Adlerian Family and Couples Therapy 1

Adlerian Family and Couples Therapy1

Zivit Abramson

Tel-Aviv, Israel

1
Printed for Vilnius Congress 2008. Taken from 'The Journal of Individual Psychology', Vol.
63(4), winter 2007.
zivitabramson@hotmail.com
 Adlerian Family and Couples Therapy 2

Abstract

The author describes the points in which Adlerian Family Therapy differs from Adlerian

Individual Therapy and the ensuing differences in therapeutic technique, whilst providing

examples to illustrate these points. The "Four Phases of Therapy" as formulated and described

by Rudolf Dreikurs serve as a starting point for the above comparison. The observations and

recommendations presented in this article are based on experience gained at the Clinic for

Family and Child Therapy, at the Alfred Adler Institute of Tel Aviv, Israel, over the past 3

decades.
 Adlerian Family and Couples Therapy 3

Adlerian Family and Couples Therapy

Background:

Parent education has vastly developed in Israel ever since a small group of Rudolf

Dreikurs' students founded the Alfred Adler Institute of Tel Aviv in 1963. This development

can be attributed to the work of Achi Yotam, whom Dreikurs had asked to take upon himself to

construct a Parent Education Unit.2 Open centers took place every week, and later study groups

were added. The notion that parenting today could be an acquired skill became increasingly

popular. Still, children were seen professionally only on occasions when they and their parents

were interviewed in the open center. After a while it became clear that this method of

intervention did not suffice for some children and a lengthier, more profound connection with

the child was necessary. In other words – therapy was needed.

In the summer of 1976, during Icassi in Oberlaa, Vienna, my teachers, Mika Katz, Judith

Elul and Achi Yotam, assigned me the task of adding a child guidance clinic to the Institute. It

became apparent to me that in contrast to what I have been taught as a child clinical

psychologist, this was not to be another clinic where children would be diagnosed and treated as

a separate unit. As an Adlerian psychologist, two basic assumptions stood before my eyes:

1. Man is a social being. No thought, feeling or act can be understood without its

social context.

2. Everything (thoughts, feelings and behavior) is goal-directed, and everything has

an “address” in the social arena written on it.

Thus, it became clear to me, that in order to understand children and to influence their

behavior, one needed to see them in the context of their relations with their significant others.

2
This unit is commonly referred to in Israel as the “School for Parents”.
 Adlerian Family and Couples Therapy 4

Parents and siblings are the most significant and are also usually available for therapy. Broader

social circles such as teachers, youth leaders and peers are significant as well but are usually not

available for therapy.

The study groups too did not always prove themselves to be adequate. One of Achi Yotam’s

guiding principles was that when a mother in a study group told the group leader: “I understand

what you are saying and I agree, but I can’t do it,” it indicated the need to move on to the next

stage, therapy.3 This saying was interpreted that the mother's private goal unknowingly led her

to behave in a way that contradicts the rational goal of doing the best for her child and for the

family.

We introduced a two-stage program. The first stage, the "school for parents" was suitable

for everyone. The second stage was conducted in the clinic in which interrelations between

private goals of all family members were also investigated. In other words, the clinic gradually

became a Family Therapy clinic.

In the following years, the structure and techniques of our work were developed.

Meanwhile, Family Therapy became an increasingly popular concept in Israel and its application

spread quickly. More and more professionals became interested in it until eventually, if one

wanted to practice family therapy, one had to be a certified family therapist. We then decided at

the Adler institute to open a training program where clinicians could specialize in Adlerian

Family Therapy. Today, both the Child and Family Therapy Clinic, as well as the training

program are fully active.

Adlerian Family Therapy

In contrast to the Hebrew version of the training program textbook, this current paper is written

under the assumption that the reader is familiar both with Adlerian theory and Adlerian
3
At the beginning it was almost only mothers who participated in study groups.
 Adlerian Family and Couples Therapy 5

individual therapy, it will therefore concentrate only on those points in which family therapy

differs from individual therapy.4

Intake

People who voluntarily seek individual therapy usually expect to receive treatment that

will bring about a change in them. To achieve this goal they are willing to look into their own

feelings, beliefs and actions in order to alleviate their suffering or eventually eliminate suffering

altogether. In contrast, it is a general tendency for people to begin family therapy – whether

concerning the couple or the children - with the expectation that someone else will be treated and

consequently change. This expectation should be addressed at the beginning. It should become

clear that the only change each family member is able to control, is his or her own attitudes and

behavior, and that no change will occur unless they (or at least one of them) are willing to take a

fresh look at their own contribution to the difficulties the family is experiencing.

The Therapeutic Contract

An additional difference between individual and family therapy lies in the process of

agreeing on the goal of therapy, or in other words, agreeing on a therapeutic contract.

In terms of Adlerian Psychology people seek therapy for several reasons:5

1. People who cannot achieve personal goals.

An illustrative example would be a person who strives for control but seems to have

lost it. This person would be interested in therapy in order to regain control.

2. People who achieve a fictive personal goal, but are unwilling to pay the price.

4
Unless stated otherwise, the expression Family Therapy refers also to Couples Therapy.
5
The examples given in this paper are simplified versions of situations which occur during the
course of therapy, for reasons of clarity and brevity.
 Adlerian Family and Couples Therapy 6

We see people who strive for superiority, are admired by everyone, but put so much

effort into it that they seek help due to exhaustion. In this group one may also find

those who believe that they came to therapy because they are at a crossroad, and

cannot decide which course of action they should follow, each of which has its

benefits and costs. The Adlerian therapist understands that in fact their wish is to

have the benefits of both alternatives, without paying the price for either.

3. For some individuals, undergoing therapy represents in itself a striving for their

goal. For example: a person striving for moral superiority wants to be in a position

where s/he can say: “I am doing everything I can to help the family/ to try to avoid

divorce. I am good, I am doing the right thing”.

When a family comes to therapy usually a mixed combination of these motives is

present. For example, a mother who is very strict and controlling feels lonely in her family. The

children comply with her wishes, but she complains that they do not share their personal life

with her - she does not want to pay the price for achieving her goal. The elder daughter does not

achieve her goal of being the center of attention, since her sister was born - she wants to reach

her goal through therapy. The father, who derives a sense of belonging from being a martyr,

enjoys coming to therapy and complaining about his controlling wife - in this way therapy in

itself enables him to achieve his goal.

To all of these, therapists must add their own Adlerian educational goals. 6

The therapeutic contract must then be an integration that all parties can agree on. It can

be formulated through a certain generalization such as "the family wants to reach a better

harmony, cohesiveness, better relations etc." Therapists often will suggest broadening the
6
As is described by Dreikurs (1957) in the relevant chapter entitled “Psychotherapy as
Correction of Faulty Social Values", (pp.37-47).
 Adlerian Family and Couples Therapy 7

practical goals which the clients have presented. For example they may suggest replacing the

goal that the child will do his or her schoolwork with the goal that he or she will develop into a

more responsible individual, or, may suggest that the husband will not only participate more in

house chores, but that the couple will attempt to foster a more equal sharing of responsibility

between them in all areas of life.

Resistance

The resistance in therapeutic settings seems to work almost like a mathematical formula: the

more participants in the therapeutic process, the higher the probability that someone will be

unsatisfied and show resistance.

Bearing in mind Dreikurs’ definition of resistance as “a discrepancy between the goals of

the therapist and those of the patient”(p. 7) it becomes clear that compared to individual therapy,

in family therapy the potential of any member to feel this way is much higher.

As long as there is a power contest, a rivalry or a conflict in the family, family members may

feel that improving one of the members’ self- image and understanding their motives and private

logic, or, in fact, any progress towards the achieving of someone else’s practical goals

contradicts those of another.

Resistance may arise in the other person, and this may bring about a decision to terminate

therapy in its entirety. These cases often are expressed in sentences such as “I will have to cancel

our appointment. My husband doesn’t want to continue” or “the teenager refuses to come back”.

For this reason, therapists need to be very attentive and sensitive to everybody’s feelings and

needs. They must keep an equilibrium at all times, showing each participant the same amount of

understanding. They must also help the family members gradually reach the point where there is
 Adlerian Family and Couples Therapy 8

more solidarity and friendship among them, so they understand that what is good for one is

good for the others.

Who participates?

We see no reason to insist on the participation of all family members at all times or any

time for that matter. 7 Family members can participate in large or small subgroups, or even in

singles, in different meetings. The therapist and family together decide who comes when,

according to the needs of the situation, as well as practical considerations.

It is certainly an advantage for the therapeutic process when as many members of the family as

possible participate actively.

The presence of both partners when it is couple therapy, or all the children when a child

is the Identified Patient is certainly preferable. Many of the difficulties of the partner can be

understood through becoming acquainted with the spouse, and similarly, many of those of the

child can be understood in the presence of his siblings. Therefore, we often ask those who do not

want to participate, to come even for one single session, in order to facilitate the therapeutic

process with those who come regularly, by giving us a more complete story. This is often

phrased as a request to help the therapist or the other family member(s).

Still, the belief that each family member has a great influence on the behavior of others enables

the therapist to perform “family therapy” even when only one person is present.

It is often sufficient, and certainly better than nothing, if only one family member decides to

change his/her behavior, as this change may produce a “domino effect” within the family. The

7
This is in contrast to what is practiced in System Family Therapy. See Minuchin, S. and
Fishman, C.H. (1981). Family Therapy Techniques. Cambridge and London: Harvard University
Press, (pp 6.).
 Adlerian Family and Couples Therapy 9

goals of the additional family members may slowly lose from their perceived value, especially

since nobody can fight or compete alone. The one who is making the change gives the other(s)

respect and dignity, and enables them to feel a sense of belonging. Therefore their previously

destructive behavior is no longer necessary, and they may be willing to consider and practice

new priorities.

This effect is more influential in the case of children, and most of all the very young

ones. Children collect impressions and observations and draw conclusions of their own from

whatever happens in their world, which consists mainly of their family. Therefore, changes in

the attitudes and behavior of their parents and siblings, (and even only one of them), as well as

changes in the general atmosphere of the family, (the parents change their methods of training,

which they learn in a parent education setting) will influence the children, their conclusions and

consequently their behavior and future lifestyle.

The relationship between partners usually also includes quite a strong element of

dependency. This is why each partner is a most significant factor in the decision of the other to

make a change, and in the continuity and resilience of their new learning, insights, growth and

development. In couple therapy; when both partners are present, the influence is mutual and

therefore has a double effect. But once again, one partner getting couple therapy is more than

none.

The most powerful means of a single family member who wishes to support change in

other family members is encouragement.

In the cases in which only one family member is willing to participate, s/he still has the

choice of family or couple therapy, which is different from individual therapy. In these cases the
 Adlerian Family and Couples Therapy 10

interaction and interrelations between the client who is present and those absent are the targets of

the therapeutic process and therefore at the center of attention.

Using Paradoxical Assignments

In addition to using this technique with individual members of the family, it can also be used for

a family as a whole. For example, the family will obey one of its members (indicated as “the

tyrant”), do everything he or she says, and only what he or she allows until the next meeting.

The Four Phases of Therapy

In his book “Psychodynamics, Psychotherapy and Counseling,” Dreikurs (1957) describes four

components of therapy that serve as the basis for the present comparison.

Phase One: Relationship

Dreikurs states that it is absolutely necessary to create “a relationship of mutual trust and

respect” (p. 7) with the patient. In the case of Family Therapy this can become a complex task

for two reasons. First, people who come for individual therapy most often initiated the therapy

themselves. In Family Therapy it is quite often the case that while one family member initiated

the decision of going for therapy, the others came with less enthusiasm or even full of anger and

hostility, feeling that they have been forced to join.

Naturally it is one thing to create a positive, trustful relationship with clients who have

come of their own accord, not to mention that the individual is often the one who chooses the

specific therapist, and another thing to make a connection with a child who was nearly forced to

come, or a spouse who is antagonistic to psychology, and only came because the partner

threatened with divorce.

 Adlerian Family and Couples Therapy 11

In the latter case, it is the task of the therapist to gain the person’s trust, to create

motivation where it is absent. Therapists must show the resisting persons that in contrast to what

they might expect, the therapy will be beneficial for them, and not only for the persons who

came to “complain” about them. For this, the therapist must first discover what it is that bothers

them so he or she will be able to make them realize that their private logic will also be heard and

that their point of view will also be understood and respected.

An additional difficulty arises when family members arrive with conflicting or totally

different wishes. Satisfying the wishes of one can be at the risk of alienating the other, if the

therapist is not careful. A typical example of such a situation is an angry parent who brings a

rebelling and very angry adolescent. The slightest understanding the therapist shows towards one

of them may cause total mistrust on the part of the other. In such cases it may require adding a

second therapist to the therapeutic process, or meeting with some family members separately,

until a combined meeting seems advisable.

An additional problem which might arise is that many people seek family therapy with

the image in their minds that they are going to a kind of court, where there is a judge who will

determine who is right and who is wrong, in which case of course there are clear winners and

losers. Again, one of the first missions of the therapist is therefore to clarify the essential

difference between going to court and committing oneself to therapy. This is already part of the

educational-therapeutic process the family is going through.

In his book Dreikurs states that "winning the patient’s cooperation for the common task is a

prerequisite for any therapy […] the process of maintaining a cooperative relationship is part of

an educational process" (p.7).

 Adlerian Family and Couples Therapy 12

In family therapy one strives to achieve an atmosphere of a cooperative relationship not only

between the family members and the therapist, but also amongst the different family members .

A cooperative relationship solely with the therapist would signal a failure. A more important

goal of the therapist is to create a cooperative atmosphere amongst the family members

themselves.

Phase Two: The Psychological Investigation

Dreikurs wrote:

“To know the premises on which the patient operates his life style…and to understand

the present area of his field of operation, which will explain his difficulties…" (p.8)

This is the task of the therapist in this phase.

What is being investigated? In addition to the task mentioned above, in family therapy the

therapist also wants to find out about the interactions between life- styles, beliefs, goals and

behaviors of the different family members. We want to know which goals are compatible (e.g., a

wish to have everything one wants happen his or her way and a wish to please) and which goals

contradict others (e.g., two persons who seek superiority in terms of knowing better or suffering

more). Also, we need to know who pays the price for the family members’ goals. For example,

the parents who stay home and never go out are the ones who pay the price for the child’s fears,

the price for the child’s goal to have them under his or her control. If they do not give in and

decide to go out anyway, leaving the child alone and terrified, then the child pays the price. A

second example would be if a person is extremely compulsive about cleanliness and order, then

it would be the other family members paying the price through taking extra care all the time to

put everything in its place. If it is the same individual who is doing all the cleaning and
 Adlerian Family and Couples Therapy 13

rearranging, then s/he is the one who pays a high price for their own ambition. Those who pay

the price themselves obviously also gain something, and this gain should be clarified.

In summary, the investigation in family therapy is aimed at finding the answers to the

following questions:

What is the goal of each family member? Which family members succeed in reaching

their goal and which ones do not? Which family member frustrates other family members?

What are the cost and benefit in achieving these goals, and who pays the price for achieving

them?

In addition, Dreikurs says that the therapist must investigate and understand “the present

area of the patient’s field of operation” (p.8). This end is clearly much easier obtained when the

patient’s field of operation is right there in the therapy room.

Investigation in Couples Therapy Achi Yotam frequently reminded his students how Dreikurs

used to say: “Don’t beat around the bush”. This was probably the reason we – Achi Yotam’s

pupils - in Israel tend to concentrate on pinpointing the issue as soon as possible. Following

along these lines, in an analysis of difficulties in couples’ lives we concentrate on a number of

central concepts. First, we want to know the original “marriage contract”, 8 by this we mean the

agreement that is partly unknown to them, partly implicit and partly explicit, which the couple

had made when they were first drawn to each other, and decided to make a commitment to be

together. The assumption is that when they met, in addition to sociological screening, each

partner sensed that the other would enable him or her to attain their goal, to live according to

their life style.9

8
The term “marriage contract” does not exclusively refer to married couples, and is used to
denote a committed relationship between two partners.
 Adlerian Family and Couples Therapy 14

Another crucial question concerns the level of equality between the partners, in terms of

responsibility for themselves and the others, patterns of decision -making, giving and receiving

support, warmth, encouragement, understanding and love.

A third issue we are interested in is the level of Social Interest in the relationship. It is

called here –and is almost equivalent to - “capability of partnership”. 10 The therapeutic

investigation aims at finding out how much of it the partners have.

Having established the “marriage contract”, we attempt to clarify what was it that led to

the point in which the contract no longer functioned.

There could be several reasons to this:

1. Refusal to pay the price: In this case one or both of the partners discovered the

metaphorical “price tag” attached to the qualities for which they had chosen the

other, and they have difficulties accepting this. As Dreikurs wrote, “[t]he

complaints which anyone voices against his mate indicate exactly the qualities

which stimulated attraction and love before marriage.” 11 This can be illustrated

by a number of examples. At the beginning of the relationship, the husband

needed the wife to fulfill the role of “the little wife”, to have no knowledge of the

outside world, so that he could maintain his sense of superiority at minimum

effort. Gradually, however he finds himself asking: “But why can’t she take

responsibility and spend a little less money when our situation is not good, and
9
The process of creating the “marriage contract”, its development, the difficulties that may
appear and ways to approach them according to Adlerian principles are described and illustrated
by examples, in a book published by the author of this article. Abramson, Z. (2004) Lomdim
Zugiyut [Learning Couples] Tel Aviv: Modan.
10
This is a concept developed in Abramson, Z. (2004).
11
Dreikurs, R. (1962). The Challenge of Marriage. New York: Duell, Sloan and Pearce, p 80.
 Adlerian Family and Couples Therapy 15

why can’t I count on her to help us get through these hard times? I feel alone. I

don’t have a partner”. This sentiment is justified inasmuch as there was no

equality and little “Partnership Capability”, right from the beginning, on both

sides. A second example would be a domineering woman who needed her partner

to be passive and compliant, and now complains that “He never initiates anything.

I asked him a hundred times to surprise me with something nice to show me he

cares about me, but nothing!”

2.Unparallel growth and development of one of the partners. A typical case of this

kind would be the same “little wife” from the previous paragraph who slowly

“grows up”.12 As a result, she no longer gives her partner the sense of superiority

she gave him when they had met and she was holding a non-demanding low-

paying job. She now studies, or has found an employment in which she is

appreciated and slowly gains more knowledge and experience, and consequently

is more self-assured. Her partner no longer seems so smart to her any more. The

investigation in such a case must also find out whether the partner is willing to

grow up, too, and to accept an equal as a wife.

3.Changes of life situation. Sometimes, when circumstances of life change, it

becomes clear that a partnership, which does not have two responsible adults in it,

is based on inequality and inadequate “partner capability,” cannot cope with life

tasks satisfactorily when these become more complex and demanding. A young

couple with hardly any responsibilities can get along with almost any kind of

contract. For example, a contract according to which he is creative, interesting,

12
Because modern society is still undergoing a transitional period from clear superiority of men -
towards gender equality, a great number of couples go through this process together.
 Adlerian Family and Couples Therapy 16

surprises her all the time, and makes her feel like a princess, but on the other hand

is totally impractical, may still hold somehow when the couple has one child.

Often the wife can still manage if she is an efficient hard-working person. But

once there is a second child, this contract can no longer function. The wife can no

longer accept the husband’s refusal to help care for the children, and the husband,

on his part, is unwilling to do so, since he feels it was not part of his contract.

How is the Investigation Done? Most of the tools and sources we have for performing this

investigation in individual therapy are used in a similar fashion in family therapy. The principle

of holism enables us to draw conclusions or at least make educated guesses on the basis of the

following:

1. Observation of verbal and nonverbal behavior and communication beginning with

the telephone call to make an appointment and continuing in the therapy room.

2. Content of information given by the family

3. Feelings of the therapist in response to various family members. Knowing his/her

own lifestyle, considering his sensitivities concerning children, men and women,

the therapist can use his/her reactions to make tentative assumptions.

4. Patterns of behavior that are known to have a high probability of being connected

with certain types of life style.

5. Behavioral assignments given to the family as a whole, can serve as an excellent

diagnostic tool when they are not performed as agreed upon. This occurs

although these assignments were discussed and agreed upon by the therapist

together with the active involvement and cooperation of all the family members.

One can derive important clues for the investigation by knowing when, how and
 Adlerian Family and Couples Therapy 17

through whose actions the plan was sabotaged. Statements such as “I had totally

forgotten”, “we were too tired”, “we were simply too busy”, or “I didn’t believe

she was actually going to make time for us and there was a lot to do at the office,

so I did not bother to come home early”, enable a better understanding of the

family dynamics. Whenever these things happen there is a hidden goal to be

revealed. Pinpointing the mistakes and obstacles that caused the failure of the

assignment helps us understand the dynamics of the family and enable us to draw

tentative conclusions.

6. The confirmation or negation of the therapist’s guesses is an important tool in the

investigation. In individual therapy, we use a Recognition Reflex for children,

and for adults a short spontaneous laughter or a reaction of “Doesn’t everybody?”

In family therapy we have an additional useful source of confirmation, namely

the other family members. It happens very often that a suggestion made by the

therapist is rejected by the patient to whom it is addressed, while enthusiastically

confirmed by his or her partner who also brings in information to prove the

point., A dialogue between therapist and family could be similar to the following:

Therapist: “Could it be that you get extremely impatient at the moment things

don’t go exactly your way?” Patient: “That is not the case”. His wife: “Oh, yeah,

that is exactly him!” Or: “Could it be, that in your family of origin whatever you

said was given a lot of attention and taken very seriously?” Patient: (shaking his

head in rejection); Wife (not letting him answer): “It is still like that. His mother

and his sister, they treat his words like they were God’s words”. In such cases the

therapist knows that their guesses were probably true, but the way they were
 Adlerian Family and Couples Therapy 18

expressed was unacceptable for the patient because accepting them at this point in

time would have disturbed his self- image and perturbed his goals.

7. The marriage contract is elicited by three questions, 13 or can be clearly observed

from the sources of investigation listed above.

The two final tools in the investigation are techniques commonly used in individual

therapy, but are infrequently used in family and couple therapy .

8. A full lifestyle analysis and the use of early recollections of some or all of the

participating family members.

9. Dreams and fantasy as sources of investigation are used less in family therapy

than in individual therapy, since people have a lesser tendency to share them,

especially when their children are present. In the presence of only their spouses

they might be more willing.

Phase Three: Interpretation

Investigation and interpretation take place simultaneously, as it is with individual

therapy. Interpretation is suggested in every session, whether only part(s) of the family or the

family/couple as a whole is/are present. Clients learn about their individual goals, how they fit

together, or fitted in the past. For couples, goals are discussed in terms of when the partners met
13
The three questions used to elicit the psychological marriage contract can be schematically
presented as: 1. What is it that bothers you most about your partner now? 2. When you first saw
your partner, what did you see? 3. How did you reach the decision to make a commitment or to
get married?
 Adlerian Family and Couples Therapy 19

and created their couple contract, and in what ways they clash and cause conflict in the present.

Partners slowly understand the manner in which the way they act in order to enhance or guard

their own self-esteem puts down the other, since the other’s conditions for self-esteem are

attacked.

Interpretation in family therapy often corresponds to the second point of Dreikurs’ four

points of conflict resolution, namely, the pinpointing of the real issue which is at the core of the

family conflict.14

Interpretations that are given to a certain family member in front of the other(s) help them

understand the way the same individual interprets the family interactions, as well as the

individual’s needs and behavior. Having learned this, the family can better encourage this

individual, if and when it is congruent with their goals. If it is not so, if their goal is to win a

competition and guard an upper position, they may use the information to further put him down.

Therefore, until some work has been done to address basic mistakes and attitudes, the therapist

must be careful about giving interpretations to one person in front of others.

Yet giving interpretations in front of others can be very useful in several ways. Clients

realize that behavior they interpreted as an act that is meant to hurt them is the other’s way of

trying to establish his/her place among them and to be accepted and appreciated. For example,

the mother learns that her son’s misbehavior is not directed against her but is done with the

purpose of making her notice and respect him, when he has despaired of winning a place in her

heart by constructive conduct. A second example would be a wife who learns that during his

childhood, her husband concluded that to win his mother’s positive regard he must at all times
14
On this point, see Dreikurs, R., Grunwald, B.B. and Pepper, F. C. (1971). Maintaining Sanity

in the Classroom:  Illustrated Teaching Techniques. New York: Harper and Row.

.
 Adlerian Family and Couples Therapy 20

please her. The wife understands that the over-generalization of this conclusion is what makes

him put so much effort into still acting in this manner not only with his mother, but also with the

neighbors…. Following this realization, this behavior no longer angers her. She also

understands how his need to please everyone at all times is exactly what drew her, a pampered

child, to him in the first place.

When individuals listen to the interpretation of other family members’ feelings and

behavior, this helps them learn how their own behavior, aimed at enhancing their self-esteem,

makes those others feel humiliated and lower their self esteem. If this is not their goal, the

person is ready to start making changes. For example, through therapy the husband can reach the

understanding that his tendency to deliver very long, clever and sophisticated explanations, were

originally meant to impress his over-ambitious mother and to show her that he is smarter than

his brother. Now, however, listening to interpretations given to his wife, he realizes that these

explanations make her feel humiliated, for she interprets them as his effort to show her how

stupid she is, a suspicion she holds anyway.

It may certainly be concluded that interpretations in family therapy serve many purposes and

often have a double and even triple effect.

Phase Four: Re – orientation

Similarly to the case in individual therapy, Adlerian family therapists do not only give

interpretations but perceive themselves also as teachers and guides. They inform the clients

about general rules of human relations and communication, which constitute prerequisites for a

more pleasant and harmonious family life (and life in general). They try to guide the family

members away from an atmosphere of competitiveness, criticism, and mutual humiliation

towards a family life based on mutual respect, equality, encouragement and cooperation.
 Adlerian Family and Couples Therapy 21

In family therapy the process becomes a kind of group learning. The “students” in the

group discuss the new ideas they have heard in therapy and remind each other to apply them.

The following is an example of the effect of a combination between interpretation and

teaching in couple therapy: One couple argued incessantly prior to commencing therapy. During

therapy they accepted the idea that in different ways, they both mistakenly believed that they

must always be declared right. In therapy, the subject of striving for prestige was discussed and

contrasted with striving for a friendship in which each partner is interested in each other’s

opinion and thoughts, and in which they can respectfully listen to each other, even if they do not

agree. During a subsequent meeting, they described how this changed their behavior, stating :

“We did start an argument this week but then we reminded each other what you said about how

it is a choice of what is more important, the relationship or being right, and we stopped the

argument. We decided we would like to have a pleasant relationship and really we do feel we are

equals.”

In order to facilitate the reeducation and learning of a different worldview, and to

introduce the theory which is the basis and rationale of their therapist’s work, our clients are

often encouraged to read relevant material and to participate in groups and courses in which

parent education, couple enrichment and/or Adlerian theory are taught. 15

Training

Following the clients' understanding of their basic mistakes and goals, as well as their

agreement to accept new values and attitudes, family members are ready for training.

15
At the Adler Institute in Tel Aviv.
 Adlerian Family and Couples Therapy 22

Here once again an advantage of family therapy becomes evident. The possibility it

provides for the development of a stable change grows with the number of family members who

participate in the therapeutic process.

Training people to make the changes they had decided on is done in a similar way as in

individual therapy, except that the assignments are also given to the family or the couple as a

whole. Suggestions for change can be simple and small, like: “instead of watching T.V on your

separate armchairs, how about doing it together on the sofa? You could maybe even put your

arms on the other’s shoulder from time to time, or do you like holding hands?” Or, the

assignment can be a complex one, like the family will go for a trip or a picnic, or the couple will

go away for a weekend. Such instructions can help families do things in a way they had not

experienced for a long time, or perhaps never before. When the time is right, such plans may

bring a very happy family back to the next session. When difficulties emerge, as was already

mentioned, details of the problems are analyzed, mistakes are corrected, and with the therapist’s

encouragement, optimism can continue. One way the therapist may encourage the family is to

say that this was exactly what s/he had expected, and that the experiences of the family were

very useful, since making mistakes is the best way to learn. Encouragement is a central factor in

the entire process.

Encouragement

Dreikurs stated that the: “Success of a therapist depends entirely on his ability to provide

encouragement” (p.13). In family therapy, the therapist encourages not only the individual

members, but also the family or couple as a whole. In addition to encouraging each person

through any possible way, the therapist emphasizes the strengths and assets of the family as a
 Adlerian Family and Couples Therapy 23

unit, and encourages each member to express his feelings about the positive sides they see in

each other, despite the difficulties. The therapist stresses the ways in which family members do

in fact answer the needs of each other, and helps the family members foster pride in the unit to

which they belong. Much reframing is done for these purposes. For example, in a dialogue

between a couple, she is mad at him for criticizing her. This can be reframed as follows: “You

seem to care a lot about what he thinks of you. That is because he is so important to you”. A

second example would be a couple in the following situation. She is angry for his coming late

from work, and he wants to skip some visits at her parents’ during weekends and stay at home.

This is reframed: “I noticed you are fighting about the wish of both of you to have more time

with each other. This indicates a positive prognosis.”

Nevertheless, in family therapy encouragement given only by the therapist is never

enough. If people who make a change, albeit small, in their behavior do not get encouragement

from the other(s), then no matter how high the encouraging skills of the therapist, the change

will gradually dwindle. For example, in the following case the mother decided to diminish the

amount of criticism she was used to giving. When arriving at the next session, she is well aware

of how often she nearly made a critical remark and refrained from doing so, but her husband

says: “I did not notice any difference”. Or: “I don’t believe this will last. She is only capable of

short term efforts but then she goes back to her real self”. Or: “Let us wait and see. I am not

going to say anything until it is totally different”. People have various reasons not to encourage

each other. The practice of saying only what is wrong is deep-seated in our culture. When there

is no encouragement; it is highly probable that the person who had decided to change will

despair. No amount of encouragement from the therapist will help in this case. The family is the

central factor in a person’s life and family members must learn mutual encouragement.
 Adlerian Family and Couples Therapy 24

Many times family members are willing to adopt the attitude of encouragement once they

understand not only that the other needs to receive it, but also that through encouragement, they

can more effectively bring about the changes they were formerly trying to effect through

scolding and criticizing.

Obviously, readiness to provide encouragement assumes that the family members have

altered the vertical striving in terms of relative prestige and success, to the horizontal goal of

cooperation and love. Encouragement in the Adlerian sense involves building a sense of

community and cooperation (horizontal striving) and not competition (vertical striving). Thus,

as a general rule, a family therapist must carefully avoid attempts at encouragement of one

family member through words that lower the self-esteem of another. (“You are right! What your

wife has done is enraging. Nobody would accept such behavior” or worse: “Your parents are

unfair to you, your outburst was perfectly understandable”).

However, there is one exception to this rule. This is in the often-encountered cases in

which all family members blame one person (adult or child) for all the problems and difficulties

of the family, believing that the family would have been perfect without this person. In these

cases, usually referred to as cases of a “scapegoat”, the identified patient expects the therapist to

join the others by telling him/her how bad his/her behavior is. This is of course the last thing the

therapist wants to do with such a discouraged person. On the contrary, in such cases, it is

necessary that the therapist show understanding to the I.P., even if it means taking away some

of the glory from other family members. For example, the individual perceived as the family’s

“angel” may feel quite upset as a result of the therapist’s acceptance of the “bad” one, and if the

attitude of the therapist is accepted by other family members, that “angel” may experience some

deterioration of self esteem and start behaving “bad” him/her self. Such a development is
 Adlerian Family and Couples Therapy 25

interpreted by the therapist as positive, because it demonstrates the fact that the family problem

is not one “terrible” child or adult in their midst. Understanding this may help the family see that

there are some undesirable elements which characterize the family atmosphere, and can appear

through anyone of its members. It helps the family learn that the real solution is not to get rid of

or control the I.P., but rather to create an atmosphere in which every family member is accepted

and has a place.

Checking

Dreikurs states that “An examination of the patient’s function in life indicates whether

he still continues to operate in his old concepts and premises, or whether he has changed them”

(p.13). In order to achieve this examination, Family Therapy enables the therapist to use the

additional testimony of other family members. It usually becomes very clear that people often

judge themselves according to their own intentions, while judging others according to the result.

Very often people report that they have made enormous changes in everyday functioning, while

parents or spouses hardly agree.

Family members can also correct mistakes of clients who misunderstand the real

significance of the new ideas. A person who used to be domineering can, in seeking change, may

become too submissive and stop expressing wishes and preferences altogether. A person who

used to ignore his own feelings and wishes for the sake of pleasing others may suddenly exhibit

unbearable egoism. Through the reactions of other family members it becomes clear that he has

yet to learn the difference between pleasing for the sake of being accepted, and doing so out of a

caring involvement in the needs of the other i.e., the wish to make the others happy. In family

therapy such misconceptions are easily detected and corrected. This is not so in individual
 Adlerian Family and Couples Therapy 26

therapy. Often families come for couple or family therapy with the starting point of one of them

undergoing individual therapy, and while this individual feels much better, the family reports

that their conduct has now become unbearable. 16 In such cases, working with the system as a

whole is the only way to restore a balance before the damage is too extensive

Concluding Remarks

Adlerian family therapy is a powerful and effective tool for achieving change in people’s

lives.

The suffering and difficulties people experience are not intrapsychic, nor do they occur

in a vacuum. Rather, they take place in the social arena, and are expressed first and foremost in

the individual’s family life and intimate relations. Therefore, misconceptions, mistaken

interpretations, and feelings or behavior that need to be changed are best treated in the context of

the group which shares a common field with the individual on a daily basis.

It was only natural that Adlerian family therapy should evolve from individual therapy,

and indeed this occurred in Israel, as in many other Adlerian centers around the world. The

author has presented the outcome of this process, as it took place at the Adler Institute in Tel

Aviv, and demonstrated how it differs from individual therapy, as structured by Rudolf Dreikurs.

These differences were elaborated and developed both in terms of principles and techniques, in

order to provide a useful framework for practitioners.

16
In individual therapy, therapists are often not familiar with the patient’s behavior in daily life,
since they hardly ever meet him or her in situations in which his or her sense of belonging is
threatened.
 Adlerian Family and Couples Therapy 27

References

Abramson, Z. (2004) Lomdim Zugiyut [Learning Couples] Tel Aviv: Modan.

Dreikurs, R. (1962). The Challenge of Marriage. New York: Duell, Sloan and Pearce.

Dreikurs, R. (1973). Psychodynamics, Psychotherapy, and Counseling. Chicago: Alfred Adler

Institute of Chicago.

Dreikurs, R., Grunwald, B.B. and Pepper, F. C. (1971). Maintaining Sanity in the Classroom:

Illustrated Teaching Techniques. New York: Harper and Row.

Minuchin, S. and Fishman, H. C. (1981). Family Therapy Techniques. Cambridge and London:

Harvard University Press.