Victor Yalom is an experienced psychologist, an entrepreneur and an artist. He is Founder & CEO of Psychotherapy.net, an online magazine and video production company offering valuable resources for psychotherapists all over the world.
He owns a special brand of humor, sampled in his cartoons on sfpsychologist.com, and bears a renowned surname, that proved to be both a challenge and an opportunity prompting him to find his own path in the world.
It was a pleasure talking to Victor Yalom this month!
In terms of therapy, does practice make perfect? Do you become a better psychologist over the years?
Although most therapists think so, and it would seem obvious that with practice and life experience, one would hope to become a better therapist, the research does not support that. It does not show that you become a more effective therapist over time.
Why do you think that is?
A good friend and colleague of mine, Tony Rousmaniere, who has collaborated with another researcher, Scott Miller, explored this idea of deliberate practice, as applied to psychotherapy. Deliberate practice is a general area of research, looking at how performers in a variety of fields, from music to sports to surgery become experts, how they become better. And they become better through practice. A tennis player hits millions of balls, a musician plays scales hours a day.
How does a psychologist do this deliberate practice, then?
The key point here is that practice is different than performance! Practice for a musician is practicing scales, for a tennis player is hitting a lot of balls. Then, the musician has a concert, the tennis player has a match and they’re taking all that practice and hopefully applying it in the performance situation – which is quite different. When you say „practice makes perfect”, therapists, psychologists think that practice is just seeing a lot of patients – we even call it private practice in English. But no, practice is not seeing patients, this is performance. Practice would be something different. So, what is that? I think there are a lot of ways that one could practice. One way is to do role-play exercises with your colleagues. Then you can get into many fine nuances: you can practice active listening, reframing, confronting a client or pointing out their resistance. You can practice just noticing their body language, you can practice guiding them into an inner emotional state. Of course, this is going to vary, depending on your theoretical approach, but one would hope that there are some basic building blocks that are going to be used in all sorts of approaches. My colleague, Tony Rousmaniere, has a different focus, which is, as therapists, to be able to tolerate and keep ourselves emotionally open to the painful and difficult emotions and content that our clients bring to us. One way to do that is just simply to watch recordings like we have available at Psychotherapy.net, which are training videos with showing demonstration with expert psychotherapists. But rather than focus so much on the experts, if you just listen to clients talking about their struggles and at the same time try to pay attention to what you are feeling or not feeling, you’ll learn something about yourself. Because they say, as therapists, our greatest tool is ourself. One thing is to learn to pay attention to how we react and if there is a certain type of content or emotion that is difficult for us, then it’s helpful for us to practice with recordings or colleagues, and learn to tolerate that.
Is the therapist a healer, a guide, a „sparring partner”? What’s the role of a therapist, in your opinion?
The word healer (and healing) is used a lot in our profession. I often wonder what exactly that means? Psychotherapy gets put, for a variety of reasons (historic, and, in this country administrative, with health insurance) into the medical model. There is some reason that that makes sense. But by and large I have a lot of problems with that. This is not a medical procedure! You can call it an intervention, but it’s not a procedure. It’s one person sitting down with one or more people and talking: it’s a conversation. It’s a very particular type of conversation, and you may use certain approaches, but it’s a conversation. So healing… If you have a broken bone, you can take an x-ray, you can see the bone is broken and they fix it. And if you take an x-ray 4 weeks later, the bone has miraculously rejoined. Maybe it’s slightly offset, it’s not identical to what it was before. So, it’s clear: there is a break, it heals and it’s going back more or less to the original situation. What does this mean with the human psyche and the human heart? You have some trauma or you just have some life experience and disappointments, which everyone of us has, and you are trying to work through that and come to some understanding, come to some better place. But you’re not returning, you’re not going back to the same place you were before. It’s a long way to say, we try to help people, to heal some of their pain, but it’s not a perfect analogy. A coach? In some way, we are a coach. I hesitate to say that, because there is another category, life coaches, who are not trained therapists – you do 6 weeks or a 6 months workshop and become a coach. But ultimately, using our training, hopefully some wisdom and life experience, we engage in a conversation with them in which we try to be helpful!
Maybe it is easier to say what we are not. We are not experts in how to live life. We are fellow travelers – which is a term my father uses, and I like that. We are going through life and as therapists, often we are drawn into the field, because we have some real psychological challenges ourselves, that we’ve experienced personally or in our family; we are not immune from the hardships of life. We are not experts in life. We may think we have some knowledge or wisdom, we may offer advice from time to time and that’s fine as long as we realize our advice may be wrong. So, we are not experts about the content of life. But, hopefully, we are experts in the process of helping clients work through their issues, facing things that are difficult. We notice ways that may keep themselves stuck and make them repeat the same things over and over again.
Back in the day, the psychotherapist was a „know-it-all”. Nowadays, vulnerability is the keyword. Why do you think that is and how does one keep the professional boundaries within this new approach, of the therapist being vulnerable, more human?
I wish that was more widespread, this idea that the therapist is more vulnerable and open. I am not convinced that it is. Historically, Freud kind of started our field and somewhere, this idea of the blank slate came up. That the therapist is neutral, is a blank slate and because of that, clients could project onto the blank slate. From what I understand, Freud was actually not a blank slate: his office was full of personal mementos, he would light up a celebratory cigar when he felt he made a good interpretation; these are not blank, neutral things. But along the way this became ingrained in the much traditional psychoanalysis, which was the beginning of psychotherapy. And even though most approaches that are popular now reject most of the foundational principles of psychoanalysis – or the proponents of these approaches believe they reject these principles – somehow, this idea of the therapist’s neutrality has persisted in most approaches and most professional training programs. So, the students come in and they come out being professionalized with this idea of, if not neutrality, rather severe boundaries, which I think contribute to them being rather stiff and losing some of their humanity. And then, over time, I think as they gain more experience and more confidence, some of them loosen up a bit and regain their humanity and are able to lose that professional hat and replace it with their real personhood.
The question should always be „what is helpful to the client?” Is it helpful for the client to disclose everything about yourself and not have boundaries? No, of course not. But is it helpful for you to be very distant and not disclose anything about yourself? I think, in most cases, not. I think the guiding principle should be what is helpful? And it’s generally helpful if they feel you, they feel that you care about them. If you are touched by the client and you tear up, what’s wrong with that? It’s showing them that you care. Now, if you start crying every time they talk (that’s an exaggeration) and they feel like they need to take care of you, that’s not a good thing either. So, I think you let yourself be human, let yourself reveal things, but always pay attention: is this helping this client?
Being young is not an advantage in this profession and oftentimes, psychology is a second career choice. But there are many people becoming therapists after graduating, at 20-something, without any life experience. What would your advice be for them?
It’s a challenge! It is not uncommon that people become therapists later in life after another career, after some life experience and I think this is a great advantage, to have gone through some difficulties yourself – it does help as a therapist. But the fact is that people go to college, chose professions and many people chose to become a therapist or a counselor and in early age. And you can be 23, 24, 25 and starting seeing your first clients. And you have limited life experience. So, it is a matter of being taken seriously, but also, most humans are insecure in one way or another. And so, I think that the challenge is wanting people to take you seriously in the sense that you have something to offer them. And when we are in the state of life which we often are when we are younger, when we’re insecure, kind of lost, we’re figuring out where we are, you don’t want your clients to see that. You don’t want them to think you are just as confused as they are, nor do you want your clients to idealize you as a guru, but rather to have some reasonable hope that you can be of help to them. One advantage the beginning therapists have is that they’re usually quite passionate, it’s exciting for them, they’re seeing their first clients. That’s an asset they have. One thing you could tell a younger therapist is „use your enthusiasm!”. And if clients ask you how can you help me, you are so young, be open: You are absolutely right, you are my first client. I am really excited about just getting started. I will do the best I can and I’m just learning, so I welcome any feedback from you on what I am doing that seems helpful and what I am doing that is not helpful. Please, let me know and we can work together. That’s a good approach always.
Taking about feedback, do you recall a specific feedback that a client gave you that made you improve your approach or your therapeutical alliance?
One thing does pop to mind: a few years ago, I was taking a hike by myself, and the phone rang and the caller ID showed it was a client I had seen 3-4 years previously and had completed therapy. She was a difficult client for me. One of the things I have learnt from my father, Irvin Yalom, is to work in what he calls the here and now of the therapy session. And I tried to do that kind of work with her and every time I would do that, she would get defensive. It wasn’t working. So, I stopped using that approach with her and found many other things to do, of course, and I think I helped her. But it was a little ambiguous, not a smashing success. We parted ways at some point, but I got a call a few years later and she was very appreciative, she thought I really helped her a lot. She really appreciated that I stuck with her.
Psychotherapy is not math: 2+2 does not equal 4. So, how do you measure success, by your own standards, of course?
You ask the client! Some approaches are more goal oriented. Others less so. But hopefully, at the beginning of the sessions, you are getting a sense of why they are coming to see you, either in person or now remotely. Throughout the course of the therapy you’re listening to and helping clients clarify what life goals they actually have. Some of those are more objective, exterior goals (have a relationship, make more money, move out on my own) and some of them are more interior goals (I’d like to feel better about myself, I would like not to have such obsessive thoughts, I would like to not feel suicidal). Some therapists might be more behaviorally oriented and fill out a questionnaire and rate your mood, others may not, but by the end of the therapy you want to know: have those things changed? Have there been exterior, quantifiable changes? For example, are they in a healthy relationship compared to when they started seeing you? That’s a common goal, an often a noteworthy change that occurs in the course of successful therapy.
Can we talk about an average time spent in therapy that pays off? We live in an age when we want a quick fix for everything and this does not happen with therapy.
Somewhere between 1 day and 10 years! The question reminds me of a similar one: does therapy work? And one mentor of mine, James Bugental would say that the question does therapy work is similar to does transportation work? Well, where are you going? How much time do you have? How long does the therapy take is going to have a lot of factors. If you’re dealing with a chronic schizophrenic, it is more of a supportive psychotherapy and it may be lifelong. For an average non-psychotic patient, in 6 months to a year, you can help people make some significant changes.
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There are several hundred acknowledged forms of therapy and oftentimes nowadays a therapist changes approaches a lot, a thing unheard of back in the days. What do you think about that?
I read an article the other day about Chinese manufacturers and resellers on Amazon. It turns out, if you search for „athletic shoes” and you put a low-price range, you’re gonna come to a whole bunch of Chinese manufactured sneakers with all these strange names, and it turns out it may be the same manufacturer and they register 100 different trademarks for their shoes, but they’re actually the same shoes! There are not hundreds of different approaches, there are hundreds of different brands of psychotherapy. As I said before, psychotherapy is at it’s core 2 people sitting down talking. There are some basic approaches and, certainly, a psychoanalytic approach is going to be pretty different than CBT (Cognitive behavioral therapy), but at the same time, good therapists are good therapists and there are some inherent capacities that they share a lot. I think we’re reinventing the wheel a lot, and many „approaches” are more branding than substance.
You say that psychotherapy is more of an art than a science. Yet, Psychotherapy.net contains lots of articles and videos which are very evidence-based. Care to explain a bit about psychotherapy being more of an art than a science?
When people say art versus science, I think oftentimes they mean a craft versus science. It’s a practice, it’s a skill. What I’m uncomfortable with or object to is a cookie-cutter approach, a cookbook approach, where you learn to do very specific techniques, and there are some approaches that have come up with protocols: on session 1 you do this, on session 2 you do this. I just think humans are too complex. They’ve done a lot of research on what makes therapy work and over and over again they find that the most important variable is the therapeutic relationship or alliance. And then I believe the second one is the client factor. A client that is reasonably well put together is going to be able to use therapy better than a client who is very disturbed or unmotivated. That’s science. The problem I have with the so-called evidence-based approaches is they are marketed as if the fact that this approach is evidence based suggests that is more effective than other approaches. Some approaches certainly have more research showing their effectiveness, and very structured approaches may be easier to study; but that doesn’t prove from any logical point of view that they are more effective from other approaches. Back to art versus science, no, it’s not art, like painting or sculpture, but nonetheless, it’s a very creative enterprise. We learn certain principles, but we also need to allow ourselves to listen, be moved by clients, be in touch with our own emotional responses and allow ourselves to be creative in our interventions.
How do you form a good therapeutical alliance?
I think if your clients feel you are genuinely interested in them and in entering their world, including asking questions, not pretending you know about them. Genuine interest and curiosity are one. Then, that you are authentic. I think people, generally, have pretty good bullshit detectors: are you just trying to impress them, are you keeping very stiff or aloof? And also paying attention to how they respond. If you are attuned and you are really observing, you get some sense of what may or may not be helpful for them.
Does culture „factor in” in the therapy or are people’s fears and anxieties universal, no matter where they live?
Of course, culture has a profound impact on who we are: we are social creatures. I am married to a French woman, I’ve been married to a Japanese woman and I have 2 kids who are raised partly in the U.S. and partly in Japan, so I see differences. Japan and U.S, in some cases, are almost extreme opposites. We are, in the U.S. a very individualist society and Japan is much more group oriented. My wife, who came from France, she is introverted, she came to business school here and she was blown away by the fact that you are graded for how much you speak! These are just some personal experiences I’ve had about different cultures. In therapy, on one hand, we are all humans, and there are some basic desires: to love and be loved, to be part of a community and to be respected. And, of course, there is tremendous individual variability. But if you take an average Japanese person, their beliefs about self-expression or the importance of individual’s feelings versus the group’s, it’s going to be very different from an average American. Now I just completed doing a video series with an expert of counselling African American men, and I personally learned a lot about the African American experience and what is it like to grow up as a Black man in a society where a couple of hundred years ago they were slaves (and till this day, you could be shot by the police just for being Black!) That creates a very different experience than the typical White American has. And to have medical experiments done on Black people, that were not in their interest! So, that affects how they’re going to view helping professionals, such as therapists. So, if you are working with different populations, which we all are, at least in the US, you want to educate yourself and learn about different cultures. But ultimately, we are not going to be experts on all these different cultures, our knowledge is just going to scratch the surface. And you have to be comfortable with being uncomfortable. It’s important when you are working with Black men to address racism. The client may not bring it up if you are a White therapist, so just know that it is a huge part of their experience. I worked with many Black people over the years. I might have had some awareness, but they were bringing whatever issues they were dealing with, and I was just focusing on that. And in retrospect, I think I would have done a better job saying: Tell me how are you dealing with racism. How does this impact you? Or with the Asian Americans now – There has been a lot of violence against them lately – showing them that you’re interested in their culture and their experience, and you want to learn.
You’ve founded Psychotherapy.net in 1995, inspired by your mentor. Tell us more about how it works, what your offers are.
I studied (a group of us studied) with this psychologist, James Bugental – he named his approach existential-humanistic psychotherapy. He was quite a brilliant man, but also, as part of his work, we did do a lot of practice. We would break into groups of 3 and practice different techniques and approaches and he would also do demonstrations with us; we might role-play a client, or we would work on our own personal issues. It was a small trusting group and I thought we should film him – he was 80 years old and was not getting any younger. So, we recruited clients and filmed a couple of sessions of him and made a video of that, VHS taped at that time, and ended up going to a conference and selling that and some other videos. At that time, if you wanted to see an example of a therapist working was very difficult. There were a few VHS tapes around, they were difficult to find–it was just the beginning of the internet—and they were very expensive. I went to this conference and lowered the price and ended up selling a lot. So I realized there was a need for this, there was a hunger for this. We are the strangest profession: in any other profession – dentistry, or law, dancing or plumbing – you observe a master or mentor at work, and they observe you work and you get feedback and you do that for years and years. Whereas with psychotherapy, you are reading books, you are told after a certain time ok, go see a client, then a week later ok, you have supervision and the supervisor asks you how did the session go and you say: he told me this and they say did you ask him this? Ok, then maybe next time you should ask him this. As my friend, Tony Rousmaniere (I mentioned before) would say, this would be like learning art. Like you would paint a painting and then you go to your supervisor, a week later, but you would not bring the painting, you would say I made this painting, I put a lot of blue in it. Do you think I put too much blue in it? Now, it’s very easy. You have a smart phone, you can film your sessions. In either case, I thought one thing that would be useful is to be able to see skills, therapists, doing therapy and to learn from that. So, I ended up over the years continuing to produce videos. And also finding videos that others have produced, but were not made widely available and put them on VHS and DVD and finally to streaming. So over 25 years, we now have over 300 videos with different experts, different approaches, different types of therapy (group therapy, couple’s therapy, child therapy, family therapy, all of that). We have it available on our streaming platforms, you can sign up for a membership, like Netflix. Your readers can use this discount code – psiho21 – and try us out!
You once mentioned you were unusually fortunate in having Irvin Yalom as a father. What are the disadvantages of having him as your father, professionally speaking?
Certainly, early in my career he cast a large shadow. I think it created some expectation for myself that I should do something important in our field, for example, write a book. At some point, he was revising his group psychotherapy text and asked me to help him with that. I did some research, and tried to summarize the research, and ended up writing a few sentences here and there, but it was a painful process for me. And ultimately some years down the road I realized that that’s not my calling: to do that kind of research and write books. And of course, everyone recognizes my last name, which is unusual, and it contributed to some sense of inadequacy, that I wasn’t doing anything particularly special – I was trying to have a small private practice and find enough patients, which wasn’t always easy. I think there are challenges in having a parent who is famous, in terms of being able to find your own path in the world. Fortunately, I was able to create this business and make my contribution in a very different way, that feels alligned with interests and talents that I have.
Online therapy: hate it or love it?
I don’t know if I love it, but it shows us how limited therapists – like most of the people on this globe – are in what we think is possible. I and other therapists were doing some online therapy before, but this idea that all therapists would do online work, if you would have asked this 2 years ago, they would have said you were crazy. The same in so many other fields: that most people could be working from home within a few weeks – no one would have thought that’s possible. This shows the limitations of our imagination. In terms of therapy, I’ve worked with some international clients over the years, so I already had an experience with that and I found that it actually works quite well, in terms of working with someone one-on-one. I think that the downside for someone who is in private practice and seeing 30 clients a week, is sitting in an office, just looking at a screen all day. I think therapy is isolating enough. Another experience I had doing this group (I’ve been co-leading the group for 20 plus years, with a colleague): when COVID came, we stopped the group or at least we took a pause for a few months, thinking we would do it again in a few months. When that did not happen we reached out to the group members, and asked do you want to try do this online?, and everyone said yes!. There is definitely something lost, especially when you work in a group that is interpersonally oriented in the here and now, my father’s model. It’s harder for clients to look into each other’s eye and have one-on-one interactions. They do it, but it’s not the same when you are looking at a bunch of squares on a screen. But the big advantage is that people have moved and they stayed in the group, so there is a real sense of cohesion. And if they travel, they don’t miss the group as much, there is a real advantage in that. Trying to get everyone in the same place at the same time is one of the challenges in group – with online, that’s less of an obstacle.
Apart from the physicians, the therapists have been the heroes of the day in these turbulent times. Do you think you should harness, let’s say, this momentum? Can you do that?
In this country I don’t think that there has been much recognition of therapists. They talk about the teachers and retail workers and the essential workers. When people are thinking of essential workers they are not thinking about therapists. There is a lot of discussion about mental health, though. So, hopefully that is something we can capitalize on. Hopefully there will be a continuous recognition of the importance of mental health workers.
How important is the lifelong learning? Is the same as the deliberate practice thing?
Our slogan for Psychotherapy.net is „great therapists never stop learning”. I think that it can be formal, for example via reading and consultation groups and getting supervision, but I also think it’s a mindset. Now I am studying table tennis and there is so much to learn: footwork, body position, your arm movement, the angle of your paddle, the spin. I was just playing this weekend with, some friends of mine who are not such strong players, and so I didn’t have to focus as much on my strokes. So suddenly I got this idea let’s just focus on them, because I was teaching them. And suddenly, it was a whole different perspective. So, there’s an analogy. In any complex activity, there is always so much to learn. So, I think it’s having that mindset: what can I learn, how is this going? It’s so easy, like with every activity, to go into a routine, a rut. The main thing is to take responsibility to keep aware of how alive you feel, how energized, how fresh you feel from your work and make whatever adjustments you can
You are an artist: you paint, you sculpt. If asked by a complete stranger, how would you identify? As a psychologist, as an artist? What’s the first response coming to mind?
I really enjoy doing metal sculptures right now, but I am shy about saying I am an artist. I heard about an established artist who described himself as a painter who occasionally made art. I would like, someday, to be able to say I’m a sculptor, but I don’t feel that yet. I will say I almost stopped seeing clients, except for my group and just this last couple of months, I had a few clients reach out and we started working together, and I find I am re-energize by this work. My main activity for the last decade has been running Psychotherapy.net, so in some sense I am a businessman. Good question: check back with me in a few years!
A message for the Romanian colleagues?
Honestly, I don’t know much about Romania, although my sister-in-law is Romanian. So, I don’t have a specific message, but I would say to any therapist: when we go to school and study, we are professionalized and we learn valuable things. But part of this professionalization process has its downside: we learn to put boundaries and restrain ourselves. And I think that to some degree that’s inevitable, you’re learning a new role, you put on a new hat. And when I studied with Bugental and my father, I would often think to myself when I was with clients: what would they say, should I do it like them? To some extent, that’s normal, but I think over time, the goal is to find more and more ways to tap into what your essence is. Sometimes that is a strange process in life: the older you get, the freer you become. If you’re fortunate, you reconnect with aspects of yourself from your childhood. You nurture those qualities and them all to show up more in your therapy work, so that over time there is less and less distinction between your therapy self and your authentic self. That’s one thought I have at this moment in time, and perhaps a good note to end on!
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