Twelve Stages of Creative Adlerian Depth Psychotherapy
Twelve Stages of Creative Adlerian Depth Psychotherapy
CADP ArticleIndividual Psychology, Vol. 44, No. 2, June 1988
Having studied with Sophia J. deVries for over 20 years, Henry Stein had tape-recorded and transcribed over 1100 hours of discussion about theory and practice. Her therapeutic technique, which she had learned directly from Alfred Adler and Alexander Mueller, had never been fully documented. With Sophia, Henry described, explained and analyzed the process of Classical Adlerian Depth Psychotherapy resulting in a 12-stage process. These are not steps to be followed sequentially – although they are presented in the frequently experienced order. They are rather essential aspects that together make up the process of psychotherapy as Sophia experienced it working with Adler and one of his close associates.
The dynamics of creative Adlerian Psychotherapy can be illuminated by exploring 12 stages which emerge from a study of optimal clinical practice. These stages are the result of analyzing the therapeutic techniques of Sophia de Vries, an Adlerian psychotherapist with more than 50 years of clinical practice, who studied with Alfred Adler, Alexander Mueller, and Lydia Sicher. This was the approach she was taught by Adler himself.
The concept of 12 stages is a refinement of the four overlapping phases of psychotherapy described by Heinz Ansbacher in Cooperation Between the Sexes: establishing and maintaining a good relationship with the patient; gathering data from the patient to understand the life-style; interpreting the patient to himself, providing insight; and reorientation and re-education (Alexandra Adler, 1946; Dreikurs, 1973). Henrie Ellenberger in The Discovery of the Unconscious describes three stages in Adlerian individual psychotherapy: understanding the patient and his problems; making the patient gradually aware of his fictitious life goal and life-style; the patient deciding whether he wants to change his life goal and style.
The stages to be described in this paper are: 1. empathy-relationship, 2. information, 3. clarification, 4. encouragement, 5. interpretation and recognition, 6. knowing, 7. group and marathon (if needed), 8. doing different, 9. reinforcement, 10. social interest, 11. goal-redirection, and 12. support and launching.
The process of therapy is creative. Looking back on a case we can say there are stages, but therapy is not a rigid procedure; we do not go "by the numbers" in practice. The therapist can work with spontaneity and originality, using the stages to evaluate progress and plan strategies. As the client faces the challenge of giving up his life-style, these stages can serve as a road map for his optimal development.
The life-style interpretation must be used creatively and diplomatically in psychotherapy. It should serve as a consistent guideline for encouraging the client to move in a new direction, away from his unconscious goal of self-enhancement and self-protection at the expense of others. As the client takes steps to build his courage and gain a feeling of satisfaction and pride, the life-style should be interpreted to him gradually, in the context of his presenting difficulties and symptoms. Sensitive timing, gentleness, and creativity promote an artful interpretation to a client, maximizing the acceptance of the interpretation. It should not be presented as part of a procedure. Facing a client prematurely with a summary of his mistaken ideas and goal, as in "doing a life-style," could be a painful, overwhelming, and discouraging experience.
1. EMPATHY-RELATIONSHIP STAGE
From the very beginning the therapist must establish a cooperative working relationship with the client. All progress is the result of this cooperation. In order to promote the tasks of co-thinking, co-feeling, and cooperating, the roles of the therapist and client as co-workers must be clarified and emphasized. After expressing their complaints, many clients expect to be cured, or relieved of their distress through the efforts of the therapist. In the beginning, a client may need to express a great deal of misery with little interruption. Consequently, at the very first contact, the therapist must offer genuine warmth, empathy, acceptance, and understanding. He must create an atmosphere of hope, reassurance, and encouragement, leaving the client with the feeling that "things can be different." The healthy part of the client needs to be found and acknowledged behind his screen of symptoms and complaints.
2. INFORMATION STAGE
In order to gather relevant information, the client must be given unstructured time to talk freely for approximately 5 to 10 sessions. However, a questionnaire can be given to save time. A "Current Situation and Early Recollections Questionnaire" has been developed to facilitate this. The presenting problem and other life tasks are explored, as well as the early childhood situation. In some cases it is useful to go back two generations, exploring the parents' childhoods and the character of the grandparents. Religious and cultural influences may have significance. The therapist needs to evaluate the degree of distortion in the information given, as well as what is omitted from the discussions. When appropriate, intelligence, interest, and psychological testing can be included. Eventually the core of the real problem needs to be unveiled. What the client is omitting or avoiding in the discussions may be most relevant. After studying the parallel patterns of past and present, and analyzing the rich projective material in early recollections, the therapist usually has a preliminary hypothesis about the life style and goal of the client. Interpretations, however, should be offered gradually to the client throughout the following stages with a sensitivity to his readiness to accept them. (In this respect, a "life-style procedure" of reading a list of the client's mistaken ideas in the first meetings represents a contradiction of Adler's intended use of this insight.)
3. CLARIFICATION STAGE
The client is offered a comprehensive experience in co-thinking while unique meanings that he gives to present and past circumstances are clarified. Socratic questioning is used to promote the client's active thinking and to correct the mistaken thinking, gain missing information, and begin moving away from the private logic toward common sense. The results of going in a wrong direction are evaluated and compared with what the client should be doing in life to develop himself. The client's tendency to transfer blame and responsibility to others must be corrected.
4. ENCOURAGEMENT STAGE
The client is encouraged to move in a new direction, away from his life-style. Little steps are planned in an unfamiliar direction. New feelings about efforts and results are clarified. The client is not permitted to "wear the crown" after modest successes. To encourage him sufficiently for the next stage, his strengths, assets, and genuine accomplishments are used.
5. INTERPRETATION AND RECOGNITION STAGE
After the client has some success in a new direction and feels strengthened, the dynamics of his inferiority feeling and goal of superiority are revealed to him and compared to the feelings and results of his new movements. General typologies are not as useful as a precise, unique portrait of the individual, presented in a creative way. All movements are interpreted as egocentric or outgoing. What has been avoided is illuminated. Birth order, parenting attitudes, early recollections, and dreams can be integrated into the interpretation. The stage is fully realized when the client agrees with and accepts the therapist's interpretation.
6. KNOWING STAGE
The knowing stage differs from the previous stage in one key aspect. Previously the client relied on the therapist to interpret his movements and their connection to his difficulties and symptoms. Now the client is fully aware of his goal, and he interprets situations himself, sharing his insights with the therapist.
7. GROUP AND MARATHON STAGE (IF NEEDED)
At this point in psychotherapy, group work will sometimes facilitate progress. An ongoing group, offering a new source of connection, support, and encouragement is helpful to some clients, especially isolated, lonely people. For those willing to engage in a sustained and emotionally challenging experience, intensive 1-day, 12-hour, marathon groups can accelerate growth. At the beginning of the day, contracts for specific objectives are made with the group. Role-playing, psychodrama, and guided imagery can provide corrective, encouraging, and caring experiences for current and early discouraging situations. To dissolve the deficiencies of the past some clients need re-parenting at specific ages; others need new sibling relationships. It is not unusual for people to gain a new feeling of family from the experience. Adler never used the group marathon technique. However, it can be used in an Adlerian way.
8. DOING DIFFERENT STAGE
Now the client must convert previously gained insights into significant action for overcoming old difficulties and approaching neglected responsibilities. To improve and develop his best qualities, he must begin using what he knows and attempt creative solutions to his problems. New abstract ideas become the basis for taking a series of small, experimental concrete steps in the main arenas of his life. The therapist may need to employ the technique of "spitting in the client's soup" (making negative behavior taste bad) to move the client away from actions that damage the self or others. Sometimes environmental strategies may be needed to provide unpleasant consequences for the client who resists moving in a new, healthier direction.
9. REINFORCEMENT STAGE
All new movements (away from the life-style) are encouraged. The therapist affirms positive efforts, good results, and feelings of pride and satisfaction. All movements toward change are supported, including thinking, deciding, and trying. In small ways, this has been happening throughout the previous stages. Now there is a more substantial attitude modification as the client begins overcoming difficulties that he previously avoided. Real progress, requiring struggle, is praised, and he is helped to evaluate his new achievements. He may also need coaching to develop the appropriate feelings for his accomplishments. His increased courage and better feeling of self should be emphasized.
10. SOCIAL INTEREST STAGE
The new courage and better feeling of the client can now be used to promote a greater cooperation with the therapist, which is then extended to others. New feelings of satisfaction and significance arise from doing things with others, sharing with others, and contributing to the welfare of others. The client's movements are changing from self-centered to outward-focused and task-centered. He is encouraged to put more of himself into work and relationships, to give his all, 100%, his best. His successes are affirmed when they result from an increased cooperation with other people.
11. GOAL-REDIRECTION STAGE
The client is now challenged to let go of himself and his old rigid, high goal of self-protection, self-enhancement, and personal superiority over other people. He is encouraged to set a new, conscious life goal that is flexible and socially useful. Abraham Maslow's writings about self-actualization, creativity, and values are very relevant at this stage, as the client changes his goal from demanding specific successes and compensations to a preference for generalized functioning, guided by values and the needs of a situation. A new psychological horizon opens up and the client begins to see himself, others, difficulties, and life differently. The therapist helps the client compare his new gratification in functioning fully and conquering difficulties to his former behavior, which was largely narrowed to the compensatory relief of inferiority feelings. When this stage is fulfilled, the client adopts a new goal and gives up his old one because the new direction gives him a more positive feeling of self and a more secure sense of real significance which is confirmed by the appreciation of others.
12. SUPPORT AND LAUNCHING STAGE
As the client explores the new, wider psychological horizon, he is helped to achieve a more accurate self-evaluation. He learns to love the struggle of overcoming difficulties, prefer the unfamiliar, and look forward to the unexpected. The client now feels equal to the therapist, others, and life, and wants to develop and use himself fully, connect with others, and share what he has accomplished. Finally, the therapist encourages the client to promote and sustain his personal growth and the growth of others.
Each new client presents a creative challenge for the therapist. No formula, procedure, or typology can meet the demands of understanding the uniqueness of each individual and the strategies that must be invented for him. The stages described earlier represent a map of the territory to be covered. The journey for each case will take different roads.
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REFERENCES
Adler, Alexandra. (1946). Individual Psychology: Adlerian school. In P. L. Harriman (Ed.), Encyclopedia of psychology, pp. 262-69. New York: Philosophical Library.
Ansbacher, H. L., and Ansbacher, R. R. (Eds.). (1982). Cooperation between the sexes. New York: Norton & Co.
Dreikurs, R. A. (1973). Psychodynamics, psychotherapy and counseling: Collected papers (rev. ed.). Chicago: Alfred Adler Institute.
Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books.
Maslow, A. H. (1970). Motivation and personality. New York: Harper and Row.
Maslow, A. H. (1971). The farther reaches of human nature. New York: Viking Press.
Stein, H. T. (1987). Current situation and early recollections questionnaire. San Francisco: Alfred Adler Institute of San Francisco.