Week 3 – Adlerian Therapy F09

A couple vocabulary words: teleological – goal-oriented view of human nature. Phenomenological – subjective frame of reference. For Adler, objective reality is less important than the meaning which we attach to the experience. Adler named his approach Individual Psychology and stressed understanding the whole person – how all parts of the person are interconnected and move the person toward a life goal.

Family history – Alder was born in Vienna in 1870. He was the third child, second son, of a family with 6 boys and 2 girls. His father was a grain merchant. He has very poor health – he had rickets and didn't walk until he was 4, and when he was 5 he nearly died of pneumonia. He decided at that age to become a doctor. He was pampered by his mother. He was dethroned by his younger brother, and was jealous of his older brother whose name was Sigmund. It is believed that these experiences influenced his thinking of inferiority being a main influence in human behavior.

Originally it was thought that he would not be successful in school, but he excelled and graduated at age 25 with his medical degree in 1895. He married a woman characterized as an “irreligious political revolutionary and ardent feminist who disliked domesticity.” They had 4 children, 2 of whom went on to become psychiatrists and one who died in a Russian prison for her political activism.

Work history: He started as practicing physician in Vienna in ophthalmology, then general practice, then neurology, then psychiatry. (His office was across from a circus and amusement park and his clients included circus people. It has been suggested that his insights into organ inferiorities and compensation were influenced by seeing his clients' unusual strengths and weaknesses.) He collaborated with Freud and defended Freud's book “The Interpretation of Dreams”, but he disagreed with Freud on the nature of the unconscious. He was part of the Psychoanalytic Society from 1902 – 1911 but split with Freud in 1911 and in 1912 founded Society for Individual Psychology. Freud started the rumor that Adler was a disciple who had gone astray and Adler in turn called Freud a “swindler” and “sly”.

He served as a doctor in the Austrian Army during WWI and saw the damage of the war. Adler was motivated by his desire to help people. Considered a founder of family therapy in 1922. He was very influential in child guidance movement and his followers expanded his ideas and started Adlerian Institutes. He and his family moved to the US in 1934 and he died in 1937 while on a lecture tour.

Philosophy – although still from the psychoanalytic perspective, his basic philosophy of human nature and therapy differed from Freud's approach.

• Saw people as whole: mind and body, and only when the mind was understood could you help the whole person. We are also part of the broader social context of family, culture, school and work.
• Job of therapist is not to retreat to person's past (Freud) but to strengthen the individual to help him/her face the present. Adler sees life as dynamic striving – we are “pulled” toward self-realization, not pushed by instincts.
• Thought that turning to past in extensive way only encourages the tendency to retreat from life
• Rejected Freud's tendency to reduce neurosis to sexual terms. Adler thought neurotic symptoms were a guard against threats to one's self-image and outside world, while Freud thought neurotic symptoms were a defense against instinctual drives and the need for the ego to be safe from the id and superego.
• Thought sexuality was important, but more important is the individual's perception of events and circumstances in his/her life

• Adler began by looking at man as an organism and noted that humans are inferior in spectrum of species. He concluded that this weakness caused humans to develop mental abilities and this inferiority also caused development of social life. Without development of psyche and social ways of living, humans would have become extinct. Based on this interpretation of evolutionary process, Adler developed psychology of individuals - because of innate sense of inferiority; humans feel insecure and strive for perfection. Inferiority feelings motivates a person to strive for success.
• Adler called this striving the “law of overcoming”: to be human means to possess a feeling of inferiority that is constantly pressing on towards its own conquest. The stronger the feeling of inferiority the stronger the urge to conquest

Psychology of individuals

• Adler looked for early experiences of inferiority and this brought him to work in “family constellation”. (see text for birth order discussion) He determined that the size and structure of the family unit and the relations within it provide the atmosphere for growth of personality. It is the child's interpretation and reaction to family constellation that is important, more so than what is really happening in the family. Any physical weaknesses as child leads to psychological compensation. The child's personality is formed by age 6 and style of life by age 5 but later life events can have a profound effect on our personality. Formation of personality is result of process of psychic compensation for physical weakness and the family constellation – the inferiority of one's family position. It is the person's perception of past that is most important. Our consciousness, not our unconscious is the center of our personality. He believed that we develop (by age 6) we develop this fictional vision of ourselves (he initially used the term fictional finalism, but later dropped it) as perfect or complete and this forms into our life goal. Our life goal unifies our personality and becomes the source of motivation. "Only when I am _________________ can I be ________________".
• People develop a “style of life” or plan of life which is unique to the individual and is his/her own way of facing life. This style of life is inherently social because personality can only be expressed in relation to the community. We have 3 universal life tasks that we must accomplish for good mental health: Building friendships, establishing intimacy, and contributing to society. Later Adlerians added Getting along with ourselves, and developing a spiritual dimension.
• It is fundamental in human nature that individuals have a trait called “social feeling” or “community feeling” - one's sense of connection with the community, with all humanity and to be involved in making the world a better place. One's attitude toward others involves one's attitude toward self and the way social feeling is expressed in one's style of life is the key to psychological health (or lack of)

Group work – talk about your Lifestyle assessment. What did you learn from taking it? Assume you were a client with an Adlerian therapist, what theme(s) would you want to address? Did you discover any themes from your past that influence your current lifestyle? Any that would influence your work as a counselor? How much help do you think this questionnaire would be in a therapeutic relationship?

Therapy from an Adlerian perspective – Clients are not sick, but are discouraged. Counseling is collaborative and is about teaching, guiding and encouraging. People become discouraged, and an Adlerian therapist helps people to explore their "private logic" or concepts about self, others and life, upon which their life style is based. What we see as symptoms are attempted solutions, and Adlerians help people to look at themselves in new ways, to see what are considered the mistaken beliefs. Look for mistakes in thinking and valuing such as mistrust, selfishness, unrealistic ambitions and lack of confidence.

Adlerians gather information through the family constellation questionnaire, and the use of early recollections. A few early recollections can be used to understand a person's current convictions, evaluations and attitudes. They are a picture of how we see ourselves and the world, and the therapist summarizes and interprets these recollections. Adlerians are not looking for pathology or diagnosis, they are looking for ways to help a client better grow and understand their life story. Adlerians try to provide a new “cognitive map: - understanding of purpose of their behavior and way of changing perceptions.

You can hear in the Adlerian model the roots of CBT and reality therapy – what are the mistaken beliefs and how does the symptom (such as depression) "work" for the person. The relationship is egalitarian, based on cooperation, trust and respect. Important that the goals of therapy are agreed upon and in alignment.

Four phases of counseling :

Establish a relationship – doesn't require transference; goals and interests of client and therapist must be aligned. What is called “resistance” is a discrepancy between the goals of the therapist and those of the patient. Important elements of the relationship include:

• Mutual trust and respect – colllaborative relationship
• Attending behavior and attentive listening – hear message, follow content and feelings, and seek confirmation about what you believe you heard
• Goal alignment – establish clearly why client is seeking help and what expectations are of counseling. “Is this the person you want to be?” “What will happen if you keep this pattern?”
• Reflection of feelings and empathic understanding – empathy is the communication of understanding. It reflects both feeling and cognitive content.
• Productive use of silence – silence can mean many things: the client is trying to gain control of session; maybe avoiding responsibility; goal alignment was not achieved; reflection; avoidance of material
• Non-verbal communication – can make tentative hypothesis about non-verbal signals. Counselor also has to be aware of own non-verbal communication.
• Tentative hypotheses and encouragement – this helps with understanding behavior.

Exploring the individual's dynamics : Help to understand what determines lifestyle – this phase is for understanding the life style and seeing how the life style affects the individual's functioning in the life tasks. Focus is on social and cultural context. Use both subjective interview (telling life story) and objective interview (discover information about the problem – precipitating events, medical history, coping, etc). Interviews are open-ended, but systematic gathering of data. Ways to do good assessments include gathering information about the family constellation and using early recollections.

Integration and summary – once material has been gathered prepare a summary of the information and present it to the client for discussion. – this process should result in clear, concise summary of basic mistakes, perceptions, and assets. Summary must discern patterns in life style and understand how certain behaviors reinforce certain beliefs.

Look to pinpointing the priority – establish what is the client's #1 priority, ask directly or ask to describe day. To deal effectively with priorities and life style themes, do not try to change priority but look for alternative behaviors and attitudes that can help client be more effective

• Classification of basic mistaken and self-defeating perceptions:
• Overgeneralization – “all”, “always”. There is no fairness in the world
• False or impossible goals of security. I must please everyone if I am to feel loved.
• Misperceptions of life and life's demands. Life is very difficult for me.
• Minimization or denial of one's worth. I am basically stupid, so why would anyone want anything to do with me?
• Faulty values – I must get to the top regardless of who gets hurt in the process.

Encourage self-understanding and insight : Develop insight into mistaken goals – concerned with helping clients become aware of why they choose to function as they do. Present interpretation of life style, goals and private logic. Life style is central theme.

• Method of presentation – can be made tentatively, or as a confrontation. Sometimes client is asked to interpret for him/her self.
• Goal – to create awareness
• Results – if interpretation is accurate and helpful, it can create awareness.

Helping with reorientation - Consider new alternatives – reorientation phase – work is to consider alternative attitudes, beliefs and actions.

• Establish realistic goals
• Problem solving and decision making – each course of action is considered in terms of how it helps one realize goals and values
• Seeing new and more functional alternatives – primarily a motivation – modification system; focus is on changing attitudes, beliefs, perceptions and goals so that behavior will change.

a. Immediacy – expressing experiences of the counseling session

b. The miracle question – if you were to wake up tomorrow and not have this problem, how would your life would be different.

c. Encouragement – focuses on beliefs and self-perceptions, takes many forms

d. Paradoxical intention – prescribing the symptom. Client is encouraged to emphasize or develop their symptoms even more for a specific period of time

e. Spitting in the clients soup – changing the meaning of the behavior so it is no longer attractive

f. Acting as if – behave now as he/she wishes to behave but doesn't believe can

g. Catching oneself – practice becoming aware of the behavior they want to change

h. Creating movement – surprising the client to create movement in the session

i. Avoiding the tar baby – counselor must avoid the client's traps (faulty perceptions of life)

j. Task setting and commitment – tasks must be specific and mutual

k. Terminating and summarizing the interview – establish limits, beginning and end times.

Strengths/Limitations of Model

Flexible, collaborative, stressed cultural context

Some cultures don't emphasize exploration of childhood experiences, may want counselor to be expert. Research into this model is limited.

Handouts

Videos of Stan and Tom

Homework for next week: p. 74-75 from workbook: Ways of being dead, and will we really change.

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