Monday, January 11, 2010

Adlerian Therapy




Alfred Adler was a major contributor to the development of the psychodynamic approach to therapy.  After 8-10 years of collaboration, Freud and Adler parted company, with Freud taking the position that Adler was a heretic who had deserted him.  Adler founded the Society for Individual Psychology in 1912.  Other Freudian revisionists included Karen Horney, Erich Fromm, and Harry Stack Sullivan.  These neo-Freudians agreed that social and cultural factors were of great significance in shaping personality.  They are called neo-Freudian because they moved away from Freud’s biological and deterministic point of view toward Adler’s social-psychological and goal-oriented view of human nature.  After Adler’s death in 1937, Rudolf Dreikurs was the most significant figure in bringing Adlerian psychology to the U.S.  Dreikurs is credited with the idea of child guidance centers and training professionals to work with a wide range of clients.
View of Human Nature:

Adler abandoned Freud’s basic theories because he believed Freud was excessively narrow in his stress on biological and instinctual determination.  Adler stressed the unity of personality, contending that people can only be understood as integrated and complete beings.  He emphasized that where we are striving to go is more important than where we have come from.  Adler believed that people develop a unique style of living that is a movement toward and an expression of their selected goals.   In this sense, we create ourselves rather than merely being shaped by our childhood experiences.
Adler holds that the individual begins to form an approach to life somewhere in the first 6 years of living.  According to Adler, humans are motivated primarily by social-relatedness rather than by sexual urges; behavior is purposeful and goal-directed; and consciousness more than unconsciousness is the focus of therapy.  Unlike Freud, Adler stresses choice and responsibility, meaning in life, and the striving for success, completion and perfection.
Adler’s theory focuses on inferiority feelings.  He sees these as a normal condition for all people and as a sources of all human striving.  Feelings of inferiority can be the wellspring of creativity rather than being considered a sign of weakness or abnormality.  They motivate us to strive for mastery, success (superiority) and completion.
According to Adler, at around 6 years of age our fictional vision of ourselves as perfect or complete begins to form into a life goal.  The life goal unifies the personality and becomes the source of human motivation; every striving and every effort to overcome inferiority is no in line with this goal.
According to Adler, human behavior is not determined solely by heredity and environment.  Instead, we have the capacity to interpret, influence, and create events.  Adler asserts that what we were born with is not as important as what we choose to do with the abilities and limitations we possess.  Adlerians, however, do not go to the other extreme and maintain that individuals can become whatever they want to be.  
The focus of Adlerians is on reeducating individuals and reshaping society.  Adler was the forerunner of a subjective approach to psychology that focuses on internal determinants of behavior such as values, beliefs, attitudes, goals, interests, and the individual perception of reality.  Adler was also the first systemic therapist, in that he maintained that it is essential to understand people within the system of which they are a part.
Subjective Perception of Reality:

Adlerians attempt to view the world from the client’s subjective frame of reference.  This orientation or frame of reference is described as phenomenological.  The phenomenological orientation pays attention to the individual ways in which people perceive their world.  This “subjective reality” includes the individual’s perceptions, thoughts, feelings, values, beliefs, convictions, and conclusions.  Behavior is understood from the vantage point of the subjective.  Objective reality is less important than how we interpret reality and the meanings we attach to what we experience.  Many contemporary theories have incorporated this notion of the client’s subjective worldview as a basic factor explaining behavior.
Unity and Patterns of Human Personality:

A basic premise of Adlerian Individual Psychology is that personality can only be understood holistically and systemically.  The individual is seen as an indivisible whole, born, reared, and living in specific familial, social, and cultural contexts.  People are social, creative, decision-making beings who act with purpose and cannot be fully known outside the contexts that have meaning in their lives.
-Behavior as Purposeful and Goal-Oriented:  All Human behavior has a purpose.  Humans set goals for themselves, and behavior becomes unified in the context of these goals.  The concept of the purposeful nature of behavior is perhaps the cornerstone of Adler’s theory.
A basic assumption of Individual Psychology is that we can only think, feel, and act in relation to our perception of our goal.  Therefore, we can be fully understood only in light of knowing the purposes and goals toward which we are striving.  Decisions are based on the person’s experiences, on the present situation, and on the direction in which the person is moving.  Continuity is looked for by paying attention to themes running through a person’s life.
The term fictional finalism refers to an imagined central goal that guides a person’s behavior.  Adler ceased using this term and replaced it with “guiding self-ideal” and “goal of perfection” to account for our striving toward superiority or perfection.  The guiding self-ideal represents an individual’s image of a goal of perfection for which he or she strives in any given situation.  We have the creative power to choose what we will accept as truth, how we will behave and how we will interpret events because of our subjective final goal.
-Striving for Significance and Superiority:  Adler stresses that striving for perfection and coping with inferiority by seeking mastery are innate.  These ideas are called basic inferiority and compensation.  From our earliest years, we recognize that we are helpless in many ways, which is characterized by feelings of inferiority.  The moment we experience inferiority we are pulled by the striving for superiority.  Adler maintains that the goal of success pulls people forward toward mastery and enables them to overcome obstacles.  The goal of superiority contributes to the development of human community.  “Superiority” refers to moving from a perceived lower position to a perceived higher position.  People cope with feelings of helplessness by striving for competence, mastery, and perfection.  The unique ways in which people develop a style of striving for competence is what constitutes individuality.  The way in which Adler reacted to his childhood and adolescent experiences made him a living example of this aspect of his theory.
-Lifestyle:  An individual’s core beliefs and assumptions through which the person organizes his or her reality and finds meaning in life events constitutes the individual’s lifestyle (or “plan of life, style of life, life movement, strategy for living, or road map”).  Lifestyle is the connecting theme that unifies all our actions and our lifestyle consists of all our values and perceptions regarding self, others, and life.  It is the characteristic way we move toward our life goal.  This concept accounts for why all of our behaviors fit together to provide consistency to our actions.  Understanding one’s lifestyle is somewhat like understanding the style of a composer.  Although events in the environment influence the development of personality, such events are not the causes of what people become.
In striving for the goal of superiority, Adlerians believe some individuals develop their intellect; others, their artistic talent; others, athletic skills; and so on.  These styles of life consist of people’s views about themselves and the world and their distinctive behaviors and habits as they pursue personal goals.  Experiences within the family and relationships between siblings contribute to development of this self-consistent way of perceiving, thinking, feeling, and behaving.
Our unique style is created primarily during the first 6 years of life, however, subsequent events may have a profound effect on the development of our personality.  Experiences themselves are not the decisive factors; rather, it is our interpretation of these events that shape personality.  Faulty interpretations may lead to mistaken notions in our private logic, which will significantly influence present behavior.

Social Interest and Community Feeling:

Social interest and community feeling are probably Adler’s most significant and distinctive concepts.  These terms refer to individuals’ awareness of being part of the human community and to individual’s attitudes in dealing with the social world.
Social interest includes striving for a better future for humanity.  The socialization process involves finding a place in society and acquiring a sense of belonging and of contributing.  Adler equated social interest with a sense of identification and empathy with others.  Social interest is the central indicator of mental health according to Adler.  Those with social interest tend to direct the striving toward the healthy and socially useful side of life.  As social interest develops, feelings of inferiority and alienation diminish.
A central belief of Individual Psychology is that our happiness and success are largely related to our social connectedness.  Those who lack community feeling become discouraged and end up on the useless side of life.  We seek a place in the family and in society to fulfill basic needs for security, acceptance, and worthiness.  Many of the problems we experience are related to the fear of not being accepted by the groups we value.  If our sense of belonging is not fulfilled, anxiety is the result.  
Adler taught that we must successfully master three universal life tasks:

Building friendships (social task)
Establishing intimacy (love-marriage task)
Contributing to society (occupational task)
Dreikurs and Mosak (1967) added 2 other life tasks:
Getting along with ourselves (self-acceptance) and
Developing our spiritual dimension (including values, meaning, life goals, and our relationship with the universe or cosmos)
All people need to address these tasks regardless of age, gender, time in history, culture, or nationality.  These life tasks are so fundamental to human living that dysfunction in any one of them is often an indicator of a psychological disorder.
Birth Order and Sibling Relationships:
Adler is unique in giving special attention to the relationships between siblings and the psychological birth position in one’s family.  Actual birth order itself is less important than the individual’s interpretation of his or her place in the family.)   Birth order and the interpretation of one’s position in the family have a great deal to do with how adults interact in the world.  Individuals acquire a certain style of relating to others in childhood and form a definite picture of themselves that they carry into their adult interactions.  In Adlerian therapy, working with family dynamics – especially relationships among siblings, assumes a key role.   He identified five psychological positions:
1. The oldest child – somewhat spoiled as the center of the attention.  Depends to be dependable and hard working.  Strives to keep ahead.  When a newcomer to the family arrives – seen as an intruder who will rob them of the love they are accustomed to receiving.
2. The second child – from the time of birth shares the attention with another child.  Behaves as if they were in a race and is generally under full steam at all times.  The competitive struggle between the first two children influence the later course of their lives.  The second-born is often opposite to the first-born.
3. The middle child – often feels squeezed out.  May become convinced of the unfairness of life and feel cheated.  May develop a “poor me” attitude and can become a problem child.  In families characterized by conflict, the middle child may become the switchboard and the peacemaker, the person who holds things together.  If there are four children in a family, the second child will often feel like a middle child and the third will be more easygoing, more social, and may align with the firstborn.
4. The youngest child – always the baby of the family.  Tends to be the most pampered one.  Youngest children tend to go their own way.  They often develop in ways no others in the family have thought about.
5. The only child – shares some of the characteristics of the oldest child (high achievement drive).  May not learn to share or cooperate with other children.  Will learn to deal with adults well.  May become dependently tied to one or both of them.  May want the center stage all of the time, and if their position is challenged will feel it is unfair.
 
THERAPEUTIC PROCESS
Therapeutic Goals:
Adlerian counseling rests on a collaborative arrangement between the client and the counselor.  This includes forming a relationship based on mutual respect and identifying, exploring, and disclosing mistaken goals and faulty assumptions within the person’s style of living.  This is followed by a reeducation of the client toward the useful side of life.  The main aim of therapy is to develop the client’s sense of belonging and to assist in the adoption of behaviors and processes characterized by community feeling and social interest.  This is accomplished by increasing the client’s self-awareness and challenging and modifying their fundamental premises, life goals, and basic concepts.
Adlerians do not see clients as being “sick” and in need of being “cured.”  Adlerians assume a nonpathological perspective and thus do not label clients by their diagnoses.  Instead of using a medical model to understand their clients, they assume a broader perspective based on a growth model.
They view clients as discouraged.  Symptoms are attempted solutions.  The counseling process focuses on providing information, teaching, guiding, and offering encouragement to discouraged clients.  Encouragement is the most powerful method available for changing a person’s beliefs and stimulating courage.  Courage is the willingness to act even when fearful in ways that are consistent with social interest.  Without fear there would be no need for courage.  The loss of courage, or discouragement, results in mistaken and dysfunctional behavior.  The counselor provides clients with a new “cognitive map,” which is a fundamental understanding of the purpose of their behavior.
Therapist’s Function and Role:
Clients can become discouraged and function ineffectively because of mistaken beliefs, faulty values, and goals in the useless side of life.  Therapists tend to look for major mistakes in thinking and valuing such as mistrust, selfishness, unrealistic ambition, and lack of confidence.
A major function of the therapist is to make a comprehensive assessment of the client’s functioning.  Therapists gather information by means of a questionnaire on the client’s family constellation (parents, siblings, and others living in the home).  This gives a picture of the individual’s early social world.  The therapist is able to get a perspective on the client’s major areas of success and failure and on the critical influences that have had a bearing on the role the client has decided to assume in the world.
Early recollections are also used as a diagnostic tool.  These are single incidents from childhood that we are able to reexperience.  These memories provide a brief picture of how we see ourselves and others and what we anticipate for our future.  Early recollections are summarized and interpreted,   The therapist then identifies some of the major successes and mistakes in the client’s life.  This process is called a lifestyle assessment.  When this process is completed, the therapist and the client have targets for therapy.
Client’s Experience in Therapy:
A person’s style of living serves the individual by staying stable and constant.  It is predictable.  However, it is also resistant to change throughout most of one’s life.  Generally, people fail to change because:
-they do not recognize the errors in their thinking or the purposes of their behaviors, 
-do not know what to do differently, and 
-are fearful of leaving old patterns for new and unpredictable outcomes.
In therapy, clients explore private logic – the concepts about self, others, and life that constitute the philosophy on which an individual’s lifestyle is based.  Clients’ problems arise because the conclusions based on their private logic often do not conform to the requirements of social living.  The core of the therapy experience consists of clients’ discovering the purposes of behavior or symptoms and the basic mistakes associated with their coping.  Learning how to correct faulty assumptions and conclusions is central to therapy.
Relationship Between Therapist and Client:
Adlerians consider a good client-therapist relationship to be one between equals that is based on cooperation, mutual trust, respect, confidence, and alignment of goals.  The place special value on the counselor’s modeling of communication and acting in good faith.  The client-counselor relationship is seen as two persons working equally toward specific, agree-upon goals.  At the outset of counseling, clients should begin to formulate a plan, or contract, detailing:
 -what they want, 
-how they plan to get where they are heading, 
-what is preventing-them from successfully attaining their goals, 
-how they can change nonproductive behavior into constructive behavior, and -how they can make full use of their assets in achieving their purposes.  
The therapeutic contract sets forth the goals of the counseling process and specifies the responsibilities of both therapist and client.
APPLICATION:  THERAPEUTIC TECHNIQUES AND PROCEDURES
4 phases – not linear and do not progress in rigid steps – can best be understood as a weaving that leads to a tapestry:
1.  Establishing the proper therapeutic relationship.
2.  Exploring the psychological dynamics operating in the client (an assessment).
3.  Encouraging the development of self-understanding (insight into purpose).
4.  Helping the client make new choices (reorientationand reeducation).
1. Establishing the Relationship:  Working with clients is based on a sense of deep caring, involvement, and friendship.  Adlerian therapists seek to make person-to-person contact with clients rather than starting with “the problem.”  The initial focus should be on the person, not the problem.  Therapists start by helping clients become aware of their assets and strengths, rather than dealing continually with their deficits and liabilities.  A positive relationship is created by listening, responding, demonstrating respect for clients’ capacity to understand purpose and seek change, and exhibiting faith, hope and caring.  Adlerians pay more attention to the subjective experiences of the client than they do to using techniques.  They fit their techniques to the need of each client.  During this phase, the main techniques used are attending and listening with empathy, following the subjective experience of the client as closely as possible, identifying and clarifying goals, and suggesting initial hunches about purpose in client symptoms and actions.  They attempt to access the core patterns in the client’s life.
2. Exploring the Individual’s Dynamics:  The 2nd phase consists of two interview forms:  the subjective interview and the objective interview.  The subjective interview – the counselor helps the client to tell their story as completely as possible.  What the clients says will spark an interest in the counselor and lead, to the next most significant question about the client.  The Adlerian counselor is listening for clues to the purposive aspects of the client’s coping and approaches to life.  The subjective interview should extract patterns in the person’s life, develop hypotheses about what works for the person, and determine what accounts for the various concerns in the client’s life.”  Adlerians end a subjective interview with this question, “How would your life be different, and what would you do differently, if you did not have this symptom or problem?”  The objective interview – (a) how problems in the client’s life began (b) any precipitating events (c) a medical history (d) a social history (e) the reasons the client chose therapy at this time (f) the person’s coping with life tasks (g) a lifestyle assessment.  The family constellation – Factors such as cultural and familial values, gender-role expectations, and the nature of interpersonal relationships are all influenced by a child’s observation of the interactional patterns within the family.  Assessment includes an exploration of the client’s family constellation, including the client’s evaluation of conditions that prevailed in the family when the person was a young child, birth order, parental relationship, family values, and extended family and culture.  Early recollections – Asking the client to provide their earliest memories, including the age of the person at the time of the remembered events and the feelings or reactions associated with it.  Early memories cast light on the “story of our life,” because they represent metaphors for our current views.  The counselor might say “I would like to hear about your early memories.  Think back to when you were very young, as early as you can remember, and tell me something that happened one time.”  The counselor will then ask – “What part stands out to you?  If you played the whole memory like a movie and stopped it at one frame, what would be happening?  Putting yourself in that moment, what are you feeling?  What’s your reaction?  Three memories are usually considered a minimum to assess a pattern.  Personality priorities – Nira Kefir (1981) – people rely on a number-one priority, a first line of defense that they use as an immediate response to perceived stress or difficulty.  Each priority involves a dominant behavior pattern with supporting convictions that an individual uses to cope.  (a) superiority – striving for significance through leadership, or accomplishment (b) control – looking for guarantees against ridicule – a need for complete mastery of situations (c) comfort – wanting to avoid stress or pain at all costs (d) please – avoiding rejection by seeking constant approval and acceptance.  Integration – Integrated summaries of the data are developed and presented to the client for discussion.  Mosak (2000) common basic mistakes (1) overgeneralizations (2) false or impossible goals (3) misperceptions of life and life’s demands (4) minimization or denial of one’s basic worth (5) faulty values
3. Encouraging Self-understanding and Insight:  Adlerians believe almost everything in human life has a purpose.  When speaking of insight, Adlerians are referring to an understanding of the motivations that operate in a client’s life – a special form of awareness that facilitates a meaningful understanding within the therapeutic relationship and acts as a foundation for change.  Disclosure and well-times interpretations are techniques that facilitate the process of gaining insight.  They are hunches or guesses and they are often stated:  “It seems to me that . . . “ “Could it be that . . . “ “This is how it appears to me . . . “
4. Helping with Reorientation:  The action-oriented phase – helping people discover new and more functional alternatives.  People need to be reoriented to the useful side of life.  The useful side of life involves a sense of belonging and being values, having an interest in others and their welfare, courage, the acceptance of imperfection, confidence, a sense of humor, a willingness to contribute, and an outgoing friendliness.  Encouragement is the most distinctive Adlerian procedure and is central to all phases of counseling and therapy.  As a part of the encouragement process, Adlerians use a variety of cognitive, behavioral, and experiential techniques to help clients identify and challenge self-defeating cognitions, generate perceptional alternatives, and make use of assets, strengths, and resources.  Clients are encouraged to “as if” they were the people they want to be.  Clients are asked to catch themselves in the process of repeating old patterns.  Commitment is an essential part of this process.  Adlerian practitioners focus on motivation modification more than behavior change and encourage clients to make holistic changes on the useful side of living.
Areas of Application:
Adler anticipated the future direction of the helping professions by calling upon therapists to become social activists by addressing the prevention and remediation of social conditions that were contrary to social interest and resulted in human problems.  Individual Psychology is based on a growth model and is applicable to many areas:  child guidance, parent-child counseling, marital counseling, family therapy, group counseling, individual counseling, cultural conflicts, correctional and rehabilitation counseling, substance abuse programs, combating poverty and crime.
ADLERIAN THERAPY FROM A MULTICULTURAL PERSPECTIVE 
Adler introduced notions with implications toward multiculturalism that have as much or more relevance today as they did during Adler’s time.  Adlerian therapists tend to focus on cooperation and socially oriented values as opposed to competitive and individualist values.  For example, Native American clients tend to value cooperation over competition.  Adlerian therapy is easily adaptable to cultural values that emphasize community.  Adler was one of the first psychologists at the turn of the century to advocate equality for women.
Limitations:  The Adlerian approach tends to focus on the self as the locus of change and responsibility.  This primary emphasis on changing the autonomous self may be problematic for some clients.  Many clients who have pressing problems are likely to resent intrusions into areas of their lives that they may not see as connected to the struggles that bring them into therapy.  Members of some cultures may believe it is inappropriate to reveal family information.
Contributions of the Adlerian Approach:  Flexibility and its integrative nature.  Adlerian therapists can be both theoretically integrative and technically eclectic.  The Adlerian therapy approach tends to lend itself to short-term formats.  One of Adler’s most important contribution is his influence on other therapy systems.  Many of his basic ideas have found their way into other psychological schools:  family systems approaches, Gestalt therapy, learning theory, reality therapy, rational emotive behavior therapy, cognitive therapy, person-centered therapy, existential therapy, and the post-modern approaches to therapy.
Limitations and Criticisms:  A large part of the theory still requires empirical testing and comparative analysis.  Adlerian theory is of limited use for clients seeking immediate solutions to their problems and for clients who have little interest in exploring early childhood experiences and memories. 
Dr. Rebecca Curtis
www.auburn.edu/cspd/fall04/counseling

2 comments:

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