Which kind of Adlerian Psychotherapy?
The power of different theoretical issues
underlying different clinical practices
The identity of nowadays Individual Psychology is not univocal. Among Adlerian therapists, a wide discussion about the future of Individual Psychology has taken place, according to some historical cultural factors and conditions:
1. Since Adler’s thought deeply influenced other psychological theories, although not always in explicit way, there’s a significant variety of relationship between Adlerian treatments and other psychotherapies.
2. After the first comprehensive descriptions of the psychotherapeutic technique by Alfred and Kurt Adler, Wexberg, Dreikurs, Künkel and Ansbacher, subsequent contributions of many authors, mainly from Austria, Germany, Switzerland, USA, France and Italy, highline different ways to develop Adlerian heritage.
3. So, now it’s possible to recognize many technical definitions of the treatment process, more or less structured: Adlerian Therapy, Classical Adlerian Therapy, Adlerian Analysis, Adlerian Psychodynamic Psychotherapy, Psychoanalytic-Oriented Individual Psychology Psychotherapy, Adlerian Cognitive-Behaviour Therapy, Constructivism-Oriented Adlerian Therapy, Adlerian Metaphor Therapy, Adlerian Family Counselling and Psychotherapy, Brief Adlerian Psychotherapy, Brief Adlerian Psychodynamic Psychotherapy, Self-Oriented Adlerian Brief Psychotherapy, Adlerian Psychodrama, many Adlerian Group Treatments, etc.
4. However, Adlerian Psychotherapies don’t only refer to different models of psychopathology and technique but also to different episthemological roots. Then, we can probably distinguish Adlerian therapists oriented toward Rationalism (objective psychology), or Constructivism (subjective psychology) or Phaenomenology (inter-subjective psychology).
5. Finally, though considering a lot of common and aspecific factors underlying different techniques and bringing about treatments outcome (e.g. early therapeutic alliance, therapist personality, therapist training and the natural course of disorders), perhaps we put forward to recognize three most important ways to define Adlerian Psychotherapy today, according to psychopathological, technical and episthemologic standards.
A useful example of these theoretical orientations about the psychotherapeutic technique is provided by the following papers from Gisela Eife (D), Serge Kutek (F) and Ursula Oberst (E), presented during the last Congress of International Association of Individual Psychology (IAIP) in Turin 2005.
6. Actually, these different episthemological and theoretical issues, underlying different clinical practices, are they related to different treatments outcome? Moreover, do the effectiveness of different Adlerian techniques of psychotherapy is capable of being valued independently from patient’s disorder, or rather specific techniques are requested in order to treat specific pathologies?
Treatments vary according to categorical or dimensional diagnosis, or else considering personality organization and socio-cultural conditions? Finally, the life meaning’s research can be reduced to a technique? Which are psychotherapists responsibilities while participating to the patient’s change?
7. In order to answer some questions above, it’s possible to set up specific process indicators differentiating each Adlerian Psychotherapy from other treatments. They could be referred to episthemological premises, mind’s theory, psychopathology, technique, clinical indications and objectives.
A short example of definition of some psychotherapeutic process indicators was also provided during the IAIP Congress in München (2002) and in Turin (2005) by Andrea Ferrero and SAIGA Institute of Research (I).
80538 München, Germany
Adlerian Essentials in Psychodynamic Therapy
Therapy in Individual Psychology is a psychodynamic psychotherapy derived from the psychodynamic model which Alfred Adler has developed in his book “The neurotic character” 1912 and completed in his later works by the concept of Gemeinschaftsgefühl.
The questions Dr Ferrero has asked us to answer accept the scientific definitions of contemporary theoretical models of psychotherapy as criteria to relate Individual Psychology to one of these models: psychodynamic, cognitive, interpersonal. I will try to deduce my criteria of psychodynamic therapy not so much from psychotherapeutic research but from Adler’s theory itself.
The Adlerian concept of psychodynamic comprises the following traits:
1. The inner life is controlled by an unconscious striving.
This is Adler’s fundamental principle for all human life: the striving towards a goal of superiority in order to overcome the deficiency of human existence. By an effort of the will for power a sense of authorship about the individual life is achieved. Since the origin and impact of this striving is unconscious, psychosomatic and is contained in the implicit memory the therapy can address this fundamental striving not only by conscious and directive interventions. The therapy is a cognitive method, but it is furthermore psychodynamic insofar as the implicit preconditions of the patient’s self-concepts, thoughts and beliefs are crucial. All this mental material, according to Adler, is ordered towards a hypnotizing goal. The different traits of the individual concept of self and life are concrete realisations of the lifestyle as an abstract principle. The specific contents of the life-style are explored in therapy, and the psychodynamic perspective interprets every single phenomenon as a step of the patient’s movement from his state of neediness to his idea of achievement.
2. This striving towards a goal forms a “Gestalt”.
A “Gestalt” cannot be divided into several parts. Every symptom and character trait, even every event in a patient’s life are interconnected, form an image like eyes, nose and mouth form a face, like the notes form a melody. To recognise the individual “Gestalt” it is important that the whole is preserved. You can even drop or miss the pitch of some notes and still recognise the melody. That means that in therapy you cannot comprehend the individual personality of the patient by compiling a full inventory of his symptoms or character traits but you have to intuitively sense the uniqueness of the person’s self and core. Adler sought to comprehend the uniqueness of a person by his mode of movement, his law of movement, his drama of life.
According to this perception of human individuality the Adlerian therapeutic approach has to be psychodynamic. The individual movement of the patient, his lifestyle, that is his dynamic, can be understood by artistic awareness, empathy, and intuition, in other words by the co-movement of the therapist. Life-style as “Gestalt” belongs to a completely different dimension than the details of clinical symptoms. The scientific way of thinking goes from the diagnosis of a disorder to the development of an autonomous self, from the particular to the whole. Adler’s approach is reverse: He suggests proceeding from an intuitively sensed whole.
In the treatment the emphasis lies on the patient’s experience and the processing of his experience. That means: In each gesture during the session Adler looks for the basic subjective source of the neurotic development. That can be for example an early traumatisation or an experience of object relation. Adler calls this starting point the “operation line of the patient” (Adler 1913 A, S. 48; 1913 a/1974 A, S. 60). In therapy Adler is anxious to track down and unmask this subjective source of the neurotic development “in all its expression movements and trains of thought” (Adler 1913 A, S. 48; 1913 a/1974 A, S. 60). In other words: The attention is not directly aimed at the goal analysis, but each expression of the patient in the “here and now” is understood as a manifestation of the unfavourable starting situation and the patient’s attempt to overcome it.
3. The life-style movement can be found in every phenomenon.
The therapeutic work proceeds along the analysis of single events. We work with childhood recollections, dreams, conflicts, problems in social and family life. Now Adler’s theory is that each of these phenomena shows the whole lifestyle in form of the ever repeated pattern. In his article “Individual psychological treatment of neuroses” Adler explicates his findings by means of two hypotheses: The first hypothesis assumes the emergence of the neurosis “under adversarial conditions” (Adler 1913 A, S. 46; 1913 a/1974 A, S. 58) and looks for patterns of experience and reactions in the childhood, which resemble the present life-style pattern. The second hypothesis analyses the pattern according to the above principle of overcoming these disadvantages. The common psychotherapeutic subjects, such as birth trauma, neglecting or pampering upbringing, abuse, oedipal conflicts, deal with these adversarial conditions. In the analysis of these circumstances the modern concepts of psychoanalysis, self-psychology, trauma therapy, etc. can be applied. The concept of mentalisation, paranoid-schizoid and depressive position, projective identification, and enactment are very useful if taken as descriptive assessments and not as theoretical dogmas. The Adlerian psychodynamic therapy makes use of all these instruments. We do not translate Adlerian concepts in order to integrate them into psychoanalytic theory, but in reverse we insert psychoanalytic descriptions into Adler’s lifestyle theory.
4. Adlerian psychodynamic therapy generates transference and countertransference.
As the lifestyle is created within the early parent and child relationship it is to be expected that the patterns of the early relationships are repeated in the patient-therapist relationship. We do not think that the contents of transference are aggressive or sexual wishes, but we hold them to be the modes of relatedness which were significant of danger, safety, and power. Thus the patients in therapy tend to view the therapist under the aspect: what will help them to save or sustain their self assertiveness. Transference in this aspect is not resistance but a means of coping with a would-be dangerous situation. Again this attitude comprises the lifestyle structure, i.e. the felt inferiority and the fictitious superiority in every instance. Thus, therapy creates new transference situations in the here and now of the therapeutic process. These experiences are structured by the old pattern, but they likewise are the beginning of transformation into new coping strategies. The intention of the patient’s lifestyle patterns is felt by the therapist in the here and now of the session. That is part of the countertransference. The therapist has to prove how he would – or unconsciously does – react to the transference. This demands a psychodynamic analysis not only of the patient’s unconscious goals but also of the therapist’s unconscious feelings and goals.
Adler’s treatment guidelines express a certain internal attitude of the therapist. I quote to a large extent directly from Adler (Adler 1913 A. S. 47; 1913 a/1974 A, S. 59): Adler avoids a superior position, aims at equality and cooperation. He lets the patient guide the therapist and puts “ostentatiously the hands into the lap”, because “the change in the personality of the patient can only be his own work” (Adler 1913 A, S. 49; 1913 a/1974 A, S. 62). It is only under the condition of such an empathic interpersonal attitude that the specific analytic interventions of Adler are therapeutically effective. The view of the life style protects Adler against regarding the general neurotic negativism as a sign of a bad character or as a personal offence. Adler also shows this tolerant and critically analyzing attitude towards himself; because “the “Gottähnlichkeit”, “the would-be similarity to god” occasionally plays tricks also on the therapist” (Adler 1913 A, S. 46; 1913 a/1974 A, S. 58).
As a summary here are
Some features of modern Adlerian treatment
1. Adlerian therapists emphasise emotional attunement and the analyst’s subjective immersion into the patient’s subjective experience.
We do not put the method before the patient. Therefore we decide according to the patient and to the stage of the therapeutic process whether we choose the couch or the vis-à-vis setting or whether we prefer a more directive or an interpretive intervention.
2. In principle Adlerians avoid acting as an authority and knowing better than the patient. This is due to our conviction that the process of therapy and insight is highly intersubjective. According to the structure of each individual’s will for self determination it would cause resistance if we tried to guide a person.
3. In the analysis of transference and counter-transference we first check real aspects and possible disturbances of the therapist-patient relation before interpreting early childhood models or life style patterns.
4. One aspect of psychodynamic therapy is the wish to compensate for past overstimulation or understimulation of the patient’s archaic self. Here the analyst is responsible for providing the conditions for new corrective emotional experiences. But she or he must not try to be the saviour.
5. Since every single feeling and action of the individual has a meaning and a goal in the social field the therapist is required to focus consistently on the intersubjective field in the relationship between patient and analyst, and have in mind that the patient’s emotional growth depends on the integration of new affective interpersonal experiences.
6. The intersubjective and interpersonal approach favours a constructivist model: So we do not believe in an objective knowledge about the patients’ inner states nor do we prescribe a would-be curative behaviour. Instead we discuss and interpret the patients’ own experiences and observe and reinforce the incorporation of new affective and relational experiences.
ALFRED ADLER AND HUMANIST PSYCHOANALYSIS:
A century ago the birth of psychoanalysis drastically changed our human conception of thought. We discovered to our amazement that our subconscious is at work at every moment of our existence. Our inner self is not merely what we are conscious of. It is deeply rooted in the dark areas of our being, in our personal histories whose origins date back to our ancestors who have left us their marks, if not their painful scars. One of the essential contributions of psychoanalysis is the opening it gives onto the mystery of life in the sense that life is not only the subject of study but the place where the human being comes to terms with himself in his encounter with the other.
Psychoanalysis raises the question of ethics. This is at the heart of our practice which cannot be conceived of without it. Ethics lie in the passage of the human being from its source to the place of emergence in the relationship of the dialogue. Its subject-matter is, what is to come, what is not yet known, what is to be found out rather than what is to be. Ethics is not an acquired fact in the sense that it is constantly being reinvented as its end- product is never totally achieved. It is to be found there where the human being reveals himself. It therefore belongs to the realms of mystery.
In these times dominated by pragmatism where humanity is losing itself in its quest for efficiency, productivity and profitability it seems to us that is is crucial to place the person of the human being in search of his destiny, at the heart of our preoccupations. The very future of psychoanalysis lies in the taking up of this challenge.
A Few Words About Humanism The Humanist movement, which reached its apotheosis in the 16th century, places the human person and individual dignity above all other values. Faith in mankind is a central element with the emphasis being put on man’s creativity and his freedom to choose between animality and divinity.
Humanism proposes a model of human perfection. This model is an ethical one for philosophers and moralists, an aesthetic one for artists and a social one for lawyers and politicians. This movement was inspired by ancient Greek and Roman literature.
Humanists express the idea that man is working towards intellectual, moral and religious self-realisation and self-accomplishment. They emphasize the upwardly-aspiring human soul which simultaneously encompasses both heaven and earth. Education therefore takes on great importance and its implementation can contradict traditional school learning. A child must be taught in a progressive, ongoing way from birth to adulthood and even beyond. It is in this way that humanity leaves its natural state to enter into the specific environment of mankind which is the world of culture (Erasmus, ‘The upbringing of children’, 1529 ).
Humanism defines the movement of the liberation of man through the rediscovery of intellectual and moral values enshrined in greco-roman literature and adapted to modern needs. It is also characterized by the spirit of ecumenism, by the love of people and the desire for balance and harmony between powers. Humanists are, by definition, reformers, as can be seen in the ‘In Praise of Folly’ by Erasmus(1511), More’s Utopia (1515-1516) and Rabelais’ Gargantua(1534).
In modern philosophical thought the word humanism has a different meaning. For Karl Marx it is a criticism of man’s alienation, whether it be religious or economic. Man’s ambition is to rediscover his alienated being. Modern humanism gives man his place as an individual free to act as he chooses.
The anti-humanism movement in contemporary philosophy is a criticism of classical and modern humanism. It unthrones man from his position as all-powerful leader. Paradoxically, anti-humanism is also a form of humanism as it confers on man his rightful place. Martin Heidegger, in his “letter on humanism”(1947), shows in fact that man’s dignity forbids him from believing himself to be the originator of his state. He is not the subject in the usual sense of the word but the “Guardian of the Being”, that is to say, the place where the being reveals himself and takes on meaning. Freedom, thought and language are the requirements of the Being who by making himself known to us calls us to him. It really is man who speaks as long as words are left free to come to him, for language is the “dwelling place of the Being”. In other words, man is not the centre of the world, another comes before him, that is the Being.
A CERTAIN VISION OF HUMANKIND
Alfred Adler’s vision of man is based on a few basic concepts around which a dynamic and coherent theory has been construed. As we will see in the course of this argumentation, Adler’s ideas adhere to the classical, modern and contemporary stream of humanism. The basis of Adler’s theory is the feeling of inferiority. This makes up the cornerstone on which the edifice of the personality rests. At the beginning of his career, Adler, based on the discovery of the vicarious nature of the internal balance of the body, became interested in the inferior state of the bodily organs and their psychic compensation. During the period of his collaboration with Freud, he published in 1907 a book on the inferiority of the bodily organs. ”The psychical compensation of the inferiority of the body organs”. This publication is the starting point of Adlerian theory as to the formation of the personality. At that time Adler attributed the inferiority complex to organ deficiency. He soon discovered that the inferiority is innately human and independent of any link with the organs of the body. Adler wrote of the inferiority complex : “this feeling conceived and developed naturally, resembles a painful tension which requires a solution to relieve it. This solution is not necessarily pleasant as Freud maintains, but it can be accompanied by a feeling of satisfaction…” Further on he adds : “We have to consider the history of mankind as the history of an inferiority complex and the attempts made to remedy the ailment…..This impulsion should not be considered to be morbid as ,on the contrary, it is orientated towards acquiring control of the outside world and not at all towards seeking a compromise situation or a restful state of inertia….Man is in a permanent emotional state of inferiority which spurs him on constantly, making him act in order to achieve a greater sense of security.” This last remark deserves to be looked into. In fact, not only does the inferiority complex, through its attempts at compensation, structure the personality, but it also structures the course of history by pushing humanity towards its own destiny. In this way Adlerian theory takes on a cosmic and transcendental dimension. Adler does not only bring us a therapeutic method but above all a vision of mankind that goes beyond its own individuality and which concerns the whole of history. This quotation by Adler confirms what we are putting forward : “Who could seriously doubt that the individual, so disadvantaged by nature, has been providentially provided with a powerful inferiority complex which propulses him upwards towards a higher state, towards security and conquest? This formidable and imposed revolt against an inherent inferiority complex which awakens and renews itself in every young child and toddler, is a fundamental part of human evolution”. Man compensates his inferiority complex by projecting himself towards a future goal of greater security whose role is to preserve his ideal of personality. This means preserving his internal cohesion while he constructs his life at the heart of a community. It is in this way that he works out a project which gives meaning to the ‘todayness’ of his life, sheds light on his history and guides his future.
According to Adler, security is an element that is constantly sought for and never found. It is through the fact of being sought for and not possessed that the quest for security becomes a strongly motivating factor. It is the answer to an unfathomable desire.
The idea of creative thought is essential to Adlerian thought. This means that the workings of the human psyche are not entirely determined by the surroundings in which they evolve. The individual has the freedom to direct his life in view of a finality guided by an intentionality. The person as an articulate subject creates his own life. What is more, there would be no possible therapeutic act without this creative freedom. There could be no creativity either without freedom. According to Adler, psychic phenomena do not belong to the domain of their causal explanation but need to be understood in terms of their orientation towards a finality. This concerns the question of how rather than why. The subject thus organises a directive fictional situation, a source of energy around which he constructs his way of being in the world which cristallises the interpretation that he makes of himself and his surroundings.
Adler shows that the subject creates himself in his relations to another. He calls Gemeinschaftgefühl ( a sense of community) the impulse towards the other without which we could not live, which makes us recognize our similarity and difference and which guides us towards a greater existence. The face of the other reminds us constantly of what we are in the process of becoming.. It is probable that the Gemeinschaftgefühl, which takes root in the early link with the mother reaches its most sophisticated expression in our love life. This relationship is the crucible of the process of humanization which continues throughout the history of the person and throughout the course of the history of mankind.
How can Adler’s ideas be linked to humanism? The same spirit pervades both of them. Man evolving towards a more human destiny is at the centre of Adlerian theory. The author has a more optimistic vision of man in that he sees him freely creating his destiny in a vast, rich and often tortuous compensatory reaction to his sense of original inferiority. The creative force which drives on this impulse is the desire to advance towards realising oneself fully. This is the road towards oneself in the meeting with our fellow creatures. Like Abraham whose story is told in the book of Genesis, we have to leave by the wayside certain protections which offer a false illusion of security to go towards an unknown place where we will find ourselves. The face of the other reminds us of our own mystery, a remarkable and necessary confrontation where our meaningful story is created .
We cannot think of psychoanalysis without asking the question of ethics which is at the heart of our practice. Ethics is at the heart of the transitional movement of the being into its relationship of dialogue. It is not acquired in the sense that it is always to be reinvented as its goal is never achieved. It is to be found there where the being reveals itself . It is thus of the order of mystery. The ethical intention in the psychoanaytical relationship, whose goal is the concern for the self-accomplishment and the greater freedom of the subject , is of the order of transcendence in so far as it opens onto a future that is rich in potential and onto a humanity in search of meaning . This implies faith in a humankind that is capable of goodness and love.
Adlerian humanism is not however, completely transferable to that of the 16th century although the foundations are the same : faith in man as a free creator of his own life, respect for the other and transcendence towards being more fully human, the important role of education. Adler describes in actual fact the perverse consequences of over compensation of the inferiority complex towards a condition of omnipotence.. His vision of man can be compared to that of Martin Heidegger who we mentioned earlier, as seen in this perspective, the person who is decentred from himself does not fall into the trap of suicidal omnipotence. Actually the philosopher’s intuition tells him that the Being precedes him. Man, says Heidegger, is the Da-sein, the Being there, that is to say the place where the Being materializes into thought.
The Being precedes the human, through whom he comes into being, by making him grow towards all that is more human. Adler expressed this idea by evoking the development of humanity towards a goal of perfection, seen from the angle of eternity. To say that man is preceded by something that is bigger than he is, which makes and moulds him whilst at the same
time giving him his place as subject, the unique place where the Being emerges, confers on him his full dignity by not placing him at the centre of the universe. We can guess the dangers of an upbringing whereby the child is the King with all the possible excesses leading towards the superiority complex. Man works his way, through the relationship with the other, towards what he does not know and which nontheless calls and questions him. This questioning makes sense insofar as it incites him to freely create paths of life which raise other questions; The danger lies in the temptation of a set response fixed into a dogma which leads only into immobility and death.
Adlerian psychology gives a coherent, dynamic and optimistic picture of man. Far from being a prisoner of his original frailty, this frailty enables him to grow and to realize his potential by projecting himself into the future.
The Adlerian man is free, although his freedom often leads him to build walls which close him in. He creates his own paths of life, which are an expression of his creative power, to go towards what he does not yet know but which he senses intuitively that he needs for his development. In Adler’s vision of things, man matures through his desires and is constantly moving towards what is not immediately comprehensible but which makes sense.
Adler tackles the human personality in all its dimensions, biological, psychological and social seeing in him a tireless seeker of meaning. He makes of him a being who is essentially spiritual. The danger in our technical society dominated by the clamour for productivity and pragmatism is not to hear the voice of our inner self calling us, the part which echoes our feeling of inferiority and which calls us to life. Forgetting the Being leads to dehumanization and death.
What is original about Alfred Adler in the domain of psychoanalysis, is his vision of the individual incarnated in the terrestrial and the biological and yet at the same time leaning beyond what is immediately apparent where the potentialities of his humanity are unveiled. Man’s suffering in the here and now of his present and of his history really makes sense when it is understood in relation to its constantly evolving existence. For these reasons Adler is part of the humanist current. It is essential today more than ever before to nuture oases of words where a person can start to listen to himself in a unique encounter with another who accompanies him for a time on the paths of life. This is, we believe, the mission of a humanist psychoanalysis.
Ursula Oberst, Ph.D.
Department of Psychology
Ramon Llull University
c/ Císter, 34
08022 Barcelona (Spain)
Email: [email protected]
Alan E. Stewart, Ph.D.
The University of Georgia
Department of Counseling & Human Development
402 Aderhold Hall
Athens, Georgia 30602-7142
Email: [email protected]
Social interest: Adlerian Psychology in the context of constructivist and humanistic theories
Alfred Adler’s Individual Psychology (IP) is traditionally considered a psychoanalytic or “in-depth” approach. Similarities with psychodynamic schools notwithstanding, this paper considers that Individual Psychology has many similarities with other theoretical orientations in psychology and psychotherapy, which appeared following the emergence of psychoanalysis and IP, for example cognitive psychotherapy, humanistic and constructivist theories. In this paper, we will discuss IP within the frame of constructivist and humanistic metatheory. We consider that this discussion is not a theoretical exercise of little practical significance. On the contrary, we think that it can have important implications for counselling and therapy practice.
The challenge of integration in psychotherapy
In order to survive and to develop along productive lines, all psychotherapy approaches have to face the challenge of two current tendencies in psychotherapy: that of integration with other theories and that of constructivist metatheory. The proliferation of different schools of psychotherapy on one hand and the notion that there is not one exclusively efficient technical procedure in therapy on the other has led to various attempts to integrate different approaches into a broader system. This effort after integration often poses the question of: what are the elements shared by diverse therapies that have been shown as effective strategies and techniques for change? There are many different perspectives among the scientific community; with respect to IP, the most important integration theories can be summarized by the following:
Purism represents the most conservative standpoint; for Adlerian Psychology, this would mean to preserve the theory “as it is” and to only maintain the classical tenets without admitting innovative, though theoretically consistent, features stemming from other approaches. Technical eclecticism represents a spurious picking out of what are considered the best (i.e. most effective) techniques of other therapies and applying them, under the name of Adlerian therapy. Theoretical integration would mean the fusion of Adlerian theory with other theories of and, in the extreme case, becoming a “hyphenated approach” (see Carlson, 2000), e.g. a “narrative-Adlerian”. Meta-theoretical integration (e.g. Neimeyer’s 1988 concept of Theoretically Progressive Integration) is an approach that proposes the integration of different psychotherapies that are epistemologically compatible in order to “cross-fertilize” each other. As we have outlined elsewhere (Oberst & Stewart, 2002), it is our position that Adlerian Psychology could be put under the umbrella of a specific meta-theory or epistemology, and benefit from the commonalities with other approaches, incorporate innovative techniques, and also inform these other approaches with respect to theory and practices.
Constructivism and post-modern thought
In the strictest sense, constructivism is not a psychology but an epistemic standpoint (i.e., a theory of knowledge), the basic postulate of which implies that it is the observer who actively construes his or her knowledge of the world and that reality can be interpreted in different ways. Realities (“facts”) are not discovered but rather constructed, in the sense that Reality is not the real world “out there”, but only our mental construction in terms of our previous experiences and meaning structures. And perception is not an act that allows us to know and to represent reality as Kelly (1955/1991) asserted, but it is a construing act. In this sense, our perception seldom gives us an objective image of an ontological reality (“the world as it is”), and thus, may rarely offer us the “Truth” about it.
Things become clearer when we compare constructivism to its traditional opposite, objectivism. Following Botella’s (1994) suggestion, we can use four criteria in order to compare both approaches: view of human being, view of the world, conception of human knowledge, and nature of justification. In the traditional objectivist viewpoint, the human being is viewed as reactive, passive, and determined by circumstances. Constructivism, alternatively, sees the human being as pro-active, goal-directed and in a dialectical relationship with the material and social environment. In objectivism, the world view is mechanistic and subject to causality, while in constructivism it is organicist and contextualist. The conception of human knowledge in objectivism has been described as accumulative fragmentalism by George Kelly (1955/1991), the first author who formally introduced constructivism in a complex psychological theory. This expression means that accumulating more and more knowledge facts about the world we gradually come to an ever better understanding of it. As a consequence, the nature of justification is the truth value of knowledge claims. Our knowledge of the world is valid if it is correct, objective and represents the Truth. According to Kelly, from the constructivist epistemic viewpoint, knowledge is not simply the progressive accumulation of isolated facts; instead, facts about reality can be weighted differentially to allow multiple, adaptive perspectives on the same person, event or object in the world. Kelly called this flexibility in meaning-making constructive alternativism. This means that there is also no absolute Truth about reality, but only the pragmatic value of our claims. In psychological terms this also means that, according to Kelly, the human being creates “constructs” (a concept very similar to Vaihinger’s and Adler’s “fictions”) and tries to adapt them to reality. The adjustment is not always perfect, but without these constructs (or fictions) we would be unable to find meaning in the world. Kelly writes:
“”We take the stand that there are always some alternative constructions available to choose among in dealing with the world. No one needs to paint himself into a corner; no one needs to be completely hemmed in by circumstances; no one needs to be the victim of his biography. We call this philosophical position constructive alternativism.”
(Kelly 1955/1991, p. 11)
Some theorists claim that constructivism is the most adequate epistemic position in a post-modern world. Postmodernism (or postmodernity) is considered to be the contemporary cultural condition of the developed post-industrial societies. It is thought that this postmodern turn is a consequence of the increasing dissatisfaction with the project of modernity with its rationalist concepts and its belief in the values of Enlightenment, such as Reason, Truth, Progress, Science, etc. In postmodernism, these beliefs in universal values have been replaced by a progressively relativist attitude: incredulity, ambivalence, and disbelief (Botella 1995). Postmodern thought has even been associated with a mentality of “anything goes”: any artistic, philosophical, political, etc. expression or standpoint is as valid as any other, none is better or preferable (MacKay, 2003). As basic themes of postmodern thought, Polkinghorne (1992) identifies four aspects: foundationlessness (as we have no direct access to reality, we have no sure epistemological foundation upon which knowledge can be built), fragmentariness (the real is a disunited, fragmented accumulation of disparate elements and events, so knowledge claims should be concerned not with the search of context-free laws, but with these local and specific occurrences), constructivism (knowledge is not a mirrored reflection of reality, but a construction built from cognitive processes), and neopragmatism: given the three other aspects, the only valid criterion for accepting a knowledge claim is not its correspondence with the inaccessible reality, but its predictive usefulness for guiding human action to fulfil intended purposes.
Adlerian Psychology as a constructivist theory
Several authors have already identified the constructivist elements in Adlerian Psychology or even re-define it as a constructivist theory (Master, 1991, Shulman & Watts, 1997, Oberst, 1998; Oberst & Stewart, 2002). Adler can be clearly considered as an early constructivist because of his reliance upon Vaihinger (1925). If we analyze Adlerian Psychology with respect to the four criteria of constructivist psychology, we can state the following: With his ideas of goal-directedness, social-embeddedness, pro-activeness, tendentious apperception, the creative self and, especially, the notion of fictions, Adler’s view of the human being as well as his world view can clearly be considered as constructivist. With respect to the conception of knowledge, the quotation above from Kelly (1955/1991, p.11) could stem from Adler. For Adler, individuals always have the possibility to respond alternatively to their experiences (Adler’s notion of the “opinion”). Adler suggests in a quite constructivist way:
“No experience is a cause of success or failure. We do not suffer from the shock of our experiences – the so-called trauma – but we make out of them just what suits our purposes. We are self-determined by the meaning we give to our experiences, and there is probably always something of a mistake involved when we take particular experiences as the basis for our future life. Meanings are not determined by situations, but we determine ourselves by the meaning we give to situations.”
(Adler, in Ansbacher and Ansbacher, 1955 , p. 208)
Thus, we have no problem in classifying the Adlerian conception of knowledge as constructivist.
Social interest and Constructivism
The difficulties arise when it comes to the nature of justification. As we have said, constructivism claims that there is no absolute Truth and therefore no universal ethical principle that could guide our moral acts. But Adler does seem to have the idea of the existence of a general principle, capable to distinguish true from false, right from wrong, psychologically healthy from neurotic: that of social interest. Whereas in the realm of personality, with its notions of fictions and fictionate goals, holism, proactivity, social embeddedness, etc., IP can be considered constructivist, the concept of social interest versus striving for superiority as criterion for mental health clearly does not contribute to the constructivist view of IP. For constructivists, the criteria of truth are only our own fictions, therefore Truth itself cannot exist. Instead of Truth, Botella (1995) proposes the pragmatic value of our knowledge claims, their predictive efficiency, their viability and fertility. In other words, their usefulness.
But Adler has a different concept of “usefulness”, which extends beyond individual knowing and individuals goals: while (neo-)pragmatic usefulness refers to the practical value of successfully helping individual to fulfil their intended purposes (Polkinghorne 1992), Adler’s view of usefulness refers much more broadly to social interest—orienting towards others to a greater or lesser extent. Adler’s meanings for useful (“nützlich”) extend more broadly to include those thoughts, attitudes and behaviours that are useful for an individual’s sense of adaptation and belonging within the community as well as for the community as a whole.
Thus, if “anything goes”, it may be acceptable and highly “useful” (pragmatic) to kill your hated mother-in-law and get away with her money. Constructivism has no answer to this dilemma, because it is epistemologically neutral to moral values. In a pragmatical sense, it may even be useful to behave in a prosocial way, because of the advantages that getting along well with other confers to the individual (because the other people may return you a favour or because it allows you to feel morally superior, etc.). In the Adlerian sense, usefulness has a connotation that goes beyond the utilitarian idea of “it’s good to be good, because then people will be good to me”. In its strictest interpretation, for Adler it is not acceptable to behave in a prosocial or altruistic way in order to be returned the favor or in order to feel “morally good”, as this attitude can be interpreted as an expression of striving for power and therefore, as a lack of social interest.
Some constructivist authors (e.g. Botella and Figueras, 1995) point out that constructivism confers to the individual precisely the personal responsibility for his or her acts, because the gradual loss of the existent legitimating systems (e.g. Philosophy, Religion, political theories) in postmodernity denies him or her the commodity and the security of a universally valid principle. In contrast, Adler does claim a universal criterion for truth. Some of Adler’s writings seem quite objectivist and Adler himself often seems convinced of being in possession of knowing what is right and what is wrong. Not only does he qualify some cognitions as “erroneous” (which implies the existence of a correct point of view), but also as “antisocial” cognitions (which implies even a value-laden standpoint).
In some of Adler’s publications, the concept of social interest sounds like an absolute, eternal, and universal truth (“the iron logic of social life”). In their interpretation, Ansbacher and Ansbacher (1956), Adler’s “absolute truth” only expresses his conviction that human beings in their interactions with other people need a reference point for their orientation, therefore social interest itself would be only a fiction, maybe the most pragmatic one, or, in Vaihinger’s terms: the most expedient error. Oberst & Stewart (2002) have discussed in detail how the concept of social interest could be interpreted or re-interpreted in constructivist terms; but the constructivist nature or not of social interest remains controversial.
Adlerian Psychology and humanistic theories
As Neimeyer and Stewart (1999) already stated, Adler’s view of the human being, his orientation away from an exclusive intrapsychic determinism, the adoption of Vaihinger’s idea of fictions, etc. allow us to see Individual Psychology as a first approximation of constructivism in psychology and psychotherapy. From Adler’s bibliography we can appreciate the evolution of his personal epistemological standpoint and learn how the young Adler (before World War II) struggled to free himself from Psychoanalysis and the medical model, and how the adult Adler elaborated an innovative and early constructivist theory. In contrast, the mature Adler (approximately from 1925 on) seems to turn his back on some of his theoretical constructivist standpoints for the sake of his humanistic and sometimes even missionary desire to improve the psychological conditions of mankind and the living together of people. Some scholars believed that this turn in Adler’s focus and energies stemmed from his experiences as a physician in the military during World War I (Hoffman (1994). Adler was intrigued by the possibilities of the potential welfare and wellbeing that could be achieved if the destructive capabilities of nations were redirected for communitarian purposes. Thus, at the threshold of postmodernism, Adler decided to take an alternate path from an otherwise direct course towards postmodernism to follow a course instead that embraced a humanistic world-view.
The similarities of Adlerian Psychology and humanistic theories have been pointed out earlier (Birnbaum, 1961; Ellis, 1970; Frankl, 1970; Maslow, 1979 Dreyfus & Nikelly, 1979; see also Oberst & Stewart, 2002). The humanistic aspects of Adlerian theory refer mainly to such concepts like the therapist attitudes, the view of people being inherently good, the idea of people striving for personal improvement and being endowed of a free will and therefore being responsible for their acts. And of course, social interest occupies a key role in this therapeutic approach. If we accept with Adler the idea of social interest as being a) the sense of life (“the goal of pursuing the welfare of all mankind”; Adler, 1933), b) the (unattainable) goal of perfection c) the ethical criterion for mental health, then the concept of social interest takes on a humanistic colouring.
Adler’s embrace of a humanistic orientation in discussing the nature of social interest as attitudes and behaviours that demonstrate care for others may seem to some psychologists as quaintly-dated in the face of economic globalization over the last decade. Unprecedented levels of competition exist among people, communities, corporations, and even nations as these entities seek positions of economic security or excellence. This climate in westernized cultures, especially in the United States with its emphasis on American exceptionalism, makes postmodernism or constructivism particularly appealing approach insofar as one’s epistemology can serve one’s motives. In this climate, it may seem self-defeating or strategically disadvantageous to think of another in a socially-interested way or to behave in a manner that makes one less competitive, and so forth. To encourage people (clients) to enact social interest in this manner may even smack of imposing the therapists’ value system on the client.
Although asserting the existence or iron logic of social interest may seem to transgress constructivist assumptions regarding the know-ability of the world and peoples’ abilities to act upon this knowledge in a value-free manner, it is a given that humans must coexist with each other. The reality that all people must respond to the social—to find a way to conceptualize and respond to other—cannot be dealt with by assuming that a real world or the truth (the social included) simply does not exist. Finding a way to peacefully and productively coexist not only has survival value but can be of immense psychological value as the vast literature on social support has documented (e. g., Folkman & Lazarus, 1980; Uchino, Cacioppo, Kiecolt-Glaser, 1996; Yoshikawa, 1994).
Social interest: humanistic by nature, constructivist in conception and essence
How can we reconcile the humanistic essence of social interest with a constructivist epistemic concerning the view of the world and of the human being? Social interest and its humanistic essence embrace constructivism in at least two ways: 1. in conceiving of what is a healthy and productive stance towards other people, and 2. how this conception is enacted behaviourally. With respect to the former, one need only to consider what may be of help or use to another (or to the community) and to consider what one wishes to accomplish (i. e., what are the goals or motives)? Each person can develop his or her own unique approach to these tasks of life without having to consult or uncritically adopt the value system of another. For any person’s particular conceptualisation of social interest, there may be many ways to enact it, again without adhering to a single objectively-defined standard. The viability of a person’s conception and enactment of social interest ultimately can be evaluated by how others receive it. Here, people may differ in how receive another person’s offering of social interest (i. e., assessing the act and attempting to discern motives). Overall, myriad ways exist for people to find some way of orienting towards others such that they experience the psychological benefits (i. e., health according to Adler) that attends a sense of belonging (Baumeister & Leary). According to Adler the individual exercises a high degree of creativity and uniqueness to construct a viable orientation towards others—there is no one right way to do this. What might this look like in therapeutic practice? First, although the therapist knows of the significance of developing social interest, the tentative and client-oriented approach characteristic of Individual Psychology precludes the therapist adopting a directive, objectivist stance in steering the client towards an outwardly-supplied objective. Instead the therapist helps the client to come to his or her own conclusions regarding the viability and adaptability of his or her interpersonal manoeuvres (i. e., attention-getting, attempting to dominate others, etc.). Many alternative approaches may be tried before the client discovers that moving towards others in a cooperative, interested, and benevolent manner yields results that are beneficial. In some cases the Adlerian therapist will test hypotheses about a client’s motives, behaviours, or the outcomes of interpersonal transactions. Suggesting alternatives along these lines does not necessarily render the therapy objectivist. Rather, the way in which the therapist’s experience of the client is offered, the process and timing components, affect how it is received and whether the client is more likely to experience it as an authoritarian prescription that precludes the client making his or her own meanings.
As a conclusion of the abovementioned challenges – integration in psychotherapy and constructivism – the authors of this paper want to present their personal perspectives on the metatheoretical assignment of IP:
We consider neither purism nor fusing with other theories as a valid option for the future of Individual Psychology. On one hand, we propose to preserve the Adlerian essence: its view of psychological problems (“neurosis”) as a consequence of the self-defeating attempts at compensating inferiority feelings by striving for superiority; its view of neurosis as an excuse for not adaptively and productively interacting with others (i. e., demonstrating social interest), which is a goal of the neurotic symptoms; its view of social interest as an innate positive tendency in the individual that has to be fostered in early childhood; its claim for fomenting social interest in therapy as an important element of healing. We propose to keep the Adlerian commitment to an ethical stance and to a humanistic attitude. On the other hand, we want to encourage Adlerian psychologist to explore the constructivist view of human being and of human knowledge and its many possibilities of applying new points of view and innovative therapy techniques stemming from other (constructivist) psychotherapies. In this sense, we also encourage the investigation with respect to meta-theoretical cross-fertilization in order to develop innovative and effective therapy techniques.
Beyond theoretical questions and practical applications in psychotherapy, Adlerians have always viewed Individual Psychology not only as a psychotherapy approach but also as a theory that can address the questions of social living. In this sense, we consider that the Adlerian commitment for an ethical stance may be a valid option for individuals, if we understand social interest in the sense a socially shared fiction and not an absolute truth somebody possesses by virtue of being an Adlerian psychologist. In this sense, social interest can represent a conscious and responsible act in face of relativism. Here is precisely a new opportunity for Adlerian Psychology within a constructivist and postmodern framework: to explore to which degree social interest can become an acceptable answer to the ethical questions that emerge from the postmodern condition.
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Authors’ note: part of this article is based on the conference given by U. Oberst at the 23rd Congress of the International Association of Individual Psychology. Torino, Italia, 26-29 de mayo de 2005. Which kind of Adlerian Psychology?: Adlerian Psychotherapy and its relation to constructivism and humanistic therapies.
Psychiatrist, Psychotherapy Unit – DSM ASL 7 Chivasso-Turin (I); SIPI Training Analyst; Director of SAIGA Institute of Research, Turin (I); Professor of Psychotherapy, Psychiatry Specialization School, University of Turin (I).
IAIP Chairperson of the Section Science: Theory and Research
e-mail: [email protected]
Adlerian Psychodynamic Psychotherapy (APP):
elements of theory of the technique
APP is an analytic-oriented medium and long term psychotherapy, whose standards were defined in Italy by:
- SAIGA Institute of Research – Turin
- Neurosciences Department – University of Turin
- Psychotherapy Unit – Department of Mental Health ASL 7- Chivasso, Turin
in cooperation with:
- Section Science: Theory and Research – International Association of Individual Psychology
1. Epistemological premises
APP refers to Individual Psychology as a “Network Model” (Rovera et al., 1984), characterized by the research of limits and conditions setting boundaries of human possibilities, nevertheless allowing the possibility of new individual’s experiences. This epistemological model is partly consistent with the hermeneutic paradigm (Sampaio, 1998) and some phenomenological and existential foundations toward sciences of living. The presence of others is rated as a constitutive element of the identity, conceived like a project (Witte, 1991).
The objectivity of scientific research is coherently defined as intersubjectivity, or “protocols criteria” (Agazzi, 1976).
2. Metapsychological premises
Individual Psychology is considered as one of psychodynamic theories of mind. The metapsychology underlying APP technique derives from an attempt to discuss it and bring Adlerian psychology up to date.
Three paradigms are particularly stressed (Ferrero 2004b):
Psychosomatic unity of the individual
The original Adler’s propositions concerning the psychic compensation of organic inferiority are useful to understand how the biological matrix of personality (temperament) and the psychosocial one (character) are involved in the identity definition (Fassino, Amianto and Ferrero, 2004)
The concepts of self-regulation and bond patterns are useful to describe how striving for power and social interest interact, both at social or intrapsychic level.
Actually, individual’s self-image and levels of self-esteem are strictly related to the internalisation of relevant social experiences. While experiencing significant human relationships, the individual build specific relations between his inner needs and instances by symbolic connections which are mainly unconscious.
3. Psychopathological premises
Accordingly with other psychodynamic schools, psychiatric symptoms can be generally conceived as symbolic expression of a primary trouble. Lack of primary tenderness (Brunner1982) and other defective experiences, regressive conflicts and defence mechanisms are considered.
As a difference from other psychodynamic schools, vulnerability to mental disorders is not conceived as only consequent to psychological processes. Also biological factors determine the instinctive responses before individual’s interpretation (psychodynamic coping).
So, the patient’s inferiority feeling has radically different meanings when it refers to the failing self-fragmentation of schizophrenia, to the identity diffusion of borderline personality, or to the sense of existential failure of neurosis. The categorical diagnosis has to be integrated by a psychodynamic assessment of personality.
Moreover, symptoms are ed to patient’s goals, abilities, cultural and social context.
4. Technical issues of psychotherapeutic process
Concerning the most general aspects of the technique, APP refers to the definition of the “analytic method” that Adler supplied for the first time in 1910 (quoted by Ansbacher, 1987) in the introductory speech at the meeting of the Viennese Psychoanalytic Society.
He sustained, in brief, that:
1)There is meaning in the unconscious mechanism (symbolic-fictional) that implies psychic phenomenon in the healthy and the sick, with respect to which:
2) it is important to trace the source of psychic material and to follow the phases of its evolution (continuity of the psychic life-genetic point of view);
3) intra-psychic relationship between the various needs and the instances of the psyche as well as relationships between the inside and outside worlds determine the dynamics of the compensatory manifestations that structure the psyche (dynamic point of view);
4) analyst’s recognition of the material comes from the communications of the patient, that is from his psycho-emotional life (organization of personality), characterized by a simple unconscious meaning and an extremely complex conscious elaboration, using refinement and psychological sensibility (empathy).
The “analytic method”, as defined by Adler, allows for the reconsideration of two dichotomies present in the various theories of technique of psychodynamic treatments (Ferrero, 2000).
The first dichotomy refers to the opposition between recognition therapy or therapy of the corrective emotional experience, that is between comprehension or attachment as a specific curative factor (Cremerius,1979; Migone (1995). This opposition has been important to the development of the theory of technique as much for Psychoanalysis as for Individual Psychology .
According to supporters of comprehension, cognitive factors (explanation, education, background) are those which mainly bring on the insight of the symbolic world.
According to supporters of attachment, the interpretation makes one feel something new through interest and comprehension.
One may consider, however, that unconscious symbolism, for Individual Psychology, is an expression of lifestyle, inasmuch as it expresses the most profound subjective connections that one wishes to assign to his own past experiences depending on his current mood and what he expects from the future.
Symbolic expressions contains both self-deception of the patient who receives, in a unilateral way, the things that are in harmony with his lifestyle, as well as the corrective mechanism of the hardened tendencies of consciousness. They also have a relational meaning and refer to a combination of social values, because the intra-psychic world of the individual is situated within an environment filled with pre-existing cultural references and standards (Rovera, 1988).
Then, symbol is seen as a creative fiction and the interpretation itself also represents a dual creative process, so that which the psychotherapist reads and proposes behind the content expressed by the patient is re-interpreted. At the time, (Rovera and Ferrero, 1983) we defined this circular event, which is simultaneously intra-psychic and relational, of disconnection and reconnection of meanings, with the term “translation manual”. So, it’s important to connect the symbolic motive that the patient brings to analysis to the near and far context that defines the relational distance (Adler, 1920). The aim is to be able to give it a new reading that is at the same time memory and birth of a new psychic life.
If the interpretation is considered as a research activity with the patient and needs to be considered as a complex communicative event, it cannot contrast with encouragement: comprehension does not exclude attachment, in fact, it provides for it. Relational space must be correlated to internal space for there to be insight (Datler, 1988).
The trusted accompaniment of the therapist in retracing the patient’s most painful experiences is one of the analytic functions of encouragement of the patient towards the intra-psychic world: it is an invitation to a new and creative encounter with the deficit (Seidel, 1985), with inferiority.
As Fassino (1984) remarked, it is an active process, earmarked by the intention to receive communication from another person, decoding his most significant emotions and symbolic expressions.
In this sense, I feel that today we must discuss active technique (Ferrero e Fassina, 2003) in analysis. I believe that the legitimization of acting-out and the manipulation of the relationship in order to overcome resistance is confusing. Analytic or therapeutic neutrality is not an attitude of discouraging abstention at the service of the analyst’s superiority; it is a “neutral” suspension of judgment over the content of the life experience, as a sign that the patient has erected to his own restrictive absolute truth.
The aim is to recreate the freedom of subjective expression of unconscious symbolism in the relationship. It is this that provides for the formation of new bond patterns (Rovera, 1988; Ferrero, 2004a), that is: of new configurations of requests and needs; new transference configurations; new social relationships; new configurations of existential projects (Ferrero, 2000).
A second dichotomy present in the analytic theories regards the expressive or supportive polarities to which the elements of the technical theory of a psycho-dynamically addressed psychotherapy or of analysis refer.
The conceptual and terminological scheme makes reference to the well-known Menninger Clinic Treatment Intervention Project. According to this research protocol, the therapist’s interventions can be divided into seven categories along a continuum. Interpretation lies at the expressive extreme, and moving gradually towards the supportive pole, confrontation, clarification, encouragement to elaborate, empathetic validation, advice and praise, and confirmation are all considered.
The basic idea is that every psychodynamic psychotherapy possesses all these elements, but it is possible to distinguish mainly expressive or supportive interventions according to the technique used, according to the principle: “be expressive when you can and supportive when you must” (Wallerstein, 1986), which tends to establish a precise preferential hierarchy in favor of the first. In truth, the current belief is that the more the pathology in question has defective roots, the more supportive the intervention will presumably need to be, and vice versa.
The mental arrangement of psychotherapy according to Adler (1928-1931), is defined in terms of patience, dedication and humble commitment, courage, openness towards others and willingness: how can we believe that interventions defined as supportive do not constitute a specific and decisive element of the analytic process on a par with expressive interventions, the most important of these being interpretations?
In reality, the element that should mainly characterize the expressive polarity of psychodynamic psychotherapy, interpretation, contains many supportive elements. In some pathological conditions (for example where the split and projected identification are not the specific subject of the interpretative intervention) a generic function of recognition, denomination and validation of the patient’s psychological balance can be performed; from the relational point of view, interpretation can contain prescriptive aspects (Rovera, 1964) which, instead of having a disorganizing effect, can have a containing effect.
On the other hand, supportive aspects can be a vehicle for approaching the unconscious. In the affirmations of Adler, the promotion of change is connected to a process of encouragement which depends on the fact that the psychotherapeutic couple has succeeded in gathering various crucial symbolic aspects of the communication as it develops. Interventions of empathic validation correspond, at least in the beginning, to an adequate reading of the needs of the organization of the personality aimed at not perceiving ambivalence (i.e. borderline, or narcissistic); they also constitute the basis for subsequent confrontations and interpretations.
More recent studies (Cooper,1992; Jacobs, 1990; Pulver, 1992) have also acknowledged how expressive and supportive elements are variably interwoven within the different parameters of the psychotherapeutic technique.
Consequently, the expressive-supportive opposition seems deceptive in some cases. Psychodynamic psychotherapy means, above all, choosing and distributing the interventions of the therapist according to the balance of the patient’s defenses (which manifest themselves during the session as resistances) and of his relational and social condition.
The diagnosis, therefore, will orient the therapist in a dynamic-structural sense, because it will provide a meaning for each element of the theory of the technique, destined either to respect and reinforce the defences of the patient or to provoke a change in the organization of the personality.
In this sense, the psychotherapist is not so much called upon to dose more or less expressive and supportive interventions as to recognize the conservative or mutative nature of the technique (Ferrero, 2000), in relation to a specific personality structure and to the specific psychosocial balance of the patient in every moment.
Unlike the approaches of non-psychodynamic psychotherapy, the evaluation is based on the quality of the patient’s unconscious opposition to change. This starts from “good reasons” for not wanting to change anything, since the unpleasant results of his attitude induced to him to seek help.
Nevertheless, each life experience possesses more than an intra-psychic reference: in the two-way communication that occurs during the session, the life experience refers simultaneously to a relational and social dimension.
Consequently, Adler wrote (Der Sinn des Lebens, 1933) that the patient needs to be placed in a condition of living an experience of friendship and given the chance to transfer his social feeling, reawakened in analysis, onto others.
This intra-psychic and, at the same time, relational process is described by many Adlerians as intersubjective (Ferrero, 1995), in accordance with the studies of Stolorow, Attwood (1994) and other psychoanalysts oriented towards to the Psychology of Self. The reciprocity of the change that takes place within the patient and the therapist and the influence of the therapist’s behaviour during the therapy are stressed. These changes do not only refer to transference and counter-transference, but also to how much positivity really can occur between one and the other, in the here and now of the session and in the span of the entire treatment.
The setting is also responsible for the specificity of helping patients by the psychotherapy.
This is more decisive in case of intensive therapy, devoted to the patient’s insight and creativity: it is necessary that the sessions are defined according to parameters of space and time and rules of communication.
In particular, the non intermixing of the life of the patient with that of the psychotherapist remains, in my opinion, the basic foundation for the possibility of intimacy. This avoids binding existential consequences which might invalidate any therapeutic aim.
Abstinence from acting-out and asymmetries of the relationship, in which the patient exposes his very life and the psychotherapist rarely explains himself and often indirectly, sets the boundaries of the relationship. These same boundaries however, also outline the potential of the very special relationship (also because it is a little unnatural ) that will develop during the treatment.
It is within this framework that the level of activity of the therapist is developed.
The psychotherapeutic setting may be distinguished from other settings which are appropriate for a multitude of therapeutic or rehabilitative projects which also use Individual Psychology for the comprehension of the patient’s problem as rationale of the clinical intervention.
5. Treatment’s development and phases
According to the original propositions of Rovera, Fassino e Angelini (1977), APP develops itself through three different aspects or phases (Ferrero, 2004). Each phase can repeatedly occur without a settled framework.
The first “explorative phase” concerns the acknowledgment of the life-style and the building of the therapeutic alliance with the patient. The second “transformative phase” concerns encreasing the insight and encouragement process. The third “prospective phase” concerns the analysis of the project. The fourth “ending phase” concerns the cognitive synthesis of the process, the elaboration of the transference, the detachment and the treatment end.
In every phase these goals are detailed also in terms of every single element of the therapeutic technique, according to expressive-supportive continuum settled by the Menninger Intervention Project.
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