The following questions, answers, and comments about Classical Adlerian philosophy, theory, and practice have been excerpted from discussion forums, newsgroups, and e-mail correspondence. The text has been edited minimally for clarity and readability. All of this material is protected by copyright and may not be reproduced without the expressed consent of Dr. Stein at email@example.com.
|28. Treatment of Sexual Offenders||30. Treatment of Symtoms||33. Treatment of Trauma|
Question from Forum: Adler views sexual offenders as lacking social interest and tending towards a pampered lifestyle. I have been working with offenders for a number of years from an Adlerian perspective and have come to believe that whether a sex offender reoffends or not is directly related to social interest. However, because of the danger they represent to society they are often treated as undesirables and unredeemable. I believe this kind of hopelessness discourages social interest. I have advocated both a clear set of boundaries in conjunction with emotional honesty and compassion. Any ideas about how to encourage social interest and promote a sense of social equality while protecting the society from sexual aggression?Dr. Stein: Encouraging social interest and promoting a sense of social equality are certainly parts of a general treatment strategy for rehabilitating sexual offenders. However, unless the style of life is actually "dissolved" there is still the risk of repeated offending. See the Stages of Psychotherapy section of "Classical Adlerian Theory and Practice" for an overview of therapeutic stages and strategies. From an Adlerian perspective, the best way to fully protect society from any individual's acts of aggression, exploitation, or destruction is to change that individual's fictional final goal of dominance, superiority, and revenge. This may take more time and skill than is actually available.
I am interested both in balancing the therapeutic need for the sex offender to enter into a social world of mutual respect and connectedness while at the same time recognizing the potential dangers.
I also am interested in looking at the issue of social embededness as it relates to the whole issue of why some people cross sexual boundaries in our society and others don't. I am concerned that as our culture becomes less personally connected that social interest while decline and sex offending will increase. Does that make sense? Let me know your thoughts on this subject.
Our culture seems to be drifting toward people becoming "less personally connected." This can certainly contribute to an increase in sexual offending as well as other forms of exploitation. Another factor that may be influential is the uncertainty of sexual roles. In periods of transition, from the dominance of one sex, to equality, or to the dominance of the other sex, many people become insecure and confused about their sexual role. The experience of "social embeddedness" may become more difficult to attain, especially if one is simply trying to figure out, and then fit into, the shifting social expectations.
If a psychologically rooted "feeling of equality" is not promoted in a culture, it is possible, over long periods of time, for norms to alternate between male and female dominance, passing briefly through periods of "superficial social equality." (This topic will be covered in depth in our summer seminar "Love, Sex, and Money: Helping Couples Cooperate," July 9-12, 1999, in San Francisco.)
Question from Forum: I have been thinking about the issue of "treating symptoms" and am confused. It seems that if I honor the patient's initial request to treat his symptom, I demonstrate the flexibility, collaboration, problem solving and effort the client will need to meet life's challenges. I understand the idea that it is better to "put out the fire" rather than "blow the smoke away", but don't you first have to "see where the fire is?" My "behaviorist-within" reminds me of the power of shaping procedures (helping a person to gradually and systematically reach their goals).Dr. Stein: We do not ignore the client's request for help with symptoms. First, however, we should determine if the symptom has an organic cause, by suggesting a medical checkup. (For example, anxiety may be related to a thyroid problem.) We can then proceed to check for a psychological influence. After responding empathically to the clients distress, we usually try to find out the genesis of their symptoms: when they started, and what was happening at the time. Generally, symptoms begin when an individual is not prepared to meet a life task, and begins to feel the shock of his anticipated failure. Sensitive or inferior may organs reflect the increased psychological vibration of acute or chronic negative feelings and emotions. Often, we can trace the prototype of an adult's symptoms back to childhood (i.e., the use of crying to secure attention and sympathy).
Clients are often ambivalent about giving up their symptoms. On one hand, they may be suffering more intensely compared to a previously tolerable level of distress (the benefits of the symptom are no longer worth the price); on the other hand, if they give up the symptomn entirely, they may feel obligated to face a challenge that they are not prepared to meet. The trap, for the therapist, could be focusing on managing or reducing the symptom to the exclusion of addressing the challenging task or responsibility. It is not too difficult for a client to invent and declare war with two sides of himself, wage a heroic "side-show" battle with a symptom that he has created, and emerge an exhausted warrior who has no energy left for the events in the main arena of life (work, love, friendship).
Alfred Adler expressed the purpose of symptoms succinctly:
The neurotic symptom has to fulfil three very important functions: It has to serve as an alibi for failing to accomplish what would bring about the craved triumph. It makes it possible to postpone decisions. It permits greater expectation of appreciation for smaller achievements, as these had to be worked against the impediment of suffering.
Lydia Sicher also offered useful insights:
The moment that an individual approaches his problems with the feeling that, "If it were not for my symptom I could do this or that," the purpose of the symptom is quite evident. The symptom itself may affect the body (functional neuroses) and lead through chronic abuse of the organ to real diseases. Or it can lie in the field of thinking, expressing itself in doubts, scruples, fears (obsessions), in the realm of feeling with emotional outbreaks in anger, self-pity, despair, (moods). Or it can be in the sphere of action as raptus, fugues, rituals (compulsions).
Whatever the symptom, it always proves that there is fire burning under the surface of which the visible smoke is the symptom. The problem that the individual fears to face can often be unveiled with the question, "What would you do, if you did not suffer from this trouble?" The answer mostly indicates which situation in the individual's life is menacing his self esteem, or at least so in his own estimation.
If the individual would produce his symptoms voluntarily, he would not be neurotic but a swindler. But he does not know about the deep inner fight that is going on within himself although the faulty attitudes are constantly trained in apperception, dreams, memories.
A cure of the symptom alone without the treatment of the whole person will be necessarily unsatisfactory and mostly bring relief for some (limited) time only.
Medication can sometimes reduce a disabling symptom sufficiently for therapy to proceed; however, it may also mask a problem and reduce the incentive to discover and dissolve the root of the problem. Reducing the client's distress is often a priority, but some level of that distress can be used to promote a change in behavior and attitude. We must also consider the negative impact of the client's behavior on others.
Unless the therapist eventually perceives the purpose of the symptom, the reduction of one symptom may lead to the creation of another one. (Adler suggested that either manic or depressive behavior could be used for the same purpose of annoying people.) I had one client who studied psychology texts and developed a remarkable sequence of symptoms. He was intent on proving that no therapist would be able to cure him. (He had already "defeated" several therapists.) As soon as one symptom seemed to subside, a new one would emerge. When I told him that I didn't think that I could do anything directly to eliminate his series of symptoms, but that I could teach him some new ones, he looked quite surpised and started laughing. He eventually recognized that his symptoms were weapons in his "war against the world."
Comment: If I understand the idea: The symptom may be a clue that is important in its own right. It is the context or meaning the person gives to the symptom that is most important. The symptom is not what drove the person to treatment (even though they suffer from it). What dives the person to treatment is their difficulty with social reality and its requirements and demands. The symptom could be a "creative fiction" to mask the conflict with social reality. It is the non-acceptance of social reality that leads the person to create a mistaken style of living. When the person begins to understand the purpose of their fictional goal they can begin to re-adjust their course.Dr. Stein: You're basically on the right track, but let me add some clarifications. The client does not actually give meaning to a symptom in a conscious, cognitive sense; the meaning is implied in the purpose of the symtom, which is conveniently kept out of consciousness. What drives a client into therapy may be a felt difficulty with a life task, but it may also be the intolerable discomfort of the symptom, or even the pressure of a family member. Understanding one's fictional final goal is not enough to influence a person to readjust his direction in life. We must also reduce his inferiority feeling, build his courage and confidence, increase his feeling of community, and help him conclude (through Socratic questioning) that a new direction would lead to a happier life. It is difficult to convince a person to give up his symptoms, if there are too many perceieved benefits that are achieved at modest emotional or physical cost.
Significant change takes more than insight; it requires intellectual, emotional, and social risk-taking experiments that slowly build a climate of persistent, creative problem-solving that leads to new successes.
Question from Forum: I am a practicing cognitive therapist (now an Adlerian oriented cognitive therapist). In a recent list of cognitive therapists there is a discussion about the treatment of trauma victims using techniques such as prolonged exposure, EMDR and cognitive processing therapy. The focus of each of these modalities is to have the person re-experience the traumatic memories under safe (and guided) conditions. By the therapist taking on the role of "avoidance buster" it is assumed that the traumatic memory will lose its "sting" and the person can integrate the traumatic experience and move on. Of course, as with the cognitive model in general, there are numerous studies supporting this approach. My problem with the approach is that the implementation of these procedures would require a client who is extraordinarily courageous or desperate for relief. I am not saying that these procedures are ineffective but that they are not likely to be beneficial for all clients. I am not so sure they are for all therapists (even when suitably trained) either.Dr. Stein: In Classical Adlerian treatment of an "incapacity due to trauma", an important factor to consider would be the style of life that was established before the trauma took place. How the individual experiences, digests, and deals with the painful event, is strongly influenced by his pre-existing fictional final goal. Knowledge of this mental structure, would offer the therapist a clue regarding the tendency of that client to cooperate with treatment, or exploit the "trauma" as an excuse for avoiding a challenge that would "threaten" the fictional goal.
My question is how would a classical Adlerian approach someone who has been traumatized and has become incapacitated from their recollections of the experience?
If the therapist is able to offer deep empathy and understanding that invites the client to share the burden of the remembered experience, a full, cathartic, emotional expression may be elicited. Healing can gradually take place by exploring alternative, imagined scenarios of justice, forgiveness, or other "resolutions" that might provide closure for the client. If the client genuinely wants to overcome the chronic, painful, and disabling recollections, and return to normal functioning, he would need to cooperate with the therapist by intellectually and emotionally accepting one of the co-invented resolutions.
A client who has been exploiting a trauma for attention, sympathy, support, or as an excuse for avoiding responsibility, may resist any therapeutic intervention, and feel a secret victory over that therapist's inability to diminish their continuing anguish.
Some of the best clues to the style of life (that existed prior to the trauma) are usually embedded in the client's earliest childhood recollections. The issue of courage is intimately connected to the vision of the world that is represented in those memories. If a client has a devastating, negative world view, one that would take a heroic degree of courage to survive, we probably would have to alter that client's world view in order to generate a normal level of courage for daily living.
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