BOOK REVIEWS

Every Day Gets a Little Closer: A Twice-Told Therapy, by Irvin when one of his Freudian friends remarked after having read
D. Ya/om, M.D. and Ginny . Elkin. New York, N. Y. . Basic the manuscript that Yalom’s behavior was an example of Wil-
Books. 1974. 244 pp. $8. 95. . helm Reich’s definition of the chaotic situation-that in which
the therapist says everything that comes to mind.
This book records a psychotherapeutic encounter between What of Ginny’s response? Although she too is reasonably
Dr. Irvin Yalom and a young woman who is given the name of open and frank about her responses, they are not nearly so self-
Ginny Elkin. They saw each other at weekly intervals over a pe- revelatory as are Dr. Yalom’s. This is partly because she is able
nod of 20 months. to conceal herself to some extent behind her considerable liter-
The arrangements under which the therapy was carried out ary talent. However, there is more to it than that-she notes
were unusual. Instead of receiving financial payment from Gin- that she “thinks and writes only in analogies. Everything is like
ny, Dr. Yalom entered into an agreement with her that each of something else.”
them would write an immediate, no-holds-barred account of cv- There is something basically elusive about Ginny. It may be
cry session after it was completed and that at intervals of ap- that she is never really sufficiently in touch with who she is and
proximately 6 months the write-ups of each participant would what she is feeling to be able to convey to the reader anything
be made available to the other. but the “as if-ness” of her personality. There is no doubt, how-
Why did Dr. Yalom propose such a contract? First, Ginny, ever, about what she wants. She wants Dr. Yalom. It is an iron-
who in addition to presenting with problems in her sense of ic commentary both on Dr. Yalom’s hopes for moderating her
identity, an inordinate need for the approval ofothers, difficulty picture of him and on the savage, ferocious strength of the de-
in expressing negative or angry feelings, lack of self-confidence pendent yearnings of this kind of patient that almost everything
(especially in her ability to function sexually), was also a talent- he says or writes about himself, no matter how negative, has the
ed writer who was suffering severe writer’s block; Dr. Yalom effect of further enhancing her idealization of him. There is also
hoped that the need to pay for her sessions by writing might an almost comic, even if rather poignant, quality about the ab-
provide motivation to overcome this symptom. sence of consensus between the participants about what was go-
In addition, Dr. Yalom was well aware that Ginny, with ing on in some of the sessions. Thus, after one jnterview, Dr.
whom he had had previous contact for 18 months when he was Yalom congratulates himself on the guilt-relieving con-
co-therapist for a group that she attended, was in the throes of a sequences for Ginny of his telling her that everybody mastur-
massive idealizing positive transference toward him generated bates. The actual effect of this statement on Ginny, however, is
by her unresolved dependency conflicts. He felt that the revela- to make her “burn with shame” because of the implication that
tions about his motivations and feelings that would emerge in this puts her “perfect” therapist among the masturbators.
his writings might provide a salutory corrective for her unrealis- There are many ups and downs in the therapy as Ginny
tic evaluation of him. progresses and retrogresses. However, when formal meetings
Finally, Dr. Yalom makes no secret of the fact that the possi- end, Ginny clearly seems to be better. Furthermore, in follow-
bility of a collaborative publication was in his mind from the up interviews and letters, and in spite of untoward events in her
onset. life, she does come across as a more integrated and self-accept-
I enjoyed reading the book; to use a word not ordinarily em- ing person than she was when therapy began. To the extent that
ployed in reviews of this kind, I found it charming. In a post- this was brought about by the treatment, it seems clearly to
script that gives the impression of being something of an after- have been the result of her contact with a strong and interested
thought, Dr. Yalom formulates his theoretical approach in person who cared about her and, yes, even loved her. She was
terms of interpersonal theory. However, the technique he em- able to internalize this experience even though she certainly is
ploys is, to say the least, not the slave of theory; it is certainly not really a different person in a characterological sense and
freewheeling. There is also something contradictory in his cx- does not seem to have acquired a store of wise and useful in-
plicit decision to utilize rather than analyze Ginny’s enduring sights.
idealizing transference toward him and the apparent aim of his I highly recommend this book to all those engaged in the
self-revelations, which is to alter this transference in a more re- strange and puzzling task of trying constructively to influence
alistic direction. other people by talking to them. I think it would be particularly
In the sessions, Yalom goes after Ginny in every way he can useful to beginning psychiatric residents who sometimes seem
think of. I-Ic exhorts, he advises, he encourages, he scolds, he to have the notion that a distorted and defensive imitation of
role-plays, he interprets her behavior (but not her psycho- the psychoanalytic model of therapist neutrality is the only way
genetics). I-Ic employs every resource of what comes across to do psychotherapy. They will learn from this book that the
clearly as a rather powerful and benevolent personality. In his psychotherapeutic bow has more than one string, and they will
write-ups, which he is more faithful about than is Ginny, he learn that being themselves with their patients can also help.
lives up to the requirement that he be self-revelatory and open
about his feelings and his motivations. He is so uninhibited, in PAUL CHODOFF, M.D.
fact, that he was almost deterred from publishing the book Washington. D.C.

A m ) Psychiatry 132:12, December /975 1335