In Part 1 of this series, I discussed my own efforts to integrate two of what I see as the most personally congruent theories for my work. Although the influences have been many, I limited the discussion to Adlerian Psychology and Family Systems in order to demonstrate how eclecticism can be a reflection of a thoughtful integrated whole, not “sloppy thinking” as I was once admonished by a senior theorist.
This is not to suggest that everyone follow my path. The intent is to encourage new and experienced therapists to articulate clearly for themselves how they are integrating the many sources available to us over the course of our careers.
Our interventions should always be driven by two things: Diagnosis and our theoretical construct. It is the connection between the two that keeps us on track as we work to help the client gain relief from symptoms and become a happier and mentally healthier person.
A therapist once told me that when treating a new client, he throws as much mud on the wall as he can think of and sees what sticks. I suppose that’s one way to go about it. But I think being eclectic isn’t about randomly throwing things out there to see what happens. Becoming responsibly eclectic to me means thoughtfully using the tools that are consistent with our theoretical base.
Interventions are the tools we use for inspiring and supporting change. Every therapist develops a “toolbox” over time. Like you, I’ve added many such tools from professional conferences, workshops, reading and consultations.
However, for the purpose of this article, I will continue to limit the discussion to the tools I’ve learned from the two theories discussed in Part I (Adlerian and Family Systems).
Although Alfred Adler was way ahead of his time as an activist around social, economic and gender issues, he did not operationalize his thinking into specific psychotherapy interventions.
One of his students, Rudolf Dreikurs, did develop a brilliant and simple application of Adlerian principles for parents and teachers that included an understanding of family and social dynamics as well as instruction in the utilization of encouragement and consequences.
When family therapy flowered in the 80’s, I was eager to layer what I was learning on the foundation laid by Adler and Dreikurs. Basic tools I regularly use from each school include:
From Adlerian Psychology
1) Central to individual work is the client-therapist relationship. Adlerians seek to create a collaborative relationship with their clients that is based on mutual trust and equality.
2) To Adlerians, “unconscious” is a verb, not a noun. Adlerians are not interested in discovering the “causes” of behavior buried in an unconscious. Rather they are interested in understanding the conclusions a person has perhaps unconsciously reached about who they are and what they need to do to survive and thrive, the “fictional goal” the client is striving toward.
I therefore do not dig into the past except to help the client understand and reconsider the conclusions they have reached that inform their present and their idea of their future.
3) The primary “technique” is Socratic questioning to help the client define their fictional goal and discover for themselves where that goal came from and how to use their strengths to make change.
Beyond that, Adlerians are already very eclectic in their selection and use of therapeutic techniques, while applying the Adlerian principles. I therefore feel free to use techniques from various schools of family therapy, hypnosis, role playing and story-telling as well as techniques drawn from DBT, CBT and other methodologies depending on what the client and I find most helpful to that person at that time.
4) I provide support for trying on new behaviors (in Adlerian vocabulary, acting “as if” a new idea is true) and processing the outcome.
5) Like most Adlerians, I weave the following threads into treatment: Constant encouragement, challenging self-defeating ideas about how to get along in the world (the “fictional goal”), increasing the individual’s feeling of belonging in community and promoting feelings of equality, personal empowerment and social contribution.
From Family Systems
Although I’ve always preferred to work with the family as a whole, it is often not practical. Sometimes it isn’t even wise. Family members may be at a distance, unwilling to engage in therapy or so cut off from one another that bringing them into the same room is impossible, at least at first. Sometimes family members are so hostile to each other that getting them together will result in further emotional/psychological damage to individuals.
Whatever the case, we are often left with only one individual in treatment. However, I firmly believe that individuals always mentally bring the whole family ecology in the door. Whether seeing only an individual or the entire family, I regularly draw on these tools:
1) Constructing a genogram together as a way to help us understand the family’s idea of its own history and each individual’s idea of their place in it. The family’s response to issues around gender, race, culture and class are important aspects of that discussion.
I’m interested in helping clients see that their family also has a “lifestyle,” a way of managing their collective understanding of what it takes to belong in the world, even if that understanding seems/is a negative one.
2) Positive reframing of what has been seen as sources of distress in order to help the client (or each family member) develop a compassionate understanding of self, family members and events. I find that this approach helps clients move beyond blame and shame and to begin to examine where they can make cognitive, emotional and behavioral change.
3) Framing what may be seen as “resistance” as the assertion of a consistent or persistent family style; Challenging those ideas.
4) Examining the possible consequences, positive and negative, of changing someone’s role or stance in the family ecology. By doing so, we may be able to predict how others’ reactions might support or undermine such efforts. We can then plan positive responses.
5) And I borrow liberally from my teachers in family work, using action techniques and prescriptions that help the client and family experience alternative ways of being.
As in Part I (Eclectic Assessment), this summary is by no means a full discussion of what I’ve drawn from each school of therapy. Nor is it to be understood as an argument that other therapists should embrace my choices and conclusions. Rather it is a demonstration of how I’ve worked to thoughtfully integrate what I have found to be profoundly useful techniques from both approaches to our work.
In our busy lives as therapists (seeing our clients, dealing with paperwork, and balancing work and home life), it is often difficult to find the time to reflect carefully on what we are doing and why. Yet it is that very reflection time that helps us become our best selves as helpers and healers. Giving ourselves the gift of a few hours a week to just sit and think about how we are putting theory into practice results in better treatment for our clients and further evolution of our own competence.