This LibGuide is devoted to the life and work of Irvin Yalom, a writer, practicing counselor, and perhaps the leading contemporary proponent of existential psychotherapy. Yalom is one of the few practicing counselors whose works are widely read and well-regarded in both popular and academic contexts. The works upon which his reputation is largely founded--The Theory and Practice of Group Psychotherapy, Existential Psychotherapy, and Inpatient Group Psychotherapy--today are required reading in many schools of counseling across the United States. Yalom is also the author of nine works of fiction, many of which serve as creative explorations of his thought. Yalom says that he often prefers "literary exposition" to "formal philosophical argument" because it offers readers a more immediate perception of the absurdities and contradictions of their own situation.
Yalom is most known for his contributions to the theory and practice of group therapy, as well as for his writings on existential psychotherapy, a therapeutic school pioneered by Viktor Frankl and Otto Rank. Even at the age of 90, he has continued to write, lecture, and see patients. While Yalom's academic work is well-regarded, his fame rests largely upon his uncanny ability to translate often abstruse and forbidding psychoanalytic concepts to a lay audience. Yalom is a great communicator, and even his textbooks are marked by the precision, grace, and clarity of his prose.
Existential psychotherapy acknowledges that most individuals have unresolved questions about the meaning of their own life, and that these questions can serve as sources of profound suffering and dysfunction. These questions resolve around the four "ultimate concerns" of existence, that is, freedom, loneliness, meaninglessness, and the inevitability of death (Yalom, 1998, pgs 172-73). Each of these concerns is "dynamic" insofar as they embody clashes between bewildering and contradictory existential conditions: we wish for structure and direction in a groundless universe, we face life alone but we long for community, we are "meaning-seeking creatures who are thrown into a universe that has no meaning," and we wish to live, but we know we will die.
Yalom argues that too often modern therapists disregard these most fundamental of human questions as unanswerable, unscientific, and perhaps even clinically dangerous--what counselor would dare to bring up the apparent "meaninglessness" of life or the inevitability of death with a depressed patient? Most psychotherapists have no philosophical training and so are unprepared with patients bring them into the counseling session. So, modern therapists generally restrict themselves to ameliorating the symptoms through therapeutic techniques, prescription medications, or by "pathologizing" the fundamental source of their angst by ascribing it to some biochemical defect.
Similarly, research into therapeutic methods largely revolves around quantifying certain narrowly defined clinical outcomes. Therefore the modern therapists tends to deflect existential questions as beyond their purview, and to direct their patients towards empirically-tested palliatives and coping-mechanisms in the hopes that these will remove or at least dim some of the symptoms of existence. However, as Yalom states, such an approach often leaves patients with their deepest questions unacknowledged and their deepest needs unmet. A purely-empirical description of mental functions or brain chemistry, no matter how minute, can never account for "the meaning of this psychic structure to the person who possesses it" (Yalom, 1998, pg. 180). It is only by embracing "man's search for meaning" that the counselor can begin to attend to his patient as a human being, and not as a miscellany of disconnected symptoms and urges. The greatest gift a counselor can offer a patient is wisdom, wisdom gained through a clear-eyed reckoning with the human situation, not just the clinical data.
Yalom identifies 11 therapeutic factors for success in a group therapy context.
1) The Instillation of Hope.
Yalom writes that the "instillation and maintenance of hope is crucial in any psychotherapy." Group therapy (or any therapeutic practice, for that matter) is effective insofar as it is able to inspire hope in clients. If a client does not believe that group therapy will help them, then it won't. Hope is necessary to keep clients in therapy and it is necessary in and of itself. One of the great gifts that group therapy can offer clients is hope, hope that things can improve. Yalom is careful to observe that learning to hope is like learning any other skill--it require practice, discipline, and feedback. Group therapy is an excellent crucible for learning how to hope.
2) Universality
Yalom notes that "many patients enter therapy with the disquieting thought that they are unique in their wretchedness, that they alone have certain frightening or unacceptable problems, thoughts, impulses, and fantasies." Group therapy is one way to disabuse patients of that notion, by showing them how common many of their symptoms are. Viewed this way, one of the uses of group therapy is that it creates a communion of fellow-sufferers, who have no choice but to realize that their deepest struggles are shared struggles.
3) Imparting Information
Uncertainty, according to Yalom, is the great source of all human anxiety and fear. Most patients enter the group therapy context experiencing certain inexplicable symptoms or urges whose very uncertainty and unpredictability exacerbate their effects. By engaging with others with similar symptoms, patients learn more about their prior-to mysterious and unnameable afflictions, relieving them of the anxiety of the unknown. Of course, information in the therapeutic context is also simply practical: patients learn tips from other patients about how to heal.
4) Altruism
In the traditional counseling model, the counselor gives and the client receives: the help, or "altruistic impulse" flows one direction. But many patients in the therapy setting simply do not have many close relationships where they can practice acts of reciprocal love and service. Humans have a deep hunger to contribute, according to Yalom, and group-therapy provides people with a setting and a context where they can finally help another person, not simply be helped. The therapist should encourage this dynamic as a necessary component of therapy by valuing the contributions and seeing patients as partners, with something to contribute to the therapeutic venture.
5) The Corrective Recapitualition of the Primary Family Group
Many, perhaps most, patients who enter group therapy have had highly damaging, even traumatic family lives, and group therapy can allow them to practice healthy family dynamics as patients learn to share the attention of the therapist and communicate positively with each other. Yalom writes, "the therapy group resembles a family in many aspects: there are authority/parental figures, peer simblings, deep personal revelations, strong emotions, and deep intimacy as well as hostile, competitive feelings." Group therapy allows patients to explore these dynamics and learn more helpful ways of coping.
6) Imitative Behavior
Yalom writes that, "It is not uncommon for patients throughout therapy to "try on," as it were, bits and pieces of other people and then relinquish them as ill fitting. This process may have solid therapeutic impact; finding out what we are not is progress toward finding out what we are." Patients learn who they are by observing other patients. Through watching other people, we observe other possible selves, and select between traits we find attractive.
7) Development of Socialization Techniques
It is not uncommon for patients in the group therapy context have never received accurate feedback about their behavior in social contexts. Many have not experienced a positive family dynamic in the past, and lack the sort of close friends or intimate partners who could provide them with honest feedback on their behaviors. Patients may have no idea that certain behaviors are obnoxious, for example.
8) Catharsis
While venting or "purging" is not, in and of itself, helpful in the group therapy context, especially not early on in the process, once close interpersonal relationships have formed, the open expression of emotion and the ensuing acceptance of that emotion by the group, can be a deeply healing part of the therapeutic process. Note that catharsis can also be dangerous, and should only be encouraged once a group has gotten to know each other.
9) Existential Factors
The basic existential factors of group therapy for Yalom include: "1) Recognizing that no matter how close I get to people, I must still face life alone; (2) facing the basic issues of my life and death, and thus living my life more honestly and being less caught up in trivialities; (3) learning that I must take the ultimate responsibility for the way I live my life no matter how much guidance and support I get from others."
10) Group Cohesiveness
The sine qua non for effective therapy outcome is a proper therapeutic relationship. The feelings of mutual "trust, warmth, empathetic understanding, and acceptance" engendered in a properly run group are a critical part of the therapeutic process. Group cohesion is required for any of the other therapeutic processes to take effect--if the group does not or cannot engender the "conditions in which the necessary risk taking, catharsis, and intrapersonal and interpersonal exploration may unfold," than the group will not be successful.
11) Interpersonal Learning
Human personalities are shaped by relationships--it is impossible to imagine an individual or a condition in the abstract. Moreover, the counselor in the traditional therapeutic context will likely not have a chance to observe a patient's interpersonal relationships, so the therapist will be unable to offer an accurate assessments of their patient's interpersonal skills. This is a tremendous limitation, considering that our interpersonal relationships make up such a crucial part of who we are. However, in the context of group therapy, not only does the patient learn about their own foibles, but the therapist gets to observe them interacting with others, and so sees an entirely different, and perhaps truer, side of their life.
A Matter of Death and Life by 
Love's Executioner by 
Momma and the Meaning of Life by 
Lying on the Couch by 
Man's Search for Meaning, Gift Edition by 
Psychology and the Soul by 
The Yalom Reader by 
The Gift of Therapy by 
The Theory and Practice of Group Psychotherapy by 
Inpatient Group Psychotherapy by 
Existential Psychotherapy by 
Staring at the Sun by 