When I began my psychotherapy training, a friend who had just qualified gave me a book they thought I would enjoy. That book was The Gift of Therapy by the American writer, psychotherapist and existential thinker Irvin Yalom. It was the perfect present as the book is written with trainee therapists in mind, as they begin to navigate topics such as working in the 'here and now', self-disclosure and what it means to be ‘fellow travellers’, whilst exploring the human condition.
These days, the book is well thumbed and underlined and over the years has contributed to the foundation of my own psychotherapy practice.
Since Irvin Yalom is 90-years-old and based in California, I never imagined I would get to meet him or listen to him in conversation. So when I heard that he was promoting his new book on zoom through onlinevents.co.uk, I signed up straight away; perhaps one small consolation of the pandemic lockdown.
The Gift of Therapy is dedicated to his wife Marilyn, ‘soul mate for fifty years. Still counting.’ and this new book, A Matter of Death and Life: love, loss and what matters in the end, was written by both Irv - as he likes to be known - and Marilyn, whilst Marilyn was going through treatment for blood cancer. It is an examination of the consolation of lives well-lived, a shared love story as the protagonists face their separate mortality together. It was completed by Irv following Marilyn's death in late 2019.
The online talk was the first time he has spoken publicly about the book.
I had pictured a frail, elderly man. Irv has survived a stroke and now walks with canes, he also has a pacemaker fitted, but in fact he is still sharp and energetic and there is a clear twinkle in his eye. He told us about the abyss of grief he has found himself in after Marilyn’s death and that he is still unable to visit her grave or have photographs of her around their home. He revealed that grief torments him in curious ways, with intrusive thoughts about women’s breasts, something he has found disturbing though perhaps not totally surprising as Marilyn is the author of a book entitled A History of the Breast.
Anyone who is familiar with Yalom's work will know that this type of candid self-disclosure is at the heart of his practice. He has never found it detrimental. As he says, being able to relate to someone as a real person, whatever their role, is where the healing happens. When he was a trainee back in the 1950s, he undertook psychoanalysis 4 days a week. Lying on a couch, with a therapist who just nodded sagely, was an expensive way to realise that psychoanalysis does not work. Instead, he began to explore ‘interpersonal therapy’ where the focus was on the important relationships in peoples’ lives: parents, childhood friends, siblings and even pets. Through this, he was able to build a picture of the needs and deficits of the people he saw in his practice, and perhaps even more importantly, something emerged between himself and these people, which he has come to define as the ‘here and now’ relationship. There is something reciprocal and reparative for both parties in the question ‘how are we doing?’ and together they become ‘fellow travellers’, as they explore the vicissitudes of life and what it means to be human.
Irv worked in psychiatric settings for much of his career, where a focus on medicalisation can be both pathologizing and dehumanising. What he offered was a more bio-humanistic approach; the question was not ‘what is wrong with you?’ but ‘what happened to you?' This has become a more accepted way of working in psychiatry and psychotherapy though he acknowledges that there is still much work to be done, and with this in mind, supporting new psychiatrists and psychotherapists, through his writing and friendship, is the focus of his work today.
At 90-years-old, Irv still practices psychotherapy, but due to his failing memory, he offers just one-session therapy now. He is in weekly therapy himself; his curiosity about people, human stories and the inner self is undimmed. It was this love of stories which brought Irv and Marilyn together back in 9th grade; she was reading Gone With The Wind and that book was the conversation starter which would lead to a 65 year marriage.
The final chapter of A Matter of Death and Life is a letter to Marilyn. In it Irv asks her, ‘how come the smartest, most beautiful girl decided to spend her life with me the class nerd?’ At this point he told us, that if he continued to read the letter, the tears would flow. He accepts that grief is not something he will ever recover from, rather it is something he will have to adapt to. He was asked, ‘what do you fear at this stage of life?’ to which he replied ‘dementia’. He explained that to still be able to participate in the phenomenon of consciousness is a gift and whilst he has no religious belief in the afterlife, he finds comfort in the idea of joining Marilyn one day.
A Matter of Death and Life: love, loss and what matters in the end - Irvin and Marilyn Yalom
The Gift of Therapy - Irvin Yalom