Adlerian Brief Therapy 1Running head: TWO APPROACHES TO ADLERIAN BRIEF THERAPYRelational Strategies: Two Approaches to Adlerian Brief TherapyJames Robert BitterEast Tennessee State University William G. Nicoll, Ph.D. Florida Atlantic UniversityAdlerian Brief Therapy 2AbstractAdlerian Brief Therapy is a specific approach to Individual Psychology that uses relational strategies to bring about effective change in the lives of individuals, groups, couples and families (Bitter, Christensen, Hawes, & Nicoll,1998; Sonstegard, Bitter, Pelonis-Peneros, & Nicoll, 2001). In this article, the authors discuss a relationship intervention continuum as an integration of two approaches. A therapy session demonstrating Adlerian Brief Therapy with individuals is used to highlight the integration.Adlerian Brief Therapy 3Relational Strategies: Two Approaches to Adlerian Brief TherapyAdlerian Brief Therapy is a specific application of Individual Psychology that we have introduced and described elsewhere (Bitter & Nicoll, 2000). Individual Psychology provides the foundation for how we think about clients and the therapeutic process. We believe that all behavior is rooted in socially constructed meaning and is only understandable with reference to its socially embedded context. Human behavior and human interactions are best understood teleologically, as goal-oriented. Indeed, the central human goal reflects one's idiosyncratic striving to belong and to complete, actualize, or perfect oneself; it is this striving that unifies the personality. In general, people who find a place within the human community and are interested in the well- being of others tend to do better than those who are self-absorbed, and/or feel disconnected or alienated. They develop what Adler called psychological tolerance (Ansbacher & Ansbacher, 1956, p. 243) and are able to meet the challenges of life rather than seek the perceived safety of psychological retreat (Adler, 1996a/1935, 1996b/1935). Adlerian Brief therapy is based on an understanding of lifestyle, the individual's socially constructed meaning and pattern of living, and a commitment to holistic, systemic, and teleological assessments and treatment. These core Adlerian beliefs also form the foundation for integrating other models and interventions into our work (Nicoll, 1999).There are five considerations that keep therapeutic processes brief: (a)time-limitation, (b) focus, (c) counselor directiveness and optimism, (d)Adlerian Brief Therapy 4symptoms as solutions, and (e) the assignment of behavioral tasks. These five aspects have been described as a foundation for Adlerian Brief Therapy (Nicoll, Bitter, Christensen, & Hawes, 2000). The two of us differ to some extent upon the relative emphases that should be given to a definitive time limitation, counselor directiveness, and the assignment of behavioral tasks. We both agree, however, that focused work will tend to keep therapy brief, that non-organic symptoms arethe client's solution to a personal problem, and that motivation modification is the goal when both directive interventions and behavioral tasks are used. Of the five dimensions, therapeutic focus is the most critical to successful therapy.In Adlerian Brief Therapy, two foci anchor therapeutic interventions: (a) a focus on who the person is and (b) a focus on what the person wants from therapy. This dual focus can be viewed as two points on a line, leading to a directional question: How does the person move from their current life position toward the preferred or desired position?If we start with who the person is, there are specific Adlerian assessments that tend to yield an immediately useful and holistic understanding of the individual. Among these assessments are the presentation of self and concerns; the individual's interpretation of place within her or his original family constellation (family system); developmental processes and the tasks of life; and early recollections (see Adler, 1958; Bitter, Christensen, Hawes, & Nicoll, 1998; Bitter & Nicoll, 2000; Dreikurs, 1997). Taken together, the data collected from these assessments constitute what Adlerians call a lifestyle assessment (Eckstein &Adlerian Brief Therapy 5Baruth, 1996; Powers & Griffith, 1987, 1995/1986; Shulman & Mosak, 1988). Such assessments are holistic, systemic, and often produce an initial narrative of the individual's movement through life (Disque & Bitter, 1998).Integrating a time limitation into therapy reflects the reality that therapists meet people in the middle of their lives, and they say goodbye to them in the middle of their lives. There is an implied agreement in a brief therapy contract:In a relatively short period of time it is possible to make a significant difference in one's style of living and coping. There is optimism in the contract that stems from a belief in the client's ability to change or improve a personal life situation. While Adlerians do not always define the exact number and duration of sessions with a client, when we do, therapeutic work progresses more quickly, staying focused on collaboratively chosen outcomes.The process within sessions often resembles a meeting of minds and hearts. While some therapists choose to focus on the heart and some on strategies for change, effectivenessespecially within a brief therapyframeworkrequires balance and the recognition that therapeutic relationship and client change are intimately connected. For the time devoted to therapy, the therapist's focus is on being fully present with clients. We ask ourselves recurrently: Where are we going . . . and with whom?Given these foci, there are obviously some similarities between solution- focused therapy and the Adlerian model (La Fountain, 1996; La Fountain & Garner, 1998; Watts & Pietrzak, 2000; Watts & Shulman, in press). There is,Adlerian Brief Therapy 6however, at least one significant difference. Solution-focused therapists assume that expressed, preferred outcomes are really desired by the client. The Miracle Question (de Shazer, 1988) was designed to help clients construct intended outcomes: If a miracle happened tonight and you woke up with the problem solved, or you were reasonably confident you were on a track to solving it, what would you be doing differently? (Walter & Peller, 1992, p. 78). Any answer to this question may seem like a desired outcome that can serve as both a goal and focus of therapy. If it is, however, why do counselors who ask some variation of this question seem to run into so much resistance when attempting to help clients reach the goals they have articulated? [See Berg, 1993; O'Hanlon, 1995]In 1929, Adler (1964) developed The Question, an intervention that Dreikurs (1997) later re-phrased as What would you be doing if you didn't have these symptoms or problems? Unlike modern solution-focused therapists, however, Dreikurs believed that presenting problems were often the solutions that the client had chosen in order to avoid or retreat from the larger life tasks of social responsibility, occupation, and intimacy. Adlerians use The Question to assess which task(s) the client is choosing to avoid.If I weren't depressed, I would enjoy going to work. I would be able to focus on the projects I have been given, and I would meet deadlines that would bring the company recognition. And I would probably do so well, I would be promoted. Such an answer sounds like a goal the client actually has, but Adlerians suspect that the individual actually lacks the courage to face theAdlerian Brief Therapy 7demands of work. If perfection is the perceived requirement for promotion, then failure seems all too imminent. In a psychology of use (Ansbacher & Ansbacher,1956), depression is the client's solution when faced with the perceived possibility of failure: It serves as an excuse for the client's retreat from the occupational life task.Toward a Relationship Intervention ContinuumTherapeutic relationship has a direct influence on therapeutic interventions and therapeutic outcomes. Those interventions that connect the client to both internal and external resources tend to empower the individual and encourage movement in therapy. The therapist may initially be the only external resource the client has. A quality relationship is based on mutual respect, requires an interest in and fascination with the client and what she or he bringsto therapy, and is facilitated by a collaboration that seeks to make an immediate difference in the client's life. When the therapist and client arrive at strategies for change at about the same time, resistance is all but non-existent and motivationis high.For example, in a session where a mother is struggling with what to do when her child throws a temper tantrum, she realizes that yelling at him to stop yelling is not effective. Instead of giving a direct recommendation, the therapist explores the possibilities already available to her.Therapist: So doing something that doesn't involve speaking or talking might be useful to you.Adlerian Brief Therapy 8Client: Yes. I don't want to hear myself like that. Therapist: What do you want to do?Client: (gesturing as if to wrap her child in her arms) I just want to hold him.Therapist: So when you feel calm in the face of his tantrum, you would go to him, wrap him in your arms, say nothing, and just hold him until he is calm with you.Client: Yes.One way to think about the therapeutic relationship in Adlerian Brief Therapy is through the use of the acronym, PACE. This acronym also speaks to the rhythms and flow of therapy. P stands for purpose, a concept that is central to the Adlerian model. It includes a focus on what purpose(s) the client has for therapy; the motivations for behaviors, emotions, convictions, and beliefs maintained in daily living; and even what goals may be involved in interactions between the client and therapist (Mosak, 1977). A stands for awareness and is related to the level of attention that both the therapist and the client bring to their work. Awareness is both the alpha and omega of experience (Polster & Polster,1996): It focuses attention so that experience is no longer non-conscious, and it brings experience into a resolution or a reflectionand sometimes, even a celebration. In this sense, insight is simply one form of awareness. C stands for contact and includes the quality of contact between the therapist and the client asAdlerian Brief Therapy 9well as the quality of the contact the client has with self, with others, and with the environments in which he or she lives. The constructs of awareness and contact are well defined within the work of the Gestalt therapists, Erv and Miriam Polster (1973, 1999). E stands for experience, which both flows from relationship and provides the interventions and transitions for therapeutic change. It is not uncommon for a focus on purpose, awareness, or contact to evolve into therapeutic interventions, strategies for change, experiments, enactments, or even homework, any of which may lead to the integration of new experiences in the client's life.The question of what makes a new experience useful or even therapeutic can be addressed through another acronym, BURP, which has been described in greater detail by Nicoll et al. (2000). B stands for strategies related to behavioral descriptions. From an optimistic interest in presenting issues [What would you like to see going better in your life?] to recurrent patterns, Adlerians focus on what people do, how they feel, and the results of these processes in interactive experiences. Such questions as when was the last time this occurred? or what happens when you feel . . . ? or who is most affected when you feel . . . ? focus the client on movement and process rather than helplessness.Individual purposes are often revealed in the responses that others have to what the client does. I was depressed all the time at the university. When I went home, my parents took care of me, and I slowly got better. I don't feelAdlerian Brief Therapy 10much like going back. Such a statement suggests that having someone take care of the client may be one of the goals of the depression.A second strategy is actually an investigation: U stands for understanding the client's underlying rules of interaction. Adlerians believe that all behavior is social in nature: It is enacted in social systems and gains meaning in interaction. The client's rules of interaction guide the client's movement or style of living through daily life; these rules also comprise the client's perspective on self, others, the world, and life, itself. Since the rules of interaction start to form when people are very young, Adlerians use birth order and family constellations, developmental processes and life task assessments, and early recollections, to name a few, as avenues of investigation (Carlson & Slavik, 1997; Mosak & Maniacci, 1998; Sweeney, 1998). Whatever the assessment process, meaning is shared with the intent of a conscious consideration of the function of underlying rules, past and present, through a process Nicoll (1999) calls active wondering.I'm not sure here, but I can't help but wonder if perhaps sometimes your depressive episodes don't also work for you a little in helping you avoid difficult situations and mobilizing others to take care of you (Nicoll et al., 2000, p. 236).R stands for re-orientation. Re-orientation is the process of helping clients to consider a new perspective. It aims at enlarging the awareness of clients so that they can think about and intend solutions in a manner that is different than the thinking that generated the problem in the first place. Reframing, re-Adlerian Brief Therapy 11labeling, normalization, generating hope and options, and uses of humor, metaphors, and even storytelling all enhance the re-orientation process (Nicoll,1999; Watts & Carlson, 1999). Whatever the intervention, Adlerians aim tochange more than mere behavior; re-orientation seeks to shift rules of interaction, process, and motivation. Such shifts are often facilitated through specificchanges in awareness, contact, and experience that take place within a counseling session but which are transformed into action outside of the session.Therapist: Do you know why people always seem to provoke you into getting angry?Client: Because I'm not liked.Therapist: I have a different idea. Could it be that people know you go off easily, and they want to see it happen. Maybe they sense this rule you have: that no one gets to tell you what to do and get away with it!!!Client: Yeah, I think that does happen . . . all the time, actually.P stands for prescribing new behaviors or behavioral rituals. Behavioral rituals involve regularly repeated actions that maintain human interactions or patterns and their underlying rules of interaction. In this sense, family, school, religion, and society all enact routines, ritual behaviors, and celebrations that serve the function of reinforcing or reaffirming their cultural worldview andAdlerian Brief Therapy 12eliminating alternative positions (Foucault, 1980). Similarly, client symptoms and life problems are often enacted as rituals, making their power and necessity seem overwhelming. In Adlerian Brief Therapy, new behaviors or rituals are additive. While prescribed behaviors or rituals are most often developed collaboratively with the client, we want them to (a) directly impact the client's underlying rules and (b) enhance the individual's ability to act with social interest and in socially useful ways.To continue with the example above:Therapist: What would you be doing if you were demonstrating your determination not to get angry when provoked?Client: Well, I just wouldn't do anything. Therapist: Yes, but what would you be doing instead. Client: Smiling at them, I guess.Therapist: As if to say . . .Client: Nice try, but you don't get me this time. Therapist: Yes, nice try. It's a perfect internal response.Here is a summary of how PACE and BURP can be used in therapy:Adlerian Brief Therapy 13Place Table 1 About HereWhen we consider these two foci together, they form a relationship intervention continuum that can be displayed as follows:Place Figure 1 About HereWhile any of the considerations and interventions on the continuum might be used at any time in therapy, purpose and behavioral descriptions tend to be early considerations, and they have a recursive relationship with each other. Similarly, considerations and interventions around awareness, contact, and the understanding and reorientation of underlying rules tend to happen in the middle of therapy. We also try to create or co-create new experiences in therapy as a foundation for reorientation and new behavioral rituals. Such experiences may include experiments or enactments integrated from other models.A Case ExampleThe following session is a typescript of a taped demonstration of Adlerian Brief Therapy conducted at a national convention (Bitter, 2002)with a signed release by the client. It has been edited for grammar and clarity of content. Names and places have been changed to provide some degree of anonymity.Adlerian Brief Therapy 14Commentaries in brackets have been added to highlight various aspects of relational interventions and strategies.Forming A RelationshipTherapist: We've met before. Do you remember where? Client: Butte, Montana, I believe.Therapist: Butte. Ah, yes. And I met you this morning coming out of my hotel room door, because you're across the hall from me. (Pause)So what would you like to see going better in your life? I'm not going to go into it right now. I'm just going to get a picture of it so I have a focus.Client: That's the problem. I was thinking as I was coming here: Gosh, I don't know if I should be coming to you, because I don't know who I am and I don't know what I want.Therapist: Okay, so would one way of thinking about it be that there is some confusion in your life?Client: Yes. [A possible, but undisclosed, purpose for confusion is that it keeps the person from moving, from having to make a decision, or taking a stand.]Therapist: Are you at a point where you like the confusion or where you would like some clarity?Client: No, I'd like some clarity, and I'd like to get things settled.Adlerian Brief Therapy 15Therapist: Okay. Is there anything that among a number of things that you would most like some clarity about or is it just amorphous to you?Client: Well, it's a lot of things. You know, . . . what am I going to do when I grow up? I have just retired from my job, and I want to start another one. I want to start a private practice; and I want to write a book; and I want to do all these things; and my family is falling apart, and I'd like to re-establish my relationships with my family. [There are probably a number of things in this list that the client is not ready to face, e.g., starting a private practice, writing a book. The most potent aspect, however, is her sense that the family is falling apart, a declaration that deserves therapeutic focus.]Therapist: Okay. So there are some specifics to all of that, but a lot of it seems overwhelming at the moment.Client: Yes, it is.Therapist: Now could you tell me a little about you? Help me know you.Client: Well, let's see. I don't know where to start. [There is something in her tone of voice and the way she seems to be searching several pictures in her head that suggests she is looking for the perfect way to present herself.]Adlerian Brief Therapy 16Therapist: Start at the worst possible place.Client: Well, I'm an old lady. I guess that's as bad as you can get.I . . . [She starts with almost a depressing voice, in a monotone as if she is playing a tape. I want a shift in her awareness immediately, and I want to engage her, make contact, in a different manner.]Therapist: You know the problem is not that you are an old lady. The problem is that you are older than you want to be at this time. How old do you want to be?Client: Forty-fiveTherapist: Forty-five: one of my favorite years too. What was good about 45 for you?Client: Well, I don't really know. I just said that. I guess I was kind of at peace with myself at that time when I think back on it.I was a school counselor and enjoying it. I loved the kids, and they loved me. I felt like I had a great life.Therapist: Okay, so regardless of what else might have been going on, there was contentment, and you knew what you were doing, so you had a sense of being capable. You had a sense ofbeing useful and important and doing things of value and you knew how to do them. Comfort. Nice. So what is keeping that from happening now?Adlerian Brief Therapy 17Identifying the focus issue: Getting a behavioral descriptionClient: I don't know. I just feel unappreciated and unloved, and I don't know. [This time, she speaks with real sadness in her voice, and I sense tears in her.]Therapist: And there's some real sadness for you in that. Client: Yes.Therapist: Whom do you feel unappreciated by?Client: Just about everybody. [Her hurt is not global; it is specific, andI want to know the specifics.]Therapist: Of all the people you know who don't appreciate you, who is most important you. Who have you lost that is most important?Client: My son.Therapist: Your son. Shall we stay with that for a while? Client: Ok.Therapist: Can you tell me a little about him and you, and what your relationship is like?Client: We were always very close. My son . . . I was divorced when he was six. I had another son who was four: so four and six. My older son kind of, I guess, took on the father role. I wasn't aware of that at the time. I just went through life, and I didn't think I was putting anything on him, butAdlerian Brief Therapy 18looking back on it, he thinks I did. [She is putting more importance on her son's thoughts than her own. I want her to at least voice her own position.]Therapist: Um, hmm. What do you think now?Client: Well, I still don't think I was putting anything on him. Ithink it was his choice.Therapist: So you're in disagreement at this point.Client: But as we went through life, we were very close all the time.And when he moved back to Butteafter failing at his doctoral degreewe just did a lot of things together, and he kept inviting me. I'm not someone who would just invite myself places, and I guess that's a bad thing, because I have to wait for everybody else to invite me.Therapist: You can wind up feeling lonely sometimes.Client: Yes. All the time. Anyway, he always invited me, and I always went. We had a great time. We liked the same kinds of things, and he was about my best friend, you know . . . really. My friends always told me that I was too close tohim. [Again, someone else's voice has been given preference over her own. I want to challenge that.]Therapist: Well, exactly what is too close?Adlerian Brief Therapy 19Client: Well, that's what I have never been able to understand. It seems to me that family members can be close and do things together as long as it isTherapist: You weren't still diapering him.Client: No, no, and I wasn't sleeping with him. To me it seemed okay.Therapist: Then why the hell did you listen to those people? Client: Well, I didn't. And I kept going. And when I got mydoctorate he helped me through it. I emailed him every paper I wrote, except my sex therapy papers.Therapist: [smiling with a twinkle in his eye] You have to draw the line somewhere.Client: [laughs] He would critique them and send them back to me, and I felt like I really had support there. He really supported me through my doctorate. I would have never made it without him, probably. And then, I came back to Montana, and we continued seeing each other from time to time and had fun together and so forth. All of the sudden, he got this girlfriend who hated me. I didn't know she waseven a girlfriend. She was someone he was helping out. She was quite a bit younger than he, and she needed a lot ofhelp. So, he was helping her and still, when he would inviteAdlerian Brief Therapy 20me to go places, I would go. And she would be there, too, and I just thought that was fine. And all of the sudden she just waylaid me and said I was just awful and that I just ruined my children and that he couldn't stand on his own two feet.Therapist: What'd she want from you?Client: She wanted me to leave him alone. She said I called him too much. So I quit. I wouldn't call him, except maybe once . . . [There is a pattern developing that suggests part of her rules of interactions: She wants to be a good person, and to be seen that way, no matter what. And a good person does not argue, disagree, fight, or even so much as stand up for herself. In her attempt to please everyone, she loses a sense of identity, a sense of self, and her even her voice.]Therapist: Now, why in God's name would you give up a good fight like this?Client: Well, I didn't want to ruin his life, and I thought if he wants her . . . [No one can really ruin someone else's life without that person allowing it. So this is an opening for a shift in awareness, a re-orientation.]Therapist: You're not that powerful. Client: Well, anyway, she still . . .Adlerian Brief Therapy 21Therapist: [smiling] You didn't want to hear that one at all did you?Have you actually ruined anybody's life? Client: I don't think so.Therapist: Have you tried? Client: No.Therapist: So, not only have you not done it, but you haven't put any effort into doing it. So we don't even know if you're any good at it or not. Well, let's try the other end of it. Have you made anybody's life worth living?Client: Well, yeah. I think I helped a lot of kids in the schools and parents.Therapist: So tell me a little about that. What do you do to help people have a good life.Client: Well, when I was an elementary counselor I helped lots of kids. I taught them things that they needed to know to be happy in their lives.Therapist: You know if I had a couple of days with you I would let you get by with that, but I've got really a short amount of time. So tell me what you did to help them. Concrete stuff.Client: Okay. I helped kids feel good about themselves. Therapist: How'd you do that?Client: I, um . . . that's a good question.Adlerian Brief Therapy 22Therapist: Thank you.Client: I was happy to see them. I enjoyed being with them, and Ilet them know that.Therapist: You were happy to see all of them? Client: Yeah, I was.Therapist: Even those trouble makers?Client: Yeah, I enjoyed those little troublemakers. Therapist: What'd you enjoy about the little devils?Client: I enjoyed their, what's the word . . . their ability, their creativity, I guess.Therapist: So who was the most creative troublemaker you ever met? Client: Oh, boy.Therapist: You're the oldest child in your family aren't you? Client: No, I'm the youngest.Therapist: The youngest? Then you have no business having this perfectionism. Did you have nothing but derelicts above you? [Use of humor to facilitate therapeutic relationships also helps the client to step back and re-assess her rules of interaction.]Client: I had two brothers.Therapist: So you did have nothing but derelicts. Okay, we'll just set a couple of ground rules. If I make the mistake, which I could, and say, What's the most, what's the best, what's theAdlerian Brief Therapy 23biggest?: just ignore me. Just pick anything, because otherwise you will be searching your memory for the most important one, and I'm down to thirty minutes. So just pick one. Pick one of the great troublemakers of your time.Client: Ok. Well, I can remember way back in my very beginning years as a counselor. I was in Junior High, and this kid would come in to see me everyday, and he'd do that just to get out of class, but I really enjoyed being with him. The teachers hated him, so they were glad to get rid of him, and it turned out everybody was happy.Therapist: What did you do with him?Client: We just talked about whatever he wanted to talk about. Therapist: Mm, hmm. Did he trust you right away?Client: I think so. Therapist: Why?Client: Because I'm a trustworthy person. I don't know. Therapist: Could be, but you must have done something todemonstrate that, because all the other people who looked like you were teachers, and he hated them.Client: That's true. I guess I was probably a good excuse to get out of class.Therapist: What did you do?Adlerian Brief Therapy 24Client: I listened to him.Therapist: Did you disagree with him?Client: Probably, I don't really remember all that, but I just remember enjoying him. It made me feel important, and I liked that.Therapist: Ok. Now, did you ever have anyone who just hated you? Client: My son's girlfriend.Therapist: Besides her.Client: No, I can't think of anyone. Therapist: So this is a new experience for you. Client: Yeah, yeah I guess so.Therapist: So actually you don't really have a lot of life experience on what to do with people who are really just obnoxious.Client: Right, but I'm getting it fast.Therapist: And fortunately you have a therapist that can help you with that, because I have a lot of experience being obnoxious. [Client laughs] Are you having fun yet?Client: Yeah.Therapist: Ok. I think you have something that you are going to have to decide. [The therapist moves from a playful interaction to a very serious discussion. The contrast focuses attention, heightens awareness, and augments the therapeutic contact.]Adlerian Brief Therapy 25Client: Ok.Therapist: You are going to have to decide whether you want to stilllive or you want to just die and walk around until your body catches up.Client: I don't understand. Therapist: Which part?Client: The whole thing.Therapist: Ok, to live, you're going to have to become a person. And if you just want to die and wait until your body catches up, you can just do exactly what you're doing.Client: Hmm.Therapist: Got any feel for which way you want to go? Client: I'd like to live.Therapist: Would you? Client: Um, hmm. Therapist: As a real person? Client: Um, hmm. Therapist: Okay.Client: Yeah, because I just feel like I've been meeting everyone else's needs.Therapist: That's right. You know what happens to somebody who spends her life pleasing everyone else?Adlerian Brief Therapy 26Client: They don't get pleased.Therapist: And what do people do with doormats? Client: They step on them.Therapist: Yeah. I probably have not said anything this hard to anyone in a long time. This is a hard thing for me to say to you, and I think it's probably a hard thing for you to hear, isn't it?Client: Um, hmm.Therapist: You see, initially I thought you were possibly grieving about the loss of your son, but now I know you were getting ready to grieve for the loss of yourself.Client: Quite true. Therapist: How old are you? Client: 65.Therapist: Only ten years older than me, and I'll tell you something: you're at the age, now, that, when I am your age, I plan on kicking butt and taking no prisoners. Now, what kind of person do you want to be?Client: I've always wanted to be bubbly. I've never been bubbly.And I envy people who are bubbly. [Note: Bubbly isn't a behavioral description; it's an evaluation.]Therapist: Do you? What do bubbly people do?Adlerian Brief Therapy 27Client: They can talk to everybody and say anything and not care what others think.Therapist: Can I stop for just a second? Client: Uh, huh.Therapist: I want to make a point here. This is just a gentler version of the question. What's she afraid of? [With an audience, the therapist has an indirect means of talking to the client that at one and the same time lets her hear what is being suggested and also take a break from our work.]Audience: Rejection (comment from the audience).Therapist: Yes. She doesn't have any confidence in her ability to be this person that she would like to be. She just spent probably a good 20+ years of her life watching all those people who do have it. She's a measurer. She looks at it, and she says that's them, this is me, and the gulf is too damn big to get over.Am I right? Client: That's right.Therapist: Yeah. And so, if I start working with her right now on being a bubbly person, which of us is going to win that one? Ithink we need something else. Let's see. It'll help me if I can get a few small pieces of kind of objective stuff about you. Is that okay?Adlerian Brief Therapy 28Client: Mm, hmm.A Psychological Investigation: Underlying rules of interactionTherapist: You said you are the youngest. Client: Mm, hmm.Therapist: Any miscarriages? Client: No.Therapist: Any daughters in your family besides you, or were you the only little princess everybody had?Client: I was just the princess.Therapist: Okay, who is closest to you in age? Client: My brother, Mark.Therapist: Mark? And how much older than you is he? Client: Four years.Therapist: And are you more like him or different from him? Client: Probably different.Therapist: In what way?Client: Well, he wasn't as studious, and he was kind of slovenly.He was easy going.Therapist: He wasn't as studious; he was slovenly; he was easy going. Client: I think I was kind of easy going, though.Therapist: I'll help you with the other one if you want me to. He was bubbly. [Bad guess, but nothing lost.]Adlerian Brief Therapy 29Client: Well no, but he wasn't afraid of anybody. Therapist: Okay, so he made friends easily.Client: Yeah.Therapist: Did you find it hard making friends? Client: No.Therapist: So, how is he different?Client: Well, he had bad grammar. That's another bad thing. Therapist: And who, besides you, had good grammar?Client: My brother, Dave, my older brother. Therapist: And Dave turned out to be what? Client: He's a sign painter.Therapist: He's a sign painter. Well, you need good grammar for that. Client: It's amazing how many sign painters put bad grammar ontheir signs.Therapist: What does Mark do? Client: He's a farmer.Therapist: So were you the first person in your family to get a college degree?Client: Mm, hmm.Therapist: Anyone celebrate that?Client: Yeah, and when I got my doctorate, my brother Dave came. Therapist: How about your family, your parents?Adlerian Brief Therapy 30Client: My dad came to it.Therapist: Is he like Dave or like Mark? Client: He's like Mark.Therapist: In what way?Client: He doesn't like to dress up. He was a rancher or a farmer. Therapist: So you doctoral type people are a bit uppity for him? Client: No, he was always just very accepting of everybody. Therapist: He was? That's nice. What about your mother?Client: My mother was very demanding. I never liked my mother much. Until I got married, and then I thought she was wonderful.Therapist: What changed? Client: She was very helpful.Therapist: In child rearing and that kind of stuff? Client: Yeah.Therapist: How did you find your husband? Client: We were in college together.Therapist: Did you go after him or him after you? Client: Well, he went after me, I guess. Therapist: So why did you give in?Client: Because somebody told me I should.Adlerian Brief Therapy 31Therapist: So someone told you that you should kind of get interested in the guy, and you caved in and did it. You got married right after college?Client: No, we got married when I was a sophomore.Therapist: Okay. Think back to when you were really young, and then I am going to stop doing my quasi-objective stuff. What's something you remember from when you were really little?Client: Well, my very earliest memory was when I was just a toddler, and I remember we were at the ocean, and all the sudden the water was coming at me, and it scared me to death, and my dad picked me up.Therapist: And how did you feel?Client: I felt scared when the water was coming at me, but then daddy saved me.Therapist: Got any others?Client: One time we went camping. I was, I don't know, 4 or 5, and we were . . . my brothers and my dad were out in the boat, and my mother and I were in camp, and I was wandering around from campground to campground, and I saw this . . . what had been a fire, and the ashes were just so soft. And I took off my shoes and waded through it barefoot, because I thought it would feel good on my feet.Adlerian Brief Therapy 32Therapist: What happened? Client: My feet got burned. Therapist: How'd you feel? Client: Hurt.Therapist: Hurt. Okay, one last one.Client: Let me think. My mind's blank. [pause] . . . I remember in first grade I was in a play, and it was a great big auditorium, and it was packed with people, and so I was talking really, really loud, and it was about mice running around. And Igot up on this chair, stood on the chair, and I gave this long speech and realized it was the wrong one.Therapist: The wrong speech?Client: The wrong line. And so I yelled out Oh no and turned around and gave the right speech, the right line.Therapist: How'd you feel?Client: I felt . . . and everybody laughed . . . and I felt okay. I felt like I had fixed it.Therapist: Good for you. If you hadn't had that memory, I would have been sitting here until we found one. You've been doing [interpreting early memories] for some time. What do you think about the first two memories you had?Adlerian Brief Therapy 33Client: Well, I've analyzed them and analyzed them. I can't . . . I'm not sure. Maybe I want somebody to save me, or when I do things on my own, I get in trouble, and it hurts me.Therapist: Ok. I might have said it a little differently, but we're in the same ballpark. What do you get from the third memory?Client: I can make mistakes, and I'm still okay.Re-orientation: Shifting the Underlying RulesTherapist: Now we're at the critical juncture of life. If you would like to be a person, you will have to spend more time with the third memory, and less with the other two, and if you want to be dead you have to join with the other two.Client: Okay.Therapist: How would a really tough broad . . . ? (she smiles) You like this already don't you? How would a really tough broad handle herself after she mistakenly tramps through the coals?Client: I don't know, put on boots.Therapist: Yep, let's say you didn't have any. Let's say you actually got yourself into it; you're running across hot coals, and in the middle you realize this was a mistake, how does a tough broad handle it?Client: Get out of there.Adlerian Brief Therapy 34Therapist: Yes, and?Client: Take care of my feet.Therapist: I'm going to tell you something an old teacher of mine told me back in 1975 just before I went out to do my first presentation on the Family Education Center before the world famous Kiwanis Club. He said to me, Just go out and do it as if you know what you're talking about.And I said, Yeah, but I don't.He said Yes, but they don't know that.I said: I don't know if I have that confidence.He said, You know when we were out tramping in that cow pasture the other night, and you stepped in stuff, and madea big deal out of it? I said: Yes.He said: Confidence is walking on as if you hadn't done it. Now, then, this is a secret about life. There is no such thing as a confident person: just those who are good at faking it, and those who aren't.And the big problem, or at least part of the problem that you've had in life, is that you've had the illusion that there really are confident people out there: Somehow they've got it together, and you just can't seem to do it. But you seeAdlerian Brief Therapy 35you've got that third memory, and you're in trouble, because even you know that you can. What were the strengths inthat memory?Client: Being able to redirect. Therapist: That's right.Client: Making people laugh. Therapist: Absolutely.Client: Speaking loud. Therapist: Yes!Client: Memorized two different lines.Therapist: You have options. What kept you from looking out at the audience and seeing a huge wave coming at you that was going to kill you?Client: I don't know.Therapist: See if you can get there. Close your eyes for a second. Let's go back. Put yourself on that stage. Just look out at those people. You can do that. You're an elegant, beautiful, 65 year old woman who can look out there and not be frightened by them. So, just take a look. What do you see?Client: Accepting people. Therapist: What do they look like?Client: They look the same as everybody.Adlerian Brief Therapy 36Therapist: They look the same as everybody. Now, up until a few weeks ago, you were the Will Rogers of Butte, Montana. You never met anybody you didn't like and who didn't like you. It's true, isn't it?Client: It's more than a few weeks. It's been several years. And my brother now is turned against me too. [Her last statement isan invitation to de-focus that the therapist cannot follow.] Therapist: Well, this is also true: When it rains it pours. The good newsis that it also works the other way around. When you turn one thing around, whole bunches of things start to work out. Now, what were the skills that you used all those years in school counseling to win over everybody from the brilliant student to the snot? What were those skills that you used?Client: I just did what I could. Therapist: Like what?Client: I followed the rules. Therapist: That's important. What else?Client: I reached out to others, and I was there for them.Prescribing new behavioral rituals through therapeutic experienceTherapist: Okay, let's try something. I will do a really bad version of your possible future daughter-in-law.Client: I hope not.Adlerian Brief Therapy 37Therapist: And you do your skills. You've ruined everything.Client: [The client leans forward, takes a deep breath, and focuses.] Therapist: Now, before you start, I loved what you just did. What didyou just do? [Performance is enhanced by awareness and full contact with oneself and one's energy.]Client: I moved in. Therapist: Yes, what else?Client: I looked you in the eye. Therapist: Yes, what else?Client: I took a breath.Therapist: Yes, and that's the difference between living and dying.People who are living have to take a breath. So the first thing you do is take a breath in; then you lean forward, and you put all of your energy into your center just like you did. Now what do you have to say?Client: I don't know.Therapist: Start over. Because this is what your breath was like when I just asked you what you had to say. [Therapist takes in shallow breath and holds it.] I want you to breathe. Keep in mind you have been handling people just like this, even though they haven't seemed like this: You've been handlingAdlerian Brief Therapy 38people like this for 25 years. What do you have to say to this person?Client: I'm sorry you feel that way. If Gary is so bad, why do you like him?Therapist: Now, how does it feel for you to say that? Client: It gives me power.Therapist: Yes, and how's it feel to say that? Client: It feels good.Therapist: What kind of good? Client: Well, I got it out.Therapist: What happens if it just stays in? Client: It just smolders there.Therapist: Yes. When you're smoldering inside, are you living or dying?Client: Dying.Therapist: Okay, let's carry it one step further.Well, I don't need you around. He's hard enough for me as he is. I don't need to tell you why I love him. After all, it's not your business.Client: [in her strongest, most centered voice] I realize that, but I want the best for my son, and I hope that you're the best for him.Adlerian Brief Therapy 39Therapist: Oooh. How's that? Client: That was really hard.Therapist: Yes, but it was practically perfect. You just took my breathaway. You don't have to back down from any punk kid.You haven't done it for 25 years, and no reason to do it now. The main thing is this: You already have everything you need inside you; you've always had it; and what's left for you is to stop ignoring it and use it. You might want to practice a little bit, because you are a little rusty, but you aren't dead. And then when you get done with your son, and his new friend, you start inviting other people to do things with you. You invite them and don't wait for them to invite you, because, by God, you are worth having as a friend. How's this been for you?Client: It's been great. Therapist: You've been great. Client: Thank you. Therapist: You're welcome.Concluding RemarksWhat happens with this client will depend a great deal on what she chooses to do when she gets back home. Finding one's voice does not always equal the choice to use it. This is only one session. If there were an opportunityAdlerian Brief Therapy 40for more, the possibilities for change might generalize to other parts of her life and thereby reinforce and reaffirm a shift in her underlying rules of interaction and her motivations in living.The flow of this session reflects many of the aspects of therapy along the continuum that we prize. It starts by choosing a focus for the session, which is also to say, a purpose for therapy. The initial pace is a slow, careful, tight therapeutic sequence (Polster, 1987) in which the therapist follows the client as if considering each stitch in a developing tapestry. Yet, even within these sequences there are shifts that we have noted in the typescript that are chosen to interrupt the deadening of experience, enhance awareness, and bring the client into better contact with self and others. The movement from initial issue focus to a focus on the person to getting a behavioral description is, perhaps, the most common initiating process we use in Adlerian Brief Therapy.Behavioral descriptions to be useful must be specific and concrete. Concrete descriptions highlight interaction, movement, style, and patterns in the person's life. It is in her interactions with others, in the doing of life, that patterns of pleasing, goodness, and perfectionism emerge. The immediacy of brief therapy almost requires that there be some challenge to the usefulness of these embedded rules of interaction. Humor in the form of delight and play has two very useful dimensions: (a) It lightens the process by joining the client incommon human folly, and (b) it provides a process and context against which aAdlerian Brief Therapy 41shift to a more serious intervention is instantly recognized (again, enhancing awareness).The interventions that asked the client to decide between living or dying, between becoming a real person or giving up, represented a real shift in the conversation from more playful to more serious, and it is literally the beginning of reorienting the rules. At the same time, the therapist also discloses that saying something so difficult and direct can be hard to hear, inviting the client to comment, if she wants to, on her experience of this intervention. She chooses not to comment, which is her prerogative. A short time later, it seems useful to note a fear of rejection she might have, but therapeutically, the counselor does not want two relatively hard disclosures in a row. In this case, there is an audience, and asking the audience what the fear might be allows the client to take the information in from another source. Further, since the therapist has turned his awareness and contact toward the audience, the client is allowed to breathe, to relax a little, and to settle briefly into observation.This relaxation in the flow of therapy is also facilitated by a shift to Dreikurs' (1997) objective interview. In the middle of approaching new options and strategies for change, a challenge that can often feel overwhelming, the client is invited to regain the role of expert in her own life, to bring the counselor up-to- date on her family constellation, the family atmosphere, and her early recollections. Throughout this process, the therapist is gathering a sense of the strength that is in the client and in the client's background. These will becomeAdlerian Brief Therapy 42the internal resources she needs in both a reorientation of her rules and the development of new behaviors, new interactions, and even new rituals.In this case, we are presented with a woman who has accomplished good breeding from humble beginnings, who has enjoyed the support of others and has come rather optimistically to expect it to continue, and who has an early memory of triumphing over adversity. It is a picture that does not fit with voiceless-ness in the face of her son and his partner. The weaving of re-discovered strengths into the practice of new behaviors creates a closing experience that can serve as a launching of a new sense of self into the world.Still, real change happens between sessions, not in therapy, itself. It is one thing to arrive together at a strategy for change. It is another to enact it. It takes courage (and encouragement) to bring what one learns in therapy to daily life. Further, almost nothing enacted in the real world goes exactly the way it is role- played in therapy. Adlerian brief therapists seek to establish in their clients a renewed faith in self as well as optimism and hope for their immediate and long- term futures. It is caring, however, that guarantees the client support and a safe return in a future session, no matter how the real world enactment has gone (Mosak & Maniacci, 1998).Adlerian Brief Therapy 43ReferencesAdler, A. (1958). What life should mean to you. New York: Capricorn. (Original work published 1931)Adler, A. (1964). Problems of neurosis: A book of case histories (P. Mairet, Ed.). NewYork: Harper & Row. (Original work published 1929).Adler, A. (1996a). The structure of neurosis. Individual Psychology, 52(4), 351 362. (Original work published 1935)Adler, A. (1996b). What is neurosis? Individual Psychology, 52(4), 318 333. (Original work published 1935)Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1956). The Individual Psychology ofAlfred Adler. New York: Basic Books.Berg, I. K. (Speaker). (1993). Solution-focused brief therapy (IAMFC distinguished presenter series #6 ACA convention). Bowling Green, KY: CmtiPress.Bitter, J. R. (Speaker). (2002). Adlerian brief therapy with individuals: Process and demonstration (Cassette #220523-120 NASAP Convention). La Crescenta, CA: Audio Archives International, Inc.Bitter, J. R., Christensen, O. C., Hawes, C., & Nicoll, W. G. (1998). Adlerian brief therapy with individuals, couples, and families. Directions in Clinical and Counseling Psychology, 8(8), 95-112.Bitter, J. R., & Nicoll, W. G. (2000). Adlerian brief therapy with individuals: Process and practice. The Journal of Individual Psychology, 56(1), 31-44.Adlerian Brief Therapy 44Carlson, J., & Slavik, S. (Eds.). (1997). Techniques in Adlerian psychology.Washington, DC: Accelerated Development.de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.Disque, J. G., & Bitter, J. R. (1998). Integrating narrative therapy with Adlerian lifestyle assessment: A case study. The Journal of Individual Psychology,54(4), 431-450.Dreikurs, R. (1997). Holistic medicine. Individual Psychology, 53(2), 127-205. Eckstein, D., & Baruth, L. (1996). The theory and practice of lifestyle assessment (4thed.). Dubuque, IA: Kendall-Hunt.Foucault, M. (1980). Power/knowledge: Selected interviews and other writings. NewYork: Pantheon Books.La Fountain, R. M. (1996). Social interest: A key to solutions. IndividualPsychology, 52, 150-157.La Fountain, R. M., & Garner, N. E. (1998). A school with solutions: Implementing a solution-focused/Adlerian based comprehensive school counseling program. Alexandria, VA: American School Counseling Association.Mosak, H. H. (1977). On purpose. Chicago, IL: Alfred Adler Institute.Mosak, H. H., & Maniacci, M. P. (1998). Tactics in counseling and psychotherapy.Itasca, IL: F. E. Peacock.Nicoll, W. G. (1999). Brief therapy strategies and techniques: An integrative framework. In R. Watts & J. Carlson (Eds.), Strategies and interventions inAdlerian Brief Therapy 45counseling and psychotherapy (pp. 15-30). Philadelphia: AcceleratedDevelopment.Nicoll, W., Bitter, J. R., Christensen, O.C. & Hawes, C. (2000). Adlerian brief therapy: Strategies and tactics. In J. Carlson & L. Sperry (Eds.), Brief therapy strategies with individuals and couples (pp. 220-247). Phoenix: Zeig/Tucker.O'Hanlon, B. (Speaker). (1995). Brief solution oriented therapy. (IAMFC distinguished presenter series #11 ACA convention). Bowling Green, KY: CmtiPress.Polster, E. (1987). Every person's life is worth a novel. New York: Norton. Polster, E., & Polster M. (1973). Gestalt therapy integrated: Contours of theory andpractice. New York: Vintage.Polster, E., & Polster M. (Speakers). (November 6, 1996). Presentation at the First International Gestalt Conference [video]. Cambridge, MA: The Gestalt Journal Press.Polster, E., & Polster M. (Eds.). (1999). From the radical center: The heart of Gestalt therapy: Selected writings of Erving and Miriam Polster. Cleveland, OH: Gestalt Institute of Cleveland Press.Powers, R. L., & Griffith, J. (1987). Understanding life style: The psycho-clarity process. Chicago: AIAS.Powers, R. L., & Griffith, J. (1995). Individual Psychology client workbook (with supplements). Chicago: AIAS. (Original work published 1986)Adlerian Brief Therapy 46Shulman, B. H., & Mosak, H. H. (1988). Manual for lifestyle assessment. Muncie, IN: Accelerated Development.Sonstegard, M. A., Bitter, J. R., Pelonis-Peneros, P., & Nicoll, W. G. (2001).Adlerian group psychotherapy: A brief therapy approach. Directions inClinical and Counseling Psychology, 11(2), 11-24.Sweeney, T. J. (1998). Adlerian counseling: A practitioner's approach (4th ed.).Philadelphia: Accelerated Development.Walter, J. L., & Peller, J. E. (1992). Becoming solution-focused in brief therapy. NewYork: Brunner/Mazel.Watts, R. E., & Carlson, J. (Eds.). (1999). Interventions and strategies in counseling and psychotherapy. Philadelphia: Accelerated Development.Watts, R. E., & Pietrzak, D. (2000). Adlerian "encouragement" and the therapeutic process of solution-focused brief therapy. Journal of Counseling and Development, 78, 442-447.Watts, R. E., & Shulman, B. H. (in press). Integrating Adlerian and constructive therapies: An Adlerian perspective. In R. E. Watts (Ed.), Adlerian, cognitive, and constructivist approaches to psychotherapy: An integrative dialogue. New York: Springer Publishing.Adlerian Brief Therapy 47Authors NotesJames Robert Bitter, Ed.D., is Professor of Counseling in the Department of Human Development & Learning at East Tennessee State University. He is the past editor of the Journal of Individual Psychology, and his many publications include articles on family mapping and family constellation, created memories versus early recollections, and family reconstruction. He was associated with Virginia Satir for the last ten years of her life and is a past President of her AVANTA Network of trainers. Jim has also studied with the Gestalt therapists, Erv and Miriam Polster.William G. Nicoll, Ph.D., is Professor in the Department of Counselor Education at Florida Atlantic University in Boca Raton, Florida. He also serves as President of the Adlerian Training Institute, Inc. and has served as the national trainer in Brief Counseling for the American Counseling Association's national professional development program. He has provided training in Adlerian based interventions across the United States as well as Europe, Asia,Latin America and Africa. He has also recently produced a video demonstration of Adlerian Brief Therapy that is available through the Adlerian Training Institute in Boca Raton, Florida.