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Irvin Yalom: Group Therapy Sketchnotes & an Open Letter on “Love’s Executioner”

This article is in two parts:

#1, Group Therapy Sketchnotes

and #2 An Open Letter I’ve written to educators who are using Yalom’s text “Love’s Executioner” as a textbook. [click here to jump to Part 2]


Image of two diagrams. The first says, "Good groups start like this:" and has a blue block with a "T" in it connected with straight lines to seven different grey blocks with "M's" in them. The second diagram says, "And then become:" with a blue block with a "T" in it connected to seven grey blocks with "M's" in them, which are all connected to each other.

Group Therapy Sketchnotes

In graduate school, I had the privilege of learning under instructors who were mostly very receptive to the idea that not all students take in, process, and organize newly learned information in the same way. Group therapy was one of several courses during my time at The Seattle School of Theology and Psychology in which I was permitted to turn in book report type papers in the form of sketch notes. Since we know that information that is handwritten – and especially information that is drawn – is more easily remembered than information that is typed, being able to complete these sort of papers in the form of a sketch note facilitated my own learning and produced some pretty helpful resources that I’m able to share now.

In this selection of sketch notes (which it feels more accurate to call “doodle notes,” given my own style of visual note-taking), I summarized the high points of a few chapters from my group therapy class in graduate school. Most of these pages reference chapters in Irvin Yalom’s canonical group therapy textbook, “The Theory and Practice of Group Psychotherapy.”

Venn Diagram: a gold circle on the left that says "here and now process" that overlaps with a blue circle that says "examination of process." The word "drama!" is written to the left side with an arrow pointing to the gold circle. The word "boring!" is written to the right and is pointing to the blue circle. A box is drawn below that says, "Integration of both creates content to learn from and the context to learn in." An arrow is pointing from the box to the overlap of the circles.

These pages discuss working in the “here and now” versus “there and then,” what it means to focus on process versus story, ways that leaders can miss valuable group-growth through efforts to avoid discomfort, how to facilitate vulnerability via engaging as a leader with vulnerability, etc.

Drawing of four boxes stacked horizontally with arrows pointing down from box to box. The first box says, "interpersonal bonds." The second box says, "safety and trust." The third box says, "vulnerability." The fourth box says, "growth and change."

As you might guess from this rundown, I didn’t choose to publish this old set of notes randomly – these instructions for facilitating an effective psychotherapy group are reminders we can all use right now as we navigate brave conversations around what is happening in our country as important discussions are coming to head in regards to racist criminal justice systems, white privilege and fragility, and police brutality.

Being able to hear someone else’s “here and now reality” without interjecting our own commentary can help us be better listeners. Willingness – even (especially) as people who may be “experts” in difficult conversations – to enter conversations brave enough to engage vulnerably even when we don’t know what to say can hold space for new levels of authenticity. (If you are a white person and you aren’t sure if saying anything at all right now is ok, check out last week’s sketchnote on Robin DiAngelo’s Article “Nothing to Add: A Challenge to White Silence in Racial Discussions” for some helpful points to consider).

A yellow banner that says, "Ways a leader can create a vulnerability-safe place:" Pink box with the number 1 in it, with text that says, "Slow process to focus on affect-producing material. Below this is a pink box with the number 2 in it, with text that says, "Staying with affect for longer than comfortable." A green banner underneath says, "Say: stay with the feeling." Below this is a pink box with the number 3 in it, with text that says, "Leader choosing to be emphatically involved in affect experience."

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Open Letter to Educators Using Irvin Yalom’s “Love’s Executioner” As A Text in Counseling, Psychology, and Social Work Training Programs.

Irvin Yalom is a venerable leader in our field, and an author whose prolific and authentic writing about the experience of being a relational psychotherapist has helped shape the clinical minds of thousands of young therapists. While Yalom’s work offers countless valuable resources to new clinicians, today I want to ask you to engage a more critical reading of Yalom and invite you to use care in how his writing, particularly the book “Love’s Executioner,” is placed within the context of your curriculum.

As you may be aware, a chapter in this book titled “Fat Lady” outlines – in vividly cruel detail – Yalom’s disgust with large bodies, his decision to take on a client in a large body on the basis of being able to use her as a professional challenge, his delight in the woman’s development of disordered eating, and his conclusion that he healed her – despite his failure to learn to regard a large body with basic dignity.

Educators placing this text in their curriculum should consider if, at any point in the training you provide them, students are asked to consider their own bias in regards to body size. Research shows that “people of all ages, sexes, and from a number of different cultures stigmatize and subsequently discriminate against obese people.”[1] These stereotypes are independent of the body size of the person doing the rating[2] and independent of the large person’s competency.[3] Weight-based stigma is “pervasive and intensifying,”[4] having more than doubled between 1995 and 2006.[5] 

Yalom’s text is not without merit if taught in an appropriate context, but if used as a text without confronting these body-based biases and exposing students to the robust body of evidence on the long term outcomes of restrictive eating behaviors,[12] [13] students are at risk to read this text as prescriptive for their own work rather than as a route to engage how all clinicians – even those as well-regarded as Yalom – have blind spots and biases.

Yalom, in his treatment of this client and in how he dismisses as “boring” her disclosures of stigmatization and marginalization, IS an act of stigmatization. Research shows clearly that weight-based stigma negatively impacts mental health,[7] increases binge eating,[8] [9] decreases the use of health care services,[10] and increases the likelihood of weight gain over time.[11] Long-term studies repeatedly show that after a period of food restriction such as the one Yalom counseled his patient through, virtually all bodies will return to their beginning weight or heavier, often with poorer overall health due to the effects of weight cycling.[12] [13]

If you choose to assign this text, actively engage it, and do so with the understanding that it is a dangerous text. Without a critical reading and robust discussion led by evidence-based HAES allies, Yalom’s text has the capacity to cause continued harm both to large-bodied students and all therapists who will encounter diverse bodies in their professional work.

Hopefully,

-Lindsay Braman

Black background with white writing. The title reads, "Intolerance of body diversity can neuropsychologically cause weight gain." There is a diagram drawn underneath that has four text boxes that are connected to each other by arrows: "Experience of weight stigma," "Weight gain," "Traumatic disregulation," and "Binge eating." Under "Traumatic Disregulation" is written: "Prefrontal cortex offline - ability to  complex problem-solve and make goal-based decisions unavailable." An arrow is drawn from "Traumatic Disregulation" to "Binge eating." Text on the arrow reads, "soothe-seeking." Underneath "Binge Eating is written, "brains in this state use  most basic self-soothing" with a squiggly arrow drawn back to "Traumatic disregulation." From "Traumatic deregulation," there is an arrow that reads, "avoidance of stigma," that points to text that reads, "reduced exposure to context  of stigma experience (like gyms, medical offices, relationships, etc.), which is then pointing to "Weight gain."
Often stigma cuts people off from accessing health care, enjoying activities, or being able to trust their family- all of which are health risk factors and can contribute to weight gain over time.

[1] Jane Ogden and Cecelia Clementi, “The Experience of Being Obese and the Many Consequences of Stigma,” Journal Of Obesity (2010): 2.

[2] Tiggeman and Rothblum, 1988, cited by Ogden and Cecelia Clementi, “The Experience of Being Obese and the Many Consequences of Stigma,” Journal Of Obesity (2010): 2.

[3] Larken & Pines, 1979, cited by Ogden and Cecelia Clementi, “The Experience of Being Obese and the Many Consequences of Stigma,” Journal Of Obesity (2010): 2.

[4] Andreyeva, Puhl, & Brownell, 2008; Vartanian, Pinkus, & Smyth, 2014 cited by Jeffery M. Hunger, et al., “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,” Social & Personality Psychology Compass 9, no. 6 (2015): 255.

[5] https://www.ncbi.nlm.nih.gov/pubmed/18356847

[7] Bacon & Aphramor, 2011, cited by Jeffery M. Hunger, et al., “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,” Social & Personality Psychology Compass 9, no. 6 (2015): 256.

[8] Almeida, Savoy, & Boxer, 2011, cited by Jeffery M. Hunger, et al., “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,” Social & Personality Psychology Compass 9, no. 6 (2015): 255.

[9] Rebecca L. Pearl, Rebecca M. Puhl, and Kelly D. Brownell, “Positive media portrayals of obese persons: Impact on attitudes and image preferences,” Health Psychology 31, no. 6 (2012):  821

[10] Ibid.

[11] Hunger & Tomiyama, 2014, cited by Jeffery M. Hunger, et al., “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,” Social & Personality Psychology Compass 9, no. 6 (2015): 255.

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/

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