Irvin D. Yalom – The Gift of Therapy

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Book Review, Irvin D. Yalom, Psychoanalysis, Psychotherapy, The Gift of Therapy

Absorbing reflections reaching more widely than merely the ‘new generation of therapists and their patients’

I admire the wisdom and compassion expressed in the writing and the thinking behind the writing of existential humanistic psychotherapist Irvin Yalom

Now in his late 80s, Yalom inspires not just those who practice psychotherapy, counselling, psychoanalysis or psychiatry. He is a philosophical thinker, rather than one who focuses on human ‘lesions’ or pathologies. Or, as he simply, profoundly says :

A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis

He has written books which tell the stories (anonymised, given narrative structure, and with permission) or particular encounters with patients over his decades of practice. These do not read like dry, clinical, case histories. Yalom inhabits the understanding that what is happening in the psychotherapeutic encounter is what happens in any human encounter – relationship. The therapist, though they must strive to understand their own subjective agenda within the client/practitioner encounter, can never be a robotic observer, but always brings themselves into the field of encounter with the client, as much as the client brings themselves into that field. And the connection itself will shape outcomes.

Yalom also, as to some extent here, writes books which are perhaps a little less geared towards the lay-person, but which might serve as useful guide or instruction to anyone engaged in holding any kind of therapeutic space, whether one to one, or with groups

He also writes a third kind of book, one where he turns deep thinking about philosophy and the questions which surely we all return to, across our lives, the attempt to understand primal ‘whys’ into the form of dramatic narrative. For Yalom is as much a writer, an imaginative, dramatic, shaping one, as he is someone working within the pursuit of emotional, integral healing and wholeness for individuals seeking this in the psychotherapy field.

Something I absolutely appreciate with Yalom is his acknowledgement and laying bare of his own errors, challenges and difficulties in his work. Perhaps this is one reason is so genuinely admired, so genuinely an inspirer – he shows his failures, reveals how the journey of practice goes wrong.

I like the central idea, expressed in many different ways in his books, of holding fast to the idea of the wholeness within the individual, however broken they might appear :

As a young psychotherapy student the most useful book I read was Karen Horney’s Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity towards self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree

Yalom is always revealing far more than the ostensible subject matter of his books, and, is always writing about meaning with wider reach

I underlined page after page, as being useful to return to, whether thinking about my own professional requirements, or, those deeper thoughts about the ‘whys’

Here is an example, ostensibly Yalom is cautioning against the fashion for shorter trainings, shorter interventions, and the following of rigid single patterns of thought in psychiatric evaluations and treatments, but more is opened out

In these days of relentless attack on the field of psychotherapy, the analytic institutes may become the last bastion, the repository of collected psychotherapy wisdom, in much the same way the church for centuries was the repository of philosophical wisdom and the only realm where serious existential questions – life purpose, values, ethics, responsibility, freedom, death, community, connectedness – were discussed. There are similarities between psychoanalytic institutes and religious institutions of the past, and it is important that we do not repeat the tendencies of some religious institutions to suppress other forums of thoughtful discourse and to legislate what thinkers are allowed to think

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John Marzillier – To Hell and Back

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Book Review, John Marzillier, Psychiatry, Psychological Therapies, Psychology, Psychotherapy, PTSD, To Hell and Back, Trauma

A wise, thoughtful, compassionate and skillful book about PTSD revealed through the words of those who have experienced this.

It’s funny how synchronicity works. Because I read Noel Hawley’s highly recommended Before The Fall, which I highly recommend, and which features a small boy who suffers a profound traumatic event, and clearly would be diagnosed with PTSD, and because I have a professional interest in the subject, I was reminded that John Marzillier, a British clinical psychologist and later, psychotherapist had written a book on the subject.

I had been moved and beautifully taught much in another book by him, The Gossamer Thread, where he explored his wide journey of development as a practitioner, and the deep exploration, refining, and ambiguity in human relationships that happen throughout all our lives, within and without any kind of formal therapeutic setting, simply because human beings are complex, and so each and every encounter between self and other is fraught with – an endless possibility.

Duke and Duchess of Cambridge and Prince Harry: Promoting the charity Heads Together to open up discussion of mental health issues

So, I started to read the in some ways, more geared towards the practitioner, slightly more left brain, slightly less poetical/metaphorical To Hell and Back: Personal Experiences of Trauma and How We Recover and Move on. And during my reading and reflecting period, mental health, particularly linked to the experience of dealing with psychological trauma, suddenly became positive news, due to Prince Harry, and also Prince William, speaking openly about the deep, hidden effects caused by their mother’s death. Public figures speaking out in such a way, honestly, – particularly public figures who are, not being rude, part of the Establishment rather than famous for flashier, sex-and-drugs-and-rock-and-roll lifestyles, not to mention ‘reality TV’ famous only for being famous ‘stars’, will be listened to more seriously.

Expression of emotion is more common, and I would say, generally a good thing, with the exception of the artificial stimulation of emotion in reality TV shows!

But, he also cautions against those who assume it always IS the right approach to bare the suffering soul:

Is avoiding talking about feelings always wrong? I do not think that one can or should make such a categorical statement. So much depends on the context and the person, not to mention their relationships with family and close friends and on timing

Focusing on a wide range of traumatic single events – Marzillier in this book is exploring the kind of ‘out of a moderately clear blue sky’ unexpected and traumatic event, rather than, say the trauma of repeated brutal events from early childhood – the author looks both at the unpredictable horrors caused by acts of deliberate chosen malevolence, and the impersonal ‘being in the wrong place at the wrong time’ of major accidents like train crashes due to mechanical failures. Marzillier was, for many years, employed by Thames Valley Police, working with those who have to deal with traumatic events, which arise out of the nature of their work – police, firefighters, army personnel, ambulance personnel. The professionals have to maintain a distance from their own natural ‘alert! Danger! I am under threat! autonomic nervous system response of flight, fight, freeze or dissociation which is our physiological survival response. The fact that they are trained to do this, and have techniques to use, cannot ever completely over-ride that ancient animal response, and this kind of ‘trauma is my 9-5, day in-day out worker’ may well find health problems which arise out of the continual overriding of the normal response to danger – get out of here!

How people feel and behave once they are out of danger and the traumatic event is over is a product of the intensity of the experience itself, the nature of the person and the context – that is, what their life is after the event

As in his previous book, what most blazes out, necessarily and importantly, is Marzillier’s artistry, his compassion, his flexibility and his open-ness to meet each individual he interviews for this book, making space for a joint exploration of their stories. Time and again he cautions against the single fix-it approach to PTSD – and, indeed, to the single, fashionable diagnosis of the condition. There may be other mental and emotional health issues experienced by someone who has been in a ‘traumatic’ situation, and other approaches, other diagnoses may need to be made. Don’t jump to a PTSD conclusion, he cautions.

It is a mistake to sweep all post-trauma psychological reactions into one simple category, or to assume that if someone shows PTSD symptoms then nothing needs to be done but treat the person’s PTSD

At the heart of this book, is the often stated central idea that whatever ‘the diagnosis’ says, that it is a unique individual with all their individual personality, history, belief systems and social networks who is receiving the diagnosis, and there CAN be no ‘one way’ of treatment. As in Gossamer Thread, Marzillier stresses it is the relationship between practitioner/clinician and patient/client which actually matters MORE than any ‘specific’ method. Sure, the practitioner must have relevant skills which can work in this field, and preferably, the flexibility and skill to acknowledge that ‘their’ skillset may not be the right one for THIS client at this point. Marzillier even acknowledges that treatment approaches which lie outside his particular belief system and training, DO work for some people, – with the right practitioner. He is extremely open-minded, whilst being at the same time, a scientist by training.

This book has a lot, highly relevant, to say to both the clinical psychologist and the ‘energy worker’ working in this field.

It is a marvellous book, serious, analytical, warm, open minded and hearted – and, always important, beautifully written, and authentic – he has allowed the individual voices of the many people he interviewed in this book – those who had experienced events, and been diagnosed with PTSD – to recount their stories, and the different treatments and outcomes. These are not, in the main, ‘his clients or former clients’ . They are people who chose to respond to a general request made ‘public’ when he was planning on writing a book on this subject.

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John Marzillier – The Gossamer Thread: My Life As A Psychotherapist

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Book Review, CBT, John Marzillier, Psychological Therapies, Psychotherapy, The Gossamer Thread: My Life As A Psychotherapist

The Gossamer Thread and The Boundless Ocean

I thoroughly appreciated John Marzillier’s wonderful book on psychological therapy, as the reading of it caused deep reflection which led me into many fields. Not least of which is the whole relationship we have with the reflective activity of reading itself. Doors open, horizons widen, intense emotional experiences and thoughtful, reasoned self-questioning occurs; ideas become developed or discarded; change happens.

I most value those books, fiction or non-fiction, which take me into these areas.

Marzillier’s beautifully titled book explores his own development in the field of psychological therapy, and the development of particular therapeutic approaches, as much as it also explores his successful or less than successful experiences with clients, suitably anonymised, and often with stories changed, to also protect the confidential integrity of the client’s story, in case a former client reads and thinks ‘that is me!’

John Marzillier almost stumbled into clinical work by default, beginning to work using behavioural techniques – a very reductive, lab-rat approach (or so it seems to this reader) in the late 60s and early 70s. The model, it seems, was heavily based on physiology and learned behaviours, biased towards large scale statistical ‘objective’ scientific studies, and drew much of its methodology from observed animal behaviour. However, Marzillier was beginning to feel uneasy, as ’something’ was missing in this approach, and almost by instinct he found himself, through a more dynamic engaged relationship with individual clients, drawn to exploring thought processes and even gaining curiosity about ‘back stories’

In fact, he was moving closer to embracing the role of the relationship between client and practitioner as integral to treatment. The ‘relational field’ approach though was still in the future for his work. This is a concept central within psychotherapeutic and psychoanalytical approaches, but was barely engaged with by the more ‘impartial’ scientific observational ideology of the behavioural approach.

He began to formally train in a then new discipline, cognitive therapy, examining the internal thought processes, the scripts and dialogues which run through our heads. Cognitive therapy of course, in tandem with the earlier behavioural approach, became mainstream as Cognitive Behavioural Therapy (CBT)

My sense, reading this book is that perhaps Marzillier was always as much an artist as a scientist, and therefore, by his own nature, more likely to find that any approach which has fairly set protocols, and a fairly rigid methodology might quickly begin to seem as if it were missing something. It seems to me that no one method or approach, in this field, is ever going to be successful with all people, at all times. What the left brain approach lacks is the imaginative gestalt, the whole-person poetry of the various strands of ‘relational’ right brain methods. Science versus art of psyche.

Marzillier ended up having a kind of revelation, listening to a lecture given by Dorothy Rowe, well-known for her work in the field of depression, about the centrality of core belief and how it can become entwined with one’s very identity. A belief may be useful or destructive, but even a self-destructive and painful core belief can provide the security of comfort – a reinforcements of the sense of self. To LOSE, for example, the certainly that life is meaningless or you yourself are worthless and bad things happen to you because you are worthless can be a frightening change too far – though a belief may or may not be a helpful one to an individual,  – and may or may not be right, it is YOURS. We all struggle with complex responses to being WRONG

His process of progression from scientific certainty, where the steps are known, and the methods can be approached sequentially, so that the method, not the person employing the method ‘makes’ the cure, eventually led him to the uncharted, waters of the mysterious ‘unknown’ of other, and the personal, uncertain route of that more narrative, right brain approach. I had a sense of the psychodynamic psychotherapist (a further training in this followed) like a boat in the middle of an ocean, lacking a map, with destination unknown, steering by instinct, feeling, sense, gut reaction on a journey of trust with his client. This sort of work comes closer to the relationships we have with ‘the others that are not self’ as we move through life. There are forms and structures, rough maps and sketched instructions which guide us, but the relationship between self and any other is something like a dance, which though the steps may be known, veers off into something jazzy, freeform, improvisational. Things may go horribly wrong, and the dancers fall over, step on each others’ toes – but they may also get to a dazzling, inventive, dynamic place with their dance.

Later, his journey takes him into analysis, to experience the procedure from the other side. He is as thoughtful about himself as an analysand, as he is about his patients, teasing out his sense of the process, and his resistance

As Marzillian points out, there are difficulties in psychoanalysis being properly verified by the statistical tools – because it is not dealing in certainties, but in ambiguities – the subjectivity of the practitioner is always within the encounter. There is not a set protocol of method, session to session, with set aims and objectives. This is the very real challenge of that therapy. It seems to me that IF the practitioner is both skilful, and congruent , on some deep level, with the client, the work can be amazing, profound, transformational. It is about much more than the client being free of the ‘symptom’ which brought them into treatment, and about much more than the client being ‘made well’ by the method – or by the therapist using ‘the method’. Instead, there is the possibility of (like with any authentic human encounter), both participants stepping into ‘meaning’ An epiphany of sorts, if you will. The big problem of course, is that it always beset around by those IFS.

Like that other wonderful writer in this field – the humanistic, existentialist psychotherapist Irvin D Yalom, Marzillier is steeped with a sense of art, awareness of metaphor, the poetic. He often illustrates by using literary allusion – literature is indeed a potent source helping us to understand the depth and vitality of human experience.

Marzillier also writes not only with warmth, clarity and authenticity – but with a fine sense of the absurd humour that is to be found in even the most serious places.

What is also utterly compelling about this journey Marzillier takes the reader through, is that he is a man who accepts the confusions, the hesitations, the contradictions within any ‘method’ No wonder he embarked on so many trainings, with that recognition that any one party line is too reductive and fixed to capture human exchanges in all their complexity

Or, as he more cogently puts it

If I have learned anything from a lifetime career as a psychotherapist, it is that there is no universal truth, that everyone is different, and that you, the reader, should take what I or anyone else tells you about psychotherapy with a large pinch of salt

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Irvin D. Yalom – Love’s Executioner

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Book Review, Existentialism, Irvin D. Yalom, Love's Executioner, Psychotherapy

Living with the givens : Isolation, Meaninglessness, Mortality, Freedom

I value Irvin D. Yalom‘s books on his psychotherapy work hugely, because the weight of his arguments go far outside the field of psychotherapy, and explore what the beingness of human entails.  Much of what he explores in the one-to-one sessions can be translated into the relationship each of us has, firstly, with ourselves, and secondly, with ‘the other’. This to me is the fascination of the existential approach : how we deal with these givens: isolation, meaninglessness, mortality and freedom.

These are not just problems for those society might perceive of as ‘unwell’ and needing help – they are the bedrock of being a self-conscious embodied being, and flow, like a deep river, more or less acknowledged and observed, through our day to day moment to moment lives.

Eros y Thantos – Nat Smith’s   photostream. Flicr Commons

The wonderful and shocking title of the book refers to the role of therapy in helping us to see clear and live outside denial – the denial of the challenges of those four givens. The psychotherapist is here cast as the executioner of illusion – not of love itself, but the giddy, distorting, exhilarating, wondrous ‘being in love’ state. We all crave and enjoy this – but it is an illusory state, a kind of unreal, seductive, beautiful madness; it is intoxication, and is possibly the most potent of intoxicants. The broken illusions and despairs of the Western Romantic Tradition bring many into therapy. How do we live with the loving, which will always bring losing (through mortality, if nothing else) when the champagne intoxication of blissfulness (in love) loses the bubble, and we taste it without that giddy sparkle

What I particularly like, from the psychotherapeutic encounter considerations of  this book is that Yalom is able to say ‘this is where I got in the way, this is where my own agenda inhibited the client’s journey and progress’ He is not afraid to step outside of the illusory framework of ‘the objective, non-judgemental practitioner’ and say that though this is what we may aim for, in theory, in the reality of practice as human beings we cannot help but bring our own prejudices into the treatment room. Far from being appalled by (for example) his honesty about his inability to see the real suffering individual behind his stereotypical very overweight client, I am impressed that he is honest enough to look at himself and his prejudices, and how they impact, negatively or positively, upon the process for the client, and offer that honesty to us, his readers. What is important is to be able to acknowledge our prejudices, not pretend we don’t have them, or be in denial about the buttons clients (or any other human being) may push. We need to know what is our stuff, in order to really see our clients (or any other)

Some fellow professionals have criticised Yalom for writing so much about himself, however I think this is the strength of the book. It shows the willing, but inevitably imperfect practitioner in action. Self-reflection is always crucial, and its great to see such an obviously highly revered practitioner and teacher showing where he fails his clients, as well as where he supports them beautifully. The perfect therapist/client encounter (for the client) is an ongoing journey in process, sometimes practitioners and clients manage a session almost perfectly, sometimes the dynamic isn’t quite right; its great to see honesty, rather than the great guru displaying his perfection. The really great guru is the one who lets us see his imperfections!

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Irvin D. Yalom – Staring at the Sun: Overcoming the Terror of Death

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Book Review, Existentialism, Irvin D. Yalom, Psychotherapy, Staring at the Sun

Compassion in action

I very much value this book, where ‘existentialist humanist’ psychotherapist Yalom explores the belief that it is the awareness of our own mortality, and the mortality of all around us, which is at the root of much of our deepest insecurities and anxieties. It is this which he looks to explore rather than the more day to day, personality based concerns which may be brought to the therapeutic encounter.

Two major strands which I found intensely moving in this book. Firstly Yalom’s willingness to be deeply honest, personal and authentic with his clients, rather than taking a god-like position assuming his own rightness. This leads to his willingness to share of himself with clients. This is something which can be seen as a bit of a no-no, in some schools, as of course the session is for and about the client, not the therapist, although of course the relationship between the two is crucial. However, if in therapy the client is always the one who is vulnerable, and the therapist never, it could be said there is an inauthenticity going on. Yalom is willing – WHERE THIS WILL BE OF USE FOR THE CLIENT – to reveal his own messy humanity. Willing to admit his wrongness. Willing to admit his difference and the client’s difference.

Secondly, and carrying on from the last sentence – I was particularly moved by his recounting of sessions with someone who had strong, what Yalom terms – ‘paranormal beliefs’.  Yalom is an atheist, and expresses his disbelief in what might be thought ‘New Age’ thinking. Through his recognition and respect for the human being in his treatment room, he was able to acknowledge that the client’s beliefs were not ones he could share, but deeply recognise the health, not just the pathology, that caused his client to hold those beliefs. In other words, Yalom can work with paradox.

He is also a humane, warm and tender writer, able to communicate ideas with coherence and with clarity. The book feels like someone having a conversation with you, not someone preaching at you

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