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Developing Courage on the Couch : LOVE'S EXECUTIONER AND OTHER TALES OF PSYCHOTHERAPY by Irvin Yalom MD (Basic Books: $19.95; 288 pp.)

August 27, 1989|Thomas Davey | Davey is a psychologist in Boston. His most recent book is "A Generation Divided: German Children and the Berlin Wall." and

Irvin Yalom is a psychiatrist deeply familiar with the vicissitudes of clinical practice, and author of a number of books on psychotherapy. Philosophically committed to "existential psychotherapy" (he has published a book on the subject), Yalom believes that the "primal stuff" of psychotherapy is what he calls "existence pain," and not repressed instinctual urges or the painfully unresolved moments of events of an individual's earlier life. The questions that haunt his patients are the very ones posed by Gauguin in his famous triptych: "Where Do We Come From? What Are We? Where Are We Going?"

During the course of his clinical work with patients, Yalom has come to recognize four "givens" especially relevant to psychotherapy: the inevitability of death for each of us; the freedom we possess to make what we will of our lives; our basic aloneness, and the lack of any real, sustaining meaning to life. It is these essential facts, as he sees them, with which his patients wrestle, and more often than not have come to a painful, deeply unsatisfying truce with. Part of his task, as a psychotherapist, is to assist in "dis-illusioning" his patients; to help them to accept these "facts" of existence. "Though the fact of death destroys us," he is inspired by one patient to write, "the idea of death may save us."

"Love's Executioner and Other Tales of Psychotherapy" is a collection of case histories derived from Yalom's work with 10 of his patients, the best of which read as finely wrought short stories. With them he breathes life into his philosophical and clinical preoccupations.

A psychiatrist with an aversion to overly rigid theoretical or methodological constraints, Yalom has wisely chosen to transmute the daunting, private struggles waged weekly (occasionally more often) in the psychotherapeutic relationship into these illuminating "tales." In so doing, he sidesteps much of the dreary and often banal language of his field. These stories, some more sharply etched and revealing than others, all harbor a premise long familiar to the novelist and short story writer: namely, that a given life can be illuminated and to some degree shared, yet it can never be fully explained. Each life retains a measure of mystery that ultimately can only be appreciated and respected. "The soul of man is (indeed) a far country," as D. M. Thomas observed in "The White Hotel."

Aside from illustrating the ways in which "existence pain" is woven into the lives, and symptoms, of Yalom's patients, these stories are essentially a meditation on character as it is revealed in the relationship with the therapist. (It is invigorating to see a psychiatrist turn his attention to character, as opposed to character disorders.)

Many of these stories manage, through vivid dialogue and a keen attention to the myriad details that comprise the fabric of a life, to reveal a great deal about these individual men and women. Yalom in this way underscores what he sees as the banality and limitations of the standard diagnostic approach to personality. "I . . . marvel that anyone can take diagnosis seriously, that it can ever be considered more than a simple cluster of symptoms and behavioral traits. . . . If we relate to people believing that we can categorize them, we will neither identify nor nurture the parts, the vital parts, of the other that transcends category. The enabling relationship always assumes that the other is never fully knowable." With these stories, Yalom seeks to replace categories that restrict our vision, with metaphors (or one should say, different metaphors, since a diagnosis is a metaphor of sorts) that expand our vision.

Certain of these tales are gems of compression, offering vivid and detailed portraits. The title story, one of the best, "Love's Executioner," introduces us to Thelma, desperately seeking relief from an incapacitating love obsession. Here is Yalom's initial encounter with her: "Thelma, in the opening minutes of our first interview, told me that she was hopelessly, tragically in love, and I never hesitated, not for one moment, to accept her for treatment. Everything I saw in my first glance--her wrinkled 70-year-old face with that senile chin tremor; her thinning, peroxided, unkempt yellow hair; her emaciated blue-veined hands--told me she had to be mistaken, that she could not be in love. How could love ever choose to ravage that frail, totering old body, or to house itself in that shapeless polyester jogging suit?"

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