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The Observer Observed 

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The therapist is unique among creative artists in that he continues to work, year after year, in the absence of an audience. So concludes a character in one of Irvin Yalom's novels.

In this age of managed care, with its emphasis on hit-and-run therapy and pharmacological solutions to existential problems, it seems surprising that many therapists continue to regard what they do as an art. Less surprising, perhaps, is that they should clamor for some sort of recognition; with its compartmentalization, its air of confidentiality and its cabal-like hoarding of professional secrets, psychotherapy can be the most anonymous and isolating of professions.

As Irvin Yalom would be the first to admit, the shape of his own career -- first as one of the founders of group therapy, and subsequently as the author of two novels, an account of individual therapy and several collections of tales drawn from his own practice -- corresponds to an inner compulsion: the desire to avoid the "unobserved life," to perform before an audience.

Who this audience really is becomes clear in "Momma and the Meaning of Life," the title story in his latest collection of therapeutic tales. Yalom tells of a recurring dream: He finds himself transported from his hospital deathbed back to the amusement park of his childhood; before being swallowed up by the black maw of a ride he calls the House of Horrors, he turns to see his mother in a crowd of onlookers and waves to her, yelling "How'd I do, Momma?"

Yalom goes on to recount a childhood filled with the shame and mutual incomprehension common to the educated children of working-class immigrant parents. For his mother, whose every waking minute was devoted to serving others, love and resentment were inseparable.

Yalom describes visiting his mother in her retirement-home apartment, its tables overflowing with various editions of the books he had written, books she could not possibly read or understand, but that she was proud of as tangible products of her own sacrifice. In a concluding dialogue with his dead mother, Yalom begs her to leave his dream and get on with her own life. But Mom, as she does in childhood, gets to have the last word: "Your dream? That's what I want to say to you. That's the mistake, Oyvin -- your thinking I was in your dream. That dream was not your dream, Sonny. It was my dream. Mothers get to have dreams too."

In "Travels With Paula," Yalom describes a life-changing encounter with a terminal cancer patient who had come to believe that her calling was to overhaul the medical profession's attitude toward death. With her encouragement and illumination, she and Yalom founded the first support groups for dying patients. Yalom describes Paula's extraordinary energy, her healing warmth, her resourcefulness: "What to name the group? Paula suggested the 'Bridge Group.' Why? Two reasons. First, the group created a bridge from one cancer patient to another. Second, it was a group where we put our cards on the table ... typical Paula touch."

It all seems too good to be true, and of course, it is. Their wonderful joint enterprise degenerates into a turf war. Paula becomes increasingly embittered, paranoid and irrational, but expresses her rage with typical New Age indirection. When they have their final rupture, she brings an "anger rock" to the meeting. It is a human paradox that transcendent emotions and pettiness can exist in the same person, Yalom seems to be saying.

Like Primo Levi's works on the chemicals business or Louis Auchincloss' vignettes about the law, these tales are about not just the inner workings of a profession but also the special way of looking at life the profession provides.

For Yalom the existential therapist, this special view is a sense that life is about the search for meaning, the discovery of patterns and the ironical beauty of living with contradictions. In this sense, Yalom the storyteller is in perfect harmony with Yalom the therapist.

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