Learning from the practice of psycho-therapy

Shortly after her last therapy session with Dr. Irwin Yallom, his patient, a 45 year-old woman (called M.), wrote and posted a ‘sad’ letter to him. The letter included the lines:

“I always imagined that you might write something about me. I wanted to leave an imprint on your life. I don’t want to be “just another patient.” I wanted to be “special.” I want to be something, anything. I feel like nothing, no one. If I left an imprint on your life, maybe I would be someone, someone you wouldn’t forget. I’d exist then.”

M. had presented Dr. Yallom with a seemingly insurmountable challenge: her life had been a ruin and, in all honesty, it stood every chance of remaining a ruin. As her letter showed, she was still, despite some progress in therapy, on a knife-edge: she remained liable to deep (and suicidal) depression; she might even be moved to end it all…

However, Dr. Yallom did write about her. Her existence did matter to him (and would still matter even if he wasn’t around).

In so doing, he provides us with a vivid and riveting account of what it is like to try and establish an effective therapeutic relationship with a person in such deep distress. His task was enormously difficult because M. was locked within the wreckage of her life; rarely had Dr. Yallom met anyone with so much self-hatred. Things really did look hopeless. She was a ‘misfit’. But this was really ‘her depression talking’. In fact, M. was not only an exceptionally intelligent person but also a creative and highly attractive woman.

In addition to charting the course of his work with M. and describing his testing experiences with her – including a powerful self-induced hypnosis in which M. revealed another powerful yet devastating ‘personality’ – Dr. Yallom also reached certain conclusions about what really matters in psychotherapy. Amongst these conclusions is a very profound learning concerning something at the very heart of the therapist/patient encounter.

He leads us to this major conclusion in the following way:

“When I first began as a therapist, I naively believed that the past was fixed and knowable, that if I were perspicacious enough, I could discover the first false turn, that fateful trail that has led to a life gone wrong; and that I could act on this discovery to set things right again. In those days I would have deepened M’s hypnotic state, regressed her in age, asked her to explore early traumas – for example – her father’s sexual abuse [of her]- and urged her to experience and discharge all the attendant feelings, the fear, the arousal, the rage, the betrayal.

But over the years I’ve learned that the therapist’s venture is not to engage the patient in a joint archeological dig. If any patients have ever been helped in that fashion, it wasn’t because of the search and the finding of a false trail … No, a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested: and by believing that their joint activity will ultimately be redemptive and healing. The drama of age regression and incest recapitulation (or for that matter any therapeutic cathartic or intellectual project) is healing only because it provides therapist and patient with some interesting shared activity while the real therapeutic force – the relationship – is ripening on the tree.”

And so Dr. Yallom devoted himself to being ‘present’ and faithful to M. In other words, he  rejected the ‘false’ personalties of M. – even though they could be beguiling – and he did his best to help M. do some sort of justice to the deep and enduring aspects of herself.

Irwin Yallom’s discussion of M., the individual therapeutic process and the therapeutic relationship is presented in a chapter entitled ‘Therapeutic monogamy’ in his book ‘Love’s executioner.’ I was given the chapter to read by a student in London who is currently exploring integrative and psychodynamic approaches to counselling and psychotherapy. I think it a frank, sometimes tragic, always sobering and very perceptive account.