Victor Yalom, son of one of the most influential present-day psychotherapists, Irvin Yalom, talks to Contemporary Psychotherapy about his work as a therapist and publisher. It is not surprising that Victor is often asked about his father but his work has also been hugely influenced by James Bugental. Having taught recently in China, Victor returned home to California inspired by the enthusiasm of the Chinese therapists who attended his workshops. The interview was conducted by Werner Kierski.
What is your current field of work?
Well, I could answer in a couple of ways. Most of my energies these days are geared towards running the magazine and business of www.psychotherapy.net. I’m doing that about eighty percent of the time now and that exposes me to a wide range in the field and many interesting activities and opportunities but I’ve continued to maintain a part–time psychotherapy practice in San Francisco.
I consider myself fortunate in that I work with high functioning, successful, creative sorts. I do a lot of couples therapy, which I really enjoy, and I’ve continued to run one therapy group, which has been going on in various iterations for almost the last twenty years.
How did your leaning more towards publishing and running the website business, with just a small proportion of clinical work, come about?
Yeah, it’s by choice and by evolution and by necessity in a way. I had the great fortune when I finished school to start studying with a very brilliant – probably lesser-known over in the UK and other parts of the world – existential psychologist, James Bugental.
I was part of a group of therapists who studied with him over the course of ten or twelve years. In the midst of this he turned eighty and, although he’s written several groundbreaking and very important books – probably his classic is called The Art of the Psychotherapist which I would encourage anyone to read – I thought his real gift was doing the work.
Was there something special about how he did the work, something that attracted you?
Yes, what he’d been writing about for many, many years was therapeutic presence, helping the client be fully present in the moment and the therapist as well to be present with the client. Mind you, this was well before the current boom of mindfulness and I find it a little disconcerting, although I’m very supportive of the basic principles of mindfulness, that so little credence is given to people like Bugental who have been developing these ideas for decades. His ability to engage with the client in the moment and then to work with what he would refer to as resistance – but a different conception of resistance, not resistance to the therapist or to therapy but resistance to be fully present and alive in the moment – his ability to note that or to bring it to the client’s awareness was superb.
Bugental had such an exquisite talent for this that his work needed to be captured on video to preserve it for future generations, especially as his mental faculties were starting to fail a bit at that time. So we talked about this for years and finally I got together some clients willing to be filmed and produced a video – Existential Humanistic Psychotherapy in Action – of him working with two clients.
The next thing that happened was that he was presenting at a large conference, The Evolution of Psychotherapy . This conference occurs only every five years and, unfortunately, each time some of the grand masters are no longer around. But he was speaking at the time and so I thought I might as well go there and see whether I could sell a few tapes and make back my production costs. I had no plan to start a business but one thing led to another and that’s how I got into the business of producing and distributing psychotherapy training videos; that, in turn, led to a full website where we have content, including articles and interviews with therapists, and cartoons which I draw and the like.
You said that Bugental is not well known but there are a lot of mindfulness approaches around at the moment; why do you think that is?
Well, I think it’s probably typical of what goes on in our field. There are a lot of masterful, in some cases brilliant, practitioners and theorists out there but we tend to keep trying to reinvent the wheel. I don’t think we’re building as much of a cumulative knowledge as we might, or even as is possible.
In other words, although there are some four hundred different therapy models, everybody seems to develop their own approach rather than synthesising and bringing together what already exists?
I’m not sure what to think about that. I’ve heard it said that we have to create a new therapy for each patient we work with. So I think it’s great that there are so many creative approaches, as long as the originators of each approach don’t take themselves too seriously and realize that in most cases they are reworking concepts or ideas or techniques that are not entirely new. I heard Carl Rogers say at one point on a video interview that he was not comfortable with the term ‘Rogerian’; he hadn’t wanted to create a cadre of Rogerian therapists, although he was comfortable with the idea of ‘person-centred’ and contributing some ideas.
Rogerian is a very commonly used term.
Sure, but what he meant is that he didn’t want people trying to copy him – and that’s certainly a criticism you hear of people parroting what is called ‘the Rogerian response’, repeating back the client’s words in a wooden mechanical fashion.
I think the art of the psychotherapist is to learn these various approaches and orientations and find what suits them; after years of work and practice you begin to develop more and more your own voice, you integrate those ideas into what’s congruent with you as a person and as a therapist.
You mentioned therapy masters or very influential therapists and you talked about Bugental; are there other therapists that you consider very influential at the moment?
My father, of course, has greatly influenced my work both in terms of group therapy, which I think continues to be an underutilised but very clinically effective and economically efficient way to treat people, but more important to me – and to many clinicians who have read his works – is his focus on utilising the therapeutic relationship in a here-and-now way. He’s written about this in many different ways, although not in as formal writings as his group therapy or existential psychotherapy texts. And the gist of what he advocates is finding a way to see how the client’s difficulties and issues and symptoms get recreated and re-enacted in the therapeutic relationship, and then finding a way to have discussions about these that are useful for the client. Someone else who has influenced me is Erving Polster, a gestalt therapist I’ve had the opportunity to meet and interview; I have also studied him on video.
Do you find yourself being compared in your work to your father?
Well, of course, I have a rather unusual last name so when people encounter me in the field it usually doesn’t take them long to ask if I’m related to Irvin Yalom and, often within thirty seconds, asking me what it was like to have him as my father; I’m always a little puzzled about how to respond to that.
What do you usually say then?
If I’m in a flippant mood I might say that I can’t give my life story in a fifteen second sound-bite. Growing up, he was my father so he influenced me in many, many ways, and I wouldn’t even know where to begin. Professionally speaking, he’s been a model – not only for some of his theories which I have briefly talked about – but also for his willingness to be quite candid and open, vulnerable and human with clients. This, I think, has been one of his strongest contributions.
One of his first books, which is lesser known, was entitled Every Day Gets a Little Closer; he wrote this probably around 1970, right after his first book on group psychotherapy, and it was quite an innovative and bold thing to do at the time. He had a client who suffered from writer’s block. She had limited funds to pay for treatment and so he made a bargain with her: he said he wouldn’t charge her for therapy but they would write together; after every session they would each write an account of the session and every six months they would exchange accounts with one another.
They ended up publishing their respective accounts of the therapy and his writings and hers were both quite candid. One thing he notes is that their impressions of the same session could be quite divergent. For example, he might have thought that he made a clever therapeutic comment or interpretation, whereas she was most taken by the fact that he commented that her attire looked nice.
Your father’s latest book is on death and dying; does it worry you that he talks about this topic now?
I’ve gotten used to it.
He talks potentially about his own death.
Although I understand you’re originally from Germany, you’re being very polite and British when you say potentially! Or maybe you’re demonstrating what he talks about, which is our reluctance to confront the raw facts of death in a brutally honest manner, when there’s no ‘potential’ about it, since it’s one thing we’re certain of.
And which we try to avoid sometimes.
Right, right. So, no, I’m certainly used to his interest in the concepts of death anxiety and death avoidance and certainly, as he gets older, I’m aware that inevitability will happen sooner rather than later; but so far he’s active and vital and productive.
Over here your father is known as an existential psychotherapist. Bugental works in an existential-humanistic way; is this where you locate your work too?
If I’m forced to pigeon-hole myself, which I’m always reluctant to do, certainly existential, humanistic and interpersonal describe some of the approaches that have most influenced me but I’m always wary when a client asks me what my approach is. I’m a little wary because what those few words would mean to a therapist can be so broadly interpreted and misinterpreted, and for clients even more so. And the other thing research has shown is that how therapists choose to identify themselves, what kind of orientation they hang their hat on, may have little bearing on what they do in the room with the client. I don’t know, if someone took a look at how I worked, I don’t know what they would call it.
You travelled to China to teach?
I recently had this wonderful opportunity to go to Beijing and teach a four-day workshop with a colleague of mine, Don Summers; we introduced existential and humanistic psychotherapy to Chinese therapists. I really did not know what to expect and was a little apprehensive but it was an incredibly rich, exciting and vibrant experience for me. There were about ninety students there, therapists with varying levels of experience, but for the most part therapy is a relatively new phenomenon in China. And what was so wonderful was the level of enthusiasm of the students – something that I don’t experience much in this country.
I would imagine it was like that here before I got into the field. In the heyday of the human potential movement, in the ’70s, the epicentre was in California where I grew up, the San Francisco Bay Area and Esalen in Big Sur. Therapy was not an entirely new thing, but new in terms of being made more available on a large scale basis in society, and there were new orientations springing up left and right: gestalt therapy, person-centred, and a multitude of other approaches. There was a vibrancy and people were going to workshops and going to retreats at Esalen with Fritz Perls and the like not because they needed continuing education credit but because they wanted to learn and wanted to experience. Now, unfortunately, there’s a professionalism in the field and people go to workshops it seems more because they have to fulfil their CE [CPD] credits. Of course, that’s not universally the case but I had the sense in China that this was so new, that people were so eager to learn.
One of the hallmarks of my father’s approach in group psychotherapy is to lead the group as much as possible in the here-and-now and by that he means specifically getting people to engage with each other, share their immediate reactions with each other; the theory is that inner personal difficulties and challenges that they’re facing in their lives will be recreated in the group interactions. We led these types of groups in China. Usually it takes considerable effort to get clients to work in the here-and-now interactive mode – one of the group therapist’s main jobs is to keep directing clients in that manner and to help develop the culture where the group begins to do that on its own - and we were just astounded that the therapists in China were willing to engage immediately with one another in this manner.
This kind of belies some of the stereotypes we might have about Asian cultures being less willing to relate on a direct emotional level. It’s not at all the case and by the end of the workshop we had them lead a couple of demonstration groups so they acted as therapists; I was planning to act as a consultant to the group but I had to do very little. The therapists, after observing for a few days, were able to lead a group that was almost one hundred percent operating in the here-and-now – something I never achieve running groups on my own here in California. So that was quite phenomenal.
Did you have to change the way you normally work with Western clients and Western groups?
No, not at all. Not that there are not huge cultural differences in the world but I think there’s a commonality in the human spirit; I think our desires and longings and fears really transcend culture. I noticed some differences in just the group dynamics: combined with their eagerness to learn there was a willingness to express all sorts of feelings and opinions. During the breaks people were so enthusiastic they were standing in line waiting either to take our pictures or to give us some feedback, whether it was “this is fantastic, this is going to change the way I work” or “I need to give you some feedback, this morning the lecture was a little bit dull”.
They wanted to give feedback no matter what it was and I was a little taken aback at times. When I asked one of the senior therapists there what his thoughts were on this phenomenon, he offered the idea that it’s not as common in Chinese culture for people to be able to express their opinions so freely. Being in this workshop kind of gave them carte blanche to be more frank than ever, but it was quite refreshing.
Are you planning to go back to China?
I’ve no definite plans but, judging by how we were received, I would certainly welcome the opportunity to return.
And are you planning any workshops in Europe or, particularly, in the UK?
In November I gave a talk at an existential conference in Mexico City and in a few weeks I’m giving a talk at a conference in Washington State but I don’t have anything set overseas right now.
So maybe we could explore possibilities here in the UK?
I have a warm spot in my heart for London. My father brought our family to London in 1967–68; he had a sabbatical from Stanford and ended up situating himself at the Tavistock Clinic in London during that year and that’s actually where he wrote his first book, The Theory and Practice of Group Psychotherapy. We lived in Hampstead and I went to a State school there, as it’s called in the UK, and for someone who had grown up in the suburbs, to be able to walk to school and walk to shops and take the tube, it was just a wonderful year. I was back in the UK in 2004 and had a chance to visit the old house where I lived and walk around. So I love London.
What would you recommend to people who are about to embark on a career as a psychotherapist?
I would recommend a number of things. Don’t get pigeon-holed in terms of your training or your orientation. Expose yourself to as many teachers and supervisors and personal therapists as possible. One of the most powerful ways I think we learn is to be in personal therapy, to be able to have the experience of how therapy works from the client’s perspective, to be able to observe first-hand how another therapist operates, and how it can really make a change in one’s life. I think there is no better teacher than a good personal therapist.
You could say that about almost anything: whether you’re learning to paint or you’re studying history at university, find teachers who move and inspire you and then don’t be afraid to take risks. One thing that really interests me these days is the creative aspect of being a therapist; when you talk to therapists and find out what they’re like and what interests them in their life, there’s a high percentage who are engaged in artistic pursuits on the side. But I think far too often we don’t bring our creative spirit into the therapy sessions. I think we get very stuck in our ways: we sit in the therapist’s chair, we stick to a forty-five or fifty-minute schedule and we have certain things in our brain about what a therapist should be like and what our professional boundaries should be like. I think this inhibits us greatly from experimenting with different approaches that could be helpful to clients.
You have given this wonderful example from your father – when he worked with the client who had writer’s block and suggested that they both write about the therapy afterwards. That sounds to me like a fantastic example of a creative approach, to accommodate one particular client.
Right, and as I have a chance to interview many therapists, as you’re doing, I find one of the things that makes them great therapists is their willingness to take risks, to try very different things with different clients. One example comes to mind. Some friends of mine presented at a yearly therapy workshop; they were sharing their own experience, as a couple in therapy, of being deadlocked in a struggle about whether or not they should have children: one of them very much wanted to have children and the other very much did not. They described how their couples therapist gave them a homework assignment – not a typical homework assignment that you would do in a week, but a year-long homework assignment. For some reason, as I relate this story I become moved; I guess because I am thinking about the seriousness of the task at hand that they were facing, the monumental importance of the decision for them to bring a child into the world – or not.
So the homework assignment reflected the seriousness of that decision and the therapist instructed the man, the father – well, he was not the father yet – to spend a full year to talking to people and really exploring the downside of having children. Really exploring it by talking to his friends and observing all the reasons why his partner’s position had some merit to it. And, likewise, the wife for her to explore all the reasons that she might want to have children, all the wonderful things about having children. So they could spend a year really understanding each other’s position.
That was some deep research, over a year.
And the result was they finally decided to have a child and it’s been a wonderful thing for them but I was just struck by what a creative approach that therapist took. It’s not something you’ll get in a manual, and it might not be something that would apply to any other patient or any other couple. It’s a craft, it’s an art and you gain confidence and mastery over years in seeing dozens and hundreds of clients; I also think you gain maturity as a person, you know yourself better and you know what you can do and what you can’t do and you work with that and, as you’re more comfortable with yourself, you’re able to reveal more about yourself and bring more of your person into your work.
Bring in more of yourself….
Yeah, but show more of your own person, your vulnerability.
And in that way act a little bit like a role model, not just as a therapist who knows it all?
Yes, exactly. So I think, yes, part of what we call boundaries, or holding back, is maybe a way to protect neophyte therapists from feeling the need to expose themselves. When you’re in your twenties and thirties you’re still working out a lot of things about life and about yourself – that just seems to be the way it is. Of course, we continue to do that but I think for many people as they grow into middle age – maybe I’m just saying this because I’m turning fifty next month – but I think as you mature you get more comfortable with the different parts of yourself and in doing that you feel able to be authentic and real with clients and I think you do them a service by doing so.
Thank you very much Victor.
Dr. Werner Kierski is the editor-in-chief of Contemporary Psychotherapy. He is a psychotherapist, lecturer and tutor.
Victor Yalom, Ph.D. is the founder and president of www.Psychotherapy.net, which publishes psychotherapy videos, articles, psychotherapy interviews, and continuing education (CPD). Info on his private practice is at sfpsychologist.com.