Fluent Essays

explain The Gift of Therapy a n o p e n l e t t e r t o a n e w g e n e r a t i o n o f t h e r a p i s t s a n d t h e i r p a t i e n t s Irvin D. Yalom, M.D. to Marilyn, soul mate for over fifty years. still counting. c o n t e n t s I n t r o d u c t i o n x A c k n o w l e d g m e n t s x x c h a p t e r 2 Avoid Diagnosis (Except for c h a p t e r 3 Therapist and Patient as c h a p t e r 6 Empathy: Looking Out c h a p t e r 1 0 Create a New Therapy c h a p t e r 1 1 The Therapeutic Act, Not c h a p t e r 1 Remove the Obstacles to Growth, 1 Insurance Companies), 4 “Fellow Travelers,” 6 c h a p t e r 4 Engage the Patient, 11 c h a p t e r 5 Be Supportive, 13 the Patient’s Window, 17 c h a p t e r 7 Teach Empathy, 23 c h a p t e r 8 Let the Patient Matter to You, 26 c h a p t e r 9 Acknowledge Your Errors, 30 for Each Patient, 33 the Therapeutic Word, 37 c h a p t e r 1 2 Engage in Personal Therapy, 40 v c o n t e n t s c h a p t e r 1 3 The Therapist Has Many Patients; The Patient, One Therapist, 44 c h a p t e r 1 4 The Here-and-Now—Use It, Use It, c h a p t e r 1 6 Using the Here-and-Now— c h a p t e r 1 8 Working Through Issues in c h a p t e r 2 1 Frame Here-and-Now c h a p t e r 2 3 Check into the Here-and-Now c h a p t e r 2 6 Three Kinds of Therapist c h a p t e r 2 7 The Mechanism of Therapy— c h a p t e r 2 8 Revealing Here-and-Now Feelings— c h a p t e r 2 9 Revealing the Therapist’s Personal Life— Use It, 46 c h a p t e r 1 5 Why Use the Here-and-Now?, 47 Grow Rabbit Ears, 49 c h a p t e r 1 7 Search for Here-and-Now Equivalents, 52 the Here-and-Now, 58 c h a p t e r 1 9 The Here-and-Now Energizes Therapy, 62 c h a p t e r 2 0 Use Your Own Feelings as Data, 65 Comments Carefully, 68 c h a p t e r 2 2 All Is Grist for the Here-and-Now Mill, 70 Each Hour, 72 c h a p t e r 2 4 What Lies Have You Told Me?, 74 c h a p t e r 2 5 Blank Screen? Forget It! Be Real, 75 Self-Disclosure, 83 Be Transparent, 84 Use Discretion, 87 Use Caution, 90 v ic o n t e n t s c h a p t e r 3 0 Revealing Your Personal Life—Caveats, 94 c h a p t e r 3 4 On Taking Patients Further Than c h a p t e r 3 8 Provide Feedback Effectively c h a p t e r 3 9 Increase Receptiveness to Feedback c h a p t e r 4 7 Never (Almost Never) Make Decisions c h a p t e r 4 8 Decisions: A Via Regia into c h a p t e r 3 1 Therapist Transparency and Universality, 97 c h a p t e r 3 2 Patients Will Resist Your Disclosure, 99 c h a p t e r 3 3 Avoid the Crooked Cure, 102 You Have Gone, 104 c h a p t e r 3 5 On Being Helped by Your Patient, 106 c h a p t e r 3 6 Encourage Patient Self-Disclosure, 109 c h a p t e r 3 7 Feedback in Psychotherapy, 112 and Gently, 115 by Using “Parts,” 119 c h a p t e r 4 0 Feedback: Strike When the Iron Is Cold, 121 c h a p t e r 4 1 Talk About Death, 124 c h a p t e r 4 2 Death and Life Enhancement, 126 c h a p t e r 4 3 How to Talk About Death, 129 c h a p t e r 4 4 Talk About Life Meaning, 133 c h a p t e r 4 5 Freedom, 137 c h a p t e r 4 6 Helping Patients Assume Responsibility, 139 for the Patient, 142 Existential Bedrock, 146 c h a p t e r 4 9 Focus on Resistance to Decision, 148 c h a p t e r 5 0 Facilitating Awareness by Advice Giving, 150 vii c o n t e n t s c h a p t e r 5 1 Facilitating Decisions—Other Devices, 155 c h a p t e r 5 2 Conduct Therapy as a Continuous c h a p t e r 6 3 Don’t Be Afraid of Touching c h a p t e r 6 5 Look for Anniversary and c h a p t e r 7 0 A History of the Patient’s Session, 158 c h a p t e r 5 3 Take Notes of Each Session, 160 c h a p t e r 5 4 Encourage Self-Monitoring, 162 c h a p t e r 5 5 When Your Patient Weeps, 164 c h a p t e r 5 6 Give Yourself Time Between Patients, 166 c h a p t e r 5 7 Express Your Dilemmas Openly, 168 c h a p t e r 5 8 Do Home Visits, 171 c h a p t e r 5 9 Don’t Take Explanation Too Seriously, 174 c h a p t e r 6 0 Therapy-Accelerating Devices, 179 c h a p t e r 6 1 Therapy as a Dress Rehearsal for Life, 182 c h a p t e r 6 2 Use the Initial Complaint as Leverage, 184 Your Patient, 187 c h a p t e r 6 4 Never Be Sexual with Patients, 191 Life-Stage Issues, 195 c h a p t e r 6 6 Never Ignore “Therapy Anxiety,” 197 c h a p t e r 6 7 Doctor, Take Away My Anxiety, 200 c h a p t e r 6 8 On Being Love’s Executioner, 201 c h a p t e r 6 9 Taking a History, 206 Daily Schedule, 208 c h a p t e r 7 1 How Is the Patient’s Life Peopled?, 210 c h a p t e r 7 2 Interview the Significant Other, 211 v i i ic o n t e n t s c h a p t e r 7 3 Explore Previous Therapy, 213 c h a p t e r 7 6 CBT Is Not What It’s Cracked Up to Be . . . Or, c h a p t e r 7 7 Dreams—Use Them, Use Them, c h a p t e r 7 8 Full Interpretation of a Dream? c h a p t e r 7 9 Use Dreams Pragmatically: c h a p t e r 8 1 Learn About the Patient’s Life c h a p t e r 8 3 Attend Carefully to Dreams About c h a p t e r 7 4 Sharing the Shade of the Shadow, 215 c h a p t e r 7 5 Freud Was Not Always Wrong, 217 Don’t Be Afraid of the EVT Bogeyman, 222 Use Them, 225 Forget It! 227 Pillage and Loot, 228 c h a p t e r 8 0 Master Some Dream Navigational Skills, 235 from Dreams, 238 c h a p t e r 8 2 Pay Attention to the First Dream, 243 the Therapist, 246 c h a p t e r 8 4 Beware the Occupational Hazards, 251 c h a p t e r 8 5 Cherish the Occupational Privileges, 256 Notes 261 About the Author Other Books by Irvin D. Yalom, M.D. Credits Cover Copyright About the Publisher Introduction It is dark. I come to your office but can’t find you. Your office is empty. I enter and look around. The only thing there is your Panama hat. And it is all filled with cobwebs. M y patients’ dreams have changed. Cobwebs fill my hat. My office is dark and deserted. I am nowhere to be found. My patients worry about my health: Will I be there for the long haul of therapy? When I leave for vacation, they fear I will never return. They imagine attending my funeral or visiting my grave. My patients do not let me forget that I grow old. But they are only doing their job: Have I not asked them to disclose all feelings, thoughts, and dreams? Even potential new patients join the chorus and, without fail, greet me with the question: “Are you still taking on patients?” One of our chief modes of death denial is a belief in per- sonal specialness, a conviction that we are exempt from biologi- x i i n t r o d u c t i o n cal necessity and that life will not deal with us in the same harsh way it deals with everyone else. I remember, many years ago, visiting an optometrist because of diminishing vision. He asked my age and then responded: “Forty-eight, eh? Yep, you’re right on schedule!” Of course I knew, consciously, that he was entirely correct, but a cry welled up from deep within: “What schedule? Who’s on schedule? It is altogether right that you and others may be on schedule, but certainly not I!” And so it is daunting to realize that I am entering a desig- nated later era of life. My goals, interests, and ambitions are changing in predictable fashion. Erik Erikson, in his study of the life cycle, described this late-life stage as generativity, a post-narcissism era when attention turns from expansion of oneself toward care and concern for succeeding generations. Now, as I have reached seventy, I can appreciate the clarity of Erikson’s vision. His concept of generativity feels right to me. I want to pass on what I have learned. And as soon as possible. But offering guidance and inspiration to the next generation of psychotherapists is exceedingly problematic today, because our field is in such crisis. An economically driven health-care system mandates a radical modification in psychological treat- ment, and psychotherapy is now obliged to be streamlined— that is, above all, inexpensive and, perforce, brief, superficial, and insubstantial. I worry where the next generation of effective psychothera- pists will be trained. Not in psychiatry residency training pro- grams. Psychiatry is on the verge of abandoning the field of psychotherapy. Young psychiatrists are forced to specialize in psychopharmacology because third-party payers now reim- burse for psychotherapy only if it is delivered by low-fee (in other words, minimally trained) practitioners. It seems certain that the present generation of psychiatric clinicians, skilled in x i ii n t r o d u c t i o n both dynamic psychotherapy and in pharmacological treat- ment, is an endangered species. What about clinical psychology training programs—the obvi- ous choice to fill the gap? Unfortunately, clinical psychologists face the same market pressures, and most doctorate-granting schools of psychology are responding by teaching a therapy that is symptom-oriented, brief, and, hence, reimbursable. So I worry about psychotherapy—about how it may be deformed by economic pressures and impoverished by radically abbreviated training programs. Nonetheless, I am confident that, in the future, a cohort of therapists coming from a variety of educational disciplines (psychology, counseling, social work, pastoral counseling, clinical philosophy) will continue to pur- sue rigorous postgraduate training and, even in the crush of HMO reality, will find patients desiring extensive growth and change willing to make an open-ended commitment to therapy. It is for these therapists and these patients that I write The Gift of Therapy. throughout these pages I advise students against sectarian- ism and suggest a therapeutic pluralism in which effective inter- ventions are drawn from several different therapy approaches. Still, for the most part, I work from an interpersonal and exis- tential frame of reference. Hence, the bulk of the advice that follows issues from one or the other of these two perspectives. Since first entering the field of psychiatry, I have had two abiding interests: group therapy and existential therapy. These are parallel but separate interests: I do not practice “existential group therapy”—in fact, I don’t know what that would be. The two modes are different not only because of the format (that is, a group of approximately six to nine members versus a one-to- one setting for existential psychotherapy) but in their funda- x i i i i n t r o d u c t i o n mental frame of reference. When I see patients in group therapy I work from an interpersonal frame of reference and make the assumption that patients fall into despair because of their inability to develop and sustain gratifying interpersonal rela- tionships. However, when I operate from an existential frame of refer- ence, I make a very different assumption: patients fall into despair as a result of a confrontation with harsh facts of the human condition—the “givens” of existence. Since many of the offerings in this book issue from an existential framework that is unfamiliar to many readers, a brief introduction is in order. Definition of existential psychotherapy: Existential psy- chotherapy is a dynamic therapeutic approach that focuses on concerns rooted in existence. Let me dilate this terse definition by clarifying the phrase “dynamic approach.” Dynamic has both a lay and technical def- inition. The lay meaning of dynamic (derived from the Greek root dynasthai, to have power or strength) implying forcefulness or vitality (to wit, dynamo, a dynamic football runner or political orator) is obviously not relevant here. But if that were the meaning, applied to our profession, then where is the therapist who would claim to be other than a dynamic therapist, in other words, a sluggish or inert therapist? No, I use “dynamic” in its technical sense, which retains the idea of force but is rooted in Freud’s model of mental func- tioning, positing that forces in conflict within the individual generate the individual’s thought, emotion, and behavior. Fur- thermore—and this is a crucial point—these conflicting forces exist at varying levels of awareness; indeed some are entirely unconscious. So existential psychotherapy is a dynamic therapy that, like the various psychoanalytic therapies, assumes that uncon- scious forces influence conscious functioning. However, it x i v i n t r o d u c t i o n parts company from the various psychoanalytic ideologies when we ask the next question: What is the nature of the con- flicting internal forces? The existential psychotherapy approach posits that the inner conflict bedeviling us issues not only from our struggle with suppressed instinctual strivings or internalized significant adults or shards of forgotten traumatic memories, but also from our confrontation with the “givens” of existence. And what are these “givens” of existence? If we permit our- selves to screen out or “bracket” the everyday concerns of life and reflect deeply upon our situation in the world, we inevitably arrive at the deep structures of existence (the “ulti- mate concerns,” to use theologian Paul Tillich’s term). Four ultimate concerns, to my view, are highly salient to psychother- apy: death, isolation, meaning in life, and freedom. (Each of these ultimate concerns will be defined and discussed in a des- ignated section.) Students have often asked why I don’t advocate training pro- grams in existential psychotherapy. The reason is that I’ve never considered existential psychotherapy to be a discrete, freestanding ideological school. Rather than attempt to develop existential psychotherapy curricula, I prefer to supplement the education of all well-trained dynamic therapists by increasing their sensi- bility to existential issues. Process and content. What does existential therapy look like in practice? To answer that question one must attend to both “content” and “process,” the two major aspects of therapy discourse. “Content” is just what it says—the precise words spoken, the substantive issues addressed. “Process” refers to an entirely different and enormously important dimension: the interpersonal relationship between the patient and therapist. x v i n t r o d u c t i o n When we ask about the “process” of an interaction, we mean: What do the words (and the nonverbal behavior as well) tell us about the nature of the relationship between the parties engaged in the interaction? If my therapy sessions were observed, one might often look in vain for lengthy explicit discussions of death, freedom, meaning, or existential isolation. Such existential content may be salient for only some (but not all) patients at some (but not all) stages of therapy. In fact, the effective therapist should never try to force discussion of any content area: Therapy should not be theory-driven but relationship-driven. But observe these same sessions for some characteristic process deriving from an existential orientation and one will encounter another story entirely. A heightened sensibility to existential issues deeply influences the nature of the relationship of the therapist and patient and affects every single therapy session. I myself am surprised by the particular form this book has taken. I never expected to author a book containing a sequence of tips for therapists. Yet, looking back, I know the precise moment of inception. Two years ago, after viewing the Hunt- ington Japanese gardens in Pasadena, I noted the Huntington Library’s exhibit of best-selling books from the Renaissance in Great Britain and wandered in. Three of the ten exhibited vol- umes were books of numbered “tips”—on animal husbandry, sewing, gardening. I was struck that even then, hundreds of years ago, just after the introduction of the printing press, lists of tips attracted the attention of the multitudes. Years ago, I treated a writer who, having flagged in the writ- ing of two consecutive novels, resolved never to undertake another book until one came along and bit her on the ass. I chuckled at her remark but didn’t really comprehend what she meant until that moment in the Huntington Library when the idea of a book of tips bit me on the ass. On the spot, I resolved x v i i n t r o d u c t i o n to put away other writing projects, to begin looting my clinical notes and journals, and to write an open letter to beginning therapists. Rainer Maria Rilke’s ghost hovered over the writing of this volume. Shortly before my experience in the Huntington Library, I had reread his Letters to a Young Poet and I have con- sciously attempted to raise myself to his standards of honesty, inclusiveness, and generosity of spirit. The advice in this book is drawn from notes of forty-five years of clinical practice. It is an idiosyncratic mélange of ideas and techniques that I have found useful in my work. These ideas are so personal, opinionated, and occasionally original that the reader is unlikely to encounter them elsewhere. Hence, this volume is in no way meant to be a systematic man- ual; I intend it instead as a supplement to a comprehensive training program. I selected the eighty-five categories in this volume randomly, guided by my passion for the task rather than by any particular order or system. I began with a list of more than two hundred pieces of advice, and ultimately pruned away those for which I felt too little enthusiasm. One other factor influenced my selection of these eighty- five items. My recent novels and stories contain many descrip- tions of therapy procedures I’ve found useful in my clinical work but, since my fiction has a comic, often burlesque tone, it is unclear to many readers whether I am serious about the therapy procedures I describe. The Gift of Therapy offers me an opportunity to set the record straight. As a nuts-and-bolts collection of favorite interventions or statements, this volume is long on technique and short on the- ory. Readers seeking more theoretical background may wish to read my texts Existential Psychotherapy and The Theory and Practice of Group Psychotherapy, the mother books for this work. Being trained in medicine and psychiatry, I have grown xv i i i n t r o d u c t i o n accustomed to the term patient (from the Latin patiens—one who suffers or endures) but I use it synonymously with client, the common appellation of psychology and counseling tradi- tions. To some, the term patient suggests an aloof, disinter- ested, unengaged, authoritarian therapist stance. But read on—I intend to encourage throughout a therapeutic relation- ship based on engagement, openness, and egalitarianism. Many books, my own included, consist of a limited number of substantive points and then considerable filler to connect the points in a graceful manner. Because I have selected a large number of suggestions, many freestanding, and omitted much filler and transitions, the text will have an episodic, lurching quality. Though I selected these suggestions haphazardly and expect many readers to sample these offerings in an unsystematic man- ner, I have tried, as an afterthought, to group them in a reader- friendly fashion. The first section (1–40) addresses the nature of the therapist-patient relationship, with particular emphasis on the here-and-now, the therapist’s use of the self, and therapist self- disclosure. The next section (41–51) turns from process to content and suggests methods of exploring the ultimate concerns of death, meaning in life, and freedom (encompassing responsibility and decision). The third section (52–76) addresses a variety of issues aris- ing in the everyday conduct of therapy. In the fourth section (77–83) I address the use of dreams in therapy. The final section (84–85) discusses the hazards and privi- leges of being a therapist. This text is sprinkled with many of my favorite specific x v i i i i n t r o d u c t i o n phrases and interventions. At the same time I encourage spon- taneity and creativity. Hence do not view my idiosyncratic inter- ventions as a specific procedural recipe; they represent my own perspective and my attempt to reach inside to find my own style and voice. Many students will find that other theoretical posi- tions and technical styles will prove more compatible for them. The advice in this book derives from my clinical practice with moderately high- to high-functioning patients (rather than those who are psychotic or markedly disabled) meeting once or, less commonly, twice a week, for a few months to two to three years. My therapy goals with these patients are ambitious: in addition to symptom removal and alleviation of pain, I strive to facilitate personal growth and basic character change. I know that many of my readers may have a different clinical situation: a different setting with a different patient population and a briefer duration of therapy. Still it is my hope that readers find their own creative way to adapt and apply what I have learned to their own particular work situation. Acknowledgments M any have assisted me in the writing of this book. First, as always, I am much indebted to my wife, Marilyn, always my first and most thorough reader. Several colleagues read and expertly critiqued the entire man- uscript: Murray Bilmes, Peter Rosenbaum, David Spiegel, Ruthellen Josselson, and Saul Spiro. A number of colleagues and students critiqued parts of the manuscript: Neil Brast, Rick Van Rheenen, Martel Bryant, Ivan Gendzel, Randy Wein- garten, Ines Roe, Evelyn Beck, Susan Goldberg, Tracy Larue Yalom, and Scott Haigley. Members of my professional support group generously granted me considerable air time to discuss sections of this book. Several of my patients permitted me to include incidents and dreams from their therapy. To all, my gratitude. ch a p t e r 1 Remove the Obstacles to Growth W hen I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney’s Neurosis and Human Growth. And the sin- gle most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree. “Just as an acorn develops into an oak . . .” What a wonder- fully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient’s path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteris- tics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automati- cally, fueled by the self-actualizing forces within the patient. 2 t h e g i f t o f t h e r a p y I remember a young widow with, as she put it, a “failed heart”—an inability ever to love again. It felt daunting to address the inability to love. I didn’t know how to do that. But dedicating myself to identifying and uprooting her many blocks to loving? I could do that. I soon learned that love felt treasonous to her. To love another was to betray her dead husband; it felt to her like pounding the final nails in her husband’s coffin. To love another as deeply as she did her husband (and she would settle for nothing less) meant that her love for her husband had been in some way insufficient or flawed. To love another would be self- destructive because loss, and the searing pain of loss, was inevitable. To love again felt irresponsible: she was evil and jinxed, and her kiss was the kiss of death. We worked hard for many months to identify all these obsta- cles to her loving another man. For months we wrestled with each irrational obstacle in turn. But once that was done, the patient’s internal processes took over: she met a man, she fell in love, she married again. I didn’t have to teach her to search, to give, to cherish, to love—I wouldn’t have known how to do that. A few words about Karen Horney: Her name is unfamiliar to most young therapists. Because the shelf life of eminent theo- rists in our field has grown so short, I shall, from time to time, lapse into reminiscence—not merely for the sake of paying homage but to emphasize the point that our field has a long his- tory of remarkably able contributors who have laid deep foun- dations for our therapy work today. One uniquely American addition to psychodynamic theory is embodied in the “neo-Freudian” movement—a group of cli- nicians and theorists who reacted against Freud’s original focus on drive theory, that is, the notion that the developing individ- ual is largely controlled by the unfolding and expression of inbuilt drives. 3 R e m o v e t h e O b s t a c l e s t o G r o w t h Instead, the neo-Freudians emphasized that we consider the vast influence of the interpersonal environment that envelops the individual and that, throughout life, shapes character struc- ture. The best-known interpersonal theorists, Harry Stack Sul- livan, Erich Fromm, and Karen Horney, have been so deeply integrated and assimilated into our therapy language and prac- tice that we are all, without knowing it, neo-Freudians. One is reminded of Monsieur Jourdain in Molière’s Le Bourgeois Gen- tilhomme, who, upon learning the definition of “prose,” exclaims with wonderment, “To think that all my life I’ve been speaking prose without knowing it.” ch a p t e r 2 Avoid Diagnosis (Except for Insurance Companies) T oday’s psychotherapy students are exposed to too much emphasis on diagnosis. Managed-care administrators demand that therapists arrive quickly at a precise diag- nosis and then proceed upon a course of brief, focused therapy that matches that particular diagnosis. Sounds good. Sounds logical and efficient. But it has precious little to do with reality. It represents instead an illusory attempt to legislate scientific precision into being when it is neither possible nor desirable. Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it dimin- 5 Av o i d D i a g n o s i s ishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and corre- spondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self- fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy). And what therapist has not been struck by how much easier it is to make a DSM-IV diagnosis following the first interview than much later, let us say, after the tenth session, when we know a great deal more about the individual? Is this not a strange kind of science? A colleague of mine brings this point home to his psychiatric residents by asking, “If you are in per- sonal psychotherapy or are considering it, what DSM-IV diag- nosis do you think your therapist could justifiably use to describe someone as complicated as you?” In the therapeutic enterprise we must tread a fine line between some, but not too much, objectivity; if we take the DSM diagnostic system too seriously, if we really believe we are truly carving at the joints of nature, then we may threaten the human, the spontaneous, the creative and uncertain nature of the therapeutic venture. Remember that the clinicians involved in formulating previous, now … Adlerian Therapy Alfred Adler (1870-1937). Why Adlerian Therapy Adlerian psychology/psychotherapy was developed by Alfred Adler (1870-1937). A historically influential psychiatrist, Alfred Adler began focusing the philosophical world’s attention on relatively new ideas in the early 20th century. He believed that it was imperative to become intimately familiar with a person’s social context by exploring factors such as birth order, lifestyle, and parental education. Adler believed that each person strives to belong and feel significant. 01 Adler began his professional life as an ophthalmologist in 1895, before entering the world of psychiatry in the early 1900s. He was intrigued by Sigmund Freuds theories of human behavior and bravely defended Freud’s much criticized concepts of psychoanalysis. In 1907, an appreciative Freud invited Adler to join his inner circle—an exclusive Wednesday evening discussion group thought to be the foundation of the psychoanalytic movement. 02 Ultimately, Adler and Freud parted ways due to theoretical differences, and Adler established himself at the forefront of his own emerging approach to therapy and soon founded the School of Individual Psychology. In this new system, the importance of studying the entire individual was stressed. Adlers theory was institutionalized into The Society for Free Psychological Thought, which began publishing the Journal for Individual Psychology soon after. 03 Express Your Dilemma’s Openly Chapter 57: Dr. Yalom clearly identified through his experiences with his patients or fellow travelers that expressing dilemma’s during sessions only adds value to the therapeutic relationship as opposed to keeping unsettling feeling quiet. To be authentic means youre true to your own personality, values, and spirit, regardless of the pressure that youre under to act otherwise. Youre honest with yourself and with others, and you take responsibility for your mistakes. . Trust the Process The 4 Stages of Adlerian Therapy An Adlerian therapist assists individuals in comprehending the thoughts, drives, and emotions that influence their lifestyles. People in therapy are also encouraged to acquire a more positive and productive way of life by developing new insights, skills, and behaviors. These goals are achieved through the four stages of Adlerian therapy: Engagement: A trusting therapeutic relationship is built between the therapist and the person in therapy and they agree to work together to effectively address the problem. Assessment: The therapist invites the individual to speak about his or her personal history, family history, early recollections, beliefs, feelings, and motives. This helps to reveal the persons overall lifestyle pattern, including factors that might initially be thought of as insignificant or irrelevant by the person in therapy. Insight: The person in therapy is helped to develop new ways of thinking about his or her situation. Reorientation: The therapist encourages the individual to engage in satisfying and effective actions that reinforce this new insight, or which facilitate further insight. Adler believed that feelings of inferiority and inadequacy may be a result of birth order, especially if the person experienced personal devaluation at an early age, or they may be due to the presence of a physical limitation or lack of social empathy for other people. This method of therapy pays particular attention to behavior patterns and belief systems that were developed in childhood. Clinicians who use this form of therapy strongly believe that these strategies are the precursors for later self-awareness and behaviors and are directly responsible for how a person perceives themselves and others in their life. By examining these early habitual patterns, we can better develop the tools needed to create our own sense of self-worth and meaning, and ultimately create change that results in healing. Adler was a pioneer in the area of holistic theory on personality, psychotherapy, and psychopathology, and Adlerian psychology places its emphasis on a person’s ability to adapt to feelings of inadequacy and inferiority relative to others. He believed that a person will be more responsive and cooperative when he or she is encouraged and harbors feeling of adequacy and respect. Conversely, when a person is thwarted and discouraged, he or she will display counterproductive behaviors that present competition, defeat, and withdrawal. When methods of expression are found for the positive influences of encouragement, one’s feelings of fulfillment and optimism increase. Adler believed strongly that “a misbehaving child is a discouraged child,” and that children’s behavior patterns improve most significantly when they are filled with feelings of acceptance, significance, and respect. Adlerian Psychotherapy 1) Narrative Therapy Chapter 44 - Talk About Life Meaning Put it in power point slides 2) Jungian Therapy Chapter 30-Revealing Your Personal Life The founder/s What the therapy does How the therapy works and Summary 1) Narrative Therapy Chapter 44 - Talk About Life Meaning Put it in power point slides 2) Jungian Therapy Chapter 30-Revealing Your Personal Life