Sunday, March 7, 2010

More Yalom, the Here-and-Now and Authentic Relationship

Reading Yalom revolutionized my thinking. His unblinking self-awareness and honesty inspired me to be – to discover – who I am as person and professional in the therapeutic relationship. It is very intimate, powerful, rewarding and ultimately, integrating and liberating.

The following passage from the same book quoted in the previous post, Momma and the Meaning of Life, describes his counter-transference notes about a fictional patient. He uses these notes for discussion in a counter-transference group he is in with peers/colleagues. It opened my eyes to hear him say these things out loud to peers, to us (his readers) and due to some unintended high jinx, to his patient. The power of this self-awareness and revelation in his work (grounded in the here-and-now approach) with the patient reminds me of the power of process recordings. Most interns report hating them, but I don’t know any other tool that is as effective in cutting to the core of what we, as therapists, do, say and feel in therapy and why (rationale/purpose based on theoretical orientation or lack thereof). Each step is a skill that takes time. What do I think and feel in the moment that I am in with this client in the here-and-now, no matter how deep, superficial, ugly or beautiful? Most interns tend to report what they think the client is feeling instead or guard against revealing unpleasant thoughts and feelings because they sound “unprofessional.” Then, how can I take this thought or feeling and turn it into an intervention – a statement or question to the client in real time? Finally, (most don’t get here but a few have) daring the genuine exchange and authentic relationship.

“This is Dr. Lash dictating notes for countertransference seminar. Notes on Myrna, Thursday, 28 March. Typical, predictable, frustrating hour. She spent most of the session whining as usual about the lack of single available men. I get more and more impatient…irritable – lost it for a moment and made an inappropriate remark: ‘Do you see Dating Bureau on my T-shirt?’ Really hostile thing for me to do – very unlike me – can’t remember the last time I’ve been so disrespectful to a patient. Am I trying to drive her away? I never say anything supportive or positive to her. I try, but she makes it hard. She gets to me…so boring, rasping, crass, narrow. All she ever thinks about is making her two million in stock options and finding a man. Nothing else…narrow, narrow, narrow…no dreams, no fantasies, no imagination. No depth. Has she ever read a good novel? Ever said something beautiful? Or interesting…just one interesting thought? God, I’d love to see her write a poem – or try to write a poem. Now, that would be therapeutic change. She drains me. I feel like a big tit. Over and over the same material. Over and over hitting me over the head about my fee. Week after week I end up doing the same thing – I bore myself.
Today, as usual, I urged her to examine her role in her predicament, how she contributes to her own isolation. It’s not such a difficult concept, but I might as well be speaking Aramaic. She just can’t get it. Instead she accuses me of not believing that the singles scene is bad for women. And then, as she often does, she threw in a crack about wishing she could date me. But when I try to focus on that, how she feels toward me or how she makes herself lonely right here in this room with me, things get even worse. She refuses to get it; she will not relate to me, and she will not acknowledge that she doesn’t – and insists it’s not relevant anyway. She can’t be stupid. Wellesly graduate – high-level graphics work – huge salary, hell of a lot bigger than mine – half the software companies in Silicon Valley competing for her – but I feel I’m talking to a dumb person. How many goddamn times do I have to explain why it’s important to look at our relationship? And all those cracks about not getting her money’s worth – I feel demeaned. She is a vulgar lady. Does everything possible to eliminate any shred of closeness between us. Nothing I do is good enough for her. Presses so many of my buttons that there’s got to be something of my mother in this. Every time I ask her about our therapy relationship, she gives me that wary look as though I’m coming on to her. Am I? Not a whisper of it when I check into my feelings. Would I if she weren’t my patient? Not a bad-looking woman – I like her hair, gleaming – carries herself well – great-looking chest, popping those buttons – that’s definitely a plus. I worry about staring at those breasts but I don’t think I do – thanks to Alice! In high school once, I was talking to a girl named Alice and hadn’t any idea that I was staring at her tits until she put her hand under my chin and tilted my face up and said, ‘Yoo-hoo, you-hoo, I’m up here!’ I never forgot. That Alice did me a big favor.
Myrna’s hands are too big; that’s a turnoff. But I do like that great slick, sexy swish of her stockings as she crosses her legs. Yeah, I guess there are some sexual feelings there. If I had run into her when I was still single, would I have hit on her? Probably yes, I’d be attracted to her physically, until she opened her mouth and started whining or demanding. Then I’d want to get away fast. There’s no tenderness, no softness to her. She’s too self-focused, all sharp angles – elbows, knees, ungiving – [a click as the tape came to an end]”

Wow. That’s very (sometimes uncomfortably) revealing. Courageous? Pretty or not, it’s the honest-to-goodness truth and it stands between therapist and client whether we choose to look at it or not. If we look at it then we can act consciously. If we don’t look at it – because it is too disturbing – then how does it come out in ways that we are not aware?


  1. good stuff! yalom is the best. i definitely need to re-read this book. can i check out from your library?

    this was the a**-kicking that i needed re: one of my clients. i need to tap into my uncomfortable feelings and let her know that sometimes she lacks life, passion, and is, and this will be very hard to say, but i'm gonna say it regardless, she's rather boring.

  2. Of course, your library card is always good with me.

    I would start with lower risk and relationship questions before going in with the high risk ones. Yalom is really good about showing how and why he says what he does, especially when he is taking a big risk. Also, what does it mean that she is cut off from her passion - what's that about? is it a freeze response, that is, numbing? is it self-protective? was it self-protective at one time but no longer all that useful? Does she feel she needs protection in her relationship with you? How does she feel about her relationship with you?


Truth Opened

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