Adler’s Clinical Constructs

Published December 26, 2018, The NASAP Newsletter (TNN), Erik Mansager, PhD

Last time this column focused on the general therapeutic aim of Classical Adlerian Depth Psychotherapy (CADP). This time the focus is a bit more specific by looking at the application of the clinical constructs related to Adler’s comprehensive model.

These clinical constructs are not the same as the philosophical constructs of Adler’s theory: existentialism, holism, phenomenology, social embeddedness, subjectivism, teleology. Clearly, Adler steeped himself in a broad philosophical world view. He was not only among the first psychotherapists to think within this context but likely the first to think along these specific philosophical lines. Today, the philosophical constructs constitute the basis of similarity between Individual Psychology and most current therapies. But what still distinguishes Adler’s therapeutic approach from other therapies is his range of specific clinical constructs.

From studying The Collected Clinical Works of Alfred Adler (CCWAA), over 20 clinical constructs are found to be operative in fashioning and maintaining a client’s life style. Grasping them fully is a foundation for understanding the connection between theory and practice.  While Adler insisted his method of assessing the individual constituted a scientific approach (an orderly and rigorous description of the interrelation between humans and their world) he was clear that IP was not, itself, a pure example of science. Rather, his approach was a fictional construction (a system of operative guesses) about how humanity works. His creative style for understanding the individual and humanity (Menschenkentnis) demands an artistic approach, he insisted. Such artistry involves knowledge of the full-range of clinical constructs, which can be creatively applied to specific individual cases.

If we want to apply Adler’s therapeutic approach effectively, it is not necessary to prove how it matches or outperforms other approaches. We do need to better understand how constructs interact and yield such insight. It is as if we fashion, by our clinical conceptualization of the interacting constructs, a predictive field. Adler concluded that is where we find and understand our clients. It is how we most comprehensively understand the individual.

The concluding example is not an actual case and can’t convey the method of working with the constructs. Still, it offers a simplified, nonspecific description of how some of the clinical constructs (written in bold italics when first mentioned) might interact.

The clinician’s initial interest is in understanding the impact of the client’s unique inferiority feeling which provides the motive force of one’s expressive movement toward an equally unique fictional final goal. The movement expresses an imagined striving for completion. Such movement can look quite social; yet it typically involves a neurotic disposition expressed in unsocial depreciation tendencies against those in the individual’s social milieu – including the therapist. Recognizing the client’s pretended civility, or counter fiction, is required if the clinician does not want to mistake it for an expression of community feeling – and inadvertently reinforce, rather than diminish it. The actual level of one’s feeling of community determines the direction of the expressive movement – either via an approach-posture toward life on the socially useful side, or a withdrawal-posture toward the socially useless. On the useless side, the clinician will find the client involved in task avoidance (what is missing, being minimised, or what has been left out). And the “good hard work” of conceptualizing the client’s expressive movement also reveals the antithetical schema of apperception by which the client has imagined and restricted a worldview as either absolutely reassuring or absolutely threatening. The clinician will also attend to the level of activity (mental, physical, emotional activity in pursuit of the fictional final goal) within the worldview. Facility in discerning the expressive movement of the individual is the key to the client’s suffering which the clinician is committed to reduce within the cooperative therapeutic relationship.

Awareness and attention to the interaction of these (and still other) clinical constructs assure a treatment plan aimed at increasing the client’s contributive joining with others; a plan to assist in dissolving the rigid negative constructs and allow the client access to fuller potential.