PSY 245 CLINICAL PSYCHOLOGY Assoc. Prof. Dr. BAHAR BAŞTUĞ Clinical Psychologist Individual Psychology & Adlerian Therapy Alfred Adler (1870 – 1937), founder of individual psychology Welcome Today we’ll be focusing on individual psychology which is a theory and therapy approach developed by Alfred Adler. This approach is typically referred to as Adlerian therapy. Although some people still refer to Adler as one of Freud’s students, he was Freud’s contemporary and developed his own, very different, approach to counseling and psychotherapy. He’s like a man from the future. Some labels Adler as a neo-Freudian.??? Adler’s Individual Psychology is a psychoeducational, present/future oriented, and brief approach. Adler’s psychology was far ahead of its time. He’s known as the father of CBT. Alfred Adler was born to a Jewish family, second of six children, in Vienna. had a sickly childhood. He suffered from rickets. His physician told his father: «your boy is lost.» His father encouraged Adler. Alfred Adler obtained medical degree from University of Vienna. married Raissa Timofeyewna Epstein, an early socialist and feminist. Alfred Adler met Freud in 1902. Adler attended “Wednesday evenings”. He defended Freud’s “Interpretation of Dreams” and then was invited to what became the Vienna Psychoanalytic Society was man with his own ideas before meeting Freud. In 1911, as president of Vienna’s Psychoanalytic Society, Adler read a highly controversial paper (the masculine protest) at odds with Freudian theory. Adler emphasized the power of culture and socialization. He noted that some women who reacted to this cultural situation by choosing to dress and act like men were suffering not from penis envy, but from a social-psychological condition he referred to as the masculine protest. In extreme cases, males who suffered from the masculine protest began dressing and acting like girls or women. Alfred Adler After this presentation, Adler left the Vienna Psychoanalytic Society. He and his colleagues established The Society for Individual Psychology. According to Individual psychology, human functioning was not only biologically based, but also powerfully influenced by social, familial, and cultural factors. The key to psychological health and wellbeing was encouragement. THEORETICAL PRINCIPLES The Whole Person: Adler didn’t believe in dichotomies the individual into different functional parts. He emphasized unity of thinking, feeling, acting, attitudes, values, the conscious mind, and the unconscious mind. Adler avoided reductionism. Freud was reductionist. Reductionism X Holism Adlerian holism: Humans are a single complete unit; a whole that cannot and should not be divided into separate parts (id, ego, superego). Striving with Purpose According to individual psychology, humans actively shape themselves and their environments. There is a third element— beyond biology and the environment—that influences and directs behavior; Adler referred to this third force as “attitude toward life” Attitude toward life is composed of a combination of individual human choice and purpose. Striving with Purpose Human behavior is purposeful. We move toward specific goals in life. Humans are driven by hopes for the future, rather than instinctual forces from the past. Adler referred to the endpoint of our future purposeful striving as fictional finalism because the endpoint is each individual’s subjective fiction. Striving with Purpose Everyday behavior can be analyzed with respect to its purpose. When an Adlerian therapist notices a maladaptive quality to the client’s behavior patterns, threapist wonders why that behavior occurs. For Adler, the question was neither ‘How does mind affect body?’ nor ‘How does body affect mind?’ but rather ‘How does the individual use body and mind in the pursuit of goals?” Striving with Purpose Striving with purpose is helpful in child psy and parenting. Dreikurs identified «the four goals of misbehavior» to understand of children misbehavior. To get attention To get power or control To get revenge To display inadequacy Social Interest and Community Feeling Humans are born into an interpersonal context. As a consequence, the development of individual personality is shaped by interpersonal factors. When an individual experiences a deep sense of connection to others, he or she is experiencing community feeling. Social Interest and Community Feeling Social interest is community feeling in action.Social interest or a sense of social responsibility is a goal of therapy. As an individual’s social interest develops, so does the capacity for empathy. Psychologically healthy individuals feel a sense of communion with others. Social interest is positively related to spirituality,positive psychology & attachment. Striving for Superiority The most basic human motive is striving for superiority. Individuals strive for a perceived plus in themselves and their lives. Within the individual there is opportunity for both interpersonal gain and individual developmental gain. Adler is neutral. He doesn’t believe in the innate goodness or innate destructiveness of humans. He believes we are what we make ourselves; we have within us the potential for goodness and evil. Striving for Superiority (cont.) Adler viewed individualistic superiority striving as a sign of psychopathology. The basic striving is the striving for completeness. Even a flower that grows strives to reach its completeness. The fundamental law of life is to overcome one’s deficiencies. Humans strive; we are active, creative, and persistent in our drive to move toward completion and excellence. We can become discouraged and resigned due to unfortunate life circumstances, but our natural state is forward moving. Phenomenology Adler was an early existentialist; the concept of phenomenology is a central assumption of individual psy. Individual experience is a subjective fiction based on each individual’s perception. The individual actively creates and adapts personal reality. Adler had an influence on Victor Frankl and Rollo May. An Idiographic Approach For Adler, general statements about humans and human psychology are helpful, but of limited use. A human being cannot be typified or classified. Every individual is unique. To really understand an individual, a couple,or a family, you must work with that individual, couple or family. Meeting and spending time with clients are more important than providing a diagnostic label. Individual psy is about the psy of the single, unique, whole individual. Soft Determinism Individual psychology is not deterministic approach. Adler didn’t emphasize the causal determinants of human behavior. Soft determinism is the midpoint between deterministic, cause-and-effect thinking and nondeterminism which assumes no causal connections. Soft Determinism From the individual psychology perspective, human behavior is a function of a combination of influences. There is no single, direct causal factor that produces a single behavior. There are many influences or contributing factors. Adler believed every individual is responsible for his/her behavior. Adlerian theory is hopeful and optimistic. Lifestyle: The Early Cognitive Map Adler was deeply influenced by Hans Vaihinger. According to Vaihinger, we each create our own world and then live by the rules we’ve created. Vaihinger’s philosophy is based on a cognitive psychological model. Vaihinger’s book was “The Philosophy of «As If»” Adler referred to a client’s fictional goals or fictional finalism as a future-oriented concept that influences an individual’s present behavior. An individual’s lifestyle is both conscious and unconscious. It is a subjective cognitive map of how the world works. Lifestyle: The Early Cognitive Map The future is now. This is because the future strongly influence your everyday behavior. In addition, the future is then. This means that your future was established by your early childhood experiences. Humans are characterized by continuity; the past, present, and future are all closely intertwined. An individual’s personal continuity or lifestyle may be more or less adaptive. Some people hold onto beliefs about the self, world, and others that cause them emotional pain and distress. Adler has referred to these beliefs as basic mistakes, and these cognitive mistakes are an obvious target of therapy. Adler is hopeful and optimistic about the possibility for helping individuals change their cognitive maps through therapy. Tasks of Life Adler believed all humans face 3 life tasks: Work, or occupation Love and marriage Social Relationships Later, other Adlerians added 3 more tasks: Self Spirituality Parenting and Family These six tasks constitute the challenges of life. The clients come to therapy because they have had difficulty with one or more basic life tasks. The difficulties arise from mistakes and maladaptive perceptions associated with their lifestyle. The goal of therapy is to help clients adjust or modify their lifestyles in ways that help them more effectively complete their life tasks. Work or Occupation This is a life demand that we all must face and work through. Adler believed the best way to solve the life task of work or occupation was by solving the second life task, social relationships, through “friendship, social feeling, and cooperation”. Social Relationships Adler proposed positive social relationships. Establishing healthy social relationships was the key to solving the work or occupational problem. Humans are interdependent. Everyone needs to belong to some social group. Humans need to belong and are interdependent and must also face the life task of dealing with relationships. Some clients come to therapy because they have social relationship problems. From the Adlerian perspective, clients’ social problems arise from inappropriate expectations, beliefs, and interpersonal habits. Love and Marriage Adler viewed marriage as a partnership. Many clients come to therapy with intimacy problems, both sexual and nonsexual. Road to recovery: modify the lifestyle and develop empathy (community feeling). Self This task emphasizes that everyone has a relationship with himself or herself. The nature of your relationship with yourself is established during childhood. Mosak and Maniacci describe four dimensions of the self life task: Survival of self: Am I taking good care of my physical self? Am I taking good care of my psychological self ? Am I taking good care of my social self ? Body image: Is my perception of my body reasonable and congruent with my actual body? Self Opinion: What is my opinion of me? To evaluate this in an interview, Adlerians often ask clients to complete the incomplete sentence, “I ....me”. Evaluation: Some clients have various extreme perspectives of the self. From the object relations perspective, the question would be “Am I good or am I bad?” Spirituality Mosak and Maniacci describe five specific issues related to the spirituality task. As individuals grow up and face life, they must approach and deal with each of these issues: Relationship to God: Religion: Relationship to the universe: Metaphysical issues: Meaning of life: Parenting and Family Giving birth to, raising a child & functioning as a family are extensions of love and marriage task. Some individuals function as single parents and raise children outside marriage. Individual parents also develop strong feelings and beliefs about how children should be raised. How individuals face the parenting and family task is both a function of and a challenge to the lifestyle. Parenting and Family Adlerian parenting approach has some core characteristics: • • • • • • • Democratic-authoritative Autocratic/authoritarian or permissive Responsive Problem-solving Encouragement Punishment Contemporary parenting authorities Theory of Psychopathology Psychopathology is often defined as “discouragement”. The discouraged individual is unable or unwilling to approach and deal with essential life tasks. In the case of mental disorder, one or more of the life tasks have become overwhelming. The person struggling to adequately face a life task becomes discouraged. He or she feels inferior or unable to successfully manage the life task demands, and therefore symptoms arise. Psychopathology and Human Change Patients are suffering from the effects of their inaccurate or mistaken lifestyles. Symptoms become an answer to the question “What shall I do if I cannot successfully manage this life task?” From an Adlerian perspective, symptoms have a purpose and help individuals avoid facing life tasks. For example “If I become anxious, I will not have to approach one or more of the basic life tasks. Perhaps I can avoid marriage or work.” Although feelings of inferiority are natural, they can also become pathological. The Practice of Adlerian Therapy In the practice of Adlerian therapy, there are four phases: 1. Forming the therapeutic relationship 2. Lifestyle assessment and analysis 3. Interpretation and insight 4. Reorientation The Practice of Adlerian Therapy II Forming the therapeutic relationship – The relationship is equalitarian and characterized by listening and caring. – The therapist is like a friendly teacher or business consultant. Therapist and client sit on chairs of equal status and look more or less directly at one another. Therapy is conducted collaboratively. “What do you want me to know about you? – Clients are encouraged to be active participants in therapy. The Practice of Adlerian Therapy III • Therapist-client goal alignment is important; sample goals include: – Fostering client social interest or community feeling – Helping clients overcome feelings of inferiority and discouragement. – Helping clients change the basic mistakes embedded in their lifestyle. – Shifting client motivation from self-focused superiority to a community focus. – Helping clients believe and feel as equals in their relationships. – Helping clients become contributing members to society. The Practice of Adlerian Therapy IV The therapist focuses mostly on positives and not pathology. – Focus on client strengths. – There is also sometimes a focus on client problems. Adlerians focus on the person and strengths as well as problems. The goal is to establish an environment characterized by encouragement. Initial Lifestyle Interpretations “Tell your client something you’ve learned about him toward the end of the first session” The purpose of this early interpretation is to further the connection between therapist and client and begin the process of a deeper analysis. Lifestyle Assessment and Analysis Several approaches to lifestyle assessment are available. The main assessment strategies are: The family constellation interview The question Earliest recollections (memories) The Family Constellation Interview is a particular approach to obtaining information about the client’s childhood experiences. Topics covered include descriptions of each family member, descriptions of how family members interacted with one another, how each family member was viewed by the client, who fought, who didn’t fight, and more. Adler considered birth order to be a strong contributor of lifestyle. He emphasized that every individual is born into a different family; this is because with the addition of a new family member, the family dynamics change and a new family is born. Birth order We shouldn’t use birth order like astrology to describe personality and to predict human behavior. Birth order is psychological, not chronological. If a first-born child has illnesses, a second-born may adopt personality characteristics associated with first-borns. Oldest: may be spoiled, later dethroned, may be bossy, authoritarian; Oldest child may feel responsible for others, identify with father. Middle: may have trouble finding her place in life. Youngest: may feel she/he should be treated like royalty. She/he dreams of being bigger and more powerful, learns to manipulate others. Only: takes attention from both parents, feels special, may have problems with peer relationships due to lack of sharing experience. Only boy among girls: may need to prove he’s a man, is to be sensitive to feminine issues. Only girl among boys: may become feminine, tries to compete with her brothers. The Question In order to obtain information about the purpose of the client’s symptoms, the therapist asks the client “the Question.” How would your life be different if you were well? What would you be doing in your life if you no longer had your symptoms? This question is a method to look for underlying motivations or secondary gain (remember: all behavior is purposeful). Earliest Recollections This is a method for understanding the client’s lifestyle. It helps clarify the self ideal. The early recollection is a message from the past, still active in the client’s present life, a forecast of the future. The accuracy of the memory is much less important than the existence of the memory. The memory is an active expression of the client’s living lifestyle. If the memory was not important in the present, there would be no purpose for the client to remember it. Basic Mistakes An Adlerian becomes able to identify a client’s basic mistakes: 1.Overgeneralization 2.False or impossible goals 3.Misperception of life and life’s demands 4.Denial of one’s basic worth 5.Faulty values Interpretation and Insight Insight is central to Adlerian therapy. There’s a strong link between insight, motivation, and action. Insight stimulates motivation, motivation stimulates action. Insight is generally achieved through interpretation. Collaboratively «Could this be true?» The purpose of interpretation is to demonstrate continuity of an inaccurate, maladaptive lifestyle; it’s not important to show a causal connection between past and present. The Practice of Adlerian Therapy X Reorientation is the final phase of Adlerian therapy. This is where many specific teaching and learning strategies are employed, including: – The future autobiography – Creating new images – Acting “as if.” Reorientation: Specific Therapy Techniques The Future Autobiography: The future guides and shapes everyday behavior. This technique is for helping clients reshape their view of the future. This technique is especially useful for clients who like to write, draw or tell stories. First, this technique can be used as an assessment tool. The future autobiography can help identify the client’s fictional life goals (self-ideal). A discussion of the client’s future autobiography can help the client take greater conscious responsibility for directing and shaping life. The future autobiography can be used in a therapeutic manner. You can use it after gathering information about client’s past and lifestyle. You can help the client to write a realistic and adaptive future autobiography. Creating New Images Clients have images of themselves in the past, present, and future. This procedure can be used in many different ways. In some cases, the therapist may try to use a short phrase to visually and metaphorically capture a client’s behavior, attitude, or value. This technique can also be used to encourage clients to actively develop new and more adaptive selfimages. Acting “as If” Clients often wish for traits they don’t have. The “acting as if ” technique is used when clients express a desire to be different. «What if you were self-confident?» This technique is primarily experimental. Clients gain new perspectives and motivation for behaving in different, more adaptive ways. Reflecting As If There are 3 stages: – Reflecting: therapists ask clients to reflect on how they wish they might act differently. – Planning: building a hierarchy of specific behaviors linked to the ideal-self. – Implementing: the client identifies one or two as if behaviors that would be easiest to implement. RAI can be used with adults, children & couples. The Push-Button Technique Adler believed that under every feeling there is a cognition. The technique is designed to help clients have greater emotional control. The push-button technique is an ABA reversal experimental design that teaches clients the power of thoughts and images over feelings. “Depressed people feel depressed. It’s because they’re consistently thinking depressing thoughts.” This technique can be used with depressed people. Spitting in the Client’s Soup Clients avoid demands & responsibilities of basic life tasks. Spitting in the client’s soup is a metaphor and technique for destroying the client’s avoidance strategy. Its purpose is to increase client awareness and destroy the use of the maladaptive behavior pattern in the future. – Develop a friendly and supportive relationship with the client characterized by good listening and encouragement. – Identify a repeating and unhelpful behavior or thinking pattern (basic mistake) that the client uses repeatedly and plans to use in the future. – Ask and get the client’s permission to share an insight. – Share the repeating and unhelpful pattern that the client is planning to continue using. – Be open to discussing the client’s reaction to having his/her soup spat in. Catching Oneself Self-awareness and self-control is designed to help clients become aware of their maladaptive behavior patterns and goals. The therapist coaches the client on how to catch himself when he or she slips into old, unhelpful behaviors. The technique of catching oneself is a historical precursor of CBT’s selfmonitoring and thought stopping. Paradoxical Strategies Paradox in therapy involves prescribing the symptom. If the client is self-critical, therapist might suggest that she negatively analyze and criticize herself at a higher rate. Advice, Suggestion, and Direction Adlerian therapists offer advice within the context of a friendly, collaborative, positive relationship. • I’ll Betcha Case Analysis and Treatment Planning • The Problem List – Inferiority feelings or low self-esteem – A range of different maladaptive behaviors and cognition. • Problem Formulation • Interventions • Outcomes Measurements Outcomes Measurements Assessment is integrated into the treatment process and assessment via lifestyle analysis. A primary goal is to develop client social interest. It focuses on the ability of clients to face and complete the tasks of life. These goals are measurable and relevant to treatment outcomes. Research shows that higher self-interest scores are associated with fewer symptoms and lower diagnostic rates. – Sulliman Social Interest Scale – Social Interest Index – Social Interest Scale Cultural and Gender Considerations Adlerian theory and therapy is not value- free. One value is social equality. His feminist perspective is, of course, welcomed by feminists. He stated that women’s psychopathology is shaped by a prejudiced society. His emphasis on family and family dynamics as influencing the individual also plays well in multicultural counseling. Evidence-Based Status Professionals and teachers have applied the principles of individual psy within educational settings, for parent education, and for group, family, couple, and individual therapy. Numerous contemporary approaches such as CBT, existential and reality therapy borrow from individual psy. Despite the prominent use of Adler’s concepts, empirical research confirming to the efficacy of Adlerian therapy is little. Perhaps the greatest reason for this is the fact that Adler found nomothetic research that compares group outcomes to be relatively useless. Consequently, the Adlerian focus continues to be idiographic case studies. Evidence-Based Status Early research reviews, based on only four empirical studies of Adlerian psychotherapy, indicate that the procedures are slightly more effective than placebo treatment and have efficacy similar to psychoanalytic and person-centered therapy. Birth order and social interest have studied. The relationship of birth order to specific personality traits have been mixed. Positive correlation between positive psy & social interest Positive correlation between spirituality & social interest Higher social interest is associated with fewer symptoms and increased well-being.