In Therapy

A user's guide to psychotherapy

Yalom on Therapy and Meaning

Excerpts from an interview with Irvin Yalom

I'm fortunate to have spoken with Irvin Yalom a few times. The interviews usually have a particular focus, but as it is in many conversations, some of the best material is off topic. Today I thought I'd share a few extra tidbits from one of our meetings. These responses deserve to be heard. 

If you’re not famliar, Dr. Yalom is Stanford Professor Emeritus and the author of numerous non-fiction books including the seminal Theory and Practice of Group Psychotherapy, Love’s Executioner, and my classroom favorite The Gift of Therapy. He’s also used his writing talents to bring psychological theory and practice to the masses through his popular fiction books including Lying on the Couch, When Neitzsche Wept, and The Spinoza Problem. He is a revered author and popular speaker, regarded both for his wisdom and vulnerability.

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Read a few of his books, listen to a few of his talks, and you’ll see why he’s referred to as the modern grandfather of psychotherapy. His warmth, empathy, and persistent focus on the here-and-now have made him a wise spokesman for the field.

Once again, a little thought-provoking b-roll from a living icon in the world of therapy:

After reading The Gift of Therapy with my students, I gave them a chance to submit a question and told them I’d pick the best ones to ask you.

I can’t imagine what this is going to be!

What would you say is generally missing from clinical programs? What are we not teaching our students?

I have lately been feeling more and more concerned about the passing of psychotherapy. I teach at Stanford Medical School and everywhere I look I see this total swing to this mechanistic, manual-driven cognitive behavioral therapy. Whereas I know that it has its place and it’s valuable at times I just feel that if I want to get patients to a wise therapist in my community my numbers are limited. There’s not a whole lot of people I can find who encourage patients to go deep. And when I look at training programs I get really scared this whole thing is going to fade away someday. So it keeps me going. I want to keep writing and try to make these books as accessible as possible to students.

We’re not teaching our students the importance of relationships with other people: how you work with them, what the relational pathology consists of, how you examine your own conscience, how you examine the inner world, how you examine your dreams. All this, all the psychodynamics are just not getting to them. It’s just too hard to teach. It’s so much simpler to teach CBT. And then the absolute maniacal need to empirically validate everything you do. This becomes foolish after a while because of the intricate, complex quality of things, you just can’t do that. Even so, the new studies on outcome showing psychodynamic therapy of 20-24 sessions is equally effective, perhaps more because it’s more long-lasting. All this new work by Shedler. But I feel at such a crossroads, even in my own department of psychiatry. I gave grand rounds a couple of weeks ago and I just see how students are really craving for some more teaching. Just this last week I made an offer to meet with the residents over at my home once a month just so they have exposure to this other form of thinking. I do worry about that a good bit.

I hope it’s well attended!

I hope so, we’ll see. I just made the invitation, we’ll see what happens.

You’re saying there used to be a stronger emphasis on the relationship and the internal factors and now we’ve become so manualized that we’re basically technicians.

Oh yes. When I was at Stanford years ago I had an outpatient clinic with 30 groups going - all my students, all the residents had groups. I couldn’t find 30 groups in almost all of Northern California at this point. You see, that shrunk so much.

On an existential note, you write that the problem of meaninglessness is best approached obliquely through engagement. How does one take that leap into commitment and action when even engagement seems meaningless and arbitrary?

I’m currently writing about a patient who was dying, she was very depressed. One day she told me that she had decided that she can be a “pioneer of dying” for all of her friends and acquaintances. A pioneer of dying. I thought that was an incredible term. And what was so important about it, I thought, is that it imbues her life with meaning until the very last minute. She’s doing something meaningful. I think all kinds of meanings in life transcend your self. They’re linked to other generations of people around us, to our children and our family. We’re passing on something of ourselves to others. I feel that’s what makes our life full of meaning. It’s hard to have meaning in a closet, encapsulated by nothing. I think you really have to expand yourself and your life and do what you can for other people.

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Let the musing begin. A special thanks to my students Barbod Salimi and David Choi for these questions.

If you’d like to read more Yalom in non-book form, take a look at this interview from the Seven Questions Project series, an interview for Staring At the Sun for the Psychotherapy Networker, some of his thoughts on the here-and-now, and an interview on his most recent fiction writing, The Spinoza Problem.

You can also approach me obliquely through my website or facebook page.

By the way, Dr. Yalom is a fan of something called National Psychotherapy Day (September 25). He went as far as to say “I’m pleased to support National Psychotherapy Day and honor the therapists and patients who courageously travel together on this most intimate, meaningful, and big-hearted journey.” From the sound of that, it must be pretty important. If you'd like to partner with Irvin on this important day, join the facebook page, the LinkedIn group, and visit the website.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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