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Abstract
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DRAFT: This module has unpublished changes.
Yalom’s Tales of Psychotherapy
Yalom’s Love’s Executioner and other tales of psychotherapy which shines a light on the misunderstood process of psychotherapy is a window into what really happens in a psychotherapist’s office between a psychotherapist and his patients. The ten tales that have been told through this book is not just an eye opener into existentialism, what happens between a psychotherapist and his patient, but also deep down how a psychotherapist feels towards his patients. The four givens in every person’s life that Yalom talks about in the prologue which are the inevitability of death of self and people we love, the freedom to make our lives as we will; our aloneness; and the absence of a sense of life; are prevalent in his psychotherapy in all ten stories of this book. According to Yalom, at the root of all his patients’ problems is the desire to have what they cannot have or to get back what they once had. It is the wanting of something that is at the root of the problem. What existentialists like Yalom believe in is that psychological dysfunction is a result of self deception. It is when people hide from responsibilities and do not recognize that it is not up to others but up to themselves to give meaning to their lives. The freedom of choice lies within themselves and not with someone else. Existentialists work at bringing people away from dwelling on the past and to live in the present.
One of the stories that really captured my interest was, “Love’s Executioner”, which is from the first chapter of the book. This is about a seventy year old woman whose life has been stuck in time. She cannot get over an affair she had with a therapist for twenty seven days, eight years ago. Her whole existence revolves around the twenty seven days that they had spent together, intimately. In other words she was obsessed with that affair and could not and would not let go. She was contemplating suicide when she sought Yalom’s help. She agreed to six months of therapy with Yalom and in those six months she made a promise not to consider suicide. What they uncovered together was that it was not a man that was the source of her distress but it was the obsession with her youth that was the underlying problem. What she wanted was to feel and to be young forever.
When I first began reading this story, I was very upset with what Mathew had done to Thelma. I felt that Mathew was a selfish and a sick man who used Thelma and then when he had gotten what he wanted, he shrugged her off ruthlessly. As I continued reading, my anger toward Mathew lessened but my frustration at Thelma’s stubbornness rose. I was thinking to myself that if I were in Yalom’s shoes, I would tell her to find another therapist. I felt that Yalom was a little too patient with her. I actually wanted to shake her and tell her to wake up and to take a good look at herself. I wanted to tell her that she was living a lie and she needed to wake up and face reality. She was so stubborn that it made me want to take her by the shoulders and shake her.
What brought Thelma to therapy was the fear that she would succeed if she tried to commit suicide. She had tried that once but she was saved. The likely diagnoses for Thelma would be that she suffered from major depressive disorder with psychosis. She was deeply depressed, suicidal, obsessed, anxious, frustrated, alienated, hypochondriatic, and psychotic. She was delusional and lived eight years of her life with an illusion of love that was one-sided. She had an extreme fear of aging and death. There were times when she did not have the energy to be bothered with taking care of her appearance and looking presentable which is something you see in depressed people. She and Yalom had a strictly professional relationship with no issues of transference on the patient’s part or counter-transference on the therapist’s part.
Thelma was a very stubborn woman and she angered me to the point where I developed a dislike for her and felt that Yalom was a little too patient with her. There were times when I felt that Yalom’s approach was not aggressive enough. He let her continue with her obsession and let her go on and on about something that was just a fantasy of hers. I do not think I could have worked with Thelma at all because Thelma wanted to live a life of self-deception. She was manipulative and it was not Thelma who was manipulated. She manipulated Mathew because she was too selfish to let go of her sick obsession for youth. She wanted Mathew to call her and talk to her because the only person that mattered to Thelma was Thelma herself. Even after she found out that Mathew had his own struggles he had to deal with, she never took her thoughts away from herself and thing about what Mathew’s problems were. She wanted to be asked how she was doing but never considered asking Mathew how he was doing. It was always about her.
At the beginning of the therapy, Yalom was not very keen on taking on a case of people in love. Once he got involved, he did not want to stop the sessions. He was deeply disappointed when Thelma decided to discontinue with the therapy. In the beginning he believed that Thelma was a victim and Mathew an unethical therapist who took advantage of an old lady’s vulnerability, however, by the end of the therapy, Yalom felt it was Mathew who had been manipulated by Thelma. His feelings and thoughts about Mathew changed completely. Even though Yalom did not see it, I believe his sessions with Thelma were a success. He had succeeded in removing Thelma’s obsession as she finally faced the truth. Thelma; however, did not see it this way. She saw it as her life without that obsession was a life without hope like most people with major depressive disorder do. She felt that the therapy had left a void in her life. I definitely would have handled the case a lot more aggressively because she infuriated me with her stubbornness and selfishness.
The next story is from chapter three and it is titled, “The Wrong One Died”. This is a story of Penny, a thirty eight year old woman who is divorced. She showed up at Yalom’s door after reading an article in the newspaper which Yalom had placed, in search for candidates for a research project he was working on. It was a research project on people who could not overcome their grief. Penny could not afford therapy with a therapist let alone Yalom so she jumped at the chance and went to see Yalom. Penny had lost her daughter to leukemia four years ago but was still suffering from that loss. She was unable to get over it. She had blacked out and woke up driving on the wrong side of the road and that scared her. That is when she decided she needed to see Yalom. She felt that she had not been completely there for her dying daughter and was guilty about it. She had also lost her husband as a result of the non-stop grieving and her sons were not faring very well. In simple words, her life was a mess.
The patient came to Yalom because she was burdened by her sense of guilt she felt after her daughter’s death. She was guilty for blacking out when her daughter died, she blamed herself for her daughter’s illness being prolonged leading to her death. Penny was suffering from depression and she was functionally impaired. Grief, loss, bereavement, and intense guilt were at the root of Penny’s illness. She also goes on and on about how she could have done something to make things different. Survivor’s guilt, anger, irritability, aggression towards her sons and the fact that she had blacked out completely when she was driving suggested that she was suffering from post traumatic stress disorder due to indirect exposure. Another diagnosis for Penny would be that she also suffered from major depressive disorder. Her grief had lasted years and it was deeply intense. She also has no memories of when and how she learned of her daughter’s death suggesting memory loss that happens during the trauma.
Yalom had started out working with Penny as a research participant and not a patient but was so intrigued by the case that he took her on as a patient even though he did not quite have the time. He developed a solid therapeutic relationship with her and wanted to help her get over her grief. Together they were able to identify that she was not just guilty over her daughter’s death but was also fighting the thoughts that her daughter was the wrong one in the family to have died. Deep down she had been thinking that it should have been one of her two sons who died, who according to her were not as good as Chrissie, her daughter, had been. Yalom’s therapy also led to the discovery that Penny had given up two twin daughters for adopting when she was sixteen.
This case that Yalom worked on was a success in a lot of ways. Not only were they able to work out what was the underlying cause of the prolonged grief but also Yalom was able to work with Penny selflessly. His counter-transference did not interfere with the therapy in any way. The therapy was totally patient centered but of course like in all cases Yalom believes that he is the ultimate healer; that when all else fails, he is the one to turn to for the cure.
I felt sorry for Penny and could identify with her loss because I have an aunt whose son committed suicide by shooting himself to heath, twenty-five years ago, and she still believes that someday he will come back. My aunt has never gotten over her grief. I liked Penny and sympathized with her loss and grief. I am also glad that she finally decided she needed to work on herself. I believe I would have been able to work with this client because she was not stubborn but was a good client. She was not a difficult patient in any ways. She is someone I would want to work with and hope to change her condition for the better. The fact that she felt that it was one of her sons who should have died does not appall me but makes me feel that she is just being human. Her grief is so intense that she is feeling that way. I would have felt the same way if I were in her shoes. I would have said the same thing, “the wrong one died”.
What changed for Yalom was he had the chance to really learn about bereavement and that was a first for him. It was an eye opener for him. In Penny’s case, at the beginning of the therapy, her grief had been deadlock but at the end it was more fluid. She also went from living and dwelling in the past to finally living in the present even though the process was not without pain. Penny was visiting her daughter’s grave less frequently at the end of the therapy and began to focus on her sons. I see this case as a success. Yalom was able to uncover a huge amount of guilt and a lot of conflicts that lay at the root of Penny’s bereavement. Together in a very short time, Yalom and Penny had been able to uncover a lot of grief and troubles in Penny’s mind. The best thing that also came from this was she finally broke down and cried for herself, for the life that she should have lived but had failed to do so because of living in the past. She went from living in the past to living in the present. I would not have been able to handle this case because I am not very good at dealing with grief. I feel sorry for her and can identify with her but I am not strong enough to carry that burden of grief. I am afraid it would have been difficult for me to stay neutral and it would have had a negative effect on me.
The third case is, “Fat Lady”, which is from chapter four of the book. This story is about Betty who is obese and the obesity was getting her down. She had previously seen a therapist who had been so bored with him that he had fallen asleep during their sessions. That is what brought her to Yalom. According to Betty her life was a total chaos with her binging and antisocial behavior. She did not have friends or any kind of social life. Her work was suffering as a consequence of her unpopularity with her co-workers and her work performance which had not progressed at all. She believes that her weight which was two hundred and fifty pounds was the cause of all her problems.
What brought Betty to Yalom was her previous therapist had fallen asleep on her. That was however not the only problem. Her eating had gotten way out of control and that led to high blood pressure as well. She had taken the advice of her medical doctor and decided to seek out Yalom’s help. Betty was deeply depressed due to her eating disorder. Betty’s uncontrollable indulgence in food suggested she had an eating disorder and she was deeply depressed because of that. She depended on food to give her comfort. She had extremely low self-esteem and felt isolated socially. She also developed a dependency of having Yalom as someone she could reach out to. The thought that her sessions with him were finally coming to an end crushed her and led to her binging yet again after having made so much progress in that area. This is typical of depressed people to be become clingy, needy, and dependent on someone dominant. All this suggested she suffered from major depressive disorder as well.
Right from the time that Yalom saw Betty in his office for the first time, he had been repulsed by her obesity. Yalom’s counter-transference and feelings of disgust toward this patient had its roots in his own childhood. As a child he had been surrounded by not just racism towards his being Jewish but also witnessed fat people being teased for their obesity. That somehow became embedded in his mind and so had his dislike for fat people. His counter-transference, his feelings of hatred and boredom toward Betty, got in the way of therapy and Yalom was not able to develop a therapeutic relationship with this patient for the better part of the treatment. Yalom; however, persisted with treating Betty despite all those negative feelings.
I do not have any kind of strong feelings for this client. In fact I have stayed very neutral in my feelings for her. I have not felt frustrated with her nor have I felt any sympathy for her condition. I find it hard to identify with her. I do; however, admire her success with losing a hundred pounds. I also admire her for persisting with the therapy even though all the time she was well aware of yalom’s disgust with her obesity. She did not let that get in her way nor did she let that deter her. I salute her for that. I think I could have worked with Betty because of my objectivity towards her. I could have listened to her and worked with her without letting my feelings get in the way because I do not dislike obese people.
By the end of the therapy, Yalom’s disgust towards obesity had changed considerably. He was no longer disgusted by Betty or her obesity. What started out as boring was no longer boring to Yalom. He was more comfortable around her. He even admitted to being ashamed of his earlier response to Betty. A lot changed for Betty at the end of the treatment. She went from weighing two hundred and fifty pounds to a hundred and sixty pounds. She also admitted that deep down she had hated her obese father and that had been the underlying cause of all her problems; her hatred for her father that she had never openly acknowledged before but by the end of the therapy she openly admitted to it. At the beginning of the therapy Betty would cover up her true self by being a little too entertaining. She felt that she had to be entertaining all the time when she was in people’s company. However, by the end of the therapy she presented by being her true self.
Even though Yalom was disgusted and bored with Betty, he did succeed with her. He succeeded at getting her to lose weight and openly admit to her feelings for her father. To me this case was a true success even though Yalom did not think so. It is true that Betty did show some regression toward the end of the therapy but overall the case was a success. If I were in Yalom’s shoes, I believe I would have handled the case more sensitively because obesity does not affect my feelings. There would be no feelings of countertransference to interrupt the therapy. I would, however, suggest that Betty go to group therapy just like Yalom did because I believe in group therapies.
This book served as a good insight as to how “human” therapists are. People often go to therapists with their problems and share their problems with their therapists but how a therapist feels is never revealed. That is what made this book so interesting to me; so much so that I was unable to put the book down even though it was depressing at times. Each of Yalom’s cases was unique in how he approached and dealt with each patient and it was really amazing to see how each patient was transformed after receiving therapy. I will definitely look up other books by Yalom to read more about his psychotherapy.
Works Cited
Yalom, Irvin D. Love's Executioner. New York: Basic, 2012. Print.