Tales of Psychotherapy

By Irvin D. Yalom

Basic Books. 247 pp. $24

This is a collection of psychiatric memoirs--both fiction and nonfiction. Irvin Yalom, author of "Love's Executioner," has put together six essays--four of them based in fact, with names and some circumstances changed, the last two playful, fictional excursions into how the psychotherapeutic process works.

To my mind these six essays are wildly uneven, but the volume is redeemed throughout by the author's charming voice. Yalom's first chapter deals with his mother, a cantankerous immigrant who slaved and strove and rarely had a good word for anybody in order that her son could grow up to be an intellectual princeling. Of course, as a princeling, he had a difficult time relating to his comparatively unevolved mother. It's a universal paradigm of immigration in this country--parents sacrifice "everything" for their children, and often find (if they have the wit to notice) that they, too, have been sacrificed. Thus--if I read correctly--Yalom finds himself cut off from his mother's heritage but still bound inextricably to it.

He's made a career in the field of his choice and, goodness knows, has done well at it, but the precocious boy--in late middle age--begins to perceive limitations to his life. Yalom is a good Freudian but has modified the master's theories to include a "here-and-now" therapy in which the patient is constrained to go easy on bottled memories of his or her past and concentrate instead on "the space" in the office between patient and therapist. This theory has the effect--again, to this reader's eyes--of putting an inordinate amount of attention on the therapist instead of the client. But Yalom is nothing if not a hero in his own eyes.

His saving grace is that he knows it. He is hampered in the practice of his profession by the strangling effects of HMOs, which famously take a dim view of protracted talking cures. He's equally hampered by the fact that, despite his unlettered, undemonstrative mother, he's had a comparatively happy life. In the course of these essays he finds himself ministering to miseries he doesn't even pretend to understand. And as if to make up for his relatively easy existence, Yalom postulates a fierce existential atheism with the zeal of a true believer. To come to a mentally healthy view of our own lives, he firmly suggests, we must accept that there is absolutely nothing out there in the way of an afterlife or extra life. When we die, we simply die. This doesn't make the author himself feel any better, because he's not getting any younger.

So what we see here is a practicing psychotherapist, harassed by everything from HMOs to a fear of death, practicing "here-and-now" therapy, worried by his limitations, more than willing to learn from his patients and always, in every instance, redeemed by his own charm.

The centerpiece here is "Seven Advanced Lessons in the Therapy of Grief," in which the therapist is seduced by self-regard into taking on a patient he might best have left alone: "She had said the magic words--that I was the only one smart enough to treat her. The perfect plug for my socket of vanity." Irene is part of the therapist's social circle; she is as smart, he thinks, as he is, maybe smarter. Though "facts" have been changed, she's presented to us as a surgeon who's about to be widowed. Yalom is to help her in a course of grief therapy.

But Irene turns out to be a self-satisfied, narcissistic pain in the neck. Her therapy takes five years. She repeatedly insults her therapist. She rants about being the center of a noxious vicious black hole of destroying energy, and then she rants some more. It's a little hard to know what the author is advocating for her, what cause he's advancing. Because while it's hard to treat mental distress in six weeks (as those heartless HMOs would suggest therapists do), it also seems a tad inefficient to sign on to listen to one woman's repetitious vilification for five years. If every case of grief required this kind of treatment, many, many people in the world would be on the couch (or in the chair opposite) for a very long time.

Perhaps because Irene seems, to this reader at least, the last word in self-indulgent unpleasantness, Yalom lightens the end of his collection with a couple of psychiatric fables, weighted heavily by a sweet brand of wish fulfillment. In "Double Exposure" the fictionalized therapist mistakenly (?) gives a crabby, vulgar patient a tape of his own thoughts about her. He himself is attending a seminar on countertransference, and becomes convinced that there really is such a thing as "unconscious empathy"--how else can his patient quote to him exactly what he thinks of her? Naturally, she gets better, safe in the "here-and-now." The last essay charmingly (again, that word sticks like lint to Yalom's cosmic sweater) connects modern psychotherapy to some of the cultural material that his mother may have passed on to him. The hero finds himself psychoanalyzing a European fairy tale monster, a snarling feline from a damsel's troubled dream world, and by using his mother's "magic" words turns the creature into a civil kitty cat.

Talking cures have come under fire in recent years. But Yalom's lively defense of his profession presents a convincing argument (sometimes) for the meticulous, unhurried dissection of the troubled human mind.

Carolyn See, whose reviews appear on Fridays in Style