In the winter of 2014, I bedded down for a long-deserved rest. As a counselor educator, I basked in the idea that after posting final grades, the university would be closed for the holiday season. With a full private practice, often seeing 25 clients a week, I had made the executive decision to close my office between Christmas and New Year’s to make full use of my respite. Twelve days of rest, relaxation and reading! Lots and lots of reading.
I had ordered and methodically piled up in my home office every textbook or novel promoted by my clients or my students. The pile was just waiting for me to slow down long enough to open the crisp pages of wisdom and intrigue. With the holiday break, I would finally have the time to enjoy these sage words from great thinkers and authors. There, vying for my attention, were the works of Rollo May, Friedrich Nietzsche and Irvin Yalom, each enticing me in their own seductive way to join in the intimacies of the human experience.
I made myself a cup of jasmine tea, lit a fire in the fireplace and pulled my new Christmas throw over my tired shoulders. Inhaling the scent of jasmine mixed with the musty pages of the selected paperback, I caressed the book’s smooth binding and held it close to my chest. I gently set the book in my lap and turned the first page. This would be the beginning of my relationship with Irvin Yalom.
I had required my students to entertain Yalom’s philosophies surrounding the counselor-client relationship in his book The Gift of Therapy. No other has so genuinely approached the experience of being authentic and authentically human in the therapeutic relationship. Yet, I had only flirted and danced through those pages of disclosure and boundaries.
It was when I immersed myself in the titillating experience of Yalom’s literary masterpiece, When Nietzsche Wept, however, that I swore my allegiance to his wisdom. Within this teaching novel, Yalom brilliantly intertwines the lives of the successful Josef Breuer, the neophyte Sigmund Freud, the despairing Friedrich Nietzsche and the seductive Lou Salomé. The encounter that ensues captures the essence of the sacred-yet-murky therapeutic relationship and the courtship that occurs between healer and healing.
I reflected on my role as a counselor educator, a midwife to second-year clinicians-in-training who (as they experience the final stage of their birthing) make one final attempt to remain safe in the womb of graduate school. “There must be more to this therapy thing. Surely I do not know what I am doing! Teach me your tricks. Offer me your magic wand!” they implored as they faced their launch into the professional community.
I assured them they would remain in the shelter of supervision and community as they continued their journeys as helpers. I commented on the vast amount of continued work they would do, both professionally and personally. I reminded them that the most important element of the therapeutic relationship is … the relationship.
Yet, I wanted to be supportive. I wanted to offer an elixir to relieve their discomfort. I pondered the unrest of the neophyte counselors and inquired, “What would Yalom do?” To this question, I provide my learners with final lessons as interpreted by me and borrowed from When Nietzsche Wept.
1) Symptoms are messengers. Yalom’s Nietzsche suggests, “Perhaps symptoms are messengers of a meaning and will vanish only when their message is comprehended.” The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has provided us with a new manual for categorizing and labeling sets of symptoms. For many counselors — in particular new counselors — the responsibility of diagnosis can be daunting. Many of my students chide me as I refer to the “patterns of behavior” a client manifests versus a specific diagnosis. For example, “Jody” may be experiencing depressive symptoms. However, Jody is not referred to as “being depressed” because this may imply that Jody’s identity is to “be depressed.” Yalom further challenges that all behavior is purposive and serves the host. Therefore, discovering how these patterns or symptoms serve the client may provide insight into deeper meaning.
2) Cultivate meaning. Viktor Frankl, psychiatrist and author of the groundbreaking book Man’s Search for Meaning, describes meaning construction as paramount to the human condition. He notes, “You can take everything from a man, except his attitude about his circumstance.” Yalom concurs that the cultivation of understanding is key for a client’s wellness. Therefore, I am inclined to assess what meaning the client ascribes to a particular symptom or patterns of symptoms.
For example, I had a client who presented with concerns over discovering that her husband had a fetish for wearing women’s lingerie. Initially, I thought her discomfort was related to possible concerns about his sexuality. However, upon further exploration, this client’s real discomfort was related to her own body image. She found her husband to be more comfortable wearing his pink nightie than she was wearing hers, and this resulted in her envy and resentment.
3) Model honesty. To truly be honest, one necessarily experiences risk — risk of rejection, risk of betrayal. Yet vulnerability can offer great rewards in relationship. As clinicians, we ask our clients to be truthful, and we often negatively refer to those who withhold information as “resistant.” Do we ask the same of ourselves, however? Do we allow ourselves, as Yalom suggests, to model this behavior so that our clients can “learn there is no horror in openness and honesty between people?” Brené Brown, author of the 2012 bestseller Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent and Lead, writes, “Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they’re never weakness.”
4) Healer and healed are in courtship. Yalom poignantly reminds us that the secret to the therapeutic alliance is the unconscious dance that occurs between the healer and the healed. This intricate pattern between transference and countertransference may resemble a perfectly executed waltz or a more random quickstep. Rarely understood outside the counseling community, it is within this complex relationship that healing occurs.
Furthermore, the healer is often equally touched by the experience of being in relationship with the client. This is best portrayed in Hermann Hesse’s novel Magister Ludi, in which two great healers discover one another. In desperation, the young student seeks the help of the great teacher and remains in service to him until his dying days. It is during the final scene as the sage healer is dying that he confesses that he too had sought out the care of the younger healer and that both were served by the relationship.
5) Isolation exists only in isolation. Nietzsche’s emotional release results in a profound understanding by Breuer: “Isolation exists only in isolation. Once shared, it evaporates.” The importance of social supports is well documented in the research, and the therapeutic relationship provides an intimate and significant relationship for many of our clients. For some, it may be the first time that they have told their stories. This is powerful. Up until that moment of disclosure, it has remained a secret that has anchored the client to the experience and the emotional turmoil that is attached to the experience.
6) Choose your fate, love your fate. Yalom’s Nietzsche confronts Breuer about agency in one’s life, offering that we make choices in our life that contribute to our experiences. He further contends, “The spirit of a man is constructed out of his choices!”
Our clients often present to counseling feeling stuck in a life that they feel has happened to them. They do not feel that they have agency in their life. It can be powerful to simply offer that they possess the ability to choose many of their experiences in life, and they always have the ability to choose how they respond to their circumstances.
7) Take time to chimney sweep. “Chimney sweep” is a term in the text that is synonymous with brainstorming and relative to the technique of free association. It refers to the free flow of thoughts around a topic or idea as a method to access meaning. This, however, requires us to unplug and put aside all other activities that may distract us from this “housekeeping” of sorts. Additionally, chimney sweeping requires adequate time to empty our cluttered thoughts, turn our attention and eventually meditate on the topic of interest. This results in a purging of thoughts, ideas and meanings tangled within the threads of the subject matter. It adds to clarity of mind and peace of body.
8) Be more generous to your own humanity. Yalom’s Nietzsche declares a “granite sentence” of the human experience to be to “become who you are.” He continued, “That means not only to perfect yourself but also not to fall prey to another’s designs for you.”
Kristin Neff, associate professor of human development and culture in the Educational Psychology Department at the University of Texas at Austin and author of the book Self-Compassion wrote in her blog (dated June 25, 2011), “Instead of endlessly chasing self-esteem as if it were the pot of gold at the end of the rainbow, therefore, I would argue that we should encourage the development of self-compassion. That way, whether we’re on top of the world or at the bottom of the heap, we can embrace ourselves with a sense a kindness, connectedness and emotional balance. We can provide the emotional safety needed to see ourselves clearly and make whatever changes are necessary to address our suffering. We can learn to feel good about ourselves not because we’re special and above average, but because we’re human beings intrinsically worthy of respect.”
9) Die at the right time. Yalom’s Nietzsche and Breuer agonized over mortality and Nietzsche proposed, “Die at the right time. Live when you live! Death loses its terror if one dies when one has consummated one’s life. If one does not live in the right time, then one can never die at the right time.”
Consummating one’s life necessarily requires the shunning of distractions of the past and concerns for the future. It requires us to be fully present in the moment. It commands courage to take risks in life and love. This results in vulnerability (there it is, again!). However, to live fully means to embrace all aspects of the human experience. Pain, suffering, joy and ecstasy are all shared experiences of humanity. Would I give up one aspect for another?
For example, I recall the day my daughters moved from our home. They had graduated college the same week and were launching into their exciting new lives. We procrastinated in saying our goodbyes, and when the time came, we collapsed in each other’s arms in hysterical fits of tears and laughter. I remember smoothing the hair of my grown daughters, kissing their foreheads and reminding them that the reason we were experiencing grief over this milestone is because we had chosen to love deeply. I, for one, will always choose love.
Now armed with several, though certainly not all, of the nuggets of wisdom provided by the brilliant Irvin Yalom, I leave you with one final thought from my humble experience as a counselor.
10) We are people, not pathologies. We are human beings seeking relationship and wanting to belong in community. We want to love and be loved. As counselors, we have the greatest privilege in being asked to enter into the most vulnerable spaces with others and to be in relationship. That is a sacred gift and the secret to therapy.
Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. In addition to her practice, she is a visiting full-time faculty in the pastoral counseling program for Loyola University Maryland. Contact her at firstname.lastname@example.org.