Addiction counseling: An Adlerian based approach to understanding drug addicts
The Adlerian Psychotherapy Model
The Adlerian Psychotherapy Model is one that promotes holistic steps. One of the basic principles of this model involves human goal orientation. Adlerian psychotherapists encourage patients to identify and utilize their strengths to develop social interest and new, more satisfying lifestyles.
Some main tenets? An Adlerian based approach in psychotherapy is characterized by viewing the patient as:
- An individual that must be seen holistically
- An individual that has the ability to make choices in life, rather than just be determined by their past actions
- An individual affected by his/her social environment
- An individual motivated by social connections, instead of inner drives
- An individual with a subjective reality
Q: How can the Adlerian psychotherapy model be applied to addiction counseling?
A: Therapists work on an addict’s misguided beliefs and get to the core of the reasons for their addiction.
The most often reported reasons for substance use are: socializing, interacting, and a being part of the crowd. Adlerian psychotherapy is an approach that motivates addicts to develop a positive, sober lifestyle, a sense of belonging and to learn ways to change current behaviors. So, this type of approach helps addicts replace a false sense of belonging and social interest with one that is more connected.
Today, we have invited two (2) experts to tell us more. Dyanne Pienkowski MA, MFT is Director and Therapist at The Alfred Adler Institute of San Francisco. David Harley, LCSW will join her to tell us more about the benefits of Adlerian psychotherapy model in the treatment of recovering addicts.
ADDICTION BLOG: Well Dyanne and David. What is the main philosophy of Adlerian psychotherapy? What are the basic concepts?
DYANNE PIENKOWSKI AND DAVID HARLEY: Each individual is living and choosing in a social context (individual in the environment), moving as a coherent unit toward unique useful or useless personal goals – creatively developed and chosen by the individual in interactions with the environment. The individual is understood through her movements made in dealing with or avoiding life tasks.
Classical Adlerian Depth Psychotherapy (CADP) is a USE psychology, focusing on how each individual uses himself in relation to personal abilities and vulnerabilities within the social context.
The individual, a social being, requires encouragement to cooperate and contribute toward improving life in the near and far community.
Each individual seeks to turn events into some type of personal “advantage”, i.e., significance, power, personal ”gain”.
Positive mental health means: a fully actualizing (self and other) individual focused on meeting and solving life’s tasks in cooperation with others, contributing to the growing wellbeing of the community both near and far – rather than a preoccupation with defending and protecting himself with counter fictions covering a fictional hidden goal.
ADDICTION BLOG: How can addiction problems be addressed with the help of Adlerian Therapy?
DYANNE PIENKOWSKI AND DAVID HARLEY: Classical Adlerian Depth Psychotherapy (CADP) is distinctively suited for working with clients who present addiction or co-addiction issues. In addressing addiction, whether in long term depth psychotherapy or brief therapy, the focus is on the unique, creative, unity of each individual’s personality (hence Adler’s theory is called Individual Psychology).
Simply, the mind is indivisible – the lifestyle and unconscious fictional final goal move in the same direction. All behavior has a purpose. As A.A.’s Big Book states:
“Our liquor was but a symptom. So we had to get down to cause and conditions.” p. 64 Third Edition
The therapeutic focus is not on attempting to cure symptoms, but rather to deal effectively and creatively with the person who has a symptom. The therapeutic goal is to get to the underlying problem causing ideas (“stinking thinking”).
ADDICTION BLOG: What are the benefits of using Adlerian Therapy in addiction counseling?
DYANNE PIENKOWSKI AND DAVID HARLEY: Adler’s optimistic view of human nature is compatible with 12 Step programs. His philosophy of treatment describes what people can become in a socially responsible and mutually beneficial way. Through encouragement specific to each client, the radius of cooperation and interest in others increases:
“Self-seeking will slip away.” Promises p. 84 Alcoholics Anonymous Third Edition
Addiction is a lifestyle (Adler’s terminology and construct) issue. The use of the word lifestyle in common language is an oversimplified version of Adler’s original idea. He has often been misrepresented and his theory over simplified.
The repetitive, familiar and habitual nature of an individual’s lifestyle makes it difficult to change without insight. Through gentle, patient Socratic questioning the therapist gradually leads the client to establish connections from childhood impressions/early memories to present difficulties. In this way the roots of the client’s difficulties are resolved; not just the temporary relief of symptoms. Symptom relief without lifestyle change could contribute to the potential of relapse.
In order for real (not just behavioral) change:
- Cognitive Components
- Behavioral Components
- Affective Components
… all of these components must be present. CADP involves all three areas in treatment. The focus on cooperation, social interest, life tasks, and loosening or dissolving the fictional final goal move the client toward a full development of self, a genuine interest in others and contribution to society.
ADDICTION BLOG: How does this method help patients accept the negative aspects of addiction and raise awareness about their choice to use the drug(s)?
DYANNE PIENKOWSKI AND DAVID HARLEY: An important part of Adlerian treatment is reducing the client’s inferiority feeling(s). This exaggerated feeling of inferiority is at the root of addiction.
Clients usually have great difficulty accepting responsibility for their negative choices and act as if they have no choice. Until they are encouraged to face and overcome difficulties (i.e. stop using), there can be no real change or acceptance of their negative choices.
Socratic questioning is a gentle method of encouraging the client to become aware of their thinking errors leading to the choice to use a substance. Once it is clear that anyone who thought what they thought would do the same in similar circumstances there is an acceptance of their mistakes.
This questioning must be done in the spirit of equality as a co-thinker and not as an expert in order for the client to feel understood and accepted by the therapist. Once there is an acceptance of past mistakes there is a sense of encouragement to correct current and future mistakes. Overcoming difficulties builds self-esteem which reduces the inferiority feeling (s).
By reducing the inferiority/superiority feeling, extending the client’s activity and radius levels, as well as his social interest, he becomes aware that his defenses are actually dangerous and self-destructive. At this point there is a conscious awareness of the negative consequences of choosing to use drugs in order to avoid responsibility.
ADDICTION BLOG: Can you describe the stages of Adlerian Therapy?
DYANNE PIENKOWSKI AND DAVID HARLEY: There are 12 stages of psychotherapy developed by Dr. Henry Stein. Describing them would be a lengthy task. However, simply they are:
- Initial Interview & Empathy Relationship Stage
- Early Information Stage
- Later Information Stage
- Clarification Stage
- Encouragement Stage
- Interpretation-Recognition Stage
- Missing Experience Stage
- Doing Differently Stage
- Reinforcement Stage
- Social Interest Stage
- Goal-Redirection Stage
- Support & Launching Stage
To read more, please see Dr. Henry Stein’s book: Classical Adlerian Depth Psychotherapy Volume III Demonstrations of Therapeutic Techniques (2016).
ADDICTION BLOG: Which techniques do you use to challenge the client’s awareness of self in order to stop acting in self-destructive manners? Can you give us some examples?
DYANNE PIENKOWSKI AND DAVID HARLEY: CADP is not specifically technique oriented. Any technique that respects the individual/family and the philosophy of Classical Adlerian philosophy and values is utilized.
The major emphasis of CADP is to utilize respectful Socratic questioning that invites growing understanding, matched with small steps in behavioral and attitudinal changes.
Early memories, dreams and fantasies are utilized when available to highlight the individual’s movements made toward the often hidden interpersonal fictional goal(s). In addition, the individual’s movements within the therapeutic relationship highlight lifestyle patterns that offer rich opportunities for appropriate change.
CADP utilizes creative “missing experiences” to foster new learning and choices in the face of old patterns.
Example #1: A married male had a very early memory of fearfully being awake in a dark, somewhat mysterious environment. This created an early and persistent fearful and angry attitude toward the danger of risking what is unknown, e.g., learning a new software program. The risk being of looking foolish, feeling stupid, tapping into an early and exaggerated inferiority feeling of inability, fear of speaking up, looking ridiculous, reluctance of requesting help or tutoring.
In earlier years this led to fear of speaking up in graduate school, of making a mistake, drawing ridicule. Grappling with this information, with encouragement the individual was able to request the help needed to learn the software system, deriving greater self confidence in approaching new material. And, opening the door for further learning, growth and diminishing the somewhat less and less hidden fictional goal.
Example #2: A middle aged single male with deep and various inferiority feelings from family life and position with many years of substance use and abuse. Continuing to use alcohol though reducing frequency as he works to rebuild his life with employment, thinking about budgeting, exploring healthier relationships with women and his own physical appearance, he is asked how this continued alcohol use is working for him now. His exploring response begins a process of growing understanding in preparation for further change as he notes that it helps him avoid being responsible for his life/behavior.
ADDICTION BLOG: How do you use personal goals and social interest to motivate your clients in addiction recovery?
DYANNE PIENKOWSKI AND DAVID HARLEY: Frequently, the therapeutic relationship itself is the beginning of teaching and sharing cooperation in the growth journey. The client learns to cooperate; to identify goals and direction, to work with the therapist toward a shared agenda of change and; to contribute to the work both inside and outside the therapeutic session.
Goals are best understood in the context of the three human tasks of our love relationships, social relationships and work relationships. Identifying in a fluid fashion personal goals is ongoing as goals frequently shift during the therapeutic experience.
Ultimately, where the individual is experiencing life/personal difficulties, the therapist shares the task of exposing the often hidden pattern that is self focusing and self defeating. This involves uncovering the subterfuges (counter fictions) used to hide intention.
A classic counter fiction found in addictions work is the very real disability provided by the addiction operating as a justification for not being able to help self or others – “I’m not really responsible for my behavior and its impact on others”. Or, an individual caught in a criminal act insisting that he cannot be held accountable because he was raised rich, not among the common people and didn’t have the opportunity to learn empathy or, as in “West side Story”, my early abuse and neglect is my justification for my acting out now, or my chemical imbalance is responsible, not me and so on.
Respectfully listening to the client’s goals, encouraging a gradual interest in those around the person, or even in some cases a plant or an animal, stimulates social feeling to grow. Together exploring how a conscious goal may be undermined by apparently contradictory behavior also begins to reveal the hidden intention, often unrecognized consciously by the individual (counter fiction).
Of critical therapeutic need is to be consistently aware of what is missing from the individual’s behavior and thinking (lifestyle), seeking ways to invite, introduce and encourage small changes, aiding a movement toward (rather than away from or avoiding) an ideal way of living suitable to the client.
ADDICTION BLOG: What about the limitations of this method? How do you deal with the large amount of family and lifestyle information that needs to be collected?
DYANNE PIENKOWSKI AND DAVID HARLEY: CADP is limited by the intelligence and insight of the client as well as the skill and training of the psychotherapist. Encouragement, acceptance, equality, increasing the client’s level of cooperation and activity in a positive direction are always applicable.
- Therapists’ notes
- Client questionnaires (12 pages)
- Family questionnaires when appropriate
- Case consultation notes
- Any other relevant information
… is analyzed and synthesized. We use several charts, timelines and a matrix for lifestyle guessing.
In addition, we use several computer programs/applications such as:
- Ecco Pro
- The Brain
- Atlas.ti (a sophisticated qualitative analysis)
…which help put the extensive information in manageable form.
ADDICTION BLOG: How do you help people who do not have high verbal skills? How do you approach them? How do you help them become more open for communication?
DYANNE PIENKOWSKI AND DAVID HARLEY: Individuals with low verbal skills can still be reached by way of concrete and practical interest shown by the therapist. For example, use of visual art and imagery, concrete and practical applied behaviors can stimulate small changes.
The therapist, genuinely interested in the client, empties herself of preconceptions, uses the client’s capacities and strengths, focusing on encouragement and cooperation as well as utilizing the vocabulary, schemas, core beliefs and worldview of the client to foster change.
A lack of abstracting and symbolizing training or ability as sometimes found in public mental health and addictions work may inhibit generalization and identification/awareness of hidden goals (they are unlikely to exist with severely developmentally disabled, individuals).
However, a focus on encouragement, cooperation and contribution to others can and does benefit those with low verbal skills as well as those with brain and developmental disabilities.
Where a disability as indicated above is severe, behavioral therapy and intervention is indicated.
ADDICTION BLOG: Where can we learn more about the efficacy of Adlerian therapy in the treatment of addiction?
DYANNE PIENKOWSKI AND DAVID HARLEY: Visit the Classical Adlerian site at www.Adlerian.us to see what is available regarding distance training as well as many pertinent articles available on line.
Explore the numerous volumes now published by the Alfred Adler Institute of Northwestern Washington as part of a major translation project of Alfred Adler’s writing not previously available in English translation.
Investigate thoroughly volumes I, II and III of Dr. Henry Stein’s recently released, current CLASSICAL ADLERIAN DEPTH PSYCHOTHERAPY.
Review the JOURNAL OF INDIVIDUAL PSYCHOLOGY, vol. 70, number 4, Winter 2014, for an extensive coverage of CADP.
Talk with the presenters at the CADP workshop on Classical Adlerian Diagnosis. If unable to attend the workshop, look up the handouts on line or call the presenters for additional information.
ADDICTION BLOG: Do you have anything else to add for our readers?
DYANNE PIENKOWSKI AND DAVID HARLEY: Explore this arena of thought and practice. It is practical, while subtle, deep, value based and thoroughly enjoyable to practice.
About the Interviewees: Dyanne Pienkowski MA, MFT is a director and therapist at the Alfred Adler Institute of San Francisco. Her first exposure to Adler was in graduate school out of cursory. After she received her masters degree, she continued working in the field of alcoholism and drug addiction in various modalities (inpatient, outpatient, halfway house). She decided she needed more education and entered a Ph.D. program in San Francisco where she was once again exposed to Adler. She says: “Central to my development as a clinician and a woman is the mentoring experience of training, case supervision and study analysis. Adler’s original teachings have such depth they can be studied for a lifetime. His theory focuses on prevention as well as psychotherapy”. She is currently working on integrating her experience as a chemical dependency specialist with her Adlerian training, writing and working in private practice, and planning training workshops for clinicians in the field of chemical dependency.
David Harley LCSW is a part-time private practice with a focus on clinical social work counseling and psychotherapy. David is currently working with youth and adults and has a significant experience with preschool and latency aged children.
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