I say that in retrospect: at that time I don’t believe I had any idea what my future might be or what I was capable of. I knew what private practice was like, I knew that it would be a worthy life, and I also knew that private practice would offer me probably triple what I would earn as an academic psychiatrist.
Dr. Hamburg offered me a junior faculty position (a lectureship) and a salary of only $11,000 a year—$1,000 less than my army salary. He also clarified the Stanford policy: full-time faculty members were expected to be scholars and researchers and could not supplement their income with private practice.
The sharp salary discrepancy between Stanford and UCSF shocked me at first, but as I pondered my two offers, it ceased to be a factor. Though we had zero savings and lived from paycheck to paycheck, money was not a major concern. David Hamburg’s vision impressed me, and I wanted to be part of the university department he was building. I realized that what I really wanted was a life of teaching and research. Besides, if an emergency arose, I believed I had the security of my parents’ financial backing, as well as income from Marilyn’s potential career. After consulting with Marilyn on the phone, I accepted the Stanford position, and canceled my flight to the Mendota State Hospital.
CHAPTER SEVENTEEN
COMING ASHORE
In 1964, three years into my career at Stanford, I decided to attend an eight-day National Training Laboratory Institute at Lake Arrowhead in Southern California. The weeklong institute program offered many social psychological activities, but the heart of it, and my reason for going, was the daily three-hour small-group meeting. I arrived a few minutes early the morning of the first meeting, took one of the thirteen chairs placed in a circle, and glanced about at the leader and the other early arrivals. Though I had much experience leading therapy groups, and was heavily involved in group therapy research and teaching, I had never been a member of a group. It was time to remedy that.
No one spoke as the others filed in and took seats. At 8:30, the leader, Dorothy Garwood, a therapist in private practice with two PhDs (biochemistry and psychology), stood up and introduced herself: “Welcome to the 1964 Lake Arrowhead NTL Institute,” she said. “This group will be meeting every morning at this time for three hours for the next eight days, and I’d like us to keep everything we say, all of our comments, in the here-and-now.”
A long silence followed. I thought, “That’s all?” and looked around to see eleven faces radiating perplexity and eleven heads shaking in bewilderment. After a minute, members responded:
“That’s a pretty skimpy orientation.”
“Is this some kind of joke?”
“We don’t even know anyone’s name.”
No response from the leader. Gradually, the collective uncertainty began to generate its own energy:
“This is pathetic. Is this the kind of leadership we’re getting?”
“That’s rude. She’s doing her job. Don’t you get that this is a process group? We have to examine our own process.”
“Right, I have a hunch, more than a hunch, she knows exactly what she’s doing.”
“That is blind faith: I’ve never liked blind faith. The truth is we’re floundering, and where is she? Sure as hell not helping us.”
There were a few pauses between comments as members waited for the leader to respond. But she smiled and remained silent.
Other members pitched in.
“And, anyway, how are we supposed to stay in the here-and-now when we have no history together? We’ve just met today for the first time.”
“I’m always uncomfortable with this kind of silence.”
“Yeah, me too. We’re paying a good bit of money and we’re sitting here doing nothing and wasting time.”
“Personally, I like the silence. Sitting here quietly with all of you mellows me out.”
“Me, too. I just slip into meditation. I feel focused, ready for anything.”
As I engaged in this interchange and reflected upon it, I had an epiphany—I learned something that I later incorporated into the very core of my approach to group therapy. I had just witnessed a simple but extraordinarily important phenomenon: all the group members being exposed to a single stimulus (in this instance, a leader asking that all comments remain in the here-and-now), and the members responding in very different ways. A single shared stimulus and eleven different responses! Why? There was only one possible solution to this puzzle: There are eleven different inner worlds! And these eleven different responses may be the royal road into these different worlds.
Without the leader’s assistance, we each then introduced ourselves and said something about what we did professionally and why we were there. I noted that I was the only psychiatrist—there was one psychologist, and the rest were educators or social scientists.
I turned and addressed the leader directly. “I’m curious about your silence. Could you say a bit about your role here?”
This time she answered (briefly): “My role is to be the leader and to hold all the feelings and fantasies that members have about leaders.”
We continued meeting for the next seven days and began examining our relationships with one another. The psychologist member of the group was a particularly angry individual and often laced into me for being pompous and overbearing. A few days in, he related a dream he had had about being chased by a giant—which seemed to be me. And ultimately, he and I did a good bit of work—I on my discomfort with his anger and he on the competitive feelings I aroused in him—and we worked through some of the distrust between our respective professions.
Since I was the only physician at this conference, I was called upon to care for and eventually hospitalize a member in another group who developed a psychotic reaction to the stress generated in his group. This outcome made me even more aware of the power of the small group—power not only to heal but also to harm.
I grew to know Dorothy Garwood well, and years later she and her husband and Marilyn and I had a lovely vacation on Maui. She was by no means a withholding person, but had been trained in a tradition from the Tavistock Clinic—a large psychotherapy training and treatment center in London—in which the leader remained outside the group and confined all her observations to mass group phenomena. Three years later, on a sabbatical at the Tavistock Clinic, I understood more clearly the rationale for her leadership posture.
When our family of five had first arrived in Palo Alto after my discharge from the army nearly three years before, in 1962, Marilyn and I had set about finding a place to live. We could have purchased a home in the faculty housing area of Stanford, but, as in Hawaii, we chose a more diverse neighborhood. We bought a thirty-year-old house (almost ancient by California standards) fifteen minutes from the campus. Economics were so different then: with a small income, we had no difficulty buying a home on an acre of land for $32,000. The price was three times my annual Stanford income; today, the Palo Alto economy has changed so much that an equivalent home would cost thirty to forty times a young professor’s salary. My parents gave us the $7,000 down payment on the house, and that was the last time I accepted money from them. Still, even after I completed my training and we were a family of six, my father always insisted on picking up the check at restaurants. I liked his taking care of me and offered only flimsy resistance. And I have passed his generosity on by doing exactly the same for my adult children (who, in turn, also put up flimsy resistance). It’s a pathway to being remembered: my father’s face often comes to mind as I pay the bill for my children. (And we have also been able to give our children down payments on their first houses.)
When I first reported to my department, I learned that I was assigned to be the medical director of a large ward at the new Stanford Veterans Administration Hospital, ten minutes from the medical school and entirely operated by Stanford faculty. Though I supervised residents, organized a process group for medical students (i.e., a group in which w
e studied the way we related to one another), and had free time to attend departmental lectures and research symposia, I was not happy at the VA. I felt that too many of the patients, almost all World War II veterans, were unreceptive to my approach to therapy. Quite possibly the secondary gains were simply too great: free medical care, free housing and food, and a comfortable dwelling place. Toward the end of my first year, I told David Hamburg that I foresaw few research opportunities for my particular interests at the VA. When he inquired where I wished to work, I suggested the outpatient department at Stanford, the hub of the training program for residents and a site where I could organize a group therapy program for training and research. Having observed my work and attended a couple of my grand rounds presentations, he had sufficient confidence in me to agree to my request. He was never anything but helpful and supportive, and from that point on, for a great many years, I had no administrative responsibility and almost total freedom to follow my own clinical, teaching, and research interests.
In 1963, Marilyn completed her doctorate (with a dissertation titled The Motif of the Trial in the Works of Franz Kafka and Albert Camus) in the program of comparative literature at Johns Hopkins. She flew to Baltimore for the oral exams, passed her orals, and received her doctorate with distinction. She came back hoping for a position at Stanford, but was devastated when the head of the French Department, John Lapp, told her: “We don’t hire faculty wives.”
A generation later, as my consciousness of women’s issues increased, I might have sought a position at another university broad-minded enough to evaluate her solely on her merit, but in 1962 that thought never crossed my mind, nor Marilyn’s. I felt for her. I knew she deserved a Stanford position, but we both accepted the situation and simply set about looking for alternatives. Shortly thereafter, the dean of humanities at the brand new California State College at Hayward contacted Marilyn. Having heard about her from a Stanford colleague, he drove to our home and offered her a position as an assistant professor of foreign languages. Teaching at Hayward entailed a commute of almost an hour each way four days a week, which she negotiated for the next thirteen years. Marilyn’s entry salary was $8,000—$3,000 less than my entry salary at Stanford. But our two salaries allowed us to live comfortably in Palo Alto, to pay for a full-time housekeeper, and even to take several memorable trips. Marilyn had a fulfilling career at California State and was soon promoted to tenured associate professor and then to a full professorship.
For the next fifteen years at Stanford I was heavily involved in group therapy, as a clinician, teacher, researcher, and textbook author. I started a therapy group in the outpatient clinic that my students, the twelve first-year psychiatric residents, observed through a two-way mirror—just as I had watched Jerry Frank’s group when I was a student. At first I co-led it with another faculty member, but the following year I began the practice of leading it with a psychiatric resident who stayed one year and then was replaced by another resident.
My approach had been evolving steadily toward a more personal, transparent form of leadership and moving away from an aloof professional style. Since the group members, all informal Californians, referred to each other by first name, I felt more and more awkward referring to them by their last name or calling them by their first names and expecting them to refer to me as “Dr. Yalom,” so I took the shocking step of asking the group to call me “Irv.” For many years, however, I still clung to my professional identity by wearing my white hospital coat like all the other medical professional staff at the Stanford Hospital. Eventually I gave that up as well, coming to believe that what mattered in therapy was personal honesty and transparency, not professional authority. (I never threw out that white coat—it hangs still in the back of a closet at home—a souvenir of my identity as a medical doctor.) But despite doffing the accoutrements of my field, I still hold fast to my respect for medicine and the entire Hippocratic oath, with its many clauses, such as: “I will practice my profession with conscience and dignity” and “The health of my patient will be my first consideration.”
After each group therapy session, I dictated extensive summaries for my own understanding and my teaching. (Stanford generously provided a secretary.) At some point—I don’t recall the precise stimulus—it occurred to me that it might be useful to patients to read my summary of the session and my post-group reflections. This led to a bold, highly unusual experiment in therapist transparency: the day following each meeting, I mailed a copy of the group summary to all the members. Each summary described the major issues of the session (generally two or three themes) and each member’s contributions and behavior. I added the reasons behind each of my statements in the group and often added comments about things I wish I had said or things I regretted having said.
Often the group began a session by critiquing my summary of the previous meeting. Sometimes members disagreed, and sometimes they pointed out omissions, but almost always the meeting began with more energy and interaction than it had before. I found this practice to be so useful that I continued these summaries as long as I led groups. When residents co-led the group with me, they wrote the summary every other week. The summaries require so much time and self-exposure, however, that, to the best of my knowledge, few, if any, group therapists in the country followed suit. Though some therapists were critical of my self-exposure, I cannot recall a single instance in which sharing my thoughts and my personal feelings was not helpful to the patient. Why did such self-exposure come so easily to me? For one thing, I had chosen not to enroll in any postgraduate training—no Freudian or Jungian or Lacanian analytic institutes. I was entirely free of governing rules, and was guided only by my results, which I carefully monitored. A number of issues may have been at play: my ingrained iconoclasm (evident in my early responses to religious belief and ritual), my negative personal experience in analysis with an inexpressive and impersonal analyst, and the experimental atmosphere in my young department, overseen by an open-minded chairman.
Weekly department meetings were not my cup of tea: I always attended but rarely spoke. None of the subject matter—funding, obtaining grants, allocation or bickering over space, relationships with other departments, deans’ reports—interested me. What did interest me was listening to Dave Hamburg speak. I admired his thoughtful reflections, his methods of conflict resolution, and, above all, his amazing rhetorical ability. I love the spoken word in the same way others might love a musical performance, and I am entranced by the words of a truly gifted speaker.
It was obvious that I had no administrative skills, and I never volunteered or was put in charge of anything. Frankly, I just wanted to be left alone to pursue my own research, writing, therapy, and teaching. And almost immediately I began contributing articles to professional journals. This was what I enjoyed and where I felt I had something to offer. I sometimes wonder if I didn’t feign administrative ineptness. It’s possible, too, that I may have felt powerless to compete with the other young Turks in the department, all of whom were jockeying for power and recognition.
I chose to attend that Lake Arrowhead conference not only to have the experience of being a group member but also to learn as much as possible about the “T-group,” an important, nonmedical group phenomenon that emerged in the 1960s and was sweeping the country. (The “T” in T-group stood for “training”—that is, developing skills both in interpersonal relationships and in group dynamics.) The founders of this approach, leaders of the National Education Association, were not clinicians but scholars of group dynamics who wanted to alter attitudes and behavior in organizations and, later, help individuals become more sensitive to others. Their organization, the National Training Laboratories (NTL), held seminars, or social laboratories, of several days’ length in Bethel and Plymouth in Maine, and later, the one I attended in California at Lake Arrowhead.
The NTL laboratory consisted of many activities: the small skills training groups, discussion and problem-solving groups, team-buildin
g groups, large groups. But it soon became clear that the small T-groups, in which members gave one another instantaneous feedback, were, by far, the most dynamic and compelling exercise.
Gradually, over the years, as the NTL groups moved west and as Carl Rogers entered the field, the T-group shifted its emphasis to individual personal change. “Personal change!” Sounds a lot like therapy, doesn’t it? Members were encouraged to give and receive feedback, to be participant observers, to be authentic, to take risks. Eventually, the ethos shifted increasingly toward a type of psychotherapy. The groups sought to change attitudes and behavior and to improve interpersonal relationships—and soon one commonly heard slogans such as “Therapy is too good to be offered only to the sick.” The T-group evolved into something new: “group therapy for normals.”
It’s not surprising that this later development greatly threatened psychiatrists, who viewed themselves as owners of psychotherapy and regarded encounter groups as a wild, illicit form of therapy encroaching on their territory. I felt quite differently. For one thing, I was impressed with the research approach of the founders of the field. One of the early pioneers was the social scientist Kurt Lewin, whose dictum “No research without action, no action without research,” generated a vast, sophisticated body of data that I found far more interesting than the medically based group therapy research.
One of the most important things I drew from my Lake Arrowhead group experience was the singular focus on the here-and-now, and I began to implement that forcefully in my own work. As I learned at Lake Arrowhead, it is not enough to tell group members to focus on the here-and-now: we need to supply both a rationale and a roadmap. Over time I developed a short preparation talk that I gave to patients before they entered the group, in which I emphasized that a great many of their interpersonal problems would be re-created in the group, thus offering them a marvelous opportunity to learn more about themselves and to effect change. It followed (and I repeated this more than once) that their task in the group was to understand everything they could about their relationship with every patient in the group and with the group leaders. Many new members would generally find some aspects of the preparation puzzling, and often they would raise the objection that their problem was with their boss, or their spouse, or with friends, or with their anger, and it made no sense to focus on their relationships with group members because they would never see these people in the future.
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