Yalom Sees Formula for Helping Patients Address ‘Death Anxiety’

In an Evolution of Psychotherapy keynote, Irv Yalom, MD, professor emeritus of psychiatry at the Stanford University School of Medicine, California, said that in recent years, death anxiety has been a recurring topic of conversation for patients. Still, he has identified a clear formula for addressing the subject.

Yalom participated in a lengthy interview with Jeffrey K. Zeig, PhD, director of the Milton H. Erickson Foundation, Phoenix, Arizona, and lead organizer of the Evolution of Psychotherapy. The interview was conducted at Dr Yalom’s home and presented on Wednesday during the virtual meeting.

In a substantial number of consultations, Dr Yalom has identified a key aspect of addressing death anxiety, he told Dr Zeig.

“It’s very clear in my mind,” Dr Yalom said. “I hold it as absolutely true, which is that there is a correlation between the amount of death anxiety you feel and the amount of regret you have about the way you’ve lived your life. The more regret you have about how you’ve lived your life, the more likely you are to be anxious about death.”

Dr Yalom advised attendees to ask patients to explore the topic of whether they will have any regrets when they reach the end of their life.

“As they begin to talk about it, zoom in on that,” Dr Yalom said. “What can they do so they’ll begin to look at a more of a regret-free life? How can they change their life in such a way? It’s not too late at any time that you can do more about that.

“That’s true with many of the consultations I’ve worked with. What regrets do you have right now? Let’s help. What can we do about that? How can we change that? That’s a powerful leverage in psychotherapy I believe.”

Death itself has been a difficult and deeply personal subject for Dr Yalom. His wife, Marilyn, died 2 years ago, and prior to her passing, the couple began to work on a book together that was eventually published in March 2021. “A Matter of Death and Life” chronicles the couple’s experiences through the final year of Marilyn’s life after a cancer diagnosis, her decision to die by physician-assisted suicide when the pain of her illness became too much to bear, and Dr Yalom’s struggles with grief over the ensuing year.

Yalom, 90, said that he has begun to ponder his own place in life following his wife's passing, and he finds himself wrestling with rationality against thoughts and aspirations.

“The thought comes to my mind, ‘Ah, I’ll be joining Marilyn,’ ” Yalom said. “I can look at that statement with 2 visions entirely. There’s the vision that this is absurd. This is my vision of being an atheist, a vision of, ‘What do you mean you’ll be joining Marilyn? It’s an absurd idea. There is no Marilyn any longer. She’s just bones now.’ It’s such an absurd thought.”

“On the other hand, there’s this other part of me that is comforted by the thought of joining Marilyn, even though this other part says it’s absurd and I know it to be absurd. It certainly has taught me how much religion has offered mankind. Every single other religion since the beginning of time, we get comfort from the consolation that death is not the end. There’ll be something after death, and I’ll be joining Marilyn in that somewhere after death. That’s a very strong vision that I have.”

While grieving has been an ongoing challenging for Dr Yalom after the death of his wife, Dr Yalom says he himself has no issues with feelings of death anxiety.

“I don’t have those regrets about how I’ve lived my life,” Dr Yalom said. “They’re virtually none at this point. One of the things I did after Marilyn died was to re-read—I’m still doing it—I’m re-reading some of my own books. I’m so pleased with these books. I feel like I don’t have regrets about what I’ve done.”

In addition to his writing, Yalom in recent years has transitioned into providing single-session therapy to patients. Yalom said that he reached a turning point in his career when he realized he was starting to struggle with memory issues.

“I decided then that my brain wasn’t going to be helpful enough to work with patients in ongoing therapy. I began not continuing to do ongoing therapy with patients, because I just couldn’t remember too many things they had told me in the past. I began just scheduling sessions with patients just for a single session.”

Dr Yalom said that now, 6 days per week, he meets with patients for a single 1-hour session.

“When I work with patients, I’m always focusing on what’s happening, including, of course, these single sessions,” he said. “I’ll get a history. We’ll talk about why they want to talk to me, but then sooner or later, I would begin to change. Generally, with many of these patients, with most of them, I’ll say, ‘Let’s take a look at how things are going in this session. How are you feeling? How are you and I doing?’ That would be a beginning of the switch. I gradually spend a lot of time on them. ‘How do you sense what’s happening? What’s been striking you about our relationship?’

Yalom acknowledged that the approach is “going absolutely in the opposite direction that many of you have learned,” but explained that modeling closeness has helped him to provide more effective therapy and enabled patients to open up about their own experiences.

Reference

Yalom I. The art of psychotherapy. Presented at: Evolution of Psychotherapy; December 1-5, 2021; virtual.