There is no preface or foreword to Creatures of a Day, the latest book by Irvin D. Yalom detailing psychoanalysis sessions between Dr. Yalom and 10 of his patients. An introduction isn't really needed; after all, Irvin Yalom is an accomplished, gifted and celebrated existential psychoanalyst who has been treating patients for more than 50 years. A wise and empathic listener and counselor, Yalom has also written extensively, both fiction and nonfiction, about the personal relationship between therapists and patients. His popular 1989 book, Love's Executioner, solidified his literary reputation as a first-class storyteller by offering 10 absorbing, true stories that document what goes on in therapy sessions.

Creatures of a Day serves as something of a companion volume to Love's Executioner, again offering 10 revealing and creatively crafted clinical case studies about real people. This time, however, Yalom focuses less on the entire trajectory of a patient's work and more on incidents and exchanges specific to short-term therapy engagements. What emerges are vignettes where patients examine and question their lives for meaning, value and purpose, which often lead to "aha" moments of epiphany, while also offering a fascinating glimpse into the mind and heart of a mature psychoanalyst at work.

The patients presented are diverse; their problems include anxieties about the struggle to live a meaningful and fulfilling life, coping with the aging process, sustaining losses--including the loss of self--reconciling choices and facing aspects of human isolation. But it is death and its inevitability (in literal and metaphorical incarnations) that emerge as the central unifying theme of these case studies as a whole. This bears out Yalom's fervent belief that it is only when we acknowledge death that human existence can become not just bearable, but also joyful and meaningful.

Two of the stories detail intellectual and philosophical debate between therapist and patient. In "The Crooked Cure," an 84 year-old man, an intellectual obsessed with words, requests a single session with Dr. Yalom in order to address his writer's block. Over the course of a challenging, rather cryptic meeting, Yalom must solve the riddle of why this man has sought him out, why the patient stopped working on his dissertation 60 years earlier and why he wants to address this dilemma now. In the title story, "Creatures of a Day," two of Yalom's male patients--one a bright, clever, commitment-phobe in relationships with two women who both believe he will marry them, and the other a man grossly disenchanted with his career--have their personal states of affairs suddenly shift into focus via the study (and lively discussion) of the work of Marcus Aurelius.

Accomplished and high-functioning individuals with problems rooted so deep as to evade articulation are inherent in "On Being Real," where a well-educated and materially successful 37-year-old business executive, who seems to have it all, is choked by secret self-doubt, insecurity and free-floating guilt. "Don't Fence Me In" deals with a spry, spontaneous, fiercely independent 77-year-old, a former CEO, who staunchly resists the regimented structure of his new living arrangement in a retirement home he feels is confining and prison-like.

The past plays an active role in the present as some patients willingly reveal pivotal and unforgettable moments from their lives. In "Arabesque," Yalom is perplexed and intrigued when a 70-year-old Russian woman shows up at her first session cradling a photograph of herself when she was a prima ballerina at La Scala 40 years before. And in "You Must Give Up the Hope for a Better Past," a restless, 60-year-old physics technician seeks out Yalom for help in overhauling her life and reconnecting with a dream she gave up long ago.

Diagnostic labeling is viewed via its limitations in "Three Cries," a story about a female patient who must come to terms with the death of a lifelong friend who was plagued by psychological troubles. In their work together, Yalom and the woman face the truth about what place this friend actually held in her life, the truth of who he really was and how that truth affected the patient's life--for better or worse.

The intersection of life and death--and eerie coincidences of how closely people are interconnected--underscore "Thank You, Molly," where Yalom attends the funeral of his former assistant, and in the process, meets a patient he once counseled who is now a successful radiologist. Yalom pieces together the surprising connection the radiologist holds to the deceased. A similar theme plays out in "Show Some Class for Your Children," about a nurse who tended to a dying patient, one of Yalom's former therapists-in-training. The nurse seeks out Yalom in order to help heal her own damaged self-image--along with issues of anger, bitterness and rage. In her sessions with Dr. Yalom, she uncovers the impact she made upon his former student.

Throughout, Yalom is wise and well-read, citing passages from Schopenhauer, Nietzsche, Marcus Aurelius, Yeats and Greek mythology. But nowhere is he portrayed as more human and vulnerable than when he counsels the patient in "Get Your Own Damn Fatal Illness: An Homage to Ellie." Here, an introverted, childless, single woman experiences an array of feelings while battling the ravages of cancer and her impending death. In written correspondence she shares with Yalom, the doctor finds himself emotionally distancing himself from the angst of the dying woman. He offers his presence as best he can, but he ultimately admits his own limitations, how his own death anxiety "never really disappears, especially for those... who continue to poke around in their unconscious."

In each case, patients search for their identities--their true authentic selves--while looking for validation that their lives have had meaning and purpose. Through Yalom's gentle wisdom, expertise and leading--coupled with dream recognition and patients taking him through the minutiae of a day in their lives--bonding and healing occurs. The insights Yalom ultimately shares with his patients are often not anything they did not already know. "It's just easier," he states, "to fend off something told to you from the outside than it is something rising from the depths of yourself."

At the time of writing this book, Yalom was approaching his 82nd birthday, and it is clear that his passion for psychoanalysis and helping people in emotional crises and conflict has not waned. He continues to be receptive as he seeks answers to questions of how to help people and serve as a guide for their personal self-exploration and growth. He welcomes each new case and patient dilemma with an analytical mind, personal empathy and an innate curiosity that drives and shapes the two-person narrative dramas that fill this book.

In the end, no two patients or their dilemmas are alike, nor do they reach conclusions and/or self-discovery in the same way or time frame. And while the themes explored may be largely universal, the resolutions certainly are not. Yalom believes that each patient must dive into "a great-souled man's sea of wisdom" in order to emerge on the other side, often in a way that Yalom--and readers--could never predict or anticipate. --Kathleen Gerard

photo: Reid Yalom

Irvin D. Yalom is a psychotherapist, writer and Professor Emeritus of Psychiatry at Stanford University. Yalom has spent more than 50 years studying human behavior and the mysteries of life. He has said, "A good therapist fights darkness and seeks illumination," and his analytic quest has been borne on the pages of more than a dozen books of fiction and nonfiction. Yalom claims that his books are written primarily as teaching tools for therapists, students of psychotherapy and for those who have "a keen interest in the human psyche and personal growth."

"Creatures of a Day" is a phrase drawn from a quote by Roman emperor and philosopher Marcus Aurelius. What drew you to the quote, and why did you select it as the title of the book?

The title story is a complex story about my suggesting to two different patients that they read Marcus Aurelius' confessions. It deals with several issues, among them how the two patients saw very different things in their readings. One of the patients was very fixated upon my having a particular image of him in my mind. This was so important to him that he withheld important information from our therapy. One particular quotation referred to our tendency to use the phrase that we are but "creatures of a day." That turned out to be a very important concept for this patient, and we discussed that phrase several times together in our work. I liked the ring of it and immediately thought of it for the title.

Why and how did you select the stories featured in Creatures of a Day?

My method was to read and reread case notes from a lot of my patients' therapy sessions until some particular incident seemed to thump with energy, and I built the story around that incident. It's quite a different approach from my first book of stories, Love's Executioner, in which I took the case notes of the entire course of therapy and turned them into a story.

Was the writing process difficult?

This book took a long time to write. The major problem was finding each story: once I located and identified that, the writing came fairly quickly. But the intervals between writing the stories were longer and longer, and I assume that has something to do with my aging. I kept reading my notes over and over again and then as I took bicycle rides, things started to take shape in my mind.

Do you have a favorite story from this book?

I have a special relationship with each story and of course when I read them, I have a visual image of the patient involved in that story. Some stories I know much better than others, especially because I've been able to read them aloud to audiences.The shorter pieces that lend themselves well to public readings, such as "Three Cries," are the ones that are most familiar to me.

Can you share some thoughts about how you go about counseling patients?

I still continue to practice, but I am only seeing about two or three patients a day. I am very careful about my selection of patients. Since I only see patients for one year, I try to choose patients that I think I can really offer something to during that time.

How do you decide between writing stories as fiction or nonfiction?

I feel on much more comfortable ground when I write about patients that I've worked with. It's true that I've written four novels that are fictional (though there is nonfiction in them since I've written about the lives of philosophers), but I feel much more at home writing stories that are nonfiction. In my collection called Momma and the Meaning of Life, I have about three totally fictional stories. One of them involves a talking cat. Out of all the things I've written, "The Hungarian Cat Curse" was the most fun. Someone has written recently stating his intention to adapt that story into a musical.

Do you have a favorite book from those you've written?

My novels were a great kick to write. Many of them were written while on sabbatical in various places like Bali, the Seychelles, Paris and London. Above all, I loved writing When Nietzsche Wept, Lying on the Couch and The Schopenhauer Cure. I really lived those books and was completely immersed in the writing.

Why is death such a prevalent theme in all your work?

I'm an existentialist. I believe that the terror of death haunts all of us and plays a role in the discomfort of the great majority of patients. I've written about this extensively in a book called Staring at the Sun. There's also a great deal of it in a textbook called Existential Psychotherapy.

What are your own personal feelings about death? Do you believe in any sort of a hereafter?

I agree with Epicurus that we were in a "state" of non-being for eons of time before we were born and that we will pass to that same state after we die. No, I don't believe in any sort of hereafter. I agree with Stephen Hawking, who said that the hereafter is a fairytale for those who are afraid of the dark.

If you could meet the psychologist and/or writer of your choice, who would it be and why?

The psychologist I would like to meet would be Freud--he is the great genius of our field. As for writers, I think I would like to meet Dickens or Dostoyevsky.

If you weren't a psychologist or a writer, what would you have done with your life?

I enjoyed my medical training and would've been happy as an old-fashioned doctor.

Tell us about Yalom's Cure: A Guide to Happiness, the documentary about your life.

A few years ago, Swiss filmmaker Sabine Gisiger approached me; I was honored that she would have this kind of interest in my work. At the same time, I was threatened by the amount of exposure. Even now, after the film has been released, I still have these two major emotions. She and her film crew spent a great deal of time on this project over the years, visiting us in California and then accompanying me when I was on family vacations to Hawaii and France. I had no editorial control over the film and recently flew to see the premiere in Switzerland. I was very pleased by the finished product. She's an extraordinarily good filmmaker, and she has made a beautiful film. It's a good and true view of me. I wish, perhaps, it would've focused more on my writing work.

What's left for you to accomplish?

I'm working on a memoir--that, I think, is an age-appropriate task. I had a colorful, deprived and somewhat traumatic first 14 years; the memories of that time seem to be returning to me more and more vividly. --Kathleen Gerard