June / July 2004

THE GIFT OF THERAPY:
An Open Letter to A New Generation of Therapists and Their Patients
BY IRVIN D. YALOM
Perennial Books (HarperCollins),
2002, 259 pp., $12.95, ISBN:
0-06-093811-0.
Reviewed by Stan Charnofsky

Irv Yalom has given us another important book for the psychological practitioner. In this read of about 250 pages, there are 85 chapters, each a snippet of advice in itself, but with several serving as a connecting stream of ideas, such as the one on dreams.

Some may not know that Yalom was in three years of analysis, five days a week, followed by two years of existential therapy with Rollo May. These experiences, along with his own issues with his parents, certainly flavor his approach to therapy. I agree with some reviewers that he writes with the wit of O. Henry, certainly with a high skill and brilliant creativity. It is a pleasure to read his words, learned references, incisive case examples, and easy syntax.

I will certainly suggest to my students studying to be therapists to buy and absorb this very readable book. I will also inform them that I have issues with parts of it.

Probably as a legacy of his own therapeutic experience [and he is an M.D.], even though he favors the existential approach, Yalom often notes how he “treats” his “patients.” In Humanistic terminology, an accretion from Carl Rogers, we don’t usually think in those terms, preferring instead to speak of “working” with “clients.”

In my opinion, he is wonderful in his approach to the relationship between therapist and “patient,” eager to know him or her on a deep, human level. Not everyone would agree, however, with his advice to “make home visits” to get to know the patient even better. In a humanistic sense, the client will disclose to us what s/he wants us to know, and, in any case, it is the client’s awareness of her/his patterns that is more critical than the therapist’s. Yalom also encourages the therapist to meet the patient’s significant other, though he is not suggesting he would do therapy with her/him. Again, it is for the purpose of the therapist knowing more about the patient.

While dreams are certainly important elements of Humanistic therapy (Yalom cites Perls’ way of identifying with dream figures in the here and now), the way Yalom describes his patient’s dreams is more akin to an analytic style. Several times he tells the reader his patients’ dreams and what they mean—then notes how helpful it is to the therapy to get those meanings into consciousness. I find myself asking: “How can you be sure what those symbols mean?” His interpre-tations seem reasonable, and even insightful, yet a bit presumptuous.

I appreciate the advice to be transparent as a healer. The client is much more likely to trust one who is not a complete mystery as in the old Freudian approach. I also agree with Yalom’s attitude toward touching, and his abhorrence of the trend in training programs to steer therapists away from any closeness with clients. He does add, wisely, that sexual activity is never acceptable.

Yalom stridently takes on the current concept of EVT (empirically validated therapy) as having enormous negative effects on the field of psychotherapy. These managed-care-influenced requirements are, according to Yalom, often wrought with errors and achieved with “smoke and mirrors.” It reminds me of Lawrence LeShan (former AHP President) citing a book he was writing called “The Mechanic in the Garden,” stating that the truly important elements of therapy are resistant to measurement—such as how much it hurts when your mother dies, or how hard it is when you go through a divorce.

Finally, in the section on advicegiving I find myself recoiling at Yalom’s explanation that he does it on occasion to “. . . shake up an entrenched thought or behavior problem.” In his examples, it appears as if he has arrived at what his patient needs in his/her life, and makes suggestions, followed by a described resolution that is salutary. The overall effect is that Yalom’s solutions are the impetus for the patient’s progress. From a Humanistic perspective, this seems to imply that the client will have to come back to him the next time a problem occurs, so his expertise can once again be employed.

My few disagreements aside, this is a practical and helpful new resource for therapists. I have high regard for Irv Yalom’s insights, writing brilliance, thoroughness, creativity, and therapeutic acumen. As with all of us, he is human, and brings to the table a blend of his own life resolutions and challenges, including the influence of his years of analytic therapy.

STAN CHARNOFSKY is Professor of Educational Psychology & Counseling, California State University, Northridge, and former president of AHP.

THE JOY OF BURNOUT:
How The End of the World Can Be A New Beginning
BY DINA GLOUBERMAN
Inner Ocean, 2003, $14.95, 255
pp., ISBN: 1–930722–20–6.
Reviewed by John Rowan

Dina Glouberman is of course well-known in humanistic circles as one of the most experienced therapists and group leaders, and also as the founder of Skyros as a center for holistic holidays. She is always worth listening to, and this book is no exception.

What struck me most about this book was its thoroughness. It covers the whole of the process of burnout, from the first intimations, through the worst of the worst, to the new life beyond burnout, and how to deal with that. Some scholarship peeps through, and the author is obviously familiar with the literature, but most of the book is about people’s experience, including the author’s own experience of burnout. There are long cases, short vignettes, personal quotes, and lots of good advice, well expressed. This brings the book to life in a vivid way.

The central idea is that the best approach to dealing with burnout is what the author calls Radical Healing. This is adumbrated in the very first chapter, where the author says: “When we burn out, it is our old hurt personality that burns itself out. Then our soul fire begins to light our way and to bring us joy.” This is indeed a radical message. The message is that burnout is the state of mind, body, and spirit reached by those of us who have come to the end of a particular road but have not acknowledged it. The symptoms we feel are telling us that a transformation of our lives is necessary. Burnout demands that we listen.

This book takes the soul seriously, and often mentions it, so it is worthwhile to look at the author’s definition of it. She says: “When we try to describe it, we come up with words like: our true self, our values, the eternal part of us, our highest and best purpose, our creative spark, our love, our human spirit, the part of us that knows, our essence, our being . . . think of the soul in any way you are comfortable with, or just as a metaphor for our highest and most loving truth.” Some of us would prefer the word deepest to the word highest, but I don’t think this author would mind.

Contrasted with the soul is the “control mind.” This is the part of us which thinks that if we get out of control—and burnout usually means that—we must work hard to get it back. But it was the control mind which got us into the mess in the first place—it certainly does not know how to get us out of it. If we rely on it to get us out, it just gets us further in. The control mind knows how things should be: and that is exactly the problem. The people around us, who often depend on our continuing to play our roles loyally, bolster up our control mind, because it is usually more convenient for them if we persevere.

To get out of this, we need to make what the author calls the Great Yes or the Great No. This comes from our truth, which is what we need now to open the way for and discover. It is a Yes to our true selves, and No to what we think we should be. This may mean physically moving out of our present situation, or it may mean moving deeper into it. It always means moving away from the mean, petty, conditional yeses and nos we have been used to for so long, and which leave us contracted and diminished: the Great Yes or the Great No release our energy and creativity. We have to realize that what is in our highest or deepest best interest is in the highest or deepest best interest of everyone.

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STEP 1: GIVE UP HOPING And so we come to the idea of Radical Healing. The first step in this is perhaps the hardest: the author’s summing-up of it is “Wait. Give up hope. Keep the faith.” As she explains what she means by this, the wisdom behind this paradoxical statement begins to appear. It means abandoning the idea (hope) of getting the old show back on the road. That is not the way to Radical Healing. We have to give up that struggle. What we generally do to avoid pain is now causing the pain. The radical move is to stop, to wait, and to listen.

As for giving up hope—the point is that hope pushes us into the future or past. It locks us into something unreal, problematic, and uncertain. If we can stay with the present, and breathe, we may find that reality is more interesting than fantasy. What does she mean by “Keep the faith?” It is about trust and surrender. “Before, we tried to hold it all together. Now we let ourselves be held.” Whether we think of this as opening to life, or to the Universe, or to God, or to a higher power, is a matter of our own belief system, but it is certainly something which could broadly be called spiritual.

STEP 2: YOU HAVE EVERYTHING The next step in Radical Healing, says our author, is to give your soul a good home. And here comes another of her paradoxes. “You need to decide that there is nothing that will make you happy that you don’t already have.” As this sinks in we begin to realize that as soon as we have a destinaation, we are back on the train to burnout. It is this determination to get somewhere that can make us miserable. We have to learn how to work without looking for results.

STEP 3: BE TRUE TO YOU Now we are ready to take the next step in Radical Healing, which is to build up our “living truthfully muscle.” This is based on our commitment: “I put my true self first and everything else second.” And this means being honest with ourselves. It also means surrounding ourselves with people who want us to know our truth, who care enough to hear it, and are willing to confront their own truths. Not that this is easy. Our author tells us: “It hurts to be human and it is human to hurt. We cannot avoid pain, but the pain of not being ourselves ends up by being far greater.” The truth may hurt but it doesn’t harm. It is illusions that can kill.

STEP 4: COMMUNE The last step in Radical Healing is opening up to a soul community. This means having relationships with people in which real communication is possible. It also means an inner community, where the various parts of ourselves are living in harmony, and it means finding a form that allows us to be part of something larger than ourselves.

In the last chapter of this book, the author says: “When the way opens, don’t leave your joy behind.” It is full of quotes from people who have taken the journey of Radical Healing, and come out the other side regenerated and revitalized. Sometimes burnout comes back, but each time it becomes easier to pull out of it.

This is a very readable and enormously useful book for anyone who has had any experience of burnout—and this means a huge crowd of people. It is a book which powerfully reminds us of how bad things can get if we let them. And because it is written by someone with personal experience of the path, it has an authority which does not depend upon the existing authorities in the field—although it refers to them at times. I would recommend it to anyone who is burning out themselves, or who is close to someone who is.

JOHN ROWAN, an AHP member since 1970, works in London as a psychotherapist and teaches at the Minster Centre. His latest book, cowritten with Michael Jacobs, is The Therapist’s Use of Self.

CARROY U. FERGUSON, Ph. D., is Professor, University of Massachusetts- Boston, and Associate Editor, Journal of Humanistic Psychology.