1. Adlerian Contribution to Contemporary Practice
Question from Gil Levin (BOL):
Alfred Adler's name is better known to today's therapists than are his ideas and methods. Your dedication to this body of work must be based on the belief that contemporary practice is diminished because Adler's contributions are not fully enough understood or used currently. What are the key elements of the Adlerian contribution to contemporary practice?
Dr. Stein: Adler has much to offer not only to the practice of psychology but also to society in general. Our democratic way of life has eroded badly into widespread self-interest and indifference. Improvement must come not only from the top down, but mainly from the bottom up. We need individual citizens who are capable of carrying out democracy in their daily lives. Adler's theory can be used to guide this work--to foster the development of a democratic character structure in the individual, and to prevent many of our social problems. Adlerian psychology was developed to realize the values of social equality, cooperation, and responsibility for the welfare of others. It can help re-vitalize our democracy.
Adler's primary index for mental health is the person's feeling of community and connectedness with all of life. This sense of embeddedness provides the real key to the individual's genuine feeling of security and happiness. When adequately developed, it leads to an attitude of cooperative interdependency and a desire to contribute. These qualities are essential for building a healthy democracy. Adlerian child guidance and psychotherapy strengthen this feeling of community.
An Adlerian diagnosis is based on the assumptions of the unity and self-consistency of the personality, and an orientation toward an unconscious fictional goal. It re-directs understanding away from "past cause" to purpose, or "future cause." We gradually help the client understand, evaluate, and modify this goal, as well as the consistent pattern of dealing with life that supports it. Our belief in the creative power of the individual, to freely make choices and correct them, offers an encouraging perspective on responsibility and change.
Classical Adlerian psychotherapy is characterized by a diplomatic, cooperative working relationship that establishes the feeling of equality. Through Socratic questioning, the client is respectfully guided through cognitive change: clarifying thinking and feeling, making conclusions, and coming to decisions. Guided or eidetic imagery may be used to promote affective change. Role-playing and marathon group techniques can support behavioral change. A twelve-stage therapeutic structure provides a guideline for planning strategies and evaluating progress. This foundation also acts as a springboard for creative improvising and inventing. Each therapy is different, adapting to the uniqueness of the individual.
Adler's vigorous optimism, his vision of optimal human functioning, and his humanistic philosophy of life can provide constant inspiration for a behavioral scientist.
2. Diagnosis - Initial Evaluation
Question from Gil Levin:
In order to appreciate the texture of the Adlerian approach, let's talk a little about Adlerian "diagnosis." With a 'modal' actual or imagined patient/client in mind, could you walk me through an initial evaluation of a patient's problem?
Dr. Stein: My preliminary evaluation starts when I first meet the patient in the waiting room, since Adler suggested that everyone will express his or her style of life most clearly in a new situation. I look for the degree of contact in the eyes and greeting, the level of activity and posture in the short walk to the office, the initiative in choosing a seat, and the posture when seated. Anything unusual, over- or under-done, is of particular interest. Many people very eloquently express their attitude toward life in that brief episode.
After some preliminary questions about health problems, medication, and drug/alcohol use, I ask about the patient's difficulties. As the problem or symptom unfolds, I am especially interested in when the difficulty began and what else was happening at the time. This may reveal where and when the person's courage or ability to cooperate faltered. Present circumstances may also be denying the person the subjective success, significance, or pleasure they expect.
I want to see the patient's problem in the context of their main life tasks,so I ask about their work, love/sexual life, family, and friendships. This provides an overview of their level of functioning and what they value.
Within the first hour, I try to elicit a preliminary sketch of their early childhood situation, including: descriptions of each family member, relationships, attitudes, feelings, family atmosphere, and earliest childhood memories. I make notes of these descriptions, including the feelings and body language expressed.
I am especially interested in the difficulties that the individual has struggled with and overcome. These conquests often provide strengths to build on. What they have avoided in life may reveal their felt deficiencies.
After the first interview, I review my notes and try to imagine a line of psychological movement leading from the patient's memories of childhood, through the present situation and difficulties, to a future goal of ultimate compensation, significance, and security. I try to connect to this line all of the patient's thinking , feeling, and actions, including their attitude toward me and the task of therapy.
For example, a man in his mid 40's was referred to me after completing an out-patient alcohol treatment program. He was very frustrated with his career as a criminal investigator, experienced very little intimacy with his wife, and had no friends. Although he conducted extremely thorough investigations that resulted in convictions, sentences rarely included jail time.
His cold and isolated childhood left him very bitter: an unhappy mother; a remote father; and a hell-raising older brother whom he hated, but who was the center of the parents' attention and frequently got away with illegal behavior. By contrast, he was a compliant child who didn't make any trouble, and was ignored.
The felt neglect of his father and lack of love from his mother were at the roots of his inferiority feelings. His life style was catching many "bad guys" and seeing that they were locked up. Since many were not, he was perpetually frustrated. He also viewed his parents and brother as unpunished criminals. His unconscious goal was to secure compensation and revenge for his miserable childhood. Revenge was not working out to his satisfaction, but he did look forward to the compensation of a comfortable retirement, a symbol of what he felt entitled to.
His attitude toward me was guarded and minimally expressive. What made him competent in surveillance work, observing others without being seen, was a handicap in making a personal relationship. Two strengths could be built on -- he had conquered both alcohol and nicotine dependencies.
In general, my early guesses are either confirmed or modified in subsequent sessions as I gain more detailed information, which includes a written questionnaire. Frequently, a binocular view of oral and written information is very useful.
A more refined evaluation emerges within the first few weeks, since I spend a good deal of time organizing, analyzing, and synthesizing the case material. This process is facilitated by the use of computer software programs, resulting in a series of conceptual maps: a multi-generational genogram that clarifies family member descriptions and relationships; a time-line diagram that highlights significant positive and negative events; and a matrix that organizes my conclusions about the patient's style of life, including: inferiority feelings, compensatory fictional goal, level and radius of activity, use of symptoms and emotions, degree of community feeling, private logic, earliest recollections, and the antithetical scheme of apperception. These maps provide an on-going guide for treatment planning.
3. Frequently Used Interventions
Question from Gil Levin:
Your vignette makes the Adlerian assessment process crystal clear. I know from what you have said elsewhere that you view therapeutic intervention as an "art" and therefore it must be a harder to characterize briefly. I am struggling to frame a question that will get at this...... How about this: Could you spell out a couple of frequently used interventions and indicate the circumstances in the therapy that would signal you when to use them? (If you feel that a different question would take us to the heart of the matter, please answer it instead.)
Dr. Stein: At the first meeting, I frequently ask Adler's favorite diagnostic Question from Forum: "If you no longer had your symptoms, what would you do?" In their answers, patients frequently reveal the problems or responsibilities that they are trying to avoid.
In the early stages of treatment, after establishing an empathic connection, I use a therapeutic adaptation of Socratic questioning to help patients clarify meanings and feelings, recognize the purpose of emotions and actions, identify the consequences of behavior, and generate alternative solutions to problems. There are over fifty Socratic strategies that utilize a series of leading questions to help patients reach their own conclusions. To illustrate one, testing the validity of behavior by multiplying it, I asked a man who liked speeding and running red lights, "What would happen if everyone did the same thing?"
In the middle stages of therapy, after patients achieve more confidence through a series of encouraging new successes, I gradually unfold an interpretation of their style of life and fictional final goal. Earliest childhood recollections offer fertile opportunities for discussing the concrete situations, feelings, and actions that embody the life style. They can also provide effective spring boards for launching new attitudes and behaviors.
A very passive, pampered patient recalled a memory of early childhood that vividly expressed his demanding, expectant attitude. He remembered lying in bed on a cold winter morning, refusing to get up until his grandmother warmed his underwear in the oven. We first discussed the meaning of this memory, and then he tried to imagine several alternative scenarios, including one of getting up early to help his grandmother build a fire. He gradually realized that simply being cute and sad would not bring another pampering grandmother into his life, and that there was a new form of reciprocal gratification more suitable to an adult man.
I frequently have to invent strategies that fit the uniqueness of the patient and the moment. A severely depressed young man came to me after seeing many psychiatrists over a period of fifteen years. After working with him for nearly a year, he complained, "No has ever understood me!" Knowing that he had an appreciation for drama, I proposed that I play him and recite a soliloquy of his inner thoughts. He was intrigued and agreed to have me do it. For about five minutes, I expressed his private logic, attitudes, and feelings about his family, then concluded with his opinion of me. He was very adept at denying the more traditional therapeutic expressions of empathy and insight, but this unexpected form got through to him.
Another case may help illustrate the potential variety in presenting interpretation. A young boy had killed a small pet at school. He lived in a very aggressive, competitive family. His deep anger could not be openly expressed at home. Hand puppets permitted him to express a great deal of murderous rage safely in my office. He selected "Dracula" to kill my collection of thirty puppets. Over a period of weeks, he gradually selected less aggressive characters, who first protected each other, and later on played together. When I felt he was ready to understand why he had killed the animal, I selected a "Wise Old Owl" puppet to Socratically guide him into insight. His appreciation for my help was expressed through a very affectionate "Puppy Dog" puppet.
The most effective Adlerian interventions are creative applications of Adler's basic principles. To achieve significant cognitive, affective, and behavioral change, we do not follow any by-the-numbers procedures. We have to invent the means of accomplishing many therapeutic tasks that include: providing constant encouragement, reducing inferiority feelings, increasing the feeling of community, re-directing the striving for superiority, promoting the feeling of equality, interpreting the purpose of behavior, and stimulating social contribution.
Comment: What you have said so far is very interesting. Let's include others by continuing our conversation on the Behavior OnLine Forum.
4. The Dark Side of Human Nature
Question from Forum: In reviewing our your conversation elsewhere in Behavior OnLine and reading your comments in this Forum, I am struck again and again about what a thoughtful, 'decent' and respectful approach it is. I do wonder though if Adler had anything to say about the darker side of human nature. Most theorists seem to emphasize this. For Freud there's repressed impulses, for Jung there's the shadow. Even contemporary 'schools' touch on this to a degree. Cognitive therapists are concerned with negative self-attributions and constuctivists with dysfunctional narratives. Did Adler have much to say about the darker side?
Dr. Stein: Adlerian psychology addresses the complete range of human experience, from optimal to pathological. The ideal of a fully functioning individual, with a highly developed of feeling of community is posited as a benchmark, from which all deviations are evaluated.
Adler considered the darker side of human nature as a potential that could develop in individuals if their feeling of community was not sufficiently developed. He saw this darker side, not as an inevitable characteristic of all people, but as a probable reaction to early childhood neglect, abuse, or pampering. These overburdening influences inhibit the development of the feeling of community and frequently lead to mistaken conclusions about oneself and life. In these cases, the generic striving for significance may deteriorate into destructive striving for power over others. However, it is not the original childhood circumstances that "cause" the dark side to emerge in adults -- it is their unchanged, mistaken opinions of themselves and others, as well as their unchanged, unconscious, fictional goals (the choice of wrong directions).
Therapeutically, the challenge of Adlerian psychotherapy is not to merely uncover or integrate this dark side but to overcome it mentally, emotionally, and behaviorally. In this respect, Adlerian theory and practice is more optimistic about human nature and therapeutic change than many other approaches. Adler believed that an increase in the feeling of community was the primary key to the prevention and cure of mental illness, addiction, and criminal behavior.
(Additional Comments About Inferiority and Aggression)
Parental neglect, rejection, or abuse can easily provoke deep, painful feelings of insecurity or worthlessness in children. Many grow up yearning for revenge. However, pampering, overprotection and indulgence can also set the stage for intensified inferiority feelings. Pampered children may "feel humiliated" when they are not the center of attention or given everything they want. Spoiled children can become very aggressive or abusive toward parents if they eventually discontinue their indulgence. Very ambitious, competitive children, who have accomplished or preferred siblings, may feel painfully inferior by comparison, and harbor "dark thoughts" about their rivals.
Children, as well as adults, can temporarily mask or relieve their inferiority feelings with high activity, anger, and aggression. They can get "high" on this volatile mixture and often have the illusion of being very powerful. By dominating, hurting, frightening, or exploiting others they indulge in pretenses of victory. Their shallow conquests frequently involve the perverse satisfaction of defeating someone. This "dark side" strategy can become very addictive and result in a progressive indifference to the pain of others.
Question from Forum:
Your additional comment like many of your contributions is a wise one and seems animated by a kind of 'radical' environmentalism. When I raised the question of the dark side I neglected to make this consideration explicit. The nature/nurture pendulum nowadays has swung (too far?) toward the nature pole, reflecting developments in biology and perhaps the political sphere. Do you/Adler believe that personality development is solely a function of the environment?
Dr. Stein: Personality development is influenced somewhat by the training and challenges of the environment as well as the assets and liabilities of heredity; however, the strongest influence is the creative power of the individual. This premise is reflected in the potential of Classical Adlerian psychotherapy to stimulate a client into choosing a new direction in life (giving up a life style and compensatory fictional goal originally chosen in childhood).
In the early 1900's Adler recognized the impact of organ inferiority on the formation of the personality. He even hypothesized an inferiority of the CNS in most cases of schizophrenia. Yet he also pointed out the potential of productive over-compensation in certain organ deficiencies, (i.e. Beethoven's deafness and Demosthenes' stuttering).
A negative environment does not always lead to problem children, nor does a positive environment guarantee happy, cooperative children. The decisive factor is what the child makes of his situation when, after trial and error, a choice is made that seems to promise security and significance. Without the critical capacity to foresee later consequences, many errors are possible.
In Adler's own words: "It is neither heredity nor environment which determines the individual's relationship to the outside world. Heredity only endows him with certain abilities. Environment only gives him certain impressions. These abilities and impressions, and the manner in which he "experiences" them-- that is to say, the interpretation he makes of these experiences--are the bricks which he uses in his own "creative" way in building up his attitude toward life. It is his individual way of using these bricks--or in other words, it is his attitude toward life--which determines his relationship to the outside world."
At the beginning of Adler's first book, THE NEUROTIC CONSTITUTION, we find one of his favorite aphorisms: "Omina ex opinione suspensa sunt." (Everything is subject to one's opinion of it).
5. Emotions and Feelings
Question from Forum: What I am learning about the importance of values and the social responsibility is interesting, though sometimes it seems rather 'heady", what about the heart?
The feeling side of the Adlerian approach is very important, but often not sufficiently emphasized in the available literature. The personality ideal of "Gemienshaftsgefuhl" (the feeling of community) is a deep "feeling" of being connected, and embedded in all of life, past, present, and future. It begins with the infant's feeling of being positively connected to the mother, may extend to the father and siblings, and hopefully, develop beyond the family in ever-widening circles. Fundamentally, it is a feeling of being at home on this earth, yet this feeling can grow as wide as the cosmos.
By approaching our patients with warm, friendly understanding, we provide the beginning correction for their missing or deficient feeling of connectedness. First, we empathize with their emotional distress, and then gradually help them realize that most of their thoughts, feelings, and actions are consequences of their immediate or future (unconscious) goals. Patients may frequently understand the logic of trying a new direction, but their familiar feelings and emotions do not provide a sufficient spark to move in that unfamiliar direction. At that point, we may try eidetic or guided imagery to promote an emotional breakthrough. Providing corrective "missing experiences" in group therapy may also be effective.
We try to balance our therapeutic interventions so that the head and the heart are equally stimulated.
6. Treatment of Criminality
Question from Forum: What is the Adlerian approach to the treatment of criminality?
Dr. Stein: I've read the Samenow and Yochelson volumes on "The Criminal Personality," and they've created a compelling view of criminal thinking and feeling patterns, including many concepts that paralleled Adler's theory (energy level, zero state, power thrust, perfectionism). However, there are significant differences, particularly in treatment. Their approach to treatment tends to be nomothetic, systematic, and directive. The Classical Adlerian approach to treatment is more idiographic, creative, and Socratic.
We do not have special strategies for depression, anxiety, criminal behavior, or other disorders. Our challenge is to invent a unique therapeutic intervention for each "individual" who may be using symptoms or disruptive behavior in the service of a hidden goal. Initially, using a therapeutic adaptation of the Socratic method, question the client's mistaken thinking. Later on, we may use eidetic and guided imagery to generate conjunctive feelings. If needed, we may use role-playing to practice new, cooperative behavior. However, unless we also uncover and dissolve the hidden fictional goal, the mental, emotional, and behavioral changes may be superficial or temporary.
For Adler's thinking about the private logic of criminals, early childhood influences, and treatment recommendations, read "Crime and Related Disorders (Chapter 17) in THE INDIVIDUAL PSYCHOLOGY OF ALFRED ADLER, edited by Heinz and Rowena Ansbacher. Edward Hoffman, in his new biography of Adler, THE DRIVE FOR SELF: ALFRED ADLER AND THE FOUNDING OF INDIVIDUAL PSYCHOLOGY, offers some brief comments.
(Quoting Hoffman) "...Adler described most criminals, regardless of socioeconomic background, as dominated by a sense of inferiority and a lack of social feeling. Ultimately, he emphasized, they are cowards with "a cheap superiority complex," overcoming their victims through darkness, surprise, formidable weaponry, or sheer numbers.
Quite optimistically, Adler asserted that his approach could "change every single criminal," but acknowledged that such a goal was unrealistic, especially since "we find that in hard times, the number of criminals always increases." Rather, Adler offered several concrete recommendations for preventing a further escalation of crime. These included establishing programs to eliminate unemployment through job training, reducing the ostentatious display of wealth that "can act as a challenge to the criminal," and instituting group sessions with prison inmates to heighten their self esteem and social feeling. Interestingly, Adler also suggested that the mass media "not mention the names of criminals or give them so much publicity," and commented that, "We should not imagine that criminals can be terrified by the thought of capital punishment, [which] sometimes only adds to the excitement of the game."
7. Undivided Self
Question from Forum: It seems to me to that Adler, through his insistence on dynamic unity, both acknowledges 'the dark side' and puts it in perspective. Both 'the dark side' and the conscious self are dedicated to the pursuit of the fictional goal. Any comment?
Dr. Stein: Adler did not make a sharp distinction between conscious and unconscious, nor did he assume internal conflicting forces. He did not believe that everyone had a hidden dark side. Consequently, his model of the personality does not include anything similar to Jung's 'shadow' or Freud's 'Id'.
Adler's conceptions of the unity and self consistency of the personality suggest that any 'dark side' is an invention of the individual--a devise that may be useful in the pursuit of an aggressive or defensive goal.
8. Self Esteem
Question from Forum: You mentioned that one of Adler's suggestions for preventing crime was "instituting group sessions with prison inmates to heighten their self esteem". At this time in our profession, this term is used to mean many different things by different persons. Would you elaborate on Adler's conception of 'self esteem'?
Dr. Stein: An early feeling of belonging gives children the foundation for building self esteem, one that is rooted in being content with who they are, and strengthened by being accepted and liked by parents, siblings, and friends. If children have enough activity and courage, and use their creative power to find ways of conquering what is bothering them, and struggle to overcome the difficulties they face, they can develop normal self esteem.
Self esteem is not given to children by their parents. It comes from the feeling that they can do things on their own, that they don’t always need help. It comes from trying, failing, and trying repeatedly until they succeed. Encouragement is generally necessary when they begin to feel discouraged. If children are always criticized for their mistakes, or they are helped too much, they may be prevented from developing genuine self esteem.. Aspiring to goals that are too high or unrealistic for their age, or intense competitiveness with older or accomplished siblings may deny children any feelings of success and pride in their accomplishment. They may then deviate into fantasy, or rely on the opinion or behavior of others for the illusion of an exaggerated self esteem.
Adults can also set mistaken benchmarks for their self esteem. Money, power, possessions, and fame are seductive substitutes for the feeling of personal value in our culture. Most people have the opportunity of doing the best they can with what they have inherited, to improve their living situations, and to develop their interests and capacities. Satisfaction and pride in one’s progressive improvement, and the willingness to share what one has developed for the benefit of others can provide not only life-long self esteem, but earn the esteem and appreciation of others.
(Additional comments about inferiority and aggression.)
Parental neglect, rejection, or abuse can easily provoke deep, painful feelings of insecurity or worthlessness in children. Many grow up yearning for revenge. However, pampering, overprotection and indulgence can also set the stage for intensified inferiority feelings. Pampered children may "feel humiliated" when they are not the center of attention or given everything they want. Spoiled children can become very aggressive or abusive toward parents if they eventually discontinue their indulgence. Very ambitious, competitive children, who have accomplished or preferred siblings, may feel painfully inferior by comparison, and harbor "dark thoughts" about their rivals.
Children, as well as adults, can temporarily mask or relieve their inferiority feelings with high activity, anger, and aggression. They can get "high" on this volatile mixture and often have the illusion of being very powerful. By dominating, hurting, frightening, or exploiting others they indulge in pretenses of victory. Their shallow conquests frequently involve the perverse satisfaction of defeating someone. This "dark side" strategy can become very addictive and result in a progressive indifference to the pain of others.
9. Main Tools in Therapy
Question from Forum:
Adler used two main tools in therapy; were they the family constellation and life-style?
Dr. Stein: The main “tools” in Adlerian therapy are encouragement and the feeling of community. Some constructs, like family constellation, birth order, style of life, inferiority feeling, striving for superiority, fictional final goal, antithetical scheme of apperception, private logic, and earliest recollections, may emerge as more important than others in a particular case or at a specific stage of psychotherapy.
10. Metaphors in Therapy
Question from Forum:
How did Adler use metaphor therapy?
Dr. Stein: Alfred Adler did not use "metaphor therapy," if by that term you mean the use of metaphors as the primary focus in diagnostic and treatment strategies. He was very creative in treatment and used whatever technique seemed appropriate to each client. Being "creative" implies the invention of strategies that can capture the uniqueness of each individual, and that facilitate each stage of treatment. For this reason, in the Classical Adlerian approach, we use a variety of cognitive, affective, and behavioral strategies that might include: the Socratic method, eidetic and guided imagery, role-playing, bibliotherapy, dream and daydream analysis, as well as metaphors.
Metaphors can frequently be used by clients to intensify negative feelings and avoid common sense. Countering a negative metaphor with a positive one, usually offers some encouragement, but unless the underlying goal and style of life are modified, any affective or behavioral changes may be superficial and temporary.
11. Gestalt and Adlerian Theory
Question from Forum:
Is there any relationship between Adlerian Theory and Gestalt Therapy?
Dr. Stein: In The Individual Psychology of Alfred Adler, p. 11-12, Heinz Ansbacher points out the similarities between Individual Psychology and Gestalt psychology: "emphasis on the whole rather than elements, the interaction between the whole and parts, and the importance of man's social context." On page 149, he also comments about the "close theoretical relationship between the Gestalt school and Adler in the area of intelligence."
My mentor, Sophia de Vries, who studied with Adler, believes that Adlerian psychology has more in common with the early European Gestalt theorists, rather than with later American practitioners like Fritz Perls.
To my knowledge, there is not much of a dialogue today, in the United States, between the Adlerian and Gestalt advocates. Constructs like the fictional final goal and the feeling of community seem to differentiate us from many other approaches that have some limited similarity.
Several years ago, I read Creative Process in Gestalt Therapy by Paul Zinker. I found the first third of the book, about the therapist as an artist, most stimulating and consistent with the Classical Adlerian style of treatment. However, the balance of the book described Gestalt therapeutic strategies that I found less adaptable to the Adlerian model.
12. Simplified Typologies
Question from Forum:
Several years ago I began work on an instrument to measure the personality priorities set out by Kefir and also Langenfeld. There work was based on Adler's discussion of common types (along with others). I have found this an interesting research vein. However, while my program advisor was strongly Adlerian, I have not kept close to the purists in the area. I was wondering how personality priorities are viewed today?
Dr. Stein: Simplified typologies, like the "personality priorities" are often appealing to students because they seem to provide a relatively easy way to identify a client's style of life. However, they do not do justice to Adler's principle of the uniqueness of each individual. After mastering Adlerian theory, it takes many years of supervised case analysis, with an expert clinician, to learn the art of capturing that uniqueness diagnostically.
A comprehensive case analysis would include precise descriptions of the client’s: type and depth of inferiority feelings; degree and radius of activity; level of community feeling; compensatory fictional final goal; attitudes toward work, friendship and love; antithetical scheme of apperception; and private logic. These diagnostic constructs provide very useful guidelines for the course of therapy and the potential dissolution of the style of life.
Question from Forum:
I was caught off guard the other day when a student at the local university mentioned that her professor had stated that Adler believed that there were four major typologies: The dominant or ruling attitude; the "expectant attitude"; the "avoidant attitude"; and the "solution oriented attitude". It had been my belief that Adler had mentioned these types as examples of potential types. In Ansbacher's "Superiority and Social Interest" (pg 68), Adler states that these four types are presented for "...teaching purposes only." How do you understand this passage?
Dr. Stein: Simplified typologies are useful as preliminary (and temporary) schemes for orienting students at the beginning of their training. However, if we wish to do justice to Adler's view of the uniqueness of each individual, in clinical practice we must eventually abandon all typologies and learn to capture a dynamic picture of each individual's actual movements in relation to external problems and an internal, fictional final goal.
A complete style of life analysis embraces many of Adler's constructs, including: childhood prototype; primary and secondary inferiority feelings; compensatory, fictional final goal; attitudes toward the three life tasks; antithetical scheme of apperception; and private logic. It generally takes several years of weekly case consultation with an experienced clinician to master this creative art.
Although it may be tempting to use simplified typologies in practice, they never capture the uniqueness of the individual sufficiently to help clients feel deeply understood, nor do they provide adequate reference points for precise, effective treatment planning.
13. Birth Order
Question from Forum:
I am in a research science class in high school. My project is on birth order and how effects an individual's personality. I have read that Adler was the first to acknowledge this idea. I would appreciate some more information on this subject.
Dr. Stein: Read Alfred Adler's What Life Could Mean to You,Chapter 6, "Family Influences, for a good overview. Also look at Lydia Sicher: An Adlerian Perspective, edited by Adele Davidson, Chapter 17, "Family Constellation."
For a contemporary view of birth order influence, check out Robert Boynton's article, "The Birth of an Idea," in the latest issue of The New Yorker magazine. He discusses Frank Sulloway's research and new book, Born to Rebel.
14. Evolution of Adlerian Theory
Question from Forum:
It seems to me that current cognitive-behavioral/ constructivist/narrativist approaches to therapy are an evolution of Adler's observations...
And further, that (in contrast to something in an earlier thread) it is not that current theory is becoming more Adlerian, but that current theory stands on Adler's shoulders, (as well as those of others.)
Do you think Adlerian theory has evolved? If so, where is it today?
Dr. Stein: For more than twenty years I have studied and re-studied Adler's original writings, and have compared them to other and "newer" theories in psychology. Generally, I find that Adler has grasped a "totality" of the human condition unequaled by any other theoretician. He embraces a vision of the human being in the widest social context, including the perspectives of the past and future. I find many other theories that seem parallel to fragments of Adler's theory lacking in the unique totality that he provides.
For the past five years, with the generous help of Kurt Adler, I have been managing and editing the Adlerian ` Project. It has been quite extraordinary to read a steady flow of translated journal articles and unpublished manuscripts. Unlike any other author, Adler consistently penetrates to the core of the human mind and heart.
Our most recent project, a re-translation of The Neurotic Constitution (adding all the new material from the fourth edition) has provided continually profound insights into psychopathology. One unique quality that emerges is a consistent impression of "the whole" of Adler's model, no matter which paragraph one reads (like the structure of a hologram, wherein each piece is a small reflection of the entire image).
I, like my mentor, Sophia de Vries, believe that Adler's theory is complete, like a work of art. I have yet to see anyone "improve" it, although it is possible to elaborate on various aspects of his theory as long as the totality is retained. (Although Adler suggested an ideal for personality development, Abraham Maslow described optimal functioning more comprehensively. Adler, however, provided the therapeutic tools for realizing this goal.) In my teaching and writing, I have explored elaborations of: creative power; dissolving a style of life; childhood developmental scheme; levels of functioning; and private logic.
The evolution of Adlerian psychology will more likely take place in its practice. Adler's writings do not document the technique of psychotherapy in a step-by-step manner because he conceived it as a creative process. A few of his followers have contributed insights into the host of strategies and techniques that can be generated from his theory. Anthony Bruck mastered the art of brief therapy and created a set of graphics for teaching Adlerian theory. Sophia de Vries adapted and refined the Socratic method for promoting cognitive insight and change. Working together, we developed a twelve-stage therapeutic model to guide and evaluate the progress of treatment. I have explored the use of eidetic and guided imagery for providing "missing developmental experiences."
It has been difficult to gain a full appreciation of Adler's remarkable contribution, since so much of his work has been out of print, partly translated, or untranslated. We intend to publish The Collected Clinical Works of Alfred Adler once we have completed the massive job of translating and editing. It will then be possible for anyone to fully access and evaluate Adler's theory.
In your message, you expressed your perspective that "current cognitive-behavioral/constructivist/narrativist approaches to therapy are an evolution of Adler's observations" and that "current theory stands on Adler's shoulders." It would be helpful if you could be more specific and illustrate your point with examples.
Comment: I agree with the person who commented about the commonality and seeming evolution from Adler to constructivist/narative/ cognitive psychotherapy. One commonality that comes readily to mind is that both Adler and these investigators see the person as constructing their own concepts of the world and not being passive reactors to external stimuli. Also, treatment considerations may have the same process in mind. Adler talks about "dissolving the lifestyle" while constructivists talk about "re-authoring the narrative." While using different terminology the similarities seem evident. Michael Mahoney tome, Human Change Processes, summarizes the constructivist cognitive psychotherapy position. Art Freeman who is president of AABT will be presenting at the 1997 NASAP conference. His topic - The Adlerian roots of cognitive therapy - may provide further insights.
Comment: Thank you for responding to my post.I had in mind some of what was commented on, as well as other commonalities between Adlerian theory and cognitive/cognitive-behavioral/ constructivist models.
In addition to a creative, ego-centered approach to apprehending reality, I see commonalities between methods. For instance, in acting "as if", a person is "testing out" their hypotheses about self, others, and the world... as well as alternative hypotheses. In looking at early recollections, the therapist assesses the person's learning history and core belief system. (I know that ERs are not veridical, in the sense of stimulus-response theory, but I look at learning theory from a social-learning perspective.)
There is some social psychology research that supports and expands upon the concepts of early recollections. Social psychologists Miller, Potts, Fung, Hoogstra, and Mintz (1990) described cross-cultural research into the social construction of self-concept or personal narrative that both supports Adlerian theory, and provides insight into specific mechanisms by which beliefs about self and other come to be what they do. This kind of basic research could, I think, be put to good use by Adlerians, as empirical validation of Adlerian constructs.
Similarly, there is research in cognitive neuroscience that supports information-processing models that fit well with CBT, constructivist, and Adlerian theories. (I don't have the references in front of me at the moment, but it's not even terribly new research... certainly at least 4-6 years old.)
However, most areas within psychology seems reluctant to look to other areas of the field for verification of basic constructs... it's hard to read broadly enough, for one thing. And then there's an inherent territoriality in what we do, particularly when we create something that has a new twist and we want to call it ours.
At APA a couple of years ago, I wandered into a session that was on cognitive neuroscience. At first, my inclination was to leave... not the place for a practitioner, I thought. But I stayed, because it was a fun and quirky thing to do. And I discovered that the neuroscientists were "discovering" things that clinicians -- particularly Adlerian and Cognitive clinicians -- could have told them, or at least contributed to... and I realized that the lack of communication was reciprocal.We'd all support the profession of psychology better if we paid attention to our more scientific peers.
Dr. Stein: I would extend your suggestion, about paying more attention to other psychology disciplines, to the other sciences. The following excerpt, from "Classical Adlerian Theory and Practice," comments on some fascinating parallels.
Over the half century since Alfred Adler articulated his theory of personality and system of psychotherapy, his ideas have gradually and persistently permeated the whole of contemporary psychology (Ellenberger 1970, 645-648). The shift of psychoanalysis to ego psychology reflected Adler's original thinking and Adler was "hailed by certain psychoanalysts as a precursor of the later developments of psychoanalysis" (Ellenberger 1970, 638). Adler's observation that "human beings live in the realm of meanings" reflects the social constructivist view of human behavior. An early feminist, he held that both men and women suffered from our society's overvaluing of men and undervaluing of women, and he believed the only positive relationship between men and women was one of equality. His earliest work in which he argued for the unity of mind and body was a precursor of psychosomatic medicine.
Even the findings of anthropologists, biologists, and physicists parallel Adlerian concepts. Adler's view of the interconnectedness of all living beings and their natural proclivities toward cooperation has been echoed by anthropologists (Ho 1993; Kim and Berry 1993; Maybury-Lewis 1972), and biologists (Augros and Stancui 1988; Hamilton 1964; Simon 1990; Trivers 1971; Wilson 1975). His concept of the style of life, where one central theme is reflected in every psychological expression, suggests the concept in physics of the hologram, wherein each part of a whole is an enfolded image of that whole (Briggs and Peat 1989). His concept of the final goal, a fictional future reference point that pulls all movements in the same direction, is similar to that of a strange attractor in chaos theory, a magnetic end point that pulls on and sets limits for a process (Nelson 1991). He believed in the fundamental creative power of individuals and their freedom to choose and change their direction in life; this is very similar to the biological process called autopoesis which is the autonomous, self-renewing, and self-directing nature of all life forms (Nelson 1991).
When sociologists, anthropologists, biologists, mathematicians, physicists, and psychotherapists begin describing remarkably similar dynamics, one wonders if we are on the brink of a new unified field theory. Forty years ago, Alexander Müller frequently referred to Adler's body of work as "philosophical anthropology," and held that it had the potential for providing the magnetic center that would draw other disciplines together (Müller 1992).
The scientific paradigm shift and intellectual climate of the 1990's might well be ripe for a re-discovery of Adler's original and full contribution to an understanding of human beings and their relationship to the world. He created an exquisitely integrated, holistic theory of human nature and psychopathology, a set of principles and techniques of psychotherapy, a world view, and a philosophy of living.
(For the complete paper, including references, see: http://www.Adlerian.us/theoprac.htm .)
15. Striving for Superiority
Question from Forum:
Could you please discuss what Adler means by "striving for superiority." I find so many people (and clinicians) do not completely understand what Adler was trying to say.
Dr. Stein: A complete understanding of any of Adler's terms requires considerable in-depth study. Publications that attempt to simplify Adler's ideas appeal to the casual reader but mislead many, including clinicians, into thinking that his ideas are easy to assimilate. Many misconceptions are constantly repeated in textbooks and encyclopedias. Since, most of Adler's clinical writings are not yet readily available, it is not easy to find reliable sources. The work of Heinz and Rowena Ansbacher has been very helpful (see "Reading and Study Sources" in the ALFRED ADLER INSTITUTE OF SAN FRANCISCO link of the BOL home page)
The fundamental dynamic of human striving is a constant movement from a felt "minus" to an imagined "plus". The striving is influenced by: the type and intensity of the "minus" feeling (inferiority or insecurity); the degree of activity; the strength of the feeling of community; and the particular goal of an imagined "plus". The character of this movement is not easy to capture in a short phrase--it may erroneously suggest a static "snapshot" rather than a dynamic "moving picture". Also, the generalized, abstract concept of striving must be tailored to reflect the quality and direction of that striving in each individual's life.
It is helpful to consider a palette of terms to describe the variety of directions that individuals could take. People may strive for: superiority over difficulties, superiority over others, significance, completion, compensation, perfection, improvement, achievement, fulfillment, power, prestige, connection, recognition, security, adaptation, or overcoming. Generally, we evaluate each variation as either positive or negative (for the individual as well as society). The overuse of the phrases "striving for superiority" and "striving for power" in the literature implies that Adler saw all social relationship as fundamentally unequal and aggressive. In fact, he used these terms to describe only the negative or pathological variation. The desire to "be perfect, without flaw" can lead to socially useless activities, discouragement, and retreat into fantasy. The striving for godlike supremacy can lead to psychosis.
Adler's terms "striving for completion", "striving to overcome difficulties", and "striving to improve life for all people" reflect more of the positive potential of striving. At an optimal level, he talked about aligning ones striving "in the stream of evolution". He considered the active "striving for perfection" a potentially inspiring ideal, if it led to courageous improvement, correction, and refinement as well as useful social contribution. The striving to "actualize one's potential" was later echoed by Abraham Maslow.
In a spiritual/psychological context, Alexander Mueller used the phrase "striving to become one's best self" in his book YOU SHALL BE A BLESSING. Kurt Adler has talked about "striving for a better adaptation to the environment". Sophia de Vries often referred to a "striving for overcoming obstacles". Lydia Sicher wrote about "striving after some personal truth". Anthony Bruck suggested a "striving for personal significance". All of these expressions try to suggest the general upward striving of human beings. The direction of each person's striving is greatly influenced by the strength of that individual's feeling of community.
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