The following questions, answers, and comments about Classical Adlerian philosophy, theory, and practice have been excerpted from discussion forums, newsgroups, and e-mail correspondence. The text has been edited minimally for clarity and readability. New topics will be featured each week. Your questions may be posted on the Classical Adlerian Discussion Forum at Behavior OnLine. All of this material is protected by copyright and may not be reproduced without the expressed consent of Dr. Stein.

34. Treatment of Addiction

Question from Forum: I'm looking for ideas on the Adlerian approach to treating addiction. My understanding of Adlerian psychology is that the key to treatment can be found in the "life style" developed in the first few years of life.

Is it likely therefore that this will also hold the key to treating addiction? Would an Adlerian approach consider it possible that the addiction might be compensating for something lacking from the early life style?

My interest is whether addiction can be treated in the same fundamental way as other experiences, eg. trauma.

In this respect, the psychotherapeutic treatment of addiction is similar to the treatment of trauma and most symptoms. However, in order to evaluate the severity of an addiction and provide for a reliable strategy for control of a substance, I generally refer clients first to a physician (if needed) for a check of metabolic or digestive disorders, and then to an Adlerian chemical abuse specialist for an initial consultation and review of resources. Then I discuss the options with the client, explaining that psychotherapy can only be effective if he is willing to take steps to stop the use of the substance. Frequently, regular participation in AA can provide the structure and support that some clients need to stop the substance abuse. Sometimes, an in-patient hospital program is the first step in recovery.

Many people suffering from addiction feel a vague sense of emptiness that can be traced back to an absence of the feeling of belonging in early childhood. Instead of facing and conquering this painful feeling of having been neglected, rejected, or abused, they have found relief in intoxication and illusion. Others have been pampered so outrageously as children, that they cannot tolerate struggling with normal difficulties, or the frustration of their self-indulgent demands. Although, mistakes may have been made by their parents, they too may have responded with a mistaken attitude toward life that has never been corrected.

Insight into a client's hidden, personal ideal (fictional final goal) is essential for a permanent solution. Unless an overblown ideal is discovered and dissolved, there will always be a temptation to intoxicate oneself with fantasy, an activity that is easily facilitated by substance abuse. The deep inferiority that many addicts feel or fear is caused by the great distance they experience from a impossible high goal of personal superiority. Other people are often seen as obstacles or enemies, and the real, normal challenges of life are viewed as threatening tests, interruptions of personal fun and pleasure, or distractions from personal glory. Within this perspective of life, withdrawing and "getting high" can be very seductive, and the addiction can be used as a persuasive excuse for avoiding reponsibility.

For some clients, a series of "missing developmental experiences" must be offered to fill the emotional emptiness that they feel (see http://ourworld.compuserve.com/homepages/hstein/provid.htm ). Eventually, in treatment, the client's neglected responsibilities, as well as the impact of the addiction on others, have to be faced. The most effective therapeutic solution for any client's disorder is the development of "the feeling of community"-- recognizing and accepting the encouragement of those who are currently willing and able to help, and then becoming a person who helps others.

Comment: I recognise and accept the processes you have described in treating addiction where addiction involves substance or alcohol abuse.

I am interested however in whether the problem of obesity in the Western world could be considered to a large part as addiction to food and whether there are any lessons which might be learnt from treatment of other addictions. I am obviously assuming here that we are not dealing with obesity as a result of specific medical problems. I wonder if it could be true to say that overeating in many cases is an attempt to fill a sense of emptiness, similar to that experienced by other additions, where the client has attempted to replace an emotional emptiness with a perceived physical emptiness. It is generally recognised that there is a "comfort" factor attained from certain foods which seems to lend credance to my theory.

Adlerian counselling seems to me to be a good discipline for this firstly because it deals with the whole individual and his relation to the "community" and secondly it works not through blame but primarily through encouragement.

Whilst I accept that the most effective therapeutic solution for any disorder is the sense of "feeling of community" - of accepting the encouragement of others and then becoming a person who helps others, I must say that I don’t think this can be achieved before a person has a concrete sense of "self" and acceptance of "self".

Developing a "concrete sense of self" and an "acceptance of self" is indeed a prerequisite to increasing the feeling of community. In order to achieve this, the push of the inferiority feeling and the pull of the fictional final goal must be progressively diminished. A genuine sense of self is discovered after the artificial role, dictated by the style of life and fictional goal (designed to relieve a dreaded fear of inferiority) is dissolved.

An examination of the stages of Classical Adlerian psychotherapy (see http://ourworld.compuserve.com/homepages/hstein/stages2.htm) can clarify the sequence of strategies that lead up to the development of a feeling of community.

35. Software for Case Analysis

Question from Forum: I came across your posting to the BOL Computing Group in which you stated:

"To help students visualize the totality of Classical Adlerian theory and practice, as a preparation for the rigors of case analysis, I have experimented with "mind-mapping" programs like Visimap and the Axon Idea Processor."

I am very excited about the uses of "mind mapping", and have played around with both Visimap and the Axon Idea Processor. Could you go into a little more detail as to the various ways that you have used these programs to "prepare them for the rigors of case analysis."?

The discipline of case analysis requires a somewhat different set of tools. I tried using mindmaps to facilitate the process, but found their structure too confining and awkward at the early stages of organization, guessing, and analysis.

In the organization phase of case analysis, the information that I get from clients, which normally includes a comprehensive history (both oral and written), is initially transferred to a sophisticated outliner, Ecco Professional. This program permits not only a chronological order of client supplied information and therapists's notes, but a re-grouping of information into categories. I also use ABC Flowcharter to create a dynamic, multi-generational Genogram that organizes a condensation of the client's impressions of self, family members, and significant people.

In the analysis phase, using Ecco, a matrix is constructed adjacent to the outline, providing a space to record comments, guesses about dynamics, and questions to be pursued. This matrix structure challenges the student and clinician to come up with guesses about various theoretical constructs. (This approach is similar to the strategies used in qualitative analysis.)

In the synthesis phase, the matrix of categories, comments, and guesses is studied for patterns and progressively higher order principles of the individual's "law of movement." At this point, I generally print out the outline/matrix and work with colored pens marking connections and patterns, Feelings and images that arise spontaneously are also recorded since frequently offer valuable clues to finding the "totality" of a case. Eventually, the task is to boil down all of the impressions into a few core guidelines: the client's unique inferiority feeling(s), style of life, compensatory fictional goal, antithetical scheme of apperception, and private logic.

Having achieved this diagnostic result, the dynamics may be illustrated graphically for convenience and teaching. A mindmap may serve this purpose, but other, more flexible graphic forms are often better. (Axon and ABC Flowcharter offer this variety.) A fascinating program that creates circular, hierarchical, symmetric, and orthogonal layouts is the Graph Layout Toolkit-- however, it is only available to programmers.

Recently, I have been experimenting with Atlas-ti, a program that was designed for research in qualitative analysis. (It facilitates the processes of data collection, reduction, display, and conclusion drawing.) One advantage of the program is the automatic generation of a graphic network that illustrates the connections between text segments, codes, memos, and comments.

Although the process of case analysis can become very intuititve after many years of training and practice, the path to gaining that expertise can be enhanced with the use of some excellent computer programs that facilitate the organization, analysis, and synthesis of case material.

For more information about the use of computer programs in case analysis, see the AAISF distance training course, "Case Analysis and Treatment Planning," (http://ourworld.compuserve.com/homepages/hstein/dt301.htm) .

38. Treatment of OCD (Obsessive-Compulsive Disorder)

Question from Forum: Recently I have found myself with several OCD clients. I have usually used an approach of support and acceptance, followed by reframing of thoughts, education about Sympathetic Nervous System issues, and training in body awareness and control. I would like to have some feedback about how experienced Adlerians treat OCD. I suspect there are some ideas and perspectives I need to add to my collection.

As long as the hidden goal and style of life (means of getting there) are not changed, there is a strong probability, that fighting symptoms will eat up a considerable amount of therapeutic time. Retaining the symptom, can even be used to gain an imagined victory over the therapist. It is also fascinating to look at the social impact of symptoms and see who is most affected. If symptoms change, it is frequently because the new one can be used as a more effective weapon in a conflict.

For additional information about Adler's view of compulsive behavior, read chapters 10 and 12 in The Individual Psychology of Alfred Adler, and chapters 7 and 10 in Superiority and Social Interest, edited by Heinz and Rowena Ansbacher. Also, read Classical Adlerian Theory and Practice (http://ourworld.compuserve.com/homepages/hstein/theoprac.htm) and Stages of Classical Adlerian Psychotherapy (http://ourworld.compuserve.com/homepages/hstein/stages2.htm) for an overview of the Classical Adlerian therapeutic process.





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Henry T. Stein, Ph.D., Director
Alfred Adler Institute of Northwestern Washington
2565 Mayflower Lane
Bellingham, WA 98226
Phone: (360) 647-5670
E-mail: HTStein@att.net
Web Site: http://home.att.net/~Adlerian/