Counseling for Alcohol Use Disorder

Adlerian and Rogerian Approaches

Jeffrey A. Ahonen

Counseling for Alcohol Use Disorder • Alcohol use disorder is a common mental disorder in the United States Adult men -- 12.4% Adult women -- 4.9% Children (12-17) -- 4.6% Seniors (65+) -- 1.5% (APA, 2013, p. 493)

• Certain mental disorders are frequently comorbid with alcohol use disorder Bipolar disorder Antisocial personality disorder Anxiety disorders Depressive disorders (APA, 2013, pp. 496-497)

Every mental health counselor might expect to encounter a client who presents with symptoms of alcohol use disorder

Counseling for Alcohol Use Disorder • Sharf’s (2016) survey of major counseling theories illustrates the use of

techniques from a range of theoretical orientations for treating alcohol use disorder

Cognitive therapy (Sharf, 2016, pp. 413-415) Existential therapy (Sharf, 2016, pp. 194-195) Gestalt therapy (Sharf, 2016, pp. 274-275) Rational-emotive behavioral therapy (Sharf, 2016, pp. 369-370) Reality therapy (Sharf, 2016, pp. 460-461)

As a supplement to this textbook material, this presentation considersthe approaches of Adlerian therapy and Rogerian therapy

Adlerian Therapy• Alfred Adler believed that personality is formed through social interaction with

family and community members (Sharf, 2016, p. 7).

• The style of life is directed toward “becoming” a better person, by overcoming inferiority from earlier life and achieving mastery (Sharf, 2016, p. 129).

• The lifestyle also strives for development of the social interest, in which the person’s attitudes and interests are oriented toward advancing not merely the self, but the whole of the society (Sharf, 2016, p. 130).

• Adlerians’ dual emphases on the individual as a whole person and on the individual’s interconnection with his society view the individual as a creative and goal-directed individual who is responsible for his own fate (Sharf, 2016, pp. 128-129).

Adlerian Therapy – Alcohol Use Disorder Conceptualization• In the classic Adlerian conception, alcohol use disorder arises from a

perceived inferiority within the person, experienced as sense of incompleteness and lack of fulfillment. The person’s drive to create impels him to strive toward that which he believes brings about completion and fulfillment (Pienkowski, n.d., “Inferiority Feeling”).

• This striving, which may start with a superiority complex featuring a longing for power, seeks out an “illusion of significance” in order to overcome the inferiority feeling, rather than striving for genuine significance (Pienkowski, n.d., “Striving for Significance”).

• At this point, the person suffering the disorder has a very narrow view of community, which is quite self-centered and does not extend far beyond the self (Pienkowski, n.d., “Feeling of Community”).

Adlerian Therapy – Alcohol Use Disorder Conceptualization• Further, the addicted person’s view of the final goal is vain and unrealistic,

and he is guided toward achieving an unreachable goal without the requisite work and pain (Pienkowski, n.d., “Fictional Final Goal”).

• The afflicted person’s style of life typically is self-indulgent, and features all-or-nothing thought patterns that lead to avoidance of personal responsibility (Pienkowski, n.d., “Style of Life”).

• This person’s view of the self and the world limits the ability to make realistic judgments, while simultaneously directing motivation toward the fictional final goal and maladaptive style of life (Pienkowski, n.d., “Antithetical Scheme of Apperception”).

Adlerian Therapy – Alcohol Use Disorder Conceptualization• The person’s maladaptive lifestyle affects organic functions within the body,

since these are dominated by the style of life (Pienkowski, n.d., “Organ Inferiority”).

• Similar to a child’s need to develop a feeling of security, the addict develops a scheme for rigidly classifying self, others, and experiences in response to a feeling of entitlement that justifies the addictive behavior (Pienkowski, n.d., “Private Logic”).

• Social interest – the capacity for generating cooperation and interconnections with others – is limited by the lack of the addict’s contribution to society (Pienkowski, n.d., “Cooperation/Social Interest”).

Adlerian Therapy – Alcohol Use Disorder Treatment• The therapeutic task begins with the identification of the client’s specific

inferiority feeling and guidance toward recognizing and conquering it (Pienkowski, n.d., “Inferiority Feeling”).

• To address the “illusion of significance,” the therapist works with the client to find a genuine significance to overcome the inferiority feeling (Pienkowski, n.d., “Striving for Significance”).

• The self-centered and narrow view of community is expanded to extend the feeling of community to encompass everyone (Pienkowski, n.d., “Feeling of Community”).

Adlerian Therapy – Alcohol Use Disorder Treatment• The view of the final goal is lowered to a realistic, achievable level.

(Pienkowski, n.d., “Fictional Final Goal”).

• The therapist works with the client to displace the present style of life with one featuring self-discipline and acceptance of responsibility (Pienkowski, n.d., “Style of Life”).

• The person’s “black-or-white” pattern or perception is transformed as the client is taught to perceive “greyness” and nuance (Pienkowski, n.d., “Antithetical Scheme of Apperception”).

Adlerian Therapy – Alcohol Use Disorder Treatment• Organic inferiorities within the body are addressed through abstinence from

alcohol, together with improvements in diet and exercise regimens (Pienkowski, n.d., “Organ Inferiority”).

• Feelings of self-entitlement are replaced through the development of a sense of obligation toward others (Pienkowski, n.d., “Private Logic”).

• The final therapeutic goal is the development of an unlimited, unconditional social interest, manifested in the client’s believing and acting that his sobriety is not only in his best interest, but in the best interest of society at large (Pienkowski, n.d., “Cooperation/Social Interest”).

Rogerian Therapy• The Rogerian approach, also called Person-Centered Therapy, eschews

diagnosing patients and dispensing advice to them; instead, it advocates unconditional acceptance of the client and an atmosphere of trust in which the client is given responsibility for making positive change in his life (Sharf, 2016, pp. 7-8).

• The core of Rogerian therapy is the implementation of the six necessary and sufficient conditions for bringing about personality or psychotherapeutic change, developed by Rogers (1957), who opined that change would occur in the client of all six of the following conditions were met (Sharf, 2016).

Rogerian Therapy 1 Psychological contact – The counselor and client are capable of having a therapeutic impact on each other (Sharf, 2016, p. 219).

2 Incongruence – The client’s perception of himself and his actual psychological experience are not in harmony, the awareness of which opens the client to the therapeutic experience (Sharf, 2016, p. 219).

3 Congruence/Genuineness – The therapist’s perception of himself and his actual psychological experience are in harmony, and the therapist is able to be empathic and to communicate that to the client with real feelings and attitudes toward the client in play (Sharf, 2016, pp. 219-220).

Rogerian Therapy 4 Unconditional positive regard or acceptance – The therapist must have no conditions for acceptance of the client, accepting and appreciating the client as he presently is, with positive regard (Sharf, 2016, pp. 220-221).

5 Empathy – The therapist is able to enter into another person’s life and world without the influences of his own viewpoints and values, yet maintain the separation between the selves of therapist and client (Sharf, 2016, p. 222).

6 Perception of empathy and acceptance – It is important for the therapist not only to unconditionally accept and empathically understand the client, but also to communicate clearly to the client that she is understood and accepted (Sharf, 2016, pp, 222-223).

Rogerian Therapy – Alcohol Use Disorder Conceptualization• In Rogerian therapy, a client presenting with symptoms of alcohol use

disorder would not be diagnosed as such (Sharf, 2016, p. 218).

• For the Rogerian therapist, assessment of the client and his condition occurs as the therapist empathically understands the experience and needs of the client (Sharf, 2016, p. 218).

• This takes place in a nondirective way, which Rogers considered very important to the therapeutic process, with the therapist reflecting on the client’s experiences rather than asking questions or making suggestions (Sharf, 2016, p. 219).

Rogerian Therapy – Alcohol Use Disorder Treatment• Rogers (1961) identifies several stages of a client’s therapeutic progress,

ranging on a spectrum from closed, not self-aware, not open to experience, open to experience, self-aware, and positive self-regard (Sharf, 2016, pp. 225-226).

• Patients often proceed at different rates on different issues, being quite open to some and less open to others (Sharf, 2016, p. 226). Individuals at the beginning stages of openness to change are unlikely to express feelings or take responsibility for them; at advanced stages, they are able to experience and express feelings to the therapist (Sharf, 2016, p. 226). Throughout the process, clients grow more congruent, that is, more aware of their own feelings (Sharf, 2016, p. 226).

Rogerian Therapy – Alcohol Use Disorder Treatment• With progress in therapy, addicts come to understand how they have

contributed to their own problems and ought not to blame others for them (Sharf, 2016, p. 226). Experiencing genuineness, acceptance, and empathy from the counselor leads to changes in how the client relates to others (Sharf, 2016, p. 226).

• As the addiction client progresses, he approaches Rogers’s conception of the fully functioning person, able to share openly his shame, fears, and anxieties in the presence of the therapist (Sharf, 2016, p. 226). He learns to trust his own experience, feel a sense of richness in his life, become physiologically more relaxed, and experience life more fully – free of the bottle (Sharf, 2016, p. 226).

Personal Reflection

Adlerian Therapy

• I find great affinity with Adlerian therapy for its holistic interpersonal and sociological approach to therapy. As a pastor, I resonate particularly with Adler’s emphasis on the individual’s contribution to family, community, and society (Sharf, 2016, p. 7). The Adlerian practical and educational approach to therapy, in which the client is helped to root out dysfunctional thoughts and to adopt better behaviors, also is congruous with my approach to ministry. Furthermore, it works for substance use disorder therapy, in a way in which I find myself very comfortable and competent.

Personal Relfection

Rogerian Therapy

• The Rogerian orientation fits my personal and professional approach to people, unconditionally accepting each one with positive regard for all (Sharf, 2016, pp. 7-8). I also appreciate the emphasis on the client‘s responsibility for directing the therapeutic process in the way that mirrors his own progress and on the client’s responsibility for making positive changes (Sharf, 2016, pp. 7-8). I have become quite familiar with the six necessary and sufficient conditions for bringing about positive change (Rogers, 1957), and believe that I could become very comfortable and very adept at using them to help a client through the change process, especially in the context of a substance use disorder.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Pienkowski, D. (n.d.). Substance abuse from a classic Adlerian perspective. Retrieved from http://www.adlerian.us/aa-1.htm

Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.

Sharf, R. S. (2016). Theories of psychotherapy and counseling: Cases and counseling (6th ed.). Boston, MA: Cengage Learning.