Introduction
Alfred Adler’s individual psychology, his approach to psychotherapy, starts with the assumption that all people suffer from a feeling of inferiority. Though most people outgrow this complex by developing healthy compensations through their career, family, and friends, many individuals turn inward and attempt to compensate with a private logic. This is a personal and unconscious “fictional” way of understanding self and reality to assuage feelings of inferiority. Reliance on private logic, however, impairs the individual’s ability to cope.
The concept of private logic underlies Adler’s understanding of psychopathology. Each disorder represents a different manifestation of private logic. For example, schizophrenics cope with the inferiority complex by believing their own private logic so thoroughly that they separate from external reality and live in a delusional world in which they are intensely talented and important. The schizophrenic’s neologisms (invented words) can be seen as evidence of creativity. On the other hand, the critical auditory hallucinations often experienced by schizophrenics can be understood as their inability to master their internal worlds.
An obsessive-compulsive patient has focused attention exclusively on some private issue of no real objective importance; in the person’s private logic, however, the issue has great importance, which may confer on the person him- or herself some special status. A paranoid person’s private logic allows the person to believe that he or she is the most important person in the world—why else would the Mafia, CIA, or Martians, for example, persecute the person?
Adler was a general practitioner before he became a psychiatrist. As a result, he saw all sorts of patients, most of whom did not define their various diseases and problems as mental. Psychosomatic, hypochondriacal, and somatoform patients illustrate what Adler called organ dialect, in which their bodies’ problems reflect their dysfunctional approaches to life. Such physical disorders (real or imagined) mitigate feelings of inferiority by serving as an excuse for failure or a plea for sympathy.
Depressed patients suffer from low self-esteem, which may include feelings of hopelessness, helplessness, and guilt. The private logic of such a patient may be inadequate to lift the patient out of the inferiority complex. Some depressed patients even seem to rely on their own suffering as a sham sense of merit: “I suffer, therefore I am worthy.” Personality disorders, delinquency, and crime may spring from the attempt to overcome feelings of inferiority through defiance and a facade of toughness rather than by making meaningful contributions to society. Prostitutes and chemically dependent individuals have unresolved inferiority complexes coupled with ambivalent attitudes toward dependency.
What unifies people with different kinds of mental disorders, according to Adler, is that their private logic gives them a mistaken understanding of themselves and the world. They persist in their dysfunctional behaviors and attitudes to preserve their sham sense of self-esteem, but at the price of effective coping. When Adler set out to diagnose a patient, he was less interested in labeling that patient with a specific disorder than he was in reaching a deeper understanding of who the patient was: It is not so important what disease the person has, but what kind of person has the disease. Therefore, Adler’s approach to diagnosis was more qualitative than quantitative, more tailored to the individual situation than systematic and structured. However, Adler had an arsenal of a half dozen techniques that he employed regularly.
Diagnostic Techniques
Adler’s first diagnostic technique was to observe the patient’s body language. This included not only the organ dialect of the presenting (physical) problem but also all sorts of nonverbal behavior: how the patient walked into the room, how he or she wiggled or slouched in the seat, the kind of handshake, the degree of eye contact, and so on. Adler once said that one can learn more from patients in a minute of watching them as if they were mimes (and ignoring anything they say) than one can in an hour of listening to them.
A second approach was the use of direct and specific questions, not only about the manifest symptoms but also about the patient’s background. Because Adler was convinced that the formative stage of personality development is the first six years of life, he was most interested in asking about early childhood (relations with parents, siblings, teachers, and others), as well as the patient’s lifetime history of medical problems. Adler believed that people are purposive creatures and that mental disorders (and possibly physical disorders as well) are means to the end of assuaging feelings of inferiority; he would sometimes directly ask his patients: “If you were cured of this disorder, what would happen to you?” The answer could reveal what the patient most feared—sometimes that he or she would have higher expectations of his or her own performance in the areas of interpersonal relations and career.
During his ten-year association with Sigmund Freud, Adler learned to use dreams as a way of exploring a patient’s unconscious. He believed that dreams were ways in which the patient rehearsed coping for waking life. The behavior of the dreamer reflected his or her real-life coping patterns and private logic.
One diagnostic technique that originated with Adler was the use of early recollections. Asking a patient to recall early experiences is a projective technique facilitated by the question “What is the farthest back that your memory can go?” Adler realized that such recollections would be hazy on the facts, but they would provide excellent vehicles for expressing the patient’s private logic. Such recollections, like the patient’s dreams or works of art, could be made the instruments of projective techniques, because they were rich with the markings of the patient’s personality. Additionally, the patient’s current mood would color the mood of the recollection, and conflicts currently on the patient’s mind would be projected into the story. As the patient improved over the course of his or her psychotherapy, the early recollections would become more positive in tone, reflecting more effective coping strategies.
Adler’s own character is evident from the earliest recollection of his childhood. Young Alfred was lying in bed, very ill, and overheard the doctor out in the hall telling his father that Alfred would not make it through the night. Adler recalls that he resolved to live and prove the doctor wrong, and eventually to become a doctor himself and fight death. The memory shows Adler’s tremendous willpower as well as a desire to overcome suffering.
Therapy Techniques
The first step in Adlerian psychotherapy was to use diagnostic techniques to comprehend the patient’s underlying private logic. The next step was to use empathy to develop the patient’s trust. (This was not to be allowed to evolve into a transference, or the transferring of emotions that a patient feels about other people onto the therapist treating the patient. Adler regarded transference as a childish dependency that would lengthen therapy and delay progress.) Then, patients would be led to identify their own guiding private logic and to realize that it was dysfunctional. This might be accomplished through various techniques, including direct confrontation of the patient’s misfocusing, abstractness, closed-mindedness, or excessive self-expectations. The last stage of therapy was the cultivation of the patient’s social interest. It involved encouraging the patient to venture forth into interpersonal relations and the world of work, emerging from the protective shell of the private logic and into the normal world’s challenges.
Unlike Freudian psychoanalysis, Adler’s approach to psychotherapy was directive. In addition to direct confrontation, Adler sometimes attempted to shake up the patient’s guarded structure of private logic by answering with the unexpected. When one patient called him at home at three o’clock in the morning to report some trivial symptom, she ended by apologizing for awakening him; Adler responded that he had been sitting by his telephone awaiting her call. She thus gained the insight that she was behaving like a pampered child. Another patient was obsessed with the idea that he had contracted syphilis. He had compulsively sought the attention of many physicians around Vienna, all of whom had reported no evidence of the disease. Adler immediately agreed with the patient that he did, indeed, have the dreaded disease, thus pushing the patient to accept the validity of the previous diagnoses.
A variant of this technique was developed by one of Adler’s protégés, Rudolf Dreikurs, who became one of the foremost apostles of individual psychology in the United States. Dreikurs used antisuggestion, urging patients who complained of an uncontrollable urge to give in to it and even practice it.
Unlike practitioners of classical psychoanalysis, Adler believed that therapy should be brief. Progress should be apparent in weeks, and termination should be possible in less than a year. Even after their sessions have ended, patients often continue to progress on their own. Unlike the humanistic and emotional therapies of the 1960s, Adlerian psychotherapy tries not to provoke abreaction (the expression of repressed emotions or thoughts) but to build the patient’s capacity for self-control.
Case Studies
Case studies of diagnosis and counseling with three very different patients can illustrate Adlerian techniques.
Jay
Jay, age forty, had a psychophysiologic disorder (an ulcer) and was mildly depressed. He attributed his problems to organizational changes at the small firm where he had worked for a dozen years. An outstanding engineer with an earned doctorate, an MBA., and numerous patents, Jay was convinced that his own efforts had helped the company grow and survive. As vice president for research and development, Jay advocated several new projects to get the firm’s sales moving again; however, the other major figures in the company largely ignored Jay’s plans and lurched from one budget-cutting scheme to another. Jay reported, “I am working eighty-hour weeks and worrying about the company all the time, but I just can’t get things moving.”
Jay’s body language included averting his gaze and slouching, which he attributed to Vietnam War wounds. On direct questioning, he said that he was an only child: His father, fifty-five when Jay was born, wanted no children and resented the “accident” of Jay’s conception, while his mother wanted more children and had to be satisfied with one son. Jay found that his mother was extremely encouraging and loving, perhaps spoiling Jay somewhat, while his father tended to ignore him except when some major accomplishment got his father’s attention. Jay’s guiding private logic was “I must work hard and accomplish something great; then I will get attention.” This drove Jay to earn his degrees, invent new products, and work hard at the company. His frustration came from the fact that the old formula was not working in his changing corporate culture.
Jay was most angry at his company’s chief executive officer (CEO) and board of directors, whom he regarded as intellectually inferior to him. The CEO was an incredibly charming (and handsome) MBA from the sales division who rejected most of Jay’s suggestions for new products but had few ideas of his own. Jay admitted feeling envious of the CEO’s sustained popularity, “especially considering that he has been running the company into the ground for seven years.”
The earliest childhood recollection that Jay produced was that he was watching his mother use the toilet, sitting down on the bowl with the seat up, and that Jay was telling her that it was dangerous to do it that way. When the therapist encouraged Jay to ask his parents what had really happened, Jay found out that he was toilet trained early, and because he would urinate on the floor (through the crack between the seat and the bowl), his mother encouraged him to sit down on the bowl. His mother recalled that Jay then developed a fear of falling backward into the toilet. The interesting thing about Jay’s recollection is that he inverted his role with his mother’s: He was the one warning her of the danger. Although a Freudian would say something about the Oedipus complex or anal fixation here, Adlerians are more concerned with the power quality of the interpersonal relations. Jay saw himself as the one who pointed out the danger; he was also very frustrated when the parental figures (the CEO and members of the board of directors) failed to heed his warnings.
Jay’s ulcer was a badge of merit, like his earned degrees or patents (“Look at how much I have suffered for this company!”). Sacrifice and success had been Jay’s strategy for winning the attention of his “parents,” but now that strategy was not working, so he had become depressed.
An intelligent man, Jay rapidly gained insight into his private logic. After four sessions, he had the following dream: “I am going through one of my rental houses, and I discover a room that I did not remember before—a living room that looked so comfortable, I just wanted to sit and read for pleasure.” Jay enjoyed the dream and agreed that it reflected his ongoing resolution of his problem. The dream represented new possibilities in Jay’s life: a more mellow lifestyle in which he saw less need to push himself on the fast track to maintain his self-esteem.
Jay terminated after eight sessions, having made plans to seek a position with another firm. After two years in the new position, Jay reported that he made almost as much money, had slightly less status, worked half as many hours, but had twice as much enjoyment. His ulcer and depression had not recurred.
Dan
Dan was also a forty-year-old engineer when he began counseling. He met most, though not all, of the criteria for narcissistic personality disorder (which is characterized by a grandiose sense of self, lack of empathy, and other criteria). Although a brilliant computer programmer, Dan had never obtained a college degree. He had never remained with one company for more than a year, and most of his work history had been with “job shops” or as an independent consultant. The presenting problem for Dan was that he had gotten his girlfriend pregnant, and he was ambivalent about getting married and becoming a father.
Direct questioning revealed that Dan was the third of four children. His grandfather had been a famous politician, his father was an attorney, and an older brother was an accomplished (and very wealthy) surgeon. Dan directly denied feeling inferior to these male family members, for he was convinced that he was smarter than any of them and had a broader range of knowledge. Dan’s private logic worked something like this: “Everyone else needs to get a degree and work in one career line for twenty years to be a success; I don’t have to, because I am more brilliant than anyone else. Finishing my education or sticking with one company would be an admission that I am not more brilliant.”
During the first few sessions, Dan used big words and attempted to impress the therapist with his knowledge of psychology. Although Dan claimed an inability to come up with an early recollection, he was able to remember a dream: “I am at a new restaurant, and I am given a table next to the kitchen; although the waiters go back and forth, they ignore me. Finally, I am given the check and realize that I do not have enough money.” After much resistance and intellectualization, Dan agreed that the dream exposed his dissatisfaction with his life: the fear that the honors and accomplishments of the other men in his family would pass him by and that he would be unable to achieve as much.
The cultivation of Dan’s social interest took eight months, but it did progress. He accepted a position (which he initially thought to be beneath his talents) offering stable employment and advancement. He married his pregnant girlfriend and reported himself to be satisfied with his role of father, although he found his wife to be a little too “naggy.” He did not try so hard to impress people with his intelligence.
Alicia
Alicia, a sixty-four-year-old widow of fifteen years, went into therapy complaining of depression and suicidal thoughts. Her feeling of inferiority was expressed primarily as helplessness and ruminations of guilt. Direct questioning and discussion engendered by dreams indicated that she still blamed herself for her husband’s fatal heart attack (“I cooked food that was too rich”), for her son’s accidental death (“I encouraged him to follow his heart and become a pilot”), and for her daughter’s upcoming marriage to a former priest (“I did not instill enough religion in her”). The function of her depressive illness was that her daughter was talking about delaying her marriage until her mother got better.
Her earliest recollection was that her parents would punish her for wetting the bed by making her sit in a tub of cold water; once, when her parents were out of the house, she wet the bed. When her parents returned they found her sitting in a tub of cold water, telling herself “You sit there.” This consolidated the identification of her private logic: “I am responsible for things that go wrong, and I must punish myself when things go wrong.”
Alicia developed the insight that her private logic was dysfunctional and her own depression was a manipulative, though effective, way of reacting to her daughter’s forthcoming marriage. The facilitation of social interest in this case focused on getting Alicia out of the enmeshed relationship with her daughter and more involved with activities outside the home, such as religion and charity work.
Unique Contributions
Most of Sigmund Freud’s patients were “hysterical” women (with what would now be called somatoform or dissociative reactions) from the middle and upper classes of Viennese society. Most of Adler’s patients were from the poor and working classes; they were not as articulate as were Freud’s patients, so Adler had to assume a more directive stance. Adler remained in general medical practice, treating all kinds of physical illnesses and injuries as well as mental problems. Although he probably saw more patients in any given month than Freud saw in his professional lifetime, the brevity of Adler’s counseling may have given the impression that he had only a superficial understanding of their problems.
Adler, like Josef Breuer, Carl Jung, and Otto Rank, broke with Freud and came up with an alternative to psychoanalysis. He redefined Freud’s use of dreams and interpretation of patient resistance as a reaction against the threat to the private logic that assuages inferiority feeling. Adler rejected transference as an artificial by-product of therapy and as a license for the patient to continue infantile behavior. He redefined the unconscious not as a repository of sexual energy, but as the limitations of consciousness to understand one’s own private logic.
Adler’s emphasis on empathy and appreciating the uniqueness of each individual patient can be seen as a precursor to the humanistic approaches (such as that of Carl R. Rogers) that surfaced in the 1950s and 1960s. Adler’s focus on the patient’s private logic and coping strategies was echoed in the growth during the 1970s and 1980s of the cognitive approach (exemplified by Aaron T. Beck and Albert Ellis).
Some of Adler’s ideas have been challenged by modern research. The correlation between birth order and personality, for example, is lower than Adler believed. Adler’s notion that healthy people have no need to dream has been challenged by evidence from sleep laboratories that all people dream several times a night, though they might not remember their dreams. Nevertheless, Adler’s specific techniques of diagnosis and therapy are useful tools that eclectic therapists often add to their collection.
Bibliography
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Adler, Alfred. Superiority and Social Interest. Ed. Heinz L. Ansbacher and Rowena R. Ansbacher. Evanston, IL: Northwestern UP, 1964. Print.
Carlson, Jon, and Michael P. Maniacci. Alfred Adler Revisited. Hoboken, NJ: Taylor, 2011. Print.
Dinkmeyer, Don C., and W. L. Pew. Adlerian Counseling and Psychotherapy. 2d ed. Columbus, OH: Merrill, 1987. Print.
Dreikurs, Rudolf. Fundamentals of Adlerian Psychology. 1950. Reprint. Chicago: Adler Institute, 1989. Print.
Grey, Loren. Alfred Adler: The Forgotten Prophet. Westport, CT: Praeger, 1998. Print.
Mozak, Harold H., and Michael Maniacci. A Primer of Adlerian Psychology: The Analytic-Behavioral-Cognitive Psychology of Alfred Adler. Chicago: Brunner, 1999. Print.
Oberst, Ursula E. Adlerian Psychotherapy: An Advanced Approach to Individual Psychology. New York: Routledge, 2014. Digital file.
Sommers-Flanagan, John, and Rita Sommers-Flanagan. Counseling and Psychotherapy Theories in Context and Practice: Skills, Strategies, and Techniques. Hoboken, NJ: Wiley, 2012. Digital file.
Watts, Richard E., ed. Adlerian, Cognitive, and Constructivist Therapies: An Integrative Dialogue. New York: Springer, 2003. Print.
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