Life is full of ebbs and flows. The way we experience them is deeply informed by the dynamic interaction of one's culture, upbringing (including filial and sibling relationships), inherited characteristics, environment/setting, and the unique ways in which these are sensed, perceived, and encoded into memory. Inherent in all of this dynamic interaction is the possibility of a mismatch in (1) one's needs vs. whether or not they were/are being met and (2) one's current stressors vs. one’s ability to cope with them.

 

This approach, the foundation of positive psychology, assumes that people are not ill or broken, but are instead chronically discouraged to the point of reduced functioning due to the factors stated above. As such, treatment is not about fixing problems, does not blame the patient/client for experiencing the challenges they face, and is sophisticated enough to have always at least partially attributed lack of fit (including that which leads to experiences of marginality) to one’s environment and not only oneself.

 

Maladaptive patterns in living neither emerge overnight nor remit as quickly. Patterns in living are established early in life and are often constructed unconsciously in response to perceived feelings of inferiority, leading to the development of solutions. While only partially causative, early life experiences establish a tone for living that rarely serves one’s present life. As these solutions were first enacted in one's youth, they are inherently flawed for the present, often containing basic mistakes (i.e., reasoning invented by the individual to stimulate and justify a style of life). Relatedly, we conceptualize symptoms as arrangements of life factors that function as excuses for failing to meet life tasks (i.e., love, work, and leisure) and for safeguarding one’s self-concept. In short, symptoms are solutions.

 

We operate from the assumption that all behavior is serving a function for the client. This means that whether the presenting concern is persistent suicidality, challenges in intimate partnerships, internalization of stigma, anger/righteous indignation leading to challenges with employment, a desire to recover from chronic misuse of substances, challenges with body image and patterns in eating, lethargy, or academic difficulty, our first question as providers is, “I want to explore how that which is presently bringing you distress emerged as solutions to your perceived problems.” Examples of the connection between symptom and solution may include the following:

 

• Trauma: hypervigilance, identification with one’s abuser, intrusive thoughts, identity distortion are psychological and physiological solutions/by-products that protect the person from the likelihood of experiences said pain again.

• Suicidality: a solution to chronic and persistent psychological pain

• Defensiveness: resolves feelings of inferiority (an umbrella term accounting for various forms of vulnerability)

• Internalized Oppression: Recognizing there are a variety of ways, this is one way African Americans (as one example) cope with living in a society that fundamentally that dehumanizes them. Internalization may be an unconscious way to cope. It leads a person to believe that they are, in some way, inferior on the basis of race, which may place them in a maladaptive position, yet one that may be functional in that it can enable them to expect negative interactions, lean into dominant cultural norms to appear less visible as an “other,” and generally navigate troubled waters. By leaning into the dominant culture as preferred, it creates limited disruption in this illusion (i.e., distortion of reality).

• Perfectionism: Creates a shelter in the midst of chaos that helps to restore a perceived sense of agency. Though a protective mechanism, it is a form of psychological rigidity. When escalated, it may contribute to concerns (e.g., obsessions, compulsions, eating patterns). Per usual, one’s inherited characteristics play a role

• Depression: If, for example, this person tends to overgeneralize, then recent events like a break-up, coupled with the fact that they have been broken-up with in all three significant relationships, may lead this person to believe that they are incapable of being loved and as a result will be lonely, childless, and unhappy. Atop psychological context like growing up with people whose mood may have tended to be low and related biological context like sharing these proclivities with relatives may put the person in a position to “retreat.” Building on a foundation of exhibiting signs and Sx of DEP, by taking on this depressed role, the person now has an “excuse” for why their relationships have not worked out.

 

As Adler was a physician-turned psychotherapist, his approach fundamentally accounts for the presence and role of biological factors in human behavior, while emphasizing the more familiar cognitive, affective, environmental, and cultural factors that can be understood and influenced toward optimal states of well-being through ethically-practiced psychotherapy. Collectively, this enables the provider to explore the question, “What story are the symptoms telling me about a person’s self-concept, self-efficacy, problem-solving approach(es), coping strategy(ies), beliefs, and self (including in relationships and general place in the world)?”

 

The goal is to identify the function by learning about its purpose in one's private logic (i.e., their unique, internal mechanism of establishing and maintaining one's subjective reality), to support the client in developing a sense of curiosity about their experiences (vs. simply rejecting them), to encourage consciousness about how one lives in order to empower the individual to determine if they want new pattern(s) – including which new pattern(s) – toward living a more useful life. We recognize that patients/clients present to clinic often feeling extremely identified with their “problem,” wanting it to be taken from them.

 

Like defense mechanisms, private logic protects the self. It is the role of the Adlerian provider to:

 

• Create an environment and relationship safe enough for the client to consistently take the risk of unpacking their bags, revealing underlying patterns in order to embark upon a journey of upgrading the bag's contents.

• Support the client in becoming curious about the contents of said luggage, taking inventory of what was placed into the luggage by self vs. external forces (e.g., hand-me down patterns in living from family who may be less than functional themselves, societal oppression). This creates space in order to cultivate an appreciation for the ways in which the mind self-protects by distorting reality, creating maladaptive though functional solutions.

• Support the client in strengthening various task approach skills (e.g., problem-solving skills, work habits, metal sets, emotional and cognitive responses), which enhance one's life by increasing their ability and confidence (i.e., self-efficacy) to engage in critical tasks like becoming conscious of unconscious factors

• Empower individuals to make choices in living, including choosing to upgrade expired patterns

• Support clients in updating foundational beliefs (e.g., the function of emotions, expecting life to have recurring challenges)

• Use the relationship as a model for the development of healthy patterns of interaction (e.g., establishment and maintenance of boundaries).

 

Among the upgrades are an improvement in social functioning, task approach skills, awareness of underlying patterns and the problem-perpetuating scripts embedded therein (overgeneralizations, misperceptions of life and its demands). This is why I firmly believe that people likely have what they need to thrive in life, but (1) due to traumatic life events, may not know this fact and may (2) have little idea how to marshal their strengths and resources for the present. The ultimate goal of this approach to psychotherapy is a life that feels useful to the individual, vs. being purely an artifact of various forms of trauma, both “t” and “T.” It is from a useful pattern in living that one begins to expect ebbs and flows. The difference is that they are now prepared for them in order to maintain functionality and adaptation.

 

Like all forms of therapy, regardless of treatment length, clients must be able to engage an ability to cultivate a therapeutic alliance, experience some presence of motivation/hope for change/growth, able to “do their work” outside of therapy. Progress in treatment is measured through the Outcomes Rating Scale (ORS), Session Rating Scale (SRS), and the Outcomes Questionnaire (OQ.45-2).