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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyProcess-Based CBTPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive 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MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
What do you want?
This simple question
generates some of the most intimate answers, even between perfect
I want my to see my
dead mother again. I want to be
loved. I want to live forever. I want to know, Dad, that you are proud of
me. I want to be young again. I want the childhood I never had...
And between patient
and psychotherapist, answers reflect a deeper anxiety, a fear, a restless
longing, that Yalom terms "existence anxiety" or "existence
pain". Existence pain is the kind
of pain that is "always there, whirring continuously just beneath the
membrane of life. Pain that is all too easily accessible" (p. 3). Existence pain is the organizing principle
behind Yalom's approach to existential psychotherapy, and typifies what he
calls the "givens" of existence. Yalom identifies these four
"givens" as follows.
First, there is the
anxiety that is generated by the inevitability of death (for each of us as well
as for those we love). The reality of
death haunts many; most of us avoid the topic altogether (we do so by inventing
convenient myths and comforting euphemisms).
Existential psychotherapy aims to penetrate, identify, and re-assess
these layers of concealment and these multiple defenses that attempt to shut
out the reality and finality of death that are so often destructive and
pain occurs when we realize the ultimate freedom with which we live our lives. The realization that we are free to choose
how our lives will unfold leads many to deny this responsibility. Ultimately, accepting responsibility for our
lives and our ways of relating to others will empower us and put us in control.
Third, great effort
is often spent to avoid the pain of being alone. The fear of failing to achieve close and personal relationships
often sabotages the very attempt to connect with others. Coupled with the nagging sense that each of
us will face death alone, aloneness generates so much grief that many people,
paradoxically, fail generate significant relationships. Identifying these
self-defeating tendencies is the first step at removing the obstacles that
hinder the generation of significant relationships.
pain occurs when we come to realize that life is devoid of any obvious
meaning. Our attempt to cling to
artificial meaning structures (leading to behaviors such as collecting dolls
and stamps in ritualistic fashion), ultimately unravels our ability to cope
with a world of existence and death.
Each of these sources
of existence pain (death, freedom, aloneness, meaninglessness) have a
synergistic effect with each other: often we employ arguably unhealthy
strategies to avoid one source of pain, which then exacerbates the pain and
anxiety experienced in other areas.
For example, people
often fear the finality of death that ultimately awaits a loved one. This leads us to place distance between
ourselves and others (as a kind of defense mechanism to avoid the pain of
loss). But in so doing, we place
barriers between ourselves and others, thereby undermining our ability to
relate to each other authentically.
This, in turn, reinforces the anxiety that, ultimately, each of us is
alone and will die alone. Avoiding the
pain of death places us directly in the path of existence pain that results
from being alone. And the diversity of
examples are as endless as there are people in the world.
For a more detailed and scholarly examination
of this existential approach to psychotherapy, see Yalom's Existential
Psychotherapy, New York: Basic Books, 1980.
is the story of ten patients who turned to psychotherapy to deal with existence
There is the woman who yearns for her dead
daughter, visiting her grave daily, while at the same time neglecting her two
There is the 60-year-old woman who clings to
a fantasy relationship with a man 35 years younger, all in the attempt to avoid
the uncomfortable reality of aging and death.
There is the man who
has the mentality of a sexual predator, even though lymphatic cancer is slowly
eating away his body.
Still another man
who, in an attempt to deny his own mortality, cannot throw away love letters
three decades old.
And then there's the "Fat Lady" who
manages to lose 100 pounds, despite longing to understand her father's
All in all, Yalom
presents an excellent account of how psychotherapy might unfold for both
patient and clinician. Yalom provides
an uncharacteristically personal account of the therapist's own challenges and illuminates
some of the fundamental challenges associated with providing therapy. After all, the therapist, too, is dealing
with existence pain just as much as the patient. This proves to make therapy sessions particularly intriguing, and
Yalom pulls no punches when providing introspective accounts of his own
Yalom's prose is both
accessible and penetrating as he leads the reader into the depths of the human
condition in ten unique accounts of existentialist psychotherapy. I highly recommend this book (as well as
others by Yalom) to anyone, on either side of the couch, who is remotely
interested in psychotherapy. Yalom is a
delight to read, and offers penetrating insights that apply to each of us who
is caught, inescapably and firmly, in the grips of the human condition.
© 2002 James Sage
James Sage is a Ph.D. candidate in
philosophy at the University of Utah. His interests include the evolution of
mind and rationality, philosophy of science, and naturalized theories of