Book review: Hour of the Heart, Irvin D Yalom

In Hour of the Heart, psychiatrist Irvin D Yalom explores the twilight of his relationship with therapy – and life itself – when old age impacts his ability to provide long-term care for his patients. His memory failing, Yalom finds he can still offer effective treatment in condensed, one-off one-hour sessions that focus on the here and now as patients relate, or struggle to relate, to him in real time.

Hour of the Heart is a collection of vignettes of these one-hour sessions, and the book acknowledges the quiet heroism required to engage in therapy and to examine oneself to best enjoy life and to accept mortality. 

For Yalom “it is the relationship that heals” and in the short hour he has with his patients he models how intimacy may look for them in the wild by offering a therapeutic microcosm in which they can safely practise opening up. Yalom elicits intimacy in his sessions by sharing his own personal history, thoughts and feelings – a strategy he says is frowned upon in psychiatry circles. But we can see his strategy is effective and, in some cases, Yalom provides patients with the first authentic human interaction they have ever experienced by being vulnerable himself. 

Margaret, an autistic teacher, presents to Yalom suffering chronic loneliness due to her inability – so she thinks – to connect with her fellow humans in any way. Yalom recounts “the desolate images” appearing in his mind as Margaret provides him with a “bleak review of her life” devoid of any meaningful relationships. But then the writer shares with Margaret his own loneliness after the death of his wife Marilyn, with whom he had shared most of his life. This invites Margaret to share her own fears of being alone and she cries freely in front of Yalom after mourning the relationships she was never able to create. At the end of the session Yalom reminds Margaret that “you and I had a real encounter” – one she could replicate in the real world. 

While the patients in the book are no doubt suffering, their consultations with Yalom seem somewhat luxurious. Serious, pathological mental illness is absent in Yalom’s patients and their problems can be relatively first-world – such as Richard, a highly successful CEO, who, having everything in life, now wrestles with the meaning of existence. Or Millie, a privileged, educated woman doing a PhD in psychology, who complains her life is “dull, dull, dull”. One wonders if scheduling an appointment with the famous Dr Irvin D Yalom was a vanity project for some of the patients. 

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Yalom’s success as a therapist comes from his fierce self-examination and fine attunement to his emotions. He has spent his life charting the depths of his own soul so that he may understand others better. Hour of the Heart demystifies the psychiatrist as some preternatural telepathist to a person who is fallibly human but has turned a metaphysical x-ray on themselves. The book has an interesting effect on the reader, inducing a kind of mindfulness a real-life therapy session may provide. 

Hour of the Heart: Connecting in the Here and Now, Irvin D Yalom and Benjamin Yalom
Publisher: Scribe Publications
ISBN: 9781761380228
Format: Paperback
Pages: 288 pp
Publication: 26 November 2024
RRP: $29.99