The Sound of a Therapy Session


What might it be like to hear a therapist doing his work? You’ve observed actors and actresses “in therapy,” but listening in on an actual therapy session isn’t quite the same.

Here is as close as you are likely to get to the real deal. Karl Schmidt reads the last chapter from the book, Creatures of a Day: And Other Tales of Psychotherapy by a major league psychiatrist, Irvin Yalom. Not every word of a session, but close, within the limits of confidentiality. You will get a sense of the “back and forth” dialogue and what goes on in the doc’s head.

Yalom has directed his patient to the Meditations of Marcus Aurelius, a Roman Emperor of antiquity and one of the handful of great Stoic philosophers. Yet philosophy seems, on the surface, to be the least of his client Jared’s concerns. Indeed, the man on the couch is struggling with his commitment to a woman (Marie) who has brought this issue to the point of crisis for them both.

I invite you to overhear a doctor who sometimes make mistakes, sometimes apologizes, and sometimes reflects on the state of his own existence in the twilight of his life, while quietly assisting the dermatologist he is treating to envision the world and himself anew.

Issues of being open to treatment are addressed, the patient’s honesty with himself, Yalom’s honesty with Jared, and the importance to this man of what his psychiatrist thinks of him. In other words, the kinds of concerns typical in any dialogue of healing lasting as long as this one (a year).

Improvement in Jared’s life depends upon the extent to which he realizes he must become a virtuous man. Don’t say this doesn’t apply to you until you listen to Jared’s epiphany.

Here you go, but be quiet as you listen: otherwise the doctor and his patient might hear you. 😉


9 thoughts on “The Sound of a Therapy Session

  1. I really _really_ don’t want to write an essay this time 🙂 And I still need to listen to the clip….
    But just to say, as you know I’ve just finished this book and loved it so much. And it’s given me a huge amount of food for thought. It made me wonder how my therapist views our relationship – if Yalom felt at times he wasn’t making a connection, even if his client was oblivious of the fact, does my therapist feel ‘in tune’ when I do? Does she think I’m not connecting sometimes, even if I think things are going okay?
    It made me think about the whole question, still unanswered (as it must be) in his book, of how therapy ‘works’ and my assumptions about how it must work. Not just Jared, but others too, found solace in quotes, in phrases, in sayings that brought meaning, if only for a time. I used to do something similar as a teenager and in my early twenties. Can things like that, can Marcus Aurelius, really have such power? They did, they did for me, but why do they now feel like illusions or like sticking plasters? Why does the ‘answer’ feel as though it must lie in something deeper? But maybe it’s just a case of finding the words that will make sense of things and that will create a new way in which to see the world. A case of finding something ‘other’, rather than something ‘deeper’. And those words can just as easily come from an ancient text, as they can come from therapy itself, or from within ourselves.
    And of course there is always my unfortunate tendency to compare my own therapist with Yalom! All therapists are different, of course – not just in terms of their ‘school’ of psychotherapy, but in themselves, as people. But I so admire his approach of being honest and direct when things are becoming difficult and he can’t think of what to say. Directness, honesty and clarity are so important to me, and I find ambiguity so difficult. Sometimes, there is absolutely no substitute for a sentence beginning with the word ‘I…..’. A direct and personal word from therapist to client. I had an immensely painful session a few days ago with my therapist – I feel really really hurt, my trust has taken a real knock, and the majority of that hurt centres on this very issue, so this is very pertinent for me right now…
    Thank you for posting!.


    • drgeraldstein

      I imagine I could write for a long time in response to your provocative and thoughtful comment. Just a few words, though. Part of the inevitable dilemma of therapy is, as Yalom says, caring too much about the therapist’s opinion. My opinions about people and therapy evolved (I’d like to believe) over the years. Among them, too much depth isn’t necessarily a good thing and one certainly can’t “live” deep under water. For example, I looked for the meaning of life from an early age and don’t even ask the question of myself any more. As to Marcus A., I think the important thing that Jared got out of the quotes was to enact them. I suppose what I’m saying in all this is that it is essential to change how one goes about daily life, much more than it is important to understand anything. I’m going to think more about what you’ve written, for which I thank you.

      Liked by 1 person

      • This is a hugely important point – thank you – and one about which I also need to think much more. It’s potentially a paradigm-shifting statement that could therefore have a huge impact: “it is essential to change how one goes about daily life, much more than it is important to understand anything”. I think Wittgenstein (one of my philosophy heroes) would agree with that.The meaning of language is in its use – perhaps the meaning of a life is in the living (or in the enactment, as you put it). And no, I certainly could not ‘live under water’ – it can indeed feel suffocating and exhausting….
        It’s interesting that you say that you used to think about some things a great deal in the past, which don’t really trouble you now. I wonder is that because the question is no longer important? Because it seems no longer to be a meaningful question (i.e. there is no such thing, there is simply the lived value of enactment)? Or because you once found an answer of sorts which means the question never needs revisiting? Sorry, I don’t mean to intrude and these are more like rhetorical questions – more thinking aloud! It just reminded me of an immensely difficult time of depression in my late teens which also coincided with a severe crisis of faith. Eventually, having been plagued with doubts, I settled them just by accepting a very simple hypothesis, itself not capable of any sort of ‘proof’ – that the concept of faith is as ‘legitimate’ as the concept of ‘proof’. My faith has gone, and continues to go, through dips and doubts and denial of various sorts, when I’m feeling at my worst. But somehow I have never felt the need to ask the question about God’s existence again – perhaps in some measure because of all three reasons above…..
        I have a post brewing, I think, around my views of how I feel therapy ‘should’ work, versus the fact that it’s very difficult to put one’s finger on how it has actually worked in particular situations, and what that tells us or shows us about what’s important in the therapeutic process…..but I also think it may be a little time before the brew is done! Like a cup of ‘northern tea’, it needs to to sit for a while and get stronger 😉 If your further thinking ends up as another post on this matter, then I am very much looking forward to reading it 🙂


      • drgeraldstein

        With respect to the question of the meaning of life, the following. The short answer is, I suppose, that after decades of considering the question, it finally – finally – became clear I would never answer the question beyond the answers I and others had already come up with. The short list of those answers would include the only one I’m sure of (to procreate); the existential notion of creating meaning; and the one the ancients knew: to lead a virtuous life. However, the reason I don’t do much thinking about it now may simply have to do with the fact that I’m older, the chemical mix in me is different than I was when I was younger, and my brain has changed, as it inevitably does for all of us. So, I have no great insight even into how I happened to be able to set the “meaning” question aside. Obviously, I also concluded that one must live the best life one can while not making yourself dreadful and dreadfully unhappy in the process; therefore, too much time thinking robs us of the time we have to “live.” Perhaps being nearer the end than the beginning of things has had an unconscious impact on the latter thought. Now having said all that, I’d not be surprised, should I live a really long life, that I will reconsider everything I just wrote!

        Liked by 1 person

  2. Ps I should have said I bear a major major responsibility for the misunderstanding with my therapist in the first place. I myself have a habit of being very ambiguous and unclear in session – not deliberately or consciously, but it’s hard to talk about certain things. So I’m not saying she is entirely responsible for my pain. Just that I need to talk to her about how I feel I need her to respond to me in these situations – and see what she says. But of course I’m scared her response will not be the one I want to hear!


    • drgeraldstein

      Good luck with this. Courage!!

      Liked by 1 person

      • Thank you – I will most definitely need it for my session tomorrow. Our email correspondence since the last session, though very brief, has added to my sense of hurt and anger. We have a lot to work through, and I have a very fixed idea, at the moment, of what I need from her. I think she is going to challenge that, either through word or action, and I will probably find that very difficult. But I think it would be worse if we didn’t work this through – if I got into the room and, as usually happens, all my anger and confrontation melts away. I need to be able to express something that is usually repressed due to my strong desire to please and stay ‘on the right side’ of those I love. I need to know that I can verbally talk about being hurt and angry, and then know that our relationships survived that. Thank you again for the luck!


  3. I will have to read this. Yalom was my favorite author on group therapy when I was in grad school and enormously helpful ever since.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s