Bulgarian Interview: Yalom and Yalom's Hour of the Heart
Interview for Iztok-Zapad, publishers, on the release of the Bulgarian edition of Hour of the Heart
Could you share with us how the idea of writing a book together with your father, Dr. Irving Yalom, came about? What was most exciting part for you about working together on Hour of the Heart?
Hour of the Heart and the collaboration behind it came first as a result of my father's declining memory. He reached a point in his career where he thought it was no longer responsible to continue seeing clients for long term therapy, because he could not remember the salient details from one session to the next period. So he began an experiment that is at the heart of this book, which was to see patients for one single session and try to help them find the direction of personal work and therapy that they might do in the future.
And every once in a while, he would write up a story that he thought provided a valuable teaching lesson for future therapists or therapists who wanted to learn new things. He did this for three years, he collected about 40 stories that he wanted to share with people in the field. But by the time he got to the end of this collection, his memory had degraded to the extent that he could not really hold all the stories in his mind simultaneously. While it was a collection of interesting narratives, they didn't fit together as a book. At that point we decided that I should work with him in turning this disparate collection of stories into the book we have now, which I believe does a very good job of telling rich stories with theoretical information about approach to therapy and demonstrations of how to do it woven throughout. It is something of a memoir of his own memory loss.
All this was quite serendipitous, because I had recently decided to join the “family business”, and become a therapist myself, after many years avoiding his shadow, and instead being a theater director. This is how the book came about and our collaboration came about.
For me, it was a fantastic experience on two levels. First it was very powerful for the two of us to be able to spend this time together, talking about things that mattered, as he was aging. He was 93 when the book came out – and we just celebrated his 94th birthday this weekend. And while we have some remaining time together, there is not a lot of it. And from this perspective it a beautiful experience being able to spend a focused period of time together at this late stage in his life.
Second, it was also extremely helpful for me in developing my understanding of therapy and how I wanted to approach doing it. What a wonderful opportunity to have all of this one on one time with my father as my teacher.
You have extensive experience in theatre. Does it help you in your therapy work with your clients? If yes, in what ways?
My experience in my theater is extremely helpful, extremely influential, in my therapy work. One must, I think draw on one’s own life experiences and deep passions, to be an effective therapist. My father has this great depth of understanding of philosophy, and he's brought that into his therapy work – it permeates his existential approach. I have a great experience in the collaborative activities of theater, and in the way that we can use, for instance, the actor’s tools of developing characters, to help clients better understand themselves and others. This is work that I have done for decades as a director, and much of this is transferable into the therapy office. I'm also developing a very physically oriented approach to
people's understanding themselves and their values that works with the body just as much as it does work with the mind. And this is very much in line with the type of highly physical theater that I did with my company, foolsFURY, for two decades in San Francisco and New York.
Could you tell us more about your own style of psychotherapy? Have you thought about in what direction you might want to develop it?
I'm very interested in helping people uncover and articulate their deep values and ethics, and then looking at how they are living out those ethics. In many cases we find ourselves living in ways that don't
closely adhere with our deeply held beliefs, and this causes. And much of my work, then, is helping them look at ways that they might change how they're living in order to be in alignment with their values.
This has many similarities to the deep questioning about meaning and existence in my father’s work, but my approach is evolving into something a little bit different. I do embrace the idea of honesty and openness in therapy that my father places so centrally in his approach, but I also focus on some other areas as well. I've taken on aspects of narrative therapy in my work, which emphasizes the stories that people tell themselves, or that the culture that we live in suggests people tell themselves. And as I noted before, I am developing a way of working in one's body, often in group settings, that draws on many of the techniques in theater, and on the line between theater and dance, to help people further explore and express their own thoughts, dreams and emotions. It’s an exciting time for me in this developing work, as I will be teaching workshops in these techniques in China, the Netherlands, and the US next year. Bulgaria, anyone?
What do you think about the closeness and similarities between existential psychotherapy and humanistic psychology? For example, the approach presented in Hour of the Heart towards more intimate communication in the here and now, as well as the therapist’s own openness, self-disclosure and empathy are also at the heart of the philosophy and practice of Carl Rogers’s person-centered approach.
Here in the US, we usually refer to these modes of therapy together as “existential-humanistic therapy” precisely because of how closely they are related! Let us call them siblings, if not twins.
The idea presented in your book about reversing roles with patients to allow them to ask the therapist a personal question is very intriguing. Is this approach suitable only for the first (or one-off) session, in order to relieve tension and establish trusting relationships? Psychoanalyst Heinz Kohut believes that empathy is a good tool to use at the beginning “as preparation for real therapy”. Do you think this approach can be useful in the following sessions as well, or does it perhaps pose certain problems?
Well, I think my father would disagree in many ways about empathy or connection being useful only as preparation for “real therapy”. On the one hand, many forms of therapy, psychoanalysis included, benefit from developing a close therapeutic alliance, and my father's willingness to self-disclose does help relieve tension and does establish trusting relationships. But what we really talk about in this book goes well beyond that. For my farther, establishing intimacy and intimate relationship between therapist and patient is not simply a prerequisite for the therapy, but rather it is the locus of the therapy itself. Having a powerful emotional empathetic experience between the therapist and the patient, or “fellow travelers”, as my father prefers, is the space in which the transformation can occur. It is through the relationship that people learn to make connections with others and to understand themselves better. This approach is at the heart of the stories in the book. So I suspect my father would strongly disagree with this quote from Heinz Kohut, or at least disagree with the implications of it further down the line period. And while I am not quite as focused on the relationship as my father is, I would generally disagree as well. I think empathy and authenticity are important throughout the course of therapy.
If the proposal to change roles is made not by an authoritative therapist but by a young, novice psychotherapist, would the effect be different? In your opinion, what are the limitations of this approach – of a therapist sharing their personal story in the course of the therapy sessions?
I think that this proposal of changing roles was really an experiment that my father was doing to try to speed up the development of intimacy and sort of pushing self-disclosure to a highly pressurized space. I don't know that I would recommend this method for everyone, and certainly I wouldn't recommend it to anyone who doesn't have a certain amount of experience in exploring self-disclosure in therapy or in other in other contexts. So maybe this idea of asking the patient to ask any question of the therapist is one that's best used when a couple of conditions are met. And I would think that these would be one that the therapist has a very good gage of how information they might share, or the sharing of that information would be useful to the client, because it's always about what's most useful to the patient or client.
Secondly, the therapists themselves should feel relatively comfortable and confident sharing things about their own lives if they're going to do so, if it's going to present a great deal of stress and anxiety for the therapist, then it's going to have some negative repercussions, whether those are intended or not. So the argument here, or the stipulation, is that we should get better at being comfortable sharing of ourselves, so that we're able to do so in the session period. But we will all have our limitations, and if we exceed our own limitations, it probably is not helpful for the clients.
Finally, asking the client to ask questions of the therapist can have some negative repercussions, creating a sense of great stress or pressure on the client, and this is the case in one of the stories here. So again, this was a strategy my father was exploring, not necessarily suggesting that everybody should do this particular strategy, but rather using it as an exploration of the role of self-disclosure.
How do the psychotherapist’s name and authority affect the course and success of their therapy? In the book, several patients admit they were afraid to speak openly with Dr Irvin Yalom, even though they respect him so much – or in fact, it was exactly because of this respect that they felt reserved. Is it sometimes easier or more beneficial to be a more junior psychotherapist?
Being as well known and revered as he is in the field, presented both challenges and opportunities for him. Being “Dr Irvin Yalom”, put him on something of a pedestal, and there are some cases in which he's able to leverage that reverence, to feel very important to the clients so that his words have greater weight. Given the short amount of time that he was working with them, that seems to have been useful in some cases. In his views on therapy generally, however, my father prefers to be a fellow traveler with his patients rather than him be an expert and them be somehow lesser. We are experts in therapy, but the clients or patients are the experts in their lives. And my father goes to great lengths to make it clear to the patients that he is a human being, just as they are. And this leveling of their hierarchy can be very helpful.
I'm not sure if being a more junior psychotherapist makes this “easier”. Hopefully we're all getting better as we get further into our careers! But it may be better easier with certain clients to be less known, less potentially intimidating. Having a certain degree of renown or fame does again create extra opportunities and presents some real challenges.
The family psychotherapist Salvador Minuchin noted in an interview that at the end of their lives great psychotherapists – almost as a rule – move away from their original theories and methods and instead become more interested in philosophy and mysticism; they start trusting mainly their experience and intuition in their work. Hour of the Heart also seems to suggest this. What do you think about this interesting development?
Fantastic question! My first response is to say that this may be less the case with my father than with some other therapists whose approaches are more structured, and less philosophical to begin with. Take Minuchin’s own model, structural family therapy, for instance. It’s quite open ended in terms of the freedoms it offers practitioners as far as interventions go, but quite…structured…in its dynamics. My father's therapy, on some level, has always been a therapy of philosophical reflection. At least since the 1980s, when he wrote Existential Psychotherapy, and then later that decade when he wrote Love's Executioner, he has been deeply engaged in a philosophical inquiry, and thinking about how to apply ideas of great philosophers such as Nietzsche and Epicurus and Schopenhauer and Spinoza, to psychotherapy. So in essence, he's been doing that since his fifties, and perhaps prior to that. It does seem that much of his interest in the last 20 years has focused more and more in on questions of aging and questions of death and death anxiety, and how we as a culture and we as therapists handle death. That has certainly shifted a bit, and he's made some revisions of some of his previous ideas, some of those are in this book. Minuchin’s thought here is very interesting and probably valid for many. Maybe a little bit less so with my father, as he has been exploring this path of philosophy, and not mysticism, but spirituality, and deeper inner knowings of the self, for a long long time.
Most of the consultations described in the book were conducted online via Zoom. This form remains a popular means of conducting the sessions and perhaps even seems to be more convenient for older therapists. What do you think about the pros and cons and the future of online counseling?
Well, it seems to me that Zoom is now well integrated into a therapeutic culture. We've got to deal with it, whether we like to or not. And while I prefer to see clients in person, most of my clients are online at this point. And I will say that I found that with individual clients it's not half bad! Not nearly as bad as I’d feared when I began. I feel like we can still have very focused and intimate conversations. I also see a lot of couples, and the Zoom is a little more a little less ideal. With couples, it's much harder to see body language and how they're relating to each other in space, particularly if they are zooming in from different locations. I very much want my couples who are seeing me remotely to be in the same place themselves.
A great aspects of online therapy is that are that we can see people all over the place, and they can see us. There are many licensing organizations that haven't caught up with this, which seems very out of touch at this point period, but I suspect they will catch up over time. I think perhaps an even bigger story for us to be thinking about is what's going to happen with the very, very rapid increases in artificial intelligence, and how, how that's going to impact therapy. Will AI therapists become more and more prevalent? I think they will. And they're going to become better and better. To what extent they will replace human therapists remains to be seen. I am not one of the people who, in the arts or in therapy, think it's an outrage, and that AI will never be able to relate to us or replace us, because there's some core aspect of being human that can't be replicated. That may be true, but I think that core element of being human is perhaps much, much smaller, and much less unique than we would like to imagine. With enough power and sophistication an AI is going to understand human problems, and speak to us quite well. They will continue to evolve in many ways, and we as users will continue to evolve. When I see my children interacting with their iPads, I understand that they are already interacting with the technological world in a way that I find it hard to conceive of. And a couple of generations from now the interface between humans and technology will be very different, both physically and conceptually. AI based therapists may do a lot of excellent work. Does that feel like a good thing as a therapist to me? No, it's a little scary. But if it also allows people to receive support in truly helpful ways, well, that's probably a good thing.
Do you have any personal favorite psychotherapists, whom you particularly admire or have inspired you in your own practice?
I've been very invested in my father's work for many, many years, and his approaches to therapy make a lot of sense to me, and I've seen them play out in my own therapy office with some great effect. So that remains inspiring to me. As I mentioned, I have also been deeply engaged in learning about and beginning to practice Narrative Therapy, which was originally formulated by Michael White and David Epstom. My own supervisor, Tom Stone Carlson, and his partner Sanni Paljakka, have been brilliant teachers are explorers of the field. I would also add some of the great physical theater makers have offered me wonderful insights into the human experience from a different vantage point, in particular Anne Bogart, Joe Goode, and Mary Overlie.
Do you have any advice for young aspiring therapists?
My advice for young aspiring therapists is to keep exploring what is important to you, and help your patients see what is important to them. And I think what I mean in this is to say that there are many modalities and ways of doing therapy out there, and many of them are useful and potentially effective. Only by looking within yourself and getting to know yourself and what makes you thrive will you find your most effective approach to being a therapist. So you need to know yourself well, do your own therapy, and other forms of personal exploration in order to be able to bring the best of yourself to your patients. Also, don't jump too quickly to labeling your patients as “Depressed” or “ADHD”, but really look into what those things mean for them. What is their experience in the world? Being willing to be a compassionate and flawed human being yourself.
Finally, what are some of your favorite books? Is there a certain literary work, be it a novel, short story, poem or play, which you would like to personally adapt for theatre and direct?
What a juicy question! Thank you. I'm a huge fan of certain types of magical realism. I love Borges. I love Cortazar. I love Bohumil Hrabal. I've often wanted to adapt two of Hrabal’s short novels for the stage. One is Too Loud a Solitude, and another is Closely Watched Trains. And I also am a bit of a science fiction junkie. I don't know about adapting these works for stage, but I very much like the science fiction that asks big, important philosophical questions – writers like Ursula Le Guin and Stanislaus Lem.
But these are all old books! Let's jump forward in time. I'm a great fan of Adam Johnson, and particularly love his novel The Orphan Master's Son, which would be amazing to adapt to stage. I love anything by David Mitchell. And I love my good friend Doug Dorst’s novel Alive in Necropolis.