Book Chapter ♦ 2013 ♦ Adlerian Counseling

CHAPTER 38 Adlerian Counseling Richard E. Watts Sam Houston State University counseling views humans as holistic, creative, and responsible beings. Persons are not static but forward moving toward subjective, self-created goals one's cognitive life-map known as the lifestyle or of life. Feelings of inferiority, a common thread all human beings, may lead to faulty convicabout oneself, others, and the world, which can suit in self-defeating behaviors. In the Adlerian view, ladjusted persons are not sick but "discouraged." is, they lack sufficient courage to face the tasks of The counselor's role is to encourage the person, to social interest, and to help the individual a socially useful style of living through relainvestigation, and action methods. Adlerians not interested in curing "sick" individuals, groups, communities, but in reeducating individuals and in ........... f-'Ul)'; society so that all people can live together as (Carlson, Watts, & Maniacci, 2006; Mosak & MaJmacc1, 2011). Individual Psychology, or Adlerian psychological theis often misunderstood as primarily focusing on however, Adler chose the name Individual (from the Latin, "individuum" meaning for his theoretical approach because he disdained reductionism. He emphasized that persons can. be properly understood as a collection of parts but • should be viewed as a unified whole. An integra'tion. of cognitive, existential, psychodynamic, and systemic perspectives, Adlerian theory is a holistic, · socially oriented, and teleological approach to understanding and workwith people. It emphasizes the proactive, form-givand fictional nature of human cognition and its role the "realities" that persons know and to they respond. Adlerian theory asserts that construct, manufacture, or narratize ways of experiencing the world and then takes . ｾｮ､＠ fictzons for truth. It is an optimistic theory affirm- t'At11Pr1an ing that humans are not determined by heredity or environment. Rather, they are creative, proactive, meaning-making beings, having the ability to choose and to be responsible for their choices (Carlson et al., 2006; Watts & Eckstein, 2009). Alfred Adler was born in 1870 in a suburb of Vienna. He attended public school in Vienna and then trained as a physician at the University of Vienna. Adler entered private practice as an ophthalmologist. A short time later he switched to general practice and then to neurology. In 1902, he was invited by Sigmund Freud to join the Vienna Psychoanalytic Society. Due to significant theoretical disagreement with Freud, Adler resigned from the Society in 1911. He spent the remainder of his life developing a personality theory and approach to counseling and psychotherapy so far ahead of his time that Albert Ellis (1970) declared, 'Alfred Adler, more than even Freud, is probably the true father of modern psychotherapy" (p. 11). Ansbacher and Ansbacher (1979) noted that after Adler's death in 1937, his name vanished for quite some time, except among small groups of Adlerians. Adler's ideas, however, were not antiquated. In fact, many were simply ahead of their time and have subsequently reappeared in contemporary approaches to counseling and psychotherapy with different nomenclature and typically without reference to Adler (Watts & Critelli, 1997). Prochaska and Norcross (2010), echoing Ellenberger (1970), noted that many of 'Adler's ideas have quietly permeated modern psychological thinking, often without notice. It would not be easy to find another author from which so much as been borrowed from all sides without acknowledgment than Alfred Adler" (p. 91). According to Corey (2005), Adler's most important contribution was his influence of other theoretical perspectives. Adler's influence has been acknowledged by-or his vision traced to-neo-Freudian approaches, existential therapy, person-centered therapy, cognitive- The Handbook of Educational Theories, pp. 459-472 Copyright© 2013 Information Age Publishing, Inc. All rights of reproduction in any form reserved. 459 460 R. E. Watts behavioral therapies, reality therapy, family systems approaches, and, more recently, constructivist and social constructionist (e.g., solution-focused and narrative) therapies (Carlson et al., 2006; Watts, 1999). PHILOSOPHICAL UNDERPINNINGS allows to enter, what it will attend to, what affects Will be aroused and what its response will be. According to Shulman (1985), the style of life contains certain ke elements. These include "a set of constructs about thy self, the world, and the relationship between the two· e construct about what the relationship should be· ｾ＠ il image of the ideal self; and a plan of action" (p. 246). n OF ADLERIAN COUNSELING The epistemological roots of Adlerian theory are primarily found in the critical philosophy of Immanuel Kant and the "as if" philosophy of Hans Vaihinger. Both Kant and Vaihinger emphasized the proactive, form-giving, and fictional character of human knowledge and its role in constructing the "realities" we know and to which we respond. Adlerian theory asserts that humans construct, manufacture, or narratize ways of looking and experiencing the world and then takes these fictions for truth (Adler, 1956; Ellenberger, 1970; Watts, 2003b; Watts & Shulman, 2003). Adler also acknowledged the influence of Karl Marx and Friedrich Nietzsche on his theory. From Marx and Nietzsche, Adler gleaned ideas such as the sociallyembedded and fictional nature of human knowledge, the abilities and creativity of human beings, the necessity of egalitarian relationships and equal rights for all persons, and the socially useful and socially useless political and power issues involved in human relationships (Ansbacher, 1977; Ansbacher & Ansbacher, 1956, 1979; Ellenberger, 1970; Watts, 2003b; Watts & Shulman, 2003). Social constructionist therapies, via the writings of poststructural/postmodern theorists such as Derrida and Foucault, also have roots in the philosophies of Marx and Nietzsche. Consequently, many ideas Adler gleaned from Marx and Nietzsche are among the prevalent themes discussed in social constructionist therapies. HUMAN AGENCY According to Adlerian theory, humans are proactive-versus reactive and representational-in regard to the development of the style of life. This idea is inherent in the Adlerian construct known as the creative power of the self or the creative self. In discussing the creative self, Adler (1913/1956) stated, Do not forget the most important fact that not heredity and not environment are determining factors. Both are giving only the frame and the influences which are answered by the individual in regard to his styled creative power (p. xxiv) .... The individual is both the picture and the artist. He is the artist of his own personality. (p. 177) Because of this creative power, people function actors authoring their own scripts, directing their actions, and constructing their own within a socially-embedded context. Humans struct the realities to which they respond. Aocord.it1lg:tl Carlson and Sperry (1998), the realization that uals coconstruct the reality in which they live and also able to "question, deconstruct, or reconstruct ity for themselves" is a fundamental tenet "not Adlerian psychotherapy but also of other psychotherapies" (p. 68). MOTIVATION ADLERIAN COUNSELING: PERSONALITY THEORY Adlerian counseling theory affirms that humans are characterized by unity across the broad spectrum of personality-cognitions, affect, and behavior. Style of life, the Adlerian term for personality, is a cognitive blueprint or personal metanarrative containing the person's unique and individually created convictions, goals and personal beliefs for coping with the tasks and challenges of living. The style of life is uniquely created by each person, begins as a prototype in early childhood, and is progressively refined throughout life. Shulman (1973; Shulman & Mosak, 1988) described the functions of the style of life: It organizes and simplifies coping with the world by assigning rules and values; it selects, predicts, anticipates; its perceptions are guided by its own "private logic"; it selects what information it According to Adler (1913/1956), the central directionality is toward competence or selt-nlasteiJ what Adler called striving for perfection or Adler's understanding of "striving" evolved over and he used various words like completion, perfection, and superiority to describe how seek to move from "the present situation, as and interpreted, to a better one, one that was rior to the present status" (Manaster & Corsini, p. 41). Striving for perfection or superiority is the vidual's creative and compensatory answer to normal and universal feelings of insignificance disempowerment, and the accompanying ｾ･ｬｩｦｳ＠ one is less that what one should be (i.e., feelmgs of riority). Thus, striving for perfection or the natural human desire to move from a negative position to a perceived positive .one. concept of striving or teleologicaV teleonomtcal . Adlerian Counseling seen in the writings of various personality including Kurt Goldstein, Karen Horney, Jung, Abraham Maslow, Otto Rank, Carl Rogers, Robert White (Jorgensen & Nafstad, 2004; Manas& Corsini, 1982). One can find similar ideas in varcontemporary theoretical perspectives, including '--".,.''rtlvist, evolutionary, and positive psycholo(Linley & Joseph, 2004; Mahoney, 2003; Rasmus2010; Snyder, Lopez, & Pedrotti, 2011). For in discussing happiness and human patenRyan and Deci (2001) described optimal functionand development as "the striving for perfection represents the realization of one's true potential" 144). IAL EMBEDDEDNESS Adlerian psychology is a relational theory. It asserts humans are socially-embedded and that knowlis relationally distributed. Adler stressed that cannot be properly understood apart from social context. Consequently, the Adlerian peran the tasks of life-love, society, work, self spirituality-is a strongly relational one. These of life address intimate love relationships, relawith friends and fellow beings in society, relationships at work, our relationship with self, our relationship with God or the universe (Carlet al., 2006; Watts, 2003a; Watts, Williamson, & 2004). Manaster and Corsini (1982) stated that human personality or style of life "evolves from a biological being in a social context creating a sense of self in the world in 1Which he (or she) acts" (p. 77). This social context of the includes both the cultural values of the child's culture of origin and his or her experiences within his or her family constellation, Adler's phrase for the operative influences of the family structure, values, and .dynamics (Shulman, 1985). Thus, "the child sees the world in general as paralleling his (or her) home environment and eventually the wider world on the basis of his (or her) initial perceptions" (Manaster & Corsini, 1982, p. 91). According to Mosak (1989), the cardinal tenet of Adlerian psychology is gemeinschajtsgefuhl. It is typically translated social interest or community feeling, and emphasizes the relational, social-contextual nature of the theory. According to Watts and Eckstein (2009), both community feeling and social interest are needed ｾｲ＠ Ｎｾ＠ holistic understanding of gemeinschaftsgefuhl; that IS, .community feeling" addresses the affective and motivational aspects and "social interest" the cognitive ｾｮ､＠ behavioral ones. Thus, true community feeling (I.e., sense of belonging, empathy, caring, compassion, ,acceptance of others, etc.) results in social interest (i.e., thoughts and behaviors that contribute to the common 461 good, the good of the whole at both micro- and macrosystemic levels); true social interest is motivated by community feeling. Interestingly, the development of Adler's community feeling/social interest appears to remarkably parallel the development of the attachment motive in attachment theory. Both are innate, both have to be developed in interaction with primary caregivers, and the degree to which both are present in an individual's life impacts the degree to which that person moves toward or against/away from fellow human beings (Peluso, White, & Kern, 2010; Watts, 2003b; Watts & Shulman, 2003). The tendency of human beings to form attachments (social feelings) was considered by Adler to be a fact of life. The striving of the human is always in some way connected with human bonding. Social interest is the expression of this tendency in a way that promotes human welfare. Some aspects of social interest are innate as in the infant's tendency to bond with its mother. However, social interest is a potential that must be developed through training in cooperation with productive endeavor. (Shulman, 1985, p. 248) A significant difference between Adler and other personality theorists regarding the aforementioned "striving" is the role of community feeling/social interest. Adler emphasized that striving for perfection or superiority occurs in a relational context and this striving may occur in either a socially useful or a socially useless manner. How one strives, and the manifest behaviors, are predicated on one's community feeling! social interest. Thus, in Adler's (1933/1979) mature theoretical formulation, striving for perfection means that one is striving toward greater competence, both for oneself and the common good of humanity. This is a horizontal striving that is useful both for self and others, seeking to build both self- and other-esteem. Striving for superiority means to move in a self-centered manner, seeking to be superior over others. This is a vertical striving that primarily pursues personal gain without contribution to or consideration of others and the common good. The manner one chooses to strive constitutes the Adlerian criterion for mental health: healthy development follows the goal of community feeling and social interest; maladjustment is the consequence of pursuing narcissistic self-interest (Manaster & Corsini, 1982). ADLERIAN COUNSELING: PRACTICE CONSIDERATIONS MALADJUSTMENT Adlerian counseling embraces a nonpathological perspective. Clients are not viewed as sick and in need of a cure. Rather clients are viewed as discouraged, as 462 R. E. Watts lacking the courage to engage in the tasks of living. As noted earlier, all persons struggle with feelings of inferiority-feelings of insignificance and disempowerment and the accompanying beliefs that one is less that what one should be. Thus, all persons are striving to move from a perceived minus position to a perceived plus. When persons creatively respond with courage and community feeling/social interest to the challenges of life and the concomitant feelings of inferiority, they are considered well-functioning. When they do not respond with courage, or if they respond without community feeling/social interest, they are discouraged and may develop what Adler called an inferiority complex. Persons with an inferiority complex are more concerned with how others perceive them than they are with finding solutions to problems. The superiority complex is a socially useless attempt to overcome an inferiority complex; it is a variation on a theme. Persons with an inferiority complex tend be passive and withdrawing. Persons compensating for inferiority feelings by the superiority complex tend to be arrogant and boastful. In both cases, the persons are discouraged but responding to overwhelming feelings of inferiority in different ways. Adlerians affirm that early existential decisions about self and the world-decisions made within and in relation to the first sociological environment, the family-form the core convictions of a client's style of life, his or her "Story of My Life" (Adler, 1931/1992, pp. 70-71). Many of the early formed convictions may have been useful for a child to belong and survive in his or her early environment but later prove no longer useful for productive living. The Adlerian position on maladjustment resonates with that described by narrative counselors Parry and Doan (1994): The experiences that bring individuals or families to therapy represent, in our view, a "wake up call" -a message that the stories that have formed them and shaped their emotional reactions have reached their limit. Although these stories made sense to children dependent upon adults, they are no longer adequate to help individuals handle present challenges effectively. It is now time for them to question the beliefs and assumptions that their stories have coded, in order to free themselves from the constraints upon capacities that maturity and responsibility have since made available to them. (p. 42) Adlerians also agree with Littrell (1998), a solutionfocused counselor, who stated that clients present for counseling because they are "demoralized" or "discouraged," not because they are sick and in need of a cure. Clients "lack hope .... One of our tasks as counselors is to assist in the process of restoring patterns of hope" (p. 63). Whereas Adlerians view clients as discouraged rather than sick, they thus view client symptoms from ｰｲｯ｡｣ｴｩｾ･＠ rather than merely reactive ｰ･ｲｳ｣ｴｩｶｾ＠ Accordmg to Mosak and Maniacci (1999), symptoms are selected and chosen because they are perceived as facilitating movement toward a desired goal. In other words, symptoms are not merely reactions to situations, but rather attempted solutions. CLIENT HESITANCY TO CHANGE Adlerian counseling espouses a "self-protective" view of client reluctance to change. According to Shulman (1985), the core convictions of a person's style of life are essentially unconscious and are less accessible and amenable to change. When these core style of life convictions are challenged (in life or in therapy), the client often responds by use of compensation. Adler used the word compensation as an umbrella to cover all the problem-solving devices the client uses to "safeguard" his or her self-esteem, reputation, and physical self. Adlerians view client reluctance to change in terms of the client self-protecting or safeguarding his or her sense of "self" (Mosak, 1989; Shulman, 1985). In addition, Adlerian counseling views client reluctance to change in terms of goal misalignment. According to Dreikurs (1967), Therapeutic cooperation requires an alignment of goals .... What appears as "resistance" constitutes a discrepancy between the goals of the therapist and those of the [client]. In each case, the proper relationship has to be reestablished, differences solved, and agreement reached. (p. 7) Thus, as Dreikurs noted, when there is between clients and counselors regarding the goals counseling, clients will be reluctant to engage in therapeutic process. It is the responsibility of ors to ensure that they understand and are with the goals of clients. THE fOUR PHASES OF ADLERIAN COUNSELING Adlerian counseling typically proceeds in a series logical phases. The four phases of Adlerian include: relationship, analysis/assessment, interpretation, and reorientation/reeducation. CLIENT-COUNSELOR RELATIONSHIP Adlerian counseling is commonly viewed as corl::.,, .....c of four phases. The first and most important entitled relationship. Counseling occurs in a context. The client-counselor relationship in Adlerian Counseling ｬｵｴＬ｡Ｎﾷｮｾｲ＠ Ｑ｜ｃ＼ｬｵｲ｡ｧｴｾｭ･ｮＢ＠ is variously described as cooperative, collabegalitarian, optimistic, and respectful. Success .the other phases of the Adlerian approach is predion the development and continuation of a strong relationship based on the aforemencharacteristics (Watts & Pietrzak, 2000). client-counselor relationship in Adlerian counis an encouragement-focused one. Encouragement incorrectly described in secondary source textas a "technique." Adlerians place strong emphaon developing a respectful therapeutic relationship, emphasize strengths and resources, and they are and future-oriented. These characteristics what Adlerians have historically called encour' or the therapeutic modeling of social interest 1999, Watts & Pietrzak, 2000). Thus, for Adleriencouragement is not merely a technique; it is an attitude and a way of being with clients. to Watts and Pietrzak, Adler (1956) and subAdlerians consider encouragement a crucial of human growth and development. This is true in the field of counseling. Stressing the of encouragement in therapy, Adler stated: in every step of the treatment, we must not from the path of encouragement" (p. 342). (1967) agreed: "What is most important in treatment is encouragement" (p. 35). In addition, stated that therapeutic success was largely upon "(the therapist's) ability to provide and failure generally occurred" due to inability of the therapist to encourage" (pp. 12-13). . Encouragement focuses on helping counselees become aware of their worth. By encouraging them, you help your counselees recognize their own strengths and assets, so they become aware of the power they have to make decisions and choices .... Encouragement focuses on beliefs and self-perceptions. It searches intensely for assets and processes feedback so the client will become of aware of her (or his) strengths. In a mistake-centered culture like ours, this approach violates norms by ignoring deficits and stressing assets. The counselor is concerned with changing the client's negative self concept and anticipations. (Dinkmeyer, Dinkmeyer, & Sperry, 1987, p. 124) As noted previously, clients present for counseling they are discouraged and, consequently, lack confidence and "courage" to successfully engage in tasks or problems of living. The process of encour. helps build hope and the expectancy of success clients. In addition to developing and maintaining a , collaborative, egalitarian, optimistic, and client-counselor relationship by active listenempathic understanding, and communicating Adlerians use encouragement throughout the process to help clients create new patterns of 463 behavior, develop more encouraging perceptions, and access resources and strengths. These skills of encouragement include, but are not limited to communicating confidence in clients' strengths, assets, and abilities, including identifying and drawing upon past successes; helping clients distinguish between what they do and who they are (deed vs. doer); assisting clients in generating perceptual alternatives for discouraging fictional beliefs; focusing on clients' efforts and progress; and communicating affirmation and appreciation to clients (Watts, Lewis, & Peluso, 2009; Watts & Pietrzak, 2000). ASSESSMENT Adlerians take a process view of individuals and, consequently, do not see assessment as an event that categorizes clients with static diagnostic labels. Assessment is ongoing, a continual process. Although they may or may not use many traditional assessment instruments and procedures, most Adlerians do some from of style of life analysis as a part of their assessment, either formally or informally. This assessment occurs in the second phase of Adlerian counseling-the analysis/ assessment phase-and usually includes eliciting information about the client's childhood family constellation and asking the client for early recollections, a projective assessment whereby clients share memories of specific childhood events. According to Adlerian psychology, early memories are seen as invented, selected, and altered by the individual to reflect his or her current attitudes and perspectives (Watts & Eckstein, 2010). There are several different ways for counselors to conduct a style of life analysis. Some conduct the interview in the first session, while others take 2-3 sessions to complete. Some interviewers utilize a standard format for the assessment, while others may collect the information more informally. However, Adlerian counselors typically include an interview that leads to a formulation or summary of the client's style of life (Watts et al., 2009). These interviews, based on clients' memories of their family-of-origin, have many common subject areas that are explored. Interviewers first ask about siblings and how similar or different clients were relative to their siblings. Next, clients are asked about the influence of their parents. This gives the counselor information about the client's perceived ordinal position (or psychological birth order), the family constellation (how each person related to other family members), and the family atmosphere (the overarching "mood" of the family). Next Adlerian counselors ask about the client's childhood physical development, sexual development, social development, and school experience. Counselors also ask about clients' local community and socioeconomic status to help determine their view of themselves and the family's position in the larger world (Watts et al., 2009). 464 R. E. Watts The final phase of the interview is the collection of early childhood recollections. Each early recollection elicited by the counselor should be a single, specific incident preferably occurring before the age of 10. Early memories are not coincidences; they are often projections. In large measure, what we selectively attend to from the past is reflective of what we believe and how we behave in the present, and what we anticipate for the future. Clients may have difficulty accessing or sharing these beliefs when asked directly; however, by asking for early childhood memories, counselors are often able to bypass potential safe-guarding measures by clients. Interviewers collect anywhere from three to eight early memories (Watts et al., 2009). INSIGHT/INTERPRETATION Having gathered all the aforementioned data in the analysis phase of Adlerian counseling, the counselor has sufficient information to create tentative hypotheses about a client's style of life (i.e., patterns of behavior, way of viewing himself or herself, and his or her world, etc.). Next the counselor presents these hypotheses to the client (the insight/interpretation phase of the Adlerian counseling process). In this third phase, the Adlerian counselor helps the client gain self-understanding and insight by communicating hypothesis interpretations of basic themes that are self-defeating and impede client growth (basic mistakes or misperceptions). The purpose of using hypothesis interpretation is to convey to the client that more than one explanation for behavior exists, and that the counselor wants to check out his or own hunches to see if they are on the mark. The phrasing of hypothesis interpretation is important. For example, after reviewing the style of life assessment, a counselor may start the interpretation process with, "Could it be that ... " or "Is it possible that ... " Interpretations phrased in this way provide the client an opportunity to let the counselor know if he or she is on the right track. Observing an "ah-ha" moment in the client's expression (recognition reflex), or a quick glance of disapproval in response to the interpretation, would be enough for the counselor to continue or move in a different direction. Phrasing interpretations as hypotheses is also an effective way to diminish resistance in the counseling relationship. The message to the client is, "I have something to offer you, but I acknowledge that you are the expert on you. I am interested if this fits with you or not" (Carlson et al., 2006; Watts et al., 2009) It is important at this juncture to clarify what Adlerians mean by insight and how the Adlerian notion of insight has been misunderstood and misrepresented. Insight, as understood by Adlerians, is more than mere intellectual assent to facts. Rather, it is "understanding translated into constructive change" (Mosak & Maniacci, 2011, p. 89). True insight results in useful changes in cognitions, affect, and behavior. Given that one of the phases of Adlerian counseling is entitled insighV interpretation, one might erroneously assume that Adlerian counseling asserts that insight always precedes any behavioral change. To the contrary, Adlerians assert that insight can be facilitated by encouraging clients to do something different. Adlerians often use action-oriented procedures common to the reorientation phase of Adlerian counseling (e.g., acting as if) in order to facilitate insight (Watts & Pietrzak, 2000; Watts, Peluso, & Lewis, 2006). REORIENTATION This last phase of Adlerian counseling is an actionoriented one in which clients are encouraged to put feet to their insight; that is, to make the constructive changes necessary to reach their desired goals. Clients particularly need encouragement in this phase of counseling because discouraged clients are often fearful of taking risks and making necessary changes. Clients must be encouraged and challenged to courageously engage the tasks of living and the relationships therein. This process of reorientation must, however, be done in a culturally sensitive manner; that is, it should be compatible with the client's context and culture. Adlerian counselors create and modify procedures and interventions so as to be culturally and personally attuned to their clients (Carlson & Englar-Carlson, 2008; Carlson et al., 2006). GOAL OF ADLERIAN COUNSELING The fundamental goal of Adlerian counseling is to help clients experience and assimilate new information that is discrepant with existing cognitive structures (style of life). Thus, clients have opportunity to create perceptual alternatives and modify or replace growth-inhibiting beliefs or personal narratives with ones that are growth-enhancing and thereby overcome overwhelming feelings of inferiority and discouragement. Adlerians seek to help clients develop the courage to engage in the tasks of living in useful and healthy ways. The ultimate goal for Adlerians is the development or expansion of clients' community feeling/social interest. Congruent with Adlerian personality theory, the goals of Adlerian counseling are relationally focused (Carlson et al., 2006; Watts & Eckstein, 2009). TECHNIQUES Adlerians are technical eclectics and multimodal in the sense that they use a variety of cognitive, behavioral, and experiential techniques for achieving the aforementioned goals of counseling. Adlerian ing is immensely flexible and, consequently, ｮＮｵｌ＼ｏﾻｾＭ Adlerian Counseling select techniques based on the unique needs and problems of each client or client system. That is not to say, however, that there are no techniques originally developed by Adlerians. Some have already been addressed in this chapter (encouragement, hypothesis interpretation, and style of life analysis and early recollections). The following are techniques original to Adlerian counseling commonly addressed in the Adlerian literature (Carlson et al., 2006; Mosak & Maniacci, 2011; Dinkmeyer & Sperry, 2000). The Question In using The Question, counselors ask a variation of the question, "How would your life be different if, all of a sudden, you didn't have this problem anymore?" There are variations for dramatic or explanatory purposes (i.e., "Suppose I gave you a pill ... " "What if you had a magic wand ... " "What if you woke up in the morning and no longer had this problem ... ," etc.). There are three possible responses to The Question. One type of response reflects a clearly psychogenic symptom, meaning that the cause and relief from the symptom are purely psychological in nature (i.e., malingering, avoiding responsibility, or trying to "save face"). The second type reflects a somatogenic symptom meaning that the cause and relief from the symptom are purely physical in nature (i.e., chronic pain, condition, or illness). The third type of response is a combination of the psychogenic and somatogenic responses. The Question forces clients to think in terms of a new reality where they are no longer burdened by their presenting problem. As a result, clients will either be unable to hide what their symptom is doing for them (i.e., the usefulness, or "purpose" of the behavior), or they will feel a sense of encouragement because they begin to understand that they have the resources and abilities to overcome the problem (Watts et al., 2009). Acting As If and Reflecting As If In the traditional approach to using the acting as if technique, counselors ask clients to begin acting as if they were already the person they would like to be; for example, a confident individual. Using this procedure, counselors ask clients to pretend and emphasize that they are only acting. The purpose of the procedure is to bypass potential resistance to change by neutralizing some of the perceived risk. The counselor suggests a limited task, such as acting as if one had the courage to speak up for oneself. The expectation is that the client Will successfully complete the task. If the task is unsuccessful, then the counselor explores with the client what kept him or her from having a successful experience (Watts et al., 2009). A more reflective approach to acting as if asks clients to take a "reflective" step back prior to stepping for- 465 ward to act "as if." The Reflecting As If process encourages clients to reflect on how they would be different if they were acting "as if" they were the person they desire to be. By using reflective questions, counselors can help clients construct perceptual alternatives and consider alternative behaviors prior to engaging in acting as if tasks (Watts et al., 2009). Catching Oneself This technique involves encouraging clients to catch themselves in the act of performing the presenting problem. Clients may initially catch themselves too late and fall into old patterns of behavior. However, with practice, clients can learn to anticipate situations, recognize when their thoughts and perceptions are becoming self-defeating, and take steps to modify their thinking and behavior. Catching oneself involves helping clients identify the signals or triggers associated with one's problematic behavior or emotions. When triggers are identified, clients can then make decisions that stop their symptoms from overwhelming them (Watts et al., 2009). Pushbutton This technique helps clients become aware of their role in maintaining, or even creating, their unpleasant feelings. The pushbutton technique has three phases. In phase one, clients are asked to close their eyes and recall a very pleasant memory, a time when they felt happy, loved, successful, and so on. Clients are to recreate the image in their minds in as specific detail as possible and strongly focus on the positive feelings generated by the pleasant memory. In phase two, clients are asked to close their eyes and recall a very unpleasant memory, a time when they felt sad, unloved, unsuccessful, and so on. As in phase one, clients are to recall the memory in all its clarity and, this time, strongly focus on the unpleasant feelings created by the memory. In phase three, clients are asked to retrieve another very pleasant memory, or return to the one used in phase one. Again, they are to recall the memory in specific detail and strongly focus on the positive feelings. After they have relived the pleasant memory and positive feelings, clients are instructed to open their eyes. They are then asked to share what they learned from the exercise. Clients usually make the connection between beliefs and feelings. If they fail to do so, counselors should help them understand that certain thoughts or images usually generate certain types of feelings. After making sure the connection is made, counselors then give clients two make-believe pushbuttons to take for a homework assignment. These pushbuttons control the images clients create. When they push the negative pushbutton, they create unpleas- 466 R. E. Watts ant images that negatively impact how they feel. When they push the positive pushbutton, they create pleasant images that positively affect how they feel. These pushbuttons affirm that feelings or behaviors are typically a choice. When they return for the next counseling session, the discussion with the counselor can focus on which button clients have been pushing, and the purpose of the choice (Mosak & Maniacci, 2011; Watts et al., 2009). VALIDATION OF ADLERIAN COUNSELING Watkins and Guarnaccia (1999) correctly noted that although there is a solid body of research literature supporting central constructs of Adlerian psychological theory, research studies on Adlerian psychotherapy are "few, far between, and hard to find" (p. 226). They suggested that Adlerian counseling research might benefit by the development of an Adlerian treatment manual that could be used in therapist training and as a guide to research. Watkins and Guarnaccia further stated, "Such manuals are not a panacea, and problems attendant to them must be borne in mind .... Yet they could be one viable means of allowing [Adlerians] to ... research the Adlerian therapy process, its effects, its outcome" {p. 227). The above comments by Watkins and Guarnaccia regarding Adlerian research remain valid. There is a wealth of research supporting specific Adlerian theoretical constructs but very little research specifically on Adlerian counseling. This not to say, however, that there is no research supporting Adlerian counseling. There is a wealth of current research that clearly, albeit indirectly, supports the process and practice of Adlerian therapy. For example, the results of the research described by Prochaska and Norcross (1994, 2003, 2010) are remarkably similar to the contemporary theory and practice of Adlerian counseling. For example, in their most recent study, Prochaska and Norcross (2010) asked a panel of 62 experts in the field to predict trends regarding the practice of counseling and psychotherapy for the near future. Prochaska and Norcross describe the results as follows: In terms of theoretical orientations, cognitive, cognitive-behavioral, multicultural, integrative, eclectic, and systems perspectives will thrive .... In terms of methods and modalities, the consensus is that psychotherapy will become more directive, psychoeducational, technological, problem-focused, and briefer in the next decade .... In terms of therapy formats, psychoeducational groups, couples therapy, and group therapy are seen as continuing their upward swing. The largest transformation is expected in the length of therapy. Short term is in, and long term is on its way out. (p. 519) Anyone familiar with the Adlerian approach will se the remarkable similarity between Prochaska and Nor-e cross's results and the contemporary practice of Adlerian counseling. Adlerian counseling is a psychoeducational, present/future-oriented, time-limited (or brief) and integrative and eclectic approach. Furthermore, the Adlerian model clearly integrates cognitive, systemic, and multicultural counseling perspectives, and solidly resonates with postmodern approaches (Carlson et al, 2006; Watts, 2000; Watts & Pietrzak, 2000). Thus, Prochaska and Norcross's results are consistent with and provide support for the fundamental tenets of Adlerian counseling. Perhaps even more remarkable is the significant common ground between Adlerian therapy and the research addressing the transtheoretical factors commonly identified in the successful psychotherapy outcome literature (e.g., Duncan, Miller, Wampold, & Hubble, 2010; Hubble, Duncan, & Miller, 1999a; Norcross, 2002, Prochaska & Norcross, 2003; Wampold, 2001). Prochaska and Norcross (2003) stated, Despite theoretical differences, there is a central and recognizable core of psychotherapy ... [that] distinguishes it from other activities ... and glues together variations of psychotherapy. The core is composed of common factors or nonspecific variables common to all forms of psychotherapy and not specific to one. More often than not, these therapeutic commonalities are not specified by theories as being of central importance, but the research suggests exactly the opposite. (p. 6) Adlerian counseling resonates enormously with common factors of successful outcomes and these common factors are indeed specified by Adlerian therapy as being of central importance. Below is a brief description of the points of common ground between Adlerian counseling and the common factors of successful psycho· therapy outcomes. EXTRATHERAPEUTlC/CUENT FACTORS According to the research literature, make the greatest impact on psychotherapy outcome.. These factors consist of what clients bring to therapy, and the influences and circumstances in clients' lives outside of it. . Adlerian therapy stresses the importance of ｡ｴ･ｮｾＭＺ＠ ing to what clients bring to therapy; especially the11'' strengths, assets, and resources. According to Adler (1913/1956), "The actual change in ... the patient only be his own doing" (p. 336). Consequently, pists must believe that clients have the requisite bilities to solve their problems (Mosak, 1979). Duncan, and Miller expressed (1999c) it well: Adlerian Counseling It is perhaps best summarized by Alfred Adler when he said he approached all clients, "fully convinced that no matter what I might be able to say ... the patient can learn nothing from me that he, as the sufferer, does not understand better" [Adler, 1913/1956, p. 336]. Approaching clients in this manner not only helps to combat discouragement and instill hope but, as Adler also noted, "make[s] it clear that the responsibility for ... cure is the patient's business" [Adler, 1913/1956, p. 336]. (p. 411) Relationship Factors Extratherapeutidclient factors have arguably had most significant influence on the results of psychoerapy. It is clear, however, that therapeutic relationfactors play a crucial role in successful outcomes, as crucial as client factors (Duncan et al., 2010). Keseat·cn indicates that positive outcomes in psychoare clearly related to therapist relationship and are essential for building and maintaining a therapeutic alliance. Of all the common factors, Adlerian counseling most resonates with the emphasis on the therapeurelationship. Adlerian counseling, a relational consists of four phases. The first and most phase, entitled "relationship," clearly focuses establishing a strong client-therapist alliance. Furand consistent with the positive outcome ｵＺｾ｡ｮＮ＠ literature, Adlerians believe that therapeutic in other phases of Adlerian counseling is prediupon the development and continuation of a therapeutic alliance (Carlson et al., 2006). Placebo, Hope, and Expectancy Asay and Lambert (1999) noted that clients come to therapy because they have lost hope; they are not only "demoralized about having problems" but also they "have lost hope about being able to solve them" (p. 44). They note that expectancy of success generated in therapy is powerful because it helps provide clients with hope that their problems can be solved. Mosak and Maniacci (2011) described the Adlerian therapeutic process in terms of "faith, hope, and love" (p. 83). That is, expressing faith in the client, developing the client's faith in himself or herself, and both the client and therapist having faith the therapeutic process; engendering hope in clients who present with varying levels of hope of improvement; and love, in the broadest sense, in that the client experiences a relationship with a caring, empathic, nonjudgmental, genuine human being. Adlerian counseling therapy is an optiｾｳｴｩ｣＠ and encouragement-focused approach to helpmgpeople. 467 Model/Technique Factors Prochaska and Norcross (2003) stated that there is a pervasive misconception suggesting that psychotherapists who align themselves with a specific theoretical orientation are dogmatic and antiquated and refuse to adapt their counseling practices to the needs and situation of the client. According to Hubble, Duncan, and Miller (1999c), affirming that common factors do account for the majority of change in psychotherapy does not mean that one must practice a '"model less' or techniqueless' therapy" (p. 408). Rather, they suggest that therapeutic models informed by the common factors attend to and implement what works to facilitate change. Furthermore, as Lambert and Barley (2001) suggested, improvement of psychotherapy may more readily occur when therapist increase their ability to relate to clients and tailor treatment to individual clients. The Adlerian model of counseling clearly includes a rationale, offers an explanation for client's difficulties, and possesses strategies or procedures to prepare clients to take some action to help themselves. In agreement with Hubble, Duncan, and Miller (1999b), Adlerian therapists "expect their clients to do something different-to develop new understandings, feel different emotions, face fears, or alter old patterns of behavior" (p. 10). Furthermore, Adlerians are technical eclectics and therapeutic chameleons. Different clients may require different therapeutic relational emphases and different therapeutic metaphors. Adlerian counseling allows the therapist to tailor therapy to the client's unique needs and expectations, rather than forcing the client into one therapeutic or technical framework. Finally, the validation of Adlerian counseling is supported by the large number of Adlerian concepts used by other counseling approaches (although typically not acknowledged), especially those with significantly more empirical support (e.g., cognitive-behavioral therapies). According to Corey (2009), a non-Adlerian author: It is difficult to overestimate the contributions of Adler to contemporary therapeutic practice. Many of his ideas were revolutionary and far ahead of his time. His influence went beyond counseling individuals, extending into the community mental health movement.. .. One of Adler's most important contributions is his influence on other therapy systems. Many of his basic ideas have found their way into other psychological schools, such as family systems approaches, Gestalt therapy, learning theory, reality therapy, rational emotive behavior therapy, cognitive therapy, person-centered therapy, existential therapy, and the postmodern approaches to therapy are based on a similar concept of the person as purposive, self-determining, and striving for growth. In many respects, Adler seems to have paved the way for current developments in both the cognitive and constructivist therapies .... A study of 468 R. E. Watts contemporary counseling theories reveals that many of Adler's notions have reappeared in these modern approaches with different nomenclature, and often with giving Adler the credit that is due him .... It is clear that there are significant linkages of Adlerian theory with most present-day theories. (p. 125) ADLERIAN COUNSELING: MULTICULTURAL CONSIDERATIONS The demographics of North America-especially in the United States-are changing rapidly. Thus, if any approach is to be considered a relevant psychotherapy for contemporary society, it must successfully address multicultural and social equality issues (Watts, 2000). With the increasing emphasis on multiculturalism, many counselors have been drawn to postmodern approaches because of their focus on the social embeddedness of humans and, consequently, human knowledge. Adlerians and Adlerian theory addressed social equality issues and emphasized the social embeddedness of humans and human knowledge long before multiculturalism became a focal issue in the helping professions. Adler campaigned for the social equality of women, contributed much to the understanding of gender issues, spoke against the marginalization of minority groups, and specifically predicted the Black Power and Women's Liberation movements (Ansbacher & Ansbacher, 1978; Dreikurs, 1971; Hoffman, 1994; LaFountain & Mustaine, 1998; Mozdzierz, 1998; Watts, 2000). In addition, Adlerian theory played an influential positive role in the outcome of the historic Brown v. Board of Education decision of May 17, 1954: Kenneth B. Clark headed a team of social scientists who called on Adlerian theory to explain the need for equality in American society. Their argument against separate-but-equal schools swayed the highest court in its decision that ruled in favor of the plaintiffs. (LaFountain & Mustaine, 1998, p. 196) Adlerian psychotherapy is clearly relevant for working with culturally diverse populations in contemporary society. According to Gerald Corey, the Adlerian approach is "certainly compatible with many of the macrostrategies for future delivery of service to culturally diverse populations" (as cited in Sweeney, 1998, pp. 33-34). Arciniega and Newlon (1999) noted that the characteristics and assumptions of Adlerian psychology are congruent with the cultural values of many minority racial and ethnic groups and affirm that the Adlerian therapeutic process is respectful of cultural diversity. Adlerian therapy goals are not aimed at deciding for clients what they should change about themselves. Rather, the practitioner works in collaboration with r1 ents and their family networks. This theory ｯｦ･ｲｾ＠ pragmatic approach that is flexible and uses a range ｾ＠ action-oriented techniques to explore personal problems within their sociocultural context. It has the flexi｢ｩｬｴｾ＠ to ?eal both ｾｩｴｨ＠ the ｩｮｾｶ､ｵ｡ｬ＠ and the family, making 1t appropnate for raoal and ethnic groups. (p. 451) Ｐ The Adlerian psychology and psychotherapy literature addresses a wide range of multicultural issues including culture, ethnicity, gender, racism, sexual orientation, and social equality. A rapidly growing dimension of multiculturalism includes attention to and appreciation of the role of religion or spirituality in the lives of clients. The field of counseling and psychotherapy has made a 180-degree turn, from a position of disdain and avoidance, to one appreciating the influence of spiritual issues on cognition, emotion, and, ultimately, behavior. Historically, most systems of psychology have had either a neutral or negative position toward religion and spirituality. Adlerian therapy, however, has been quite open to addressing religious and spiritual issues. The topic is addressed somewhat regularly by authors in the Journal of Individual Psychology (e.g., Mansager, 2000). According to Manaster and Corsini (1982), "the most common Adlerian position toward religion is positive, viewing God as the concept of perfection .... For Adler, religion was a manifestation of social interest" (p. 63). Mosak (1995) notes that 'Adler's psychology has a religious tone. His placement of social interest at the pinnacle of his value theory is in the tradition of those religions that stress people's responsibility for each other" (p. 59). Mosak mentioned that when Adler introduced the concepts of value and meaning into psychology via his 1931 book What Life Should Mean to You, the concepts were unpopular at the time. The cardinal tenet of Adlerian theory is social interest, and Adler equated it with the mandate to "love one's neighbor as oneself" and the Golden Rule. Furthermore, Mosak identifies spirituality as one of the five major tasks of life: Although Adler alluded to the spiritual, he never specifically named it. But each of us must deal with the problems of defining the nature of the universe, the existence and nature of God, and how to relate to these concepts. (p. 54) APPLICATIONS Adler addressed the application of Adlerian ｰｳｹ｣ｨｾｬﾭ ogy via his writings, lectures, and demonstrations wtth an impressive array of problems and settings .. He addressed counseling with at-risk children, espeCially Adlerian Counseling those struggling with delinquency; woman's right and gender equality; adult education; teacher training; community mental health and the establishment of family counseling and child guidance clinics; experimental schools for public school students; and brief counseling and psychotherapy. Because it is a strength-based, growth model, as opposed to a medical model, Adlerian counseling is widely applicable to many areas of people helping. Adlerians have developed useful models for teacher education and classroom management based on the principles delineated by Adler and his foremost student, Rudolf Dreikurs. There are many Adlerian-based child and family guidance clinics throughout the world and most of the leading parent education programs and literature are based on Adlerian principles (e.g., Systematic Training for Effective Parenting, Active Parenting, Positive Discipline, Raising Kids Who Can, etc.) and Adlerians have also developed couple-enrichment programs (e.g., Dinkmeyer & Carlson, 2003). In the family therapy literature, Adler is often mentioned as the first systems-oriented theory. In the 1920s, Dreikurs began using Adlerian principles in group therapy and Adlerian group therapy has remained an important counseling modality among Adlerians. Dreikurs was the first therapist to use group therapy in private practice. Because Adler and his colleagues maintained 28 child guidance clinics in Vienna prior to World War II, and because of the success of Adlerian-oriented parent education materials, some may assume that Adlerian counseling is only useful for working with children. This would be an unfortunate assumption. Adlerian counseling is used in a wide variety of formats and with diverse client populations and problems. Adlerians practice with individuals, couples and families, in group counseling settings, and career/employment counseling settings, as well as others. The client problems addressed by Adlerian counselors and authors range from normal developmental struggles through the various conditions described listed in the Diagnostic and Statistical Manual published by the American Psychiatric Association (Mosak & Maniacci, 1999). 469 may need to address. First, Adlerian counseling emphasizes choice and responsibility. Adlerian counselors must take into consideration the role and impact of oppression on client choice and oppression when working with clients from minority populations. Second, some culturally diverse clients may be uncomfortable with the personal and family questions Adlerians often ask in securing the personal and family information during the assessment phase of counseling. Adlerian counselors may need to gather the information more informally using a brief questionnaire and interview techniques to obtain information. Third, the Adlerian model is based on principles of democracy and egalitarianism. Clients from cultures that view counselors as experts, however, come to counseling with a strong desire for structure and direction; they want the counselor to advise them regarding decisions they must make. In sum, Adlerian counselors may need to adapt their style of counseling to be maximally effective with culturally diverse clients. As noted earlier, Adlerians tailor treatment to clients' needs and contexts, a particularly useful idea when working with culturally diverse clients (Carlson & Englar-Carlson, 2008). Finally, as noted earlier, direct research supporting Adlerian counseling is limited. Although there is an exponentially growing body of research in support of Adlerian theoretical concepts, more research addressing the effectiveness of Adlerian counseling would be very useful. Given that Adlerians have historically preferred an idiographic or case study method, the recommendation by Edwards, Dattilio, and Bromley (2004)that clinical practice and case-based research be included as a significant contributor to evidence-based practice-may be of particular interest to Adlerians. Similarly, the burgeoning qualitative research methodologies may also prove useful for studying Adlerian psychotherapy. Whatever methodologies chosen by researchers, Adlerian counseling will benefit from additional research. RECENT STUDIES USING ADLERIAN THEORY CRITIQUE OF ADLERIAN COUNSELING Adler focused more on helping people by counseling practice and training others than on developing a formal and systematic theory. His writings, therefore, are sometimes difficult to read (especially those translated from German). Adler seldom wrote for professional audiences and many of his writings were notes transcribed from his lectures to lay audiences. This often gave the sense that his ideas were simplistic and unsystematic (Carlson et al., 2006; Mosak & Maniacci, 1999). Regarding work with culturally diverse clients, there are several potential issues that Adlerian counselors Watkins (1982, 1983, 1986, 1992, Watkins & Guarnaccia, 1999) provided excellent summaries of Adlerian research over the three decades immediately preceding the twenty-first century. In recent years, there has been exponential growth in the Adlerian research literature and discussion of this research is beyond the present scope; however, immediately below are brief descriptions of three recent studies investigating Adlerian theory and practice concepts. Peluso, Stoltz, Belangee, Frey, and Peluso (2010) conducted a confirmatory factor analysis of the BASIS-A inventory. The purpose of the study was to test the 470 R. E. Watts five-factor model of the BASIS-A using confirmatory factor analysis. The study's sample included 917 participants from three southern and one northern university locations in the United States. According to Peluso et al., the BASIS-A asks respondents to report early childhood memories and classifies responses to style of life themes (belonging/social interest, going along, taking charge, wanting recognition, being cautions). The results support the existing five scale structure and the overall validity of the instrument. In addition, the authors reported high Cronbach' s alpha coefficients (.81 - .88) supporting the consistency and reliability of the BASIS-A. The results support the validity of the Adlerian style of life construct and the BASIS-A as a valid and reliable measure of style of life. According to McVittie and Best (2009), a large body of research indicates that an authoritative parenting style most positively affects adolescent development. McVittie and Best investigated whether Adlerian-based parent education influenced parental behavior in a more authoritative direction. Over 1,250 participants who participated in 110 Adlerian parenting classes in the United States and Canada completed a retrospective comparison method questionnaire developed for the study that assessed parents-guardians' perceptions of their behavior prior and subsequent to the 6-10 week Adlerian parent education course. Using repeated measures ANOVA and ANCOVA statistics, McVittie and Best found that the parent-guardians reported statistically significant changes in their parenting behavior indicative of movement toward a more authoritative parenting style. Specifically, the parent-guardians reported statistically significant changes in setting clear limits, increasing their sense of positive connection, and decreasing harshness in their interactions with their children. The greatest amount of change occurred with younger parents, women, persons with the lowest income, and parents-guardians with few children. The results support Adlerian parent education as an evidence-based approach for helping families. Using the BASIS-A Inventory and selected items from the alcohol and other drug survey, Lewis and Watts (2004) examined the predictability of Adlerian lifestyle themes for college alcohol consumption. Two hundred and seventy-three undergraduates completed the instruments and the results of the multiple regression analysis indicated that 'Adlerian lifestyle combinations accounted for more variance in alcohol related behaviors than other variables commonly found to be predictive of alcohol consumption (i.e., grade of first drinking experience, gender, fraternity/sorority membership, and religious participation)" (p. 245). Overall, according to Lewis and Watts, the combined Adlerian lifestyle themes "accounted for more variability in frequency of binge drinking and frequency of alcohol consumption than the additional variables" (p. 245). CONCLUSION Adlerian counseling theory is an integration of . · · ex1stenha · · I, an d systems perspeccognlｾｶ･Ｌ＠ psych o d ynamiC, tives. H. L. Ansbacher, a noted Adlerian sch0 1 ar, described Adlerian psychology as a: holistic, phenomenological, teleological, field-theoretical, and socially-oriented approach to psychology and related fields. This approach is based upon the assumption of the uniqueness, self consistency, activity, and creativity of the human individual (style of life); an open dynamic system of motivation (striving for a subjectively conceived goal of success); and an innate potentiality for social life (social interest). (Manaster & Corsini, 1982, p. 2) The beauty of the Adlerian approach to counseling is its flexibility and applicability in a variety of settings. Adlerians can be both theoretically integrative, albeit consistent, and technically eclectic. Different clients may require different therapeutic metaphors. One client may prefer a narrative oriented approach, another a solution-focused orientation, and yet another a cognitive-behavioral or systemic one. Adlerian counseling allows the counselor to do whatever is in the best interest of his or her client, rather than forcing the clientand his or her unique situation-into one therapeutic framework (Carlson et al., 2006; Watts, 2000). 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In American Counseling Association (Ed.), The ACA encyclopedia of counseling (pp. 283-285). Alexandria, VA: American Counseling Association. Watts, R. E., & Pietrzak, D. (2000). Adlerian "encouragement" and the therapeutic process of solution-focused brief therapy. Journal of Counseling and Development, 78, 442-447. Watts, R. E., & Shulman, B. H. (2003). Integrating Adlerian and constructive therapies: An Adlerian perspective. In R.E. Watts (Ed.), Adlerian, cognitive, and constructivist psychotherapies: An integrative dialogue (pp. 9-37). New York, NY: Springer. Watts, R. E., Williamson, J., & Williamson, D. (2004). Adlerian psychology: A relational constructivist approach. Adlerian Yearbook: 2004 (pp. 7-31). London, England: Adlerian Society (UK) and Institute for Individual Psychology. Alred Author Contact Information: Richard E. Watts, PhD, LPC-S University Distinguished Professor and Director Center for Research and Doctoral Studies in Counselor Education, Sam Houston State University, Huntsville, TX. Phone: 936-294-4658. E-mail: watts@shsu .ed u