October/November 2005

REVIEWS

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IRVIN YALOM: Live Case Consultation
Psychotherapy.net, 2005, DVD, 90 min., $125.

THE GIFT OF THERAPY: A Conversation with Irvin Yalom, MD
INTERVIEWED BY RANDALL C. WYATT
Psychotherapy.net, 2002, DVD, 63 min., $95.

Reviewed by Bob Edelstein

Over the last half century, Irv Yalom, M.D., has been one of the pioneers and leaders in developing both the existential psychotherapy movement and the group psychotherapy movement. He has authored numerous books and articles, both nonfi ction and fi ction, including The New York Times bestseller Love’s Executioner and Other Tales of Psychotherapy. In my opinion, he has written the main sourcebooks for both group psychotherapy, The Theory and Practice of Group Psychotherapy, and existential psychotherapy, Existential Psychotherapy.

Irvin Yalom: Live Case Consultation demonstrates him providing group case consultation for three therapists with varying levels of experience. The therapists present the following cases: 1. “Sue,” a fi ftyyear- old divorced woman, struggling to fi nd meaning in her life after a failed marriage and an empty nest; 2. “Paul,” an artist with work inhibition, yearning for more in his life; 3. “Jeffrey,” a group and individual therapy patient, seeking help to control angry outbursts in his marriage.

Each case consultation runs about thirty minutes. In the fi rst case consultation on “Sue,” Yalom continually engages the presenting therapist by asking relevant questions such as: Why are you presenting this particular client today? What issues do you want to look at? These questions both facilitate the therapist discovering their own motivations, thoughts, and feelings more clearly, and model what a therapist might ask their client.

Yalom continually encourages the therapist to focus on what happens between therapist and patient. He also focuses on how to look at what is happening inside the therapist and using that as a lens to look at how to intervene with their patient. For instance, when the therapist working with Sue revealed to Yalom that Sue said, “I wish you hadn’t asked me that,” Yalom responds by asking the therapist, “What gets evoked in you, what do you make of it?” This type of questioning allows the therapist to access his/her inner reactions and express, as appropriate, these reactions to the client.

Throughout the DVD, I enjoy how Yalom references some of his interventions with existential concepts and the works of past existential philosophers. An example of this is that Yalom interprets Sue as having a boundary experience and existential crisis, which throws her into another state of being. Yalom alludes to Heidegger’s infl uence on these concepts, then goes on to more clearly describe them.

I like how pragmatic, direct, and clear Yalom’s interventions can be. For instance, he tells the therapist to let Sue know directly that if she doesn’t deal with the pain now, it will come out in other and worse ways. He expresses this in a gentle and matter-of-fact way.

With Yalom’s strong interpersonal emphasis, he asks Sue’s therapist a key question: “How does Sue feel toward you?” He goes on to state that in nearly every session it is important to check how the patient is feeling about the dialogue and the patient-therapist relationship.

In the second case, with “Paul,” Yalom again moves into asking Paul’s therapist about her relationship to Paul. He asks, “What is the process of therapy like? What is it like to be with him?” And, when the therapist says, “I want to have an answer to allay his anxieties,” Yalom interprets that as the therapist’s countertransference. He feels action should come from interpretation, so he suggests that the therapist express to Paul what Paul evokes in her. In addition, Yalom asks the therapist if Paul has shared any dreams, for Yalom, like Freud, sees dreams as an opening to make one’s unconscious conscious.

In feedback to Paul’s therapist, he emphasizes the existential perspective. He interprets Paul as only defi ning his existence through his performing and doing, so the idea of just being in existence isn’t there for Paul. To me, this is an example of Yalom’s pragmatic existentialism— too often existentialism is associated with ethereal and/or convoluted ideas. Another example of his pragmatic existentialism is his telling Paul’s therapist that Paul is crippled with regrets for things that he hasn’t done and for his unfulfi lled potential—and that it would be good to shift Paul’s focus on past regrets to his future, so that two years from now, more regrets are not accumulated.

Again, Yalom addresses the relationship between the therapist and her patient by focusing on the experience between them, rather than what Paul will produce or how he will perform, or how Paul’s need to produce or perform enters into the therapeutic relationship.

In the final case consultation, with “Jeffrey,” the therapist sees him in both individual and group psychotherapy. Yalom focuses primarily on the group psychotherapy aspect. He is interested in how Jeffrey operates in the group, and how Jeffrey’s existential issues are manifested in it. Yalom feels the group is a social microcosm of society, and the patient will show their pathology at some point in the group. When this occurs, and the patient’s pathology is manifest, then the group can stop-action it, and the patient can choose to use the feedback to change. In Jeffrey’s case, the group can be used to help him deal with his anger more constructively and more powerfully. Yalom feels that a great value of the group is to have so many different worlds reacting in each of their unique ways to one stimulus, in this case, anger. I resonate with this, as it demonstrates the phenomenological roots of existential psychotherapy.

In Yalom’s concluding remarks, he emphasizes the three major themes he covered in the case consultations. The fi rst theme is the importance of working in the here and now, which includes: the importance of exploring the relationship between the therapist and their patient and the importance of the therapist using one’s self in the therapy. The second theme is the importance of identifying and exploring existential issues, such as grief, loss, responsibility, death-anxiety, and our search for meaning in life. The third theme is the importance and value of group psychotherapy as a means through which a patient can reveal and heal their pathology.

While I appreciated the incredible scope of Yalom’s knowledge, I would like him at times to be less certain of his conclusions and to allow more space for the unknown. I also would like him to elicit more comments from the participating therapists regarding their observations of the other cases presented. I felt this limited facilitation of comments was a bit ironic given how much and how powerfully Yalom uses group process and dynamics.

Finally, while I value his emphasis on the interpersonal aspects of the here and now, I feel it is at times at the expense of the intrapsychic aspects of the here and now. I admit to years of training with Jim Bugental, who emphasizes the intrapsychic aspects.

In The Gift of Therapy, the interview of Dr. Yalom by Randall Wyatt, Ph.D., is excellent, and there is obvious rapport between the two men. Yalom discusses passionate and meaningful themes of his life’s work as a psychotherapist and writer. He addresses such core concepts as existential psychotherapy, therapists’ fear of self-disclosure, working in the here-and-now, group psychotherapy, and challenges for the next generation of therapists.

Yalom begins the interview process by stating his reason for writing The Gift of Therapy. In his youth, Letters to a Young Poet by Rilke had a profound infl uence on him. I greatly appreciate Yalom’s self-disclosing manner throughout the whole interview, including his acknowledgment that he has accomplished a great deal in his life.

Yalom wisely, beautifully, and clearly describes existential psychotherapy and what it means to him. He similarly describes his interpersonal focus in psychotherapy.

I particularly liked his nuggets of wisdom: The word patient means one who suffers, so because we all suffer in one form or another, we are all fellow patients; The perfectly analyzed therapist is a myth; Let the patient matter to you, and let the patient know that; Happiness and meaning flow from engagements and encounters in relationships; It is the relationship that heals; Throw-ins are an important component of the therapeutic process. This triggered a warm memory for me. I once had a client who was anxious about dating a woman. I said: “It would just be a date. You’re not proposing marriage.” This throw-in comment relaxed him enough to ask her out. Sure enough, he ended up marrying her.

I especially appreciated Yalom’s nonjudgmental attitude, his gentleness, and his deep caring for the human being. It touched me when he shared that self-disclosure is important to him, as he doesn’t want to infantilize the patient. Thus, he will often disclose how he is feeling in the therapy process. He believes that being egalitarian in this mutual sharing process is a good thing. His comprehensiveness, wisdom, wit, and intuitiveness also come across in this interview.

I value Yalom’s openness in the interview, such as his disclosure about his experimentation with different therapeutic ideas and processes. One example of this is he shared that he sent out weekly reports to his groups which included bringing into consideration his own mistakes in the group that week.

He says “I am still eager to see patients, to see what is going on, what will evolve, and what will be the next chapter in their story.” I appreciated hearing this, as it resonates with a strong belief I have, that enthusiasm is a key quality to being an effective therapist.

His approach to his life and work describes to me the actualized human being.

BOB EDELSTEIN, LMFT, MFT, is an existential-humanistic psychotherapist based in Portland, Oregon. He also provides consultation, supervision, and training for other professionals, as well as workshops on Authentic Engagement: A Radical Way of Being in the World. Bob can be reached at BobEdeLMFT@aol.com, (503) 288- 3967, www.BobEdelstein.com.

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SECRETS, LIES, BETRAYALS: The Body/Mind Connection
BY MAGGIE SCARF
Ballantine, 2005, 384 pp., $14.95,
e-book $9.95, ISBN 0345481178.

Reviewed by Stanley Krippner

The basic theme of this provocative book is that the body knows more about our experiences than words are capable of expressing. Secrets, lies, betrayals, and the like have long-lasting effects not only upon our mental health but also upon our physical health. As a result, according to Maggie Scarf, a therapist and best-selling author, our bodies speak to us by means of such phenomena as sleep disorders, hyperarousal, irritability, emotional outbursts, and depression. Secrets lie dormant because of shame, fear, loyalty, and even love. These furtive stories may be kept from the mind, but they are not kept from the body.

Our emotional lives are deeply rooted in our bodily experiences of emotionally charged events that are currently happening or that have happened in the past. Scarf calls them “somatic memories,” and they have been the focus of such therapists as Lowen, Rolf, Feldenkrais, Rubenfeld, Gendlin, Mindell, and Hannah—all of them familiar to humanistic psychologists. It is the contention of these therapists that all the discussion, understanding, and insight given by family, friends, and psychoanalysts often fail to dispel the painful images, reactions, and somatic aftereffects of events that were once experienced as out of control or overwhelming. Because many of life’s most distressing experiences cannot be “talked away,” the remedy is what Scarf calls “top-down processing,” from the prefrontal cortex to the rest of the body. She maintains that the body “stores” memories of intensively stressful experiences, particularly in the limbic system; bodily states of extreme stress trigger a panoply of psychophysiological responses. In a situation of threat, activating biochemicals such as the hormone cortisol (which is manufactured in the tiny adrenal glands above the kidneys), are immediately pressed into a state of high activity, as are “neural messengers” that serve to augment vigilance and to sharpen an individual’s attention to the danger at hand. Severely emotional experiences are “stored” in the amygdala, often for years.

One of the many virtues of Scarf’s book is her description of the psychophysiology involved in this “storage” process. The hippocampus and amygdala are part of the limbic system, which maintains one’s internal state, including fi ght or fl ight, and the ability to react before one is fully aware of the danger (as demonstrated by an elevated heart rate and an increase in blood pressure). Traumatized people have smaller hippocampuses (that sort and organize sensory experiences) than non-traumatized people.

Two approaches recommended by Scarf to “unlock” the body’s secrets are eye movement deprocessing and reprocessing (EMDR) and Albert Pesso’s psychomotor approach, both of which have accumulated signifi cant supportive research data over the decades. Practitioners of these therapies attempt to “detoxify” bodily memories from the traumatic stresses that (in the words of the American Psychiatric Association’s Diagnostic and Statistical Manual) have led to “the disorganization of a core sense of self and safety in the world,” leaving “an indelible mark on one’s worldview.”

This book, with its useful appendixes, is extremely timely in that one in three Iraqi veterans suffers from post-traumatic stress disorder (PTSD) or some other emotional diffi culty, not to mention the soldier suicides in Iraq. Scarf also notes that the fi refi ghters of 9/ll are requesting marital or family counseling at a rate more than three times higher than what was requested before the attacks on Manhattan and Washington, D.C.

Scarf writes in an engaging manner, utilizing case studies that illustrate her concepts, and ends with useful suggestions regarding what questions her readers can ask prospective therapists. Secrets, Lies, Betrayals is instructive not only to people trying to untangle their body/mind knots but also for those people who are endeavoring to support their struggle.

STANLEY KRIPPNER, Ph.D., teaches at Saybrook Graduate School and is a past AHP President.