When I was offered the chance to review another book by Irvin Yalom by my dear Reviews Editor, I felt a deep sense of comfort. Firstly, there are two Yaloms on the cover, and next, in amongst what I can only describe as a deep despair at the chaos and unfolding depravity around us, Irv seems to be an anchor, always there, honest to a fault and a connection with a potentially easier time. Personally, thoughts of him continue to transport me back to my first encounter with him while I was a psychiatric patient, when his Staring at the Sun played no small part in my falling for the profession and in finding again a reason to engage with life, something I had been quietly losing hold of around that time. It was, however, a time of innocence, when the end of human interaction belonged purely to the realm of dystopian fiction, rather than as it is now, written about in the business pages as a utopian dream of tech billionaires who want to live forever, surrounded and supported by armies of AI and robots.

Still, back to Hour of the Heart. In this book Yalom charts the last couple of years of his practice when he has realised that his memory and stamina are not conducive to long-term work. This is probably the last book by Irvin Yalom, rather than Benjamin, his son, who is also a writer of some acclaim and currently training to be a psychotherapist. Potentially, because according to Benjamin, Irvin is writing his final one even though this has become a running joke within the family. Benjamin contributes the last chapter of the book as himself. I have no doubt that his hand is behind a great deal of the words within the book, but it is a testament to him that it did not feel as if the preceding chapters were not Irving.

I have found myself, somewhat unwillingly, recommending either explicitly or implicitly, lessons from the book. Yalom seems to have gone even further into the honesty bracket in a way that feels uncomfortable, and potentially in a way only he can. I think there could have been more acknowledgement that working on a single session basis, two at most, while in one’s nineties and presumably affluent enough (an assumption I based on his walk to an office in his garden in California which suggests money is not an issue) provides a freedom that others, I for one, cannot feel.

Similarly, thanks to his international reputation, he can post single sessions on Facebook advertising and have prospective clients wait for multiple weeks. Personally, I am unconvinced of this as a business strategy, and I cannot help but wonder whether this is actually promoting ‘existential psychotherapy’ or just ‘Yalom’ as a brand. In fact, I ask myself if this is playing into the hands of the more modern view that change can happen quickly, and that celebrity culture is important. Yalom is famous for being an author who writes about therapy rather than being a psychotherapist. Whether he is any good as a therapist, I cannot judge. After all, his whole practice could be a work of fiction. I doubt it, but ultimately my valuing him for his ability to craft words is, to a degree, misplaced. I also admire the writings of Roald Dahl, but I doubt he would have made much of a therapist. And this points to something I find troubling in a world where practitioners work behind closed doors: we end up celebrating those who excel at an allied skill rather than at the thing itself. If I were a leading project manager, then I could get peer reviews not of what I said was happening in my project but of actually what is happening. I could hand over the financials, the plans, talk through the change control logs, present the board papers and a reviewer would get evidence. I could be awful as a presenter, or as somebody writing academic papers but acknowledged as a genius at project management. In fact, when I worked in that world, I knew several people whose reputation was based on their project management ability alone and the publicity afforded them by word of mouth. Yalom is at the other end of the spectrum. He is judged by a relatively minor number of case studies, all jazzed up to be of literary interest, and I fear if you follow that trail then you could also end up suggesting AI is a decent therapist. And personally, that is not where I want to be, and it is not where I think our profession should be.

Despite my misgivings about Yalom’s position, and acceptance of that position, I think there is something in his ability and willingness to be honest, personal and to disclose that we could be missing. In some of the later sessions in the book, he attempts to build a relationship in encouraging the client to ask him questions. While I would be somewhat uncomfortable with this, a number of clients do ask me personal questions; the painted lion that resides in my background or my choice of china for a drink have been the subject of enquiry. These are pretty normal questions because the lion is striking and colourful and disclosing a certain joy, while one of the mugs I use is large, floral and pink, in contrast to my shirt and beard. Why shouldn’t we disclose? Why shouldn’t clients ask questions? On a more serious note, I sit with a sense of fear about the potentially imminent death of my mother, and what I should tell my clients. Why are we encouraged, at all, to infantilise clients in pretending they do not know we too are beings in the world who have loved ones around us who will die, as well as other human stresses?

I feel sad for Yalom but I also get the sense he realises, accepts and embraces, as well he can, that this is simply the price one has to pay for living a life that has meant something, and as such is truly ‘human’. He is clearly hurting from the loss of his wife, his companion for almost his entire life. He is clearly hurting from the absence of his children, not through neglect or lack of love, but because they have full lives of their own and are themselves well past middle age. He is clearly hurting from the loss of his friends, most of whom have died, and without his wife to help him forge new connections, that absence will remain unfilled. And he is clearly missing his work with patients, and the sense of meaning it gave him. All of this amounts to a quietly devastating portrait of what ageing looks like when you live a very long life, regardless of one’s achievements, fame or the depth of relationships one has known. I feel this as much in my body as in my mind, not least because of what is happening in my life right now, as the son of a mother who is bed-bound and longing for death.

I would recommend this book. It has flaws, of course it does. I struggled to get a real sense of Yalom’s declining memory beyond the words and the description; it reads like more like a literary technique than something genuinely felt and I think it is a weakness. His attitude towards privilege is at times vague, and that too feels like an omission given the country he is writing in and the moment he is writing in. Yet as I write that, I am reminded of the quote attributed to Michael Jordan that Republicans buy sneakers too, and with that in mind I find myself questioning the essence of Yalom’s honesty. Perhaps this is simply misplaced anger. If I am angry with him for not living up to my expectations, it may be the thought that this is his last contribution to clinical work, and the loss is too great.

As always, his book offers as many lessons in what not to do as in what to do, but that is useful material for any practitioner. And as a piece of literature, there is a beauty and tenderness present. At its heart, both the book and the work itself is a remarkable project, undertaken in response to the requests of others who have been moved by him across cultural boundaries, and in a range of fields and circumstances. Yalom has brought existential ideas and ways of being to the fore in a way no other psychotherapeutic practitioner has managed, and for that he deserves our applause. If this book really is his last, it is a fitting place to end.

Ben Scanlan