Category: Irvin Yalom

Looking Out the Patient’s Window Redux: Self-disclosure and Genuineness

Posted on by Psychotherapy.net Team

Nancy

In my fifteen-minute break—before seeing Nancy, my last patient of the day—I checked my voice mail and listened to a message from a San Francisco radio station. "Dr. Yalom, hope you don't mind but we've decided to change the format of our program tomorrow morning: We've invited another psychiatrist to join us and, instead of an interview, we'll have a three-way discussion. See you tomorrow morning at eight thirty. I assume this is all okay with you."

Okay? It wasn't okay at all and the more I thought about it the less okay it felt. I had agreed to be interviewed on the radio show in order to publicize my new book, The Gift of Therapy. Though I'd been interviewed many times, I felt anxious about this interview. Though the interviewer was extremely skilled, he was highly demanding. Furthermore, it was an hour long, the size of the radio audience was enormous and, finally, it was in my hometown with many friends listening. This voice mail message further fueled my anxiety. I didn't know the other psychiatrist; but to juice up the interview they had, no doubt, invited someone with an opposing point of view. I brooded about it: The last thing I, or my book, needed was an hour-long hostile confrontation in front of a hundred thousand listeners. I phoned back but there was no answer.

I was not in a good frame of mind to see a patient but the hour struck six and I escorted Nancy into my office. Nancy, a fifty-year-old nursing school professor, first came to see me twenty years before following the death of her older sister who had died of a brain malignancy. I remember how she began: "Eight sessions. That's all I want. No more, no less. I want to talk about the loss of the dearest and closest person in my life. And I want to figure how to make sense of life without her." Those eight sessions clicked by quickly: Nancy brought an agenda to each session: important memories of her sister, their three fights—one of which initiated a frosty silent four-year era which only ended at the funeral of their mother, her sister's disapproval of her boyfriends, her deep love for her sister—a love she had never expressed openly. “Her family was a family of secrets and silences; feelings, especially positive ones, were rarely voiced.”

Nancy was smart and quick: A self-starter in therapy, she worked hard and appeared to want or need little input from me. At the end of the tenth session she thanked me and left, a satisfied customer. I wasn't entirely satisfied, however. I would have preferred more ambitious therapy and I had spotted several areas, especially in the realm of intimacy, where further work could have been done. Over the next twenty years she called me two other times for brief therapy and, repeating the same pattern, used the time efficiently. And then, a few months ago, she phoned once again and asked to meet for a longer time, perhaps six months, in order to work on some significant marital problems.

She and her husband, Arnold, had grown increasingly distant from one another and for many years had slept in different rooms on separate floors of their home. We had been meeting weekly for a few months and she had so improved her relationship with her husband and her adult children that, a couple of weeks previously, I had raised the question of termination. She agreed she was getting close but requested a few additional sessions to deal with one additional problem that had arisen: stage fright. She was awash with anxiety about an upcoming lecture to a large prestigious audience.

As soon as Nancy and I sat down she plunged immediately into anxiety about her upcoming lecture. I welcomed her energy: it diverted my attention from that damn radio show. She spoke of her insomnia, her fears of failure, her dislike of her voice, her embarrassment about her physical appearance. I knew exactly what to do and began to escort her down a familiar therapeutic path: I reminded her of her mastery of her material, that she knew far more about her topic than anyone in the audience. Though I was distracted by my own anxiety, I was able to remind her that she had always sparkled as a lecturer and was on the verge of pointing out the irrationality of her views of her voice and physical appearance when a wave of queasiness swept over me.

How hypocritical could I be? Hadn't my therapy mantra always been "it's the relationship that heals, it's the relationship that heals." Hadn't I always, in my writing and teaching, beat the drum of authenticity? “The solid, genuine, I-thou relationship—wasn't that the ticket, the significant ingredient in successful therapy?” And yet here I was—riddled with anxiety about that radio show and yet hiding it all behind my pasted-on compassionate therapist countenance. And with a patient who had almost identical concerns. And a patient who wanted to work on intimacy to boot! No, I could not continue with this hypocrisy.

So I took a deep breath and fessed up. I told her all about the voice mail message I received just before she entered and about my anxiety and anger for my dilemma. She listened intently to my words and then, in a solicitous voice, asked, "What are you going to do?"

"I'm considering refusing to go on the program if they insist on this new arrangement."

"Yes, that seems very reasonable to me," she said, "you agreed to another format entirely and the station has no right to make the change without clearance from you. I'd be really upset about that, too. Is there any downside of your refusing?"

"None that I can think of. Perhaps I won't be invited back for the next book but who knows when or if I'll write another."

"So, no downside of refusing and lots of possible downside in your agreeing to do this?"

"Seems that way. Thanks Nancy, that's helpful."

We sat together in silence for a few moments and I asked, "Before we turn back to your stage fright, let me ask you something: How did that feel to you? This has not been our everyday hour."

"I liked your doing that. It was very important to me," she replied, paused for a moment to collect her thoughts and added, "I have a lot of feelings about it. Honored that you shared so much of your self with me. And ‘normalized': Your performance anxiety makes me more accepting of my own. And I think your openness will be contagious. I mean, you've given me the courage to talk about something I didn't think I'd be able to bring up."

"Great. Let's get into it."

"Well," Nancy looked uncomfortable and squirmed in her chair. She inhaled and said, "Well, here goes . . ."

I sat back in my chair, eager with anticipation. It was like waiting for the curtain to rise on a good drama. One of my great pleasures. A good story in the wings ready to make an entrance is like no other anticipatory pleasure I know. And my anxiety and annoyance at the interview and the radio station? What interview? What radio station? I had totally forgotten it. The power of the narrative drowned all cares.

"Your mentioning your book, The Gift of Therapy, gives me the opportunity to tell you something. A couple of weeks ago I read the whole book in a single sitting, till three a.m." She paused.

"And?" I shamelessly fished for a compliment.

"Well, I liked it but I was . . . uh, curious, about your using my story of the two streams."

"Your story of the two streams? Nancy, that was someone else's story, a woman dead these many years—I described her in the book. I've used that story in therapy and teaching for more years than I can remember."

"No, Irv. It was my story. I told it to you during our first therapy, twenty years ago."

I shook my head. I knew it was Bonnie's story. Why, I could still visualize Bonnie's face as she told me the story, I could see her wistful eyes as she reminisced about her father, I could still see the violet turban around her head—she had lost her hair from chemotherapy.

"Nancy, I can still see this woman telling me the story, I can . . ."

"No, it was my story," Nancy said firmly. "And what's more, it wasn't even my father and me. It was my father and my aunt, his younger sister. And it wasn't on the way to college—it was a vacation they took in France."

I sat stunned. Nancy was a very precise person. The strength of her assertion caught my attention. I turned inwards searching for the truth, listening to the trickling of memory coursing in from outposts of my mind. It was an impasse: Nancy was certain she told me this. I was absolutely certain I heard it from Bonnie. But I knew I had to remain open-minded. One of Nietzsche's marvelous aphorisms entered my mind and served as a cautionary tale: “"Memory says, I did that. Pride replies, I could not have done that. Eventually memory yields."”

As Nancy and I continued to talk, a new and astounding thought dawned. Oh, my God, could there have been two stories? Yes, yes, that's it. There must have been! The first story was Bonnie's story about her father, her yearning for reconciliation, and their unsuccessful drive to college; the second story was Nancy's two-stream story about her father and aunt. Now, all at once, I realized exactly what had happened: My gestalt-hungry, story-seeking memory had conflated the two stories into a single event.

It's always a shock to experience the fragility of memory. I've worked with many patients who have been destabilized when they learned that their past was not what they had thought it was. I remember one patient whose wife told him (at the breakup of their marriage) that, throughout their three-year marriage, she had been obsessed with another man, her previous lover. He was shattered: All those shared memories (romantic sunsets, candlelit dinners, walks on the beaches of small Greek islands) were chimerical. His wife was not there at all. She was obsessing about someone else. He told me more than once that he suffered more from losing his past than from losing his wife. I didn't fully understand that at the time but now, as I sat with Nancy, I could finally empathize with him and appreciate how unsettling one feels when the past decomposes.

“The past: wasn't it a concrete entity, unforgettable events etched indelibly into stone-like leaves of experience? How tightly I clung to that solid view of existence.” But I knew now, I really knew, the fickleness of memory. Never again would I ever doubt the existence of false memories! What made it even more confounding was the way I had embroidered the false memory (for example, the wistful look on Bonnie's face) which made it entirely indistinguishable from a real memory. All of these things I said to Nancy along with my apology for not having obtained her permission for the story of the two streams. Nancy was untroubled by the issue of permission. She had written science fiction stories and was well aware of the blurring of remembrance and fiction. She instantaneously accepted my apology for publishing something of hers without her permission and then added that she liked her story being used. She took pride in it having prove helpful to my students and other patients.

Her acceptance of my apology left me in a mellow mood and I told her of a conversation a few hours previously with a visiting Danish psychologist. He was writing an article about my work for a Danish psychology journal and asked whether my intense closeness with patients made it more difficult for them to terminate. "Given the fact that we're near termination, Nancy, let me pose that very question to you. Is it true that our closeness interferes with your ending your meetings with me?"

She thought about it for a long time before responding, "I agree. I do feel close to you, perhaps as close as with any other person in my life. But your phrase, that therapy is a dress rehearsal for life, which you said so many times—I think you overdid it by the way . . . well, that phrase helped keep things in perspective. No, I'm going to be able to stop soon and keep a lot from here inside me. From day one of our last set of meetings you did keep focusing on my husband. You did keep focusing on our relationship, but scarcely an hour passed without your moving over to the intimacy between me and Arnold."

Nancy ended the hour by giving me a lovely dream (remember Nancy and Arnold slept in separate rooms).

"I was sitting on Arnold's bed. He was in the room and watching me. I didn't mind his being there and was busy with makeup. I was taking off a makeup mask, peeling it off in front of him."

The dream-maker inside of us (whoever, wherever, he or she is) has many constrictions in the construction of the finished product. One of the major constrictions faced is that the dream final product must be almost entirely visual. Hence, an important challenge in the dream work is to transform abstract concepts into a visual representation. What better way to depict increased openness and trust with one's spouse than to peel off a mask?

Discussion

Let's review the major points conveyed in this vignette. First, let's consider my self-disclosure of my personal anxiety evoked by an event that occurred just before the start of the therapy hour. Why choose to share this? First, there was the consideration of genuineness. I felt too phony, inauthentic, sitting on my anxiety while trying to help her deal with anxiety about a very similar issue. Second, there is the matter of effectiveness: I believe that my preoccupation with my personal issues was hampering my ability to work effectively. Third, there is the factor of role modeling. My experience over decades of doing therapy is that such revelation inevitably catalyzes patient revelation and accelerates therapy.

After my self-revelation there was, for a few minutes, a role reversal as Nancy offered me effective counsel. I thanked her and then initiated a discussion of our relationship by commenting that something unusual had just happened. (In the language of therapists, I did a "process check.") Earlier I made the point that therapy is, or should be, an alternating sequence of action and then reflection upon that action.

Her response was highly informative. First, she felt honored by my sharing my issues with her—that I would treat her as an equal and accept her counsel. Second, she felt "normalized"—that is, my anxiety made her more accepting of her own. Last, my revealing served as a model and an impetus for her further revealing. Research confirms that therapists who model personal transparency influence their patients to reveal more of themselves.

Nancy's response to my disclosure is, in my clinical experience, typical. For a great many years I have worked with patients who have had an unsatisfactory prior experience in therapy. What are their complaints? Almost invariably, they say that their previous therapist was too distant, too impersonal, too disinterested. “I believe that therapists have everything to gain and nothing to lose by appropriate self-disclosure.”

How much should therapists reveal? When to reveal? When not? The guiding in answering such questions is always the same: What is best for the patient? Nancy was a patient I had known for a long time and I had a strong intuition that my genuineness would facilitate her work. Timing was an important factor as well: Self-disclosure early in therapy, before we established a good working alliance, might have been counterproductive. The session with Nancy was an atypical session and I do not generally reveal my own personal disquiet to my patients: After all, we therapists are there to help, not to deal with our own internal conflicts. If we face personal problems of such magnitude that they interfere with therapy then obviously we should be seeking personal therapy.

That said, let me add that on countless occasions I have gone into a session troubled with some personal issues and, by the end of the session (without having mentioned a word about my discomfort), felt remarkably better! I've often wondered why that was so. Perhaps because of the diversion from my self-absorption, or the deep pleasure of being helpful to another, or the boost in self-regard from effectively employing my professional expertise, or the effect of increased connectivity that all of us want and need. This effect of therapy helping the therapist is, in my experience, even greater in group therapy. All of the reasons noted above are in effect but there is an additional factor in group therapy: A mature, caring therapy group in which members share their deepest inner concerns has a healing ambiance in which I have the privilege of immersing myself. 

Staring at the Sun: Overcoming the Terror of Death

Posted on by rezendevknowfully.com

THE MORTAL WOUND (from chapter 1)

Self-awareness is a supreme gift, a treasure as precious as life. This is what makes us human. But it comes with a costly price: the wound of mortality. Our existence is forever shadowed by the knowledge that we will grow, blossom, and, inevitably, diminish and die.

Mortality has haunted us from the beginning of history. Four thousand years ago, the Babylonian hero Gilgamesh reflected on the death of his friend Enkidu with the words from the epigraph above: “Thou hast become dark and cannot hear me. When I die shall I not be like Enkidu? Sorrow enters my heart. I am afraid of death.”

Gilgamesh speaks for all of us. As he feared death, so do we all—each and every man, woman, and child. For some of us the fear of death manifests only indirectly, either as generalized unrest or masqueraded as another psychological symptom; other individuals experience an explicit and conscious stream of anxiety about death; and for some of us the fear of death erupts into terror that negates all happiness and fulfillment.

For eons, thoughtful philosophers have attempted to dress the wound of mortality and to help us fashion lives of harmony and peace. As a psychotherapist treating many individuals struggling with death anxiety, I have found that ancient wisdom, particularly that of the ancient Greek philosophers, is thoroughly relevant today.

Indeed, in my work as a therapist, I take as my intellectual ancestors not so much the great psychiatrists and psychologists of the late nineteenth and early twentieth centuries—Pinel, Freud, Jung, Pavlov, Rorschach, and Skinner—but classical Greek philosophers, particularly Epicurus. The more I learn about this extraordinary Athenian thinker, the more strongly I recognize Epicurus as the proto-existentialist psychotherapist, and I will make use of his ideas throughout this work.

. . . Had I been a citizen of ancient Athens circa 300 B.C.E.(a time often called the golden age of philosophy) and experienced a death panic or a nightmare, to whom would I have turned to clear my mind of the web of fear? It’s likely I’d have trudged off to the agora, a section of ancient Athens where many of the important schools of philosophy were located. I’d have walked past the Academy founded by Plato, now directed by his nephew, Speucippus; and also the Lyceum, the school of Aristotle, once a student of Plato, but too philosophically divergent to be appointed his successor.

I’d have passed the schools of the Stoics and the Cynics and ignored any itinerant philosophers searching for students. Finally, I’d have reached the Garden of Epicurus, and there I think I would have found help. Where today do people with unmanageable death anxiety turn? Some seek help from their family and friends; others turn to their church or to therapy; still others may consult a book such as this. I’ve worked with a great many individuals terrified by death. I believe that the observations, reflections, and interventions I’ve developed in a lifetime of therapeutic work can offer significant help and insight to those who cannot dispel death anxiety on their own.

. . . Why, you may ask, take on this unpleasant, frightening subject? Why stare into the sun? Why not follow the advice of the venerable dean of American psychiatry, Adolph Meyer, who, a century ago, cautioned psychiatrists, “Don’t scratch where it doesn’t itch”? Why grapple with the most terrible, the darkest and most unchangeable aspect of life? Indeed, in recent years, the advent of managed care, brief therapy, symptom control, and attempts to alter thinking patterns have only exacerbated this blinkered point of view.

Death, however, does itch. It itches all the time; it is always with us, scratching at some inner door, whirring softly, barely audibly, just under the membrane of consciousness. Hidden and disguised, leaking out in a variety of symptoms, it is the wellspring of many of our worries, stresses, and conflicts.

I feel strongly—as a man who will himself die one day in the not-too-distant future and as a psychiatrist who has spent decades dealing with death anxiety— that confronting death allows us, not to open some noisome Pandora’s box, but to reenter life in a richer, more compassionate manner.

So I offer this book optimistically. I believe that it will help you stare death in the face and, in so doing, not only ameliorate terror but enrich your life.

OVERCOMING DEATH TERROR THROUGH CONNECTION (from Chapter 5)

THE POWER OF PRESENCE

One can offer no greater service to someone facing death (and from this point on I speak either of those suffering from a fatal illness or physically healthy individuals experiencing death terror) than to offer him or her your sheer presence.

The following vignette, which describes my attempt to assuage a woman’s death terror, provides guidelines to friends or family members offering aid to one another.

Reaching Out to Friends: Alice

Alice—the widow whose story I told in Chapter Three, who was distressed at having to sell her home and her memory-laden collection of musical instruments—was on the verge of moving into a retirement community. Shortly before her move, I left town for a few days’ vacation and, knowing this would be a difficult time for her, gave her my cell phone number in case of an emergency. As the movers began to empty her house, Alice experienced a paralyzing panic that her friends, physician, and massage therapist could not quell. She phoned me, and we had a twenty-minute talk:

“I can’t sit still,” she began. “I’m so edgy I feel I’m going to burst. I cannot find relief.”

“Look straight into the heart of your panic. Tell me what you see.”

“Ending. Everything ending. That’s all. The end of my house, all my things, my memories, my attachments to my past. The end of everything. The end of me—that’s the heart of it. You want to know what I fear. It’s simple: it’s no more me!”

“We’ve discussed this in other meetings, Alice, so I know I’m repeating myself, but I want to remind you that selling your house and moving to a retirement home is an extraordinary trauma, and of course you’re going to feel major dislocation and major shock. I would feel that way if I were in your place. Anyone would. But remember our talks about how it will look if you fast-forward to three weeks from now—”

“Irv,” she interrupted, “that doesn’t help—this pain is too raw. This is death surrounding me. Death everywhere. I want to scream.”

“Bear with me, Alice. Stay with me—I’m going to ask that same simplistic question I’ve asked before: what precisely is it about death that so frightens you? Let’s hone in on it.”

 “We’ve gone over this.” Alice sounded irritated and impatient.

“Not enough. Keep going, Alice. Humor me, please. Come on, let’s get to work.”

“Well, it’s not the pain of dying. I trust my oncologist; he will be there when I need morphine or something. And it has nothing to do with an afterlife—you know I let go of all that stuff a half century ago.”

“So it’s not the act of dying and not the fear of an afterlife. Keep going. What is it about death that terrifies you?”

“It’s not that I feel unfinished; I know I’ve had a full life. I’ve done what I’ve wanted to do. We’ve gone over all this.”

“Please keep going, Alice.”

“It’s what I just said: no more me. I just don’t want to leave this life . . . I’ll tell you what it is: I want to see the endings. I want to be here to see what happens to my son—will he decide to have children after all. It’s painful to realize I won’t ever be able to know.”

“But you won’t know you’re not here. You won’t know you won’t know. You say you believe (as I do) that death is complete cessation of consciousness.”

“I know, I know, you’ve said it so many times that I know the whole litany by heart: the state of nonexistence is not terrifying because we won’t know we are not existing, and so on and so on. And that means I won’t know that I am missing important things. And I remember also what you’ve already said about the state of nonbeing—that it’s identical to the state I was in before I was born. It helped before, but it just doesn’t help now—this feeling is too strong, Irv—ideas won’t crack it; they won’t even touch it.”

“Not yet they won’t. That only means we have to keep going, keep figuring it out. We can do it together. I’ll be in there with you and help you go as deep as you can.”

“It’s gripping terror. There is some menace I cannot name or find.”

“Alice, at the very base of all our feelings about death there is a biological fear that is hardwired into us. I know this fear is inchoate—I’ve experienced it too. It doesn’t have words. But every living creature wishes to persist in its own being—Spinoza said that around 350 years ago. We just have to know this, expect it. The hardwiring will zap us with terror from time to time. We all have it.”

After about twenty minutes, Alice sounded calmer, and we ended the call. A few hours later, however, she left a curt phone message telling me that the phone session felt like a slap in the face and that I was cold and unempathic. Almost as a postscript she added that, unaccountably, she felt better. The following day she left another message saying that her panic had entirely subsided—again, she said, for reasons unknown.

Now, why was Alice helped by this conversation? Was it the ideas I presented? Probably not. She dismissed my arguments from Epicurus—that, with her consciousness extinguished, she wouldn’t know that she’d never find out how the stories of people close to her ended, and that after death she would be in the same state as she was before her birth. Nor did any of my other suggestions—for example, that she project herself three weeks into the future to gain some perspective on her life—have any impact whatsoever. She was simply too panicky. As she put it, ““I know you’re trying, but these ideas won’t crack it; they don’t even touch what’s here—this anguished heaviness in my chest.””

So ideas didn’t help. But let’s examine the conversation from the perspective of relationship. First, I spoke to her on my vacation, thereby indicating my full willingness to be involved with her. I said, in effect, let’s you and I keep working on this together. I didn’t shrink from any aspect of her anxiety. I continued inquiring into her feelings about death. I acknowledged my own anxiety. I assured her that we were in this together, that she and I and everyone else are hardwired to feel anxious about death.

Second, behind my explicit offer of presence, there was a strong implicit message: “No matter how much terror you have, I will never shun or abandon you.” I was simply doing what the housemaid, Anna, did in Cries and Whispers. I held her, stayed with her.

Although I felt fully involved with her, I made sure that I kept her terror contained. I did not permit it to be contagious. I maintained an unruffled, matter-of-fact tone as I urged her to join me in dissecting and analyzing the terror. Although she criticized me the following day for being cold and unempathic, my calmness nonetheless steadied her and helped allay her terror.

“The lesson here is simple: connection is paramount. Whether you are a family member, a friend, or a therapist, jump in.” Get close in any way that feels appropriate. Speak from your heart. Reveal your own fears. Improvise. Hold the suffering one in any way that gives comfort.

Once, decades ago, as I was saying goodbye to a patient near death, she asked me to lie next to her on her bed for a while. I did as she requested and, I believe, offered her comfort. Sheer presence is the greatest gift you can offer anyone facing death (or a physically healthy person in a death panic).

SELF-DISCLOSURE

A great deal of a therapist’s training, as I’ll discuss in Chapter Seven, focuses on the centrality of connection. An essential part of that training should, in my opinion, focus on the therapist’s willingness and ability to increase connection through his or her own transparency. Because many therapists have trained in traditions that stress the importance of opaqueness and neutrality, friends willing to reveal themselves to one another may, in this regard, have an advantage over professional therapists.

In close relationships, the more one reveals of one’s inner feelings and thoughts, the easier it is for others to reveal themselves. Self-disclosure plays a crucial role in the development of intimacy. Generally, relationships build by a process of reciprocal self-revelations. One individual takes the leap and reveals some intimate material, thereby placing himself or herself at risk; the other closes the gap by reciprocating in kind; together, they deepen the relationship via a spiral of self-revelation. If the person at risk is left hanging without the other reciprocating, then the friendship often flounders.

The more you can be truly yourself, can share yourself fully, the deeper and more sustaining the friendship. In the presence of such intimacy, all words, all modes of comfort, and all ideas take on greater meaning.

Friends must keep reminding one another (and themselves) that they, too, experience the fear of death. Thus, in my conversation with Alice, I included myself in discussions of death’s inevitability. Such disclosure is not high risk: it is merely making explicit what is implicit. After all, we are all creatures who are frightened at the thought of “no more me.” We all face the sense of our smallness and insignificance when measured against the infinite extent of the universe (sometimes referred to as the “experience of the tremendum”). Each of us is but a speck, a grain of sand, in the vastness of the cosmos. As Pascal said in the seventeenth century, “the eternal silence of infinite spaces terrifies me.” The need for intimacy in the face of death is heartbreakingly described in a recent rehearsal of a new play, Let Me Down Easy, by Anna Deavere Smith. In this play, one of the characters portrayed was a remarkable woman who cared for African children with AIDS. Little help was available at her shelter. Children died every day. When asked what she did to ease the dying children’s terror, she answered with two phrases: “I never let them die alone in the dark, and I say to them, ‘You will always be with me here in my heart.’”

Even for those with a deeply ingrained block against openness—those who have always avoided deep friendships—the idea of death may be an awakening experience, catalyzing an enormous shift in their desire for intimacy and their willingness to make efforts to attain it. Many people who work with dying patients have found that those who were previously distant become strikingly and suddenly accessible to deep engagement.

RIPPLING IN ACTION

As I explained in the previous chapter, the belief that one may persist, not in one’s individual personhood, but through values and actions that ripple on and on through generations to come can be a powerful consolation to anyone anxious about his or her mortality.

Alleviating the Loneliness of Death

Although Everyman, the medieval morality play, dramatizes the loneliness of one’s encounter with death, it may also be read as portraying the consoling power of rippling. A theatrical crowd pleaser for centuries, Everyman played in front of churches before large throngs of parishioners. It tells the allegorical tale of Everyman, who is visited by the angel of death and learns that the time of his final journey has arrived.

Everyman pleads for a reprieve. “Nothing doing,” replies the angel of death. Then another request: “Can I invite someone to accompany me on this desperately “lonely journey?” The angel grins and readily agrees: “Oh, yes—if you can find someone.”

The remainder of the play consists of Everyman’s attempts to recruit someone to be his companion on the journey. Every friend and acquaintance declines; his cousin, for example, is indisposed by a cramp in her toe. Even metaphorical figures (Worldly Goods, Beauty, Strength, Knowledge) refuse his invitation. Finally, as he resigns himself to his lonely journey, he discovers one companion, Good Deeds, who is available and willing to accompany him, even unto death.

Everyman’s discovery that there is one companion, Good Deeds, who is able to accompany him is, of course, the Christian moral of this morality play: that you can take with you from this world nothing that you have received; you can take only what you have given. A secular interpretation of this drama suggests that rippling—that is, the realization of your good deeds, of your virtuous influence on others that persists beyond yourself—may soften the pain and loneliness of the final journey.

The Role of Gratitude

Rippling, like so many of the ideas I find useful, assumes far more power in the context of an intimate relationship where one can know at first hand how one’s life has benefited someone else. Friends may thank someone for what he or she has done or meant. But mere thanks is not the point. The truly effective message is, “I have taken some part of you into me. It has changed and enriched me, and I shall pass it on to others.”

Far too often, gratitude for how a person has sent influential ripples out into the world is expressed not when the person is still alive but only in a posthumous eulogy. How many times at funerals have you wished (or overheard others express the wish) that the dead person were there to hear the eulogies and expressions of gratitude? “How many of us have wished we could be like Scrooge and eavesdrop on our own funeral?” I have. One technique for overcoming this “too little, too late” problem with rippling is the “gratitude visit,” a splendid way to enhance rippling when one is alive. I first came upon this exercise at a workshop conducted by Martin Seligman, one of the leaders of the positive psychology movement. He asked a large audience to participate in an exercise that, as I recall, went along these lines:

Think of someone still living toward whom you feel great gratitude that you have never expressed. Spend ten minutes writing that person a gratitude letter and then pair up with someone here, and each of you read your letter to the other. The final step is that you pay a personal visit to that person sometime in the near future and read that letter aloud.

After the letters were read in pairs, several volunteers were selected from the audience to read their letters aloud to the entire audience. Without exception, each person choked up with emotion during the reading. I learned that such displays of emotion invariably occur in this exercise: very few participants get through the reading without being swept by a deep emotional current. I did the exercise myself and wrote such a letter to David Hamburg, who had been a superbly enabling chairman of the Department of Psychiatry during my first ten years at Stanford. When I next visited New York, where he lived at this time, we spent a moving evening together. I felt good expressing my gratitude, beamed with pleasure when reading my letter. As I age, I think more and more about rippling. As a paterfamilias, I always pick up the check when my family dines at a restaurant. My four children always thank me graciously (after offering only feeble resistance), and I always say to them, “Thank your grandfather Ben Yalom. I’m only a vessel passing on his generosity. He always picked up the check for me.” (And I, by the way, also offered only feeble resistance.)

Rippling and Modeling

In the first group I led for patients with terminal cancer, I often found the members’ despondency contagious. So many members were in despair; so many waited day after day listening for the approaching footsteps of death; so many claimed that life had become empty and stripped of all meaning. And then, one fine day, a member opened our meeting with an announcement: “I have decided that there is, after all, something that I can still offer. I can offer an example of how to die. I can set a model for my children and my friends by facing death with courage and dignity.”

It was a revelation that lifted her spirits, and mine, and those of the other members of the group. She had found a way to imbue her life, to its very end, with meaning.

The phenomenon of rippling was evident in the cancer group members’ attitude toward student observers. It is vital for the education of group therapists that they observe experienced clinicians leading groups, and I have usually had students observing my groups, sometimes using TV monitors but generally through a one-way mirror. Although groups in educational settings give permission for such observation, the group members generally grumble about the observers and, from time to time, openly voice resentment at the intrusion.

Not so with my groups of cancer patients: they welcomed observers. They felt that as a result of their confrontation with death, they had grown wise and had much to pass on to students and regretted only, as I mentioned earlier, that they had waited so long to learn how to live.

Note: Signed copies of Staring at the Sun and other Ivin Yalom books are available here.

The Gift of Therapy

Posted on by Psychotherapy.net Team

The Gift of Therapy has 85 short chapters, each offering a suggestion or tip for therapy. The first three chapters are reproduced here.

Remove the Obstacles to Growth

When I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney's Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree.

"Just as an acorn develops into an oak." What a wonderfully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient's path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient.

I remember a young widow with, as she put it, a "failed heart"—an inability ever to love again. It felt daunting to address the inability to love. I didn't know how to do that. But dedicating myself to identifying and uprooting her many blocks to loving? I could do that.

I soon learned that love felt treasonous to her. To love another was to betray her dead husband; it felt to her like pounding the final nails in her husband's coffin. To love another as deeply as she did her husband (and she would settle for nothing less) meant that her love for her husband had been in some way insufficient or flawed. To love another would be self-destructive because loss, and the searing pain of loss, was inevitable. To love again felt irresponsible: she was evil and jinxed, and her kiss was the kiss of death.

We worked hard for many months to identify all these obstacles to her loving another man. For months we wrestled with each irrational obstacle in turn. But once that was done, the patient's internal processes took over: she met a man, she fell in love, she married again. I didn't have to teach her to search, to give, to cherish, to love. I wouldn't have known how to do that.

Avoid Diagnosis (except for insurance companies)

Today's psychotherapy students are exposed to too much emphasis on diagnosis. Managed care administrators demand that therapists arrive quickly at a precise diagnosis and then proceed upon a course of brief, focused therapy that matches that particular diagnosis. Sounds good. Sounds logical and efficient. But it has precious little to do with reality. It represents instead an illusory attempt to legislate scientific precision into being when it is neither possible nor desirable.

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes or infectious agents) diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients.

Why? For one thing, psychotherapy consists of a gradually unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision, it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient which do not fit into that particular diagnosis, and we correspondingly over-attend to subtle features which appear to confirm an initial diagnosis. What's more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a "borderline" or a "hysteric" may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorders category (the very patients often engaging in longer-term psychotherapy.)

And what therapist has not been struck by how much easier it is to make a DSM-IV diagnosis following the first interview than much later, let us say, after the tenth session, when we know a great deal more about the individual? Is this not a strange kind of science? A colleague of mine brings this point home to his psychiatric residents by asking: "If you were in personal psychotherapy or are considering it, what DSM-IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?" (C. P. Rosenbaum, personal communication, Nov. 2000)

In the therapeutic enterprise we must tread a fine line between some, but not too much, objectivity; if we take the DSM diagnostic system too seriously, if we really believe we are truly carving at the joints of nature, then we may threaten the human, the spontaneous, the creative and uncertain nature of the therapeutic venture. Remember that the clinicians involved in formulating previous, now discarded, diagnostic systems were competent, proud, and just as confident as the current members of DSM committees. Undoubtedly the time will come when the DSM-IV Chinese restaurant menu format will appear ludicrous to mental health professionals.

Therapist and Patient as "Fellow Travelers"

Andrè Malraux, the French novelist, described a country priest who had taken confession for many decades and summed up what he had learned about human nature in this manner: "First of all, people are much more unhappy than one thinks…and there is no such thing as a grown-up person." Everyone—and that includes therapists as well as patients—is destined to experience not only the exhilaration of life, but also its inevitable darkness: disillusionment, aging, illness, isolation, loss, meaninglessness, painful choices, and death.

No one put things more starkly and more bleakly than the German philosopher Arthur Schopenhauer:

In early youth, as we contemplate our coming life, we are like children in a theater before the curtain is raised, sitting there in high spirits and eagerly waiting for the play to begin. It is a blessing that we do not know what is really going to happen. Could we foresee it, there are times when children might seem like condemned prisoners, condemned, not to death, but to life, and as yet all unconscious of what their sentence means.

Or again:

We are like lambs in the field, disporting themselves under the eyes of the butcher, who picks out one first and then another for his prey. So it is that in our good days we are all unconscious of the evil that Fate may have presently in store for us — sickness, poverty, mutilation, loss of sight or reason.

Though Schopenhauer's view is colored heavily by his own personal unhappiness, still it is difficult to deny the inbuilt despair in the life of every self-conscious individual. My wife and I have sometimes amused ourselves by planning imaginary dinner parties for groups of people sharing similar propensities—for example, a party for monopolists, or flaming narcissists, or artful passive-aggressives we have known or, conversely, a "happy" party to which we invite only the truly happy people we have encountered. Though we've encountered no problems filling all sorts of other whimsical tables, we've never been able to populate a full table for our "happy people" party. Each time we identify a few characterologically cheerful people and place them on a waiting list while we continue our search to complete the table, we find that one or another of our happy guests is eventually stricken by some major life adversity—often a severe illness or that of a child or spouse.

This tragic but realistic view of life has long influenced my relationship to those who seek my help. Though there are many phrases for the therapeutic relationship (patient/therapist, client/counselor, analysand/analyst, client/facilitator, and the latest—and, by far, the most repulsive—user/provider), none of these phrases accurately convey my sense of the therapeutic relationship. Instead I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between "them" (the afflicted) and "us" (the healers). During my training I was often exposed to the idea of the fully analyzed therapist, but as I have progressed through life, formed intimate relationships with a good many of my therapist colleagues, met the senior figures in the field, been called upon to render help to my former therapists and teachers, and myself become a teacher and an elder, I have come to realize the mythic nature of this idea. We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence.

One of my favorite tales of healing, found in Hermann Hesse's Magister Ludi, involves Joseph and Dion, two renowned healers, who lived in biblical times. Though both were highly effective, they worked in different ways. The younger healer, Joseph, healed through quiet, inspired listening. Pilgrims trusted Joseph. Suffering and anxiety poured into his ears vanished like water on the desert sand and penitents left his presence emptied and calmed. On the other hand, Dion, the older healer, actively confronted those who sought his help. He divined their unconfessed sins. He was a great judge, chastiser, scolder, and rectifier, and he healed through active intervention. Treating the penitents as children, he gave advice, punished by assigning penance, ordered pilgrimages and marriages, and compelled enemies to make up.

The two healers never met, and they worked as rivals for many years until Joseph grew spiritually ill, fell into dark despair, and was assailed with ideas of self-destruction. Unable to heal himself with his own therapeutic methods, he set out on a journey to the south to seek help from Dion.

On his pilgrimage, Joseph rested one evening at an oasis, where he fell into a conversation with an older traveler. When Joseph described the purpose and destination of his pilgrimage, the traveler offered himself as a guide to assist in the search for Dion. Later, in the midst of their long journey together the old traveler revealed his identity to Joseph. Mirabile dictu: he himself was Dion—the very man Joseph sought.

Without hesitation Dion invited his younger, despairing rival into his home, where they lived and worked together for many years. Dion first asked Joseph to be a servant. Later he elevated him to a student and, finally, to full colleagueship. Years later, Dion fell ill and on his deathbed called his young colleague to him in order to hear a confession. He spoke of Joseph's earlier terrible illness and his journey to old Dion to plead for help. He spoke of how Joseph had felt it was a miracle that his fellow traveler and guide turned out to be Dion himself.

Now that he was dying, the hour had come, Dion told Joseph, to break his silence about that miracle. Dion confessed that at the time it had seemed a miracle to him as well, for he, too, had fallen into despair. He, too, felt empty and spiritually dead and, unable to help himself, had set off on a journey to seek help. On the very night that they had met at the oasis he was on a pilgrimage to a famous healer named Joseph.

Hesse's tale has always moved me in a preternatural way. It strikes me as a deeply illuminating statement about giving and receiving help, about honesty and duplicity, and about the relationship between healer and patient. The two men received powerful help but in very different ways. The younger healer was nurtured, nursed, taught, mentored, and parented. The older healer, on the other hand, was helped through serving another, through obtaining a disciple from whom he received filial love, respect, and salve for his isolation.

But now, reconsidering the story, I question whether these two wounded healers could not have been of even more service to one another. Perhaps they missed the opportunity for something deeper, more authentic, more powerfully mutative. Perhaps the real therapy occurred at the deathbed scene, when they moved into honesty with the revelation that they were fellow travelers, both simply human, all too human. The twenty years of secrecy, helpful as they were, may have obstructed and prevented a more profound kind of help. What might have happened if Dion's deathbed confession had occurred twenty years earlier, if healer and seeker had joined together in facing the questions that have no answers?

All of this echoes Rilke's letters to a young poet in which he advises, "Have patience with everything unresolved and try to love the questions themselves." I would add: "Try to love the questioners as well."

The Schopenhauer Cure

Posted on by Psychotherapy.net Team

Psychotherapy.net has arranged with the author to publish an exclusive online excerpt of this exciting new book. 

Publisher's Summary

At one time or another, all of us have wondered what we'd do in the face of death. Suddenly confronted with his own mortality after a routine check-up, distinguished psychotherapist Julius Hertzfeld is forced to reexamine his life and work. He feels compelled to contact his patients of long ago. Has he really made an enduring difference in their lives? And what about the patients he failed to help? What has happened to them? Now that he was wiser and riper, can he rescue them yet?

Reaching beyond the safety of his thriving San Francisco practice, Julius feels compelled to seek out Philip Slate, whom he treated for sex addiction some twenty-three years earlier. At that time, Philip's only means of connecting to humans was through brief sexual interludes with countless women, and Julius's therapy did not change that. He meets with Philip who claims to have cured himself—by reading the pessimistic and misanthropic philosopher Arthur Schopenhauer.

Much to Julius's surprise, Philip has become a philosophical counselor and requests that Julius provide him with the supervisory hours he needs to obtain a license to practice. In return, Philip offers to tutor Julius in the work of Schopenhauer. Julius hesitates. How can Philip possibly become a therapist? He is still the same arrogant, uncaring, self-absorbed person he had always been. In fact, in every way he resembles his mentor, Schopenhauer. But eventually they strike a Faustian bargain: Julius agrees to supervise Philip, provided that Philip first join his therapy group. Julius is hoping that six months with the group will address Philip's misanthropy and that by being part of a circle of fellow patients he will develop the relationship skills necessary to become a therapist.

Philip enters the group, but he is more interested in educating the members in Schopenhauer's philosophy—which he claims is all the therapy anyone should need—than he is in their (or his) individual problems. Soon Julius and Philip, using very different therapy approaches, are competing for the hearts and minds of the group members. Is this going to be Julius's swan song—a splintered group and years of good work down the drain? Or will all the members, including Philip, find a way to rise to the occasion that brings with it the potential for extraordinary change?

This novel knits together fact and fiction and contains an accurate portrayal of group therapy in action as well as a presentation of the life and influence of Arthur Schopenhauer, Philip's personal guru and professional inspiration.

Letting the Patient Matter: Some Thoughts on Irvin Yalom’s View of the Therapeutic Relationship

Posted on by Psychotherapy.net Team

In his recent book The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, psychiatrist and writer Irvin Yalom recalls a poignant encounter with one of his cancer patients. The woman is embarrassed by her hair loss after chemotherapy, and during one of her therapy sessions, she reveals that she would like a sign from Yalom that her baldness does not repulse him. Yalom, who has always admired this patient for the intelligence that illuminates her features, tells her he's not repulsed at all. In fact, he asks if he can act on his impulse to run his fingers through the lovely gray strands of hair remaining on her head. The result is a warm, intimate moment that is cathartic for both.

Such moments, related in his latest book, The Gift of Therapy, serve as vivid arguments for breaking down the walls that separate patient and therapist. Directed to a new generation of therapists and their patients, Yalom is a keen advocate for unmasking the therapist. One of the main reasons that patients fall into despair is that they are unable to sustain gratifying relationships. According to Yalom, therapy is their opportunity to establish a healthy give-and-take with an empathetic counselor; one who is not afraid to show his or her own vulnerabilities.

Opening the Secret Door

A professor emeritus of psychiatry at Stanford University and the author of several widely read books and novels on psychotherapy—including the best-selling therapeutic memoir Love's Executioner and various classic textbooks on group psychotherapy and existential psychotherapy—Yalom's insight into this world throws open the secret door to therapy, both for counselors and the patients who visit them.

What we see behind Yalom's door is a far cry from the stereotype of a therapist. From comic strips to Hollywood features, the analyst is often portrayed seated behind a desk or a notebook, literally out of reach and out of sight of the person being analyzed. “As patients, we perceive that person sitting across from us as a powerful and impenetrable figure, yet we're expected to reveal ourselves up to their scrutiny.” Within the charged atmosphere of the 50-minute therapeutic hour, our psyches are exposed, while the therapist maintains an enigmatic mask.

This may be the traditional model of psychoanalysis, but Yalom challenges it as ineffective and ultimately unhealthy. Real treatment, he says, requires an intimacy between therapist and patient that is born from a solid bond of trust. After all, a patient regularly entrusts a therapist with intimate revelations, so the therapist must be able to respond with true spontaneous empathy rather than stock therapeutic phrases. Nor does empathy evolve in a vacuum. "Friendship between therapist and patient is a necessary condition in the process of therapy," says Yalom, and he encourages the therapist to "”let the patient know that he or she matters to you.”"

When a Patient Spells Trouble

Sometimes letting the patient matter can be a challenge. In his book Love's Executioner, Yalom describes an incident with an Argentine patient who is in the last stages of incurable lymphoma. Because "Carlos" was isolated and depressed, Yalom sent him to a therapy group led by a female colleague, thinking that Carlos might form some personal connections to help him through the challenges of his last months of life. Instead, Carlos' obsession with the female patients alienated everyone in the group. After several of the women brought up their painful experiences with rape, Carlos voyeuristically interrogated them about intimate details and then declared the assaults "no big deal." Furious, the therapist asked Carlos to leave the group.

Although repelled by Carlos' behavior, Yalom persuaded the group leader to let him work with him to see whether he might be able to change his attitude. Carlos defended his prurient interrogations to Yalom, leering that, "All men are turned on by rape," and "If rape were legal, I'd do it . . . once in a while." Sitting in silence for a few minutes, Yalom wondered whether Carlos was as depraved as he sounded, or whether his crudeness was partly bluster. "I was interested in, grateful for, his last few words: the 'once in a while,'" he recalls. "Those words, added almost as an afterthought, seemed to suggest some scrap of self-consciousness or shame." Knowing that his patient was close to his teenage children, Yalom decided to turn the tables on him.

"All right, Carlos, let's consider this ideal society you're imagining and advocating. Think now, for a few minutes, about your daughter. How would it be for her living in this community—being available for legal rape?" At that point, Carlos' macho mask begins to crumble. He winces visibly and stammers that he wouldn't like that for her. What he wants, he says, is for his daughter to have a loving relationship with a man, and to have a loving family. Again, Yalom presses him to confront his own words: "But how can that happen if her father is advocating a world of rape? “If you want her to live in a loving world, it's up to you to construct that world—and you have to start with your own behavior.”" The discussion was so difficult for Carlos that he became faint, but shortly thereafter he was able to change his cynical approach to other people. Following this breakthrough, he was able to rejoin the group that had rejected him and, in the months before his death, to enjoy a number of close, supportive friendships with the women and men there.

Therapist Blunders and Breakthroughs

As in any other intimate relationship, Yalom feels that it is important for both parties to admit when they have made an error or blunder. He notes that when he has owned up to his own limitations and lack of understanding, it has often led to an important breakthrough in therapy.

Such was the case when Yalom found himself extremely uncomfortable while counseling a chatty, obese woman suffering from depression—another story he relates in Love's Executioner. He takes us through his challenging journey to understand his resistance to treating "Betty," beginning with his family and its line of "fat, controlling women," to his need for a scapegoat in his high school years in racially segregated Washington D.C., in which he was regularly attacked for being white and Jewish. (Yalom recalls that he, in turn, could look down on the "fat kids": "I supposed I needed someone to hate, too," he reflects. "Maybe that was where I learned it.") In the process of therapy, Yalom persuades Betty, who deflects most of his questions with a joke, to stop trying to "entertain" him and to talk about her life with the seriousness it deserved. When she does, he eventually conquers his discomfort and comes to feel an enormous respect and liking for his patient. And, after some months of treatment, Betty is able to overcome her depression and achieve a more comfortable weight for herself.

A Doctor Making House Calls?

Yalom's personal involvement during therapy doesn't stop with sharing his own biases. By occasionally visiting patients at home, Yalom says he has learned important information that he's been able to put to good use in therapy. For example, one severely depressed patient was for months unable to move beyond the initial phases of grieving over his wife's death. When Yalom made a house call, he found that the patient had so saturated his environment with material reminders of his wife—to the point of keeping the ratty sofa where his wife had died on prominent display in the living room—that his own personality had all but disappeared.

Together, patient and therapist worked out a series of changes in the house that would help free the patient from some of the invisible chains that bound him.

Patient as Fellow Traveler

Because building trust and intimacy takes time, Yalom is critical of the current trend towards short stints of behavioral therapy. While they may work in some instances, he allows, there is no substitute for ongoing, weekly sessions in which a caring doctor and a troubled patient engage in a "dress rehearsal for life." Although the "life" in question is usually the patient's, Yalom feels that if change does not occur in the therapist as well, the therapist is not working effectively.

Forty-five years of clinical practice have led Yalom to note that “the patient and therapist are "fellow travelers" in therapy—they're both human beings dealing with essential problems of existence and must work cooperatively to solve them.” The therapist must be able to "look out the other's window." Learning to actively empathize with a patient's experience is the most important gift a therapist can give a patient, Yalom says.

Certainly the world of analysis and therapy have changed dramatically from the days of glorifying the neutral, distant and emotionally removed therapist with a pipe in hand. In particular, Yalom's works pose a far-reaching question: Is it time for psychoanalysts and psychotherapists to reveal more of themselves to their patients? And, in addition to challenging their patients to grow, should they remember to treat them with empathy and simple human kindness beyond that of the detached professional caring? In The Gift of Therapy, Yalom makes the brave assertion that the therapist is responsible for bringing his or her own humanity to the forefront of the therapy. After all, this may be the most valuable gift that the therapist can offer the client.

References

Yalom, I. D. (2002). The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. NY: Harper Collins.

Yalom, I. D. (1989). Love's Executioner and Other Tales of Psychotherapy: For Anyone Who's Ever Been on Either Side of the Couch. NY: Harper Perennial.

This article is adapted from an article originally published on the Consumer Health Interactive website (www.yourhealthconnection.com) (2002).

In Search of Self: My Therapy with Rogers, Satir, Bugental, Polster, Yalom, & Maslow

Posted on by rezendevknowfully.com
Have you ever wondered what would it be like to work with psychotherapists who most of us have only read about, heard speak at a conference, or watched on video? Like many psychology students, I have often pondered the question of what it would be like to meet with the masters in our field. At critical crossroads of my life, I have wished for the guidance of these sages. In my mind, over the years, I have assembled my own personal therapist dream team: Carl Rogers, Virginia Satir, James Bugental, Erving Polster, Irvin Yalom, and Abraham Maslow. (I suspect each of us could construct our own cadre of master therapists.) What these therapists have in common is that they all value the importance of self-determination, autonomy, and the intrinsic potential for growth. They all seek to provide the optimal conditions for individuals to heal and grow, despite the pressures and circumstances of life. By helping to remove any obstacles towards growth, these therapists empower individuals as they let go of their symptoms and engage more fully in their lives.

I have imagined what it would be like if each of these renowned professionals could share with me their unique approaches and help me understand myself, confront my struggles, and achieve my potential. I invite you to join me now, in eternal time and space, as I begin my psychotherapy encounters with my dream team. But first, here's a little background.

In Search of Acceptance

For as long as I can remember, I have always been a high achiever. My relentless drive for perfection earned me countless academic awards and recognitions. I knew that as long as I succeeded academically, I would be accepted in the eyes of others. Continuing to persevere, I earned a master's degree in chemistry from Stanford University. I was proud of my academic achievements, but I had always sensed that my heart wasn't  there.

For the next several years, I was on a mission to find my passion in life. Although I had not been successful in finding a fulfilling career, I was determined to find a relationship that would make me feel whole. Depressed and frustrated, I entered therapy when I could not convince my ex-boyfriend Brian to give me just one more chance. I was determined to be the person I needed to be so that he would accept me and come back into my life. I was convinced that if he could accept me, then I could finally be happy.

Carl Rogers: Conveying the Core Conditions

Rogers Intro: During Deb's first therapy session with me, she tearfully commented, "I have lost my direction in life, and I do not know where I am going." She explained that her job as a researcher was "just not me" but she did not know what else to do. She described how the security of having an income helped her overlook the reality that she did not enjoy the work. After the first half of the session, Deb started to describe her "on-and-off" relationship with her ex-boyfriend Brian.

Deb: From the moment I met him, I knew he was the person I had been searching for. We had so much in common and we seemed to understand each other pretty well. I remember him telling me how I was one of the few people who could really understand him and be on his wavelength. I still remember how nice it felt on our first date when I made him laugh. After that first date, I knew I was hooked.

Rogers: It sounds like that first date with Brian was a really special time for you. He recognized you as someone who could understand him, and when he laughed you felt as if he could really appreciate you.

Deb: Yes, that's exactly how I felt. And I felt so safe with him. I know this may sound kind of silly, but I took so much comfort in the fact that he was so tall and strong. When I was in his arms, it felt like nothing else mattered. Being with him provided me an escape from the rest of my life…and from myself.

Rogers: That does not sound silly at all. By escaping to Brian, you felt as if you could escape from your problems. But, in doing so, it sounds like you also lost parts of yourself.

Deb (crying): You're right. I used to feel so strong and have such a clear idea of who I was. But since I started depending on him to be the source of strength in my life, I've had no clue as to who I am. All I can think about now is doing what I need to do to get him back into my life again.

Rogers: Your tears show what a compassionate and sensitive person you are. I see how much pain you are in now, but I also hear how determined you are to discover your true self. Just the fact that you are here shows that you are ready to find your "direction in life."

Rogers Wrap-up: My main goal with Deb was to create a growth-promoting environment by helping her identify and remove the internal and external obstacles blocking her inherent growth. Conveying the core therapeutic conditions of accurate empathy, unconditional positive regard, and genuineness, I helped Deb realize and accept her congruent self and begin her growth process toward self-actualization. As Deb started to move in the direction of growth, I noticed she was developing openness to experience, gaining a trust in herself, developing an internal locus of evaluation, and demonstrating a willingness to continue to grow. She was beginning to discover her own strength—instead of escaping to that of her ex-boyfriend. During our final session, Deb mentioned that she was even considering her long-term goal of enrolling in a psychology graduate program.

Virginia Satir: Engineering the Self

Satir Intro: After attending one of my personal growth workshops, Deb approached me about helping her in the process of rediscovering and rebuilding her self. Always enthusiastic to help an individual in the area of personal growth, I agreed to see Deb right away. When I met with her during our first session, I had the sense that she had the motivation to grow, but she just needed a little direction to help her stay on her path.

Deb: I know that I should be ready to move on, but I still find myself feeling so sad over the end of my relationship with Brian. I wish I could just ignore my feelings, but it seems there's no escape.

Satir: I think that it is great you are so in touch with your feelings now. Maybe it would help if you could think of these feelings as the "juice" that keeps you in a whole piece and gives you the abilities to see better, to think better, to feel better. By owning these emotions, you can actually feel more alive.

Deb: That sounds much better than trying to fight these feelings. But as I am dealing with all of these feelings, how do I get unstuck? I just don't understand why I can't move on with my life!

Satir: Anytime we try to change something that has been a part of our life for so long, it's so tempting to stay with what's familiar. Often when we try to take one step forward, the familiar brings us right back. This struggle you are having is certainly a common one. Just ask anyone who has ever tried to quit smoking, or change any kind of habit.

Deb: That definitely helps me put things in perspective. But, how do you suggest I break my "habit"?

Satir: Changing oneself is one of the most difficult things in the world to do. I think the most important tools you need to have now are faith in and forgiveness for yourself. Your faith will help you move forward in your commitment to grow, and your forgiveness will save you during the backslides. I see just how committed you are, and I know that you're going to keep on moving ahead, and eventually you're going to be able to make it.

Deb: Thanks for the encouragement. But, I have to admit it's those backslides you just mentioned that scare me the most. I am just not sure how to find the strength and courage to move on when I feel like I've taken a step backwards.

Satir: The pulls back into the familiar are indeed powerful. If you find yourself doing the familiar, my advice would be to give yourself an "A" for being so aware. Then, you can give yourself the choice about what you want to do next. After all, you own yourself, and therefore you are the engineer of yourself.

Deb: Oh, I really like that idea. So if I don't like the way I am doing something, I have the choice to do it differently.

Satir: Exactly. I think the key to life is to change when the situation calls for it, and to find ways to accommodate to what is new and different. It's important to keep the part of the old that is still useful, and discard what is not.

Deb: So your advice is to change what no longer works, but to hold on to what still does. That means I don't have to completely start over.

Satir: That's right. You already have a great start on your journey. Let me read you something that I wrote a few years ago that may encourage you as you continue in your process of change: "I am Me. I own my fantasies, my dreams, my hopes, my fears. I own my triumphs and successes, all my failures and mistakes. I have the tools to survive, to be close to others, to be productive. I am me, and I am okay."

Satir Wrap-up: During our next sessions, I helped Deb to develop ways to cope with the ending of her relationship. I helped her understand that in our lives, problems are not the problems—coping is the problem. I pointed out to Deb that life is not what it's supposed to be. It's what it is. The way one copes with it is what makes the difference. She eventually saw the ending of her relationship as an opportunity for positive change, which would ultimately make her stronger for the upcoming "bumps in the road." Over the next few months, Deb developed the strength and self-esteem to directly confront many of the everyday challenges she faced in life. I enthusiastically watched her become stronger and stronger with each of these encounters. During our last session she admitted, "It's much easier to face a problem directly than to try to find the energy to avoid it."

James Bugental: Experiencing the Moment

Bugental Intro: Before she left for the Esalen Institute in Big Sur to develop their Human Potential Development Program, Virginia Satir referred her client Deb to me. She felt that Deb was beginning to trust herself and her feelings, and she thought that I might be able to help her tune into her "Wisdom Box" to access her inner truth. During our first few sessions, I realized that Deb was more in tune with the needs of others than with those of herself. Then, during our fourth session, we had a major experiential breakthrough.

Bugental: When you were in the waiting room, I noticed that something seemed different with you today.

Deb: Oh, really? That's interesting you sensed that. I think I'm okay…

Bugental: Right when I saw you, I had this feeling that you had contact with Brian this week.

Deb: Wow, you're right. I did. That's kind of freaky you could pick up on that!

Bugental: I notice you are shaking right now.

Deb: I am? Oh, you're right, I am. Maybe it is because my blood sugar is low or something…

Bugental: And?

Deb: So, you're right. I did see Brian this weekend. But, everything is fine. I feel totally in control, and I am not afraid of spiraling backwards again. I think I'm ready to have him in my life again.

Bugental: Did you realize that as you said that your leg started shaking even more?

Deb: Uh, yeah. I can't quite stop that.

Bugental: What do you think your shaking is trying to say to you?

Deb: I don't know.

Bugental: Can you ask it?

Deb: Well…maybe it's trying to tell me that I'm not ready to have him in my life again. Perhaps it's a reminder of all the pain I have been through before, and a warning not to go there again.

Bugental: It's almost as if his being in your life threatens your stability and "shakes" your foundation of strength, and even chips away at your bedrock of self-esteem. Does that sound right to you?

Deb: Wow, you know I didn't think of it that way. But, yes, there is definitely some truth in that.

Bugental: Now I see you're shaking even more. What are you feeling now?

Deb: Oh, so many feelings are going through me now, I don't even know where to start.

Bugental: What if you just close your eyes now and breathe in and out. Now imagine what your shaking leg is trying to tell you. With all of that energy, it must have an important message for you. Just concentrate on what it is saying.

Deb (tearfully): It is saying that it is time for me to be seen, heard, and respected. It is realizing that I've been so busy taking care of other people's needs that I have not been in tune with my own. Brian really has no respect for me, and I'm so sick of being a doormat!

Bugental Wrap-up: During my next several sessions with Deb, I assisted her in tuning into what she was experiencing in the moment. In essence, by helping Deb to focus on the present and become mindful of what was happening in the here-and-now, I helped her become more self-aware. Then, by reflecting her newfound awareness back to her, I assisted her in better comprehending her situation, and ultimately increasing her choices so she could begin to make a change. It was also essential for me to enter into Deb's world without disrupting it and changing her personal experience. I wanted to help Deb discover her own images, without intrusively bringing in my ideas. I also wanted to challenge her to look at her own attitude towards herself. This process was aimed at facilitating Deb in taking charge of her life, and ultimately claiming her power to engage in her journey toward self-actualization.

Erving Polster: Gaining Awareness through Gestalt

Polster Intro: I received a call from Deb, a graduate student in psychology, who was interested in learning about how my Gestalt approach might help her achieve a new level of awareness. She explained that she would like to get in touch with and unleash the anger that she had been internalizing all her life. I agreed to help in her process. Right when I met Deb, I sensed she was ready to get to work.

Polster: I'm wondering how you have been able to get in touch with your anger in the past.

Deb: To be honest, I've always been afraid of getting angry at people. It just seems more natural to keep it locked inside.

Polster: What if we could try something that might help you unlock this anger before it breaks down the door on its own?

Deb: I'd be up for that. But how would I do that?

Polster: How about you just imagine that Brian is sitting there in that empty chair right now. Get in touch with how you feel that he just entered and left your life again. What do you want to say to him?

Deb: Um, that I'm mad.

Polster: Tell it to the chair. And say it like you really mean it.

Deb (angry): You just don't have a heart. I was trying to understand how your coming into my life again could make sense to you. And then I realized you didn't just think—you knew, you totally knew, that you were going to come into my life for a limited amount of time, and then just leave. There was no thought in there of me at all except what I could do for you. It's all about you!!

Polster: That's it. Now go even deeper into that anger.

Deb: I just don't get it. And I'm just really mad that you could just come into my life again, and show me the side of you that I missed. Then, when you were no longer lonely, you just left my life again. I'm so sick of this!

Polster: Go to the core of your anger. What do you really want to tell him?

Deb: I've always been there to support you. I've never ever, ever let you down. I've always been there for you and there have never been any consequences for you. But you're never here for me, Brian! It's such a one-way thing. I can't count on you for anything except to be a fleeting part of my life. That's all that I can expect from you, and I'm done with you! I deserve better!!

Polster: Where is your anger now? Where do you feel it most? Let it out.

Deb (raising her voice): Stay out of my life! Stay out of my life, Brian!!!

Polster Wrap-up: Gestalt therapy served as an effective means for Deb to become more fully present with her unexpressed emotions. When she could be more in the "now," she developed a clearer sense about the growthful direction in which she needed to move—i.e., away from her ex-boyfriend—and her change naturally unfolded. Her previously alien anger was transformed into an acceptable expression, which ultimately led to new possibilities in her life. During the next few months, Deb's increased self-awareness enabled her to take back her power and restore her self-support. Her new awareness also allowed her to experiment with new behaviors, which, in turn, facilitated further growth. Deb realized that finally giving a voice to her anger allowed her to focus her energies on her interests and passions, instead of on her regrets and fears.

Irvin Yalom: Confronting the Existential Givens in the Here and Now

Yalom Intro: I received an enthusiastic email from Deb who explained to me how my book, Existential Psychotherapy, had made quite an impact in her life. Since she was living nearby, she expressed her desire to consult with me on her existential quest, and I agreed to meet with her. When we met in my office, I could not help but notice that Deb seemed a bit star-struck. (And, of course, I have to admit that this is indeed a nice reaction for a man in his 70s to encounter.) But these stars soon faded, and we got down to the business of her life.

Yalom: Hi Deb—it's really nice to meet you in person.

Deb: Wow, thanks. Uh, I'm feeling a bit nervous right now. I've been admiring your work for so long, and I just can't believe that you are right here in front of me now!

Yalom: It's nice to know that you've been able to appreciate my work.

Deb: Not to sound like a groupie or anything, but in many ways that book changed my life. Especially my ability to really begin to let go of a painful relationship I was having with my ex-boyfriend Brian.

Yalom: Now you've got me curious. What in the book helped you the most in being able to move on with your life?

Deb: Where do I begin? Let's see…well, your whole premise that underneath all of our motivations and experiences lies this "existential bedrock" which forces us to be aware, on some level at least, of life's existential givens of death, isolation, freedom, and meaninglessness, really hit home with me. At first this concept was just an intellectual one to me, but as I drank in each word of your book, I realized that these concerns lie at the origins of my major life challenges.

Yalom: Yes, I have observed time and time again how both on a conscious and unconscious level, these "givens of existence" constitute the core struggles of humankind. It is these ultimate concerns that provide both the process and content for therapy.

Deb: Your book convinced me of that! While I was in the midst of reading through the chapters on death, I did a lot of thinking—and dreaming—about death. In fact, one night I had the most terrifying nightmare that death was literally at my door, and I had to use all of my energies to protect myself from it. Until that dream, I did not realize how fearful I actually was of my own death. And, that's when I realized that my "death grip" on Brian represented my attempts to assuage my death fears by believing that he was my "ultimate rescuer" who would protect me from death.

Yalom: Wow, what an insight.

Deb: Interestingly enough, when I was able to confront the inevitability of my own death on such a deep level, I became more engaged in my life.

Yalom: That's the paradox of accepting death—although the physicality of death destroys us, the idea of death saves us.

Deb: I also discovered a similar paradox regarding existential isolation. I realized that my irrational quest for unconditional (and unrealistic) acceptance from Brian was actually a form of denying my existential isolation. But once I was able to confront the reality that I was ultimately alone, I have felt so much less lonely!

Yalom: As you've discovered, the fear of existential isolation is the driving force behind many interpersonal relationships. But true relationships do not use the "other" as the functional "it" to guard against existential isolation. Once a person can accept that they are ultimately alone and can not have all of their needs met by others, then they can develop richer, more tolerant, and more loving relationships based on a deeper sense of communion. When we are able to stand alone and dip within ourselves for our own strength, our relationships with others are based more on fulfillment, not on deprivation.

Deb: Wow, what a comforting thought!

Yalom: Indeed it is. It is only by facing aloneness that we can meaningfully and authentically engage with another. Love—although it doesn't take us away from our existential isolation—is our best mode for coping with the pain of separateness.

Deb: So in a sense, we are all together in our separateness.

Yalom: Yes, that's very true. We are separate but can still connect to each other.

Deb: In addition to helping me gain personal insight into the existential concepts of death and isolation, your book also gave me the opportunity to process my thoughts about freedom. Your concept of freedom—that everyone is ultimately responsible for their (and only their) life and has the choice to make (or not) decisions and change their life as needed—is pretty much the very core of my whole outlook in life.

Yalom: Good for you. I've found that many people are actually frightened by the concept of freedom which implies that beneath them exists a "groundlessness" lacking any form of structure. But you seem to have to come to a place in your life where you are accepting this freedom and realize that you can create your life by the process of feeling, wishing, willing, choosing, acting, and changing.

Deb: My recent realization based on this concept—that I am the one who is responsible for both my needless suffering over Brian as well my solution to search for alternatives that really honor who I am and what I want—has brought me an incredible sense of empowerment! Your idea that we are responsible for our own lives and well-being has become my new mantra!

Yalom: As I've always said, until one realizes one's own role in contributing to one's problems, there can be no motivation to change.

Deb: I'm a true believer in that idea! And the final section of your book on meaninglessness really gave me plenty of food for thought too.

Yalom: Oh yes, the riddle of the meaning of life…Since the beginning of time, people have struggled with the classic existential dilemma of seeking meaning and certainty in a world that can offer them neither.

Deb: I loved your idea of engagement in life as the antidote to meaninglessness.

Yalom: Yes—it's better to embrace the solution of engagement rather than become preoccupied with the problem of meaninglessness. I have discovered that one must immerse oneself in the river of life and let the question drift to the background, attending to it when necessary.

Deb: I completely agree. And, I've found that approaching life's inherent meaninglessness with the realization that it's up to each of us to create and aspire to fulfill our own meaning is quite a satisfying way to live.

Yalom: Wow, so I see that you have really explored these existential concepts in a way that makes sense for you. Sounds like you've been able to put theory into practice.

Deb: I think so. If the whole point of theory really is to serve as a foundation and help one achieve a sense of order and control in an otherwise chaotic world, then I think I'm finding mine!

Yalom: It is so nice to know that my books have been able to offer you so much insight into your life. Now, I'm wondering how that felt for you to share with me how much you've enjoyed my work and put it into practice in your own life.

Deb: Hey, that sounds like an attempt to bring our session back to the "here-and-now"!

Yalom (laughing): Okay, now I'm convinced that you may have read a few too many of my books. But it was a serious question. You must have had some image of what this would be like. So, how has it been for you to meet with me in person? Any surprises so far? Any disappointments?

Deb: I admit I was nervous prior to our meeting. I guess I was intimidated by all the books you have written, and by the fact that you're, uh, Yalom! I was hoping that I would not embarrass myself. But, much to my surprise, soon after we met, it was easy to open up and talk to you about myself and existential issues.

Yalom: So it sounds like you are pleasantly surprised that you feel comfortable talking with me. Anything else that you wanted to share today, but have not?

Deb: Well, let me think about that for a moment. I guess we have been talking a lot about existential issues and struggles I have dealt with in the past. Maybe I was trying to impress you with my knowledge (smiles sheepishly). But I have not revealed much about what I want to work on in my life now.

Yalom: I appreciate you telling me that you wanted to impress me. You have succeeded on that count! But it sounds like your desire to impress me might have gotten in the way of you sharing more pressing needs. Maybe I played some part in that as well, but we don't have much time left today, so maybe we should use that time to begin talking about what you would like to work on now in your life.

Deb: Yes, I would. This is little harder for me, but here goes…

Yalom Wrap-up: Deb continued to meet with me on a weekly basis until the end of the summer. As our sessions progressed, she focused less on intellectual topics and more on the here-and-now space between us. During our last session, Deb explained to me why our therapeutic relationship had been so valuable to her. With tears in her eyes, she told me that she could now truly understand my maxim of psychotherapy that "It is the relationship that heals."

She explained how she particularly enjoyed my approach where I saw us as "fellow travelers" in a world full of inherent tragedies of existence, and she appreciated how I could be both an observer and a participant in her life. She mentioned that although she had previously read how I entered each therapeutic relationship with openness, engagement, and egalitarianism, she was amazed to personally experience the true power of these therapeutic ingredients. Deb realized that what had been most helpful about our sessions was how my authenticity, genuineness, and transparency eventually allowed her to discover these same qualities in her self. I explained to her that this is precisely why I have always believed that therapist authenticity is ultimately redemptive. She also realized that my being able to enter into her world and see her as she truly was enabled her to do so herself. As she hugged me at the end of our last session she said "Thank you for giving me the gift of therapy."

Abraham Maslow: Journeying toward Self-actualization

Maslow Intro: When I ran into Irv Yalom at the Evolution of Psychotherapy conference, I mentioned to him that I was in the process of revising my book Motivation and Personality. After he got over the shock of seeing me (he really did look like he had seen a ghost!), I expressed to him that I have always enjoyed how his textbooks read more like novels with their captivating vignettes, and that I was currently using this technique to revise my text. When I mentioned that I wanted to work with people who were on their journey toward self-actualization, he told me he knew of a person who might be interested in meeting with me.

A few days later Deb called me, and her pursuit of self-actualization was evident right away. I decided that it would be helpful to meet with her a few times to discuss what was on her mind. I met with Deb for the first time after she just finished a day full of play therapy sessions with young children. I could not help but notice that she was sparkling—both literally due to all the glitter she had on her from doing art therapy with the children, and also figuratively from finding work that allowed her to shine from the inside out.

Maslow (jokingly): Wow, it looks like you're really getting into your work with the children!

Deb: Oh yes—and on so many levels too! I've always been drawn to children. When I'm with them, I just feel myself light up.

Maslow: And I'd guess that illumination lights the path for both you and them.

Deb: It certainly feels that way to me. I noticed that being able to see them has also given me the ability to see myself. When I was working with children at my school's expressive arts camp this summer, I discovered that what the kids needed most was to be seen, heard, and understood. Soon after, I realized that that's exactly what I need to give myself as well.

Maslow: So the work you are doing with children reflects and invigorates the work you have been doing with yourself.

Deb: Yes, I feel that what I have been able to provide the kids is also what I am learning to give myself. In the therapy room, I give each child the freedom to be themselves while I honor, reflect, and validate their individuality. In life, I try to give myself these same opportunities.

Maslow: It sounds like being in tune with the children has helped you to become in tune with you own inner voice.

Deb: Exactly. And, paradoxically enough, I'm discovering that listening to the child inside of me has been the best way for me to navigate through my life as an adult. Now I trust my feelings. If something doesn't feel right with me, I know that it's not. It is also increasingly clear to me when I am doing something that is congruent with who I truly am inside.

Maslow: That reminds me of the quote "To thine own self be true."

Deb: That quote really resonates with me. Before I started therapy, I measured my successes in education, career, relationships, and life choices through the eyes of others. I was motivated by external rewards. But now, I just follow my heart.

Maslow: It sounds like you have discovered that the only way for you to lead an honest life is by following your own inner truth.

Deb: Yes, that has been my most powerful discovery.

Maslow: How would you describe your life now?

Deb: Well, I feel like all of my life I've been carrying around these unopened gifts. And, now, I've reached a place where I can finally unwrap them. Being able to enjoy these gifts with myself and share them with others has given me such a sense of inner peace.

Maslow: Wow. You seem to have discovered your true self.

Deb: And, I'm happy to say that I really like my discovery.

Maslow Wrap-up: When Deb started on her therapeutic journey several years ago, she was motivated by what I have termed the "deficit needs," or "D-needs." Although her physiological and security needs had been met, she was struggling to fulfill her higher needs of love/belonging and esteem. Lacking a satisfying relationship as well as a sense of community, Deb was increasingly susceptible to loneliness and relationship difficulties. Furthermore, not feeling respected by others (or even herself at times) Deb experienced an all-time low in her self-esteem. Fortunately, through her hard work in therapy, Deb has been able to make changes in her life—including pursuing her graduate studies in psychology and moving away from her relationship with her ex-boyfriend—which allowed her to satisfy her love/belonging and self-esteem needs.

Since I started my work with Deb a few months ago, I have noticed that she has devoted herself to fulfilling her potentials. Instead of being motivated by deficits, she is now motivated by growth. Striving to satisfy her "being needs," or "B-needs," she has reached the self-actualization level of the hierarchy of needs. As she feeds these higher needs, they are becoming increasingly stronger, as is her desire to realize her potentials. Whereas Deb once relentlessly strove to gain the acceptance of others, she now enthusiastically thrives in being true to her own nature. Deb has recently discovered that what she can be is also what she must be.

Discovery of Self

My therapeutic encounters have inspired me in my search to discover more about myself. When I started my therapeutic journey, Carl Rogers' use of accurate empathy, unconditional positive regard, and genuineness facilitated my ability to begin to see my true self. Next, my sessions with Virginia Satir helped me to understand and embark upon the process of change. My sessions with James Bugental allowed me to recognize my unvoiced anger, while my Gestalt work with Erving Polster encouraged me to express this anger. After Irvin Yalom's book, Existential Psychotherapy, provided me a valuable framework for understanding my life, my here-and-now encounters with him allowed me to experience the healing power of the therapeutic relationship. Finally, my work with Abraham Maslow offered me an opportunity to reflect on and appreciate my journey toward self-actualization.

While it was my search for external truth that brought me to therapy, it was the discovery of my internal truth that brought me back to life. My therapeutic journey has allowed me to identify and overcome obstacles to my growth, while recognizing my inherent potential. By pursuing a path of self-reflection, self-examination, and openness to new experiences, I have been able to engage more fully in meaningful goals and fulfilling experiences in my life. As I continue on the path of my life, I take with me a greater sense of my authentic self that my therapist dream team helped me discover.

Resources on Deb's Psychotherapists

Branfman, F. (1996). "A matter of life and death." (Interview with Irvin Yalom.) Salon.
Retrieved November 20, 2006, from: http://www.salon.com/weekly/yalom960805.html.

Bugental, J. F. T. (1992). The art of the psychotherapist (1992). W.W. Norton, NY.
Zeig, Tucker & Theisen.

Bugental, J.F.T (2006). Existential-Humanistic Psychotherapy in Action. San Francisco: Psychotherapy.net.

Bugental, J.F.T (1997). Existential-Humanistic Psychotherapy, in Psychotherapy with the Experts Video Series. San Francisco: Psychotherapy.net.

Bugental, J.F.T (2008). James Bugental: Live Case Consultation. San Francisco: Psychotherapy.net.

Bugental, J. F. T. (1999). Psychotherapy isn't what you think: Bringing the psychotherapeutic engagement into the living moment. Phoenix, AZ: Zeig, Tucker & Theisen.

Bugental, J.F.T (1988). The search for authenticity: An existential-analytic approach to psychotherapy. NY: Irvington Publishers.

Maslow, A.H. (1968). Toward a psychology of being. NY: Van Nostrand Reinhold Company.

Maslow, A.H. (1987). Motivation and personality. NY: HarperCollins Publishers Inc.

Polster, E. A. & Polster, M. (1974) Gestalt therapy integrated: Contours of theory & practice. NY: Vintage.

Polster, E. A. (1990). Humanization of technique. Phoenix, AZ: Milton Erickson Foundation.

Polster, Erving (2006). Psychotherapy with the Unmotivated Patient. San Francisco: Psychotherapy.net.

Rogers, C. R. (1961). To be that self which one truly is: A therapist's view of personal goals.
In Rogers, C. R. (Ed.), Becoming a person (pp.163-182). Boston: Houghton Mifflin.

Rogers, C.R. (1977). Carl Rogers on personal power. NY: Delacorte Press.

Satir, V. M. (2001). Self esteem. Berkeley, CA: Celestial Arts.

Satir, V. M. (1988). The new people making. Palo Alto, CA: Science and Behavior Books.

Satir, V. M., and Baldwin, M. (1983). Satir step by step: A guide to creating change in families. Palo Alto, CA: Science and Behavior Books.

Yalom, I. D. (1980). Existential psychotherapy. NY: Basic Books.

Yalom, I.D. (2008). Irvin Yalom: Live Case Consultation. San Francisco: Psychotherapy.net

Yalom, I. D. (2000). Love's executioner. NY: First Perennial Classics.

Yalom, I.D. (2003). The gift of therapy. NY: HarperCollins Publishers Inc.

Yalom, I.D. (2006). The Gift of Therapy: A Conversation with Irvin Yalom, MD. San Francisco: Psychotherapy.net.

Yalom, I.D. (2006). Understanding Group Psychotherapy, Volumes I – III. San Francisco: Psychotherapy.net.