The Case of Sally with Adlerian Therapy
Sally’s predominant reason for coming to counseling is to alleviate a number of somatic complaints such as panic, anxiety, and possibly depression. Her physical symptoms have included: hot flashes, cold sweats, shortness of breath, tremors, fainting, heart racing, fears dying of heart attack, shakes, hot flashes, and cold sweats. Although there was no stated medical causes, hot flashes could be the beginnings of peri-menopause due to her age being 39 years old and although early, hormonal changes could be contributing to her distress.
I chose an Adlerian approach because Sally needs immediate help as panic can be debilitating and frightening and an Adlerian therapist can get to the core issues quicker than could a psychoanalytic approach. I would be concerned that an existential approach could exacerbate her problems and cause her to look elsewhere for therapy. An Adlerian therapist would look beyond Sally’s symptoms to the causes which could include the following: transitioning to mid-life and her role of parenting coming to a close, dissatisfaction with her marriage, feeling stuck about actually getting a job as a teacher, and feeling overweight.
Although she takes pride in her role of homemaker, mother and wife, she is aware that she has lived for others and wants to become more motivated and assertive about her own life goals. That is, Adlerian therapy never places the counselor in a ‘superior’ position with respect to truth, or express disrespect, condescension or lack of empathy.
Sally is feeling very inferior and and needs to know that the therapist will provide the support to find encouragement and hope again. An Adlerian therapist would work to build respect, confidence, equality, and cooperation with Sally.
Sally reports a number of fear based thoughts that the therapist should take note of such as: her husband will leave her if she makes any changes in herself, she might go to hell for not believing the same dogmatic beliefs as her parents, and she is afraid of taking the initiative to work outside the home. Her reasons for most of these issues are losing the approval of her family, husband, and children.
She does not report that she has friendships or social contacts other than attending a church.
Since childhood she has always felt socially awkward, constantly being worried about what others have thought of her. Finally, she has concerns about death and dying and evidence supports that panic attacks can certainly perpetuate that notion in a client with high anxiety. It seems appropriate that Sally is questioning life right now and she does show some insight into her issues already as she previously questioned the dogmatic beliefs she was raised with enough to attend a different church than her parents.
And yet this too has caused consternation as well because of her fear of going to hell and losing parental love and approval. Even though her life is consistent and stable, she considers it boring and stale and wants help from therapy to push her out of this and yet fears that therapy could make her even worse.
According to Adler, all behavior is purposeful and for Sally to be this anxious and panicky has hidden goals. The therapist would work with Sally to help her assume responsibility for finding her life beyond her role of only a mother and wife.
An Adlerian therapist would say that Sally is unconsciously avoiding meeting life tasks. Although her problems are manifesting somatically, her issues would best be solved if viewed through a social context and life tasks: building friendships, establishing intimacy, and contributing to society. Sally has not worked through friendships, she has contributed to society by raising her children but that role is coming to a close and she has not fulfilled her task to become a teacher, and she is in a marriage but she’s not experiencing intimacy. So all three universal tasks are not developed and an Adlerian would be concerned with all three areas.
According to Corey (2009) there are four processes in Adlerian psychotherapy:
- forming a relationship
- investigating the client’s life style through assessment and interviews both subjective and objective,
- interpreting the data to the client and
- helping the client to reorient towards a more prosocial stance by modifying certain convictions held by the client that aren’t helpful and promoting courage, optimism and finding meaning in life.
Another area of focus would be Sally’s early recollections and especially her being the oldest child and how she feels affected by that. First born children tend to be rule bound, dependable, hard-working and take on a pseudo-parenting role. Because of her birth order, Sally is most likely resistant to new ideas and has a habit of being right thing oriented. Sally could talk about her feelings about being an oldest and the pressure involved.
Sally could explore how that early role of taking care of others is not necessarily the only way she has to define herself.
How can taking care of yourself help your marriage and your relationship with your children? What kind of role model does this give to your children? Is the goal of creating dependency in others really the healthiest aim? The following are some possible issues a therapist could go over in terms of Sally’s “private logic” or mistaken beliefs:
- I should adhere to my parents’ morals and rules and not my own.
- If I find out who I really am, I’ll not only find nothing or I could be worse off than before.
- I am socially awkward and weird and noone will want to be my friend.
- My purpose in life is to take care of others.
- I believe I should share my parents religious beliefs or I might go to hell or lose their approval.
- My husband will leave me if I make changes in myself, such as work outside the home.
- Life is boring and should not be fun, not even sexually fun.
- I am afraid of confrontation and not doing the right thing.
- The world is a scary place.
The goal of the second phase with Sally would be to utilize her autobiography, and the Life Style Assessment and interview which includes information regarding family constellation, early recollections, and birth order.
By utilizing a Life Style Assessment, the therapist works on modifying Sally’s mistaken attitudes, and not just eliminating symptoms. At this point the therapist can make use of what Dreikurs (1997) calls “The Question. ” The therapist would ask Sally, “If I could wave a magic wand and your symptoms would go away, how would your life be different and what would you be doing differently? ” After a relationship is established and the client has a comfort level, the counselor would discuss client goals for therapy.
Although not required in Adlerian therapy, a contract or plan would promote better focus. Sally and her therapist should begin to formulate a plan or contract detailing what she wants, how she plans to get it and what is preventing her from successfully attaining her goal, how can she change nonproductive behavior into constructive behavior, and how can she make full use of her assets in achieving her purpose. In Sally’s case there was no information offered about her dreams but an Adlerian therapist could use this as another way to interpret her issues.
Adlerians view dreams as rehearsals for possible future courses of action. There are so many different techniques that an Adlerian therapist can apply. The therapist could remind Sally and celebrate the reality that she already done the hard work of going back to school and getting a teaching degree. An Adlerian could help Sally explore her fears about stepping into the workplace and what the worst case would be. Is the fear of failure holding her back from making any attempts at all? We already know that Sally’s birth order contributed to her fear of change and fear of failure.
The therapist could also help Sally with the technique of “as if”. Sally is already acting “as if” she might not get hired or “as if” there are no new roles for her. Would her family really fall apart? Can she teach her children to be less dependent on her so they become healthy as well? It would be helpful for Sally to see that her own lack of activity is causing her more stress. She knows she wants to find herself and take some risks and what would be the worst case if she failed in her job? What would the best case look like?
Because of Sally’s case and my choice for Adlerian therapy, I researched Adler’s beliefs about women in the workplace and found he was a man ahead of his time. In Chandler’s article, she states “it is not easy in our culture for a girl to have self-confidence and courage. From an early age girls are told through various social modalities that they are incapable and are suitable for only subordinate work.
Obviously a girl who is unable to examine such judgment s for their correctness will regard female inability as woman’s inevitable fate, and will ultimately herself believe in her own inability.
Sally shared with the therapist at the start that she likes to be “in control. ” Sally could be helped to see that the only people who have difficulties with fears are those that have to be in control. We can choose to be afraid of a lot of things because so many things can go wrong. But is living in fear and paralysis really good living? According to Adler, Sally is lacking courage, the courage to take a risk which would be to interview and get a job. Sally’s symptoms could indicate her faulty belief that she has to be perfect, have love and approval and that she cannot make mistakes and fail.
Her anxiety and panic keep her immobilized from finding out that she can succeed or even that maybe she would fail but is that worse than sitting home with panic? Life changed for her because her children grew up and she can’t control that. Life is never a constant and we are better off if we change with it and find new purpose. If Sally disagrees with the client that she is in control by manifesting panic and anxiety and being immobilized then the Adlerian that would refute her rationalizations that she is “out of control” is called “spitting in the soup. ” She may still feel out of control about her anxiety but it won’t taste good.
The therapist would want to find out if Sally is afraid of getting a job because she won’t “need” her husband anymore and work with her on her new job bringing a source of joy to her that will help her marriage.
It seems that Sally’s courage was undermined by her father’s harshness and rigidity and also by her husband’s lack of promoting her efforts to work outside the home. The therapist would teach Sally that she can’t change her mind about working if she doesn’t know her own mind. It makes sense that she is not working because her mom didn’t work and because she has never wanted to challenge her father and now husband.
Is Sally also holding back because she still continues to feel awkward in the presence of others like she did as a child? Also, if Sally sought her children to be her friends and now that they are growing up and leaving, this could be causing anxiety. It sounds like Sally was never really allowed to have a teenage life with a boyfriend as well as girlfriends so she missed important years for developing this aspect of her life.
If she finds that she does not get support and make friends at her job, she can always look for another job.
Or she can stay in that job and work through her friendship skills with the help of a counselor. And not everyone always has a friend at their job. Sometimes we benefit from just the work experience itself but either way, working helps us to learn more about ourselves, especially socially where Sally is lacking confidence. Another technique to be used is the paradoxical intention which would involve having Sally exaggerate her stuck thoughts and behaviors, go with their resistance, rather than against it and become aware of her behavior and her responsibility for its consequences.
A therapist would use disclosure and well-timed interpretations such as “It seems to me that……or Could it be that…….
Or this is how it appears to me. ” Sally would never be led to defend herself and she would be free to discuss and even argue with the counselor any hunches and impressions. According to Hilary Silver in her article Reflections on Alfred Adler, she states that “In turn, dignity bestows well-being: job satisfaction, a livable pace of work, creativity, meaning, and fulfillment. Dignity may be inherent in being human, but people also earn dignity through their actions.
Work is not only a way to earn a living it is also a way of being useful. ” In the reorientation phase of therapy, Sally and her therapist could consider alternative attitudes, beliefs and actions.
Hopefully, Sally will no longer be locked into the past pattern of avoiding and she feels more encourage and powerful enough to make the changes she needs. Sally will have learned that its not enough to gain insight but that we have to become action-oriented. Sally could be given some tasks and homework such as calling some school districts, and putting in some applications.
The therapist could role play the interview process with Sally to give her a comfort level. Also Sally could role-play talking with her husband and working through her perceived resistance about her working outside the home. The therapist could switch roles and be Sally and Sally could be her husband.
To sum up, Adler believed that our answers can be found by looking at life through a social context. We find our highest ideals by by incorporating such traits as caring for others, the courage to be imperfect, and contribution to the common welfare.
If Sally goes on to get a job she will see and recognize her importance in society and not just to her family. This will increase her confidence in herself and allow for more intimacy in the family, not a one down position to her husband. By learning more assertiveness in herself, she can take more risks, become more active and courageous, and less in control.
When this occurs she will lose the panic feelings and anxiety, and feel confident and positive about her new life as a teacher, as a lover and spouse, and friend to those in the community.