) mean that mental healthcare today is running the risk of being "deformed by economic pressures and impoverished by radically abbreviated training programs" (xv). It is for those who also want to resist these pressures, and learn how to offer a form of therapy that is deeper, longer, and open to exploring existential issues (about which Yalom has written elsewhere several times) that Yalom has written The Gift of Therapy.
Part of what immediately endeared Yalom to me is that he makes it plain that his enemies are also mine: he is explicitly "against sectarianism" and in favour of "therapeutic pluralism in which effective interventions are drawn from several different therapy approaches" (xv). Some of his friends are also mine, and so I happily note his positive references to such existentialists as Paul Tillich and others, including Nietzsche.
Even more delightful was to encounter a name I have not seen, nor read, since high-school: Rainer Maria Rilke, whose Letters to a Young Poet I read at a crucial time and have stayed with me all these years later as an example of what Christopher Bollas (in his first and, to my mind, still his best book, The Shadow of the Object) would recognize as a largely unconscious "transformational object." Rilke shows up again at the end of ch.3, where Yalom quotes his wise counsel: "Have patience with everything unresolved and try to love the questions themselves" to which Yalom himself adds "try to love the questioners as well."
Yalom's The Gift of Therapy exhibits an openness to the questions and insights from giants of the near-past without idolizing them: names like Karen Horney (who graces the first page of ch.1), Winnicott, Ferenczi, Fromm, Erikson, and of course Freud are cited here with critical appreciation. Given its nature ("this volume is in no way meant to be a systematic manual") it does not of course lend itself to a standard review, so instead I shall simply mosey around the book highlighting things that stand out. (This will be an on-going series of posts.)
Chapter 3 opens with an observation Yalom draws from the French novelist André Malraux about one of his characters: "there is no such thing as a grown-up person." That immediately put me in mind of Adam Phillips, the other person I have spent the last four years reading very closely, and who will feature on this blog regularly. He says in one of his many books that "we remain children for a very long time." In this light I am also minded to think of an observation I heard (perhaps in the Ken Burns' PBS series The Roosevelts?) someone make about Teddy Roosevelt to the effect that "you have to understand the president is, at heart, just a six-year-old boy." It's a pity too many of us would regard that as a fault or failing!
In ch.4 and elsewhere, Yalom offers a simple question I have started using with people and that is to ask them some version of this: As you are driving home today/leaving from here, what are you telling yourself about this conversation? What are you taking away? This, as he says later, is a useful window to help him see that he and the patient do not always "have the same experience during the hour."
Ch. 5 offers one pithy bit of advice: "Don't be stingy" in offering positive feedback to patients. Too many today, Yalom fears, may in fact be stingy, and I would wonder if some of this does not go back to Freud's rule of "abstinence" in that the therapist was to leave the patient as undisturbed as possible by refusing to offer advice or feedback. But as Paul Roazen has demonstrated, Freud talking to fellow therapists comes across as strict and forbidding, but Freud's own clinical practice was often much more relaxed about the rules he laid down (and sometimes, as the correspondence with Ferenczi makes clear, this was not always to the good!).
Ch. 7 deftly deals with statements from patients such as "you must be bored of me by now" by turning them around: "Is there a question in there for me? "
Ch.8 (without quoting her) sounds very similar to advice the great Nina Coltart (about whom I have a post coming) offers in allowing patients to matter to therapists, and not to be afraid to acknowledge that. This must be nicely judged, however, so that things do not get too awry and patients matter too much or the counter-transference gets out of hand. But to be totally unmoved, sitting in lofty and aloof silence, will help nobody.
Several times throughout the book Yalom says that therapists should just acknowledge a cock-up and deal with it openly: "I'm sorry I made a mistake" will help things get back on track more swiftly and successfully than pretending nothing happened.
Several times he also uses words like "spontaneous," "dynamic," and "ever-evolving" to describe how therapy should proceed, and in this way pushes back against the increasing tendency towards manualized, standardized "therapy."
Yalom's Ch.12, with which I shall end for now, contains what I regard as the central and most important insight and counsel in the entire book, captured by its title: "Engage in personal therapy." I am frankly amazed that plenty of people can enter the therapeutic vocation (as Coltart rightly calls it) without having undergone, and regularly undergoing, their own therapy. As I have argued elsewhere recently, a personal psychoanalysis has been the most transformational experience of my life and I remain profoundly grateful.
I have been happily rectifying my ignorance since then by reading several of Irvin Yalom's books, starting with his landmark work, which I used for a project in a group therapy class: The Theory and Practice of Group Psychotherapy, which is fascinating and so much better written than any textbook I've read so far in the area. I expect this will be the kind of book I shall return to often in the coming years.
Next up I ordered The Gift of Therapy. It, too, will reward re-reading over the years. It is, in some respects, almost a collection of aphorisms, though most chapters are a little longer than the typical aphorism, and in that regard the subtitle is apt: An Open Letter to a New Generation of Therapists and Their Patients.
The book's 85 chapters are thus seen as something longer than an aphorism but shorter than a really long letter: they are in fact short letters, some of them less than a page, and the longest of them just over six pages. Yalom writes with a light and often charming touch, so these are an easy read.
That is not to say they are flippant in any way. Some of these letters strike me as such obvious counsel that they do not need saying (e.g., ch. 64, "Never be Sexual with Patients"), but clearly they do need saying as sexual abuse by clinicians is by no means unknown even today. One of the startling and disgusting experiences of my undergraduate days was finding out that a professor, whom I really liked, who had taught a class on personality theories, which was one of my favourite classes, was later tried by the College of Psychologists of Ontario and had his license stripped after on-going sexual relationships with several patients, to whom he was later ordered by the courts to pay extensive damages.
Part of the motivation for writing this book, Yalom says in the introduction, is that "our field is in such crisis," in large part because (at least in America under its horrid and rapacious health insurance industry) of the pressure that all therapy be "brief, superficial, and insubstantial." Such pressures (ongoing in 2020, as this letter from Division 39 of the APA shows) mean that mental healthcare today is running the risk of being "deformed by economic pressures and impoverished by radically abbreviated training programs" (xv). It is for those who also want to resist these pressures, and learn how to offer a form of therapy that is deeper, longer, and open to exploring existential issues (about which Yalom has written elsewhere several times) that Yalom has written The Gift of Therapy.
Part of what immediately endeared Yalom to me is that he makes it plain that his enemies are also mine: he is explicitly "against sectarianism" and in favour of "therapeutic pluralism in which effective interventions are drawn from several different therapy approaches" (xv). Some of his friends are also mine, and so I happily note his positive references to such existentialists as Paul Tillich and others, including Nietzsche.
Even more delightful was to encounter a name I have not seen, nor read, since high-school: Rainer Maria Rilke, whose Letters to a Young Poet I read at a crucial time and have stayed with me all these years later as an example of what Christopher Bollas (in his first and, to my mind, still his best book, The Shadow of the Object) would recognize as a largely unconscious "transformational object." Rilke shows up again at the end of ch.3, where Yalom quotes his wise counsel: "Have patience with everything unresolved and try to love the questions themselves" to which Yalom himself adds "try to love the questioners as well."
Yalom's The Gift of Therapy exhibits an openness to the questions and insights from giants of the near-past without idolizing them: names like Karen Horney (who graces the first page of ch.1), Winnicott, Ferenczi, Fromm, Erikson, and of course Freud are cited here with critical appreciation. Given its nature ("this volume is in no way meant to be a systematic manual") it does not of course lend itself to a standard review, so instead I shall simply mosey around the book highlighting things that stand out. (This will be an on-going series of posts.)
Chapter 3 opens with an observation Yalom draws from the French novelist André Malraux about one of his characters: "there is no such thing as a grown-up person." That immediately put me in mind of Adam Phillips, the other person I have spent the last four years reading very closely, and who will feature on this blog regularly. He says in one of his many books that "we remain children for a very long time." In this light I am also minded to think of an observation I heard (perhaps in the Ken Burns' PBS series The Roosevelts?) someone make about Teddy Roosevelt to the effect that "you have to understand the president is, at heart, just a six-year-old boy." It's a pity too many of us would regard that as a fault or failing!
In ch.4 and elsewhere, Yalom offers a simple question I have started using with people and that is to ask them some version of this: As you are driving home today/leaving from here, what are you telling yourself about this conversation? What are you taking away? This, as he says later, is a useful window to help him see that he and the patient do not always "have the same experience during the hour."
Ch. 5 offers one pithy bit of advice: "Don't be stingy" in offering positive feedback to patients. Too many today, Yalom fears, may in fact be stingy, and I would wonder if some of this does not go back to Freud's rule of "abstinence" in that the therapist was to leave the patient as undisturbed as possible by refusing to offer advice or feedback. But as Paul Roazen has demonstrated, Freud talking to fellow therapists comes across as strict and forbidding, but Freud's own clinical practice was often much more relaxed about the rules he laid down (and sometimes, as the correspondence with Ferenczi makes clear, this was not always to the good!).
Ch. 7 deftly deals with statements from patients such as "you must be bored of me by now" by turning them around: "Is there a question in there for me? "
Ch.8 (without quoting her) sounds very similar to advice the great Nina Coltart (about whom I have a post coming) offers in allowing patients to matter to therapists, and not to be afraid to acknowledge that. This must be nicely judged, however, so that things do not get too awry and patients matter too much or the counter-transference gets out of hand. But to be totally unmoved, sitting in lofty and aloof silence, will help nobody.
Several times throughout the book Yalom says that therapists should just acknowledge a cock-up and deal with it openly: "I'm sorry I made a mistake" will help things get back on track more swiftly and successfully than pretending nothing happened.
Several times he also uses words like "spontaneous," "dynamic," and "ever-evolving" to describe how therapy should proceed, and in this way pushes back against the increasing tendency towards manualized, standardized "therapy."
Yalom's Ch.12, with which I shall end for now, contains what I regard as the central and most important insight and counsel in the entire book, captured by its title: "Engage in personal therapy." I am frankly amazed that plenty of people can enter the therapeutic vocation (as Coltart rightly calls it) without having undergone, and regularly undergoing, their own therapy. As I have argued elsewhere recently, a personal psychoanalysis has been the most transformational experience of my life and I remain profoundly grateful.
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