The Therapeutic System

"What ails?" is a question Dr. Irvin Yalom repeatedly asks his patients. According to Dr. Yalom's Love's Executioner, therapist and patient can only answer this question and thereby come to a successful place in psychotherapy through personal interaction and mutual respect. The therapist's ability to lay down internal defenses, confront his own prejudices, all the while tolerating uncertainty, is critical.

Whereas the layman may assume that the therapist guides the patient through systematic and pre-determined stages of therapy toward a set, predetermined goal, in reality, rarely is this the actual case. Often, the therapist is armed with a map of training and past experience that proves to be of dubious merit. Yet, Dr. Yalom believes that the fumbling that ensues along the route to improvement is to be expected.

As the therapist searches for terra firma, he may even arrive at a successful as much by relative luck as by design. In fact, complete reliance in a particular therapeutic system may lead to unsatisfactory results. The temptation to pigeon-hole clients is overwhelming, while the therapist can be closed-off to observations and understanding that do not fall within his obscured view.

"Even the most liberal system of psychiatric

nomenclature does violence to the being of another.

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

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). As one case study client said to Dr. Yalom on his death bed, "Thank you for saving my life." (86) The final reality is that life is irrevocably entwined with death. Freedom, a given of existence, presents a dilemma for the individual, since change posits an act of will. The therapist endeavors to influence a patient's will. He may be personally involved in his approach - badgering, arguing, coercing, even imploring (9). Dr. Yalom uses all of these methods. In addition to a penchant for dream therapy, he is confessional - speaking freely of the "limits to his own hypocrisy," (154) as well as of his "tendency to sexualize much in his environment." (155) Dr. Yalom is not above sharing his own failings with a client. Transference is an ever-present danger in psychoanalysis. The tendency for both therapist and client to transfer or counter transfer irrational feelings is inevitable. Such a practice may make deep therapy difficult. In the particular case of Betty in "Fat Lady" whose weight had reached life-threatening proportions, the question arose of whether Dr. Yalom could truly engage in an honest and compassionate relationship. In transferring his prior negative feeling about fat women onto Betty, could he succe

Category: Psychology - T