Handouts - Two Approaches to Adlerian Brief Therapy

7/17/2019 Handouts - Two Approaches to Adlerian Brief Therapy

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Adlerian Brief Therapy 1

Running head: TWO APPROACHES TO ADLERIAN BRIEF THERAPY

Relational Strategies: Two Approaches to Adlerian Brief Therapy

James Robert Bitter

East Tennessee State University

William G. Nicoll, Ph.D.

Florida Atlantic University




Abstract

Adlerian Brief Therapy is a specific approach to Individual Psychology

that uses relational strategies to bring about effective change in the lives of

individuals, groups, couples and families (Bitter, Christensen, Hawes, & Nicoll,

1998; Sonstegard, Bitter, Pelonis-Peneros, & Nicoll, 2001). In this article, the

authors discuss a relationship – intervention continuum as an integration of two

approaches. A therapy session demonstrating Adlerian Brief Therapy with

individuals is used to highlight the integration.




Relational Strategies: Two Approaches to Adlerian Brief Therapy

Adlerian Brief Therapy is a specific application of Individual Psychology

that we have introduced and described elsewhere (Bitter & Nicoll, 2000).

Individual Psychology provides the foundation for how we think about clients

and the therapeutic process. We believe that all behavior is rooted in socially

constructed meaning and is only understandable with reference to its socially

embedded context. Human behavior and human interactions are best

understood teleologically, as goal-oriented. Indeed, the central human goal

reflects one’s idiosyncratic striving to belong and to complete, actualize, or

perfect oneself; it is this striving that unifies the personality. In general, people

who find a place within the human community and are interested in the well-

being of others tend to do better than those who are self-absorbed, and/or feel

disconnected or alienated. They develop what Adler called “psychological

tolerance” (Ansbacher & Ansbacher, 1956, p. 243) and are able to meet the

challenges of life rather than seek the perceived safety of psychological retreat

(Adler, 1996a/1935, 1996b/1935). Adlerian Brief therapy is based on an

understanding of lifestyle, the individual’s socially constructed meaning and

pattern of living, and a commitment to holistic, systemic, and teleological

assessments and treatment. These core Adlerian beliefs also form the foundation

for integrating other models and interventions into our work (Nicoll, 1999).

There are five considerations that keep therapeutic processes brief: (a)

time-limitation, (b) focus, (c) counselor directiveness and optimism, (d)




symptoms as solutions, and (e) the assignment of behavioral tasks. These five

aspects have been described as a foundation for Adlerian Brief Therapy (Nicoll,

Bitter, Christensen, & Hawes, 2000). The two of us differ to some extent upon the

relative emphases that should be given to a definitive time limitation, counselor

directiveness, and the assignment of behavioral tasks. We both agree, however,

that focused work will tend to keep therapy brief, that non-organic symptoms are

the client’s solution to a personal problem, and that motivation modification is the

goal when both directive interventions and behavioral tasks are used. Of the five

dimensions, therapeutic focus is the most critical to successful therapy.

In Adlerian Brief Therapy, two foci anchor therapeutic interventions: (a) a

focus on who the person is and (b) a focus on what the person wants from therapy.

This dual focus can be viewed as two points on a line, leading to a directional

question: How does the person move from their current life position toward the

preferred or desired position?

If we start with who the person is, there are specific Adlerian assessments

that tend to yield an immediately useful and holistic understanding of the

individual. Among these assessments are the presentation of self and concerns;

the individual’s interpretation of place within her or his original family

constellation (family system); developmental processes and the tasks of life; and

early recollections (see Adler, 1958; Bitter, Christensen, Hawes, & Nicoll, 1998;

Bitter & Nicoll, 2000; Dreikurs, 1997). Taken together, the data collected from

these assessments constitute what Adlerians call a lifestyle assessment (Eckstein &




Baruth, 1996; Powers & Griffith, 1987, 1995/1986; Shulman & Mosak, 1988). Such

assessments are holistic, systemic, and often produce an initial narrative of the

individual’s movement through life (Disque & Bitter, 1998).

Integrating a time limitation into therapy reflects the reality that therapists

meet people in the middle of their lives, and they say “goodbye” to them in the

middle of their lives. There is an implied agreement in a brief therapy contract:

In a relatively short period of time it is possible to make a significant difference

in one’s style of living and coping. There is optimism in the contract that stems

from a belief in the client’s ability to change or improve a personal life situation.

While Adlerians do not always define the exact number and duration of sessions

with a client, when we do, therapeutic work progresses more quickly, staying

focused on collaboratively chosen outcomes.

The process within sessions often resembles a meeting of minds and

hearts. While some therapists choose to focus on the heart and some on

strategies for change, effectiveness—especially within a brief therapy

framework—requires balance and the recognition that “therapeutic relationship”

and “client change” are intimately connected. For the time devoted to therapy,

the therapist’s focus is on being fully present with clients. We ask ourselves

recurrently: “Where are we going . . . and with whom?”

Given these foci, there are obviously some similarities between solution-

focused therapy and the Adlerian model (La Fountain, 1996; La Fountain &

Garner, 1998; Watts & Pietrzak, 2000; Watts & Shulman, in press). There is,




however, at least one significant difference. Solution-focused therapists assume

that expressed, preferred outcomes are really desired by the client. The Miracle

Question (de Shazer, 1988) was designed to help clients construct intended

outcomes: “If a miracle happened tonight and you woke up with the problem

solved, or you were reasonably confident you were on a track to solving it, what

would you be doing differently?” (Walter & Peller, 1992, p. 78). Any answer to

this question may seem like a desired outcome that can serve as both a goal and

focus of therapy. If it is, however, why do counselors who ask some variation of

this question seem to run into so much resistance when attempting to help clients

reach the goals they have articulated? [See Berg, 1993; O’Hanlon, 1995]

In 1929, Adler (1964) developed “The Question,” an intervention that

Dreikurs (1997) later re-phrased as “What would you be doing if you didn’t have

these symptoms or problems?” Unlike modern solution-focused therapists,

however, Dreikurs believed that presenting problems were often the solutions

that the client had chosen in order to avoid or retreat from the larger life tasks of

social responsibility, occupation, and intimacy. Adlerians use “The Question” to

assess which task(s) the client is choosing to avoid.

“If I weren’t depressed, I would enjoy going to work. I would be able to

focus on the projects I have been given, and I would meet deadlines that would

bring the company recognition. And I would probably do so well, I would be

promoted.” Such an answer sounds like a goal the client actually has, but

Adlerians suspect that the individual actually lacks the courage to face the




demands of work. If perfection is the perceived requirement for promotion, then

failure seems all too imminent. In a psychology of use (Ansbacher & Ansbacher,

1956), depression is the client’s solution when faced with the perceived

possibility of failure: It serves as an excuse for the client’s retreat from the

occupational life task.

Toward a Relationship – Intervention Continuum

Therapeutic relationship has a direct influence on therapeutic

interventions and therapeutic outcomes. Those interventions that connect the

client to both internal and external resources tend to empower the individual and

encourage movement in therapy. The therapist may initially be the only external

resource the client has. A quality relationship is based on mutual respect,

requires an interest in and fascination with the client and what she or he brings

to therapy, and is facilitated by a collaboration that seeks to make an immediate

difference in the client’s life. When the therapist and client arrive at strategies for

change at about the same time, resistance is all but non-existent and motivation

is high.

For example, in a session where a mother is struggling with what to do

when her child throws a temper tantrum, she realizes that yelling at him to “stop

yelling” is not effective. Instead of giving a direct recommendation, the therapist

explores the possibilities already available to her.

Therapist: So doing something that doesn’t involve speaking or talking

might be useful to you.




Client: Yes. I don’t want to hear myself like that.

Therapist: What do you want to do?

Client: (gesturing as if to wrap her child in her arms) I just want to

hold him.

Therapist: So when you feel calm in the face of his tantrum, you would

go to him, wrap him in your arms, say nothing, and just hold

him until he is calm with you.

Client: Yes.

One way to think about the therapeutic relationship in Adlerian Brief

Therapy is through the use of the acronym, PACE. This acronym also speaks to

the rhythms and flow of therapy. P stands for purpose, a concept that is central to

the Adlerian model. It includes a focus on what purpose(s) the client has for

therapy; the motivations for behaviors, emotions, convictions, and beliefs

maintained in daily living; and even what goals may be involved in interactions

between the client and therapist (Mosak, 1977). A stands for awareness and is

related to the level of attention that both the therapist and the client bring to their

work. Awareness is both the alpha and omega of experience (Polster & Polster,

1996): It focuses attention so that experience is no longer non-conscious, and it

brings experience into a resolution or a reflection—and sometimes, even a

celebration. In this sense, insight is simply one form of awareness. C stands for

contact and includes the quality of contact between the therapist and the client as




well as the quality of the contact the client has with self, with others, and with

the environments in which he or she lives. The constructs of awareness and

contact are well defined within the work of the Gestalt therapists, Erv and

Miriam Polster (1973, 1999). E stands for experience, which both flows from

relationship and provides the interventions and transitions for therapeutic

change. It is not uncommon for a focus on purpose, awareness, or contact to

evolve into therapeutic interventions, strategies for change, experiments,

enactments, or even homework, any of which may lead to the integration of new

experiences in the client’s life.

The question of what makes a new experience useful or even therapeutic

can be addressed through another acronym, BURP, which has been described in

greater detail by Nicoll et al. (2000). B stands for strategies related to behavioral

descriptions. From an optimistic interest in presenting issues [“What would you

like to see going better in your life?”] to recurrent patterns, Adlerians focus on

what people do, how they feel, and the results of these processes in interactive

experiences. Such questions as “when was the last time this occurred?” or “what

happens when you feel . . . ?” or “who is most affected when you feel . . . ?” focus

the client on movement and process rather than helplessness.

Individual purposes are often revealed in the responses that others have

to what the client does. “I was depressed all the time at the university. When I

went home, my parents took care of me, and I slowly got better. I don’t feel




much like going back.” Such a statement suggests that having someone take care of

the client may be one of the goals of the depression.

A second strategy is actually an investigation: U stands for understanding

the client’s underlying rules of interaction. Adlerians believe that all behavior is

social in nature: It is enacted in social systems and gains meaning in interaction.

The client’s rules of interaction guide the client’s movement or style of living

through daily life; these rules also comprise the client’s perspective on self,

others, the world, and life, itself. Since the rules of interaction start to form when

people are very young, Adlerians use birth order and family constellations,

developmental processes and life task assessments, and early recollections, to

name a few, as avenues of investigation (Carlson & Slavik, 1997; Mosak &

Maniacci, 1998; Sweeney, 1998). Whatever the assessment process, meaning is

shared with the intent of a conscious consideration of the function of underlying

rules, past and present, through a process Nicoll (1999) calls “active wondering.”

“I’m not sure here, but I can’t help but wonder if perhaps sometimes your

depressive episodes don’t also work for you a little in helping you avoid difficult

situations and mobilizing others to take care of you” (Nicoll et al., 2000, p. 236).

R stands for re-orientation. Re-orientation is the process of helping clients

to consider a new perspective. It aims at enlarging the awareness of clients so

that they can think about and intend solutions in a manner that is different than

the thinking that generated “the problem” in the first place. Reframing, re-




labeling, normalization, generating hope and options, and uses of humor,

metaphors, and even storytelling all enhance the re-orientation process (Nicoll,

1999; Watts & Carlson, 1999). Whatever the intervention, Adlerians aim to

change more than mere behavior; re-orientation seeks to shift rules of interaction,

process, and motivation. Such shifts are often facilitated through specific

changes in awareness, contact, and experience that take place within a

counseling session but which are transformed into action outside of the session.

Therapist: Do you know why people always seem to provoke you into

getting angry?

Client: Because I’m not liked.

Therapist: I have a different idea. Could it be that people know you

“go off” easily, and they want to see it happen. Maybe they

sense this rule you have: that “no one gets to tell you what to

do and get away with it!!!”

Client: Yeah, I think that does happen . . . all the time, actually.

P stands for prescribing new behaviors or behavioral rituals. Behavioral

rituals involve regularly repeated actions that maintain human interactions or

patterns and their underlying rules of interaction. In this sense, family, school,

religion, and society all enact routines, ritual behaviors, and celebrations that

serve the function of reinforcing or reaffirming their cultural worldview and




eliminating alternative positions (Foucault, 1980). Similarly, client symptoms

and life problems are often enacted as rituals, making their power and necessity

seem overwhelming. In Adlerian Brief Therapy, new behaviors or rituals are

additive. While “prescribed” behaviors or rituals are most often developed

collaboratively with the client, we want them to (a) directly impact the client’s

underlying rules and (b) enhance the individual’s ability to act with social

interest and in socially useful ways.

To continue with the example above:

Therapist: What would you be doing if you were demonstrating your

determination not to get angry when provoked?

Client: Well, I just wouldn’t do anything.

Therapist: Yes, but what would you be doing instead.

Client: Smiling at them, I guess.

Therapist: As if to say . . .

Client: Nice try, but you don’t get me this time.

Therapist: Yes, “nice try.” It’s a perfect internal response.

Here is a summary of how PACE and BURP can be used in therapy:




Place Table 1 About Here

When we consider these two foci together, they form a relationship –

intervention continuum that can be displayed as follows:

Place Figure 1 About Here

While any of the considerations and interventions on the continuum

might be used at any time in therapy, purpose and behavioral descriptions tend

to be early considerations, and they have a recursive relationship with each

other. Similarly, considerations and interventions around awareness, contact,

and the understanding and reorientation of underlying rules tend to happen in

the middle of therapy. We also try to create or co-create new experiences in

therapy as a foundation for reorientation and new behavioral rituals. Such

experiences may include experiments or enactments integrated from other

models.

A Case Example

The following session is a typescript of a taped demonstration of Adlerian

Brief Therapy conducted at a national convention (Bitter, 2002)—with a signed

release by the client. It has been edited for grammar and clarity of content.

Names and places have been changed to provide some degree of anonymity.




Commentaries in brackets have been added to highlight various aspects of

relational interventions and strategies.

Forming A Relationship

Therapist: We’ve met before. Do you remember where?

Client: Butte, Montana, I believe.

Therapist: Butte. Ah, yes. And I met you this morning coming out of

my hotel room door, because you’re across the hall from me.

(Pause)

So what would you like to see going better in your life? I’m

not going to go into it right now. I’m just going to get a

picture of it so I have a focus.

Client: That’s the problem. I was thinking as I was coming here:

“Gosh, I don’t know if I should be coming to you, because I

don’t know who I am and I don’t know what I want.”

Therapist: Okay, so would one way of thinking about it be that there is

some confusion in your life?

Client: Yes. [ A possible, but undisclosed, purpose for confusion is that it

keeps the person from moving, from having to make a decision, or

taking a stand.]

Therapist: Are you at a point where you like the confusion or where

you would like some clarity?

Client: No, I’d like some clarity, and I’d like to get things settled.




Therapist: Okay. Is there anything that among a number of things that

you would most like some clarity about or is it just

amorphous to you?

Client: Well, it’s a lot of things. You know, . . . what am I going to

do when I grow up? I have just retired from my job, and I

want to start another one. I want to start a private practice;

and I want to write a book; and I want to do all these things;

and my family is falling apart, and I’d like to re-establish my

relationships with my family. [There are probably a number of

things in this list that the client is not ready to face, e.g., starting a

private practice, writing a book. The most potent aspect, however,

is her sense that the family is falling apart, a declaration that

deserves therapeutic focus.]

Therapist: Okay. So there are some specifics to all of that, but a lot of it

seems overwhelming at the moment.

Client: Yes, it is.

Therapist: Now could you tell me a little about you? Help me know

you.

Client: Well, let’s see. I don’t know where to start. [There is

something in her tone of voice and the way she seems to be

searching several pictures in her head that suggests she is looking

for “the perfect” way to present herself.]




Therapist: Start at the worst possible place.

Client: Well, I’m an old lady. I guess that’s as bad as you can get.

I . . . [She starts with almost a depressing voice, in a monotone as if

she is playing a tape. I want a shift in her awareness immediately,

and I want to engage her, make contact, in a different manner.]

Therapist: You know the problem is not that you are an old lady. The

problem is that you are older than you want to be at this

time. How old do you want to be?

Client: Forty-five

Therapist: Forty-five: one of my favorite years too. What was good

about 45 for you?

Client: Well, I don’t really know. I just said that. I guess I was kind

of at peace with myself at that time when I think back on it.

I was a school counselor and enjoying it. I loved the kids,

and they loved me. I felt like I had a great life.

Therapist: Okay, so regardless of what else might have been going on,

there was contentment, and you knew what you were doing,

so you had a sense of being capable. You had a sense of

being useful and important and doing things of value and

you knew how to do them. Comfort. Nice. So what is

keeping that from happening now?




Identifying the focus issue: Getting a behavioral description

Client: I don’t know. I just feel unappreciated and unloved, and I

don’t know. [This time, she speaks with real sadness in her voice,

and I sense tears in her.]

Therapist: And there’s some real sadness for you in that.

Client: Yes.

Therapist: Whom do you feel unappreciated by?

Client: Just about everybody. [Her hurt is not global; it is specific, and

I want to know the specifics.]

Therapist: Of all the people you know who don’t appreciate you, who

is most important you. Who have you lost that is most

important?

Client: My son.

Therapist: Your son. Shall we stay with that for a while?

Client: Ok.

Therapist: Can you tell me a little about him and you, and what your

relationship is like?

Client: We were always very close. My son . . . I was divorced

when he was six. I had another son who was four: so four

and six. My older son kind of, I guess, took on the father

role. I wasn’t aware of that at the time. I just went through

life, and I didn’t think I was putting anything on him, but




looking back on it, he thinks I did. [She is putting more

importance on her son’s thoughts than her own. I want her to at

least voice her own position.]

Therapist: Um, hmm. What do you think now?

Client: Well, I still don’t think I was putting anything on him. I

think it was his choice.

Therapist: So you’re in disagreement at this point.

Client: But as we went through life, we were very close all the time.

And when he moved back to Butte—after failing at his

doctoral degree—we just did a lot of things together, and he

kept inviting me. I’m not someone who would just invite

myself places, and I guess that’s a bad thing, because I have

to wait for everybody else to invite me.

Therapist: You can wind up feeling lonely sometimes.

Client: Yes. All the time. Anyway, he always invited me, and I

always went. We had a great time. We liked the same kinds

of things, and he was about my best friend, you know . . .

really. My friends always told me that I was too close to

him. [ Again, someone else’s voice has been given preference over

her own. I want to challenge that.]

Therapist: Well, exactly what is too close?




Client: Well, that’s what I have never been able to understand. It

seems to me that family members can be close and do things

together as long as it is…

Therapist: You weren’t still diapering him.

Client: No, no, and I wasn’t sleeping with him. To me it seemed

okay.

Therapist: Then why the hell did you listen to those people?

Client: Well, I didn’t. And I kept going. And when I got my

doctorate he helped me through it. I emailed him every

paper I wrote, except my sex therapy papers.

Therapist: [smiling with a twinkle in his eye] You have to draw the line

somewhere.

Client: [laughs] He would critique them and send them back to me,

and I felt like I really had support there. He really

supported me through my doctorate. I would have never

made it without him, probably. And then, I came back to

Montana, and we continued seeing each other from time to

time and had fun together and so forth. All of the sudden,

he got this girlfriend who hated me. I didn’t know she was

even a girlfriend. She was someone he was helping out. She

was quite a bit younger than he, and she needed a lot of

help. So, he was helping her and still, when he would invite




me to go places, I would go. And she would be there, too,

and I just thought that was fine. And all of the sudden she

just waylaid me and said I was just awful and that I just

ruined my children and that he couldn’t stand on his own

two feet.

Therapist: What’d she want from you?

Client: She wanted me to leave him alone. She said I called him too

much. So I quit. I wouldn’t call him, except maybe once . . .

[There is a pattern developing that suggests part of her rules of

interactions: She wants to be a “good” person, and to be seen that

way, no matter what. And a good person does not argue, disagree,

fight, or even so much as stand up for herself. In her attempt to

please everyone, she loses a sense of identity, a sense of self, and her

even her voice.]

Therapist: Now, why in God’s name would you give up a good fight

like this?

Client: Well, I didn’t want to ruin his life, and I thought if he wants

her . . . [No one can really ruin someone else’s life without that

person allowing it. So this is an opening for a shift in awareness, a

re-orientation.]

Therapist: You’re not that powerful.

Client: Well, anyway, she still . . .




Therapist: [smiling] You didn’t want to hear that one at all did you?

Have you actually ruined anybody’s life?

Client: I don’t think so.

Therapist: Have you tried?

Client: No.

Therapist: So, not only have you not done it, but you haven’t put any

effort into doing it. So we don’t even know if you’re any

good at it or not. Well, let’s try the other end of it. Have you

made anybody’s life worth living?

Client: Well, yeah. I think I helped a lot of kids in the schools and

parents.

Therapist: So tell me a little about that. What do you do to help people

have a good life.

Client: Well, when I was an elementary counselor I helped lots of

kids. I taught them things that they needed to know to be

happy in their lives.

Therapist: You know if I had a couple of days with you I would let you

get by with that, but I’ve got really a short amount of time.

So tell me what you did to help them. Concrete stuff.

Client: Okay. I helped kids feel good about themselves.

Therapist: How’d you do that?

Client: I, um . . . that’s a good question.




Therapist: Thank you.

Client: I was happy to see them. I enjoyed being with them, and I

let them know that.

Therapist: You were happy to see all of them?

Client: Yeah, I was.

Therapist: Even those trouble makers?

Client: Yeah, I enjoyed those little troublemakers.

Therapist: What’d you enjoy about the little devils?

Client: I enjoyed their, what’s the word . . . their ability, their

creativity, I guess.

Therapist: So who was the most creative troublemaker you ever met?

Client: Oh, boy.

Therapist: You’re the oldest child in your family aren’t you?

Client: No, I’m the youngest.

Therapist: The youngest? Then you have no business having this

perfectionism. Did you have nothing but derelicts above

you? [Use of humor to facilitate therapeutic relationships also

helps the client to step back and re-assess her rules of interaction.]

Client: I had two brothers.

Therapist: So you did have nothing but derelicts. Okay, we’ll just set a

couple of ground rules. If I make the mistake, which I could,

and say, “What’s the most, what’s the best, what’s the




biggest?”: just ignore me. Just pick anything, because

otherwise you will be searching your memory for the most

important one, and I’m down to thirty minutes. So just pick

one. Pick one of the great troublemakers of your time.

Client: Ok. Well, I can remember way back in my very beginning

years as a counselor. I was in Junior High, and this kid

would come in to see me everyday, and he’d do that just to

get out of class, but I really enjoyed being with him. The

teachers hated him, so they were glad to get rid of him, and

it turned out everybody was happy.

Therapist: What did you do with him?

Client: We just talked about whatever he wanted to talk about.

Therapist: Mm, hmm. Did he trust you right away?

Client: I think so.

Therapist: Why?

Client: Because I’m a trustworthy person. I don’t know.

Therapist: Could be, but you must have done something to

demonstrate that, because all the other people who looked

like you were teachers, and he hated them.

Client: That’s true. I guess I was probably a good excuse to get out

of class.

Therapist: What did you do?




Client: I listened to him.

Therapist: Did you disagree with him?

Client: Probably, I don’t really remember all that, but I just

remember enjoying him. It made me feel important, and I

liked that.

Therapist: Ok. Now, did you ever have anyone who just hated you?

Client: My son’s girlfriend.

Therapist: Besides her.

Client: No, I can’t think of anyone.

Therapist: So this is a new experience for you.

Client: Yeah, yeah I guess so.

Therapist: So actually you don’t really have a lot of life experience on

what to do with people who are really just obnoxious.

Client: Right, but I’m getting it fast.

Therapist: And fortunately you have a therapist that can help you with

that, because I have a lot of experience being obnoxious.

[Client laughs] Are you having fun yet?

Client: Yeah.

Therapist: Ok. I think you have something that you are going to have

to decide. [The therapist moves from a playful interaction to a

very serious discussion. The contrast focuses attention, heightens

awareness, and augments the therapeutic contact.]




Client: Ok.

Therapist: You are going to have to decide whether you want to still

live or you want to just die and walk around until your body

catches up.

Client: I don’t understand.

Therapist: Which part?

Client: The whole thing.

Therapist: Ok, to live, you’re going to have to become a person. And if

you just want to die and wait until your body catches up,

you can just do exactly what you’re doing.

Client: Hmm.

Therapist: Got any feel for which way you want to go?

Client: I’d like to live.

Therapist: Would you?

Client: Um, hmm.

Therapist: As a real person?

Client: Um, hmm.

Therapist: Okay.

Client: Yeah, because I just feel like I’ve been meeting everyone

else’s needs.

Therapist: That’s right. You know what happens to somebody who

spends her life pleasing everyone else?




Client: They don’t get pleased.

Therapist: And what do people do with doormats?

Client: They step on them.

Therapist: Yeah. I probably have not said anything this hard to anyone

in a long time. This is a hard thing for me to say to you, and

I think it’s probably a hard thing for you to hear, isn’t it?

Client: Um, hmm.

Therapist: You see, initially I thought you were possibly grieving about

the loss of your son, but now I know you were getting ready

to grieve for the loss of yourself.

Client: Quite true.

Therapist: How old are you?

Client: 65.

Therapist: Only ten years older than me, and I’ll tell you something:

you’re at the age, now, that, when I am your age, I plan on

kicking butt and taking no prisoners. Now, what kind of

person do you want to be?

Client: I’ve always wanted to be bubbly. I’ve never been bubbly.

And I envy people who are bubbly. [Note: “Bubbly” isn’t a

behavioral description; it’s an evaluation.]

Therapist: Do you? What do bubbly people do?




Client: They can talk to everybody and say anything and not care

what others think.

Therapist: Can I stop for just a second?

Client: Uh, huh.

Therapist: I want to make a point here. This is just a gentler version of

the question. What’s she afraid of? [With an audience, the

therapist has an indirect means of talking to the client that at one

and the same time lets her hear what is being suggested and also

take a break from our work.]

Audience: Rejection (comment from the audience).

Therapist: Yes. She doesn’t have any confidence in her ability to be this

person that she would like to be. She just spent probably a

good 20+ years of her life watching all those people who do

have it. She’s a measurer. She looks at it, and she says that’s

them, this is me, and the gulf is too damn big to get over.

Am I right?

Client: That’s right.

Therapist: Yeah. And so, if I start working with her right now on being

a bubbly person, which of us is going to win that one? I

think we need something else. Let’s see. It’ll help me if I can

get a few small pieces of kind of objective stuff about you. Is

that okay?




Client: Mm, hmm.

A Psychological Investigation: Underlying rules of interaction

Therapist: You said you are the youngest.

Client: Mm, hmm.

Therapist: Any miscarriages?

Client: No.

Therapist: Any daughters in your family besides you, or were you the

only little princess everybody had?

Client: I was just the princess.

Therapist: Okay, who is closest to you in age?

Client: My brother, Mark.

Therapist: Mark? And how much older than you is he?

Client: Four years.

Therapist: And are you more like him or different from him?

Client: Probably different.

Therapist: In what way?

Client: Well, he wasn’t as studious, and he was kind of slovenly.

He was easy going.

Therapist: He wasn’t as studious; he was slovenly; he was easy going.

Client: I think I was kind of easy going, though.

Therapist: I’ll help you with the other one if you want me to. He was

bubbly. [Bad guess, but nothing lost.]




Client: Well no, but he wasn’t afraid of anybody.

Therapist: Okay, so he made friends easily.

Client: Yeah.

Therapist: Did you find it hard making friends?

Client: No.

Therapist: So, how is he different?

Client: Well, he had bad grammar. That’s another bad thing.

Therapist: And who, besides you, had good grammar?

Client: My brother, Dave, my older brother.

Therapist: And Dave turned out to be what?

Client: He’s a sign painter.

Therapist: He’s a sign painter. Well, you need good grammar for that.

Client: It’s amazing how many sign painters put bad grammar on

their signs.

Therapist: What does Mark do?

Client: He’s a farmer.

Therapist: So were you the first person in your family to get a college

degree?

Client: Mm, hmm.

Therapist: Anyone celebrate that?

Client: Yeah, and when I got my doctorate, my brother Dave came.

Therapist: How about your family, your parents?




Client: My dad came to it.

Therapist: Is he like Dave or like Mark?

Client: He’s like Mark.

Therapist: In what way?

Client: He doesn’t like to dress up. He was a rancher or a farmer.

Therapist: So you doctoral type people are a bit uppity for him?

Client: No, he was always just very accepting of everybody.

Therapist: He was? That’s nice. What about your mother?

Client: My mother was very demanding. I never liked my mother

much. Until I got married, and then I thought she was

wonderful.

Therapist: What changed?

Client: She was very helpful.

Therapist: In child rearing and that kind of stuff?

Client: Yeah.

Therapist: How did you find your husband?

Client: We were in college together.

Therapist: Did you go after him or him after you?

Client: Well, he went after me, I guess.

Therapist: So why did you give in?

Client: Because somebody told me I should.




Therapist: So someone told you that you should kind of get interested

in the guy, and you caved in and did it. You got married

right after college?

Client: No, we got married when I was a sophomore.

Therapist: Okay. Think back to when you were really young, and then

I am going to stop doing my quasi-objective stuff. What’s

something you remember from when you were really little?

Client: Well, my very earliest memory was when I was just a

toddler, and I remember we were at the ocean, and all the

sudden the water was coming at me, and it scared me to

death, and my dad picked me up.

Therapist: And how did you feel?

Client: I felt scared when the water was coming at me, but then

daddy saved me.

Therapist: Got any others?

Client: One time we went camping. I was, I don’t know, 4 or 5, and

we were . . . my brothers and my dad were out in the boat,

and my mother and I were in camp, and I was wandering

around from campground to campground, and I saw this . . .

what had been a fire, and the ashes were just so soft. And I

took off my shoes and waded through it barefoot, because I

thought it would feel good on my feet.




Therapist: What happened?

Client: My feet got burned.

Therapist: How’d you feel?

Client: Hurt.

Therapist: Hurt. Okay, one last one.

Client: Let me think. My mind’s blank. [pause] . . . I remember in

first grade I was in a play, and it was a great big auditorium,

and it was packed with people, and so I was talking really,

really loud, and it was about mice running around. And I

got up on this chair, stood on the chair, and I gave this long

speech and realized it was the wrong one.

Therapist: The wrong speech?

Client: The wrong line. And so I yelled out “Oh no” and turned

around and gave the right speech, the right line.

Therapist: How’d you feel?

Client: I felt . . . and everybody laughed . . . and I felt okay. I felt

like I had fixed it.

Therapist: Good for you. If you hadn’t had that memory, I would have

been sitting here until we found one. You’ve been doing

[interpreting early memories] for some time. What do you

think about the first two memories you had?




Client: Well, I’ve analyzed them and analyzed them. I can’t . . . I’m

not sure. Maybe I want somebody to save me, or when I do

things on my own, I get in trouble, and it hurts me.

Therapist: Ok. I might have said it a little differently, but we’re in the

same ballpark. What do you get from the third memory?

Client: I can make mistakes, and I’m still okay.

Re-orientation: Shifting the Underlying Rules

Therapist: Now we’re at the critical juncture of life. If you would like

to be a person, you will have to spend more time with the

third memory, and less with the other two, and if you want

to be dead you have to join with the other two.

Client: Okay.

Therapist: How would a really tough broad . . . ? (she smiles) You like

this already don’t you? How would a really tough broad

handle herself after she mistakenly tramps through the

coals?

Client: I don’t know, put on boots.

Therapist: Yep, let’s say you didn’t have any. Let’s say you actually got

yourself into it; you’re running across hot coals, and in the

middle you realize this was a mistake, how does a tough

broad handle it?

Client: Get out of there.




Therapist: Yes, and?

Client: Take care of my feet.

Therapist: I’m going to tell you something an old teacher of mine told

me back in 1975 just before I went out to do my first

presentation on the Family Education Center before the

world famous Kiwanis Club. He said to me, “Just go out

and do it as if you know what you’re talking about.”

And I said, “Yeah, but I don’t.”

He said “Yes, but they don’t know that.”

I said: “I don’t know if I have that confidence.

He said, “You know when we were out tramping in that cow

pasture the other night, and you stepped in stuff, and made

a big deal out of it?”

I said: “Yes.”

He said: “Confidence is walking on as if you hadn’t done it.”

Now, then, this is a secret about life. There is no such thing

as a confident person: just those who are good at faking it,

and those who aren’t.

And the big problem, or at least part of the problem that

you’ve had in life, is that you’ve had the illusion that there

really are confident people out there: Somehow they’ve got

it together, and you just can’t seem to do it. But you see




you’ve got that third memory, and you’re in trouble, because

even you know that you can. What were the strengths in

that memory?

Client: Being able to redirect.

Therapist: That’s right.

Client: Making people laugh.

Therapist: Absolutely.

Client: Speaking loud.

Therapist: Yes!

Client: Memorized two different lines.

Therapist: You have options. What kept you from looking out at the

audience and seeing a huge wave coming at you that was

going to kill you?

Client: I don’t know.

Therapist: See if you can get there. Close your eyes for a second. Let’s

go back. Put yourself on that stage. Just look out at those

people. You can do that. You’re an elegant, beautiful, 65

year old woman who can look out there and not be

frightened by them. So, just take a look. What do you see?

Client: Accepting people.

Therapist: What do they look like?

Client: They look the same as everybody.




Therapist: They look the same as everybody. Now, up until a few

weeks ago, you were the Will Rogers of Butte, Montana.

You never met anybody you didn’t like and who didn’t like

you. It’s true, isn’t it?

Client: It’s more than a few weeks. It’s been several years. And my

brother now is turned against me too. [Her last statement is

an invitation to de-focus that the therapist cannot follow.]

Therapist: Well, this is also true: When it rains it pours. The good news

is that it also works the other way around. When you turn

one thing around, whole bunches of things start to work out.

Now, what were the skills that you used all those years in

school counseling to win over everybody from the brilliant

student to the snot? What were those skills that you used?

Client: I just did what I could.

Therapist: Like what?

Client: I followed the rules.

Therapist: That’s important. What else?

Client: I reached out to others, and I was there for them.

Prescribing new behavioral rituals through therapeutic experience

Therapist: Okay, let’s try something. I will do a really bad version of

your possible future daughter-in-law.

Client: I hope not.




Therapist: And you do your skills.

“You’ve ruined everything.”

Client: [The client leans forward, takes a deep breath, and focuses.]

Therapist: Now, before you start, I loved what you just did. What did

you just do? [Performance is enhanced by awareness and full

contact with oneself and one’s energy.]

Client: I moved in.

Therapist: Yes, what else?

Client: I looked you in the eye.

Therapist: Yes, what else?

Client: I took a breath.

Therapist: Yes, and that’s the difference between living and dying.

People who are living have to take a breath. So the first

thing you do is take a breath in; then you lean forward, and

you put all of your energy into your center just like you did.

Now what do you have to say?

Client: I don’t know.

Therapist: Start over. Because this is what your breath was like when I

just asked you what you had to say. [Therapist takes in

shallow breath and holds it.] I want you to breathe. Keep in

mind you have been handling people just like this, even

though they haven’t seemed like this: You’ve been handling




people like this for 25 years. What do you have to say to this

person?

Client: I’m sorry you feel that way. If Gary is so bad, why do you

like him?

Therapist: Now, how does it feel for you to say that?

Client: It gives me power.

Therapist: Yes, and how’s it feel to say that?

Client: It feels good.

Therapist: What kind of good?

Client: Well, I got it out.

Therapist: What happens if it just stays in?

Client: It just smolders there.

Therapist: Yes. When you’re smoldering inside, are you living or

dying?

Client: Dying.

Therapist: Okay, let’s carry it one step further.

“Well, I don’t need you around. He’s hard enough for me as

he is. I don’t need to tell you why I love him. After all, it’s

not your business.”

Client: [in her strongest, most centered voice] I realize that, but I

want the best for my son, and I hope that you’re the best for

him.




Therapist: Oooh. How’s that?

Client: That was really hard.

Therapist: Yes, but it was practically perfect. You just took my breath

away. You don’t have to back down from any punk kid.

You haven’t done it for 25 years, and no reason to do it now.

The main thing is this: You already have everything you

need inside you; you’ve always had it; and what’s left for

you is to stop ignoring it and use it. You might want to

practice a little bit, because you are a little rusty, but you

aren’t dead. And then when you get done with your son,

and his new friend, you start inviting other people to do

things with you. You invite them and don’t wait for them to

invite you, because, by God, you are worth having as a

friend. How’s this been for you?

Client: It’s been great.

Therapist: You’ve been great.

Client: Thank you.

Therapist: You’re welcome.

Concluding Remarks

What happens with this client will depend a great deal on what she

chooses to do when she gets back home. Finding one’s voice does not always

equal the choice to use it. This is only one session. If there were an opportunity




for more, the possibilities for change might generalize to other parts of her life

and thereby reinforce and reaffirm a shift in her underlying rules of interaction

and her motivations in living.

The flow of this session reflects many of the aspects of therapy along the

continuum that we prize. It starts by choosing a focus for the session, which is

also to say, a purpose for therapy. The initial pace is a slow, careful, tight

therapeutic sequence (Polster, 1987) in which the therapist follows the client as if

considering each stitch in a developing tapestry. Yet, even within these

sequences there are shifts that we have noted in the typescript that are chosen to

interrupt the deadening of experience, enhance awareness, and bring the client

into better contact with self and others. The movement from initial issue focus to

a focus on the person to getting a behavioral description is, perhaps, the most

common initiating process we use in Adlerian Brief Therapy.

Behavioral descriptions to be useful must be specific and concrete.

Concrete descriptions highlight interaction, movement, style, and patterns in the

person’s life. It is in her interactions with others, in the doing of life, that patterns

of pleasing, “goodness,” and perfectionism emerge. The immediacy of brief

therapy almost requires that there be some challenge to the usefulness of these

embedded rules of interaction. Humor in the form of delight and play has two

very useful dimensions: (a) It lightens the process by joining the client in

common human folly, and (b) it provides a process and context against which a




shift to a more serious intervention is instantly recognized (again, enhancing

awareness).

The interventions that asked the client to decide between living or dying,

between becoming a real person or giving up, represented a real shift in the

conversation from more playful to more serious, and it is literally the beginning

of reorienting the rules. At the same time, the therapist also discloses that saying

something so difficult and direct can be hard to hear, inviting the client to

comment, if she wants to, on her experience of this intervention. She chooses not

to comment, which is her prerogative. A short time later, it seems useful to note

a fear of rejection she might have, but therapeutically, the counselor does not

want two relatively hard disclosures in a row. In this case, there is an audience,

and asking the audience “what the fear might be” allows the client to take the

information in from another source. Further, since the therapist has turned his

awareness and contact toward the audience, the client is allowed to breathe, to

relax a little, and to settle briefly into observation.

This relaxation in the flow of therapy is also facilitated by a shift to

Dreikurs’ (1997) objective interview. In the middle of approaching new options

and strategies for change, a challenge that can often feel overwhelming, the client

is invited to regain the role of expert in her own life, to bring the counselor up-to-

date on her family constellation, the family atmosphere, and her early

recollections. Throughout this process, the therapist is gathering a sense of the

strength that is in the client and in the client’s background. These will become




the internal resources she needs in both a reorientation of her rules and the

development of new behaviors, new interactions, and even new rituals.

In this case, we are presented with a woman who has accomplished good

breeding from humble beginnings, who has enjoyed the support of others and

has come rather optimistically to expect it to continue, and who has an early

memory of triumphing over adversity. It is a picture that does not fit with

voiceless-ness in the face of her son and his partner. The weaving of re-discovered

strengths into the practice of new behaviors creates a closing experience that can

serve as a launching of a new sense of self into the world.

Still, real change happens between sessions, not in therapy, itself. It is one

thing to arrive together at a strategy for change. It is another to enact it. It takes

courage (and encouragement) to bring what one learns in therapy to daily life.

Further, almost nothing enacted in the real world goes exactly the way it is role-

played in therapy. Adlerian brief therapists seek to establish in their clients a

renewed faith in self as well as optimism and hope for their immediate and long-

term futures. It is caring, however, that guarantees the client support and a safe

return in a future session, no matter how the real world enactment has gone

(Mosak & Maniacci, 1998).




References

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Authors Notes

James Robert Bitter, Ed.D., is Professor of Counseling in the Department

of Human Development & Learning at East Tennessee State University. He is

the past editor of the Journal of Individual Psychology, and his many publications

include articles on family mapping and family constellation, created memories

versus early recollections, and family reconstruction. He was associated with

Virginia Satir for the last ten years of her life and is a past President of her

AVANTA Network of trainers. Jim has also studied with the Gestalt therapists,

Erv and Miriam Polster.

William G. Nicoll, Ph.D., is Professor in the Department of Counselor

Education at Florida Atlantic University in Boca Raton, Florida. He also serves

as President of the Adlerian Training Institute, Inc. and has served as the

national trainer in Brief Counseling for the American Counseling Association’s

national professional development program. He has provided training in

Adlerian based interventions across the United States as well as Europe, Asia,

Latin America and Africa. He has also recently produced a video demonstration

of Adlerian Brief Therapy that is available through the Adlerian Training

Institute in Boca Raton, Florida.

Handouts - Two Approaches to Adlerian Brief Therapy

Documents

therapy brief

adlerian brief therapy

d adlerian brief therapy

therapy session

successful therapy

therapeutic processes

bitter nicoll

core adlerian beliefs