Alfred Adler Institutes of San Francisco and Northwestern Washington

Providing the Missing Developmental Experience in Classical Adlerian Psychotherapy

By Henry T. Stein, Ph.D. & Martha E. Edwards, Ph.D.

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Alfred Adler Institute of Northwestern Washignton, (360) 647-5670, E-mail: HTStein@att.net .


In Classical Adlerian therapy, the missing developmental experience (MDE) is used to make a therapeutic breakthrough and help the client move toward more full functioning. In this article, we first discuss the MDE within the context of Classical Adlerian therapy. Then we describe the process of planning the content and form of the MDE, implementing it in a therapy session, and debriefing afterwards. Finally, we give example of an MDE from an actual therapy session to illustrate the process.

Introduction

There may be times in the course of individual psychotherapy when clients have sufficient insight, but appear to lack the inner resources needed for a breakthrough to a new level of functioning. When we look into the early childhoods of these clients, we often find deficiencies (real and imagined) of parental acceptance, support, love, encouragement, respect, or even positive challenge. For some of these clients, a well-timed, precise, and vivid simulation of a missing developmental experience (MDE) is able to give them the internal fortification that they need to break out of a narrow rut of limited functioning into an expansive, creative way of living.

Two sources have been influential in developing this therapeutic strategy. Robert Postel (Painter & Vernon, 1981) created a treatment modality for working with clients who had been neglected as children. In this model, both a male and female therapist provide psychological re-parenting through a series of role-played experiences. Achkter Ahsen (Ahsen, 1977) utilized eidetic imagery diagnostically and therapeutically to correct negative parental images. Both approaches have much to offer in principle. In practice, however, both follow a predetermined protocol and are, thus, too narrowly focused and too highly structured to be incorporated into the very creative Classical Adlerian psychotherapy.

The MDE techniques described in this article can be used ways that are consistent with Alfred Adler's original principles and style of treatment. These techniques are intended to be implemented in the context of a full psychotherapy, for the purpose of enhancing psychological change and growth. Used out of this context, they could be interesting and even very emotionally moving, but they probably would not promote significant personality change. When the client is properly prepared, the MDE frequently stimulates deep feelings and emotions, usually triggered by a moving role-played or narrated experience, or vivid imagery. This experience may provide a very deep level of encouragement and emotional healing that has the power to ignite significant change.

The MDE in the Context of Classical Adlerian Psychotherapy

For the purpose of orientation, Table 1 provides an abbreviated overview of the twelve stages of Classical Adlerian psychotherapy, locating the missing developmental experience approximately mid-way in the process (Stein, 1991) [For a comprehensive overview of Adlerian Psychology, see "Classical Adlerian Theory and Practice," (Stein & Edwards, 1997).]

A full psychotherapy can be envisioned as a progression through the twelve stages, however, these stages should be considered as teaching guidelines and should not be interpreted as a systematic procedure. Psychotherapy is an art that must be practiced creatively--the best therapeutic strategy is frequently a unique invention for the individual client.


TABLE 1: STAGES OF CLASSICAL ADLERIAN PSYCHOTHERAPY
PHASES STAGE NO. STAGE TASKS TO BE ACCOMPLISHED
Support 1 Empathy & Relationship Providing warmth, empathy, and acceptance.
Generating hope, reassurance, and encouragement.
Establishing a cooperative working relationship.
2 Information Unstructured gathering of relevant information:
Eliciting details of presenting problem & life tasks.
Exploring early childhood influences and memories.
Encouragement 3 Clarification Clarifying vague thinking with Socratic questioning.
Evaluating consequences of ideas and actions.
Correcting mistaken ideas about self and others.
4 Encouragement Helping generate alternatives.
Stimulating movement in a new direction, away from life style.
Clarifying new feelings about effort and results.
Insight 5 Interpretation - Recognition Interpreting inferiority feelings & goal of superiority.
Identifying what has been avoided.
Integrating birth order, recollections, dreams, & daydreams.
6 Knowing Client fully aware of life style without help.
Individual knows and accepts what needs to be changed.
In spite of insight, client may feel emotionally blocked.
Change 7 Missing Developmental Experience When needed, promoting an emotional breakthrough.
Offering corrective or missing developmental experiences.
Creative use of role-playing, guided imagery, and narration.
8 Doing Differently Converting insight into new attitude--breaking old patterns.
Fostering experiments, concrete steps based on abstract ideas.
Making the unproductive feel unpleasant.
9 Reinforcement Encouraging all new movements toward significant change.
Affirming positive results and feelings.
Evaluating progress and new courage.
Challenge 10 Social Interest Using client's better feeling of self to promote more cooperation.
Extending feeling of equality, cooperation and empathy to others.
Giving one's all, 100% in relationships and work--taking risks.
11 Goal Redirection Challenging client to let go of self and old fictional goal.
Dissolving the old style of life--finding a new direction.
Opening a new psychological horizon--living by new values.
12 Support & Launching Inspiring client to love the struggle and prefer the unfamiliar.
Strengthening the feeling of connectedness & desire to share.
Promoting a path of continual growth for self and others.
Meta-Therapy - Post-Therapeutic Dialogue A philosophical and/or spiritual discussion of values, the meaning of ones' life, and the committment to a mission.


The Classical Adlerian approach is generally characterized by a diplomatic, warm, empathic, and Socratic style of treatment. This climate embodies the qualities of respect and equality necessary for building a trusting, cooperative relationship. Throughout all of the stages, a variety of treatment strategies are utilized to stimulate cognitive, affective, and behavioral change. The Socratic method guides clients to: clarify meanings, reasons, and feelings; gain insight into intentions and consequences; consider alternative opportunities; reach rational decisions; and generate effective plans for action. Focusing on the here and now of emotional experience and guided and eidetic imagery techniques facilitate affective awareness, change, and growth. Role-playing and "future scenarios" provide safe and encouraging behavioral preparation and practice. Progressive positive and/or negative circumstances can be devised to build confidence in dealing with difficult or unfamiliar experiences.

Classical Adlerian psychotherapy has the potential for bringing each individual to an optimal level of personal, interpersonal, and occupational functioning. For many clients, however, brief therapy is the limit of their current interest or budget, and therapy therefore stops somewhere between the fourth and sixth stages. Normally this involves modest behavioral and cognitive change. (Treatment may be resumed at a later date to continue the desired therapeutic progress.) A complete psychotherapy targets deeper attitude and personality change. The limits of the style of life are at least reduced, and sometimes eliminated, opening the door for fully functioning, creative living. Some clients, after completing the twelve stages, may wish to discuss philosophical and/or spiritual issues. This stage of meta-therapy represents a transcendence from the deficiency motivation inherent in the style of life to the "meta-motivation" of higher values (Maslow 1971).

If we have made a good therapeutic relationship, encouraged the client to achieve new successes, and provided accurate insight, a MDE might stimulate significant progress by dissolving the residues of early, painful, inferiority feelings, and discouragement. A new, positive substitute experience is created to replace the remembered or imagined negative memories and images. We are inventing an "as if" situation, a precisely shaped make-believe that has the impact to reach the client at a deeper level. Long before the current constructivist wave of thinking, Adler pointed out that we are never dealing with objective reality; what we experience is always a subjective fiction. Our task is to create positive, healing therapeutic fictions that have more power and appeal than the client's familiar negative fictions.

Planning, Implementing and Debriefing the MDE

For maximum impact, the MDE must be carefully planned in collaboration with the client. Afterwards, a careful debriefing is important to help the client digest and use the experience.

Identifying the MDE Needed by the Client

To design a missing experience, the therapist must have a picture of the client's childhood. This includes information about at least three generations in the family of origin (self as child, siblings, parents, and grandparents), as well as the client's early recollections. It may also be useful to obtain the client's eidetic images of important family members. A genogram, which illustrates the dynamics of relationship and personality, is a useful way of organizing this information.

With this information, the therapist can imagine the client as a child in his family, and consider which normal, positive experiences were missing from his development, and the ages when these experiences may have been crucial (windows of opportunity). Clients may clearly articulate what they yearned for as children, or they may only express the symptoms that gives us the clues. Were they accepted and liked by their parents? Was there verbal and physical affection? Did they feel loved? Did they feel safe? Was the climate optimistic or pessimistic? Were they permitted to express their opinions and feelings? Did they see examples of courage, cooperation, and caring? Did they see adults admitting and correcting mistakes? Were they encouraged to overcome obstacles, to do their best, and share with others? Were they expected to act like adults?

Often, we must provide the opposite of what was remembered: if the client recalls rejection, we offer acceptance; approval instead of criticism, warmth instead of coldness, and patience instead of impatience. We must also correct the effects of indulgence with loving limits, and replace the destructive influence of pampering with respectful challenge.

Whatever mistakes the parents made, it is also possible that the child's response was mistaken. The challenge of providing a therapeutic missing experience is to correct both.

How far back in the client's childhood does the missing experience need to go? For a few clients, imagining a positive mother's pregnancy (Verney, 1981) and a "gentle birth" (Leboyer, 1976) has yielded a new feeling of peace and self-acceptance. The therapist must wait for the right opportunity, and then with great precision and vivid narration create a healing image.

The basics of the client's early relationship with his mother or father -- being held, fed, changed, and talked to -- may need to be re-done. A busy, absent, distressed, alcoholic, or sick parent could have omitted or distorted these fundamental opportunities for benevolent contact. Many important childhood experiences may have been missed or minimized. Did the parent spend much time with the child, play with him, talk to him, encourage and praise him, teach him, guide and correct him, express love and affection, or provide a good model for him?

Later on in the client's childhood, issues of sexual identity, preparation for bodily changes, sexual education, acceptance as young adult, and new found freedom and independence may not have been well resolved with parents. What should have happened in the teen years between parent and young adult can be created in the form the client can best accept.

The corrective experience must provide the client with the significant figure who possesses the necessary qualities to promote psychological healing. Frequently the mother figure must be used, but some clients need the father more than the mother. It does not always need to be a parent. A sibling may be selected for a desired brotherly or sisterly influence. Sibling rivalry may be dissolved into mutual appreciation and support. An intellectually discouraged person may benefit from a benevolent teacher. A wise grandparent, kindly uncle or aunt may be the influential figure for the client.

There are many childhood opportunities for learning and growth, but the most helpful situations for the therapist and client to work on are those which were discouraging to the client. At some point the growing process stopped and the child felt, "I cannot handle this". We must find a way to help him over this hurdle and to regain the feeling, "Perhaps I can handle this." Our task is to provide the right encouraging experience that allows the client to draw a new conclusion about himself and others.

Selecting the Context for an MDE

After the content of the MDE is determined, the length of the session and type of session (individual or group) must be decided on. A single individual session may not be long enough to warm up, engage in a strategy, and then de-brief the experience. Double sessions permit greater flexibility and opportunity. An ideal environment is a nine-hour marathon group of eight to ten people, who are available for role-playing . In a group setting, other group members can be invited or volunteer to play roles. This gives the client who is working a chance to choose people who have some quality he finds helpful. The therapist can also provide direction and coaching, to tailor, refine, or correct a dramatized sequence. There is also an opportunity to create a mother and father or family scene. Sometimes the missing experience is having the child feeling his parents being close and caring.

The initial MDE may be staged at a very early age. During the de-briefing, while the client is digesting the experience, he can be asked, "How old do you feel right now? Is there any other experience you would like right now?" The client may say he feels a few years older and that he would like another, different experience to be staged. It may be possible, if there is enough time during an extended session or during a marathon group, to work the client up thorough a series of experiences to his current age. It is rare to do this in one day, but the therapist should be prepared to accommodate this intensive progress. Usually, it is sufficient to bring the client a little further each session.

Implementing the MDE in One of Five Forms

Once we have determined the psychological deficiency within the client, we must discover the best means of delivering this therapeutic "vitamin." Whatever we try, we must constantly monitor the effects of the intervention, so that we are acutely sensitive to the client's reactions, and the subtle signals for more, less, or stopping completely.

The client and therapist collaborate in setting up the MDE, inventing the situation, characters, ages, and the beginning of the scene. The experience to be gained is also defined. Occasionally the therapist may suggest a scene if the client is genuinely stuck. Whatever is suggested must be accepted by the client before an MDE is started. He may be anxious, but must be willing to proceed.

There are five forms of the MDE: role play, guided memory, guided imagery, narration, and role reversal. The form of providing the MDE can be selected for varying degrees of intimacy, involvement, and emotional proximity. Role-playing is the most direct and intense form. Guided memory and imagery permit working in the privacy of the imagination. Narration offers more distance for the client. Role reversal can be done in any of the other four forms.

Role-Playing

Given that role playing is the most direct form of providing a missing experience, it is not recommended that the therapist play the role of another person in the client's life. The potential for blurring the boundary between the therapist and these others, and the attendant confusion of feelings, images, and ideas, is too great. Consequently, role playing should be done when someone else can play the necessary roles. This someone else could be a second therapist or another client in a group session.

Once the role-play begins, it is generally best not to interrupt it. However, if it is going in the wrong direction, it is better to stop, even briefly, to talk about it and resume in a better direction. The therapist must develop a sense of when to stop. Sometimes, the client begins to get frightened, tearful, or angry, and it is a good idea to check and see if he wants to continue. Under no circumstance should the client be forced into a dramatic emotional catharsis. Some marathon leaders try to push the client to anger or tears. This is a cruel and aggressive indulgence. The client has to proceed at his own pace and tolerable level of emotional intensity.

If the scene is going well, there will come a point when the client feels saturated with an experience. The therapist must be sensitive to subtle cues and verify his guess by saying, "Is this enough for now?", or "Is this as far a you want to go right now?" Adults who are trying something new need sensitive monitoring of their capacity for emotional absorption.

Guided Memory

A client may not feel comfortable with the directness and involvement of a role-play. Guided memory offers a different, but no less powerful experience.

Early recollections are very fertile material for guided memory. The client may describe a specific memory of discouragement or other childhood difficulties. The therapist can elicit details and feelings to clarify the scene. The client can then be invited to create a parallel memory with changes. This alternate can be whatever the client wishes. Other people can behave differently, he can function differently, other people can be included, or the entire memory can be changed to its opposite. Abusive, cold, rejecting, or neglecting parents can become gentle, warm, and loving. Parents who didn't touch can embrace a child; parents who didn't say much that was positive can express caring and encouragement.

Frequently the client does not know how to correct a memory in the right direction. Having experienced early neglect, he may want to go from neglect to pampering. The therapist can ask permission to guide the client through a revised or new memory. The client can be invited to relax, close his eyes, and then imagine the scene described by the therapist. This is a very powerful technique for replacing the early childhood negative imprints with positive encouraging experiences. The corrective experiences described by the therapist must be done slowly, and the client's reactions must be monitored carefully. The clues revealing the impact of the guided memory are facial expression, body posture, gestures, and breathing. Gentle smiling, tears, and deeper breathing often signal the beneficial effect of the guided memory.

Guided and Eidetic Imagery

Mental images of significant early childhood figures can be powerful symbols of meaning and feeling. They should be distinguished from early memories which the client believes are events that actually took place. The image is like an artist's interpretive portrait rather than a photograph.

The client can be asked to form a mental image of one of his parents. Generally, asking him to close his eyes helps eliminate distraction. We can then ask him to describe what he sees. After his responses, details can gradually be elicited. We can ask, "Where is she? What is she doing? What is her posture? What is her facial expression? What do you see in her eyes? What is she saying? What feeling do you get from this image?" The image of the other parent can than be explored. Next, an image of the parents together can be examined. What are they doing? How close are they? What are their postures, and which way are they facing? Are they talking to each other? What is the feeling between them? How does the client feel about this image? Other significant figures can be included in this process. Sometimes a grandparent, sibling, maid, baby-sitter, or teacher is a strong, early influence.

The client can then be given an opportunity to change any of these images to what he would like them to be. In the spirit of make-believe, he can be encouraged to imagine changes. A parent can become warmer, gentler, affectionate, understanding, and encouraging. If the client blocks making positive changes in the images, the therapist can ask the client if he is willing to listen to suggested changes. If so, a slow descriptive, image transformation from negative to positive qualities gives the client a chance to gradually adjust to this new experience.

After the experience, we elicit impressions and feelings about the new image that contrast with the old image. It is important to evaluate if the client accepts the new image. He may not be ready for it and the unfamiliarity may bring out a feeling of insecurity. The old image may be unpleasant, but it may feel safer. He may need to build his courage a little further in order to permit himself a new positive response. A client who felt rejected, betrayed, or abandoned as a child will find it hard to allow his positive feelings to emerge again.

Narration

The greatest initial psychological distance from an experience can be achieved with narration. However, vivid story-telling can draw a client deeply into an experience. The client can remain at what feels like a safe distance or become more involved, accepting what he wants. The therapist can tell the client about a parent who would treat a child in a particular way under various circum- stances. This alternative to an early memory can be presented in a generalized fashion so that the client is not in the role of the child and it is not his parenting being described. In this scenario, the client may take as much as he wants from the story. The distance can be reduced with a narration starting with, "If I were the parent, and you were the child, this is what I would have done." This level of story-telling can have great emotional impact on a client, so it must be used with discretion.

Many illustrations of positive child guidance can be used. Various circumstances can be described with appropriate actions and words from an enlightened parent. The client can discover the best way to deal with a child's misbehavior and mistakes. He can also see how one handles a child's expression of hurt, jealousy, and anger.

Having the client read selected books can be a useful adjunct to this process. Children: The Challenge (Dreikurs & Soltz, 1987) is one of the best book on the principles of healthy child guidance. When reading the book, a client can imagine himself being parented in a democratic, respectful way. Your Inner Child of the Past (Missildine, 1963) offers vivid descriptions of dysfunctional child-parent relationships. Someone who was neglected, rejected, or punished severely in childhood will find a sympathetic general understanding in this book.

Role-Reversal

Another way to create the appropriate experience is to let the client give it to someone instead of being given it. The therapist can suggest a situation where the client is the parent who is providing the needed experience to a imagined child. We can coach the client when necessary and then ask what he thinks the child would have felt and gained from the experience. If the client hesitates or goes blank, the therapist can fill in the child's probable responses, and then verify that the client believes that such a result would emerge. Eventually the therapist can ask the client to put himself in the shoes of the imaginary child he has helped. There are some clients who can re-parent themselves in this way.

Debriefing After an MDE

Intense emotional experiences require a gradual digestion. After stopping a scene and suggesting that the person slowly return to the normal discussion, the therapist needs to check first on the person's present emotional state by asking, "How do you feel right now?" Then the de-briefing can continue with questions about feelings during the experience. Following an emotional survey of the experience, the next phase would be asking about conclusions the client could make about it. Was it enough for now? Is there anything else he wants to do at the moment? To capitalize on the positive impact of the experience, the client should be asked how he plans to use what happened. Can he hold on to the experience, and remember it when he needs the emotional reinforcement?

A successful intervention helps the client make an emotional breakthrough. An experience is created that gets through his protective shell and moves him deeply. He may have digested the experience at the right age during a regressed role-play or guided imagery. When he returns to his real age, he is then capable of identifying what happened to him emotionally. He can find words to express what he felt and why he felt that way.

The key to a lasting effect of an MDE is the client's willingness to accept a substitute experience. Can he permit a make-believe role-play or fantasy to satisfy his emotional hunger? Can he dissolve his ancient, felt deficiencies and permit himself to grow up and become the person that he is? The decision to accept and use what is available, and to give up impossible dreams, signals the dissolving of a spoiled, demanding style of life.

What does the client think about his new experience? What does it mean to him? When new feelings are experienced, new ideas are stimulated. Does he like what has happened to him? Does he want to build on this feeling?

The client may be brought through a series of progressive ages and experiences. Eventually, the challenge emerges of becoming an adult who gives and elicits appropriate adult emotional experiences. Does the client want to become a fully loving and giving adult? Can he learn to give others what they really need to grow as human beings? Can he give to others because it is the right thing to do, not to get something from them?

How will he use what has happened to him? Will he hold on to the new experience, remember it, even practice replacing old negative memories and images with the new positive ones? Will he use the pretend experiences to inspire him to create encouraging and fulfilling reality experiences?

Therapist's Role

The MDE techniques should only be attempted if the therapist is reasonably comfortable with role-playing and imagery. Playing or narrating parental roles requires a clear capacity to understand and serve the client's real emotional need at any psychological age. We can step into the role, and put deep feeling into our portrayal; then we must step out of the role and help the client evaluate the experience.

Demonstration of the MDE

The following transcription is a demonstration of the MDE technique in an actual session. The "T" signifies the therapist and "C" the client.

[This session was conducted by the first author as part of a presentation titled "Providing the Missing Experience" at a conference of the North American Society for Individual Psychology. The volunteer had previously been in therapy with the first author. The text has been edited minimally to promote readability.]

T: I appreciate your help and willingness to work with me. Since we haven't discussed any of this for some time, is there a difficulty that you are experiencing now or have experienced recently that you would like to talk about?

C: Yes there is. There is something that I've been struggling with, and I need some help with it, and I think it goes back to my mother. I'm kind of stuck on it.

I have a friend, Thelma. She is a friend of 11 years and we supposedly had a real good friendship. I met her as a principal when I was a teacher. I was awed by the authority figures. And it was like she controlled me for 11 years and took care of me in a lot of ways. And I let her do that. And now I'm at a point in my development where if she calls me, I'm torn and I just tremble. I cannot talk to the woman. I'm getting trembly now. And it's like she'll say, "Hi, I'm calling to check in on you." That's what she says. And I just tremble now after 11 years. And we've done things together, and at times it's been equal but at times I can get into the car with the woman and I feel little. Ok, and I'm aware of that.

Now I tried to sit down and talk to her about it because there are a couple issues in the present day that I want to talk to her about. I say this is a mature way to go about it. She looked at me and she said, "I don't want to talk about it." I just couldn't...I got real rebellious and all that.

I want to say, "I don't want to see you anymore." I want to get out, I am getting confused, and I'm feeling really little, and that I am a child with her in this friendship. I don't want to be friends anymore with her on an adult level, but there is something I'm still holding on to that plugs me into her and I see that it is an abusive relationship at times. You know she abuses me the way she talks to me and I permit that. I need the courage to just say, "I don't want to be your friend anymore." But after 11 years it's kind of scary to let her go.

So I need some help. What's going on? Am I angry ? You know she can call me at work. I'm a manager at a business and here I am, I'm trembling. I need some help in the direction to go now, I'm confused about where to go.

T: What do you do about your trembling? How do you get over it?

C: How do I get over my trembling?

T: Yes.

C: Well, I give curt answers, and I get off the phone, and then I either go out of the room and I get some water or I do something like that. I just have to leave, to calm down. I have to calm down.

T: But you eventually calm down.

C: Yes.

T: How do you calm yourself down?

C: Well, I think I get angry through it and then I say to myself, "This is ridiculous. I'm a grown woman." I know I won't call her, and so I just say the next time she calls, I'm going to do it differently. But I know I'm not going to call her.

T: Louise, when this happens, you said you feel like a child.

C: Yes.

T: About how old do you feel when it happens?

C: I feel like 4 or 5. I feel real little....real little and I can feel it now.

T: You can feel it right now. Ok, you feel it. Can you stay with the feeling for a while? As long as you can?

C: Yes.

T: O.K. Just as you get to feeling real little, between 4 and 5, how do you feel about that?

C: Not very good.

T: Can you tell me about it?

C: I feel agitation in my stomach. I don't like being this way. I don't. I feel fear. l feel neglected.

T: You feel neglected. Which is stronger being scared or ..

C: Neglected.

T: Do you have an idea of who's neglecting you?

C: My mother? My parents? My father?

T: Who is more important at the moment? Your mother or your father?

C: My mother.

T: What is she doing that you don't like so much? Is she just ignoring you?

C: No. She never helped me.

T: She never helped you. Even as an infant she never helped?

C: Well, I can remember one time she helped me. That's all I can remember, but the neglect is really strong.

T: What do you think a good mother should do to a child who is feeling neglected?

C: Well, she should love the child and care for the child. I think just being gentle. My mother was so abusive that she even spoke harshly. She gave orders rather than encouragement. And I had to obey, or I'd get hit.

T: You had to obey or you'd get hit. That's out of fear.

C: Honor thy father and thy mother.

T: Obey!

C: Obey.

T: How would you have liked your mother to treat you?

C: I would like her to be my pal and to hold me, to understand me, to let me just be a little kid, play with me and touch me.

T: We can't do all of that right now, but let's make one day. O.K.? You're four years old and it's...What day of the week is it?

C: I hated Sunday. So let's do Sunday.

T: Let's do Sunday.

C: I hated Sunday.

T: OK. What time on Sunday?

C: Well, you could start right out in the morning. We'd get up and we'd have to get ready for mass. And I had to get myself ready.

T: What we're going to do, Louise, is we're going to make it different.

C: All right.

T: It's going to be a Sunday in the morning, but it's going to be the way you think it should be. OK? So what we need to do is start from the beginning. You're asleep. O.K.? Now, how are you going to get up? By yourself, or is somebody going to wake you?

C: I would want my mother to come in and wake me up.

T: You would want her to come in and wake you up. O.K. How do you want to do this? Do you want to tell me the story? Can you visualize this and tell this to me?

C: Um hum.

T: The way you want it.

C: Um huh. I think... What is the other option?

S: Well, let us try this one first. O.K.? Why don't you tell me as if you were telling this story about how it happens O.K.? You are asleep. Please describe it to me.

C: O.K. Well, I slept with my sisters, so we're sleeping together in the bed and I'm on my side. We each had to have our side. I can remember waking up curled up, so I'd wake up curled up. I would want my mother to come in and just, you know, gently wake me up and say, "Louise it's time to get up."

T: Excuse me, can I make a suggestion to you.

C: Yes.

T: Put it in the present as if it is happening. O.K.? Sorry to interrupt you.

C: All right.

T: So put it in the present.

C: O.K. "Louise, Louise, honey, it's time to get up. You need to get ready to go to church now." "OK mom, I'll get up, I'll get up don't worry." All right. And then she would leave.

T: Now what happens.

C: I lie there a little bit and then I kind of get up and pull the covers back and get out of bed and I start getting dressed.

T: How do you feel right now?

C: I feel good.

T: You feel good.

C: Yes, I feel good in the morning.

T: Was it nice to be waked up by mom?

C: Yes.

T: You liked that. O.K. All right, now what happens?

C: Well, the night before she would have given me a bath. She gave me a bath. I felt real good.

T: Yes.

C: And she curled my hair and she had my clothes out. So then I'd go about getting ready and I knew what I was going to wear. And I just put my clothes on and get dressed. And try to look my best. And then mom would come in and say, "How's it going? Are you about getting ready? You have about five more minutes and then we have to leave." I want to be with her.

T: You want to be with her. How does she look when she comes in?

C: Oh, she looks great. She looks great. She looks happy to see me.

T: Happy to see you.

C: Like she wants to be with me. So then I get excited and I have a doll. I love my doll. I get to bring my doll to church. I get my doll and I put her in my arm and I go out of my room and I have to go down stairs to the car and go to church.

(After a few moments)

T: How did that feel? Did mom do what you really like?

C: Yea.

T: Now, can I add something to this?

C: Uh huh.

T: Mom is going to come in and sit down on the bed with you. O.K.?

C: Uh huh.

T: It's going to be just a quiet moment between you and her. And she is going to tell you some things. O.K.?

C: O.K. ...(tears)

T: She's going to tell you some things that you would really like for her to say.

C: O.K.

T: Can you help me with this? What would she say?

C: No, I can't help you with it.

T: You can't help me? Will you try just a little? Maybe one thing? O.K.? I'll add to it.

C: O.K.

T: One nice thing she would say.

C: "You look pretty."

T: Does she mean it?

C: Uh hum.

T: Does it feel good?

C: Uh huh.

T: What else would you like her to say?

C: I'd like her to touch my hair and say, "I really love you." (tears)

T: So you'd like her to look at you and tell you how much she really loves you.

C: Uh huh.

T: What if your mom was sitting in front of you and she touched your hair and she said deep from inside that she loved you very much.

C: Uh huh. That would be great.

T: That would be great. Let's make believe it's happening. O.K.?

C: O.K.

T: Let's see, mom is sitting in front of you and she looks into your eyes and she says, "You're a wonderful girl. I love you so much."

C: I'd want to hug her.

T: You'd want to hug her?

C: Uh huh.

T: Well then, why don't you.

C: "Thanks mom, I love you too."

T: I know that there are some other things you probably would like her to do.

C: Yes.

T: You'd probably like her to hold you for a while.

C: Yes.

T: You can have her do that right now.

C: Yes.

(She imagines her mother holding her quietly for a few minutes.)

T: How are you feeling right now?

C: I'm feeling really loved, and I feel warm inside. I'm feeling loved.

T: What does this mean to you? Can you make any kind of conclusion about it?

C: You mean at age four?

T: How old are you right now?

C: Well, now I feel like I'm older.

T: You're older right now. How old are you?

C: Well, I think I'm here.

T: You're here? That's fast.

C: Yes, I'm back.

T: O.K. So you want to make a conclusion now?

C: How I would have felt about it?

T: How do you feel right now? What conclusion do you make about what just happened?

C: I think it's wonderful. I feel real good about what just happened. Obviously, something that was within me, something that was really there on the surface I needed to get past.

T: How are you going to use this?

C: How am I going to use this?

T: How are you going to use this?

C: With Thelma?

T: Let's come back to Thelma. Does this have any connection with her?

C: Yes. It's amazing--all the friendships I have after hearing what I've said. I hate to say this, but I obsess on the relationship with Thelma. She's a friend with whom I pulled up all the stuff from the past. So the feeling of being loved is the way out of this.

T: I'm going to make some suggestions to you. Because we have to sort of compress this a little bit.

C: Right.

T: The feeling of being loved can begin anywhere. You felt this now as a role-play.

C: Uh hum.

T: It's a beginning. But you have to continue. You have to make it continue. Love really goes on. So if you, in your own thinking and your own imagination can repeat this and develop it, so that you have an idea of that loving experience, in a sense, Louise, you heal yourself. You can do this, if you know what to do and if you accept it.

C: So that in the friendship, just recall this?

T: No, that's too late.

C: Too late?

T: Yes. You've got to be prepared.

C: I've got to do homework.

T: You've got to do some homework so that you have the feeling inside of you that you don't need anything from Thelma.

C: Oh. Well, that's right. Then what happens to our friendship?

T: Well, I think what's going to happen is that you'll begin to re-think the meaning of friendship after you get this solid base here. You have the beginning of that feeling of real love. You'll have the feeling of acceptance. Then the experience of friendship will begin to come to you in a different way. (Friendship is something that you give to someone, not something you get from them.)

One more thing I'm going to suggest to you. And that is that you make another experience by yourself. An experience where the mother treats you like an equal and doesn't give any orders. One where she talks with you and you discuss things together. And you're your not afraid of her. O.K.?

C: I can do that.

T: Do you think you can do that?

C: I think so.

T: Because the overcoming of your fear is basis of the beginning of love.

C: Say that again.

T: The overcoming of fear is that if you feel that Thelma loves you, then you will listen to what she has to say. If she encourages you and she treats you as an equal, there won't be any fear.

C: O.K.

T: I'm feeling that we've done a lot fast.

C: Yes. That's O.K.

T: Is it too much?

C: No.

T: It's all right?

C: I'm O.K.

T: When Thelma calls, what will you do?

C: I'll talk to her...I don't know.

T: You can't really tell in advance can you?

C: No.

T: So in a way you're going to have to trust that you'll do some preparation that allows you to feel better within yourself, so that you take care of the little child. Then the little child won't come out with Thelma. You will be the adult who you are, and you're very effective.

C: And I know that because I've done it other ways and other times and it worked. I mean I know that will happen. I mean I trust that because it has happened before.

T: Enough?

C: Enough.

T: Thank you.

Conclusion

Because we had established a solid, prior foundation of connection, trust, and insight, the client was willing to open up emotionally and collaborate in the creative healing process. Over the next few weeks, during individual follow-up sessions, we affirmed and extended the growth process that had been ignited in the demonstration.

Although the process of deep psychological change in therapy is usually very gradual over a long period of time, it is possible for clients literally to "grow up" in a few hours -- they feel, look, and act differently. It is as if an inner child who has been burdened with a painful feeling of insufficiency gradually feels liberated to discover the adult that she or he can become.

However, a word of caution: the MDE is not a shortcut around the substantial amount of gradual cognitive, affective, and behavioral therapeutic work that usually must usually be done to facilitate deeper psychological change in clients. Without the clarity of thinking and insight that can be stimulated with the Socratic method, it is unlikely that a MDE would be fully digested and used as an incentive for more responsible, courageous action. It is important to remember that there are several therapeutic stages (Stein 1991) before and after the MDE that are required to significantly alter or dissolve a mistaken style of life.



References

Ahsen, A. (1977). Psycheye: Self-analytic consciousness. New York, Brandon House.

Dreikurs, R., & Stoltz, V. (1987). Children: the challenge. New York, E.P. Dutton.

Leboyer, F. (1976). Birth without violence. New York, Alfred A. Knopf.

Maslow, A. H. (1971). The Farther reaches of human nature. New York, Viking Press.

Missildine, H. W. (1963). Your inner child of the past. New York, Simon and Schuster.

Painter, G., & Vernon, S. (1981). Primary relationship therapy. Handbook of innovative psychotherapies. R. J. E. Corsini. New York, John Wiley & Sons: 665-677.

Stein, H. T. (1991). Classical Adlerian psychotherapy: A Socratic approach. (an audio cassette tape study/consultation program). San Francisco, Alfred Adler Institute of San Francisco.

Stein, H.T., & Edwards, M.E. (in press). Classical Adlerian theory and practice. Psychoanalytic versions of the human condition and clinical practice. Paul Marcus and Alan Rosenberg. New York, Addison Wesley.

Verney, T. K., J. (1981). The secret life of the unborn child. New York, Summit Books.




Suggestions For Additional Study

"Classical Adlerian Theory and Practice," by Henry Stein and Martha Edwards (comprehensive overview)
A Demonstration of Classical Adlerian Psychotherapy Technique, Using Socratic Questioning
"Classical Adlerian Psychotherapy: A Socratic Approach," an Audio Cassette Study/Consultation Program by Henry Stein



Distance Training Courses Featuring MDE Techniques

DT302A - Individual Adult Psychotherapy: Part I
DT302B - Individual Adult Psychotherapy: Part II
DT305 - Brief, Group, and Marathon Therapy



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