Hour of the Heart: Connecting in the here and now

Distilling wisdom: Irvin Yalom’s heartfelt hour – a book review by Dr Anne Sarzin

For those struggling to develop, nurture and maintain close relationships with others, Stanford University psychiatrist Professor Emeritus Irvin D. Yalom extends his helping hand, compassionate heart, engaged mind and, most importantly, the warm humanity he has manifested towards others throughout his professional career and for most of his ninety-three years. His innovative and brave interpersonal methodology is described in his latest book, Hour of the Heart: Connecting in the here and now.

With humility and touching vulnerability, Yalom connects with his patients in a highly original way, hoping they will respond as openly as he does. At times, this approach includes the role reversal of interlocutor and subject, differing radically from conventional psychiatric practice.  It differs, too, from the way he previously viewed patients through an existential lens, addressing their fears of being alone and lonely in the world. Nonetheless, he finds linkages between his new and old methodologies, thus making for a richer and more rewarding relationship between practitioner and patient while generating valuable insights for both.

Yalom’s previous books on psychotherapy, such as Love’s Executioner, The Gift of Therapy and The Theory and Practice of Group Psychotherapy, are valued as foundational texts in his discipline, some of which inspired students to enter the profession.

So what led Professor Yalom, at the age of 93, to embark courageously on a new intellectual adventure, documenting in this book a different professional direction, at an age when so many senior citizens, stricken with memory loss, idle away the hours in a vegetative state? Now 93, Dr Yalom acknowledges that the answer lies in his failing memory, the tattered relic of a once-focused intellect. He found he could not longer remember details of his patients’ conversations, confidences and lives. In order to circumvent this disabling professional handicap, he ended long-term counselling and initiated instead a one-hour ‘consultation’ for each patient. In this single hour, he attempted to discover and address deep-seated traumas, troubling issues and questions that prompted these patients to request a consultation. As he conducted these sessions online during the enforced COVID lockdowns, the 22 patients whose stories are documented in this book were drawn from countries around the world, reflecting different demographics, ethnicities and faiths.

There is an unflinching honesty in Yalom’s writing, evident in the very first chapter title, ‘A day in the life of a very old therapist’, and in the title of his last chapter, ‘Dementia, Ah Dementia’. And this characteristic suffuses his one-hour consultations with a transparency that he models, resulting frequently in a comparably open response from patients. He is aware of potential hazards and acknowledges that his interpersonal approach has critics in conservative psychiatric circles, where students are encouraged to maintain emotional distance and to avoid answering ‘prying’ questions. But readers can judge for themselves Yalom’s successes and the occasional failure. Of course, patients are rigorously de-identified and their permission obtained for publication of their authentic stories.

Strangely, given the confessional nature of these stories, I never felt voyeuristic. Instead, it is possible to mine these 22 one-hour sessions for insights that enlighten and potentially help others grappling with similar problems or attempting to resolve deep-seated issues, potentially enabling readers to understand their own painful histories. Perhaps, in this way, some might be encouraged to find a good therapist to aid their progress and journey towards healing and recovery.

Personally, I was inspired by Yalom’s own story. Despite the loss of his beloved wife Marilyn, whom he met when they were both 14 and whom he mourns so deeply, and despite the enormous challenge of a deteriorating memory that effectively ended his long-term counselling, he has found a way to move beyond these limitations, to move forward so bravely and competently,  and to continue imparting his wisdom,  knowledge and understanding to patients, and through this book to so many more.  Therein, for me, lies his magic and enduring impact.

In the book’s ‘Afterword’, written by Irvin’s son, psychotherapist Benjamin Yalom, he refers to his father’s mantra, ‘It’s the relationship that heals’. Benjamin states that the therapeutic alliance between therapist and patient accounts for 30 to 50 per cent of therapy’s success or failure. He urges psychotherapists to engage intimately and share deeply with patients. ‘We often do so cautiously, feeling as if we were breaking some taboo rather than embracing this powerful approach,’ he writes.

Benjamin concludes that his father’s theory is one of human connection, ‘of letting others matter to us deeply, of seeking meaning and sharing ourselves in the richest and most useful ways possible’. It is a fitting summary of the life of a psychiatrist who cared deeply about his patients and mapped new territory of the mind and heart for so many. That’s a gift that goes on giving.

Hour of the Heart: Connecting in the Here and Now

Irvin D. Yalom and Benjamin Yalom

Scribe Publications, Melbourne

2024