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4.4: Alderian Psychotherapy

  • Page ID
    12197
  • Adler’s approach to psychotherapy has been the topic of numerous books and chapters (e.g., Dinkmeyer, Dinkmeyer, Jr., & Sperry, 1979; Mosak, 1995; Nikelly, 1971a; Watts & Carlson, 1999), including specific books on family therapy and lifestyle counseling for people with disabilities (Rule, 1984; Sherman & Dinkmeyer, 1987). It is generally accepted that Adlerian psychotherapists have no specific technique, but rather are eclectic in their approach. There are, however, a few key elements to Individual Psychology. First is the goal of understanding the style of life. Once the therapist understands the style of life, they can understand most everything the patient does. The therapist then helps the patient to strengthen their social interest. This involves a practical application of social interest: reorienting and readjusting the patient’s style of life. Underlying the success of therapy in Individual Psychology is a supportive therapeutic relationship. Adler believed in facing his clients, on an equal basis. The therapist helps to educate the patient on the nature of therapy and the goals that might be pursued, which involves helping the client to recognize the mistaken style of life and goals they have been pursuing in the past. In this way, the therapist helps the client in their own creative process of personality change (Dinkmeyer, Dinkmeyer, Jr., & Sperry, 1979; Mosak, 1995). This approach shares many similarities with both the client-centered approach popularized by Carl Rogers and the behavioral-cognitive approaches developed by Albert Ellis and Aaron Beck.

    Understanding the Style of Life

    Psychotherapy is about helping people to change their lives for the better. Thus, it involves looking forward, despite whether or not we need to know what has happened in the past (and different theories consider the importance of the past in radically different ways). According to Adler, “in order to understand a person’s future we must understand his style of life” (pg. 99; Adler, 1929a). The style of life, and the associated scheme of apperception, brings all experience into line with the person’s fictional final goal. So, if we can understand how a person is living their life, if we understand their style of life, we can help them to understand it as well, and then perhaps make changes for the better. So, how might we go about understanding the style of life?

    As Freud and Breuer had before him, one area of interest for Adler was the analysis of dreams. However, Adler did not distinguish between the conscious and unconscious, or between waking and sleep. He considered dreams to be a reflection of the style of life, and the individual’s striving for superiority. Thus, dreams do not hold any special meaning (Adler, 1912b/1963, 1928, 1929a, 1932b/1964). As such, their interpretation can be relatively straight-forward:

    Take, for instance, our knowledge that mankind as a whole is really cowardly. From this general fact we can presuppose that the largest number of dreams will be dreams of fear, danger, or anxiety. And so if we know a person and see that his goal is to escape the solution of life’s problems, we can guess that he often dreams that he falls down. Such a dream is like a warning to him: “Do not go on - you will be defeated.” (pg. 155; Adler, 1929a)

    Of greater interest to Adler was the analysis of early memories. He believed that the earliest childhood recollections provided valuable information, and he did not let a single patient go without having been asked about them:

    The information regarding memory is significant. Memory is an activity. It is based on the life style, which here steps in by selecting from old impressions a single one. This leads us to the question, why this single one? In it the entire life style resonates. (pg. 197; Adler, 1932b/1964)

    It is not even important if the memory is, in fact, true. A “memory” may be created by a child based on their conscious experience in order to reflect an attitude, or an emotional tone, if that is necessary to pursue their unique, personal goal (Adler, 1928). Accordingly, if we can obtain a person’s earliest memories, we make reasonable predictions regarding the future course of their life. However, early memories are not reasons for behavior, but they are hints. It is also true that some forgotten memories (or unconscious memories) may have played a role in the creation of the style of life, but they are obviously more difficult to obtain, so they defy analysis. But, Adler did not consider them to be any different in content and tone from the conscious memories; the unconscious psyche enacts the same style of life toward the same final goal (as with dreams; Adler, 1929a, 1931a, 1964). There may, however, be some interesting differences in early memories based on culture. For example, Wang (2006b) examined the earliest memories of European American and Taiwanese college students in response to five cue words: self, mother, family, friend, and surroundings. In both groups, memories for ‘mother’ came from an earlier time than memories for ‘self,’ and memories for ‘mother,’ ‘family,’ and ‘friend’ were more socially oriented. The European Americans typically had memories from earlier ages, and their memories tended to report more specific events and to focus on their personal roles and autonomy in those memories. Thus, early memories not only reflect one’s style of life, but do so within a cultural context.

    In two major case studies published by Adler, The Case of Miss R. (1929b) and The Case of Mrs. A (1931b), the subtitle of each book refers to the style of life. In the latter book, he concludes by saying: “I have simply wanted to show you the COHERENCE OF A LIFE-STYLE” (pg. 46; Adler, 1931b). Moving well beyond neurosis, both Adler and his son Kurt applied the study of the style of life to patients suffering from psychotic disorders, including schizophrenia and manic phase of bipolar disorder (Adler, 1929/1964; Kurt Adler, 1959). Kurt Adler does an excellent job of summarizing Individual Psychology, and he quotes his father’s description of neurosis and psychosis as attempts by a person to avoid clashing with reality and exposing their weakness and inferiority. However, these are “failed” styles of life, because they lead to an avoidance of social interest, which is necessary for solving life’s challenges in cooperation with others. In the case of a disorder such as schizophrenia, the child begins life with extreme feelings of inferiority, which lead to an exaggerated fictional goal. Subsequently, it is more difficult to achieve any success in life, which creates a vicious cycle of failure and greater distrust of others. Finally, as the individual fails to develop social-emotional capacities, common sense, or logic, they retreat into the private world that accommodates their exaggerated fictional personal goal. The subsequent treatment of psychotic patients is difficult, particularly if the therapist expects too much. Kurt Adler extends his father’s caution that the therapist must be aware of their own style of life, set aside any personal expectations, and never expect anything of the patient (Kurt Adler, 1959). As we will see below, Harry Stack Sullivan also paid special attention to psychodynamic processes in schizophrenia.

    Discussion Question: What are your earliest memories, especially of your mother, father, and sense of self? Can you see a clear relationship between the content of those memories and your style of life? How does your life plan fit with those memories?

    Strengthening Social Interest and Reorienting the Style of Life

    Adler believed that everyone has some degree of social interest, but in neurotic and psychotic patients there is relatively less. He described Freudian transference as an expression of the patient’s social interest, directed toward the therapist. Resistance is simply the patient lacking the courage (i.e., feeling too inferior) to return to social usefulness and cooperation with others. The therapist must, therefore, help the patient to strengthen their social interest and reorient their style of life. Since the style of life is creatively formed, it becomes important to understand how and when the failed style of life began. Just as the individual took time and was selective in the formation of their failed style of life, the therapist must take time to understand it and educate the patient about it (Adler, 1913b/1963, 1929/1964, 1930c, 1932b/1964, 1958).

    Individual Psychology stresses enormously that the psychological development of a person can reach a normal condition only when he can achieve the necessary degree of ability to cooperate. (pg. 199; Adler, 1932b/1964)

    It is almost impossible to exaggerate the value of an increase in social feeling…The feeling of worth and value is heightened, giving courage and an optimistic view…The individual feels at home in life and feels his existence to be worthwhile just so far as he is useful to others… (pg. 79; Adler, 1929/1964)

    There are numerous ways in which a therapist can help a client to increase their social interest. It begins with the therapist openly communicating with and accepting the patient, which is, of course, a social interaction. This is especially effective if the therapist displays social feeling themselves, while also helping the patient to recognize the patient’s value as a human being (as well as the value of other people). The therapist can point out that if other people, including the therapist, had the same values, goals, and cognitive orientation as the patient then others would also have the same problems as the patient. The therapist can then nudge the patient toward their own niche, where they can feel comfortable with others without fearing being the loser in personal interactions. And finally, the therapist can encourage the patient to get involved in concerns outside themselves (Nikelly, 1971b). Each of these ways of encouraging social interest can be a part of the reorientation and readjustment process, the “working-through” phase of therapy, in which the patient gains insight into their style of life, confronts their goals, and realizes that they are capable of making choices and decisions (Nikelly & Bostrom, 1971). The patient must be encouraged to understand and believe that they have the power to implement their insights and change their life.

    The client must not be allowed to think of himself as the victim of past circumstances but must come to recognize that the problem is his alone and that he alone will solve it. In contrast, emphasis on past history may lead to rationalization and intellectualization without appropriate action. The client learns more and more about his problem and does less and less about it. (pg. 103; Nikelly & Bostrom, 1971)

    Group Psychotherapy and Family Therapy

    Our discussion of Adlerian psychotherapy would not be complete without mentioning group psychotherapy, and in the same breath, family therapy. Group psychotherapy probably has multiple origins, having been tried by a variety of independent therapists. In 1921, Adler began interviewing and counseling parents in front of a group of professionals. This fit well within his perspective on the three life tasks and social interest, since he felt that parents, family, and other important people, such as school teachers, needed to be involved in the development of children. Adler soon discovered that these settings led to personal growth in everyone present, establishing a form of group therapy that may be the oldest still in use. Strictly speaking, Individual Psychology does not prescribe any specific techniques for group psychotherapy, but rather, there is Individual Psychology for patients in a private setting as well as for patients receiving therapy in a group setting (Corsini, 1971).

    Involving the parents in a child’s therapy is, quite obviously, the beginning of family therapy. However, when Adler established his child guidance centers, they were open for parents, teachers, social workers, and other interested people to be able to observe the process of psychotherapy. Adler felt it was important for everyone involved in the development of children to be educated in the important process of Individual Psychology, and the same was true of Rudolf Dreikurs, a student of Adler who opened family education centers in the United States (the first in Chicago in 1937; see Dreikurs, 1950; Sherman & Dinkmeyer, 1987). This education may be particularly important for the parents, whose attitude can have a profound influence on whether psychotherapy for a child is successful or not. As for teachers, understanding Individual Psychology can help them to put a child’s academic performance into a context that helps to explain it as a style of life aimed toward a particular goal, even if that goal is dysfunctional and interferes with schoolwork (Friedmann, 1930; Spiel & Birnbaum, 1930). Overall, the goal of family therapy is to improve communication and cooperation amongst all members of the family, and to help parents avoid the most difficult problems (Alexandra Adler, 1930a; Adler, 1930d).

    In our conversations with the parents we relentlessly try to make them realize that children must not be beaten. Beating can only lead to a discouragement of the child, and we know well enough that this can make the child worse and not better…We always dissuade parents from engaging in warfare with the child, since the child inevitably remains in the end the stronger party. (pp. 110-111; Alexandra Adler, 1930a)

    Discussion Question: Have you ever experienced group psychotherapy, family therapy, or anything similar (or know anyone who has)? What advantages did you experience, or what do you think you might experience if you were to work on your relationships with family members or other people?