Adlerian Therapy

Function

Adler's Theory of Personality

Alder's doctrine supports the hypothesis that personality development begins at a young age and is a consequence of experiences during infancy. Adler claimed that one's personality is a comprehensive unification, which is the foundation of holism. According to the Adlerian conception, nine principal aspects are essential for the occurrence of this phenomenon: (1) Social Interest, (2) Lifestyle, (3) Goal-directed and Purposeful Conduct, (4) Inferiority Complex, (5) Striving for Superiority, (6) Masculine Protest, (7) Fictional Finalism, (8) Family Constellation, and (9) Birth Order.[5]

Social Interest

Social interest, also known as Gemeinschaftsgefühl, is a German word that means "community feeling." Adler suggested this concept as a "sense of direction to living collectively with others and a lifestyle that esteems the commonwealth beyond one's interests and desires." Social interest is attributed to an individual's feeling of being part of the community and their approach toward others. No one can avoid connecting with other individuals because society involves interaction, which is a part of survival. Therefore, people work together to communicate their social interests. Individuals cooperate and assist the community by acknowledging their personal and collective goals. Individuals develop character and emotions from childhood when they find their places in society. This search fosters a sense of belonging, empathy, and acceptance, leading to cooperation for the greater good. Subsequently, these individuals cultivate a feeling of social belongingness as a collective.[6]

Adler acknowledged that associating with others was the first social task encountered. Our capacity to get along with others becomes a part of our lifestyle and consequently influences how well or poorly we will face life crises. When social involvement develops adequately, we can find solutions to these difficulties. However, it is pathogenic when a person is not involved with his community or is not interested in the welfare of the rest. Pathological lifestyles demonstrate egocentric, exploitive, demanding, detached, or combative actions. Criminal behavior frequently develops from a pathological lifestyle. Thus, developing social interests is critical in preventing antisocial conduct. Adler suggested that community feeling is the answer to overcoming antisocial and criminal behaviors. Additionally, social interest provides an optimistic perspective on life and an impetus to develop the welfare of others.[6]

Lifestyle 

Lifestyle or style of life, the Adlerian terminology for personality, is a personal metanarrative that involves an individual's particular beliefs, purposes, and principles for dealing with the adversities of living. This life plan is distinctive for each person and emerges early in life, approximately when the individual reaches 6 years of age. Lifestyle consists of our comprehension of events rather than the events themselves, profoundly influencing our personalities. This notion includes self-concept, self-ideals, views of the world, and ethical convictions. Later, this cognitive orientation is molded within the initial social setting of the family constellation. The family constellation consists of family atmosphere, values, and gender lines.[7] These aspects influence an individual's lifestyle and determine how we act, think, perceive, or live. We select methods for enduring life challenges and cues from developing lifestyles. According to the Adlerian theory, humans are proactive and creative in developing their lifestyle, functioning as playwrights and actors while constructing their personalities within a socially embedded context. Adler outlined 4 basic lifestyles: the socially useful, the ruling type, the getting type, and the avoiding type.[8] The "socially useful" is also described as a responsible lifestyle. This category includes individuals who are the healthiest, most complete, and most cheerful typology. They possess a strong sense of social responsibility and strive daily to improve themselves, overcome their worries, build resilience, and eliminate greed. Socially useful individuals tend to be mature, optimistic, well-adjusted, polite, and respectful of others. They do not aim for superiority but to solve adversities in ways that are cognizant of others.[9] The "ruling type" is also described as a selfish lifestyle. Individuals with limited social interests attempt to demonstrate authority and seek dominance over others. These people tend to be confrontational and possess harsh energy that subjugates anyone who gets in their way. They adopt an antisocial approach to society. The most energetic of these are intimidators and sadists. Meanwhile, less active individuals turn their power inward and hurt themselves, such as individuals with substance use disorders and suicidal ideation.[9] The "getting type" is also known as a dependent lifestyle. These individuals conduct their existence in one direction: obtaining reinforcements from others. They usually want to receive everything from others without any effort or struggle. They have low social interests and non-reciprocity. The main explanation for their behavior is that they have not overcome their feelings of inferiority. Consequently, they develop relationships of dependence and absolute submission.[9] The "avoiding type" is also recognized as an escapist lifestyle. These people try to dodge duties, evade responsibilities, and cannot maintain relationships. They display childish behaviors, pursue an easy life, and experience immediate satisfaction. They tend to have the lowest energy and prefer unrealistic daydreaming and being fanciful instead of facing reality. Additionally, individuals of this type demonstrate little social contact because of fear of rejection, evading life in general and others in particular.[9]

Goal-directed and Purposeful Behavior

As reported by Adler, human conduct is not exclusively specified by heredity and the environment. Instead, individuals can analyze, impact, set goals, and act purposefully. All decisions and conduct become unified with every person's ambition, purposes, current circumstances, and paths in which the person moves. While individuals could or could not be aware of their motivation for a specific action, their behaviors are still purposeful and goal-directed. From an Adlerian perspective, every individual establishes objectives that provide security and give them a place in life. Establishing objectives depends on individual "private logic," a subjective and personal ideology that helps individuals achieve goals. Private logic is the reasoning an individual invents to stimulate and justify a style of life. When humans become familiar with their unique private philosophy, they develop a healthy view of the world. This phenomenon indicates that each person perceives a situation from a unique perspective. Every person lives and operates as if their idea of the world is accurate or correct. When society distorts an individual's perspective, their emotions become destructive and distorted. Consequently, this person could develop inappropriate behaviors.[5]

Feelings of Inferiority 

This statement in Adlerian psychology refers to the pervasive impression that one's capabilities are inferior to those of others. Equivalently, this hypothesis states that all individuals experience feelings of inadequacy. Because this condition is typical for all individuals, it is not a symptom of defects or aberrations. Individuals' feelings of inferiority stem from a perceived sense of inadequacy which they strive to overcome. These feelings of inferiority originate partly from infancy's helplessness and inability to handle meaningful life situations. The main reason for its origin is because the child's parents and most others are physically older, more sophisticated, and more skilled than them. However, this sentiment becomes more evident during infancy. In this phase, a sense of inadequacy emerges from 3 origins in childhood: organic inferiority, spoiling, and neglect.[10]

This inevitable sensation of inadequacy encourages individuals to strive for achievement. According to Adler, most children overpower this perception of incapacity through 3 different mechanisms: dreaming of becoming adults, creating other areas of strength, or establishing a superiority complex. All of these illustrate the methods of overcompensation. This term attributes camouflaging inefficiencies, feelings of weakness, and incompetence in a particular area by outshining in a different area and gaining fulfillment. According to Adler, the same principle applies to survival because our innate perception of inadequacy allows humans to survive. These sentiments motivate growth and development, whereas non-human species become extinct.[11]

Even though sensations of inefficiency are universal, it is crucial to differentiate inferiority feelings and complexes. An inferiority complex arises when people cannot compensate for their disadvantages, or immediately they cannot overpower their life adversities. By definition, an inferiority complex is a pervasive feeling that one's abilities and characteristics are inferior to those of others. Exaggerated feelings of inferiority and insecurity lead to maladjusted behavior.[10] Whereas inferiority feelings are normal, an inferiority complex is abnormal. Individuals who are at the highest risk of developing an inferiority complex comprise those who show evidence of poor self-esteem, low socioeconomic status, or a history of depressive symptoms.[11]

Striving for Superiority

As proposed by Adler, each person navigates life with perceived physical inadequacies, culminating in a perception of inferiority. To counterbalance the aforementioned sentiments, perseverance for excellence is the principal motivation. Striving for superiority means an individual's effort to become competent by definition. Aiming for superiority brings up a particular idea in which people are encouraged by a supreme initiative to realize their full potential. As a result, this motivation aids individuals in accomplishing self-centered purposes. Individuals aim to master external factors and acquire power and status, not only for themselves but also for the common good of humanity. Adler stated, "Striving is useless if it does not favor other people; it is healthy if it proceeds in the direction of social interest." It is closely related to the community because individuals live in realism with their social world and, as a result, build a better life. When feelings of inadequacy result in an inferiority complex, the awareness of such thoughts can be overwhelming. As a result, they can develop into a "distinctive delusion" that Adler reported as a superiority complex. Nevertheless, aiming for preeminence is not equivalent to the denomination superiority complex.[12]

A superiority complex arises immediately when individuals overestimate their qualities and capacities, displaying an impression of being more competent than others, intended to conquer sentiments of worthlessness. A false feeling of power and security invariably conceals an underlying inferior complex. It is not an extension of the traditional approach of persevering for dominance. A superiority complex develops from an attempt to evade one's problems rather than face them. These individuals are commonly described as "impertinent, supercilious, and disdainful" towards the rest, negatively impacting society. The complexity of the superiority complex and its origin of inadequacy can be seen not only in mental diseases but also in criminal conduct. On the other hand, healthy individuals' endeavors for preeminence do not evolve into arrogance to camouflage the perception of mediocrity. Aiming for preeminence assists with the advancement of society since it encourages us to contribute positively to science, technology, and the arts.[12]

Masculine Protest

Concerning this hypothesis, Adler stated the existence of gender polarity amid masculinity and femininity. However, Adler highlighted that the feminist point is devaluated in culture and related to vulnerability. Females are typically devaluated compared with men in many areas of society. Also, children of both genders are considered powerless and propelled to occupy the feminine position. As a result, women reject a feminine identity so they can be valued and compensated like men. Adler was an advocate of women's rights. He claimed that if females had the same opportunities as men, they could deal successfully with feelings of worthlessness. As a result of his dedication to equal rights, Adler developed the idea of masculine protest as the desire to be a "real man," such as being superior or striving to be perfect. This principle is not exclusive to women; it can similarly apply to men. Male individuals tend to carefully suppress their feminine traits by having excessive masculine wishes and efforts. Likewise, men who suffer from masculine protests tend to develop pathological fantasies, grandiose behaviors, and feelings of being powerful and more important than others. Quite the opposite, masculine protest among females consists of pursuing prestige in male-dominated fields or adopting typical features associated with masculinity, such as combativeness or male mannerisms.[13]

Fictional Finalism and Creative Self

Alder proposed that every individual has an aim and inspiration. This hypothesis states that people modify their behavior in consonance with their personal goals also known as 'Subjective final goal' or 'guiding self-idea.' Human conduct is guided when someone tries to achieve a complete goal that correlates to their self-ideal. By classification, it is an imagined final goal for one's life and behavior. Nevertheless, this final goal develops an individual's personality and is ample for explaining anything the individual does, thinks, strives, or feels. The goal does not have to be based on reality but instead describes the person's thoughts. Hence, according to Adler, human beings constantly aim for the fictive, essential goal of perfection, which decreases the distress of feelings of inferiority.[14]

During childhood, the individual develops a fictional ideal of success that satisfies the child's unbearable feelings of inferiority. As the individual grows, the goal continues to guide fiction in any current situation. It directs the person's movement while redirecting to new forms of concretization for adult life's purposes. People typically demonstrate a vague and imprecise notion of fictional finalism. This purpose is partially known and relatively unknown. The unknown portion of this purpose comprises the unconscious. Throughout life, the prevailing direction of striving continues, but the precise comprehension of the objective may vary. Whereas a healthy individual adjusts the plan, on the contrary, pathology may display as an immovable ideal where conduct is not adaptative. In other words, fictional ideas or ideals affect personal conduct because they are unconsciously encouraged by plans, purposes, and forthcoming. This belief does not focus on childhood experiences. The philosopher Hans Vaihinger impacted Adler, stating that all individuals live with many fictional ideals that have no relationship with reality. Fictionalism develops during childhood and can help us to deal more efficiently with reality. For example, if we believe that heaven and hell exist, such ideas will impact our way of living. In the view of fictional finalism, Adler admits that the past is meaningful but assumes that what matters is the future. The important thing is not what individuals have done but what they will do with their creative selves because the ultimate goal is to explain human behavior.[14]

Family Constellation and Birth Order

The standing in which an individual enters the family at birth is that person's birth order. This hypothesis suggests that an individual's standing in his family constellation is a significant factor in his development, explaining the dynamic relationship between siblings in a family and the different constituents of the family group. Adler proposed that one's rank would impact diverse personality traits, including responsibility, ambition, sociability, and willingness to break the rules.[15]

The family constellation is the structure of the family system, which includes such elements as birth order, the person's perception of self, and sibling and parental relationships. It moderates the difference between the genetic and constitutional factors the child brings and the cultural factors the child learns from the family. He also declared birth order is meaningful regarding how adults interrelate with others and develop their personality traits. There are 5 ordinal positions within a family constellation: (1) firstborn, (2) secondborn, (3) middle child, (4) youngest child, and (5) only child. Adler stated that individuals with specific birth order standings usually reflect a behavior pattern consistent with lifestyle configurations. It is not the child's rank in the hierarchy of successive births that impacts his character, but the circumstances in which he is born and how he interprets it. The psychological position, as perceived by the individual, is of tremendous importance more than the birth order itself. Favorable or unfavorable consequences may exist depending on the birth order position. Our birth order presents us with particular challenges and encourages us to create complex rivalries and alliances with our family members.[16]

Research on Adlerian birth order theory is mixed. Although Adler claimed that the secondborn was the highest achiever, research has been inconclusive. Birth order research has helped psychologists understand why siblings are no more similar in personality than those from different families.[16] The family is not a shared environment but a set of niches that provide siblings with different outlooks on life. The siblings' personalities vary within the same family because they adopt different strategies to achieve parental favor.[17] 

The Firstborn

The oldest children are the foremost and undisputed rulers of the household, who receive undivided attention, the cause of glad tidings, and happily the center of attention. Many parents spend considerable time caring for their first child. As a result, the child may have a secure standing within the family. With the arrival of a second child, parents must split their time with the new arrival. That child will build dissatisfaction, and the battle will begin to regain the parent's complete awareness.[18]

Adler hypothesized that all firstborns mourn the loss of their privileged positions. However, those whose parents spoiled them felt great resentment, discouragement, and hostility toward the new sibling. The new arrival causes high pressure and standards of commitment and cooperation on the eldest child. Consequently, the firstborn is ready to meet adult expectations and strive for perfection as a guiding fictive goal. Firstborns tend to become conservative, highly organized, responsible, moral, and disproportionally interested in maintaining the status quo. However, when these individuals lack social interest, they tend to be insecure, distrustful, and hostile toward society. Meanwhile, younger children assume social commitment and design appropriate ways of coping with life's tasks.[19]

The Second and Middle Children

The second offspring arrives to discover that somebody is already preceding them. While the firstborn has a period when the parent's attention is full-time, the second will always have to split the attention. The second born was born in distinctive circumstances from the first. The second child typically pursues the opposite way to find their place compared to the older child. They can be less accountable, more autonomous, and more curious in whatever the eldest does not pursue to conquer. Adler considered that the second child might react competitively, seeing the first child as a pacesetter. The second child usually seeks to be number one. The competition, frequently known as sibling rivalry, can be extreme in families that motivate comparisons between relatives. Every so often, the second offspring is victorious in the competition, but multiple second children behave as if the competition never happened. This ongoing competition influences each child's lifestyle. When a family has two children, the older child is often considered more dominant. Consequently, the second child can feel discouraged and respond differently in similar situations to reduce the discouragement that may arise with direct competition.[20]

When a third child arrives, the second becomes a middle child. Middle children commonly feel stressed and pressured in families of three. They recognize themselves as disadvantaged and defeated by their siblings. Such situations can make them sensitive to criticism and easily outraged. Consequently, they may become more independent, rebellious, judgmental, or overthinkers. However, they also have assets, especially in larger families where they can learn from others' mistakes.[20]

The Youngest Child

The youngest child is frequently the most pampered and overindulged within the family constellation. They typically evolve as the center of attention and are often portrayed as cute, charming, and the family's baby. In addition to parents, they have older siblings to entertain and provide nurture. Some youngest children develop a competitive orientation and become high achievers, but mostly become spoiled, expecting others to take care of them. When they reach adulthood, they may find adult responsibilities too much to handle or gain independence, sometimes using their charm and manipulative ways to get others to fulfill their needs. They can be great entertainers and comfortable before an audience, whereas many hate public speaking. One favorable consequence of being the youngest child is the opportunity to compete. A possible unfavorable outcome is that one feels insufficient to everyone. They typically perceive inferiority because everyone in the family is older and seen as superior. Adler also mentioned that when the youngest offspring is unwanted, they feel neglected, disdained, and disregarded.[20]

The Only Child

Only children might have the perceptions of the oldest, and they get pampered as the youngest child. An outstanding exception from the others is that they never feel dethroned and are less likely to feel the pressure of a close competitor. Likewise, they develop rich imaginations because they spend much time alone. The only child usually lacks models or competitors, so they seldom learn to share or compete for attention. However, they may be perceived as mature for their age, comfortable with adults, responsible, cooperative, and developing mastery of cognitive skills. However, they may have little or no intimate give-and-take with other children, unlike their peers. These characteristics can make early school experiences more difficult for these children as they begin coping with new life situations involving peer groups.[21]

In line with his interest in the social determinants of personality, Adler observed that the personalities of a family's oldest, middle, and youngest children were variable. He attributed these differences to the distinctive experiences of each child as a member of the social group.[22] Alder hypothesized that neurotics, criminals, and drunkards have characteristics usually displayed in the firstborn child. He also proposed that the youngest child in the family is most likely to become the problem child and later a maladjusted adult. Adler saw the second or middle child as ambitious, striving to surpass the older sibling, and well-adjusted, although tending to be rebellious and envious.[23]

Issues of Concern

Goals of Adlerian Therapy

The fundamental goal of Adlerian psychotherapy is to aid patients in participating and incorporating techniques that are discrepant with existing cognitive structures or lifestyles. Hence, patients can correspondingly design perceptual alternatives and adjust or substitute growth-inhibiting beliefs or personal narratives with growth-enhancing ones, thereby overpowering feelings of inadequacy and disheartenment. The primary purpose of therapy is to conceive the patient's sense of belonging and to aid in adopting behaviors denoted by community feeling and social interest. This is achieved by raising the patient's self-awareness and adjusting their constitutional beliefs and life goals. The Adlerian model does not view patients as ill but acknowledges the need to re-educate individuals and reshape society. Adler contended that patients are often discouraged instead of having a disease. Its approach concentrates on supplying knowledge, instruction, advising, and motivating dispirited individuals.[8] 

Encouragement is proposed as the most powerful strategy for modifying a person's assumptions. It allows patients to build self-confidence and promotes courage. Courage is the willingness to perform even when fearful in ways compatible with social interest. Fear and bravery go hand in hand; without dread, boldness would not be necessary—the loss of courage or despondency develops maladjusted conduct. Discouraged individuals do not serve in line with social interests. Adlerian therapists allow patients to view things differently, but it's up to them to accept or decline the alternative perspective. Adler assisted his patients in reaching their defined self-goals.[8] 

Technique

Contemporary Adlerian counseling and psychotherapy integrates supportive, cognitive, constructivist, existential-humanistic, systemic, and psychodynamic perspectives. A primary goal of Adlerian therapy is to motivate patients to believe that change is achievable by helping them experience and assimilate new information that is discrepant with existing cognitive structures or lifestyles. Adlerian therapists also motivate their patients to use their talents to assist others. In this way, individuals develop a social interest. Thus, patients can create perceptual alternatives and modify or replace growth-inhibiting beliefs or personal narratives with growth-enhancing ones, overcoming overwhelming feelings of worthlessness and discouragement.[24]

Adlerian therapists use several techniques in working with their patients. They maintain a time limit of 30 minutes for children and 45 to 50 minutes for adults. Near the end of the session, therapists do not introduce new techniques. Instead, they summarize the interview with the patient's assistance, and at the end of the therapy session, they assign homework. Some popular techniques include offering encouragement, style of life analysis, the question, hypothesis interpretation, acting as if, catching oneself, the pushbutton technique, and others.[25]

1) Offering Encouragement

Encouragement is a principle and method that pervades all Adlerian therapy; it is essential when working with children. It strengthens the ability to deal with life tasks. Adler asserted that motivation is necessary to develop healthily, combat discouragement, and work toward personal goals. Children become what they are encouraged to become. Encouragement skills or techniques enclose the following:[25] 

• Valuing patients as they are.
• Demonstrating consideration for patients through active listening, respect, and empathy.
• Focusing on the patient's strengths, assets, and abilities, including identifying past successes and communicating confidence.
• Helping patients generate perceptual alternatives for discouraging fictional beliefs and oppressing narratives.
• Helping patients distinguish between what they do and who they are.
• Focusing on the patient's efforts and progress.
• Communicating affirmation and appreciation to patients.
• Assisting patients in seeing the humor in life.[25]  

2) Asking "The Question"

In using the question technique, therapists ask a variation of the question that Adler developed: "How would your life be distinct if you no longer had this issue?" Such questions help patients understand what they want to see changed in their lives. As a result, patients cannot necessarily ignore symptoms, or they will feel motivated because they begin to comprehend that they have the resources and abilities to overcome the problem. Typically, patients get asked this question at the beginning of counseling. Solution-focused therapists relabeled this method as the "miracle question."[25]  

3) Acting "As If"

In the traditional approach, "as if" is a therapeutic technique in which the clinician asks the patient to act "as if" there were no barriers to achieving his or her goal. They are instructed to behave "as if" they possess a particular conduct and are encouraged to try new demeanors and roles. This approach aims to sidestep the possible modification resistance by counteracting some perceived risks.[25] 

4) Using Pushbutton Technique

Most of the time, patients are unaware of their unpleasant feelings. This technique aims to help patients become aware of their role in maintaining or creating unpleasant feelings. The push button technique has 3 phases. In the first phase, Adler asked patients to imagine a pushing button. Then, he directed them to close their eyes and recall a pleasant experience in as much detail and vividness as possible. Next, Adler requested patients to make notes of that pleasant memory. As a second phase, Adler would give similar directions, but this time asking patients to imagine a negative experience in as much detail as feasible. In phase 3, Adler asked patients to retrieve another pleasant memory or return to the one in phase 1. Again, they should recall the memory in detail and focus on the positive feelings. After they relived the pleasant memory and positive feelings, Adler instructed them to open their eyes. Finally, patients reflect on what they learned, and they usually make a connection between beliefs and feelings. Typically, they mention that their thoughts produced certain feelings. Occasionally, however, patients are unable to make a connection between beliefs and feelings.[1]

After ensuring the patient established this connection, Adler gave 2 pushbuttons to take for a homework assignment. When patients press the positive push button, they create pleasant images that positively affect their feelings. Likewise, when they press the negative push button, it negatively affects their feelings. These pushbuttons affirm that feelings or behavior are typically a choice. When they return for the next counseling session, the discussion with the therapist can focus on which button patients have been pushing and the purpose of choice.[1]

5) Catching Oneself

Catching oneself aids patients in being aware of their self-destructive behaviors or thoughts without feeling guilty. This technique involves encouraging patients to catch themselves in the act of performing the presenting problem. The intent is to help patients change maladaptive old habits. With proper training, patients can learn to anticipate situations, identify when their thoughts and perceptions are becoming self-defeating, and take steps to modify their thinking and behavior. Catching oneself involves assisting patients in identifying the signals or triggers associated with one's problematic behavior or emotions. When patients identify their triggers, they can make decisions that hasten overwhelming symptoms.[26]

6) Style-of-Life Analysis

This technique typically includes an interview that leads to a formulation or summary of the patient's style of life. Based on patients' memories of their family of origin, these interviews give the therapist information about the patient's perceived ordinal position, family constellation, and family atmosphere. Then, the Adlerian therapist asks about the patient's childhood physical development, school experience, and sexual and social development. Adler also used to ask about the patient's local community and socioeconomic status to help determine their view of themselves and the family's position in the larger world.[8]

The final phase of the interview is the collection of early childhood recollections. These remembrances are not coincidences; they are usually projections. Having gathered all the previously mentioned data, the Adlerian therapist has all the information necessary to create a tentative hypothesis about a patient's lifestyle. This lifestyle includes patterns of behavior and ways of viewing themselves and the world around them.[8]

7) Hypothesis Interpretation

The purpose of hypothesis interpretation is to explain to the patient when more than one justification exists for his or her behavior. For example, after the style of life analysis, the therapist can ask the patient, "Could it be that?". This technique will help the therapist know if his or her interpretations are correct.[8]

8) Task Setting

Adlerian therapists give task assignments so patients can practice a different manner of conducting themselves, which can lead to a distinct perspective. Using this technique, the patient finds threatening situations less and less frightening. Adler suggested giving a depressed patient the task of doing something enjoyable each day on a "pleasant day" schedule. Moreover, to promote the patient's social interest, Adler proposed to assign community service to his patients, such as volunteering at a homeless shelter. These concepts are fundamental to modern-day behavioral activation therapy.[1]

9) Brainstorming

After helping the patient identify misconceptions in thinking, Adlerian therapists brainstorm with the patient's alternative hypotheses and beliefs. Instead of saying, "I never get what I want," a patient can substitute with "Sometimes I get what I want." The last conviction promotes healthy development.[1]

The 4 Phases of Adlerian Psychotherapy 

The fundamental purpose of Adlerian psychoanalysis is to aid patients in dismissing discouraging style-of-life convictions, experiencing and assimilating new information, and engaging in behavior modification consistent with additional supportive and encouraging perspectives. The final objective of Adlerians is developing and expanding the patient's social interest or community feeling. Adlerian psychotherapy typically proceeds in a succession of logical steps. The 4 phases include relationship, analysis/assessment, insight/interpretation, and reorientation/reeducation.[27]

• Phase 1 of Adlerian Therapy: Establishing the Therapeutic Relationship

At the beginning of psychotherapy, Adlerian therapists initiate a comfortable therapeutic alliance by using humor and small talk to institute an equalitarian partnership. This therapeutic relationship shall be encouraging and respectful. This stage is the first and most meaningful. Adlerian psychotherapists sit facing the patient with their chairs at the same level. The principal goal of Adlerian Psychotherapy is to motivate patients and permit them to perceive that transformation is feasible. The therapeutic process should be a harmonious partnership established on respect and trust. As a final goal, this sort of psychotherapy helps individuals to eliminate mistaken thoughts about themselves. The objective mentioned above can be reached by understanding each individual's unique private beliefs and approaches. With that understanding, Alder motivated his patients to create wholesome lifestyles and overpower feelings of inadequacy. The 3 entrance gates to an individual's mental life: (1) his/her birth order position in the family of origin, (2) his/her first childhood memory, and (3) his/her dreams.[28]

Despite the egalitarian focus, Adlerian psychotherapy also takes on a psychoeducational atmosphere because it inspires patients to use their talents to assist others in developing a social interest. Adler used to believe their patients were discouraged when they began psychotherapy. Consequently, Adlerian therapists strive to create a supportive and encouraging therapeutic alliance. Adlerian therapists are empathic and caring, but they confront patients with their basic errors, misplaced objectives, and self-defeating conduct. Such confrontations help patients deal with the contradictions in their lives and replace mistaken pursuits.[28] 

• Phase 2 of Adlerian Therapy: Uncovering the Patients' Dynamics or Assessment

The second stage is the psychological inquiry of the process. This methodology will vary according to the nature of the problem, psychological inventories, tests, case histories, and family. It gets divided into the patient's lifestyle and early recollections. First, the Adlerian psychotherapist assesses the patient's lifestyle. After obtaining a summary of their patient's early recollection and lifestyle, they examine their basic mistakes. Usually, individuals acquire these fundamental mistakes during childhood when they construct reasons and principles regarding their experiences. These experiences may be purely or partially fictional.[29]

Second, the psychotherapist assesses and interprets the patient's early memories, a projective assessment whereby patients share remembrances of specific childhood events. According to Adler, we select remembrances that concur with our fundamental inferences about ourselves and the rest of the world. It makes little difference whether or not these memories are actual events or fantasies. Our adult lives revolve around what we perceive as having happened. Our earliest memories provide the therapist with a comprehension of our mistaken assumptions, social interests, and future actions. Adler alleged that dreams were a form of dealing with insecurities. Our goals help us to try out strategies for overcoming our limitations, or they may portray a type of desire fulfillment. Dreams can operate as a bridge to what we want. From his perspective, our striving for perfection and need for control drives us. Moreover, dreams prepare individuals to solve their current problems or overcome their present circumstances by rehearsing for future actions.[29]

• Phase 3 of Adlerian Therapy: Patient Insight and Self-Understanding

The third phase, the Adlerian interpretation process, involves insight and self-understanding, a core principle of modern psychodynamic therapy. Insight represents the patient's understanding of the purposive nature of their behavior and the mistaken beliefs that sustained it. Adlerian therapists promote patient insight through standard communication, dreams, fantasies, behavior, symptoms, or patient-clinician interactions. During interpretations, the emphasis is on discovering the purpose rather than the cause of the patient's conduct. A proper interpretation provides clues regarding the purpose of a patient's behavior. From his perspective, insight alone was insufficient for successful therapy.[30]

• Phase 4 of Adlerian Therapy: Reorientation

The final stage of an Adlerian intervention depends on the patient's desire to institute a change. It is also known as reorientation. The reorientation phase of therapy aims to help the patient recover the courage to confront life's challenges. As a result, the patient decides what behaviors stay to reach unique purposes and what behaviors get discarded. During reorientation, the therapist encourages the patient to develop more social interests. Throughout this phase of psychotherapy, the dominant technique used is motivation.[29]

Adler and Parenting Style

The theory of personality and therapy had a crucial impact on developing good parenting skills. Adler acknowledged that the finest fortune for a child was the development of personal courage to cope with life by allowing them to experience the natural consequences of their acts without fear. Adler identified two parenting styles: Pampering and Neglect. Pampering refers to overprotecting children, giving them too much attention, and protecting them from the harsh difficulties of life. This results in children who are poorly prepared to deal with the realities of everyday living and a high level of dependence. They approach life, work, and marriage from a self-centered orientation with unrealistic demands.[31]

On the other hand, the neglected child is the one who receives very little support. As an adult grows up fearing the world, distrusting others, and experiencing difficulty forming close interpersonal relationships. When parents fail to provide sufficient love and care for their children, the net result is that such children view adults negatively. Their inadequacy is manifested by suspicious behavior, isolation, and maliciousness. Although both the pampered and neglected child receive different types of parental treatment, the final results of the treatment may be the same: feelings of inadequacy. Many of Adler's ideas about good parenting techniques include:

• Mutual respect between themselves and others.
• Encouragement: faith and consideration for children as they are rather than as we want them to be. 
• Natural and logical consequences: this allows kids to experience and learn from the results of their behavior.
• Setting freedom and limits for children.[31]  

Adler's Theory of Life Tasks

Adler considered the desire to experience a heightened sense of belongingness with other people as a universal drive. Our drive for belongingness motivates us to become involved in life tasks prominent for our psychological development and mental health. Those 3 fundamental life tasks are work, social, and love-marriage or intimacy. Modern theorists have suggested additional areas to master: self, spiritual, parenting, and family. Work or occupational tasks should be meaningful, satisfying, and contributing to the community. Adler acknowledged that our life is made possible by the work of others. This task includes all forms of obligation and responsibility, not just money. For students, it corresponds to school; meanwhile, for adults, it corresponds to their career and job satisfaction.[32]

The social task is learning to build gratifying friendships with others and ourselves. Adler emphasized that each person needs to find a place among others that allows them to cooperate. He also highlighted that belonging to a social group and fitting in with others are basic needs. The negative consequences of "not belonging" are decreased cognitive functioning, increased cortisol and stress levels, and increased preoccupation with social stimuli. Love-marriage or intimacy tasks should be addressed by learning to love oneself and another. The love task begins for children in the intimacy of breastfeeding, which Adler noted is the child's first experience of cooperation. During childhood, the child unconsciously constructs ideas about relationships based on their parents and consciously follows other models of love and marriage. The child can receive educational guidance and meet the challenges of adolescence and sexuality with common sense and courage. Alternatively, the child can be overburdened and discouraged to overcome inevitable feelings of inferiority. This child will have a hesitating attitude and be compulsive or hostile toward others.[33]

Self-task describes the relationship with oneself, and it develops during childhood. It has 4 dimensions: self-survival, body image, opinion, and evaluation. This task allows the individual to accurately perceive their care and expectations of their physical appearance, psychological, and social self. Spirituality tasks encompass community feeling, social interest, and cooperation. It comprehends the relationship with religious beliefs, the universe, the meaning of life, and metaphysical controversies such as heaven, hell, reincarnation, karma, and salvation. Parenting and family tasks involve giving birth, raising children, and functioning as a family. Therapy goals should help individuals modify their lifestyles, accomplish life tasks, and face life challenges.[33]

Adler's Healthy Mental Development and Development of Maladaptive Behavior or Psychopathology

Alder proposed that the seeds for psychopathology germinate early in life, especially within the family and within our sibling relationships. Developing adequate social interest is critical to individuals' positive mental health. Adler believed that if an individual cannot find their place in life, they will become discouraged and may engage in disturbing behavior to find their place. According to Adler, an individual's underdeveloped social interest is the one factor that underlies psychological maladjustments. They are often at risk for depression, frustration, anger, and social alienation.[34]

Individuals develop maladjusted or disordered conduct primarily because (1) they have increased feelings of inferiority and (2) they develop inappropriate compensatory responses to offset their deep-seated feelings of inferiority. Although the average and maladjusted person manifests feelings of inferiority, these feelings are exaggerated in the maladjusted individual. Adler believed that poor mental health results when people behave as if they are inferior. From his perspective, the mother is the primary person for teaching children social interests because she demonstrates nurture, cooperation, and social welfare.[34] 

Clinical Significance

The world of counseling and psychotherapy has evolved considerably compared to when Adler developed his theories. Adler has influenced contemporary psychotherapy practices in many ways. His theory of Individual Psychology has acquired popularity; this could be attributed to the fact that many writers have adopted the original theory. It has also been employed in various other applications and settings, such as schools, organizations, and medical settings. One of the ways that Alder's proposals have remained contemporary is by recognizing the aspects of Adler's original model, which are theoretically consistent with modern psychotherapy. In many ways, this model has moved away from allegiance to single theories of personality and has readily adopted integrative theoretical models.[35] Alderian concepts are fundamental to modern supportive psychotherapy, psychodynamic therapy, and cognitive behavioral therapies, including behavioral activation. Adler developed his original theories and model when campaigning for the social equality of women, contributing to the understanding of gender issues, speaking out for the rights of working-class and poor people, and addressing the rights of minority groups. Within that context, many practitioners of Adlerian therapy were addressing social equality and using a contextual framework for understanding people. Multiculturalism and respect for diversity are now recognized as essential components of psychotherapy.[36]

Adlerian psychotherapy is relevant for working with culturally diverse populations in contemporary society because it addresses various multicultural issues, including culture, ethnicity, gender, racism, sexual orientation, and social equality. A rapidly growing dimension of multiculturalism includes attention and appreciation for religion or spirituality in patients' lives. Historically, most systems of psychology have had either a neutral or negative position toward religion and spirituality. However, Adlerian therapy addresses religious and spiritual issues. Researchers have studied several patient populations that commonly benefit from Adlerian Therapy concepts, such as individuals struggling with anxiety, depression, schizophrenia, eating disorders, substance abuse, family education, gender equality, and personality disorders.[35]

Anxiety

From an Adlerian perspective, when someone develops anxiety, this individual demonstrates excessive uneasiness and excessive self-consciousness. As a result, the individual will believe that he or she does not have the required skills to cope with a threat. From an Adlerian perspective, the anxious patient fears not belonging and may start believing that they are losing control. In Adlerian theory, all behavior is viewed as serving a purpose; anxiety indicates the fear of failure and lack of belongingness. 

Family Therapy

Adlerian Family Therapy is a method that enables individuals to let go of negative and futile emotions and behaviors that serve as barriers to developing positive relationships with self and others. This type of therapy may be used with individuals, couples, and families. It aims to improve family dynamics and offer perspectives and learnings about where individuals "fit in" or belong within the family unit, community, and society. The family therapist questions the influences of birth order, family atmosphere, lifestyle, and priorities. Individuals are viewed as indivisible, social, decision-making beings whose actions and movements have a purpose.[37] 

Techniques that improve family members' interactions with each other are outlined:

(1) Understand a person's beliefs and perceptions, which shape their goals and sense of belonging and impact their emotions.

(2) Establish ground rules for family communication.

(3) Focus on the real issue, not the issue at the surface.

(4) Align the goals between the family and therapist.

(5) Stimulate social interest.

(6) Encourage by listening, being empathic, understanding meaning, understanding the system, and identifying and affirming assets and resources.

(7) Confront each family member's private logic and mistaken beliefs and perceptions.

(8) Intervene by sharing a tentative hypothesis.

(9) Use paradoxical intention (i.e., encourage the family to do the very things it claims it wants to stop doing).[38] 

Research has demonstrated that family therapy will change patient perspectives, increase the family's overall sense of humor, and increase the functioning of the family.[39]

Eating Disorders

Adlerian theorists propose that people generally strive for significance and superiority, and they acknowledge that eating disorders can be a pathological way to cope with inferiority issues. Alderian theorists suggest that individuals with eating disorders use food and eating to communicate their sense of inadequacy symbolically in the face of life's requirements. This sense of inadequacy stems from their failure to master those skills essential to living effectively and healthily with others.[40] A controlled clinical trial evaluated the outcome of Adlerian Parental Counseling (APC) on individuals affected by an eating disorder. This research showed that individuals with eating disorders significantly improved after APC compared to the baseline and the placebo groups. Parents reported a subjective improvement in psychopathology scales and refinement of their perception of family dynamics.[41]

Other Issues

Personnel

As the North American Society of Adlerian Psychology (NASAP) requires, Adlerian therapists must earn a minimum of a master's degree to satisfy entry-level qualifications. Advanced graduate studies include 90 hours of Adlerian Focused Study, with at least 8 years of application. Certified personnel must complete 4 Adlerian-based programs or seminars at a NASAP Conference and 2 Adlerian-oriented publications and have at least 3 years of leadership in local, national, or international Adlerian activities or organizations.[42]

Enhancing Healthcare Team Outcomes

Adlerian therapy has an essential influence on modern psychotherapies. Although Adlerian therapy is not commonly utilized as a first-line treatment, the influence of Alfred Alder's doctrine has had a significant influence on many common first-line psychotherapies. This includes psychodynamic therapy, behavioral activation, cognitive behavioral therapies, and supportive psychotherapy. Applying these principles can have a meaningful impact on psychiatric symptoms and should be considered for application in patients who may benefit from them. Although psychiatrists and psychologists commonly utilize Adlerian techniques, other interprofessional team members can also implement them to enhance patient care. This includes nursing and support staff applying principles of supportive psychotherapy and mental health professionals using more advanced techniques with appropriate training.

Furthermore, social workers and case managers can refer patients to the proper therapeutic resources. Collaboration with an interprofessional team and exploring the patient's perspectives on goals of care ultimately enhances the benefit of Alderian therapy.