Running head: ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
Adlerian Psychotherapy and Cognitive Therapy: A Theoretical Comparison
Assignment #2
Dianne L. Ballance
ID#00939966
University of Calgary
CAAP 601 Fall 2010
Instructor: Aida Miloti
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ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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Adlerian Psychotherapy and Cognitive Therapy: A Theoretical Comparison
This paper will explore a theoretical comparison of Adlerian Psychotherapy (AP) and
Cognitive Therapy (CT) within the framework of The Nature of Theory commentary through
discussion of the philosophical, descriptive, prescriptive, and evaluative theory elements. These
theories were chosen on the basis of personal preference of areas of interest as well as an effort
to further understand both historical and contemporary influences in counselling psychology.
Adlerian psychotherapy may be considered as an early contributor to the field of
psychology that influenced the development of contemporary theories and approaches to
counselling and psychotherapy (Watts, 2003). Adlerian psychology is also referred to as
Individual Psychology, and was developed by Alfred Adler circa 1931 (Mosak & Maniacci,
2011; Shifron, 2010). Contemporary practice of Adlerian therapy focuses on a cooperative,
psychoeducational, present/future oriented, and a brief or time-limited approach (Mosak &
Maniacci, 2011; Watts, 2003). This theory appealed to me in that it highlights a positive
viewpoint of human nature, and considers both the social context and a holistic stance in regards
to the understanding and counselling of individuals (Mosak & Maniacci, 2011). I was interested
in developing my knowledge of Adlerian psychology as I feel it strongly relates to my future
work as a school psychologist, and how we view the broader social environment of schools and
communities.
Cognitive Therapy as developed by Aaron T. Beck is a widely used therapy in mental
health settings, and is the dominant clinical approach (Sperry, 2003). Cognitive therapy is a
collaborative problem solving approach that recognizes the influence of cognitive, affective,
motivational, and behavioural responses in human perception and learning (Beck & Weishaar,
2011). I am familiar with how cognitive therapy can be modified within an educational setting
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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in my experience in providing interventions for children (behavioural and academic), and was
interested in developing a more detailed understanding of the theoretical foundations of this
theory and how it is applied in both counselling and educational psychology.
The Philosophical Element
Theoretical Assumptions
The AP viewpoint is broad and holistic in nature, and includes intrapsychic,
interpersonal, relational and environmental factors (Dowd, 2003; Mosak & Maniacci, 2011;
Osborn, 2001; Sperry, 2003; Watts, 2000). Adlerian psychotherapy is concerned with early life
and systemic factors, including family, peer, and social dynamics (Shifron, 2010; Sperry, 2003,
2009). Adlerian psychotherapy views humans as embedded within the social context in which
one is raised and lives (Freeman & Urschel, 2003; Shifron, 2010; Watts, 2000). Difficulties are
viewed as social problems that involve human interconnectedness and a sense of belonging
(Freeman & Urschel, 2003; Shifron, 2010). Social interest is created first with the relationship
between mother and child, and continues through cooperation as children extend themselves
beyond this relationship (Freeman & Urschel, 2003). Children who are fortified with the
realization that early relationships are dependable, warm, and sensitive will develop
identification with family, peers, and the larger community in a healthy lifestyle (Freeman &
Urschel, 2003). Children’s perceptions of family constellation and their place within the family
system contribute to their personality development (Mosak & Maniacci, 2011).
Adlerian psychotherapy emphasizes that human behaviour is purposive, goal-directed,
and future-oriented, which is referred to as the teleological principle; therefore AP is anticipatory
in nature (Dowd, 2003; Sperry, 2009; Watts, 2000). Humans are conceptualized as active agents
from a dynamic and structural view, and have aspects that are known and unknown (Maniacci,
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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2003; Watts, 2000). Individuals are viewed holistically, creative, responsible, and moving
towards goals (Mosak & Maniacci, 2011; Sperry, 2009; Watts, 2000). Psychopathology in
individuals is viewed as forms of self-defeat or “basic mistakes” due to discouragement or
inferiority feelings rather than a‘sickness’ (Mosak & Maniacci, 2011; Watts, 2000). Central
values of AP are encouragement and democracy in therapy as well as in consultation and in
education (Sperry, 2003).
Cognitive therapy is mostly intrapsychic in nature, although it does allow for the
appreciation of behaviour in a social context and recognition of the role of early relationships in
schema (Beck, 2005; Dowd, 2003; Neimeyer). Core cognitive schemas direct behaviour and are
motivated by past consequences; therefore CT is consequential in nature (Dowd, 2003). The self
is placed at the centre of control in CT (Maniacci, 2003). Cognitive distortions and deficits are
the processes that influence pathology, perceptual errors, and faulty interpretations (Mosak &
Maniacci, 2011). Individual learning influences an individual’s cognitive system to deal with
perceptions, interpretations, and meaning of events (Beck & Weishaar, 2011).
Both AP and CT have similar assumptions about human nature that reflects an underlying
rational philosophy of mind and the ability of individuals to make choices (Shifron, 2010;
Sperry, 2003). Individual’s assumptions about self and the world govern motivation, behaviour
and attitudes, and are formed early in life; although individual’s may not be aware of these
underlying beliefs (Freeman & Urschel, 2003; Mosak & Maniacci, 2011). Adlerian
psychotherapy refers to early recollections as creating these assumptions, and CT refers to first
perceptual processes that integrate emotions and needs, to form these beliefs and schemas
(Freeman & Urschel, 2003). Cognitive structures are therefore the common element in creating
the AP lifestyle and the CT schema (Mosak & Maniacci, 2011). The notion of the unconscious
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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is addressed by AP through inferred concepts such as guiding fictions, lifestyle analysis, realm of
meanings and the teleological principle (Dowd, 2003). The unconscious in AP is what is not
understood, although it contributes to individual’s goals in addition to the conscious (Mosak &
Maniacci, 2011). Cognitive therapy has also incorporated some aspects of the unconscious in
terms of processing and knowledge in terms of implicit and tacit knowledge, and primal
thinking; although CT maintains that dysfunctional schemas are not deeply buried in the
unconscious (Beck & Wesishaar, 2011; Dowd, 2003).
The Descriptive Element
Human Nature
In AP, individuals develop their own life stories that organize the content of their
experience, and their personality is a unity or integrated whole (Neimeyer, 2003). Cognitive
organization, private logic, and perceptions contribute to the formation of convictions early in
life, and the development of a lifestyle in how they perceive life (Mosak & Maniacci, 2011;
Stein, 2008). Distortions and symptoms are selected as they are perceived as facilitating goals,
and compensations are attempts at safeguarding lifestyle convictions (Neimeyer, 2003).
Individuals are motivated by self-selected goals (rather than heredity and environment) and are
involved in an ongoing process of self-realization and self-actualization through life tasks
(Mosak & Maniacci, 2011). In AP, healthy individuals have developed social interest and are
committed to life-tasks through a useful and healthy lifestyle (Mosak & Maniacci, 2011; Osborn,
2001). The human potential and creative power are key elements of AP (Osborn, 2001; Stein,
2008; Watts, 2000).
Cognitive therapy views personality as shaped by interactions between innate disposition
and environment, and emphasizes the role in information processing in human responses and
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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adaptation that are crucial in individual’s lives and how they function (Beck & Weishaar, 2011;
David & Szentagotai, 2006). Individuals respond to situations cognitively, emotionally,
motivationally, and behaviourally through a set of schemas (Beck & Weishaar, 2011; Weinrach,
1988). In CT, early negative experiences are the developmental precursors for negative schemas
regarding the self, current circumstances, and the future; however, there is little recognition of
early life determinants including birth order, family constellation, or personality that are included
in AP (Sperry, 2003). Cognitive schemas contain people’s perceptions of self and the world,
goals and expectations, memories, and previous learning (Beck & Weishaar, 2011; Dowd, Clen,
& Arnold, 2010). Schemas that are strongly held are seen to be essential for individual’s safety
and well-being will be a more powerful and directing force within a person’s life (Freeman &
Urschel, 2003). Schemas are self-selective in an active and evolutionary process in which all
perceptions and cognitive functions are applied to new functions. Schemas are central to
psychopathology, and those schemas that distort reality, fail to fit new circumstances,
accommodate new structures, or create distortions would be maladaptive and considered
cognitive shifts or vulnerabilities and generate problems (Beck & Weishaar, 2011; Freeman &
Urschel, 2003; Dowd et al., 2010; Neimeyer, 2003). CT sees pathology as a consequence of a
number of factors that include learning history, biological, developmental, and environmental
influences (Beck, 2005; Beck & Weishaar, 2011). The individual is free to choose alternative
lifestyles and schemas in both theories (Beck & Weishaar, 2011; Mosak & Maniacci, 2011).
Process of Therapy
The main therapeutic focus in AP is lifestyle convictions, while schemas are the focus of
CT. Essentially these constructs comprise cognitive organization and perceptions of the
individual, and describe their convictions or beliefs about the self and the world (Sperry, 2003).
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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Both are dynamic therapies that help individuals listen and understand their thinking, and
appraise how thinking is influenced by lifestyle and schema. Both AP and CT examine how
individuals perceive self and their world, and experiment with different ways of responding to
alter negative affect, change their view of life experience, and behave more adaptively (Freeman
& Urschel, 2003). Differences between AP and CT are greatest in consideration of strategies
and technical implementation of the theories (Freeman & Urschel, 2003).
The therapeutic relationship in both AP and CT is a collaborative one (Sperry, 2003).
Cognitive therapy refers to the therapeutic relationship as one that involves collaborative
empiricism where the therapist and patient are co-investigators (Sperry, 2003). The therapist’s
role in CT utilizes warmth, empathy, and genuineness to guide corrective experiences (Sperry,
2003). Adlerian psychotherapy is also essentially an exercise of cooperation, and considers a
good therapeutic relationship to be a friendly one between equals (Sperry, 2003).
AP is psychoeducational, present-future oriented, and time-limited in its approach to
therapy (Watts, 2000). Cognitive therapy is a problem-focused, short-term, active, directive,
collaborative, psychoeducational model of psychotherapy (Freeman & Urschel, 2003; Weinrach,
1988). CT offers a high degree of structure in which the therapist takes a directive role in
treatment conceptualization, collaboration, and planning (Beck & Weishaar, 2011; Freeman &
Urschel, 2003). Cognitive therapy has a beginning, middle, and an end; with goals for each stage
that move from a symptom focus to a schema focus (Freeman & Urschel, 2003). Therapy
addresses schemas from the cognitive, behavioural, situational, and affective perspectives
(Freeman & Urschel, 2003). Interpretations are avoided in favour of Socratic questioning to
encourage individual’s self-efficacy and greater awareness (Freeman & Urschel, 2003). The
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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goal of CT is not cure, rather more effective coping; termination of therapy is accomplished
gradually to allow for ongoing modifications and corrections (Freeman & Urschel, 2003).
Context of Human Experience
Adlerian psychotherapy supports equality between gender, culture, and race (Mosak &
Maniacci, 2011; Watts, 2000). The social interest embedded with AP lends itself to community
and global social issues, and has made significant contributions to education, hospital, and
community therapies and programs (Mosak & Maniacci, 2011). Traditionally AP has
demonstrated a willingness to undertake treatment for any individual ranging from individual
and group therapy for a variety of pathologies (Mosak & Maniacci, 2011). The lifestyle
assessment used in AP may contribute to a sensitive understanding of an individual’s family
situation, values, interactions, social, cultural, and religious factors of development (Mosak &
Maniacci, 2011). This lifestyle assessment allows AP therapists to learn about the individual and
may provide a bridge between cultures (Mosak & Maniacci, 2011). The social nature of AP
offers a wide range of benefits to humanity and promise for addressing multi-cultural issues
(Stein, 2008; Watts, 2000).
Cognitive therapy is best suited for individuals in which problems can be delineated and
cognitive distortions are apparent (Beck & Weishaar, 2011). It has been widely used for a
variety of psychiatric disorders alone or in combination with another form of psychotherapy.
Traditionally CT was used on an individual basis, but is now used with couples, families, and
groups (Beck & Weishaar, 2011). CT is not recommended as the inclusive treatment for
individuals with some serious disorders and psychoses (i.e. bipolar, psychotic depression,
schizophrenia) or when individuals are not currently stable (Beck & Weishaar, 2011; Weinrach,
1988). Individuals who have an adequate sense of reality, cognitive abilities (concentration,
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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memory, etc.), and are motivated for therapy and change will benefit from CT (Beck &
Weishaar, 2011). CT may be used for individuals with different levels of income, education, and
background as CT begins with an understanding of the individual’s beliefs, values and attitudes
that exist within multiple contexts including culture (Beck & Weishaar, 2011).
The Prescriptive Element
Nature of Change
Adlerian psychotherapy can be described as optimistic in its assumption of the possibility
of significant human change (Dowd, 2003; Stein, 2008). The beliefs and convictions that a
person develops are what becomes the lifestyle, and direct individual’s movement through life
towards goals (Freeman & Urschel, 2003). The basic aspect of selfhood is a unifying core
construct, as is resistance and compensation (Freeman & Urschel, 2003). Adlerian
psychotherapy focuses on the various aspects of the social system and not the individual in
isolation, as such AP views individuals as constantly undergoing change as their cognitive
systems interact with their environment (Dowd, 2003; Freeman & Urschel, 2003).
Psychotherapy is considered one mechanism for potential creation of change within the context
of AP. Change requires that individuals gain insight into perceptions and awareness of basic
convictions and life styles (Neimeyer, 2003).
Cognitive therapists focus on the dual levels of symptom structure and underlying
schema structures, as the basis for understanding and changing individuals’ maladaptive patterns
(Sperry, 2003). Cognitive therapy shares an optimistic assumption about the possibility of
human change. CT aims to adjust the information processing and initiate positive change in all
systems through the cognitive system (Beck & Weishaar, 2011; Dowd et al., 2010). Cognitive
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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change occurs at several levels: voluntary thoughts, automatic thoughts, underlying assumptions,
and core beliefs (Beck & Weishaar, 2011).
Both lifestyles and schemas are developed early in life (Freeman & Urschel, 2003).
These similarities of examining the rules of life create a common conceptual framework between
AP and CT (Freeman & Urschel, 2003). Both AP and CT view the individual as an active
participant in the therapeutic process and that personality is a structure that can be changed
(Beck & Weishaar, 2011; Freeman & Urschel, 2003; Mosak & Maniacci, 2011). Both theories
support the idea that people have the capacity for change regarding their present and future life.
Goals of Therapy
Adlerian psychotherapy focuses on the uncovering and change process in a step-by-step
incremental fashion through encouragement, re-education, and reorientation and offers clear
guidelines on what constitutes optimal mental health (Sperry, 2003; Stein, 2008). Cognitive
therapy focuses on working to alter basic schemas. Cognitive assessment seeks to identify
individual’s basic mistakes, cognitive errors, and skill deficits; whereas AP is primarily assesses
by qualitative idiographic interview procedures to determine concerns, core convictions, and
goals. CT is problem-focused and diagnostic, relying on Socratic questioning to reveal faulty
assumptions. The goal of CT is to dispel the delusions and errors and biases in information
processing that characterize thinking and schemas through systematic instruction and approved
techniques (Beck & Weishaar, 2011; Neimeyer, 2003). The goal of AP is to follow an
individual’s concerns and heighten their awareness to achieve their goals through encouragement
and experimenting with new insights in practical life contexts that draw on strengths and
competencies in a solution-focused manner (Mosak & Maniacci, 2011; Neimeyer, 2003; Stein,
2008; Watts, 2000). Therapeutic tasks in AP encourage activation of social interest and the
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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creative power of individuals to develop new life-styles through relationship, analysis,
interpretation and insight, through verbal and action methods (Mosak & Maniacci, 2011; Stein,
2008). Re-education, learning “basic mistakes” in the cognitive map, and the process of
changing faulty social values are involved in AP (Mosak & Maniacci, 2011). Cognitive therapy
includes reality testing through continuous evaluation of personal conclusions to shift
information processing to a more neutral position as an immediate goal (Beck & Weishaar,
2011). CT treats dysfunctional schemas by deactivating them through modification of content
and structure, and the creation of more adaptive schemas (Beck & Weishaar, 2011). Both CT
and AP include in the therapeutic process the development of a collaborative relationship,
determining individual dynamics (lifestyle and schema assessments), re-education and
reorientation (Beck & Weishaar, 2011; Mosak & Maniacci, 2011).
Intervention Strategies
Interventions and strategies in AP target negative self-evaluations and feared objects and
move towards helpful environmental aspects and learning of greater self-control and mastery
(Sperry, 2003). Adlerian psychotherapy distinguishes itself by utilizing a wide array of
treatment tactics and techniques (Sperry, 2003; Watts, 2000). The method for eliciting early
recollections and lifestyle is an interview technique that is essentially projective and
straightforward (Sperry, 2003; Stein, 2008). Early recollections provide rich clinical material
regarding individual’s emotions and lifestyle in AP (Shifron, 2010). The approach to therapy in
AP tends to be global and idiosyncratic as opposed to a systemized series of techniques, or the
specific change methods of CT (Dowd, 2003; Stein, 2008). Traditional AP requires therapists to
be creative, inventing new strategies to fit individual’s uniqueness (Stein, 2008). Individuals are
encouraged to draw on assets, focus on progress, and overall therapy is a process of
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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encouragement not cures (Neimeyer, 2003). Some techniques in AP include: birth-order
analysis, acting ‘as if’, magic wand, ‘the question’, early recollections, task-setting, public
education, push-button technique, dream analysis, catching onseself, creating images, the “aha”
experience, and prescribing the symptom (Mosak & Maniacci, 2011; Neimeyer, 2003).
Cognitive therapy targets cognition through cognitive restructuring (Sperry, 2003).
Cognitive therapy has developed and adapted many treatment strategies. Some examples of
interventions include: questioning the evidence, reattribution, self-instruction, thought-stopping,
labelling of distortions, graded task assignments, role-play, relaxation training, challenging
dysfunctional thoughts, homework assignments, and skills training (Beck & Weishaar, 2011;
Freeman & Urschel, 2003; Ramsay, 1998). Recent extensions in therapy include integration of
cognitive and behavioural psychology in acceptance and commitment therapy and mindfulness
based cognitive therapy (Dowd et al., 2010). A number of specific assessment tools and
protocols for various psychiatric disorders and cognitive profiles has also been developed and
studied for efficacy (Beck, 2005; Beck & Weishaar, 2011). A distinguishing feature of CT is the
combination of cognitive therapies and other treatment modalities; such as Behaviour Therapy
and/or medication (Sperry, 2003). Some criticisms of CT are the complex techniques to elicit
schemas, and the development of treatment conceptualizations that has a required high level of
clinical sophistication (Sperry, 2003). Therapists in CT choose interventions that are based upon
theory and empirical findings.
The Evaluative Element
Confirmatory Research
Cognitive therapy has long stressed the primacy of observable objective data to be of
scientific interest and psychologically valid, and has been in the forefront of the empirically
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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supported treatments movement (Beck, 1993, 2005; Dowd, 2003; Dowd et al., 2010; Weinrach,
1988). Key theoretical concepts regarding patterns of thoughts and behaviour, cognitive profiles
for disorders has been a primary area of concern in CT; and the development of assessment
scales and the integration of other forms of psychotherapy all contribute to the ease and amount
of CT research (Beck & Weishaar, 2011; Weinrach, 1988). Research has tested both the
theoretical aspects and efficacy of CT for a range of disorders (Beck & Weishaar, 2011; David &
Szentagotai, 2006). Support for the negative cognitive triad and biased cognitive processing, and
dysfunctional beliefs as been found to operate in some disorders (Beck & Weishaar, 2011). The
efficacy of CT for depression, anxiety, panic disorder, social phobia, substance abuse, eating
disorders, marital problems, obsessive-compulsive disorder, post-traumatic stress disorder, and
schizophrenia has been demonstrated in controlled studies (Beck & Weishaar, 2011; David &
Szentagotai, 2006). The cognitive specificity hypothesis for different cognitive profiles in
psychiatric disorders has also been supported through research (Beck, 2005; Beck & Weishaar,
2011). Lower rates of relapse have also been supported for CT (Beck & Weishaar, 2011).
Little research has emerged regarding the evidence of AP which perhaps is due to a
reliance on case method examination and the AP notion that rejects causal factors in pathology
(Mosak & Maniacci, 2011). Adlerian psychotherapy has not articulated in detail how lifestyle
determines the individual and how the individual perceives, thinks, and remembers in a way that
would facilitate rigorous empirical or conceptual investigation (Maniacci, 2003). There is some
evidence that therapeutic relationships in AP and other approaches are equally effective, and that
the time-limited approach is both effective and efficient (Mosak & Maniacci, 2011).
Interestingly, the research on family constellation has been conducted by non-Adlerians which
may posit problems in connecting research to AP theory specifically (Mosak & Maniacci, 2011).
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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Studies of early recollections and the hypothesis of life goals, and the use of an Adlerian
personality inventory has had promising results, however; AP could benefit from additional
research to support its theoretical foundations (Mosak & Maniacci, 2011).
Advances in the cognitive neurosciences and research in narrative analysis have offered
considerable confirmation to the basic theoretical premises of both AP and CT in the areas of
schemas and lifestyle convictions (Sperry, 2003).
Conclusion
Adlerian psychotherapy and cognitive therapy have many elements in common that stem
from a focus on phenomenological psychology, a concern with how individuals view self and the
world, an emphasis of cognition on emotion and behaviour, and a collaborative approach to
therapy (Mosak & Maniacci, 2011). Differences are evident in technical delivery of theoretical
assumptions and the way in which each therapy focuses on change and growth. Sperry (2003)
identifies three basic constructs that are common between AP and CT. These constructs include
the therapeutic focus on lifestyle or schema, the cooperative and collaborative nature of the
therapeutic relationship, and the process of therapeutic change as re-education and reorientation.
Goals of both CT and AP consist of uncovering the individual’s lifestyles and schemas that
define life goals, to recognize and increase understanding of self, and establish more adaptive life
goals and behaviours (Freeman & Urschel, 2003). Both theories are optimistic in regards to
human potential and change, and provide useful therapies and techniques for both counselling
and educational psychology. I believe this examination of these two theories has potential
application for my future work as a school psychologist due to a deeper knowledge of their
theoretical elements and interventions will prepare me for understanding my own limitations and
possibilities when working with children, their families, and educators.
ADLERIAN PSYCHOTHERAPY AND COGNITIVE THERAPY
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