In the otherwise forgettable Analyze This, there’s a lovely moment when the milquetoast shrink, played by Billy Crystal, daydreams about telling off a patient who is particularly whiny and self-indulgent. The outburst is clearly not for the benefit of the patient. If Robert De Niro’s mobster has forced himself into the doctor’s personal life, at least the doctor has acknowledged his own emotional quandaries about the imperfections of that life.
“What is the therapist’s most valuable instrument,” asks Irvin Yalom, somewhat cheekily in an opening section of this remarkable book. “The therapist’s own self ... We must demonstrate our willingness to enter into deep intimacy with our patient, a process that requires us to be adept at mining the best source of reliable data about our patient — our own feelings.” Accurate empathy is what makes therapy a dynamic intervention and a therapist an artist.
Yalom is 71 and, after a long and distinguished career as a professor at Stanford University and in private practice, one might expect that he would be ready to take down his shingle and bid his besieged profession a less-than-fond farewell. Indeed, one is struck by the valedictorian tone of the book, perfectly captured in the drawing that adorns the cover — a mod-looking table is bathed in late-afternoon sunlight, casting moody sidelong shadows on a blue notebook and a Bauhaus-era lamp.
“I’m more than melancholic,” offers Yalom on the phone from his perch in Palo Alto, Calif. “I’m terrified.”
“Psychiatry is on the verge of abandoning the field of psychotherapy. Young psychiatrists are forced to specialize in psychopharmacology because third-party payers now reimburse for psychotherapy only if it is delivered by low-fee (in other words, minimally trained) practitioners. It seems certain that the present generation of psychiatric clinicians, skilled in both dynamic psychotherapy and in pharmacological treatment, is an endangered species.”
For Yalom, an apt metaphor for the therapist fraternity is the Renaissance guild of healing artisans, learning the art at the side of older masters and then nurturing their own expertise among themselves.
Thus, the book, for all its minor-key notes, is very much forward-looking — a call to arms for the couch. The format is a collection of epigrams and short essays assembled in an organic pentangle of “topics.” The first section covers the therapist-patient relationship. While the therapist should be empathetic to a patient, how does one get the patient to be honest with the therapist? Yalom contends that the biography of the patient is less important than the interpersonal strategies the person manifests in the here-and-now of the therapeutic relationship. Tearful dissembling about what a dreadful meddler your mother was has little truck in the Yalom program.
We only need to look to the world of celebrity to realize how bracing a notion this is. Many fans of Eminem prize him for his tortured biography precisely because it streamlines with their own. In such a world, biography is destiny. Victimization and self-pity ring the till. The entertainment-industrial complex has given the culture the tools and the permission to be blamelessly sick and chronically unhappy.
The second, and most profound, section discusses the elemental concerns that underpin Yalom’s dynamic approach to therapy: “Patients fall into despair as a result of confrontation with harsh facts of the human condition — the ‘givens’ of existence. The existential psychotherapy approach posits that the inner conflict bedeviling us issues not only from our struggle with suppressed instinctual strivings or internalized significant adults but also from our confrontation with these givens.”
Yalom doesn’t consider existential therapy to be a discrete, freestanding entity. Rather, it embraces and employs a variety of strategies with a keen eye toward death, isolation, meaning in life and freedom. Sartre wrote that we are “condemned to freedom.” One must take responsibility for one’s life and whatever meaning there is to be found in it.
“Responsibility assumption is an essential first step in the therapeutic process,” writes Yalom. “Once individuals recognize their role in creating their own life predicament, they also realize that they, and only they, have the power to change that situation.”
Thus, a savvy therapist leaves life-changing decisions to the patient; but decide they must, as awful as it may seem: “Making a decision cuts us off from other possibilities. Choosing one woman, or one career, or one school, means relinquishing the possibilities of others. The more we face our limits, the more we have to relinquish our myth of personal specialness, unlimited potential, imperishability, and immunity to laws of biological destiny.”
Decisions put us at the frontier of anxiety, where the ground is less firm and the horizon less expansive. Yalom quotes the protagonist from a John Gardner novel: “Everything fades and alternatives exclude.”
For all his hard-nosed discussion of the big concerns, I’m struck by the man’s unerring sense of humanity. The warm, steady tone of his voice speaks of a rewarding career that has spanned almost half a century. He has given much counsel and taken the same.
“We are cradlers of secrets,” he writes in the moving, final epistle. “Receiving such secrets is a privilege given to very few. The secrets provide a backstage view of the human condition without social frills, role-playing, bravado, or stage posturing. Sometimes the secrets scorch me and I go home and hold my wife and count my blessings.”
No doubt his patients count theirs, having encountered such a wizard, one for whom no curtain is left drawn.
Timothy Dugdale writes about books and visual culture for the Metro Times. E-mail him at [email protected].