A Review of Irvin Yalom: On Psychotherapy & Writing
Reviewed by Cheri L. Marmarosh, & Avi Margolies
PsycCRITIQUES September 7, 2015, Vol. 60, No. 36, Article 9 © 2015 American Psychological Association
As I started the Yalom video, I reminisced about his first book I read, Love’s Executioner, and Other Tales of Psychotherapy (Yalom, 1989), 20 years ago. At the time, I was in graduate school, and I knew very little about how to help my patients. While the faculty supervisors appeared confident and had all the right answers, I felt like a complete charlatan. As I read Yalom’s books, I began to see that there were no “right” answers and that being present in the therapeutic relationship was really the key to change. More importantly, I felt less alone as I challenged myself to take risks and be with my patients. Twenty years later, I enjoy sharing Yalom’s work with my graduate students, and I use his textbook in my group therapy course (Yalom & Leszcz, 2005). Because my students have valued his writing over the years, I decided to invite a gifted doctoral student, Avi Margolies, to coauthor this review of Yalom’s video with me.
Overview of the Video
Marmarosh: Unlike many videos I have reviewed that focus on demonstrating a theory and technique, this video is an interview with Yalom about his life’s work by one of his close colleagues, Orah Krug. Krug asks Yalom questions that address his development as a writer and master clinician. She does a wonderful job interviewing Yalom and highlighting different aspects of his diverse career. She is able to create an intimate space where Yalom opens up about his family background and how he came to be a psychiatrist and writer. The interview transitions smoothly into different sections that address his books, teaching methods, and clinical work. The interview reveals Yalom’s humor, passion for philosophy, empathy for patients, and, as always, leaves us hungry for more. Weeks after viewing the video, I noticed how his interview had a profound influence on me. I used one of his stories in a
group therapy class, I thought of his clinical vignette when working with a patient in my practice, and I found myself asking myself existential questions that were difficult to answer. He impacted me in the video just as he has over the years with his writing.
Margolies: As Yalom shares his passion for doing and teaching this work, I quickly come to understand why his capable host, Orah Krug, is so thrilled to be sitting with this man. He is endlessly curious, palpably warm, open, and authentic, and just plain funny. Yalom’s vision of psychotherapy and writing as “almost inseparable” is borne out as he describes looking for the “next chapter” each week with his patients. While this viewpoint lends itself to literary plotlines, it also no doubt helps his patients work toward the important goal of forming their own, more cohesive narratives. As Yalom speaks, it is easy to understand how the transition from nonfiction to fiction felt seamless to him. Regardless of the genre, his goal of teaching has remained, and his love for both exploring and developing people’s stories is contagious.
Yalom’s Teaching: His Work Influences Many Generations
Marmarosh: In one of the early sections, Krug asked Yalom about his teaching style, and Yalom describes how he is always focused on teaching, even when he is writing novels. As a professor and writer, it was intriguing to hear Yalom’s thoughts about When Nietzsche Wept (Yalom, 1993), The Schopenhauer Cure (Yalom, 2005), Lying on the Couch (Yalom, 1997), and The Spinoza Problem (Yalom, 2012). His empathy for the great philosophers is impressive, and his desire to connect to them, even cure many of them, is touching. He describes the despair of Nietzsche, Schopenhauer’s narcissism, Ferenzi’s risk taking, and the courage and isolation of Spinoza. Listening to him share his feelings, thoughts, and intentions behind the stories makes you want to read them all over again.
Margolies: As a graduate student in the field, it is easy to see how clinicians and patients alike can benefit from reading Yalom’s novels. Several years ago, before I knew I wanted to be a therapist, I read Lying on the Couch, and it had a profound impact on my life. When I read it, it illuminated aspects of the therapeutic relationship I had not conceived of at the time, and I was motivated to venture into new territory with my therapist. As Yalom discusses each of his novels, his energy, playfulness, and adventurous spirit come alive as he describes his attempts to treat various historical figures, seemingly unsure himself of how the fictional treatment would go at the outset.
Power of the Therapy Relationship: The Most Important Contribution
Marmarosh: This is by far the most meaningful portion of the interview with Yalom. In this section of the interview, he describes his work with patients and his interpersonal theory of change and gives wonderful clinical examples. I am especially struck by his retelling of a clinical case where a woman dying of cancer is invited to take a risk in treatment. He describes his immediate paralysis when she challenges him, and then he shares a mantra that immediately comes to his mind, “Tell the truth.” It is so simple, yet not easy to do.
Listening to Yalom describe the importance of the here-and-now and his interpersonal approach is still as useful to me at this stage of my career as it was when I first started practicing. After the interview is over, I find myself thinking of my patients. Do I ask them to take risks in each session? Do I take risks with them? Am I as bold in my own life as I want to be? I am thrilled that Yalom concludes this section encouraging therapists to get into psychotherapy in order to know themselves in order to help their patients. His own vulnerability about his personal struggles facilitates a sense of safety for others to face their own challenges and to appreciate their humanity.
Margolies: I relished the opportunity to hear Yalom describe his moment-to-moment work with patients in his own words. He speaks honestly and openly about how working in the here-and-now with patients can be challenging and “messy,” as all relationships can be. However, his message has never been clearer—the connection and closeness that can result from navigating those rough waters can be profoundly transcendent. It is funny when his anecdote about a patient challenging him in the here-and-now ends with his reducing her fee by half, but while that story could send some therapists running, he somehow makes the technique seem worth even that risk.
I also appreciate that Yalom highlights the importance of therapists receiving therapy, as he notes the ultimate goal when working interpersonally is still to prioritize the patient’s experience; and, one can only do this if they are sufficiently aware of their own. Equally striking was seeing the intersection of Yalom’s interpersonal and existential thoughts, as he emphasizes addressing the ideas of regrets—both past regrets and potential future regrets—and taking risks, with patients in the here-and-now. As he wrote in When Nietzsche Wept, “If one does not live in the right time, then one can never die at the right time” (Yalom, 1993, p. 247), and for Yalom, the right time for living is now.
No Interview Is Perfect: It Has to End
Marmarosh: Similar to a powerful therapy session, I felt closer to Yalom after the interview but I had more unanswered questions at the end than when it began. One thing that I kept wondering was what motivated Yalom to tape this interview and to share his innermost thoughts with us now. In the video, he reveals his own death anxiety and how he came to write his textbook on existential psychotherapy (Yalom, 1980). I recall my favorite quote from his book Staring at the Sun: Overcoming the Terror of Death: “Though the physicality of death destroys us, the idea of death can save us” (Yalom, 2008, p. 33). In many ways, Yalom saves us (again) in this video by reminding us how important authentic relationships are and how precious time is. As he describes in Staring at the Sun, in the video he is “leaving behind something from his life experience; some trait; some piece of wisdom, guidance, virtue, comfort that passes on to others known and unknown” (Yalom, 2008, pp. 83–84). In this interview, Yalom shares himself with us again, and that is the greatest gift of all.
Margolies: As a novice therapist, I feel extremely lucky to be able to hear Yalom speak so openly about his therapeutic work and writing. When he reflected on how he uses difficult countertransference feelings, such as boredom, to better connect with a patient in the here- and-now by sharing with them that he felt farther away from them, I took note. When he shared insight into his writing process, I reflected on my experience reading his novels and felt like I had been given private access to an artist’s world. I think this video will have a
powerful impact on therapists of various experience levels and fans of Yalom in general. His endless pursuit of knowledge, love of learning, and authentic openness are a contagious combination. As he writes in The Spinoza Problem, “Your greatest instrument is you, yourself, and the work of self-understanding is endless. I’m still learning” (Yalom, 2012, p. 170). I am grateful he let me learn with him.
References
Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books. PsycINFO → Yalom, I. D. (1989). Love’s executioner, and other tales of psychotherapy. New York, NY:
HarperCollins. PsycINFO → Yalom, I. D. (1993). When Nietzsche wept. New York, NY: HarperCollins. Yalom, I. D. (1997). Lying on the couch. New York, NY: HarperCollins. Yalom, I. D. (2005). The Schopenhauer cure. New York, NY: HarperCollins. PsycINFO → Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA:
Jossey-Bass. PsycINFO → Yalom, I. D. (2012). The Spinoza problem. New York, NY: Basic Books. Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books. PsycINFO →