The here-and-now in therapy
In 2002 Irvin Yalom published The Gift of Therapy, subtitled "An Open Letter to a New Generation of Therapists and Their Patients". It is a book of short chapters, most of them only a few pages long. One topic runs through more of them than any other. Yalom calls it the here-and-now, and says outright that he will discuss it more than anything else in the book.
The book is written for therapists. The idea its advice rests on also concerns the person in the other chair.
What the term covers
Chapter 14 gives the definition. The here-and-now is what happens during the hour itself: in this office, in this relationship, in the space between two people, and in this hour rather than last week.
Yalom calls the approach basically ahistoric. It does not throw out the past or the rest of a person's life. It turns attention away from them, toward what is going on between the two people who are present.
That can sound like a strange priority. A person usually comes to therapy because of something out there: a marriage, a job, a loneliness that has lasted years. Chapter 15, "Why Use the Here-and-Now?", is Yalom's answer to that objection. It is two pages long.
Two assumptions
The argument rests on two assumptions. The first is that relationships matter enormously. Yalom does not spend long on it. People are social creatures, he writes, and a person's image of themselves is built largely from how they see themselves reflected in the eyes of those who matter to them. Most people who come to therapy, he adds, have trouble forming and keeping lasting, satisfying relationships.
The second assumption sits at the center of the chapter: therapy is a social microcosm. Given time, and provided the hours are not too tightly structured, a person's difficulties with other people show up in the relationship with the therapist. Yalom lists the forms these can take. A person may be demanding, fearful, arrogant, self-effacing, seductive, controlling or judgmental. Whatever it is, it will come into the room.
He sums up the chapter in one sentence:
"...the rationale for using the here-and-now is that human problems are largely relational and that an individual's interpersonal problems will ultimately be manifested in the here-and-now of the therapy encounter."
— Irvin D. Yalom, The Gift of Therapy (New York: HarperCollins, 2002), chapter 15, "Why Use the Here-and-Now?", p. 48
From this he draws a practical conclusion. There is little need for a long history to see a pattern. It will soon be on display in the room.
A report and a sample
When someone describes a quarrel with a colleague, the therapist hears one side of it, already edited by the person who lived it. Yalom notes in chapter 17 that such accounts are often inaccurate. What happens in the room needs no retelling. Both people are there when it happens.
The next chapter shows how ordinary this material is. Yalom's office stood at the end of a garden path, and every patient walked down it. Most remarked on the flowers. One man never failed to find something wrong: the mud, the lack of a railing in the rain, the noise of a neighbor's leaf-blower. The same man later asked why Yalom's directions to the office named a pleasant restaurant as a landmark and not the fast-food place on the opposite corner.
Everyone meets the same path and the same box of tissues. So the way one person meets them tells the therapist something. He compares therapy to a living Rorschach test. One patient apologized each time she moved the tissue box. Another would not take the last tissue. A third would not let him hand her one.
Between two people
Read quickly, this could sound like surveillance, every gesture noted and filed. Yet a pattern seen in the room happened between two people, and both of them saw it.
Bugental, in his chapter on presence, asks how much of a person is in what they say. Yalom looks at the relationship in the room. For him the room is one more place where a person lives the way they live everywhere.
The chapter implies a question without asking it outright. Is the way I am in this conversation, right now, the way I am with everyone else?
Epimelea is an app built around the existential school. The conversation carries over from one meeting to the next. The archive is encrypted on the device and belongs to the person who wrote it.
About the app: an AI therapist for long-term therapy
This page is about a school of psychotherapy. It is not medical advice and not emergency help. If you are in danger right now, contact your local emergency number, or find a helpline in your country at findahelpline.com.