How Adlerian Theory is used in Therapy

My fellow therapists, do you find yourself taking an interest in Psychodynamic therapy but can't get behind all of Freud’s ideas and theories? Perhaps, just like me you have had a love-hate relationship with Freud’s work but would still like to incorporate more of psychodynamic approach in your work. 

If yes, then I've got an exciting alternative for you! 

Welcome to Adlerian Therapy! 

Taking a deep dive into this therapeutic approach will help us see the influence of Adlerian therapy on modern supportive psychotherapy and how the model developed by Adler advocates for the individual client. The principles he brought to the therapy room campaign for the social equality of women, the working-class and poor, and address the rights of minority groups. 

Adlerian theory come from the works of Alfred Adler and although once a colleague of Freud, he differs quite a bit from his ideology. Their only similarity is their belief that personalities are formed in our early years, before the age of 6. Adler saw people as both the creators and the creations of their own lives; that is, people develop a unique style of living that is both a movement toward and an expression of their selected goals. In this sense, we create ourselves rather than merely being shaped by our childhood experiences.

Expanding on that notion, he believed that the individual begins to form an approach to life somewhere in their first six years. He focused on the person’s past as perceived in the present and how an individual’s interpretation of early events continues to influence that person’s present behaviour. 

According to Adler, humans are motivated primarily by social relatedness rather than by sexual urges; behaviour is purposeful and goal-directed; and consciousness, more than unconsciousness, is the focus of therapy. Adler stressed choice and responsibility, meaning in life, and the striving for success, completion, and perfection. 

Tenets of Adlerian Theory

Adler advocated for the uniqueness of individuals, coining the term “individual psychology.” He believed in treating people according to their nuances, rather than pairing diagnostic labels with one-dimensional treatments. According to Adlerian theory, individual experiences in life are more important than psychological labels or personality types. Understanding certain factors about yourself may help you create a more fulfilling life. These factors include:

• Lifestyle: He described it as our perceptions regarding self, others, and the world, including the connecting themes and rules of interaction that give meaning to our actions. It is the characteristic way we think, act, feel, perceive, and live. 
• Birth order:  For Adler, birth order could have an impact on how a child relates to society and the development of their style of life. Rather than actual birth order, he was more interested in the individual’s interpretation, or the psychological position of the child’s place in the family.  
• Social interest:  Adler viewed social interest as an innate concept that evolves in three stages: aptitude, ability, and secondary dynamic characteristics.  An individual has an aptitude for cooperation and social living, which eventually develops into abilities that express social cooperation in various activities. Afterwards, secondary dynamic characteristics develop which express themselves as attitudes and interests in a variety of activities, becoming a means of expressing social interest. He believed that the parent-child relationship was highly instrumental in developing it.
• Inferiority and Superiority: One of Adler’s key beliefs was that everyone experiences feeling inferior from time to time, which may cause some people to overcompensate and act out. For example, a child might act out when they feel insecure to gain a parent’s attention. 

Self-esteem problems may develop from unresolved feelings of inferiority, which Adler described as the superiority and inferiority complex. The superiority complex may develop when someone feels they need to prove they are better than others, which may present as behaviour and attitudes that are: 

• arrogant
• pretentious
• cocky

Application of Adlerian Theory in Therapy

Adler believed that he could help the patient within 8 to 10 weeks. Therefore,  Adlerians focus on limiting time rather than limiting goals. Being action and goal-oriented in their focus on the problem helps Adlerians limit the time needed for therapy. 

Adlerian counselling is structured around four central objectives that correspond to the following four phases of the therapeutic process.

Phase 1 - Therapeutic Relationship

The Adlerian practitioner works collaboratively with clients, and this relationship

is based on a sense of interest that grows into caring, involvement, and friendship. In Adlerian therapy, therapeutic progress relies on an alignment of clearly defined goals between the therapist and the client. The counselling process, to be effective, must deal with the personal issues the client recognizes as significant and is willing to explore and change. 

This approach emphasises heavily on the development and continuation of a solid therapeutic relationship during this first phase of therapy. Even though clients’ concerns may surface rather quickly in therapy, the initial focus should be on the person, not the problem. One way Adlerian therapy creates an effective therapeutic relationship is for counsellors to help clients become aware of their assets and strengths rather than jumping into dealing with their deficits and problems continuously. A positive relationship is created by listening, responding, demonstrating respect for clients’ capacity to understand purpose and seek change, and exhibiting hope and caring. 

When clients enter therapy, they typically have a diminished sense of self-worth and self-respect. They lack faith in their ability to cope with the tasks of life, and they often feel discouraged. Adlerian therapy understands that therapists provide support, which is an antidote to despair and discouragement. For some people, therapy may be one of the few times in which they have truly experienced a caring human relationship. During this phase, the therapist uses techniques that are fitted to the needs of each client and may include attending and listening with empathy, following the subjective experience of the client as closely as possible, identifying and clarifying goals, and suggesting initial hunches about the client’s symptoms, actions, and interactions. Adlerian counsellors are generally active, especially during the initial sessions. They provide structure and assist clients in defining personal goals, conduct psychological assessments, and offer interpretations

Phase 2 - Assessing the Individual’s Psychological Dynamics

The second phase of Adlerian therapy aims to get a deeper understanding of an individual’s lifestyle. During this assessment phase, the focus is on understanding the client’s identity and how that identity relates to the world at large. This assessment phase proceeds from two interview forms: the subjective interview and the objective interview. 

In the subjective interview, the therapist helps the client tell his or her life story as completely as possible. Using empathic listening and responding, the subjective interview follows from a sense of wonder, fascination, and interest. Interest in what the client presents will naturally lead the therapist to the next most significant question and inquiry about the client and their life story. The underlying belief that Adlerian therapy holds is that clients are the experts in their own lives, allowing clients to feel completely heard. 

Throughout the subjective interview, the Adlerian therapist is listening for clues to the client’s coping and approaches to life. Toward the end of this part of the interview, Adlerian brief therapists ask, “Is there anything else you think I should know to understand you and your concerns?” or “How would your life be different, and what would you be doing differently, if you did not have this symptom or problem?” 

On the other hand, the objective interview seeks to discover information about 

• how problems in the client’s life began
• any precipitating events
• medical history, including current and past medications
• social history
• the reasons the client chose therapy at this time
• the person’s coping with life tasks
• lifestyle assessment

Based on interview approaches developed by Adler and Dreikurs, the lifestyle assessment starts with an investigation of the person’s family constellation and early childhood history. Therapists interpret the person’s early memories, seeking to understand the meaning that they have attached to life experiences. They operate on the assumption that it is the interpretations people develop about themselves, others, the world, and life that govern what they do. 

Lifestyle assessment seeks to develop a holistic narrative of the person’s life, to make sense of the way the person copes with life tasks, and to uncover the private interpretations and logic involved in that coping. For example, if Radha has lived most of her life in a critical environment, she may now believe that she must be perfect to avoid even the appearance of failure. The assessment process will highlight the restricted living that flows from this perspective. 

Adlerian assessment relies heavily on an exploration of the client’s family constellation, including the client’s evaluation of conditions that prevailed in the family when the person was a young child (family atmosphere), birth order, parental relationship and family values, and extended family and culture. Some of these questions are almost always explored:

• Who was the favourite child?
• What was your father’s relationship with the children? Your mother’s?
• Which child was most like your father? Your mother? In what respects?
• Who among the siblings was most different from you? In what ways?
• Who among the siblings was most like you? In what ways?
• What were you like as a child?
• How did your parents get along? In what did they both agree? How did they handle disagreements? How did they discipline the children?

The questions are always tailored to the individual client to elicit the client’s perceptions of self and others, of development, and of the experiences that have affected that development.

Another assessment procedure used by Adlerians is to ask the client to provide his or her earliest memories, including the age of the person at the time of the remembered events and the feelings or reactions associated with the recollections. Early recollections are one-time occurrences, usually before the age of 10, that can be pictured by the client in clear detail. This also leads to an understanding of how we view ourselves, how we see the world, what our life goals are, what motivates us, what we value and believe in, and what we anticipate for our future. 

After receiving each memory, the counsellor might also ask: “What part stands out to you? What was the most vivid part of your early memory? If you played the whole memory like a movie and stopped it at one frame, what would be happening? Putting yourself in that moment, what are you feeling? What’s your reaction?” 

To assess a pattern a minimum of three memories is necessary. 

Another aspect of lifestyle assessment would be dreams, either childhood or more recent recurrent dreams. Throughout therapy, clients are encouraged to share dreams with the therapist. Adler believed that dreams were purposeful and that they were often indications of an individual’s lifestyle. Also, dreams help in determining what the individual may like or fear for their future. In Adlerian therapy, to understand a dream, one must know the individual dreamer as it may help assess their current change and progress. 

Phase 3 - Encourage Self-Understanding and Insight

During this third phase, Adlerian therapists interpret the findings of the assessment as an avenue for promoting self-understanding and insight. Here insight refers to gaining an understanding of the motivations of the client. Self-understanding is only possible when hidden purposes and goals of behaviour are made conscious. 

Adlerians consider insight as a special form of awareness that facilitates a meaningful understanding within the therapeutic relationship and acts as a foundation for change. However, Insight without action is not enough. Rather, people can make rapid and significant changes without much insight.

Disclosure and well-timed interpretations are techniques that facilitate the process

of gaining insight. Interpretation deals with clients’ underlying motives for behaving the way they do in the here and now. Adlerian disclosures and interpretations are concerned with creating awareness of one’s direction in life, one’s goals and purposes, one’s private logic and how it works, and one’s current behavior.

Typically an Adlerian interpretation would be a suggestion presented as an open-ended question that can be explored in the sessions. For example, “I could be wrong, but I am wondering if …,” “Could it be that …,” or “Is it possible that …” Because interpretations are presented in this manner, clients are not led to defend themselves, and they feel free to discuss and even argue with the counsellor’s hunches and impressions.

Through this process, both counsellor and client eventually come to understand the client’s motivations, how these motivations are now contributing to the maintenance of the problem, and what the client can do to correct the situation. During this phase of therapy, the counsellor helps the client understand the limitations of the style of life the client has chosen.

Phase 4 - Reorientation and Reeducation

The final stage of the therapeutic process is the action-oriented phase known as reorientation and reeducation: putting insights into practice. This phase focuses on helping clients discover a new and more functional perspective. Clients are both encouraged and challenged to develop the courage to take risks and make changes in their lives. 

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 humour, a willingness to contribute, and 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 seeks to help clients gain courage and connect to strengths within themselves, to others, and 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. Throughout this phase, no intervention is more important than encouragement.

In Summary 

Adlerian theory is directive but also emphasizes warmth in therapeutic relationships to facilitate growth. Central concepts applied in Adlerian theory include:

• childhood experiences
• how a person attaches meaning to their life
• understanding feelings of inferiority

Adlerian therapy often progresses in four different stages. Each stage is essential for understanding and increasing fulfilment and social connectedness in a person’s life.

Adlerian therapy can be used to treat various mental health conditions and in different therapeutic settings as well. But most importantly, it is well suited to counselling diverse populations such as ours and doing social justice work.  

References

Corey, G. (2017). Theory and Practice of Counseling and Psychotherapy. Cengage Learning.

National Library of Medicine. (2024, January 11). Adlerian Therapy - StatPearls. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK599518/

PsychCentral. (2022, January 25). Accepting the Individual: How Adlerian Theory Is Used in Therapy. Psych Central. https://psychcentral.com/health/adlerian-theory

Psychology Today. (2022, April 27). Adlerian Therapy. Psychology Today. https://www.psychologytoday.com/intl/therapy-types/adlerian-therapy

Sharf, R. S. (2012). Theories of Psychotherapy & Counseling: Concepts and Cases. Cengage Learning.