Irvin Yalom: “Creativity gives meaning to life”

Psychologies: You are a supporter of existential psychotherapy. Why?

Irvin Yalom: For me, existentialism is not some separate form of psychotherapy. Any psychotherapist should be keenly aware of the existential questions facing each person. In the United States, many psychotherapists, for financial reasons, are forced to limit themselves to short-term therapy: insurance companies pay only for short courses of treatment … Such psychotherapy works with certain symptoms, such as unhealthy eating habits, and is aimed at eliminating them. But many come to the appointment with deep existential problems: these are elderly people who are faced with a serious illness or fear of death, or those who retire and do not know how to fill the void ahead of them … These are, of course, philosophical problems, but they touch the lives of each of us. Existential psychotherapy is addressed to these people.

Can psychotherapy alleviate a person’s suffering?

AND I.: Certainly. We all experience anxiety to one degree or another, we are all tormented by eternal questions. This suffering is familiar to all of us, but some people are more susceptible to it than others because they faced it too early or because they did not have parents who would help them gain the feeling of emotional security needed in life’s trials … Such people suffer with head. Patients come to me in this condition, and I think I can help them.

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Are there means to overcome the sense of the meaninglessness of our existence?

AND I.: One of the great ways to give meaning to our lives is, of course, creativity. But there are other ways, for example: take care of others; dedicate yourself to fighting for something important; to love and to be loved. For some, the source of meaning may be the existence of a divine principle. In general, everything that is outside of us and that allows us to go beyond our own limits that limit us in our human nature.

Is it enough to study philosophy for this?

AND I.: Epicurus considered the fear of death to be the main cause of human unhappiness, and much of his work is devoted to how to make it easier for us to experience this fear. But psychotherapy cannot be content with expounding great principles and ideas. You also need to learn (sometimes anew) to communicate, build relationships with others. My novel Schopenhauer as Medicine is about this: Philip, a former patient preparing to become a psychotherapist, believes he can treat others with Schopenhauer’s philosophy. Until the day when he realizes that first he himself needs to be cured of Schopenhauer. Mere transfer of knowledge is not enough for effective therapy, it must be accompanied by a deep connection between therapist and patient.

How do you differ from psychoanalysts?

AND I.: I have never considered psychoanalysis to be a valid treatment. To be frank, lying on the psychoanalyst’s couch twice a week for years is not very productive, do you think? In my opinion, the effectiveness of treatment is directly related to the degree of personal involvement of the psychotherapist. I have never admired such features of psychoanalysis as detachment, keeping a distance, silence, lack of eye contact. But I recommend psychoanalysis as a great way of self-knowledge, especially for those who master the profession of psychotherapist. After all, every form of psychotherapy is Freudian in one way or another. Freud invented not only psychoanalysis, but also psychotherapy. The last chapter of “Studies on Hysteria”, the very first work, written by him in 1895 together with Joseph Breuer, is devoted specifically to psychotherapy. This is truly an amazing chapter. There are already all the important questions that confronted psychotherapy over the next hundred years. If we are interested in the patient’s unconscious motivations, his dreams, how the transference affects his relationships, then we are Freudians. As soon as the word becomes part of therapy, we are already Freudians. Not orthodox followers of Freud, of course, but in spirit.

In your novel The Love Cure, you wrote: “A good therapist is not one who knows, but one who seeks.” It sounds provocative, doesn’t it?

AND I.: When I work with a patient, I do not have a pre-planned plan, I do not know where we are going with him: it is a kind of journey through unfamiliar territory. Each person is unique, and in a sense, a new therapy has to be created for each patient. But I want to be surprised, I like it! I look forward to each next session, the next meeting with the patient, to see how he has changed, to find out what has happened in his life since our previous communication. Dogmatism in psychotherapy is a mistake, like a mistake to think that we know everything about human nature.

If every psychotherapy is unique, what is the core of your practice?

AND I.: Back in the 1950s, Carl Rogers came to the conclusion that the therapist’s relationship with the patient was crucial; it depends on him whether the therapist can help the patient change. Rogers identified three main qualities of a good psychotherapist, and they remain valid. First, the therapist is definitely on the side of the patient, he supports him. Secondly, he resorts to empathy, that is, he is able to feel what his patient is experiencing. Thirdly, the therapist’s relationship with his patient must be genuine, he must participate fully in it, and not play a role, since this psychotherapeutic work relies on the way the patient communicates with his therapist. It happens, for example, that the patient insistently argues with everything I say. Then I ask him a question: is he aware of this, does he consciously disagree with me? If this happens unconsciously, together we look for reasons that could explain such behavior. Everything that happens during the session provides material for such research work.

What about group psychotherapy?

AND I.: The group psychotherapist must fulfill two important tasks: he must establish a personal connection with each member of the group, give each one something special, and, more importantly, he must allow the group to become the main agent of the changes that occur to its members. The group is very difficult. There are patients who find it difficult to communicate confidentially with a psychotherapist one on one. Such patients are especially indicated for classes in a group. The purpose of the group is to allow each participant to work on their relationship with others so that the patient can then extend this experience to his environment and to his daily life.

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What are the signs that therapy is moving in the right direction?

AND I.: First of all, you can see how patients change. The complaints with which they addressed at the beginning become less acute or disappear altogether. Their attitude towards others changes. And finally, after a few months, after a year or two (for me today this is the maximum duration of therapy), it becomes noticeable that our meetings have ceased to be the center of their existence. They live their own lives. And the reasons why they came to me gradually evaporated.

What is the joy and what is the difficulty of your profession?

AND I.: There is no doubt that our work gives meaning to our lives. The existential questions that she poses to us – to engage in others, to give them the opportunity to grow and change internally – all this evokes amazing feelings. The main problem for many of us is isolation. Although we are very close to the patients, each of us works alone all day, and contacts between colleagues are quite rare. The situation is paradoxical: on the one hand, closeness to the patient, on the other, isolation. In addition, our profession is fraught with stress: for example, the suicide of a patient can be a very big shock … But the joy that our work brings far exceeds its sorrows!