Current Psychotherapies

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Current Psychotherapies

-I! 'I CURRENT PSYCHOTHE Filth Edition EDITORS Raymond J. Corsini Danny Wedding l EDITORS Raymond J. Corsini

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-I!

'I CURRENT PSYCHOTHE Filth Edition

EDITORS

Raymond J. Corsini

Danny Wedding

l

Current Psychotherapies

EDITORS

Raymond J. Corsini Danny Wedding

CURRENT PSYCHOTHERAPIES Fifth Edition

f

F.E. Peacock Publishers, Inc.

Itasca, Illinois

Cover Image: Robert KristofikfThe Image Bank Copyright ( 1995 F.E. Peacock Publishers, Inc. All rights reserved. Printed in the U.S.A. Library of Congress Catalog Card No. 94-74615 ISBN 0-87581-392-5 Printing 10 9 8 7 6 5 4 Year 00 99 98 97 96

To My Teachers Rudolf Dreikurs,J. L. Moreno, Carl Rogers

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Outline of Book

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OVERVIEW

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128 162

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Basic Concepts

15

Other Systems

16 54' 97 130 165 200 231 268 295 326 359

HISTORY

i8 58 99 133 167 201 233 270 297 328 361

Precursors

18 58 99

Beginnings

19 59 100 134 168 202 233 270 298 329 362

Current Status

22 60 101 135 169 203 234 271 298 330 363

PERSONALITY

23 61 102 136 170 204 236 272 299

Theory of Personality

23 61 102 136 170 204 236 272 299 331 365

Variety of Concepts

25 64 105 140 173 206 238 276 302 334 366

PSYCHOTHERAPY

28 65 107 142 175 208 242 278 303 33 5 369

Theory of Psychotherapy

28 65 107 142 175 208 242 278 303

Process of Psychotherapy

30 67 109 143 177 210 245 279 304 337 371

Mechanisms of Psychotherapy

31 73 111 148 183 215 248 281 309 341 375

APPLICATIONS

33 75 113 150 185 216 248 284 310 342 376

Problems

33 75 113 150 185 216 248 284 310 342 376

Evaluation

35 76 114 151 186 219 249 285 311 343 377

Treatment

36 77 115 152 186 221 250 286 312 344 378

CASE EXAMPLE

40 81 119 154 191 222 254 288 314 347 380

SUMMARY

46

ANNOTATED BIBLIOGRAPHY

47 89 125 159 195 225 258 291 319 352 383

CASE READINGS

48 89 126 159 195 226 258 291 320 353 384

REFERENCES

49 90 126

95 128 163 198 229 263 293 323 356

167 201

270 297 328 361

365

369

87 123 1l58 193 224 257 290 318 351 382

196 226 259 292 320 353 384

Contents

Contributors

ix

Acknowledgments Preface

x

xi

1 Introduction / Raymond /. Corsini I 2 Psychoanalysis / Jacob A. Arlow

15

3 Adlerian Psychotherapy / Harold H. Mosak

51

4 Analytical Psychotherapy / ClaireDouglas 95

5 Person-Centered Therapy / NathanielJ. Raskin and CarlR. Rogers 128 6 RationalEmotiveBehaviorTherapy/AlbertEllis 7 Behavior Therapy / G. Terence Wilson

162

197

8 Cognitive Therapy /Aaron T. Beck and Marjorie Weishaar 229 9 Existential Psychotherapy / Rollo May and Irvin Yalom

262

10 Reality Therapy / William Glasser and Robert Wubbolding 293 11 MultimodalTherapy/AmoldA. Lazarus

322

12 Family Therapy / Irene Goldenberg and Herbert Goldenberg 356 13 Three Other Approaches

386

A. Asian Psychotherapies / Roger Walsh 387 B. Psychodrama lAdam Blatner 399 C. Bioenergetic Analysis /Alexander Lowen

409

14 Current Issues in Psychotherapy / Danny Wedding 419 Glossary Index

433

445

Contributors

Jacob A. Arlow, M.D. Clinical Professor of Psychiatry, New York University College of Medicine, New York, New York

Rollo May, Ph.D. Deceased

Aaron T. Beck, M.D. Professor of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

Nathaniel J. Raskin, Ph.D. Professor of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago, Illinois

Adam Blatner, M.D. Private Practice, Austin, Texas Raymond J. Corsini, Ph.D. Affiliate, Graduate faculty, University of Hawaii, Honolulu, Hawaii

Harold H. Mosak, Ph.D. Private Practice, Chicago, Illinois

Carl R. Rogers, Ph.D. Deceased

Claire Douglas, Ph.D. Private Practice, Malibu, California

Roger Walsh, M.D., Ph.D. Professor of Psychiatry, Social Sciences, and Philosophy, University of California, Irvine, California

Albert Ellis, Ph.D. Institute for Rational-Emotive Therapy, New York, New York

Danny Wedding, Ph.D. Director, Missouri Institute of Mental Health, St. Louis, Missouri

William Glasser, M.D. Private Practice, Canoga Park, California

Marjorie E. Weishaar, Ph.D. Private Practice, Providence, Rhode Island

Herbert Goldenberg, Ph.D. Emeritus Professor, California State University, Los Angeles, California

G. Terence Wilson, Ph.D. Oscar K. Buros Professor of Psychology, Rutgers University, Piscataway, New Jersey

Irene Goldenberg, Ed.D. Professor of Psychiatry, University of California Los Angeles, Los Angeles, California

Robert Wubbolding, Ed.D. Professor, Counseling, Xavier University, Cincinnati, Ohio

Arnold A. Lazarus, Ph.D. Distinguished Professor, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey

Irvin Yalom, M.D. Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Alexander Lowen, M.D. Director, International Institute for Bioenergetic Analysis, New York, New York ix

Acknowledgments

At the end of every edition, we ask colleagues as well as all professors known to be using CurrentPsychotherapiesas a text to give us suggestions for the next edition. The people listed below have in various ways made worthwhile suggestions, and we thank them for their contributions. Mary Ballou Northeastern University Bernie Beitman University of Missouri-Columbia Stephen F. Bono University of Maryland John L. Carew Cambridge College Carolyn Dillon Boston University Glen Eskedal Suffolk University Richard F. Heath Ramapo College Barry Farber Columbia University Bruce Forgus University of Idaho Brenda Freeman University of Wyoming William Frey Middlebury College Bagher Ghobary University of Teheran Glenn E. Good University of Missouri David Harder Tufts University x

James Hennessy Fordham University

Ishu Ishiyama University of British Columbia William King City University of New York Wayne Klug University of Massachusetts John R. Korte University of Dayton Arthur Lerner Los Angeles City College Mary Livingstone Louisiana Technical School Mildred Malick Hunter College Margaret McCluskey St. Louis University John McKinnon Connecticut College Robert Roth Keane College Rodney Skager University of California-LosAngeles Adaline Tryon Salisbury State University Nancy Webb Fordham University Michael Wogan Rutgers University

Preface

This fifth edition of Current Psychotherapies is its most extensive revision so far. Two new chapters have been added: Reality Therapy and Current Issues in Psychotherapy. Psychoanalysis, Analytic Psychotherapy, and Family Therapy have new authors. Rational-Emotive Therapy is now relabeled Rational Emotive Behavior Therapy, and it has been completely rewritten. Behavior Therapy has been extensively revised, and all chapters retained from prior editions have been updated. From its beginning, Current Psychotherapies has been based on a number of principles that have made it the most successful text of its kind: Chapters selected represent the most important systems in the current practice of psychotherapy. Since psychotherapy is in constant change, deciding what to put in new editions and what to take out calls for a great deal of research. The opinions of professors were central in determining changes. Professors who have taught from this book at least two years are asked at the end of each edition what they would want in the next edition and what they no longer want in the current one. Their diverse opinions helped us decide what changes to make. The most competent available authors are recruited. Newly established systems are described by their founders; older systems are covered by those best qualified to describe their systems. This book is highly disciplined. Each author follows an outline in which the various sections are limited in length and structure. The purpose of this feature is to make the systems as comparable to one another as possible, so that one can read the book "horizontally" (from section to section across the various systems) as well as in the usual "vertical" manner (chapter to chapter). Those who want to understand psychotherapy in depth should read the book twice: first vertically and then horizontally. Current Psychotherapies is carefully edited. Every section is examined to make certain its contents are appropriate and clear. In the twenty-five-year history of this text, only one chapter was ever accepted in its first draft. Some chapters have been returned to their original authors up to four times before finally being accepted. Chapters are as concise as they can possibly be and still cover the systems completely. In the prior edition, Dr. Judith MacMahon went over the entire manuscript to scc if she could find anything to cut; in this edition, Dr. Barbara Cubic repeated the same process. Suggested changes were approved by Dr. Wedding and me, then by the auxi

xii

Preface

thors. In response to a demand that the chapters be shorter, the section on Management was dropped. This is a topic of special interest only to professionals; some of the material in that section that might be of interest to students has been retained in the section on Treatment. The glossary has been expanded. A good way to begin any chapter would be to first read relevant entries in the glossary, thereby generating a mind-set that will facilitate understanding the systems. Personality theorists tend to invent new words when no existing word suffices. This clarifies their ideas, but it also makes understanding their chapters more difficult. A careful study of the glossary will reward the reader. Thanks to many who have assisted. In Honolulu, Kristine Altwies was helpful in various ways; in St. Louis, Vicki Eichthorn assisted Dr. Wedding. Linda Sage helped revise Chapter 14, and Janet Tilden reviewed the whole book, striving for linguistic perfection. As always our wives, Kleona (Corsini) and Cynthia (Wedding) were of help in various ways, and they seldom complained about the hundreds of hours we spent on this edition. Our authors deserve special thanks, particularly those in this edition for the first time. They were patient and forgiving when their manuscripts were returned, often mutilated, with requests sometimes for dozens of changes. Our recommendations almost always had to do with clarifying language. In all cases, authors complied when we explained this edition would be read by more than one hundred thousand students. Dr. Wedding has read and approved every new chapter and every change, and consequently this edition represents our combined editorial judgments, but since I am the responsible editor for this edition, any errors can be attributed to me.

Raymond Corsini Honolulu, Hawaii

1

Introduction Raymond J. Corsini

Psychotherapy cannot be defined with any precision. A definition might go as follows: Psychotherapy is a formal process of interaction between two parties, each party usually consisting of one person but with the possibility that there may be two or more people in each party, for the purpose of amelioration of distress in one of the two parties relative to any or all of the following areas of disability or malfunction: cognitive functions (disorders of thinking), affective functions (suffering or emotional discomforts), or behavioral functions (inadequacy of behavior), with the therapist having some theory of personality's origins, development, maintenance and change along with some method of treatment logically related to the theory and professional and legal approval to act as a therapist. The definition may appear rather comprehensive. Nevertheless, some modes of therapy will not fit it. Would the system of psychotherapy that Sigmund Freud underwent, about which Karen Horney (1942) wrote a book, and which Theodore Reik (1948) claimed to be the best of all therapies fit this definition? The system is self-therapy. In self-therapy there is only one party; there is no formality and no professional or legal approval, and yet it certainly is therapy. If we examine various theories and procedures in psychotherapy, we find a bewildering set of ideas and behaviors. There have been systems of therapy that had no therapist (Schmidhoffer, 1952); systems in which the therapist says and does nothing (Bion, (1948); systems in which patients are asked to scream 1

2

Raymond 1. Corsini

or to strike out (Bach & Goldberg, 1975; Janov, 1970); methods in which the therapist makes fun of the patient, treating him or her with apparent disrespect (Farrelly & Brasma, 1974), and methods that treat the patient or client with utmost respect (Losoncy, 1981); methods in which patients are treated as children (Painter & Vernon, 1981); methods that stress religion (Lair & Lair, 1973; van Kaam, 1976); and methods that are conglomerates of a wide variety of procedures (Gazda, 1981; Shostrom & Montgomery, 1978). What one authority considers to be psychotherapy may be completely different from how other authorities see the process. Counseling and psychotherapy are the same qualitatively; they differ only quantitatively. There is nothing that a psychotherapist does that a counselor does not do. Table 1.1 illustrates this basic point. No definition can be made that will include all psychotherapies and exclude all counseling methods. Various attempts to separate the psychotherapies and exclude all counseling methods have failed. The concept that psychotherapy goes into depth, while counseling does not, is gainsaid by procedures such as behavior modification that operate at the level of symptom removal (Wolpe, 1958). Behavior modifiers could hardly be called counselors, because they do not counsel. Also, when we have a term such as nondirective counseling, we have a semantic absurdity.

4. COUNSELING AND PSYCHOTHERAPY The terms counseling and psychotherapy probably seem interchangeable to many people, but they tend to have different meanings for people in the helping professions. Generally, counseling is understood by helping professionals to be a relatively short process, often occurring in one session and rarely comprising more than five sessions, whereas psychotherapy usually runs for many sessions and can even continue for years. Counseling is usually seen as problem-oriented, while psychotherapy is person-oriented. As Table 1.1 indicates, the actual processes that occur in counseling and psychotherapy are identical, but they do differ relative to the time spent, and thus quantity affects quality.

TABLE 1.1 4. Estimate of Percent of Time Spent by "Counselors" and "Psychotherapists" in Professional Activities* Process Listening Questioning Evaluating Interpreting Supporting Explaining Informing Advising Ordering

Counseling

Psychotherapy

20 15 5 1 5 15 20 10 9

60 10 5 3 10 5 3 3 1

'Based on R. J. Corsini, "Counseling and Psychotherapy" in E. F. Borgatta and W. W. Lambert (Eds.), Handbook of PersonalityTheory and Research (Chicago: Rand McNally, 1968).

Introduction

Essentially, counseling stresses the giving of information, advice, and orders by someone considered to be an expert in a particular area of human behavior, while psychotherapy is a process of helping people discover why they think, feel, and act in unsatisfactory ways. A counselor is primarily a teacher, while a psychotherapist is essentially a detective. A simple example will help illustrate the difference between counseling and psychotherapy. Say that a married couple comes to a professional helper (a psychiatrist, psychologist, social worker, nurse practitioner, etc.) for help in their marriage. The helper puts on her counseling hat, listens as they tcll their stories, asks questions and finally gives information, advice, and "orders" (that is to say, she may insist that the couple must follow her suggestions if they are to achieve their goals). After all, if they came to her for counseling, they must be prepared to make suggested changes. Let us assume the counselor gives the couple the following information: Many marriages are unhappy because of little things, but if a couple can communicate their dissatisfactions to each other and agree by means of a mutual contract to change their behavior, the marriage may change from being unhappy to happy. She then advises them to establish a new contract within their marriage. Let us assume the couple agrees to establish a mutual contract. The husband states that he wants his wife to stop smoking, and the wife wants her husband to put away his clothes and belongings rather than scattering them all over the house (two common complaints in marriages). Consequently, the helper, working as a counselor, helps the couple establish a contract relative to the wife's smoking and the husband's sloppiness in the house. Now, let us assume that both partners live up to their agreements and that thereby marital harmony is established. The counseling has been successful. Now let us assume a different scenario. The couple returns to report that they are still unhappy. The wife has stopped smoking, but the husband is still leaving his possessions all over the house. As the result of further discussions, the helper suggests that the husband may need psychotherapy to try to discover why, even though he has agreed to stop this behavior, he continues it. Say that the husband accepts the suggestion and decides to have psychotherapy. The professional now puts on her psychotherapy hat. From now on, she no longer views herself as an expert on marriage who can give information, advice, and orders but instead sees herself as a facilitator, helping the husband to understand himself in general, and specifically to find out why he was not able to keep to his agreement to be neat in the house. The helper may give no information, advice, or orders, but may act in any of a variety of unusual ways. For example, if she is a follower of Carl Rogers she will not ask or answer questions, and she will be unwilling to give advice or suggestions. In this book we discuss more than a dozen ways of thinking and acting in therapy. The helper may have her own eclectic theory, and her methods of operating may be quite diverse. Let us say that the therapy is successful, that the reason for the husband's resistance is uncovered, and that a favorable change in his behavior then occurs and the marriage is happy. Successful therapy may result regardless of theory and the method used. But what is important to recognize here is that in acting as a psychotherapist the helper did not presume to be an expert on marriage but rather served as a kind of detective relative to the husband's inability or unwillingness to conform to his own agreement. The helper as the therapist was a partner or collaborator with the husband to achieve a new state of being. Consequently, counselors are generally people who have considerable knowledge and expertise in specific areas of behavior. There are marriage and family counselors, educational and vocational counselors, counselors for people who abuse substances such as alcohol, for people who are handicapped in particular ways or have special problems such as

3

4

Raymond!. Corsini

chronic or contagious illnesses. Counselors depend on their specialized knowledge and their common sense. On the other hand, psychotherapists are generalists who tend to have any of a variety of unusual theories or combinations of theories and who may use one or more procedures to try to achieve desired results.

4. PATIENT OR CLIENT

' 11) '

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9

In the first four editions of this book, in the Adlerian chapter, Dr. Harold Mosak used the term patient; in this edition he changed this term to client. Some of our authors use one or the other of the two terms, and some use both. Psychotherapists who come out of a medical orientation tend to see those they work with as patients, while those who come from other orientations tend to see them as clients. So, it is possible for two therapists to see the same person at the same time in multiple therapy, with one viewing that person as a patient and the other therapist seeing that same person as a client. Neither term is really satisfactory. Patient implies illness, and client implies a business relationship. Someday, someone may coin a term that more exactly describes the role of the person who is undergoing psychotherapy. Meanwhile, in this book, every author uses whatever term he or she feels most comfortable with. All modes of trying to help people improve themselves via symbolic methods can be called psychotherapy, just as all methods to help improve psychological functioning through medications, surgery, electric shock, and other somatic procedures may be called psychiatry. Consequently, the interview, hypnosis, role-playing, projective techniques, and the like that we shall take up in this book can be considered procedures in counseling/psychotherapy, but it is best, in my judgment, to call them all processes of psychotherapy. Therefore, when Carl Rogers repeats what you have said, using his own terminology (as he did with me when I was in therapy with him), this is psychotherapy; and when Rudolph Dreikurs, an Adlerian, points out basic life-style errors (as he did for me when I was in therapy with him), this is psychotherapy; and when Albert Ellis contradicts your point of view (as he often has with me), this is psychotherapy; and when J.L. Moreno has people play different roles in front of a group (as I did when working with him) then this is psychotherapy. A number of years ago, in Paris, I met with a French colleague, and during the course of our conversation I mentioned psychotherapy. "Ah," she said, "Psychotherapie comme qa-ou comme ca?" (Psychotherapy like this-or like this?) At the first Va she put the palms of her hands about an inch apart, and at the second Va she moved her hands out as far as she could, with the palms still facing each other. She was asking me whether I had a narrow conception of psychotherapy or a wide one. We can do the same thing with the hands vertically and ask about the depth of psychotherapy. Essentially, depth is a function of time spent in therapy rather than a matter of technique, and two people with the same theory and technique will vary with respect to depth, depending primarily on the time spent with the client. (I call the subjects of psychotherapy clients if I see them in a private office and patients if they are in a hospital or institution.)

further personal goals. Adler (19 63a) treats unconscious as an adjective rather than a noun. A' That which is unconscious is the non-understood. Like Otto Rank, Adler felt that humans know more than they understand. Conflict, defined as intrapersonal by others, is defined as a "one step forward and one step backward movement," the net effect being to maintain the individual at a point "dead center." Although people experience themselves in the throes of a conflict, unable to move, in reality they create these antagonistic feelings, ideas, and values because they are unwilling to move in the direction of solving their problems (Mosak & LeFevre, 1976). 5. Understanding the individual requires understanding his or her cognitive organization and life-style. The latter concept refers to the convictions individuals develop early in life to help them organize experience, to understand it, to predict it, and to control it. Convictions are conclusions derived from the individual's apperceptions, and they constitute a biased mode of apperception. Consequently, a life-style is neither right nor wrong, normal nor abnormal, but merely the "spectacles" through which people view themselves in relationship to the way in which they perceive life. Subjectivity rather than so-called objective evaluation becomes the major tool for understanding the person. As Adler wrote, "We must be able to see with his eyes and listen with his ears" (1958, p. 72). 6. Behavior may change throughout a person's lifespan in accordance with both the immediate demands of the situation and the long-range goals inherent in the life-style. The life-style remains relatively constant through life unless the convictions change through the mediation of psychotherapy. Although the definition of psychotherapy customarily refers to what transpires within a consulting room, a broader view of psychotherapy would include the fact that life in itself may often be psychotherapeutic. d

-7. According to the Adlerian conception, people are not pushed by causes; that is, they are not determined by heredity and environment. "Both are giving only the frame and the influences which are answered by the individual in regard to the styled creative power" (Ansbacher & Ansbacher, 1956). People move toward self-selected goals that they feel will give them a place in the world, will provide them with security, and will preserve their self-

Adlerian Psychotherapy

esteem. Life is a dynamic striving. "The life of the human soul is not a 'being' but a 'becoming"' (Adler, 1963a, p. ix). 8. The central striving of human beings has been variously described as completion (Adler, 1958), perfection (Adler, 19 6 4a), superiority (Adler, 1972), self-realization (Horney, 1951), self-actualization (Goldstein, 1939), competence (White, 1957), and mastery (Adler, 1926). Adler distinguishes among such strivings in terms of the direction a striving takes. If strivings are solely for the individual's greater glory, he considers them socially useless and, in extreme conditions, characteristic of mental problems. On the other hand, if the strivings are for the purpose of overcoming life's problems, the individual is engaged in the striving for self-realization, in contribution to humanity, and in making the world a better place to live. 9. Moving through life, the individual is confronted with alternatives. Because Adlerians are either non-determinists or soft determinists, the conceptualization of humans as creative, choosing, self-determined decision makers permits them to choose the goals they want to pursue. Individuals may select socially useful goals or they may devote themselves to the useless side of life. They may choose to be task-oriented or they may, as does the neurotic, concern themselves with their own superiority. 10. The freedom to choose (McArthur, 1958) introduces the concepts of value and meaning into psychology. These were unpopular concepts at the time (1931) that Adler wrote What Life Should Mean to You. The greatest value for the Adlerian is Gemeinschaftsgefahl, or social interest (Ansbacher, 1968). Although Adler contends that it is an innate feature of human beings, at least as potential, acceptance of this criterion is not absolutely necessary. People possess the capacity for coexisting and interrelating with others. Indeed, the "iron logic of social living" (Adler, 1959) demands that we do so. Even in severe psychopathology, total extinction of social interest does not occur. Even the psychotic retains some commonality with "normal" people. As Rabbi Akiva noted two millennia ago, "The greatest principle of living is to love one's neighbor as oneself." If we regard ourselves as fellow human beings with fellow feeling, we are socially contributive people interested in the common welfare and, by Adler's pragmatic definition of normality, mentally healthy (Dreikurs, 1969; Shoben, 1957). If my feeling derives from my observation and conviction that life and people are hostile and I am inferior, I may divorce myself from the direct solution of life's problems and strive for personal superiority through over-compensation, wearing a mask, withdrawal, attempting only safe tasks where the outcome promises to be successful, and other devices for protecting my self-esteem. Adler said the neurotic in terms of movement displayed a "hesitating attitude" toward life (196 4a). Also, the neurotic was described as a "yes-but" personality (Adler, 1934); at still other times, the neurotic was described as an "if only..." personality (Adler, 1964a): "If only I didn't have these symptoms, I'd...." The latter provided the rationale for "The Question," a device Adler used for differential diagnosis as well as for understanding the individual's task avoidance. 11. Because Adlerians are concerned with process, little diagnosis is done in terms of nomenclature. Differential diagnosis between functional and organic disorder does often present a problem. Because all behavior is purposeful, a psychogenic symptom will have a psychological or social purpose and an organic symptom will have a somatic purpose. An Adlerian would ask "The (uestion" (Adler, 1964a; Dreikurs, 1958, 1962), "If I had a magic wand or a magic pill that would eliminate your symptom immediately, what would be different in your life?" If the patient answers, "I'd go out more often socially" or "I'd write my book," the symptom would most likely be psychogenic. If the patient responds, "I wouldn't have this excruciating pain," the symptom would most likely be organic.

53

('~r'

54

HaroldH. Mosak

12. Life presents challenges in the form of life tasks. Adler named three of these explicitly but referred to two others without specifically naming them (Dreikurs & Mosak, 1966). The original three tasks were those of society, work, and sex. The first has already been alluded to. Because no person can claim self-sufficiency, we are all interdependent. Not only do we need social recognition, each of us also is dependent upon the labor of other people and they, in turn, are dependent upon our contribution. Work thus becomes essential for human survival. The cooperative individual assumes this role willingly. In the sexual realm, because two different sexes exist, we must also learn how to relate to that fact. We must define our sex roles, partly on the basis of cultural definitions and stereotypes, and train ourselves to relate to the other, not the opposite, sex. Other people, of either sex, do not represent the enemy. They are our fellows, with whom we must learn to cooperate. Fourth (Dreikurs & Mosak, 1967) and fifth tasks (Mosak & Dreikurs, 1967) have been described. Although Adler alluded to the spiritual, he never specifically named it (Jahn & Adler, 1964). But each of us must deal with the problem of defining the nature of the universe, the existence and nature of God, and how to relate to these concepts. Finally, we must address the task of coping with ourselves. William James (1890) made the distinction between the self as subject and the self as object, and it is as imperative, for the sake of mental health, that good relations exist between the "I" and the "me" as between the "I" and other people. 13. Because life constantly provides challenges, living demands courage (Neuer, 1936). Courage is not an ability one either possesses or lacks. Nor is courage synonymous with bravery, such as falling on a grenade to save one's buddies from injury or death. Courage refers to the willingness to engage in risk-taking behavior when one either does not know Lhe consequences or when the consequences might be adverse. We are all capable of courageous behavior provided that we are willing. Our willingness will depend upon many variables, internal and external, such as our life-style convictions, our degree of social interest, the extent of risk as we appraise it, and whether we are task-oriented or prestigeoriented. Given that life offers few guarantees, all living requires risk taking. It would require very little courage to live if we were perfect, omniscient, or omnipotent. The question we must each answer is whether we have the courage to live despite the knowledge of our imperfections (Lazarsfeld, 1966). 14. LLife has no intrinsic meaning. We give meaning to life] each of us in our own fashion. We declare it to be meaningful, meaningless, an absurdity, a prison sentence (cf., the adoNA lescent's justification for doing as he pleases-"I didn't ask to be born"), a vale of tears, a tes( preparation for the next world, and so on. Dreikurs (1957, 1971) maintained that the meaning of life resided in doing for others and in contributing to social life and social change. Viktor Frankl (1963) believed the meaning of life lay in love. The meaning we atTor tribute to life will "determine" our behavior. We will behave as if life were really in accord with our perceptions, and, therefore, certain meanings will have greater practical utility than others. Optimists will live an optimistic life, take chances, and not be discouraged by failure and adversity. They will be able to distinguish between failing and being a failure. Pessimists will refuse to be engaged with life, refuse to try, sabotage their efforts if they do make an attempt, and, through their methods of operation, endeavor to confirm their preexisting pessimistic anticipations (Krausz, 1935).

L

,*

Other Systems Students often have asked, "Do you Adlerians believe in sex too?" The question is not always asked facetiously. Freud accorded sex the status of the master motive in behavior.

Adlerian Psychotherapy

Adler merely categorized sex as one of several tasks the individual was required to solve. Freud employed esoteric jargon and Adler favored common-sense language. One story has it that a psychiatrist took Adler to task after a lecture, denigrating his approach with the criticism, "You're only talking common sense," to which Adler replied, "I wish more psychiatrists did." We can place other differences between these two men in columnar form, as shown in Table 3.1. A more extended comparison of Freud's and Adler's concepts of humankind may be found in articles by H.W. von Sassen (1967) and Otto Hinrichsen (1913). Adler and the Neo-Freudians Adler once proclaimed that he was more concerned that his theories survived than that people remembered to associate his theories with his name. His wish apparently was granted. In discussing Adler's influence upon contemporary psychological theory and practice, Henri Ellenberger commented, "It would not be easy to find another author from which so much has been borrowed from all sides without acknowledgment than Adler" (1970, p. 645). Many neo-Freudians have credited Adler with contributing to and influencing their work. In her last book, Karen Homey wrote of "neurotic ambition," "the need for perfection," and "the category of power." "All drives for glory have in common the reaching out for greater knowledge, wisdom, virtue or powers than are given to human beings; they all aim at the absolute, the unlimited, the infinite" (1951, pp. 34-35). Those familiar with Adler's writings on the neurotic's perfectionistic, godlike striving will immediately be struck with the similarity in viewpoint. Homey (1951) rejected Freud's pessimism, "his disbelief in human goodness and human growth," in favor of the Adlerian view that a person could grow and could "become a decent human being." Others have also remarked upon the resemblance between the theories of Homey and Adler; the reviewer of one Homey book wrote that Karen Homey had just written a new book by Alfred Adler (Farau, 1953). Erich Fromm also expresses views similar to those of Adler. According to Fromm, people make choices. The attitude of the mother in child rearing is of paramount importance. Life fosters feelings of powerlessness and anxiety. Patrick Mullahy (1955) indicates that The only adequate solution, according to Fromm, is a relationship with man and nature, chiefly by love and productive work, which strengthens the total personality, sustains the person in his sense of uniqueness, and at the same time gives him a feeling of belonging, a sense of unity and common destiny with mankind. (pp. 251-252) Although Harry Sullivan places greater emphasis upon developmental child psychology than does Adler, Sullivan's "person" moves through life in much the same manner as does Adler's. Thus, Sullivan (1954) speaks of the "security operation" of the individual, a direct translation of Adler's and Lene Credner's (1930) Sicherungen. His "good me" and "bad me" dichotomy, in expression if not in manner of development, is essentially the same as that described by Adlerians. So many similarities between Adler and the neo-Freudians have been noted that Gardner Murphy concluded, "If this way of reasoning is correct, neurosis should be the general characteristic of man under industrialism, a point suspected by many Freudians and, in particular, by that branch of the Freudian school (Homey and her associates) that has learned most from Adler" (1947, p. 569). A summary of such resemblances appears in Heinz and Rowena Ansbacher's Individual Psychology of Alfred Adler (1956) as well as in

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TABLE 3.1 Comparison of Freud's and Adler's Concepts Freud 1. Objective 2. Physiological substratum for theory 3. Emphasized causality 4. Reductionistic. The individual was divided into "parts" that were antagonistic toward each other: e.g., id-ego-superego, Eros vs. Thanatos, conscious vs. unconscious. 5. The study of the individual centers about the intrapersonal, the intrapsychic.

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6. The establishment of intrapsychic harmony constitutes the ideal goal of psychotherapy. "Where id was, there shall ego be." 7. People are basically "bad." Civilization attempts to domesticate them, for which they pay a heavy price. Through therapy the instinctual demands may be sublimated but not eliminated.

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8. People are victims of both instinctual life and civilization.

9. Description of child development was postdictive and not based upon direct observation of children but upon the free associations of adults. 10. Emphasis upon the Oedipus situation and its resolution 11. People are enemies. Others are our competitors, and we must protect ourselves from them. Theodore Reik quotes Nestroy, "If chance brings two wolves together,... neither feels the least uneasy because the other is a wolf; two human beings, however, can never meet in the forest, but one must think: That fellow may be a robber" (1948, p. 477). 12. Women feel inferior because they envy men their penises. Women are inferior. "Anatomy is destiny."

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13. Neurosis has a sexual etiology. 14. Neurosis is the price we pay for civilization.

Adler 1. Subjective 2. A social psychology 3. Emphasized teleology 4. Holistic. The individual is indivisible. He or she is a unity, and all "parts" (memory, emotions, behavior) are in the service of the whole individual. 5. People can only be understood interpersonally and as social beings moving through and interacting with their environment. 6. The expansion of the individual, selfrealization, and the enhancement of social interest represent the ideal goals for the individual. 7. People are neither "good" nor "bad," but as creative, choosing human beings, they may choose to be "good" or "bad" or both, depending upon their life-styles and theirs praisal of the immediate situation and its payoffs. Through the medium of therapy people can choose to actualize themselves. 8. People, as choosers, can shape both their internal and their external environments. Although they cannot always choose what will happen to them, they can always choose the posture they will adopt toward life's stimuli. 9. Children were studied directly in families, in schools, and in family education centers.

10. Emphasis upon the family constellation 11. Other people are mitmenschen, fellow human beings. They are our equals, our collaborators, our cooperators in life.

12. Women feel inferior because in our cultural milieu women are undervalued. Men have privileges, rights, preferred status, although in the current cultural ferment, these roles are being reevaluated. 13. Neurosis is a failure of learning, a product of distorted perceptions. 14. Neurosis is the price we pay for our lack of civilization.

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an article by Walter James (1947). Fritz Wittels (1939) has proposed that the neo-Freudians should more properly be called "neo-Adlerians," and a study by Heinz Ansbacher (1952) suggests that many traditional Freudians would concur. Adler and Rogers Although the therapies of Adler and Carl Rogers are diametrically opposed, their theories share many commonalities. Both are phenomenological, goal-directed, and holistic. Each views people as self-consistent, creative, and capable of change. To illustrate, Rogers (1951) postulates the following: 1. The organism reacts as an organized whole to the phenomenal field (p. 486). 2. The best vantage point for understanding behavior is from the internal frame of reference of the individual himself (p. 494). 3. The organism reacts to the field as it is experienced and perceived (p. 4 8 4 -85). 4. The organism has one basic tendency and striving-to actualize, maintain, and enhance the experiencing organism (p. 487). Much of the early research on nondirective and client-centered therapy measured the discrepancy between self-concept and self-ideal. The Adlerian would describe the extent of discrepancy as a measure of inferiority feelings. Adler and Ellis The theories of Adler and Ellis exhibit many points of convergence. Albert Ellis (1970, 1971) finds his rational-emotive psychology to parallel that of Adler. What Adler calls basic mistakes, Albert Ellis refers to as irrational beliefs or attitudes. Both accept the notion that emotions are actually a form of thinking and that people create or control their emotions by controlling their thinking. They agree that we are not victims of our emotions but their creators. In psychotherapy, they (1) adopt similar stances with respect to unconscious motivation, (2) confront patients with their irrational ideas (basic mistakes or internalized sentences), (3) counterpropagandize the patient, (4) insist upon action, and (5) constantly encourage patients to assume responsibility for the direction of their lives in more positive channels. The last phrase seems to reflect the major disagreement between Adler and Ellis, namely, what is "positive." Ellis argues, Where Adler writes, therefore, that "All my efforts are devoted towards increasing the social interest of the patient," the rational therapist would prefer to say, "Most of my efforts are devoted towards increasing the self-interest of the patient." He assumes that if the individual possesses rational self-interest he will, on both biological and logical grounds, almost invariably tend to have a high degree of social interest as well. (1957, p. 43) Adler and Other Systems The many points of convergence and divergence between Adler and several of the existentialist thinkers have been noted by many writers (Birnbaum, 1961; Farau, 1964; Frankl, 1970). Phyllis Bottome had written in 1939 that "Adler was the first founder of an existence psychology" (p. 199). Given that existential psychology is not a school but a viewpoint, it is difficult to make comparisons, but interested readers may discover for themselves in an editorial by Ansbacher (1959) the lines of continuity between Adler and current existential thought. The recognition of Adler as one of the earliest humanistic psychologists is clear. Ellis pays homage to Adler as "one of the first humanistic psychologists" (1970, p. 32). Abraham Maslow (1962, 1970) published five papers in Adlerian journals over a period of 35 years.

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As we have already observed, many of Adler's ideas have been incorporated by the humanistic psychologists with little awareness of Adler's contributions. "The model of man as a composite of part functions" that James Bugental (1963) questioned has been repudiated by Adlerians for more than half a century. Adlerian psychology is a value psychology (Adler wrote What Life Should Mean to You in 1931), as Viktor Frankl and Rollo May, among others, acknowledge in their debt to Adler. Frank] wrote: What he [Adler].. .achieved and accomplished was no less than a Copernican switch.... Beyond this, Alfred Adler may well be regarded as an existential thinker and as a forerunner of the existential-psychiatric movement. (1970, p. 38)

May expresses his debt as follows: I appreciate Adler more and more.... Adler's thoughts as I learned them in studying with him in Vienna in the summers of 1932 and 1933 led me indirectly into psychology, and were very influential in the later work in this country of Sullivan and William Alanson White, etc. (1970, p. 39)

Abraham Maslow wrote: For me Alfred Adler becomes more and more correct year by year. As the facts come in, they give stronger and stronger support to his image of man. I should say that in one respect especially the times have not yet caught up with him. I refer to his holistic emphasis. (1970, p. 39)