Irvin D. Yalom - Existential Psychotherapy

M ANY have helped me in my work, and I am unable to thank them all: this book was several years in the writing, and my debts stretch back beyond my memory. Rollo May and Dagfinn Follesdal were exceptionally important teachers and guides. Many colleagues read and criticized all or parts of the manuscript: Jerome Frank, Julius Heuscher, Kent Bach, David Spiegel, Alex Comfort, James Bugental, Marguerite Lederberg, Michael Bratman, Mitchell Hall, Alberta Siegel, Alvin Rosenfeld, Herbert Leiderman, Michael Norden, and numerous Stanford psychiatric residents. To all, my gratitude.

I am indebted to Gardner Lindzey and the Center for Advanced Study in the Behavioral Sciences for providing me with an ideal setting for scholarship during my fellowship year of 197778. I am deeply grateful to Stanford University, which throughout my career has generously provided me with the equipment of academic life: intellectual freedom, material support, and professional colleagues of the highest order. I am grateful, too, to Thomas Gonda, Chairman of the Department of Psychiatry, for considerately shielding me from administrative chores. And to Marjorie Crosby, for her sponsorship and encouragement. Phoebe Hoss provided magnificent editorial assistance. This is a long book, and every word of every draft from first scribblings to finished manuscript was typed by my secretary, Bea Mitchell, whose patience, exuberance, and diligence rarely flagged over the many years we worked together. My wife, Marilyn, provided not only endless sustenance but, as with all my previous books, invaluable substantive and editorial counsel.

The Standard Edition of the Complete Psychological Works of Sigmund Freud, translated and edited by James Strachey. By permission of Sigmund Freud Copyrights Ltd., The Hogarth Press Ltd., and The Institute of Psycho-Analysis; also of Allen & Unwin Ltd. and Basic Books, Inc.

EST* 60 Hours That Transform Your Life, by Adelaide Bry. Copyright 1976 by Adelaide Bry. Reprinted by permission of Harper & Row Publishers, Inc.

Maria Nagy, The Childs Theories Concerning Death, Journal of Genetic Psychology (1948) 73:3-27. Reprinted by permission of the author and The Journal Press.

Everyman, in M. Abrams, et al., eds., The Norton Anthology of English Literature, vol. I, pp. 281-303. Copyright 1962. Reprinted by permission of W. W. Norton, Inc.

E. Fromm, D. Suzuki, and R. DeMartino, Zen Buddhism and Psychoanalysis. Copyright 1960. Reprinted by permission of Harper & Row Publishers, Inc.

Forgive, O Lord, from The Poetry of Robert Frost, edited by Edward Connery Lathem. Copyright 1962 by Robert Frost. Copyright 1967 by Holt, Rinehart and Winston. Reprinted by permission of Holt, Rinehart and Winston, Publishers. Four lines from Desert Places, from The Poetry of Robert Frost, edited by Edward Connery Lathem. Copyright 1936 by Robert Frost. Copyright 1964 by Lesley Frost Ballantine. Copyright 1969 by Holt, Rinehart and Winston. Reprinted by permission of Holt, Rinehart and Winston, Publishers.

Purpose in Life Test (PIL) by James C. Crumbaugh and Leonard T. Maholick. Reprinted with permission of James C. Crumbaugh. Published by Psychometric Affiliates, P. O. Box 3167, Munster, Indiana 46321.

V. Frankl, Fragments from the Logotherapeutic Treatment in Four Cases, in A. Burton, ed., Modern Psychotherapeutic Practice (Palo Alto, Calif.: Science Behavior Book, Inc., 1965). Reprinted by permission of Arthur Burton.

O NCE, several years ago, some friends and I enrolled in a cooking class taught by an Armenian matriarch and her aged servant. Since they spoke no English and we no Armenian, communication was not easy. She taught by demonstration; we watched (and diligently tried to quantify her recipes) as she prepared an array of marvelous eggplant and lamb dishes. But our recipes were imperfect; and, try as hard as we could, we could not duplicate her dishes. What was it, I wondered, that gave her cooking that special touch? The answer eluded me until one day, when I was keeping a particularly keen watch on the kitchen proceedings, I saw our teacher, with great dignity and deliberation, prepare a dish. She handed it to her servant who wordlessly carried it into the kitchen to the oven and, without breaking stride, threw in handful after handful of assorted spices and condiments. I am convinced that those surreptitious throw-ins made all the difference.

That cooking class often comes to mind when I think about psychotherapy, especially when I think about the critical ingredients of successful therapy. Formal texts, journal articles, and lectures portray therapy as precise and systematic, with carefully delineated stages, strategic technical interventions, the methodical development and resolution of transference, analysis of object relations, and a careful, rational program of insight-offering interpretations. Yet I believe deeply that, when no one is looking, the therapist throws in the real thing.

But what are these throw-ins, these elusive, off the record extras? They exist outside of formal theory, they are not written about, they are not explicitly taught. Therapists are often unaware of them; yet every therapist knows that he or she cannot explain why many patients improve. The critical ingredients are hard to describe, even harder to define. Indeed, is it possible to define and teach such qualities as compassion, presence, caring, extending oneself, touching the patient at a profound level, orthat most elusive one of allwisdom?