What does ‘the father of group therapy’ do at the age of 90, when he is still advising patients in the therapy sessions that have been his life’s work, and yet must face his increasing frailties and even his own mortality? Rather than melt into retirement, Dr Yalom develops another revolutionary approach.
In Hour of the Heart, Dr Irvin D. Yalom captures profound moments with his patients that happen in the span of just one hour, with people he will never see again. Taking place over two years before and during the Covid-19 pandemic, and amid Dr Yalom’s grief over losing his wife, these sessions would, as Dr Yalom writes, ‘help to sustain my client and would profoundly alter my vision of what psychotherapy can do’.
Review
At the age of 90, Dr Irvin Yalom is conscious of his increasing physical frailties as well as his deteriorating memory. Still wanting to use his skills, he ceases taking on clients for standard therapy (i.e. multiple sessions) and starts offering once-off, one-hour sessions only. He is clear that he’s not advocating for this to be the standard model of therapy, and he talks in the intro about how insurance companies’ attempts to limit the number of sessions can be disadvantageous to individuals with complex mental health needs (relatable to those of us working in Australia’s Medicare model and its’ ten-session-only rebates).
The book is a collection of stories of these one-off sessions, and they are fascinating to me as a psychologist. How effective can one hour of conversation be? It is true that Dr Yalom (or Irv, as he asks his clients to call him) does not promise to resolve his clients’ needs in one hour; in fact, every consultation is ended with him providing names of other clinicians and urging the client to continue with longer-term therapy. Still, he endeavours to provide some sort of insight, and the way he does this is by focusing on the ‘here and now’. Often, he picks up on the dynamic between him and the client and raises this with the client, linking it with the issue that brought them to him. Most of the time, this is effective.
Dr Yalom also experiments with self-disclosure and ‘role reversals’ in these sessions. His long-standing career, multiple books, and generally public profile mean that his clients know details about his life, e.g. the passing of his wife. In some sessions, he invites his clients to ask him questions and offers honest responses. This goes against the general principle of therapy, that even if you don’t subscribe to Freud’s ‘blank slate’ model, self-disclosure should be kept to a minimum. Dr Yalom talks about this as well in the book and argues that self-disclosure can be useful to building connection, the thing that accounts for 80% of success in therapy.
Both of the above approaches are food for thought to me. Commenting on the ‘here and now’ is something I have done before, e.g. when the client struggles with relational issues and they show up in the therapy room, or when I feel something has shifted in the moment or in our rapport. Self-disclosure, on the other hand, is more complicated. I don’t believe in being a blank slate; I think it’s helpful to the people I work with that I am human. However, I also believe that therapy should be about the client; there’s a line between self-disclosure and self-indulgent. I would be curious to know if or how Dr Yalom would use ‘role reversals’ when working with long-term clients. (Somewhat related, this article by Lilly Jay is really fascinating.)
Dr Yalom extends his self-disclosure to his readers as well. He talks candidly about his anxiety when his memory fails him and the errors he makes (including sending his private notes about a session to the client by accident, eeek). He writes the book in collaboration with his son, but I imagine it is mainly his voice that comes through in the writing. It is warm and compassionate, and occasionally funny.
Overall, the book is compelling and easy to read, with an interesting concept. I imagine mental health professionals and people who are interested in psychology will enjoy this book – if not for leisure, then at least as fodder for discussion.
Thank you to Scribe Publications for the review copy
Review by Priscilla
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