BACP, 2013

Reviewers Grace Hopkins and Lynda Woodroffe

On 4 February 2013, the British Association of Counselling and Psychotherapy (BACP) hosted a live video event with Irvin Yalom at the Queen Elizabeth II Conference Centre, London.

This was a large gathering of 600+ therapists in one room. It was hosted by BACP chair, Amanda Hawkins, who, in lauding the presence of Yalom amongst us, referred to this event as ‘meeting God himself’. It was clear from the audience response that this feeling was shared. Amanda then passed the baton to the new President of the BACP, Dr Mike Shooter, who pondered how he was going to introduce the God (Yalom) and how this felt like one God-comparison too many – he is just a psychotherapist after all. Shooter then presented a little of Yalom’s background, including the fact that he was the son of a grocer who worked in a poor area of Washington. This single biographical detail was one with which we in the UK are not unfamiliar having lived for many years under the rule of a home-grown grocer’s child in the form of Prime Minister Margaret Thatcher. That said, one could also argue that the former will have had a more productive influence upon the caring professions than the latter.

The overall content on the night was Yalom’s writings, starting with an unashamed plug for his book, The Spinoza Problem (2012). Of fiction, Yalom stressed that it is ‘the lie that tells the truth’ about the human psyche, a way of exploring how we operate through that medium. At the same time, reflecting upon his own work, he shared that his textbooks (collections of short stories) had been successful beyond expectation and had caused him to experience a shift in his work. He had begun by writing textbook style, using his stories as case studies to explain certain passages – as in what could be described as his ‘mother’ book, Existential Psychotherapy (1980)  – that had been intended to be used as a teaching tool. In later books his editor persuaded him to let his stories speak for themselves and Love’s Executioner (1989) was born. The themes largely centred on an eminent thinker in the field and the target audience for these ‘teaching’ novels were ‘young’ therapists, a characteristic he noted about his UK audience. By comparison to Yalom, who is 81 years old, this was true.

For Yalom, psychotherapy/psychoanalysis didn’t start with Freud, but with a group of wise men thinking about human dilemmas and how humans live. Yalom’s chosen wise men were existentialist philosophers Nietzsche, Schopenhauer and Spinoza. We noticed, as in many other professional gatherings, that there was a notable absence of female names on his list, especially profound since the audience was largely women.

Yalom said that his novels started as ‘thought experiments’. His first emerged as he pondered what might have happened had Nietzsche been able to invent a psychotherapy from his own writings and cure himself of his own despair. This had occurred in 1893, before any formalised practice of psychotherapy, and Yalom’s book, When Nietzsche Wept (1992), was set during this time. Another book, The Schopenhauer Cure (2005), attempts to portray in fictional form, how group psychotherapy works while in Lying on the Couch (1996), Yalom stated that he had attempted to face the issue of mortality and the question of disclosure by psychotherapists, a thorny and much discussed theme.

While discussing the topics raised in The Spinoza Problem (2012), Yalom asked: “How can we understand Spinoza?” He described a man excommunicated by Jews when he was twenty-three years old, living in Amsterdam where no other Jew could ever speak to or come near him, and existing in isolation and seclusion. In this book Yalom creates another character in the form of a colleague therapist to enable the reader to peer into the mind of Spinoza, and gain entry into another’s thoughts, feelings and responses to him. Creating a story around Spinoza is like bringing him to life – important because Spinoza’s own style of writing was self-effacing and his conscious attempts to be objective, make his works not so easy to read. Yalom researched what he could about this man, including visiting Spinoza’s library. Sadly, he found that Spinoza’s books had been sold to pay for his funeral and another feature indicating that Spinoza lived a very wary existence was that, before his death, he instructed his followers to destroy any personal correspondence.

The performance then moved on to questions that had been sent to Yalom in advance. One question – What ideas had he used in therapy this week? – brought the response that only that week he had asked his patients about their passions. What did they feel passionate about? If they didn’t, what was stopping this? He said to one patient: “I seem to have more curiosity about you than you have about yourself, why is that? Let’s take a look at that.” He illustrated his thoughts with a vignette, about a client and her ‘demon’ lover. He had been seeing a patient with a passion that, he felt, was misplaced; when she found an appropriate man with whom she felt she could spend the rest of her life, she wrote to Yalom describing her complicated connection with the demon lover. His response, he stated, was lifted from what he had learned about Spinoza and based on advice suggested by the man himself – that it was better to forgo an immediate lesser pleasure for what could become a future greater pleasure.

His other techniques come in the form of challenges about the here and now: he may ask whether the client feels close to him that day, or whether the client has questions for him or whether they had taken any risks that day? He also offers advice to clients and recommends risk-taking in every therapy session. He might sometimes ask: “Have you taken a risk today? What’s the closest you’ve come to taking a risk today? If you were to have taken a risk, what would you have said?”

Other questions from the audience were fairly ubiquitous – “What has been the most difficult thing to learn?” “How best to use our countertransference reactions?” “What have been your greatest learning experiences?” “What do you wish you knew earlier?” “How do you bring the relationship to an end satisfactorily?” And “How do you answer patients’ questions about death?”

While most of the questions could be answered using a textbook, the question about death is always interesting. Yalom replied that there are certain clues that emerge when with clients. For example, fear of death is omnipresent and if a person gives hints of this in dreams/nightmares and significant birthdays, there are often different kinds of reactions; a certain kind of sadness, a clue about advancing years and mortality are all signs that death is in the mind of the patient. He said that he approaches this permanent ending carefully, with, for example, a death in the family – a personal loss, maybe a pet, a first funeral, the death of a grandparent – and may ask: “When were you first aware of death entering your own life?”

Taking up this theme, BACP president, Mike Shooter asked directly: “You have talked about your age, are you afraid of death?”

Yalom replied with aplomb. In his thirties and forties he was terrified. He added that he thought it a revelation that in 700 hours of personal psychotherapy, thoughts and feelings about his own death never emerged. He believes, like Freud, that fear of our own death is hardwired into us, and therefore we cannot completely ignore it. A dictum which he felt was true for him, was that the fewer regrets he felt about his life, the less he feared death; the more regrets, the greater his fear of death. He added that now, as an old man, every now and again he thinks about death, but there is no active terror anymore. His last non-fiction work Staring at the Sun: Being at Peace with Your Own Mortality: Overcoming the Terror of Death (2008), addresses this very issue. I find it touching that this is (so far) his last piece of public writing.

Yalom drew the evening to a close with a story called Three Cries. This was a case study about a woman who cries three times during a therapy session as she recounts the story of her relationship with a recently deceased friend, Billy. She reflects on being left feeling that their friendship was a ‘nothing but… ’ friendship. In fact, her realisation that Billy was probably bi-polar changed her whole view of the relationship, thereby destroying the warmth and respect she had once had for him. Yalom commented that it was important to recognise that a ‘nothing but…’ friendship was not the whole truth for this patient and her relationship with Billy, and that her diagnostic process was largely irrelevant. He stressed that therapists, when working with loss and grief, can impede their work by reducing what is multi-dimensional to simpler explanations of many differing feelings and thoughts. By the end of Yalom’s work with this patient, the ‘Billy’ in her mind was restored to his former glory and she was able to grieve her loss.

When a man like Yalom reaches 81 years of age, one cannot help but wonder when the end will happen. Hearing about his own attitude to death, reminding ourselves that ‘Death’ comprises the first section of his tome Existential Psychotherapy, evokes a certain ruefulness. Here is a huge man in the small world of psychoanalysis, existentialism and story telling, whose impact we can only respect and acknowledge; even if we are not practising existentialists; that the man himself can talk openly about his own impending ending and the feelings around it, is impressive.

Grace Hopkins lives and works in London as an Integrative Psychotherapist and Holistic Massage Practitioner.

Lynda Woodroffe, MA Psych, has lived and worked in London since 1974; initially in education she is now a psychotherapist/counsellor in private practice.