On Being a Modern Therapist: Interview with Victor Yalom This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Europe’s Journal of Psychology, 8(1), pp. 8-17, doi:10.5964/ejop.v8i1.295 www.ejop.org On Being a Modern Therapist: Interview with Victor Yalom By Beatrice Popescu EJOP Founding Editor, University of Bucharest, Bucharest, Romania Victor Yalom, PhD is the founder and president of psychotherapy.net, an online psychotherapy magazine targeted to trainee therapists and practitioners of all psychotherapeutic approaches. Victor is also a practicing psychologist, talented couple therapist, and business consultant in San Francisco. In his spare time, he expresses his unique vision in cartoons and wonderful abstract landscape paintings. Son of one of the most influential existential psychotherapists, Irvin Yalom, Victor talks to Europe’s Journal of Psychology about his current work and the most inspirational figures in the psychotherapy world he has been fortunate enough to meet and interview during his career. Address for correspondence: Victor Yalom, 760 Market Street, Suite 945, San Francisco, CA 941 E-Mail: vyalom@psychotherapy.net EJOP: Victor, first of all thank you for offering us an interview. Just recently we came across your brainchild, www.psychotherapy.net, a fabulous and inspiring online resource for trainees in the field of psychotherapy and clinicians. How did it feel to embark on such a creative endeavor back in 1996? http://www.psychotherapy.net/ http://sfpsychologist.com/TherapyCartoons.en.html http://sfpsychologist.com/Paintings.en.html http://www.psychotherapy.net/ Europe’s Journal of Psychology 9 Victor Yalom: I can tell you're a psychologist by the way you start the interview – asking me about my feelings. My wife, who now runs psychotherapy.net with me, has a background in physics and marketing, and she constantly points out that psychotherapists like to talk about their feelings much more than other folks. And of course one can tell that I'm in the same field because I immediately make a process comment rather than responding your question! In fact, I had no awareness when I started that I was embarking on any sort of creative endeavor. I was part of a group of therapists who had been studying for many years with James Bugental. He was an existential-humanistic psychologist, and a wonderful teacher, but his real genius was as a psychotherapist. He was 80 years old, and I thought it was important to capture his talent on video, so I managed to recruit a couple of volunteer clients, and ended up producing a video of him doing two sessions of psychotherapy with one of these clients. Well one thing led to another, and I ended up producing and distributing other psychotherapy training videos, then launching a website with articles and interviews of well known therapists, drawing cartoons, and more. Although the existential-humanistic spirit is still very near and dear to me, in some sense this experience has made me a bit of a behaviorist in the sense that I learned that it is important to do things, as you never know what doors will open up for you if you take an initial action. EJOP: You kind of anticipated my next question about your mentors. Apart from the special relationship with James Bugental, who had a profound impact on your personal and professional life, what other therapists have inspired you or been particularly influential? Victor Yalom: I have been unusually fortunate in having Irvin Yalom as my father as well as a professional mentor. Fortunately, growing up he had not achieved the stature in the field that he has now, so I just knew him as "Dad," but once I entered the profession I have had the opportunity to learn a great deal from him. He taught me most of what I know about group therapy; as a graduate student I was able to observe him leading groups through a one-way mirror, which is how he taught trainees at Stanford, and then I actually co-lead a short-term group with him. That was certainly intimidating, as at the time I didn't feel I had a lot to contribute. I have been co-leading a group with a female colleague and friend of mine for 20 years now, and his interpersonal model of http://www.psychotherapy.net/ http://www.psychotherapy.net/video/existential-humanistic-bugental http://www.psychotherapy.net/video/existential-humanistic-bugental On Being a Modern Therapist 10 group therapy has stood the test of time, and although we add our own touches, it's hard to improve on this approach. Equally influential to me has been his passionate advocacy for the therapist to be authentic, transparent, and to mine the riches of the here-and-now of therapist-client relationship. Additionally I've had the opportunity to learn from the dozens of therapists we've interviewed and/or videotaped at Psychotherapy.net – this has been an invaluable fringe benefit for me which I've shamelessly exploited. Whether it's been Erving Polster, the brilliant Gestalt therapist, Sue Johnson of Emotionally Focused Therapy fame, Otto Kernberg, or Zerka Moreno, having the chance to spend a few hours or days together has added up to an ongoing lifelong education. I keep learning, and one thing this forces me to do is not get too comfortable with one way of working, one approach or orientation. EJOP: We all rejoiced at the publication of Irvin Yalom’s masterwork “The Gift of Therapy”, a book that not only inspires, but equips. In his uniquely caring and subtle style, he aims to help young psychotherapists understand their current challenges. Is therapy undergoing a paradigm shift nowadays? Victor Yalom: I recall that Thomas Kuhn originally used the term "paradigm shift" in his book The Structure of Scientific Revolutions to describe a truly monumental change in thinking, the best example being the change from a geocentric to heliocentric view of our solar system. Now that's really a BIG change, and that phrase has since been so casually bandied about as to become almost meaningless. So I'd definitely say there is no paradigm shift of that magnitude going on. We certainly are moving away from having an allegiance to a father or mother figure – e.g. defining ourselves as Freudian, Jungian, Kleinian, Rogerian – but I'm afraid that in many ways that is simply being substituted by becoming card-carrying members of a technical school, whether it be CBT, ACT, EMDR, or some other alphabet soup. I have nothing against any of these approaches – all of them certainly have something to offer – but I just don't believe there is one truth here – and Irv certainly subscribes to this viewpoint. Although he wrote the now classic text Existential Psychotherapy, he has always maintained that this is not a school of therapy, but rather one set of lenses which can be very useful. We are professionals with the difficult, but rewarding task of helping others alleviate suffering, and find meaning, satisfaction, and if possible, joy in their lives. One can't Europe’s Journal of Psychology 11 make a one-to-one comparison with other professionals, but we wouldn't think of asking our dentist or our attorney what their orientation is! We want to know if they can help us with our unique problems. Now in one sense the recent focus, at least in the U.S., of training students in "evidence-based" approaches, has the laudatory goal of focusing on what works. But I hear too many stories of real deficits with this approach – for example of therapists in some organizations being mandated to using a particular approach even if the clients don't want it! EJOP: Most practitioners, regardless of therapeutic orientation, see the carefully crafted therapeutic relationship as the most important ingredient in successful therapy. Do you think everybody can master the art of creating perfect alliances or is this some sort of a mystical power only few possess? Victor Yalom: Well the research consistently shows that the quality of the therapeutic alliance is extremely important in predicting therapy outcome – more important than orientation or approach – so I do hope that the word is getting out about this. We certainly don't need to strive for perfect alliances, whatever that would look like, but perhaps "good enough" alliances is a suitable goal, akin to good enough mothering. Therapists are humans, and humans aren't perfect, so it's fine to make mistakes or stumbles; it's how we manage those that is important. We want to find a way to connect with our clients in an authentic manner, which means we have to find a way to bring who we are into the room. That doesn't mean we share everything about ourselves, or every thought we have – that would be indicative of a psychotic break – but essential aspects of ourselves must intersect with essential aspects of our clients. I think that's a necessary condition for any meaningful relationship; therapy is just a very particular, and unusual type of relationship. So I think most therapists are capable of creating effective working relationships. Of course some are better than others, and there are some who are not so skilled, and would probably be better off in other professions. Assuming you've created a working relationship, the question becomes: "How can the two of you use that relationship most effectively to further the therapeutic goals"? In some ways the relationship can be healing in and of itself, but the really difficult and tricky part is learning how to use what occurs in the here-and-now of the relationship to help the client learn about their interpersonal world, and to make changes in how they relate to themselves and others. In psychoanalytic approaches this might be done via transference interpretations, but On Being a Modern Therapist 12 this often leaves the therapist too removed from the interaction. So how do you engage authentically with the client while at the same time attending to what's happening between the two of you, and then explore that together in a way that they can really learn something on an intellectual and emotional level, that they can then use that to improve the quality of their life? That's something that I think too few therapists are really taught in their training, and too few really master in the course of their careers. EJOP: Speaking of training, we know you had the wonderful opportunity to introduce existential and humanistic psychotherapy to Chinese therapists. Could you share with us few thoughts on working with Eastern students? Victor Yalom: What was most extraordinary about teaching there was the almost frenzied enthusiasm of the participants, who were either students or relatively inexperienced therapists. They were so excited to learn – both about the field, and about themselves. In the training we led a number of experiential exercises, and the participants were very willing to take risks and engage fully. The whole field of psychotherapy is quite new there; needless to say under the Communist regime of the past, there wasn't much encouragement for introspection or self-expression. But the society appears to be opening up in many ways. I don't know anything about the situation in Rumania, where you are from, but I'm sure you have some similar history. The level of openness and hunger for learning among the Chinese therapists was quite invigorating, and I wish I saw more of that with my colleagues in the U.S. Although I was too young to experience it directly, it reminds me of the excitement in California during the 1970's in the heyday of the human potential movement. Therapists and non- therapists alike were streaming into places like Esalen to hang out with Fritz Perls and Carl Rogers and others, and there was a sense that a revolution in self-awareness could transform society. Now some of this was overblown, and there were certainly excesses…but I think that level of passion is often missing among many therapists I encounter. Perhaps that is inevitable as the profession matures, but I hope that's not the case. EJOP: Here psychoanalysis as an "underground" form of therapy has been practiced also during the communist regime, in a rather clandestine fashion. And yes, the initial enthusiasm of embracing the new profession of psychotherapist in the late '90s reminds Europe’s Journal of Psychology 13 me a lot of the atmosphere you describe. Could the level of passion be restored, in your opinion? Victor Yalom: That's a great question. Probably when anything is novel, whether it's sexual attraction with a new partner, or seeing a 3D movie for the first time, there is a certain level of excitement that is hard to maintain. So it may not be realistic to expect therapists to have the same level of passion now as when the field was first being created. But if I ask myself what can be done to increase the aliveness of therapists, then I think one place always to look is how alive the therapy is that they are practicing. For me, that is always essential question: is something happening in the therapy? Is the client learning something new? Are they having new experiences? Is there a sense of discovery? Or conversely, are they simply telling you something that they already know about themselves? Are they repeating old, tired scripts? Because if nothing new is really happening during the therapy hour, then it's not a productive enterprise. So the therapist must always be watching for opportunities to nurture nascent aliveness in the client and in the therapeutic relationship. Of course that's easier said than done, but that is the art of psychotherapy. I still recall to this day my first experience as a client when I was in college – which fortunately, was a positive one. I was an introspective teenager, probably excessively so – I had certainly thought a great deal about the difficulties I experiences and filled many journal pages with my woes – and yet I almost invariably came out of each 50 minute hour with some new ways of seeing, experiencing, or understanding myself. I thought that was amazing! How could it possibly be that I could actually learn something new about myself from a therapist who hardly knew me? I wish I could say that I solved all my life problems during my first course of therapy – life is more complex, and not something to be "solved" – but it certainly was an enlivening experience. EJOP: You mentioned your first session as a client being an enriching and life-changing encounter. How do you remember your first experience as a therapist? Victor Yalom: My first year of internship was at a middle school, so I was working with early teens. For years I saved the files of these clients, thinking I might review them someday, but I eventually shredded them…and along with that most of my memories. On Being a Modern Therapist 14 One client I do remember was an African-American youth who had gone through a lot of disruption in his life – I forget the specifics – but what I remember is the long, painful, awkward silences. At least for quite a while I couldn't get him to say much, and this caused a lot of intense anxiety in myself, both in the sessions, and throughout the week in anticipation. But for some reason he kept showing up, so I can only hope he got something out of our meetings. But again, what stands out is my own anxiety about the situation, manifested in my worries: What if he is quiet again next session? How am I doing as a therapist? Will he keep showing up? Of course I realize now that this level of anxiety is not unusual for a beginning therapist, but it sure wasn't pleasant to go through! Another memory that pops up is when I was just starting my private practice. I only had one or two clients – one has to start somewhere – and my first client wasn't till around 5 or 6 pm. I was at home pulling nails from the hardwood floor to get it ready for refinishing, wearing some old work clothes, and realizing that in a few hours I'd dress up in a professional outfit, arrive early to the office with plenty of time to spare, and hope that my client wouldn't somehow know what I had been doing for the day! There certainly wasn't a sense of fluidity or integration between my role as a therapist, and that of a person. It was as if I was putting on a costume and an image and hope that was convincing. Twenty some years later of course things are much different, and I don't feel any separation between who I am as a person and who I am as a therapist; I imagine that's the case for most experienced therapists. But it's really hard at the beginning to have that sense of ease, especially if you enter the field with limited life experience, as I did. EJOP: So do you think a good therapist should definitely have enough life experience in order to be able to meet his client's various needs… Victor Yalom: That's a tough one. I do think that the more life experience, the better therapist one can be. So psychotherapy can make a great second career, which is not uncommon in this country. But the fact is that most folks do enter graduate school when they are in their 20s, and like myself end up treating the first patients when they still have a lot to learn about life. And they often start out working with the most challenging populations. Maybe that's okay, because those in great distress are less concerned about how old or experienced their therapist is – they are just grateful to get any help – Europe’s Journal of Psychology 15 whereas highly functioning middle age successful adults legitimately do want therapists who have some years under their belt. There's no easy solution to this, other than the basics, which to have lots of good supervision, peer consultation, personal psychotherapy, and hopefully good support in your personal life. But of course the latter is not always available, as we all have our ups and downs. When I was going through a divorce it was at times hard for me to focus on my work, and I'm sure I wasn't as effective at times as I would have liked to be. So I think we just need to recognize that life is challenging, and being a therapist is no inoculation against anxiety or depression, and somehow we have to muddle through that and do the best job we can. And there should be plenty of room to acknowledge and explore our personal issues within our professional training. And inevitably we garner additional useful life experiences as we continue to practice psychotherapy. We enter into relationships, marry, have children, cope with financial responsibilities and the like – this is all incredibly valuable. But I do think that if your entire professional life is seeing clients within the confines of your office, you may not acquire the variety of experiences that make for the optimal therapist. It can be just a bit too much of sitting on the sidelines. I always felt that the ideal therapists are a mentor of sorts, who are engaged in many activities, including accomplishing concrete tasks, working with others, involved in creative ventures, taking risks, etc, and then devote some of their time to counseling others. I know that if I were seeking some help now, I'd want to consult with someone who had really lived a 3-dimensional life. But the reality is that most therapists need to have a fairly full practice to pay their bills, and the skills they acquire in their training are not easily transferable to other money making ventures. So it can be a bit of a challenge. EJOP: In this era of confusion created by the rise of alternative and complementary therapies claiming to heal the body, mind and spirit, what would be your best piece of advice for a young peer who is now entering the profession? Victor Yalom: First, find experienced therapist as mentors, and learn as much as you can from them. If you're in school, connect with professors who really seems to embody the qualities of good therapists, and are eager to share what they know. Resist the natural temptation to try to impress them with how clever you are, but instead focus your energy on observing, and asking questions. If you have finished your formal On Being a Modern Therapist 16 training, then find a seasoned therapist or two as a mentor. Forget about the old style of supervision or consultation where you "present" your therapy cases by describing them. Instead videorecord your sessions, and show these to your mentor or consultation group – or get live supervision via Skype. I know this can feel vulnerable, but it's the best way to learn. Or do co-therapy with senior therapists, whether with individuals, couples or groups. We are perhaps the only profession that has traditionally learned our craft without working side by side with more experienced professional. Imagine dentists learning to work without actually seeing other dentist do fillings, and then being asked to do it them themselves without anyone watching – that would be crazy! Of course there are confidentiality concerns, but be creative. Watch videos – of course I'm especially enthusiastic with this, since psychotherapy.net is in the business of producing training videos – but this is a fantastic way to learn. If you are a tennis player you want to watch the greats – the way they hit, how they move around the court – and the same is true for master therapists. You can read all the books you want of their theories, but only by watching them can you see how they dance with their clients. Secondly, get as much personal therapy as you can afford, and take advantage of the inevitable struggles throughout your life to reenter therapy. This is perhaps the greatest way to learn about the process of therapy – especially if your therapist is someone that is talented, and a good match for you. If the therapy isn't working, find another therapist quickly. And experience other modalities: psychodrama, somatic therapy, group therapy. You can't help but learn immeasurably from these experiences. Finally, don't box yourself in with one approach. This is especially important early in your career. Almost all the approaches have something to offer, so keep yourself open minded. Of course some approaches will resonate more with you than others, but try to learn as much as you can from all your teachers, supervisors, and consultants. Go to workshops even if the topic doesn't sound of interest – you may pick up some valuable, unexpected nuggets of wisdom. As we say in English, "There are many ways to skin a cat." Why anyone would want to skin a cat I'm not sure…but you get the idea! One more thing…especially important for those in private practice: Beware the risks of isolation – it's dangerous for your own mental health, and to your work. Doing therapy can be very gratifying, but we are there to meet the needs of our clients, and too much time shut in our office usually doesn't nurture our soul sufficiently. Join a consultation group, either run by an experienced practitioner, or else a peer-led group, or both. http://www.psychotherapy.net/blog/title/psychotherapy-training-on-steroids-remote-live-supervision http://www.psychotherapy.net/ Europe’s Journal of Psychology 17 Looking back on my earlier career, I didn't avail myself enough of this kind of support, and I regret that. EJOP: Finally, as we move into the future and time resources become more limited, what do you see happening in the field? Could online therapy be a valid option for some clients? Victor Yalom: Well I certainly don't have a crystal ball, so I don't know if my predictions on this are better than anyone else's…but since you asked me, I'll give it a shot. I'm not sure that we are having less time, or that we just find ways to keep ourselves more busy. But certainly there is a small but growing trend towards Skype or other video based therapy, and I would indeed expect that to continue. Certainly video is much better than telephone based therapy, as it allows you to attend to all the non-verbal elements (e.g. body language, tone of voice) which are so essential to communication. From my limited experience with this, I think it works even better when you have at least had some contact with the client face-to-face before you transition to screen-to- screen, but I don't think that is absolutely essential. I have been recently consulting with a company that will be launching a video and chat based group therapy platform. There are obvious time-saving and other conveniences in using internet based technologies to give and receive therapy, but I do believe you miss something if you are not in the same room with the client. I just read about a study showing that even for scientific collaboration, the scientists who work closer together in terms of physical space produced more successful research papers. Computer technology will not eliminate the human desire for in-person contact, and so I don't think that in-person psychotherapy will ever disappear completely. EJOP: Thank you very much Victor, for taking the time to talk to us.