Case Study Reviews from Loves Executioner by Dr. Irvin D. Yalum - Term Paper Example

?Client’s Case Study Reviews from Love’s Executioner by Dr. Irvin D. Yalum Introduction Irvin D. Yalum wrote a book in which he took ten different examples of therapy for patients to use as examples of his experiences as a therapist. According to Sage, Yalum uses existential psychotherapy, which is intended to dig into the layers of defense in order to find acceptance, to frame his approach to his patients. Sage also states that Yalum frames experiences through existence pain which means that in creating choices, the fear that this brings makes many people choose to deny their responsibility for their lives. In the case of Carlos, Yalum discusses a patient who is unwilling to accept his reality and therefore has difficulty reaching out to others as he shrouds his existence in creating the character of himself, rather than living in his truth. Betty was a patient who was overweight, manifesting her fear of intimacy and rejection through an eating disorder which ruled her social life. Through cases in his own therapeutic practice history, Dr. Yalum reveals both the issues of patients and the experiences of treating them. Case Study 1: If Rape Were Legal… The case begins with an aggressive and negative assessment by a young psychiatric resident, Sarah, who is upset with a member of one of her group therapy members. Another of the members has revealed that she was raped, which inspired the young psychiatric resident to open up to the group about her own experience of being raped. As a response, one of the male members, Carlos, who is the subject of this case study, began to probe about the event and was eventually understood as being inappropriate because his questions were based upon a sexual response to the experiences of the women, leaving them both feeling violated. Both Martha and Sarah had discussed a very painful experience in their lives, but Carlos had taken that experience and used it for his own gratification without any consideration for their pain. Carlos has his own problems that he is not addressing well. Carlos has cancer which is described as a “rare, slow-growing lymphoma” (Yalom 76). This illneess had been treated for over ten years, but was now invading his lungs and heart through the size of the tumor, thus giving him a short time of life left (Yalom 76). One of the problems that defined his mental state was that he did not do well in hearing the truth or accepting what was happening to him. His support system was non-existence, with two seventeen year old twins, a boy and a girl, living in Argentina with their mother. Carlos had no significant relationships, remaining isolated because of what seemed like a fear of intimacy in any form. During an epiphany in a therapy session with the narrator of the story, Dr. Irvin Yalom, he comes to realize that in the group sessions he has the opportunity to begin to form relationships with people in a safe place. When he comes back to report to the doctor, he has come to a second epiphany in which he realizes that people all have feeling, something he relates to the idea that people all have hearts. He uses a rather explicit concept of this, relating how he pulls back the skin, the bone, and the physical body to ‘see’ the hearts of all those around him. He shifts from being completely oblivious to the feelings of others to believing that he has realized that others have feelings and that he can be instrumental in helping others to connect to those feelings. The observable problem is that he is completely absorbed by his sense of self, and never fully reaches outside of his own needs when he engages others in his life. His issue is that he is facing something formidable, and has been facing it for ten years. He is isolated and has a very difficult time relating to how others are feeling. More than that, he frames everything in reference to how it makes him into a ‘character’ rather than realistic interactions. Even as he tries to interact, his experience is to create himself at the center of the experiences of others. He states that he is like a father to others who are older than he is and is helping them. He is not a part of the group. At the beginning he makes it about him by being obnoxious, but at the end he makes himself the center of the group, his help being a core to their experience. He has difficulty being a part of something, that connection making him too vulnerable. It seems that he needs to be either a low level contributor or the core and higher than the others. He does not seem to be able to become a part of anything on a social level. The first problem presented in the narration seems to be with the psychiatric resident who was the head of the group therapy process. Yalom in a book that he co-authored with Molyn Leszcz, discusses the role of the group therapist. They determine two basic functions for the group therapist. The first is to be the technical expert. The expert is to act as a guide through the experience of therapy, to become what could be termed the shaman of the group who focuses the thoughts of the group throughframing the information from the standpoint of being the professionally trained head of the group. The way in which they accomplish this can be to “have at their disposal a wide choice of techniques to shape the group culture. These range from explicit instructions and suggestions to subtle reinforcing techniques”(Yalon and Leszcz 124). As the technical expert it was Sarah’s responsibility to lead her group through techniques that she had developed through her educational experiences. The second role that Sarah was supposed to play was as the “model setting participant’ which she failed to demonstrate. Sarah opened up her own pain to the group when she did not appear to have reconciled and worked through the issues herself. She stated to the narrator that she had not told anyone else about her experience, which indicated that the incident had likely not been addressed for her own healing experience. That she got personally angry at Carlos to the point that it brought tears to her eyes indicated that by revealing something so personal to the group she had crossed the line between professional and improper use of personal information. At the same time, it is likely that by revealing that she had been raped she was not actually helping Martha and had refocused the attention onto her own experiences, rather than continuing the focus on Martha’s painful experience. This is relevant to the intervention that Carlos made into the group session as he began to probe both women for information that he could exploit for lewd purposes. Sarah made herself vulnerable to the group, somewhat negating the professional control that she should have maintained which would not have allowed an opportunity for Carlos to intervene in the therapeutic relationship. The course of treatment did not seem to make sense. Carlos did not seem to be a good candidate for group therapy and he was with a therapist who clearly did not understand her role in the process. Because he was facing a very intimate experience, that of death, the group dynamic may not have been a good place for him to come to accept this eventuality. Placing the group as the focus of how he could find his own truth does not seem to be a very plausible type of therapy. Both sides of his experience in group were to center it in the most evasive ways possible towards others which would manipulate the focus. The first time he focused the concept of rape as being something he wanted, without consideration for the feelings of others. After he realized how others had feelings, rather than become part of the group, he chose to act as if he was leading others. Both created a barrier between himself and other members of the group, his own truths still inaccessible to himself and to the therapy process. Yalom, during his own session with Carlos, tries to lead him towards relationships with others, while also discouraging him from putting hope into the idea of being with someone else. In the example of Ruth, the 22 year old woman with whom Carlos expresses an interest in developing an intimate relationship, Yalom believes that the best way to approach that is to create a sense of reality for Carlos that is cruelly applied and intended to shake him into believing that this type of relationship is outside of what is reasonable to expect. That was interference rather than a way to help Carlos reach his own truths. The example was immaterial, but the message was that Carlos should not have too much hope, rather than a discussion of his own truths. Ruth had no place in any discussion that involved his truths because she was hope for him. He was already discussing how his behavior should have been better in relationship with her. Rather than discuss the specific problems with pursuing Ruth, Dr. Yalum should have used the opportunity to discuss how Carlos thought about his future and how that related to his inevitable death from his illness. In this case, the framework of the therapy sessions should have been towards getting Carlos to understand his truths from an internal perspective, before trying to lead him towards externalizing his feelings in a group setting, especially with a therapist who cannot maintain a professional barrier and expresses her feelings about his behavior in terms of his being ‘creepy’ or through terms that are vulgar (Yalom 77). According to Sage’s review of Yalom’s book, “Existential psychotherapy aims to penetrate, identify, and re-assess these layers of concealment and these multiple defenses that attempt to shut out the reality and finality of death that are so often destructive and unhelpful”. Carlos was creating what he believed to be his experience rather than truly accepting the truth of his experience. He had a long road on which he had travelled towards the end of his life, which had a fairly definitive expiration date. In facing death for so long a period in such isolation, a therapist should have helped him towards acceptance before trying to integrate him socially in a group setting. That would never truly be very successful. Case Study 2: Fat Lady In the case of Betty, a woman who was overweight and dealing with depression as it related to social isolation, Dr. Yalum discusses more about his own feelings about fat women leading the reader to believe that his therapy with Betty was about him rather than her interest in improving and coping with her life. He related his need to see her as thin before he could see her as human which would seem to have impaired his ability to address her issues. It was shocking to read about his beliefs about the female form, making it curious as to whether there were any women he would be qualified to have as a patient as he specifically disregarded them as human beings, making them a piece of art for his visual pleasure. As he spoke about his need to see what he considered beautiful women and that he was unique in his admiration of them displayed both narcissism on his part and objectification for those around him. This barrier between himself and his patient was a problem because he seems to have spent a great deal of time dealing with his feelings about women through examining Betty. As he discussed his problems with trying to work with Betty, he discusses the idea of countertransference, and his own position in the problems they were having in the therapeutic process. He states “I had to be clear about how much of the boredom was my problem, about how bored I would be with any fat woman” (Yalom 101). In reading this section, it seems unprofessional for him to take on a client for whom he could not divorce his personal issues for the benefit of her therapeutic process. He defined his boredom with her through stating that she “she never revealed anything intimate about herself. Second, there was her damned giggling, her reluctance to be appropriately serious” (Yalom 102). These were signs that Betty could not bring down her emotional shields and that she could not engage in a real way with others because she had issues of trusting that they would see past her size. As developed through her relationship with her father, she was manifesting her fear through a physical barrier. Having a therapist that recognized her fears and placed validation on her feelings would have given her a place from which to begin her healing process. As Betty struggled to open up to her therapist, a position of trust would have given her a greater head start towards true healing, which could not occur as long as the Doctor did not see through her exterior and was working on his own issues during her 50 minute sessions. Having only a short time period, working through his own issues seemed a waste of her therapeutic time, extending the time it would take for her to see true healing. Discussion Dr. Yalum seems to have difficulty extricating his own perspective from his practice in order to address the deeper issues of his patients. With Carlos, rather than help him to discover that he must find his truth about his existence, he focusses on Carlos’ behaviors and tries to force him into a world that he is not ready to address. In treating Carlos, therapy that is focused on his experiences as they relate to how he has experienced living with a death sentence with multiple reprieves might have been more beneficial. It is said that it is inhumane for death row inmates to face their death, only to be pulled from its brink over and over through extended appeals. This was the sentence that Carlos was living with, unable to be intimate because he was in a cycle of fear that held him away from others. From the nature of the story, he was externalizing an unreal personality to cope with the daily uncertainty of his own future. Betty was treated with disdain, the focus on her weight the primary issue rather than a focus on the causes. Betty had the same issues as Carlos, her fears manifesting in a barrier of both personality and body that held her apart and kept her safe from intimacy. While the doctor skirted this issue, his own issues blocked him from addressing anything but her weight from the beginning. Just like Carlos, she had created a public persona which acted as a shield between herself and her the rejection that she expected because of her weight issues, caused by a fear of rejection as first established by her father. Dr. Yalum categorized her as boring, something he did not do with Carlos who similarly took a long time to reveal intimate information. What should have been different is that he should have referred Betty to someone else. His inability to move beyond the surface in both cases impeded his progress in providing substantive therapy. Digging deep is difficult, and personal prejudices or frustration with patient has no true value in the process other than to slow down the process for the patient. Carlos should have been treated one on one with therapy that was focused on moving him towards understanding his own feelings about his existence and the prognosis of his illness, rather than pushing him into a group setting he was not ready to undertake. Betty should have been treated by someone else as he prolonged her progress by his own issues and prejudices. The 50 minute therapy session is a slow process, but the therapist needs to look at his or her patient in ways that delve through the exterior and work on the foundations that have manifested in the external world. Therapy sessions need to focus on revelation, peeling back the layers that people have put into place to protect themselves so that rather than coping with issues, they can heal those wounds so that the layers are no longer needed. The length of a session is finite and provides for very little time to accomplish something that has often been put in place through a lifetime of creating coping mechanisms. Works Cited Sage, James. Review: Love’s Executioner. Metapsychology. 2002. Web. 15 May 2012. Yalom, Irvin D, and Molyn Leszcz. The Theory and Practice of Group Psychotherapy. New York: Basic Books, 2005. Print. Yalom, Irvin D. Love's Executioner and Other Tales of Psychotherapy. New York: Perennial Classics, 2007. Print. Read More