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This event was an epiphany. How had he evoked such an unexpected response from his audience? Not because of his psychiatric knowledge or clinical expertise, of which he had nil. "What I had done was something quite different" I had conveyed the essence of my patient and our relationship in the form of an interesting story." Not only did the experience convey the power of narrative to bring "case histories" to vivid, blooming life, but it wakened in Yalom the realization that has been central to his approach ever since: patients can be fully known and understood only from their stories and from the relationship they form with a therapist.
Yalom's work seems to argue that most psychodynamic therapies don't go nearly deep enough. For him, the universality of death, the awareness that the grim reaper's leering mug is always just around the next corner if not right in front of us, requires a certain humility in the therapist. "Everyone—and that includes therapists as well as patients—is destined to experience not only the exhilaration of life, but also its inevitable darkness." Rather than maintaining the distinction between "us" (the healers) and "them" (the afflicted), he prefers to think of therapists and patients as "fellow travelers . . . all in this together, [with] no therapist and no person immune to the inherent tragedies of existence."
What kind of therapy does an "existential therapist" do? For Yalom, the most important antidote to existential despair—the fear of meaninglessness in the face of certain death—is full-blooded human engagement and commitment, the lack of which probably brings most patients into therapy in the first place. In fact, engagement, he writes in the prologue to Love's Executioner, "is where therapists must direct their efforts—not that engagement provides the rational answer to questions of meaning, but it makes these questions not matter."
Yalom's therapeutic credo might be summed up with his own simple directive to other therapists: "Let the patient matter to you." He illustrates what he means by a counter example, the story of a well-known therapist with whom he studied as a young psychiatrist. The therapist, 70 years old and about ready to retire, was disbanding his own therapy group, which had been running for 10 years. Yalom sat in on the group's final sessions as the group members reviewed the preceding decade, sizing up their individual accomplishments, marveling at how each one had grown and developed over the years. Everyone in the group had changed tremendously, they agreed, all except one person—the therapist. Afterward, talking to Yalom, the therapist said with great self-satisfaction, tapping the desk for emphasis, "That, my boy, is good technique." Not to Yalom it wasn't. "He had spent 10 years with these people without letting them influence or change him at all—he hadn't let them matter to him. This was the saddest story about therapy I ever heard."