Ioan-Alexandru GRĂDINARU
“Al. I. Cuza” University of Iași (Romania)
Yalom and His Lessons:
Supportive Communication and Psychotherapy
Abstract: My paper focuses on the work of Irvin Yalom in the field of existential psychotherapy. I am interested in discussing some of his key contributions in terms of integration of philosophical ideas within the theory and practice of the therapist, but also in observing similarities with the relatively new domain of supportive communication. The use of supportive messages (expressing respect, intention of help, willingness to offer care or advice) has been linked to an increased feeling of wellbeing and to better results in fighting stressful situations.
Keywords: supportive communication, existential psychotherapy, responsibility, wellbeing, Irvin Yalom
1. Introduction
Irvin Yalom has been an influential author for the past decades mainly for the fact that he dared see outside the usual tenets of his discipline. Moreover, he sought and found fruitful insight from the field of philosophy, developing a system and, consequently, a method that stems from both the experience and savoir of the psychotherapist and the daring, in-depth investigation of some of the leading thinkers of mankind.
Yalom‟s framework involves a conceptual axis which is similar to the tenets of Continental existential philosophy, namely free will – purpose – responsibility. The human being, in the tradition of Sartre, is an active agent who cannot escape the consequences of his or her actions. This view entails the fact that we, as humans, should make the most of our life here on earth. A meaningful existence should be authentic, away from both diversion and anxiety. In this context, I am interested to see what
useful conclusions (“lessons”) we can derive for the field of communication from such an interesting and rich body of work.
2. A Philosophically Supportive Method
The style advocated by Yalom involves nondirective actions and nonauthoritative presence of the psychotherapist. Also, the experiential method is characterized by flexibility and open talks about people‟s prejudices and preconceptions (similar, but not identical to cognitive approaches). Moreover, the conversational style and the authentic preoccupation of the therapist also fit well within Yalom‟s framework.
The exchange of messages is many times close to what happens in interpersonal interactions that people usually have with their close peers.
The similarity with interpersonal communication is also seen when we think about the intensity of dialogue.
It is no wonder that the four givens (Yalom 1980) that fundamentally underlie the system of existential therapy have, each one of them, a strong philosophical flavour: fear of death, freedom, the problem of isolation and the question of meaning. What is relevant for the therapist is how the client (and even the therapist himself) experiences these givens on his own. We must note the fact that nothing seems to back Yalom‟s claim that these four givens are so important in themselves so they righteously distinguish themselves from other given-candidates. It is not obvious why spirituality or class or suffering would not be put forward.
For Yalom, each person has at least one awakening experience (eventually narrated to the therapist or transformed into a founding story).
This episode helps people see their life differently. For instance, in Yalom‟s experience, people that have lived their live to the fullest and accomplished their goals and used their potential are less fearful of death.
Moreover, in the light of this awakening, the behavioural patterns become more meaningful and responsible. Yalom believes that philosophy can teach us that responsibility avoidance is detrimental to our mental wellbeing. He is fond of the authors and ideas that explicitly state that awareness and knowledge, fuelled by willpower, trigger meaningful actions. He thus steps away from the determinism present in Freud and other authors, who might be scientifically significant, but it proves practically unhelpful.
3. Communicating Effectively with Others
Communicating effectively with our peers seems to imply, for Yalom, a sort of ethical element. He says that people seldom overcome the fear of isolation by fusing with another person. We must discriminate, though, between survival and growth. If the other person is simply used for our survival (as an equipment), this entails the fact that our relationship has not touched yet its full potential. It may never will, if we keep repeating such a harmful pattern of behaviour. On the contrary, fusing with the other should lead to authentic growth for both persons. It is not arbitrary, in this vein, that Rollo May (1969, 37) included the concept of agapé in a similar context.
Supportive communication may represent a way to meet this standard, since the message exchange involved is usually targeted towards the wellbeing of our significant others. As defined by Burleson and MacGeorge (2002, 374), supportive communication is “verbal and nonverbal behaviour produced with the intention of providing assistance to others perceived as needing that aid”. This type of communication is easily noticed in times of pain, but in fact it is experienced from birth till death (Burleson and MacGeorge 2002, 374-375):
“For better or worse, the tragedy of 9/11 has made us more mindful of this essential form of human communication and the ways in which it is conducted through varied messages, within ordinary (and extraordinary) interactions and relationships, and in response to myriad life events.
Supportive interactions are ubiquitous in human life, beginning early (as caregivers seek to soothe distressed newborns) and extending to our final moments (where, if we are fortunate, we are comforted by loving others after we have lived long and full lives). At a multitude of points in our lives, all of us are seekers and providers of support.”
The relevance of social support is common knowledge for quite some time. Burleson and MacGeorge (2002, 383) note that sociological and psychological research show that there is a definite connection between support and both physical and mental wellbeing. They insist that the communication perspective adds more information on the relationship between the perceived need of the helped and the intention of the helper (see also Dunkel-Schetter et al. 1992 and Burleson 1994). Nonetheless, we must accept that supportive messages are not always efficient, on the one hand, and that they do not represent the single factor of enhancing the state of wellbeing, on the other hand.
The supportive dimension of existential therapy is seen when we acknowledge the fact that the method involves using dialogue combined with silence (van Deurzen 2007). The moments of silence allow the client to launch self-analysis. Also, there exists the firm commitment to the idea of not trying to (forcefully) change the client during the sessions.
Moreover, the therapist does not do the work of the client, but only assists in the process. The therapist sticks to the conversational style, is fully present in the encounter (Krug 2009), orients the discussion towards the issues that the client experiences and keeps optimal control in terms of session timing. The sessions present a double relevance, so to speak, because even the therapist may learn new things (even new things about his or her own self). As it is the case with interpersonal supportive interactions, the two parties become aware of the importance of message exchange and of the openness acquired. The therapist – usually an intelligent and experienced person, with a wide-enough understanding of the human condition – must be ready to explore all sorts of problems, even problems stemming from the client‟s distant past. In this vein, the therapist offers support also in the form of approaching the limits of the human condition or tackling metaphysical aspects within the client‟s personal worldview. The therapist, along the lines developed by Yalom (1980, 2002, 2005, 1999, 2008) both in his theoretical and literary writings, has a decisive role in the transition of the client from infantile patterns to full maturity. Also, what is central to the existential paradigm is the concern for the strategy of avoidance. During the work sessions, the therapist tries to influence the client in understanding the fact that support functions better when it gets rid of illusions (maintained by constant use of avoidance). This entails that supportive messages must be selected by the therapist in order to meet his or her goals. As Burleson and MacGeorge (2002, 388) state,
“Thus, supportive messages can be evaluated for their success at fulfilling immediate instrumental objectives, such as reducing distress or promoting problem-solving actions, and immediate relational objectives, such as protecting or managing the interpersonal relationship with the target, responding to relevant concerns for identity and self-presentation, and maintaining coherent interaction. […] Supportive messages can also be evaluated for their impact on distal instrumental objectives, including the development of targets‟ coping capacities, enhancement of targets‟
psychological and physical health, heightening of targets‟ perceptions of availability of support, and even influencing individuals‟ capacity to provide support for others. Similarly, evaluation of supportive messages
can be made with respect to distal relational objectives, including satisfaction, stability, and commitment in the relationship between support provider and target.”
Therapy meets real life in the process of recapitulation. The existential counsellor seeks to recreate actual situations that arise in the life of the client in the limited space and time of the session. The session, as Berry-Smith puts it (2012, 49), becomes a microcosm. Why do people remain within dysfunctional relationships, for instance? A possible answer could be that they avoid responsibility. If such a behavioural pattern emerged during a therapy session, then the therapist would choose suitable immediate relational objectives (such as using moderate support messages in case of avoidance) and modify or test distal relational objectives (he or she would wait and see if further discussions will make the client give up the above patterns).
4. Philosophical Investments and Personal Payoff
By approaching key contributions of philosophy (Spinoza, Schopenhauer, Nietzsche, for example), Yalom doesn‟t enter the usual pathway of trying to get to more abstract structures of thinking. On the contrary, he extracts useful ideas and applies them in the everyday life.
He purposely steps away from the technicalities of the respective philosophical system (while he is fully capable of exploring them, if needed) and prefers to test those ideas in concrete setups. If such an idea is found, this usually translates into the fact that we assign meanings to our experience and, incidentally, we get rid of the maladaptive projections created along the way. Evidently, philosophy does not solve the problems in our life, but it helps us build a wider perspective about them. Moreover, over the centuries, philosophical thinking proved vital in questioning the frameworks of our thought. The critique of arguments provided not only a tool to attack an opponent, but also a means for evading out-of-date paradigms or fixed conceptions that showed no sign of progress.
Schopenhauer‟s development of the concept of will and his apparent pessimistic view about the world receive a new form of theoretic treatment under Yalom‟s perspective (1980). Surely, the world is a lot stranger and frightening than we thought in the past, and we humans are not the happiest campers in this landscape. But Yalom feels that the goal of the psychotherapist is to develop a worldview from that point on and overcome the subsequent depression with a somewhat stoic approach of looking at life (and death, that is) straight in the face.
As Margaret Warner tells us, the clients who suffered premature empathy failures may develop a weak form of experiential processing (1997, 131). They might have problems keeping a certain level of intensity in their experience and get a grip on the perspective of the others without having the feeling that their own experience might be reduced to nothing. Using the work of Eugene Gendlin or Carl Rogers, Warner notices that people are generally attracted to experiences that offer the feeling of „being alive‟ and manifest the tendency to assign meanings for all the experiences that differ significantly from what they expect (1997, 136). Another key factor is the fact that such new experiences bring out the fear of unknown or uncharted territory so that seldom people try to make use of the already structured experiences to understand the new ones. The authentic role played by the empathy and its subsequent forms of communication enters the scene at this very moment: by showing empathy, we offer our peers the confirmation that their own unprecedented experience is nevertheless comprehensible and comprehended by a fellow human being (Warner 1997, 137). Many times, this also translates into the fact that a certain experience becomes even desirable, pulling off other experiences that are correlated with the first one. Rogers realized that children grow stronger and more prone to assign meanings to what happens in their life if they are raised by a parent that is attentive enough to what they tell him or her. The parent needs to relate to the narrated experience and create a conceptual frame that puts it all together. So, this dyad is functional communication wise when the parent knows how to apply the empathy-attention structure. Of course, this creates dependence between the parent and the child, but this is fine if we place it against the background of the supportive function (Kohut 1982) present in early childhood.
Warner asserts that a client that undergoes psychotherapy and shows the signs of frail processing may have a unique chance of recovery in the empathy-attention relation. The empathy, again, ensures that the client does not feel traumatized by the experience and does not feel disconnected from that experience. The inexistence of such a supportive tool may create difficulties in the sense that the client does not perceive his faith of being of any importance and, more, becomes uncappable of re-evaluating and re-elaborating the issues in his or her life. For patients that have been cut off in their childhood from empathy, Warner says, may re-open certain lines of growing that have been stopped. Of course, care is needed especially when forms of permanent empathy interactions with the therapist are present.
As Greet Vanaerschot (1997) noticed, empathy constitutes a therapeutic process and possibly the beginning of a process of substantial transformation of the client. Drawing on Gendlin‟s concept of experiencing, Vanaerschot believes that the clients who understand how this process unfolds reach deeper levels of self-exploration. As Gendlin, among others, pointed out, the process of experiencing is felt at two levels. The first is the “implicitly organic” one, while the second consists in the interface between gut feeling and symbols. If the healthy mental functioning equals adequate process of experiencing, then we (humans preoccupied by the fate of our peers or the fate of our significant others) must understand that we have to undertake the task of focusing our reflective attention on the different aspects of the meaning of a particular experience. To gain as much as possible from everyday experience, a person should step away from the perspective that our experiences are uniquely determined and have just one form of explaining/justification.
The healthier and the more useful approach is the one within which all our experiences are nothing but temporary structures that would be probably altered by future experiences, leading thus towards new forms of structuring and explanation. Thus, the way we experience the present would not be distorted by the way we have experienced the past (a feat that seems, nevertheless, to make us fight against our own biology) (Vanaerschot 1997, 145-146).
As Emily van Deurzen asserted (2007), the human being is the subject of a vast field of experience. It is pointless to presume some kind of out-of-time essence (in spite of existing human universals, to mention Brown‟s famous concept) that would be the target of a unique therapeutic solution. Rather, in the manner espoused by existential philosophy, our existence precedes anything else. We are free and responsible to create our own destiny if we fully grasp the limits of human condition. Thus, the anti-essentialist stance must be correlated with the idea of self-creation and self-reinvention. If freedom and responsibility truly exist, then we get the green light to create our meaningful path in life.
5. Why Hic et Nunc?
Yalom insisted on several occasions (1980, 1996, 2005) that in the work sessions with the client, the psychotherapist must use every opportunity available to bring everything here and now. In my view, this standpoint is much more important than it seems at first glance and thus must be explored a little further.
First, the hic et nunc approach gives the session the nuance of authenticity. The minutes are not spent in vain, the discussion is focused and meaningful, the client feels that this is quality time. Second, what the client experienced in the past becomes real again, and this freshness can help both client and therapist imagine new solutions. Third, the authenticity of seizing the moment can sometimes block the mechanisms of defence, and thus the therapeutic relationship is considerably enhanced.
Forth, living fully in the moment offers the client a direct example of meaningful life. So, if the protagonists succeed in creating such a moment, the client has all the reasons to switch to a better state of mind.
This is exactly the case with actual interpersonal communication:
from the vast amount of message exchange, some situations prove more meaningful than others, and distinguish themselves by exiting the usual routine. Evidently, this routine keeps its importance because it provides the background against which new and meaningful material turns up.
The spiritual meaning of hic et nunc is, I think, extremely relevant for the system elaborated by Yalom. The main reason for this is quite straightforward, as stated above. But I guess there are more, subtler, motifs that underlie this idea. For instance, we humans, as ultimate survival machines, are prone to all kinds of violations of the rule of
“staying in the moment”. We could easily project too much our own actions in the future as a – sometimes, pathological – token of our anticipation bias (an essential tool developed for survival). Or, on the contrary, we could live our lives too much in the past, with our minds set on previous experience. This can happen both in the situations of past performance (the glory of the golden age) or past defeat (the negative feed-back sometimes leaves crueller marks than the expected average). In both cases, we fail to grasp the fullness of the moment, and although our body seems to be here and now our mind isn‟t. By learning to be in the here and now the client/patient frees herself or himself from the asynchronous anomalies. By staying in the moment, the people that entertain meaningful interpersonal interactions fly away from annoying or senseless message exchange. As Susan Baur (1997) fruitfully noticed, the hour spent by the client with the psychotherapist should an hour of intimacy, experienced, nevertheless, within the boundaries of professional counselling (Baur illustrates very well the forms and the effects of subsequent trespassing).
Bringing the client in the here and now stance probably increases the probability of success for the supportive messages. As Burleson and MacGeorge (2002, 399-404) show, we know that this type of message
works, but we are not entirely sure why. What we do know is the fact that the messages focused on emotion and description are perceived as being more helpful than evaluative messages (hence the problems of giving a piece of advice). Moreover, the helper is doing great work when he or she manages to express obvious supportive intent, use different strategies to eliminate face threats, provide accurate information and generally create a set up centred on the person (Burleson and MacGeorge 2002, 404).
6. Conclusions
Yalom represents a good example of an author who fruitfully mixes at least two fields of inquiry. He is not afraid to bring together psychotherapy (a domain that on the one hand is empirically laden and structured, on the other hand, by solid scientific findings) with philosophy (much more open to speculation and mental experimentation). Also, Yalom discusses at length, in his works, the classical humanist problem of making/creating/finding a meaning in what we do. From a certain standpoint, our biological knowledge rules out the question of meaning.
But from the standpoint of the individual the question whether his or her actions lead somewhere (except for being the vehicle of gene reproduction) still holds strong. The quest for self-creation and self- realization still represents an issue, paradoxically, even if we are ready to conceal that there is no self. What do we do with what we have even if it doesn‟t seem this is very much?
While the work done by philosophers like Kierkegaard or Schopenhauer stressed out the overwhelming presence of anxiety within our lives, Yalom believes that the awareness of that feeling should not lead us into pessimism. On the contrary, in Sartre-like or in Camus-like fashion, the human condition must be acknowledged for what it is: facing the worst prepares us for the best. Facing the givens of our human condition represents, indeed, a tough task, but this opens the way to understand our subsequent limits and possibilities. Staring at the sun is the abrupt metaphor that expresses the direct approach of the problem of death, while wandering on the dangerous paths of searching meaning exposes us to failure. Nevertheless, this represents the only route to access actual freedom: only through understanding the realm of necessity can we discover the realm of freedom (van Deurzen 2007). In the absence of such a terrifying confrontation, we might illusion ourselves by hovering the shallow waters of fake conscience. It is not a coincidence, then, that a primary objective for existential therapy is to know and understand oneself,
to embrace a life cause and last, but not least, widen up the spiritual horizon. This, in turn, helps us enhance our performance in communicating with our peers and get a better grasp of supportive interactions.
Yalom fruitfully challenges, in my opinion, the tag of maladaptation – so common among therapists, unfortunately – used in the situations brought about by the four givens of human condition. While it is true that facing death or isolation may lead to pathologic behaviours, it is not obvious that the absence of such behaviours entails the fact that the individual has successfully solved the above issues. It is one thing to refuse to open the question of isolation and another to face it courageously and to venture the intricacies of philosophical arguments.
Yalom suggests that the failure of therapy (when it occurs) in such cases may not be related to the incurable client, but to the complexity of the issue, rather. Thus, the existential therapist presents extra-advantage because the support given to the client includes not only the usual therapy protocols, but also meaningful talk. The existential therapist is ready to admit that the chills experienced by the client when thinking about personal death are not just symptoms of maladaptation, but also proof that death has an inherent abysmal, metaphysical dimension that‟s unavoidable once the question has popped up already. Building up relevant interpersonal relationships becomes, in this perspective, not only a means to satisfy our affiliation impulse, but also a complex response to our fear of isolation and loneliness.
References
BAUR, Susan. 1997. The Intimate Hour: Love and Sex in Psychotherapy.
Boston: Houghton Mifflin.
BERRY-SMITH, S. F. 2012. Death, freedom, isolation and meaninglessness and the existential psychotherapy of Irvin D. Yalom. Doctoral dissertation.
Auckland University of Technology.
BURLESON, Brant R. and MACGEORGE, Erina L. 2002. “Supportive Communication”. In Handbook of Interpersonal Communication, third edition, edited by Mark L. Knapp and John A. Daly, 374-424. Thousand Oaks, London, New Delhi: Sage Publications.
BURLESON, Brant. 1994. “Comforting messages: Features, functions, and outcomes”. In Strategic interpersonal communication, edited by J. A.
Daly and J. M. Wiemann, 135-161. Hillsdale, NJ: Lawrence Erlbaum.
DUNKEL-SCHETTER, C., BLASBAND, D., FEINSTEIN, L., HERBERT, T.
1992. “Elements of supportive interactions: When are attempts to help
effective?”. In Helping and Being Helped: Naturalistic Studies, edited by S. Spacapan and S. Oskamp, 83-114. Newbury Park, CA: Sage.
KOHUT, H. 1982. “Introspection, empathy, and the semicircle of mental health”. International Journal of Psychoanalysis 63: 395-408.
KRUG, O. T. 2009.” James Bugental and Irvin Yalom: Two masters of existential therapy cultivate presence in the therapeutic encounter”. Journal of Humanistic Psychology 49 (3): 329-354.
MAY, Rollo. 1969. Love and Will. New York, London: W. W. Norton & Co.
van DEURZEN, Emmy. 2007. “Existential Therapy”. In Dryden’s Handbook of Individual Therapy, Fifth Edition, edited by Windy Dryden, 195-226. Los Angeles, London, New Delhi, Singapore: Sage Publications.
VANAERSCHOT, Greet. 1997. “Empathic Resonance as a Source of Experience-Enhancing Interventions”.In Empathy Reconsidered. New Directions in Psychotherapy, edited by Arthur C. Bohart and Leslie S.
Greenberg, 141-166. Washington: American Psychological Association.
WARNER, Margaret. 1997. “Does Empathy Cure? A Theoretical Consideration of Empathy, Processing, and Personal Narrative”. In Empathy Reconsidered. New Directions in Psychotherapy, edited by Arthur C.
Bohart and Leslie S. Greenberg, 125-140. Washington: American Psychological Association.
YALOM, I. D. 1980. Existential psychotherapy. New York, NY: Basic Books.
YALOM, I. D. 1996. Lying on the couch. New York, NY: Basic Books.
YALOM, I. D. 1999. Momma and the meaning of life. New York, NY: Basic Books.
YALOM, I. D. 2002. The gift of therapy. New York, NY: Harper Collins.
YALOM, I. D. 2005. The Schopenhauer cure. New York, NY: Harper Collins.
YALOM, I. D. 2008. Staring at the sun. San Francisco, Ca: Jossey-Bass.
