The other day I finally purchased a book I had passed by multiple times; each time thinking “I should read that book.” The book is The Gift of Therapy; An Open Letter to a New Generation of Therapists and their Patients (2002). The author is the emeritus professor of psychiatry at Stanford University, Irvin Yalom, M.D. Obviously written to and about a professional reading audience, Yalom calls the book a “nuts-and-bolts collection of favorite interventions or statements…long on technique and short on theory.”
Although Yalom urges therapists to work from a variety of approaches, he writes:
“Still, for the most part, I work from an interpersonal and existential frame of reference. Hence, the bulk of the advice that follows issues from one or the other of these two perspectives. Since first entering the field of psychiatry, I have had two abiding interests: group therapy and existential therapy. These are parallel but separate interests….The two modes are different not only because of the format (group versus individual), but in their fundamental frame of reference. When (I’m in a group setting), I work from an interpersonal frame of reference and make the assumption that (people) fall into despair because of their inability to develop and sustain gratifying interpersonal relationships.”
“(W)hen I operate from an existential frame of reference, I make a very different assumption: (people) fall into despair as a result of a confrontation with harsh facts of the human condition – the ‘givens’ of existence.”
These two frames of reference reminded me that I should have purchased the book much earlier than I did. Indeed, whatever else urges us to talk with a counselor-type, the challenge of relationships, and the inexorable conditions of life are among the primary influences.
Yalom’s first frame of reference: the difficulty of developing and sustaining gratifying relationships.
For all the value of gathering information about a person’s history in therapy, Yalom emphasizes the “here-and-now” importance of the “therapy relationship”; the importance of interpersonal relationships, and the idea of therapy as a social microcosm. This is to say that sometimes the interpersonal problems a person has with others (spouse, partner, parent, friend, coworker) will manifest itself in the “here-and-now” of the therapy relationship. This emphasizes something I’ve written about in earlier blogs; that what we do not or cannot communicate directly, we evoke or (re)enact with others. It’s basically the nonconscious, nonverbal behaviors we communicate unawares.
Yalom tells of a client, Albert, who was “suffused with anger but could find no way to express it.” In one of their sessions, Albert described a frustrating encounter with a girlfriend who, in his view, was “jerking him around,” yet he was afraid to confront her. Yalom writes: “The session felt repetitious to me; we had spent considerable time in many sessions discussing the same material and I always felt I had offered him little help. I could sense his frustration with me…. (So) I tried to speak for him:
‘Albert, let me see if I can guess at what you might be experiencing in this session. You travel an hour to see me and you pay me a good deal of money. Yet we seem to be repeating ourselves. You feel I don’t give you much of value. I say the same things as your friends, who give it to you free. You have got to be disappointed in me, even feeling ripped off and angry at me for giving you so little.’
(Albert) gave a thin smile and acknowledged that my assessment was fairly accurate. I was pretty close. I asked him to repeat it in his own words. He did that with some trepidation, and I responded that, though I couldn’t be happy with not having given him what he wanted, I liked very much his stating these things directly to me. It felt better to be straighter with each other, and he had been indirectly conveying these sentiments anyway. The whole interchange proved useful to Albert. His feelings toward me were an analog of his feelings toward his girlfriend.”
Rather than talk objectively about Albert’s frustration with his girlfriend, Yalom used the therapy relationship to talk directly about Albert’s difficulty with expressing feelings.
Yalom’s second frame of reference: our confrontation with the “givens” of existence.
Yalom writes: “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 or shards of forgotten traumatic memories, but also from our confrontation with the ‘givens’ of existence.
And what are these ‘givens’ of existence? If we permit ourselves to screen out…the everyday concerns of life and reflect deeply upon our situation in the world, we inevitably arrive at the deep structures of existence (the ‘ultimate concerns,’ to use theologian Paul Tillich’s term). Four ultimate concerns, to my view, are highly salient to psychotherapy: death, isolation, meaning in life, and freedom.”
That fourth “ultimate concern,” or “given”—freedom—implies responsibility; choice. Hoffman (2007) writes: “The attempt to be free without being responsible is, by nature, pathological, and arguably, immoral. The process of psychotherapy helps people embrace and enhance their freedom (by becoming more responsible).” Freedom, responsibility, and choice – all go together. They are irrevocably linked. Corey (2001) cites the existentialist philosopher Jean-Paul Sartre (1971) in speaking about “bad faith.” Examples of Sartre’s bad faith are: ‘Since that’s the way I’m made, I couldn’t help what I did’ or ‘Naturally I’m this way, because I grew up in an alcoholic family.’ Sartre claims we are constantly confronted with the choice of what kind of person we are becoming, and to exist is never to be finished with this kind of choosing.”
Hoffman (2007) again writes: “This is one of the great paradoxes of existential theory; that people are both necessarily limited in their freedom and at the same time condemned to be free. It is not possible to escape the influences of biology, genetics, and the past. Furthermore, individuals can never become fully aware of the influences lurking in their unconscious. This is what (German philosopher) Heidegger refers to as thrownness. Everyone is thrown into a particular life situation with a particular genetic makeup, with parents they have not chosen, and into a time and culture they are not able to control.”
This second frame of reference—the “givens” of existence—reminds me of theologian Reinhold Niebuhr’s “Serenity Prayer,” (1926) – but not the part you might think. The more familiar part of the prayer begins: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” A later line in the prayer seems to emphasize the inexorable “givens” of human existence. The petition reads: “That I may be reasonably happy in this life…”
“Reasonable happiness.” Sometimes I read the claims of therapies and therapists and think, “Wow! ‘Banish anxiety forever!’ ‘Live the stress-free life you’ve always dreamed of!'” Obviously, I’m being both facetious and satirical. There’s no question about the potential efficacy of therapy, but “absolute happiness?” No way. We know better.
Thus, the prayerful and realistic petition: “That I may be reasonably happy in this life.” That’s what we’re after. It’s one of the gifts of therapy.
Bill Bray, Colorado Springs, CO
