Adlerian Therapy
Phase 4: Reorientation and Reeducation
Integration and Summary Once material has been gathered from both subjective and objective interviews with the client, integrated summaries of the data are developed. Different summaries are prepared for different clients, but common ones are a narrative summary of the person’s subjective experience and life story; a summary of family constellation and developmental data; a summary of early recollections, personal strengths or assets, and interfering ideas; and a summary of coping strategies.
The summaries are presented to the client and discussed in the session, with the client and the counselor together refining specific points. This information provides the client with the chance to discuss specific topics and to raise questions.
The Student Manual that accompanies this textbook includes a concrete exam- ple of the lifestyle assessment as it is applied to the case of Stan. In Case Approach to Counseling and Psychotherapy (Corey, 2013, chap. 3), Drs. Jim Bitter and Bill Nicoll present a lifestyle assessment of another hypothetical client, Ruth.
changes in their life. During this phase, clients can choose to adopt a new style of life based on the insights they gained in the earlier phases of therapy. More commonly, clients figure out how to reorient their current style of living to the useful side of life, increasing their community feeling and social interest. The useful side involves a sense of belonging and being valued, having an interest in others and their welfare, courage, the acceptance of imperfection, confidence, a sense of humor, a willingness to contribute, and an outgoing friendliness. The useless side of life is characterized by self-absorption, withdrawal from life tasks, self-protection, or acts against one’s fellow human beings. People acting on the useless side of life become less functional and are more susceptible to psychopathology. Adlerian therapy stands in opposi- tion to self-depreciation, isolation, and retreat, and it seeks to help clients gain cour- age and to connect to strengths within themselves, to others, and to life.
reorientation involves shifting rules of interaction, process, and motivation.
These shifts are facilitated through changes in awareness, which often occur during the therapy session and which are transformed into action outside of the therapy office (Bitter & Nicoll, 2004). In addition, especially at this phase of therapy, Adlerians focus on reeducation (see the section Therapeutic Goals). Throughout this phase, no intervention is more important than encouragement.
The Encouragement Process Encouragement is the most distinctive Adlerian procedure, and it is central to all phases of counseling and therapy. It is especially important as people consider change in their lives. encouragement literally means
“to build courage.” Encouragement is a process of increasing the courage needed for a person to face difficulties in life (Carlson & Englar-Carlson, 2013). Courage develops when people become aware of their strengths, when they feel they belong and are not alone, and when they have a sense of hope and can see new possibilities for themselves and their daily living. Therapists help clients focus on their resources and strengths and to have faith that they can make life changes, even though life can be difficult. Milliren, Evans, and Newbauer (2007) consider encouragement key in promoting and activating social interest. They add that encouragement is the universal therapeutic intervention for Adlerian counselors, that it is a fundamental attitude, or way of being, rather than a technique. Because clients often do not recognize or accept their positive qualities, strengths, or internal resources, one of the counselor’s main tasks is to help them do so.
Adlerians believe discouragement is the basic condition that prevents people from functioning, and they see encouragement as the antidote. As a part of the encouragement process, Adlerians use a variety of relational, cognitive, behavioral, emotional, and experiential techniques to help clients identify and challenge self- defeating cognitions, generate perceptional alternatives, and make use of assets, strengths, and resources (Ansbacher & Ansbacher, 1964; Watts, 2015).
Encouragement takes many forms, depending on the phase of the counseling process. In the relationship phase, encouragement results from the mutual respect the counselor seeks to engender. Here is an opening intervention focusing on encouragement:
Client: I almost didn’t come . . . Counselor: . . . but you did.
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Client: Yes, but I just don’t know. Maybe it would have been better just to end it all, not even bother.
Counselor: So you are in a lot of pain, even thinking about ending it all, but still you came. That took a lot of courage, How did you manage to summon that courage and then act on it?
In the assessment phase, which is partially designed to illuminate personal strengths, clients are encouraged to recognize that they are in charge of their own lives and can make different choices based on new understandings.
During reorientation, encouragement comes when new possibilities are gener- ated and when clients are acknowledged and affirmed for taking positive steps to change their lives for the better. This later intervention focused on encouragement has a triumphant tone:
Counselor: Let me see if I understand this. You were in a familiar family setting. Your father was berating you about a minor difference of opinion, really trying to push your buttons, and you managed not only to stay calm but also offered to help him sort some materials in his office. You must feel so proud of yourself, triumphant even. What a transformation of your normal interactions.
Client: Yes, and I even walked away feeling I had made a difference in his life. I did not lose my temper. I did not strike back. I actually just heard him in a different way, knew he needed to feel right and important, and when I let that happen, everything changed between us.
Counselor: You even know the steps that got you there.
Client: Yes, I do.
Counselor: Achieving a change in long-held family patterns is one of the hardest things to attain. You have a right to feel delighted.
Change and the Search for New Possibilities During the reorientation phase of counseling, clients make decisions and modify their goals. They are encouraged to act as if they were the people they want to be, which can serve to challenge self- limiting assumptions. Clients are asked to catch themselves in the process of repeating old patterns that have led to ineffective behavior (Watts, 2015). Commitment is an essential part of reorientation. If clients hope to change, they must be willing to set tasks for themselves in everyday life and do something specific about their problems. In this way, clients translate their new insights into concrete actions.
Bitter and Nicoll (2004) emphasize that real change happens between sessions, and not in therapy itself. They state that arriving at a strategy for change is an important first step, and stress that it takes courage and encouragement for clients to apply what they have learned in therapy to daily living.
This action-oriented phase is a time for solving problems and making decisions.
The counselor and the client consider possible alternatives and their consequences, evaluate how these alternatives will meet the client’s goals, and decide on a specific course of action. The best alternatives and new possibilities are those generated
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by the client, and the counselor must offer the client a great deal of support and encouragement during this stage of the process.
Making a Difference Adlerian therapists seek to make a difference in the lives of their clients. That difference may be manifested by a change in behavior or attitude or perception. Adlerians use many different techniques to promote change, some of which have become common interventions in other therapeutic models. Techniques that go by the names of immediacy, advice, humor, silence, paradoxical intention, acting as if, catching oneself, the push-button technique, externalization, reauthoring, avoiding the traps, confrontation, use of stories and fables, early recollection analysis, lifestyle assessment, encouraging, task setting and commitment, giving homework, and terminating and summarizing have all been used (Carlson & Johnson, 2016;
Carlson et al., 2006; Dinkmeyer & Sperry, 2000; Disque & Bitter, 1998; Mozdzierz, Peluso, & Lisiecki, 2009). Contemporary Adlerian practitioners are diverse in their styles of counseling (Maniacci, 2012; Watts, 2015), and they can creatively employ a wide range of other techniques, as long as these methods are philosophically consistent with the basic theoretical premises of Adlerian psychology. Adlerians are pragmatic when it comes to using techniques that are appropriate for a given client.
In general, however, Adlerian practitioners focus on motivation modification more than behavior change and encourage clients to make holistic changes on the useful side of living.
All therapy is a cooperative effort, and making a difference depends on the therapist’s ability to win the client’s cooperation. Let’s focus on one technique tra- ditionally associated with Adlerian counseling to see what it looks like in action.
Harold Mosak, a highly respected therapist, uses the push-button technique with cli- ents who know they are depressed but feel that the depression controls them and that nothing can be done. The goal of this technique is to help clients become aware of their role in contributing to their unpleasant feelings. Typically, clients are asked to re-create an unpleasant memory, which is then followed by recalling a pleasant memory (Watts, 2015).
Counselor: I am sure we can end your depression rather easily. Let’s start with what you really need to do with your life [the set up].
Client: Wait a minute. If you can get rid of my depression easily, let’s do it.
Counselor: Well, OK. You will have to close your eyes. I want you to think about the worst, most awful thing that has happened to you recently. When you have it in mind, I want you to raise your right hand. [The client pauses for a few moments and then raises his hand.] Now, I would like you to add the feeling you feel when you think about this horrible part of your life.
[Taking the client’s right hand, the counselor presses the index finger onto the client’s leg.] We will call this your depression button.
Now, I want you to think about the best thing that has happened to you or could happen to you or you would love to have happen to you. Raise your left hand when you know what that is.
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Client: I can’t really think of anything.
Counselor: You may have to go back to an earlier time to remember a really good time that you would like to have in your life now, but I know you can do it. [A minute later the man raises his left hand.] Now, add the feeling you have thinking about that happy time. [Taking the client’s left hand, the counselor presses the index finger onto the client’s other leg.]
So you have a depression button on your right leg, and you can push it and think about everything horrible, awful, or worse, and feel depressed. Or you can push the happy button on the other leg, think about wonderful things or events or people, and feel happy. If you come in next week and tell me you have felt depressed, I will simply ask you why you decided to push the depression button rather than the happy button.
The push-button technique recognizes that “control” is a major theme in depression, and this intervention is designed to help the client regain a sense of con- trol over the negative feelings that seem overwhelming. An effective way of using this technique may be to give the client, especially a child or an adolescent, an actual push-button to carry in his or her pocket as a physical reminder.
Areas of Application
Adler anticipated the future direction of the helping professions by calling
upon therapists to become social activists and by addressing the prevention and remediation of social conditions that were contrary to social interest and resulted in human problems. Adler’s own experiences of discrimination and the influence of social inequality are well represented in his writings. Adler’s pioneering efforts on prevention services in mental health led him to increasingly advocate for the role of Individual Psychology in schools and families. Because Individual Psychol- ogy is based on a growth model, not a medical model, it is applicable to such var- ied spheres of life as child guidance; parent–child counseling; couples counseling;
family counseling and therapy; group counseling and therapy; individual counsel- ing with children, adolescents, and adults; cultural conflicts; correctional and reha- bilitation counseling; and mental health institutions. Adler’s basic ideas have been incorporated into the practices of school psychology, school counseling, the com- munity mental health movement, and parent education. Adlerian principles have been widely applied to substance abuse programs, social problems to combat pov- erty and crime, problems of the aged, school systems, religion, and business. Adle- rian ideas also have had widespread international application and acceptance (see Fall and Winter 2012 special issues of the Journal of Individual Psychology for interna- tional perspectives on Individual Psychology).
Application to Family Counseling With its emphasis on the family constellation, holism, and the freedom of the therapist to improvise, Adler’s approach contributed to the foundation of the family therapy perspective. Adlerians working with families LO11
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focus on the family atmosphere, the family constellation, and the interactive goals of each member (Bitter, 2014). The family atmosphere is the climate characterizing the relationship between the parents and their attitudes toward life, gender roles, decision making, competition, cooperation, dealing with conflict, responsibility, and so forth. This atmosphere, including the role models the parents provide, influences the children as they grow up. The therapeutic process seeks to increase awareness of the interaction of the individuals within the family system. Those who practice Adlerian family therapy strive to understand the goals, beliefs, and behaviors of each family member and the family as an entity in its own right.
Application to Group Counseling Adler and his coworkers used a group approach in their child guidance centers in Vienna as early as 1921 (Dreikurs, 1969). Dreikurs extended and popularized Adler’s work with groups and used group psychotherapy in his private practice for more than 40 years. Although Dreikurs introduced group therapy into his psychiatric practice as a way to save time, he quickly discovered some unique characteristics of groups that made them an effective way of helping people change. Inferiority feelings can be challenged and counteracted effectively in groups, and the mistaken concepts and values that are at the root of social and emotional problems can be deeply influenced because the group is a value-forming agent (Sonstegard & Bitter, 2004).
The rationale for Adlerian group counseling is based on the premise that our problems are mainly of a social nature. The group provides the social context in which members can develop a sense of belonging, social connectedness, and com- munity. Sonstegard and Bitter (2004) write that group participants come to see that many of their problems are interpersonal in nature, that their behavior has social meaning, and that their goals can best be understood in the framework of social purposes. Group counseling is particularly helpful in promoting social interest. A core therapeutic factor is the role of altruism, which is the process of helping others in the group. The process of developing group cohesion parallels social interest (pro- moting the social welfare, in this case of the group) and community feeling (feeling connected and closer to the group itself), which are primary goals of Adlerian ther- apy. For example, in a men’s group, one of the core goals is often helping discour- aged and isolated men feel useful to others (building altruism) and connected to fellow men. While this group process is building, group members are also building their social interest by feeling connected to something bigger than themselves.
The use of early recollections is a unique feature of Adlerian group counseling.
As mentioned earlier, from a series of early memories, individuals can get a clear sense of their mistaken notions, current attitudes, social interests, and possible future behavior. Through the mutual sharing of these early recollections, members develop a sense of connection with one another, and group cohesion is increased.
The group becomes an agent of change because of the improved interpersonal rela- tionships among members and the emergence of hope.
Especially valuable is the way Adlerian group counselors implement action strategies at each of the group sessions and especially during the reorientation stage when new decisions are made and goals are modified. To challenge self-limiting assumptions, members are encouraged to act as if they were the persons they want to be. They are asked to “catch themselves” in the process of repeating old patterns
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