Advanced Methods in Counseling & Psychotherapy July 2023.pptx

The Philosophy and Practice of Clinical Outpatient Therapy
Demetrios Peratsakis, MSEd, SDSAS, LPC, ACS, Certified Clinical Trauma Professional
Executive Director, Western Tidewater Community Services Board

DISCLAIMER
The purpose of training is to help improve one’s practice
of therapy through a deeper understanding of methods.
This material is intended to augment, not replace, the instruction and practice
expectations of one’s home agency or Community Services Board.
As such, the ideas presented herein are simply those that assist me in my work
and in my understanding of human motivation and pathology.
____________________ . ____________________

Philosophy of Psychotherapy Orientation
The ideas presented herein are consistent with a social construction or relational perspective, most notably surrounding the origin and development of psychological
symptoms. This differs markedly from the neurobiomedical which tends to view symptoms as the outward expression of some underlying condition, much like a fever
denotes the existence of an infection. The essential difference is that cognitive-behavioral, narrative, emotionally focused, and family systems theories tend to view symptoms
as intentional manifestations, complex belief structures shared by the individual and their relationship system. These are social constructivist and social constructionism
concepts as to how reality is perceived and shared (Vygotsky, 1978). Psychological problems are viewed as shared cognitive distortions, myths and legends that have
acquired purpose and contain social meaning and power. This does not negate the legitimacy of somatic or biomedical ailments, but rather examines the role and function of
their psychological counterpart and its use and purpose as a psychosocial tactic. This line of thinking adds inestimably to one’s insight on human nature and social pathology.
The Notes are provided in sections, each organized as a stand-alone training or module. This necessarily repeats several concepts which while irksome can be helpful as the
ideas are detailed and very complex. When viewed in its entirety, the material provides an integrated framework for advanced clinical practice.
Section 1, entitled Understanding Human Development, provides a general orientation to constructivist thinking. Section 2, Adlerian Psychotherapy, provides a more
granular application, illustrated further through the clinical management of four, common problem domains: Addiction (section 3), Psychosis (section 4), Paraphilia and
Sexual Dysfunction (section 5) and PTSD (section 6). Section 7 provides an overview of Couple and Family Therapy and section 8 provides a model for Team Case
Supervision. The Team Case Supervision Model is an excellent format for continuous skill development though group meetings, role play, and modeling. The last section,
marked Supplemental Materials, provides tips on strategic planning and technique.
Slide Deck FYIs
1. Several slides are heavily detailed and may require repeated study. These are marked by a “Cool Freud” sticker.
2. The term “marriage” is used to denote any committed partnership(s) although the material is applicable to all intimate relationships. While polyamory relations can be
more complex, the essential dynamics between people remain the same, even if the goals, terms and expectations of the relationships differ.
3. Similarly, “family” refers to whatever group of individuals share an enduring relations with one another, by blood, kinship or agreement, irrespective of the quality –or
length of time, of the relationship.
For additional information or study, please contact Demetrios Peratsakis at dperatsakis@wtcsb.org or at dperatsakis@gmail.com Thanks!
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I began formal studies with Dr. Robert (Bob) Sherman, who guided my work from 1980 until his retirement and relocation from New York City, in 1992.
Bob, was an AAMFT Clinical Supervisor, author, co-founder of Adlerian Family Therapy, a long-time Fellow at the North American Society of Adlerian
Psychology, and Chair of the Department of Marriage and Family Therapy (MFT) Graduate Programs at Queens College which he founded, where I
degreed in MFT, Guidance, and School Administration, and where I served as faculty in 1986 and 1987.
I joined small group instruction at the Adler Institute with Kurt Adler (1980), Bernard H. Shulman (1980), Harold Mosak (1980,1981) and Steven
Zuckerman (1982, 1983), hypnogogic induction with Martin Astor (1980), and live-practice seminars with Maurizio Andolfi (1981), Adia Shumsky (1982),
Carlos Sluski (1983), Murray Bowen (1984), James Framo (1985), Bunny Duhl (1986), Monica McGoldrick (1987), Carl Whitaker (1988), Jay Haley
(1989), Salvador Minuchin (1990, 1991), Salvador and Patricia Minuchin (1991) and Peggy Papp (1992).
In 1990, I joined Dr. Richard Belson, Director of the (Strategic) Family Therapy Institute of Long Island, in a 2-year, live-supervision practicum treating
chronic, highly intractable problems. Belson, an intimate collaborator with Jay Haley and Cloe Madanes at the Family Therapy Institute of Washington,
D.C., from 1980 to 1990, was on faculty at the Adelphi School of Social Work and serving as a senior Fellow on the editorial board of the Journal of
Strategic and Systemic Therapies (1981 to 1993).
I am indebted to these remarkable clinicians and the indelible mark they have left on our field.
I am especially grateful to Bob, for his training, encouragement, and love.
-Demetrios Peratsakis, MSEd, SDSAS, LPC, ACS, CCTP, Executive Director, Western Tidewater Community Services Board
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1. Section 1: Understanding Human Development (slide 6)
2. Section 2: Adlerian Psychotherapy (slide 70)
3. Section 3: Addiction (slide 212)
4. Section 4: Psychosis (slide 303)
5. Section 5: Paraphilia and Sexual Dysfunction (slide 375)
6. Section 6: PTSD (slide 429)
7. Section 7: Couple and Family Therapy (slide 545)
8. Section 8: Team Case Supervision (slide 603)
9. Section 9: Supplemental Materials (slide 651)
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The desire to feel belonging to others is the fundamental motive in man.
- Adlerian Psychology; Rudolf Dreikurs, 1949
The purpose of consciousness is to keep society together;
to predict, assess and effectively navigate complex social relationships.
- Social Intelligence Theory, Anthropology
What is the Purpose of Consciousness?
To understand human nature, we must first understand the purpose of conscious thought.
Consciousness increases the ability to innovate and thereby to adapt.
Human culture is the soup of innovation; socialization, the spoon.

- Adlerian Psychology; Rudolf Dreikurs, 1949
To understand human nature, we must first understand the purpose of conscious thought.
Consciousness is primary to socialization and, thereby, to the benefit of shared innovation, problem solving and adaptation.

“Here’s the problem with Maslow’s hierarchy,” explains Rutledge. “None of these needs
— starting with basic survival on up — are possible without social connection and
collaboration…. Without collaboration, there is no survival. It was not possible to defeat a
Woolley Mammoth, build a secure structure, or care for children while hunting without a
team effort. It’s more true now than then. Our reliance on each other grows as societies
became more complex, interconnected, and specialized. Connection is a prerequisite for
survival, physically and emotionally.”
“Needs are not hierarchical. Life is messier than that. Needs are, like most other things in
nature, an interactive, dynamic system, but they are anchored in our ability to make social
connections. Maslow's model needs rewiring so it matches our brains. Belongingness is
the driving force of human behavior, not a third tier activity. The system of human needs
from bottom to top, shelter, safety, sex, leadership, community, competence and trust, are
dependent on our ability to connect with others. Belonging to a community provides the
sense of security and agency that makes our brains happy and helps keep us safe.”
-“Social Networks: What Maslow Misses”. Psychology Today, November 2011;
by Pamela B. Rutledge Ph.D., M.B.A.; Director, Media Psychology Research Center.
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Maslow’s hierarchy wrongly assumes that personal
excellence is our ultimate drive. Adler’s “Superiority”, a social
striving for acceptance, may be more fitting.
It is, in fact, a means toward acceptance by others,
Love and Belonging, as social beings.
Love and Belonging, in turn, is the source of Self-esteem, Safety
and Security which, living in a social world, aides us in the
acquisition of our Psychological and Physiological Needs
Ideal or Perfection,
but for what purpose?
Acceptance?

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70 Million Years of Primate Evolution
Individuals add to the Group’s survival potential;
Groups add to the Individuals’ survival potential.

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Belongingness, has purpose: to contribute to the welfare and wellness of the community.
-this is why isolationism and avoidant behavior is contrary to mental health and the common good.
Belongingness is developed through Socialization, much of which occurs around the three
primary maturational tasks of adulting: Work, Friendship, and Love.
Socialization, involves two very specific survival processes:
1) the striving for achievement, mastery, and personal excellence (self-actualization/self-improvement); and,
2) the striving to become a part of the community in a meaningful way (acceptance).
Belongingness, requires developing and increasing one’s Empathy, the root of trust, intimacy and Social Interest.

1. Human Nature is Inherently Social -critical evolutionary advantage
 It creates social bonds and defines norms and rules for interaction and cohesion (socialization)
 It promotes social cooperation, collaboration and problem-solving through communication, language, shared imaginings, and tool making
 Culture breeds innovation, the cornerstone of our ability to adapt to our environment, meet our needs, and thrive as a community.
2. Humans are Motivated by the Need to Belong -the desire to be accepted and hold membership in a meaningful way
 It defines social norms and shapes identity, roles, rules, and functions; it reaffirms relationship bonds, the roots of being social
 It gives meaning to our actions and purpose to our lives (“humanness”).
 It defines Self-worth – our internal sense of being good enough and worthy of love and acceptance from others
 It fosters empathy and intimacy; trust and the ability to care for others, what Adler called Social Interest,
 It gives us the courage to risk failure and adversity.
3. Humans Belong through Intimacy & Socialization (Work, Friendship and Love) -attachment; contributing and cooperating
Humans must adapt to and reconcile individual and social developmental tasks across their life span. These tasks are mediums through which
we form relationships, practice intimacy, cooperate, accept responsibility and help to realize our full potential.
There are two, interconnected processes always at work:
1. Socialization, the process by which we learn to adapt and navigate the social relationships inherent in Work, Friendship and Love
This process fuels social interaction and our ability to belong. -Self-Worth (love/acceptance; sex)
2. Self-actualization, striving for personal accomplishment, mastery and excellence.
This process makes us feel valued and fuels our ability to maximize what we can contribute to the welfare and wellness of the
community. -Self-Esteem (achievement/accomplishment)
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4. Humans Actively Avoid Not Belonging (Avoid Isolation and Rejection)
 We actively avoid Blame and Shame, which adversely impact Self-Worth -our internal sense of
being good enough and worthy of love and acceptance from others. Impoverished self-worth is the root
of all psychological symptoms and problems and is directly attributable to two forms of injury:
1) Trauma - impacts Self-worth
A psychological injury or harm to one’s perceived sense of worth in relation to others, their self-
esteem or sense of self-worth. It is fueled by feelings of guilt and shame, negative estimations of Self
rooted in the opinion of others. Corresponding feelings of anger or resentment emerge -and worsen,
whenever there is a perception of injustice or critique. The ensuing Guilt, Anger and Shame (GASh)
corkscrew into repetitive cycles, called rumination, and deepen into feelings of worthlessness,
hopelessness, and unexpressed rage symptomatized as depression, inadequacy or failure.
Anger at Self and Others for failing to adequately protect.
2) Failure -impacts Self-Esteem
Failure results in feelings of guilt and shame and because it includes critique by others (real or
imagined), in anger. This increase avoidance which, in turn, helps mitigate responsibility for change
which, in turn, buffers feelings of failure and shame.
Anger at Self and Others for critique, real or imagined, of performance
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5. Trauma and Failure Diminish Self-Worth & Self-Esteem, Increasing Risk of Social Isolation.
Unresolved these injuries are cumulative, and the individual develops strategies to compensate
for the pain (depression) and to avoid further injury (avoidance behavior)
a) Impedes Healthful Maturation and Social Relationships
 Struggles with feelings of shame, inadequacy and worthlessness
 Continual need for validation from others
 Constant bouts of Guilt and Shame, which fuel depression and anxiety
 Difficulty with appropriate assertiveness; having weak and/or inflexible boundaries
 Self Concept continuously falls short of the Self Ideal
b) Hypersensitivity to Failure, Rejection, and Blame
 Problem accepting criticism and the risk of failure
 Problem with responsibility and the risk of judgement by others
c) Difficulty with Problem Solving, Risk Taking and Decision Making
d) Problem with Empathy, Intimacy and Commitment
 Co-dependency; giving up the self as a method of pleasing others
 Hypervigilance to critique and the opinion of others
 Difficulty with trust, communicating and speaking true feelings, beliefs, and needs
e) Problem with Anger & Aggression (passive-aggression)
 Misuse of Anger, Power and Control to feel superior or more worthy than others
 Passive-aggressive displays of revenge and blame to inflate false sense of vanity
f) Propensity for Self-deprecation, Depression and Anxiety
g) Propensity for Controlling Others through Symptomology and Subterfuge (revenge)
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5. Trauma and Failure Diminish Self-Worth & Self-Esteem, Increasing Risk of Social Isolation. (continued)
Unresolved these injuries are cumulative, and the individual develops strategies to compensate
for the pain (depression) and to avoid further injury (avoidance behavior)
h) Low Self-Worth/Self-Esteem creates or contributes to Interpersonal Problems
1) Attention seeking and self-serving behavior
2) Aggression, including discord, violence and passive-aggressive displays of power and control
3) Revenge (acts of rejection, punishment, betrayal, sabotage and vengeance)
4) Failure or Displays of Inadequacy
5) Spouse or Partner Discord
6) Dysfunction in One or More of the Children
7) Dysfunction in one of the Spouses or Partners
8) Extreme Triangulation or “scapegoating”
9) Emotional Cut-off , including expulsion, escape, or becoming the “black sheep”
* 1-4, Alfred Adler; 5-9, Murray Bowen
6. Interpersonal Problems is Human Pathology!!! -intrapsychic problems = interpersonal problems = intrapsychic problems
When avoidance strategies become the primary means of responding to societal norms, they become a method of subverting the
“rules” and controlling the interactions of others. These hardened patterns of conduct become what we term “pathology” or
“pathologic” and are characterized by the following methods to dominate:
1) Symptom Neurosis
2) Character Neurosis (Sociopathology/Personality Disorders)
3) Psychosis
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There is nothing
more painful -or liberating, than madness!

Trauma is a psychological injury or harm to one’s perceived sense of self, their self-esteem or sense of self-worth. It is fueled by
feelings of guilt and shame, negative estimations of Self rooted in the opinion of others. Corresponding feelings of anger and
resentment emerge -and worsen, whenever there is a perceived sense of injustice or critique. The ensuing Guilt, Anger and Shame
(GASh) corkscrew into repetitive cycles, called rumination, and deepen into feelings of worthlessness, hopelessness, and unexpressed
rage expressed as depression and anxiety. Childhood trauma is particularly toxic, as guilt and shame fuel the child’s inner sense of
inadequacy, promoting underlying feelings of helplessness and dependency long into adulthood.
Trauma events are best categorized by the nature of the injury and its accompanying preoccupation. Loss, results in sorrow and despair
with a pervasive desire to substitute or replace. Tragedy, natural and mand-made disasters or hardships, result in fear and distrust, and a
sense of foreboding or vulnerability and a preoccupation with protection and safety. Conflict, violence and victimization are
debilitating experiences generating recurring feelings of mistrust, anger and the desire for revenge. Unresolved, trauma mars the desire
to trust and to be intimate and can diminish one’s sense of competency and value. Symptoms may develop as a means to gain or re-
gain control and to stabilize and reorganize the individual and their relationship system. As such, they accumulate meaning and power,
the ability to influence outcome. Over time, the behaviors may concretize into established transactional patterns or habits that we call
symptoms. These become rigid and resistant to change, the emerging pattern fulfilling the mutual purposes of its participants and
providing a vehicle for communication and attachment.
As counselors, our main concern is when these conditions fulfill some important function or method of coping or avoiding the risk of
re-injury. In particular, we are concerned when they serve as a means of deflecting blame, controlling, perhaps even punishing, others,
or as a method of excusing or avoiding responsibility for change. – Demetrios Peratsakis, LPC, ACS
Unresolved, anxiety and trauma result in chronic tension expressed as
“physiological symptoms, emotional dysfunction, social illness or social misbehavior” (M. Bowen).

Difficulty reconciling significant life events

3. Trauma
(Failure, Tragedy, Loss, Betrayal)
1. Difficulty Adjusting to
Life Cycle Changes
2. Interpersonal Conflict
(Overt/Covert Power-Plays; Interpersonal
Violence and Acts of Betrayal)
Depression
and
Anxiety
Presenting Problems fall into one
of three categories, often triggering
one or both of the others
Presenting
Problem
Problems arise due to difficulties adjusting to significant events in one of three (3) main domains of life

3. Trauma
(Failure, Tragedy, Loss, Betrayal)
1. Difficulty Adjusting to
Life Cycle Changes
(Overt/Covert Power-Plays; Interpersonal
Violence and Acts of Betrayal)
Depression
and
Anxiety
Presenting Problems fall into one
of three categories, often triggering
one or both of the others
Presenting
Problem
Problems arise due to difficulties adjusting to significant events in one of three (3) main domains of life
Relational Perspective on Symptoms
Origination and formation of enduring patterns of
behavior, structures or syndromes that organize social
interaction, mediate stress and provide adaptive
response to change
1. Symptoms are hardened patterns of interaction, or
“structures”, around which individuals express
power and control.
2. Symptoms acquire history, as they organize social
interaction, including how roles, rules, boundaries,
expectations and functions are defined and how
love, hate, need and want are communicated and
shared; often, over generations.
3. Symptoms acquire Purpose, Meaning and Power.
*While any physical infirmity, medical condition, or brain injury (Congenital Brain Damage; Acquired Brain Injury; and Traumatic Brain Injury (TBI) can
acquire functional value, their origins are deemed non-psychological and should be ruled out as primary targets for psychotherapy. Significant change,
conflict, and trauma, require adjustment in role, function, identity and interpersonal relations which may be difficult to navigate or reconcile. Unresolved, this
invariably leads to depression and anxiety, fueled by Guilt, Anger, and Shame (GASh). Symptoms arise as a means of regaining or obtaining control.
Symptoms

Poor
Adjustmen
t to
Change
Conflict Trauma
Depressio
n &
Anxiety

Unattached
Young Adult
Newly Partnered/
Married Couple
Family with
Young Children
Family with
Adolescents
Launching
Family
Family in
Later Years
Family Life Cycle
 Differentiation of Self in Relation to the Family of Origin
 Tasks of Life:
1. Work/Career;
2. Friendship;
3. Love
 Developing the Couple
Relationship:
1. Strengthening the
Relationship Against Others;
2. Negotiating Power, Rules
and Roles;
3. Building Vulnerability, Trust
and Intimacy
 Establishing the Executive
Subsystem
1. Strengthening the Relationship
Against Others;
2. Negotiating Parenting Styles
 Sibling/Ordinal Positions:
1.Personality growth
2.Demarcation of roles
 Individuation creates transition of Power
 Preparing Child for Adulthood
 Building Parents’ careers
 Separation and Loss
 Making room for new additions
 Reaffirming/renegotiating Couple
 Retirement
 Loss of friends and loved ones
 Existential angst/death and
non-beingness
Common periods of emotional and intellectual relationship adjustments across the life-span (Monica McGoldrick).
Each necessitate significant adjustment to change in existing emotional processes, relationships, beliefs, and identities.
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NOTE:
Families and
relationship systems are
enormously complex
and varied.
The “Life-Cycle Stages”
depicted here are a gross
oversimplification of the
developmental social
changes of life. Within
each significant “phase”
or “stage” there are
specific emotional and
social processes that
change and that we must
adapt to and reconcile.

Breaking the impasse
by undermining or
overpowering others
Conflict
creates Anxiety
Common
Problem-solving Remedies
1. Collaboration/Alliance
(win/win)
2. Compromise
(I bend/you bend)
3. Accommodation
(I lose/you win)
4. Competition
(I win/you lose)
5. Avoidance
(no win/no lose)
6. Triangulation
(win/win/lose)
Conflict
Anxiety builds
until resolved
Unresolved,
conflict results in
Power-struggles
Common Outcomes*
1. Open Discord
a. Stable, unsatisfying
b. Unstable (unsatisfying)
2. Impairment in a Child
a. Attention Seeking
b. Power Seeking
c. Revenge Seeking
d. Displays of Inadequacy
3. Impairment in a Partner
a. Failure
b. Depression
c. Illness
4. Emotional Cut-off (escape,
expulsion, abandonment)
* Bowen (1-4); Adler (2. a,b,c,d)
Power
Struggle
Tension solidifies
into long-term
discord
Power Play
Anger and hurt
result in dire
attempts to break
the impasse
Demetrios Peratsakis, LPC, ACS, CCTP © 2014
Common Threats
Treachery or Betrayal
 theft, disloyalty, sabotage, incest,
abandonment, infidelity
Revenge
 punishment, suicide, crime,
depression, addiction, eating
disorders, failure or acts of
inadequacy
Violence
 warfare, bullying, threats, rage,
domestic violence, abuse
Scapegoating
 Severe triangulation,
victimization or bullying
A
The Good
B
The Bad
C
The Ugly
Where there’s a “Will” -there’s a “Won’t!”
Unresolved, conflict leads to power struggles and “stalemates” often “broken” by undermining or overpowering the partner or significant others.
Severe
Trauma
Trauma
Intensifies
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Tragedy or Hardship
Victimization by a manmade or natural disaster,
hazard or catastrophe causing great suffering,
hardship, destruction or distress, such as a serious
accident, threat of harm or crime.
Loss
Ambiguous loss; loss of a loved one; loss of
prestige, a prized possession, a familiar way of
being, one’s health, or one’s goal.
Conflict or Betrayal
A breach of the trust agreement among friends,
family or lovers, including abuse, neglect, incest,
back-stabbing, infidelity and sexual affairs.
Emotional experience: Fear (Dread)
Impact: sense of Vulnerability
Preoccupation: Avoidance (Safety-Needs)
 Emotional experience: Sorrow (Grief)
 Impact: sense of Emptiness
 Preoccupation: Replacement
Emotional experience: Anger (Rage)
Impact: sense of Treachery
Preoccupation: Revenge
Often
Overlap
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Source of Distress (Injury) Psychological Impact
Trauma is distress (extreme anxiety, sorrow or pain) fueled by Guilt, Anger and Shame (GASh).
1. The injury diminishes one’s sense of Worth, which is inextricably tied to others.
2. Unresolved, we seek remedies that circumvent the pain but do not reconcile the injury (Avoidance Strategies)
3. The greatest injury is borne by the trauma of betrayal of a sacred trust
4. Injury is expressed in symptoms we call Anxiety and Depression, whose purpose is to avoid the potential for re-injury

1. As social being, what underlays our most basic human nature?
2. What are the two primary drivers of human motivation?
3. What emotional process must be exercised for intimacy to develop?
4. What are primary sources of psychological problems?
5. What does each of these contribute to?
6. What are three main sources of psychological trauma?
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Protecting the Self Worth from Guilt & Shame

While assessment and diagnosis are important for ascertaining the individual’s current mental health, treatment begins with an understanding of the
client’s belief system. This relies on an understanding of how the individual interprets the world, including their core beliefs, values and loyalties. It also
necessarily includes identification of how the individual protects or safe-guards themselves from risk and from the potential for harm.
Projective techniques are the best methods for discovering the individual’s belief system: 1) Self-Concept; 2) Self-Ideal; and 3) Self-Worth
1. Early Recollections (past): having the client imagine a past or “first time” occurrence. Despite its past context, it reflects the ‘gear and now’
2. Future Biography (future): having the client craft a page, chapter or autobiographical booklet of their future, including title page and author’s
description. It could include specific Chapters, such as “My Family”; “My Advice to Humankind”; or “Parenting 101”.
3. How I View ____? (present): having the client write out their answer to one (or all) of the following questions: “How I view Myself?”; “How I
view the World?”; “How I view Men?”; “How I view Women?”; “How I view Love and Sex?”.
 Once the narrative is obtained, the individual is asked to interpret it, and then asked to explain how it pertains to their current situation or moment
in life. They may then be directed to rewrite portions of the narrative or entire scripts.
4. Genograms: Intergenerational myths, legacies and core mistaken beliefs. For tracing the origins of interpersonal as well as intergenerational
relationship dynamics.
5. Symptoms: Primary expressions of Power and Control. A thorough understanding of the origin and purpose of the symptom, while more
difficult, is the single best method of uncovering the individual’s truest motivation and intent, as well as their customary response to threat and
their manner of gaining or maintaining control in their relationship systems.
Treatment begins with understanding the individual’s belief system
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 According to Bernard Shulman, MD (1964) there are 9 perceived dangers we protect against
1. Being defective 6. Being exposed
2. Incurring disapproval 7. Being ridiculed
3. Being taken advantaged of 8. Getting necessary help
4. Submitting to order 9. Facing responsibility
5. Facing unpleasant consequences
 Safeguarding, is a cognitive-emotional-behavior that we adopt to protect our “ego” or Self-concept from any
perceived diminishment of its worth.
 When these forms of avoidance solidify into preferred transactional patterns, “symptoms” emerge.
Psychological Symptoms
 are passive-aggressive and controlling (often with expressions of resentment)
 they conceal one’s true convictions and intent, meta-communicating that the behavior is involuntary and not defensive
 they rationalize one’s behavior and mistaken beliefs (irrational beliefs; cognitive distortions)
 they develop and uphold a pretext of inherent nobility
Self-Worth, the accumulated estimation of our own value, is intricately tied to the appraisal and acceptance of others.
It is the internal sense of being good enough and worthy of love and belonging from others.
We strive for belonging and seek to avoid or mitigate rejection.
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Adler Identified 4 (four) Categories of “Safeguarding” or Self-protecting Behavior Patterns
1. Excuses
1) “Yes, but” : people first state what they claim they would like to do -something that sounds good to others, then they follow
with an excuse. Ie. “I want to go, but I haven’t a thing to wear”
2) “If only” : variation of self-excusing behavior that includes blame of another, a sense of noble struggle, or both. ie. “I would
have scored better if he had been a better tutor”
 Reduces risk of failure but diminishes opportunity for success and the prestige and valuation that accompanies it
2. Aggression/Guilt -violence, belligerence, criticism or hostility toward self or others
Offense can be the best Defense!
1) Depreciation: devaluation of others’ achievements and/or overvaluation of one’s own;
2) Accusation: blaming others for one’s foibles or failures or seeking revenge, including by depression or suicide
3) Guilt/Self-accusation: self-torture, self-accusatory behavior or self-deprecation, as a method of acknowledging wrong, while
remaining noble and reticent to change
 Reduces self-blame but also the opportunity for self-appraisal, correction and improvement
 “Depressives” (individuals that appear perpetually depressed) are the most formidable opponents as they have mastered
the use of guilt, depression and self-loathing as instruments of power and the manipulation of social interactions.
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3. Withdrawal / Distancing
Withdrawal is a form of distancing or avoidance the helps to preclude the potential for failure and, thereby, for evaluation. In essence,
constructing methods of obstructing or escaping life’s problems instead of resolving or reconciling them. Maturation is slowed or halted by
avoiding the challenges and hardships of everyday life.
Four modes of safeguarding through withdrawal:
1) Moving backward: reversion to a more comfortable or secure way of thinking or behaving
2) Standing still: avoiding choice or action in order to avoid responsibility or threat of failure
3) Hesitating: procrastination, ambiguity or reluctance as a means of thwarting choice, then blaming the insufficiency of time to prepare or act
4) Constructing obstacles: crafting challenges or obstacles and then overcoming them as a means of claiming achievement or inflating self-
esteem. If one fails to reconcile the hurdle or challenge, some excuse will then be employed.
 Reduces potential for conflict but can build resentment and social isolation reducing socialization, a key driver for cognitive improvement
4. Symptoms - rationales, tactics and strategies created for Self-protection (“Concrete Reminders”)
Symptoms are pathological patterns or transactional structures of interacting with others. They are highly effective strategies of self-protection.
They are maintained by the beliefs, behaviors and interactions of the individual and their relationship system and are intended to excuse or deflect
attention from responsibility. (Can and Won’t versus Can’t)
1) Symptom Neurosis
2) Character Neurosis (Personality Disorders/Sociopathology)
3) Psychosis
 Ingrained patterns of avoidance dimmish Social Interest and opportunities toward greater consciousness (humanness)
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Socialization places continuous pressure on the need to adapt to change and life events.
Individuals that do not believe they are capable of successfully meeting these demands seek to avoid playing by the rules.
Adler categorized these extreme safeguarding strategies as Neurosis, Sociopathology and Psychosis
Strategies for Life’s Demands
Healthy
•Plays by the Rules
•“Yes, I’ll Try!”
Rules help protect,
cooperate and
contribute. Accepts
foibles & failures;
problem-solves
challenges & learns
from mistakes.
The Goal is
acceptance; to
belong in a
meaningful way
Symptom Neurosis
Exempt from
Rules
“Yes, but…”
“If only…”
I know the rules but
want to be excused
from them.
The Goal is to
escape judgment or
to be judged less
harshly.
Character Neurosis
Defy the Rules
“F-You!”
I’m above the rules;
they’re for chumps!
The Goal is to
feel that one has got
over or got even.
Psychosis
Negate the Rules
“No!”
I will create my own
rules so that I do not
fail.
The Goal is
ostracism; to be left
alone and isolated.
Expulsion.
1. Self-esteem (Worth) = Self-ideal – Self-concept
2. The more extreme the behavior, the lower the Self-esteem
3. To increase Self-esteem, reduce isolation/increase Social Interest
Encouragement Discouragement
Social Interest = Self Worth

The protect the Self Worth from Guilt & Shame

All social interaction includes an attempt
–or struggle, to control the definition of the relationship.
Symptoms, are tactics in human relationships.
Inherent, is the metacommunication that the individual has no control over the symptom.
They are passive-aggressive power-plays.
The primary goal of the symptomatic behavior is to create an advantage
by which the individual can gain control over another and set the rules for that relationship.
(Jay Haley, Strategies of Psychotherapy, 1963, Grune and Stratton;
book dedication to the famed communication theorist Gregory Bateson, his mentor).
Jay Haley, tutored under the ground-breaking therapist Milton Erickson and collaborated with all the heavy hitters, including
John Weakland, Don D. Jackson, Virginia Satir, Cloe Madanes, Richard Belson, Paul Watzlawick, Nathan Ackerman, Carl Whitaker, and Salvador Minuchin.
I had the distinct honor of meeting Haley and watching him work, in 1987, which helped direct my studies to short-term, solution-focused therapies.
35

1. Symptom become a means by which the individual and their relationship system obtain, retain, or reinstate control. They organize roles, rules,
terms for social interaction and mutual dependency (Family Systems Therapy)
2. Symptoms deflect distress from other sources (triangulation) and serve as a “lightning rod” or “scapegoat” for blame, guilt, shame, and resentment
(M. Bowen).
3. Symptom are complex transactions that shape the communications, roles, rules, expectations and social organization of those who participate. In
essence, a pattern or “structure” around which communication and membership is organized, boundaries defined, and power expressed and
reconciled.
4. Symptoms evolve into shared mental constructs, symbols imbued with special meaning and power. They acquire history and become artifacts of
identity, both for the individual and for the relationship system. The pattern that emerges unites and holds their participating members together and
fulfills the mutual purposes of its participants, providing a vehicle for communication, love and attachment (Narrative Therapy).
5. Symptoms serve as an excuse or pretext by the individual or family for avoiding blame or responsibility for change and “safe-guarding” prestige
or their sense of Self Worth (Adler).
6. Symptoms serve as a method –often passive-aggressive, for expressing rage (Peratsakis), gaining the upper hand, controlling, retaliating, or
punishing others, or as a means to press others into one’s service (Adler).
7. Symptoms avoid intimacy and the risk of re-injury or of getting hurt again (Sherman)
8. Symptoms contain inherent traits of “nobility” creating a sense of false worth and rendering one’s struggle as morally good or superior (Adler).
36

Shared Beliefs
(cognitive distortion)
Group/Societal Beliefs
(social constructionism)
Overlap echoes and
reinforces
Shared
Distortion
Darkest
Shading
Institutionalized
Distortion
Demetrios Peratsakis © 2020
Blue Shade
Blue
Shade
Blue
Shade
Dad’s beliefs
Son’s
beliefs
Mom’s
beliefs
Shared values and opinions, represented by the overlapping shaded areas, mirror a part of each member’s belief
structures thereby reaffirming (concretizing) their ‘truth’ and purpose. Symptoms are belief structures maintained by the
sequences of thoughts and behaviors of the individual and their relationship system. Interrupting these will necessarily
alter the symptom and directly challenge its rigidity and inevitability
38

dyad
Symptom, “Scapegoat” or IP
anxiety
closeness may increase as
anxiety is reduced
39
Show “String Theory”

1. Symptoms help maintain, obtain, or reinstate control.
Symptom are complex transactions that help shape and organize communication, roles, rules, expectations, and terms for social
interaction and organization. They emerge as pattern or “structures” around which membership is organized, boundaries defined,
and power expressed, intimacy and conflict is expressed and reconciled. (Adlerian Psychology; Family Systems Therapy)
2. Symptoms “safeguard” feelings of self-worth.
Symptoms are highly effective avoidance strategies that serve as an excuse or pretext for avoiding blame or responsibility for
change, increasing safety and reducing fear, risk and the sense of vulnerability.
3. Symptoms reaffirm belief structures, values and loyalties.
Symptoms amplify power and prestige, both for the individual and their relationship system. They evolve into shared mental
constructs that acquire history and become artifacts of identity, braiding members together and fulfilling the mutual purpose of
each of its participants. As such, they provide a vehicle for communication, love and attachment (Narrative Therapy).
4. Symptoms are metaphors for pain.
Symptoms, including delusions and hallucinations, are symbolic, metaphoric expressions of the individual and system’s pain; they
are forms of meta-communications on the conditions of social engagement that amplify power and prestige. (For example, as
noted by Wilson and Lindy (2013), trauma victims might describe their sense of deprivation as “I am empty inside” and compare
the difficulty in engaging meaningful interpersonal communication to “No one can get close to me” (p.45). “Empty inside” and
“get close to”, which are everyday experiences with physically concrete properties, are used as metaphor vehicle terms (Cameron
& Maslen, 2010) to help verbalize the abstract, elusive post-traumatic feelings (i.e., the target topics). (J. Haley)
40

5. Symptoms are a form of distraction from the experience of pain (D. Peratsakis)
 They deflect distress and serve as a “lightning rod” or “scapegoat” for blame, guilt, shame, and resentment (M. Bowen).
 They always constitute one-leg of the triangle (triangulation), drawing some together, at the expense of others (D. Peratsakis)
 They help deter or avoid intimacy and the risk of re-injury or of getting hurt again by a breach of trust (R. Sherman).
6. Symptoms alleviate, mitigate or avoid the responsibility for change
7. Symptoms serve as a method –often passive-aggressive, for the expression of rage
Over-powering, gaining the upper hand, controlling, retaliating, or punishing others (D. Peratsakis).
8. Symptoms serve as a means by which to press others into one’s service (Adler).
9. Symptoms contain prestige and inherent traits of “nobility”
They create a sense of false worth, rendering one’s struggle as morally good or superior (Adler).
10. Symptoms are tactics, passive aggressive power-plays filled with deep symbolism and narrative expression (M. Erickson/Haley)
41

Once you accept the idea that a symptom has purpose, it fundamentally changes your
customary view of how problems emerge and how they should be reconciled.
42
This is the beginning of “seeing” human behavior in a different way...

45
1. We behave and feel in a manner consistent with our beliefs. Believing (truly) is Seeing!”
2. Others react to our actions which, in turn, reaffirms our beliefs about how to act.
3. In part, we drive the behavior and emotions of others in order to obtain the very reactions that
reaffirm our own belief systems.
4. Together, we create constructs and ‘shared imaginings’ called patterns and structures, such as
roles, rules, legacies and myths. These help us organize and operationalize social functions.
These acquire purpose, meaning and power.
5. All psychological symptoms, syndromes and ‘presenting problems’ emerge as social constructs
that must be unbalanced and redefined in order for change and growth to occur.
- Demetrios Peratsakis

Psychotherapies tend to follow one of two trajectories based on their philosophy, the nature of the presenting problem,
and the desires of the client: 1) fix the presenting problem or 2) fix the reason for the presenting problem. Either may necessitate the other.
Presenting
Problem
Symptom or P.P. Reduction as Purpose of Therapy
Brief, solution-focused problem resolution. 1-15 sessions, max of 6-9 months
1. Problems exist because of difficulties adapting to major change or significant life events.
2. Treatment focused on symptom amelioration, reduction of distress or a remedy to a
narrowly defined goal or problem
3. Treatment not focused on
- personality change
- symptom substitution or reoccurrence
- long-term improvements or clinical gain generalized to other areas.
Goal: Fix the Problem
Symptom or P.P. as Vehicle for Change
Problem or symptom is viewed as an expression of underlying issues and used as a vehicle
for personality or system change, healing pervasive trauma and damage to self worth.
Open, average 18 - 36 months
1. Problems exist because of approach to life (personality); often triggered by significant
change or life events
2. Treatment focused on a) problem/symptom resolution; and b) character change
3. Treatment very focused on
- personality change
- symptom substation and reoccurrence
- change in character viewed as improving several areas of being and social interaction
Fix the Problem
Goal: Fix what leads
to such problems
Trauma Work
Modifying interactional patterns; training emotional regulation; cognitive restructuring
47
Different Paths of Intervention
 Change the Symptom
 Change the System to Change the Symptom
 Change the Symptom to Change the System
 Change the Structure to Change the System to Change the Symptom

A. General Assessment (Interpersonal)
1. Global Functioning, Presenting Problem (PP) and Identified Patient (IP)
2. Relationships, Intimacy and Love Supports: partnership(s), current support system, Family of Origin, Family Constellation and
Family Atmosphere (Genogram)
3. Maturation/Life Tasks: general adjustment and adaptation to developmental demands, change, and the tasks of life. Approach and
attitude to life’s challenges, hardships and disappointments; ability to effectively resolve conflict, cooperate, and problem solving
with others; movement toward the constructive, nonconstructive and destructive.
4. Open Discord, Conflict and Power Struggles (including detouring, coalitions and collusions) passive-aggression and temper
tantrums)
5. Unresolved Trauma, especially Betrayals (including cut-offs, expulsions, abuse, rejection, affairs and abandonment)
6. Therapeutic Alliance: continuous monitoring of trust and collaboration
B. Specific Assessment (Intrapsychic)
1. The Self Concept: the combination of characteristic beliefs, values, moral convictions, and attitude toward Self, Others and the
World that form the individual's distinctive perspective; understood through themes and patterns.
2. The Self Ideal: the fictitious goal or imagined state of excellence; “self-actualization” (Purpose & Meaning)
3. Self Ideal vs Self Concept
 gauge or barometer of Self Worth/Self Esteem
 points to avoidance and self-protection tendencies (Safeguarding)
48

49
1. Unbalance the Power, Meaning and Purpose of Existing Beliefs -so as to introduce new possibilities
 1) introduce doubt 2) then allow the client to choose an alternative explanation (client retains control).
2. Assume Responsible for Change -once you accept total responsibility for change -- including blame for when therapy
fails, your work becomes exceedingly precise and deliberate. Once you forego the soft gray of ambiguity and regard each
of your responses as either therapeutic or counter-therapeutic, your work becomes nothing short of remarkable.
3. Make Session a Safe Haven -to a) experience pain, b) learn emotional regulation, and c) practice new ways of thinking,
feeling, and interacting. –Assign Homework with Care!
3. Pull for the Pain to Emerge -change requires reconciling and moving past one’s pain.
 Actively Listen (Listen with the Third Ear), validate the pain and provide an opportunity for it to emerge
 Confront efforts to distract from the pain -and it will emerge. The greater the pain, the greater the distraction.
 Ambivalence is distraction: always interrupt when work is not being done; never interrupt when it is being done.
 Caution: client pain triggers vicarious trauma (and “blind-spots”); the therapist may collude to distract from the pain.
 Caution: pain, is often used as a purposive form of distraction created to forestall the need to change or express anger.
3. Dig at the Guilt, Anger, and Shame (GASh) -to remedy depression and improve self-worth.
 Normalize terms such as depressed (sad or hurt) and anxiety (scared or worried); always validate anger.
 “Heavy” session?: 1) predict ambivalence/anger at therapist; 2) obtain agreement to return for 1-more session.
 Caution: Guilt and Shame may be intentional forms of self-loathing and self-deprecation (pity-pot); this can provide
justification to continue misbehaving. In essence, a form of contrition without the necessity to change! (Adler)
4. Use the Therapeutic Alliance as an agent of Change –intimate relationship of trust, encouragement and love
Background Strategy for Each Session

Trauma
Life
Cycle
Life
Tasks
3) Trauma
Psychological injuries due to significant
hardship, conflict, loss, natural and
manmade disasters, or human tragedies.
2) Life Tasks
Core domains of adulthood, including Work;
Friendship; and Love (Alfred Adler)
1) Life-Cycle Changes
Normative and para-normative developmental
changes that occur across the life-span
(Monica McGoldrick)
Adulthood & Maturation: 1) degree of adjustment to the significant changes created by Life Cycle events; 2) relative success in
negotiating the Tasks of Life; and acceptance of the injuries and hardships imparted by others and life’s misfortunes.
Clinical Review: given a) one’s age and b) the time one has had to adjust, how well/what should, one be doing?
Problems arise due to difficulties adjusting to significant events in one of the three (3) main domains of life.

51
1. Need to Avoid Blame & Shame
 Problem accepting criticism and the risk of failure
 Problem with responsibility and the risk of judgement by others
2. Problem with Empathy and Intimacy
 Co-dependency; giving up the self as a method of pleasing others
 Hypervigilance to critique and the opinion of others
 Difficulty with trust, communicating and speaking true feelings, beliefs, and needs
3. Poor Self-esteem & Self-worth
 Struggles with feelings of shame, inadequacy and worthlessness
 Continual need for validation from others
 Constant bouts of Guilt and Shame, which fuel depression and anxiety
 Difficulty with appropriate assertiveness; having weak and/or inflexible boundaries
 Self Concept continuously falls short of the Self Ideal
4. Problem with Anger & Aggression
 Misuse of Anger, Power and Control to feel superior or more worthy than others
 Passive-aggressive displays of revenge and blame to inflate false sense of vanity

Anger
Sadness
Fear
© 2014 Demetrios Peratsakis
Guilt
Shame
 Depression: sorrow and despair from a significant tragedy, loss or becoming the victim of
betrayal by a trusted person or loved one. Depression is past-oriented and fueled by Guilt,
Anger and Shame (GASh). “I am not competent nor complete; deep down others don’t
truly care about or think that I am worthwhile. I am helpless and my situation is hopeless”
 Anxiety: fear and foreboding due to an overestimation of danger and perceived sense of
vulnerability marked by a preoccupation with safety and concern over the potential
reoccurrence of harm (dread). Anxiety is future-oriented; “I am vulnerable and unable to
protect myself or be protected by others. Others will humiliate and harm or blame me!”
“Emotions”
“Thoughts”
Depression/Anxiety
- distress, extreme anxiety, sorrow and pain
The source of the injury determines the relative strength of each of the
“ingredients”, the triggers that surface them, and the primary preoccupation
and intensity of the narrative we braid into our mistaken beliefs.
=
Trauma results in a mix of feelings and thoughts called Depression (sadness) and Anxiety (fear), fueled by Guilt, Anger and Shame (GASh).
Trauma
-caused by interpersonal violence, betrayal, loss or tragedy
17
Ingredients: 3 Primary Emotions + 2 Thought Patterns
(Primary emotions, Anger/Disgust, Fear/Surprise, Sadness, and Joy, develop age 0-6 months).
There are 3 kinds of depression: Simple (normative sorrow and dread); Complex
(impaired ability to function); and “Depressives” (passive-aggressive personalities)

1. Stabilizing Highs and Lows in Mood
 Medication
 Training in Emotional Regulation; ie.
o Deep Breathing, Desensitization, Mindfulness, Imagery, et al
o Hypnosis
o EMDR, Cognitive Reprocessing
2. Cognitive Restructuring
 To be effective, techniques must modify existing beliefs
Treating Depression and Anxiety requires two, parallel lines of intervention

- Demetrios Peratsakis, LPC, ACS © 2015
Sadness
Fear
Anger
Guilt
Shame
1
2
3 Depression and Anxiety lift
Assess for Risk & Need for Meds; R/O Medical
Work on Guilt and Shame
(may be used to negate the need to change)
Tap into Anger *
# 1 Use Active Listening to validate
Guilt and Shame feelings.
Challenge, then reconcile underlying (cognitive) distortions.
# 2 The anger that accompanies the hurt must be validated and given voice.
As the therapist taps into the anger, the depression will lift.
The simple rule: where there is Depression, there is also Anger.
(When you see “Sad”, look for the “Mad”; to reduce the “Sad”, tap into the “Mad”)
# 3 Self-worth must be improved by increasing
confidence and prestige through social
involvement that is purposeful and meaningful.
Empowerment begins as self-worth improves.
* Never ask if the pain (guilt/shame/sorrow/fear/anger) exists; trust that it does, and then “mine” for it while neutralizing attempts at distraction.
1. “I feel this great weight, this great sense of pain/guilt/shame/sorrow/fear/anger within you; with your hand, show me where it is…”
2. “Your nervousness is your body’s way of reminding you of some pain. Let’s try something. I want you think back to the last time you remember feeling such pain.…”
3. “Some, may feel hurt by such a thing. Imagine that you are and now tell me how that would feel for you…”

Anger, sadness and fear are natural responses to psychological injury. They result in feelings of depression and anxiety, which are fueled by thoughts of guilt and shame. Anger, which can
provide a faulty sense of power, is an attempt to counter-act these feelings, as preparation for retribution, or as a defense against further injury. To sustain the anger, the harm or emotional
pain must be continually reactivated (rumination), often, in the form of self-pity or blame. This can result either result in feelings of helplessness and worthlessness or the desire to over-
power, punish or seek revenge. Unresolved, the effects of trauma are cumulative and typically erode confidence in self and the willingness to be trustful and intimate with others.
This is purposive!
Demetrios Peratsakis, LPC ACS; 1985
56
The Development and Retention
of Depression and Rage : emotional pain results in psychological injury
1 2 3
4
5
A B
Source of Injury defines
proportion of each feeling.
Rumination isn’t something
that befalls the individual. It
is a purposeful recreation of
the injury and the events
surrounding it for the
expressed purpose of
processing the harm and
developing strategies to avoid
additional and future harm.
Preoccupation
with Self-Pity
Preoccupation
with Revenge

STEP 1: Global Assessment
Standard instrument (ie DLA-20) or core realms of functioning, including SUD, depression/suicidality and
unresolved conflicts and trauma
STEP 2: Rule Out Exclude the possibility of a neurobiomedical condition
STEP 3: Challenge the Meaning and Purpose of the Symptom
1) Track the beliefs and interpersonal transactions surrounding the Presenting Problem (PP), Identified
Patient (IP) or Symptom(s);
2) Test the rigidity of the belief system, unbalance existing convictions and introduce new possibilities;
3) Return to the Presenting Problem, refocus on the goal of treatment and solidify agreement to work
(Contracting)
 Obtain an answer to these two questions:
Question 1: “Who is most affected by your symptoms or this problem -and how?”
Question 2: “What would be different in your life if you didn’t have this problem or these symptoms?”
(“The” Question; Adler, 1929. Often incorrectly credited to deShazer; used for differential dx also).
58

Symptoms
1. Difficulty Adjusting
to Significant Life Changes
(Life-Cycle Processes)
(Power Struggles, Acts of Betrayal)
3. Trauma
(Tragedy, Loss, Abuse)
Source or Cause*
Demetrios Peratsakis, LPC, ACS © 2012
*While any physical infirmity, medical condition, or brain injury (Congenital Brain Damage; Acquired Brain Injury; and Traumatic Brain Injury (TBI) can
acquire functional value, their origins are deemed non-psychological and should be ruled out as primary targets for psychotherapy. Significant change,
conflict, and trauma, require adjustment in role, function, identity and interpersonal relations which may be difficult to navigate or reconcile. Unresolved,
this invariably leads to depression and anxiety, fueled by Guilt, Anger, and Shame (GASh). Symptoms arise as a means of regaining or obtaining control.
59
Relational Perspective on Symptoms
Origination and formation of enduring patterns of
behavior, structures or syndromes that organize
social interaction, mediate stress and provide
adaptive response to change
1. Symptoms are hardened patterns of
interaction, or “structures”, around which
individuals express power and control.
2. Symptoms acquire history, as they
organize social interaction, including how
roles, rules, boundaries, expectations and
functions are defined and how love, hate,
need and want are communicated and
shared; often, over generations.
3. Symptoms acquire Purpose, Meaning
and Power.

STEP 1: Global Assessment (Mental Status; Interpersonal)
Standard instrument (ie DLA-20) or core realms of functioning, including SUD, depression/suicidality and unresolved conflicts and trauma.
Specific Assessment (Intrapsychic)
 Self Concept: the combination of characteristic beliefs, values, moral convictions, and attitude toward Self, Others and the World that form
the individual's distinctive perspective; understood through themes and patterns.
 Self Ideal: the fictitious goal or imagined state of excellence; “self-actualization” (Purpose & Meaning)
 Self Worth: Self Ideal vs Self Concept as a gauge or barometer of Self Worth/Self Esteem; points to avoidance and self-protection tendencies
STEP 2: Rule Out Exclude the possibility of a neurobiomedical condition
STEP 3: Challenge the Meaning and Rigidity of the Symptom -introduce doubt and then substitute alternative possibilities
1) Track the beliefs and interpersonal transactions surrounding the Presenting Problem (PP), Identified Patient (IP) or Symptom(s);
2) Test the rigidity of the belief system, unbalance existing convictions and introduce new possibilities;
3) Return to the Presenting Problem, refocus on the goal of treatment and solidify agreement to work (Contracting)
STEP 4: Determine the Purpose of the Symptom
1) Determine the Line of Movement of the Symptom/Behavior
2) Answer: “Who is most affected by your symptoms or this problem -and how?”
3) Answer: “What would things be different in your life if you didn’t have this problem or these symptoms?”
(“The” Question; Adler, 1929. Often incorrectly credited to deShazer; used for differential dx also).
61

Disrupt beliefs about the Symptom,
the PP or the IP; modify it meaning;
Disrupt the sequence of events,
behaviors and interactions that surround
the Symptom’s expression or aftermath;
Disrupt the social structures (shared beliefs)
that reaffirm the symptom and its expression,
including roles, rules, functions, expectations
and ways of being organized
1. Cognitive Restructuring (Critical reasoning to
sow doubt; Columbo technique;
2. Introduce alternative explanations;
3. Trial new possibilities.
The counselor must “unbalance” this rigid pattern of ideation by introducing doubt through alternative explanations, gaining
insight and then practice with new possibilities. The most common method is to use Critical Reasoning, or a process known as
Cognitive Restructuring (Doyle, 1998; Hope, 2010) to shift the client’s belief or have them behave in a different way.
34

1. Create a new symptom (ie. “I am also concerned about
________; when did you first start noticing it?”)
2. Move to a more manageable symptom (one that is
behavioral and can be scaled; ie. chores vs attitude)
3. I.P. another family member (create a new symptom-bearer or
sub-group; ie. “the kids”, “the boys”)
4. I.P. a relationship (“the relationship makes her depressed”)
5. Push for recoil through paradoxical intention (caution!)
6. “Spitting in the Soup” –make the covert intent, overt
7. Add, remove or reverse the order of the steps (having the
symptom come first)
8. Remove or add a new member to the loop
9. Inflate/deflate the intensity of the symptom or pattern
10. Change the frequency or rate of the symptom or pattern
11. Change the duration of the symptom or pattern
12. Change the time (hour/time of day/week/month/year) of
the symptom or pattern
13. Change the location (in the world or body) of the
symptom/pattern
14. Change some quality of the symptom or pattern
15. Perform the symptom without the pattern/short-circuiting
16. Change the sequence of the elements in the pattern
17. Interrupt or otherwise prevent the pattern from occurring
18. Add (at least) one new element to the pattern
19. Break up any whole elements into smaller elements
20. Link the symptoms or pattern to another pattern or goal
21. Reframe or re-label the meaning of the symptom
22. Point to disparities and create cognitive dissonance
23. Rewrite the narrative without the symptom
24. Externalize and exorcise the “voices” in the narrative
25. Manipulate the emotion associated with the symptom
Rule # 1: Narrow broad perspectives
Rule # 2: Broaden narrow perspectives
1) Caution client to go slow; predict little or no change
2) Predict that the desire to return may wane
3) Predict residual anger at therapist for being “pushy”
4) Recommend atleast 1 more meeting
Note: 1-4, Minuchin/Fishman; 5-6, 21, 22, 23, Adler; 7-20, O’Hanlon; 23, 24,
White; 25, Peratsakis. Pattern/Action may represent a concrete behavior,
emotion, or family member
Manipulating symptoms as a method of introducing doubt, alternative views and new possibilities
63

Explore the PP
Hardened (rigid)
beliefs about who
and what is the
problem
Challenge Beliefs
(Unbalancing)
Therapist explores & challenges
belief system; softens rigidity
Return/
Reaffirm PP
Therapist
continuously returns
to PP/IP; amplifies
concern if necessary
Home Base =
Safe Territory
1
2
3
Exploring, Challenging, then Returning

1. Give Task
 Assume Authority & Expertise
 All Clients are a “Forced Referral”: therapy must assure safety while pushing for experimentation and
change
 Normalize Experience: “…we see this all the time”; “Most kids…”
 Never Ask Permission!
 Direct with Simple Commands
 Keep Directives Behavioral; ie “Talk to her”; “Get up and go sit next to him”; “Get them to behave”
 Use Simple Intros to more complex tasks: “Let’s try something…”; “Most/Some people find this
helpful…”; “Let’s do an experiment”; “I’m going to have you try something that may be very difficult.. ”
 Homework is Failure Prone: script it; make behavior independent of others; predict difficulty or failure
2. Stay on Task
 Never Rescue! -Always redirect back to task
 ALWAYS Interrupt When Work is NOT Being Done!
 NEVER Interrupt When Work IS Being Done!
 Push-back is to be expected, but NOT accepted
65

66
Button Up !
3. Button-Up, 1, 2, 3
1) Stop: “Let’s stop” or “Hold up, that’s enough hard work for now…”;
add hand gestures as signals
2) Explore:
 “Was that worse than you thought it would be?”
 “That was tough work, what should we do different next time?”
 If the task was not completed
o “That was very hard; what was going on for you while you were trying it?”
o “That was very hard; tell me, what do you think would have happened if you could have
done it?” “What’s the worse thing that might have happened?”
3) Do a Temperature Check
 Examine therapeutic alliance for possible back-lash, anger, resentment or fear: “I pushed you
pretty hard, how upset with me are you?”
 Predict residual anger; “If it turns out that feel angry with me, would you be willing to come
back just for 1 more session, even to tell me you never want to see me again!?”
 Predict “relapse” or back-sliding due to difficulty of change
 Poor contracting is the #1 reason for therapist burnout
 Anger at the therapist is the #1 reason for clients leaving therapy or refusing to change
 Optional: Assign homework
 Must be “safe” and do-able in behavioral terms
 Must anticipate failure or sabotage; exaggerate its difficulty and predict what could go wrong

“Client Expressions of Power in the Therapeutic Alliance” -by Ofer Zur, Ph.D.
1. Not talking
2. Not following advice or suggestions
3. Non-disclosure [Selective disclosure] or not answering questions
4. Taking notes or recording sessions
5. Coming late or leaving sessions early
6. Non-payment or refusal to agree to terms of service
7. Stalking
8. Change seating or other office arrangements
9. Provocative or threatening clothing
10. Use of violent, vulgar, threatening or provocative language
11. Use of anger, aggression or rage
12. Dominating the conversation
13. Inappropriate touch
14. Inappropriate gifts
15. Offering incentives
16. Acting coy or seductively
Note:
These represent direct
challenges to the therapeutic
alliance and should be
confronted right away.
The simplest method is to
discuss them as a barrier to
help and a “mixed message”
: “I want counseling but I
don’t want to change!”
The client is then
encouraged to make a choice
and decide how, if at all to
proceed with counseling.
Power, is influence and control within the relationship system. It is the ability to influence outcome, the manifest expression of our
will. In this regard, it is never random but purposive and consistent with our self-concept and worldview. It colors our beliefs,
opinions, interests and desires and can best be understood through our behavior and the intended goal of our action.
“Ready or not, here it comes!”

Couple or Family Expressions of Power in Therapeutic Alliances - Demetrios Peratsakis
1. Shot-gunning/Carpet-bombing: too many Presenting Problems and Identified Patients
2. Fugue over selecting Presenting Problem
3. Sets appointment, cancels/no-shows; sets appointment, cancels/no-shows
4. Spouse/Partner sets appointment, partner refuses to attend
5. One sets appointment, then sabotages their partner’s participation
6. Both attend, one sees a problem, one does not
7. Both attend, both agree that one partner is the problem (identified patient/I.P.)
8. Both attend, agenda moves to Individual Counseling (I/C) or child focus (F/C)
9. Both attend, one begins to No-show (leaving therapist with partner/spouse)
10. Both attend, one drops a “bomb” (ie. sexual affair, drug abuse, major illness)
11. Both attend, one discloses their desire to separate or divorce
12. Both attend, one or both unclear on commitment (separate or remaining together)
13. Both attend, one or both continually triangulate the therapist
14. Both attend, the agenda and goal of therapy continually changes or vacillates
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Push-back to directives are natural to the therapeutic process and are to be expected, as well as predicted.
It should never, go unchallenged. Push-back is due to one of two factors
1. Fear
 Anxiety or Angst: comfort the fear and encourage them back to task (“This is very hard”; “Let’s slow
down and try again”)
 Morbid Dread: push; if task cannot be completed, focus on the fear: “What is the worse that would
happen?”; “What’s happening now?” “If you could do it…”
2. Power-play:
 Natural and routine to the Therapeutic Alliance; dis-arm, dis-engage and redirect the power-play, then
address resentment and anger.
 Examine the intent of the Power Play
 Stop the process and ask directly about the issue. “I think I may have stepped on your toes a bit, are we
going to be okay?……..”
 Take a 1-down: “I’m not sure where we are; how should we proceed?”; “I’m a bit lost, where should we go
from here?”
 Point to the ambivalence: “I’m getting some mixed messages. Should we move forward or not; is this
worth trying to change?”
 Seek permission to power-play: “My role is to push you in ways that will be uncomfortable. That may be
more than you bargained for but otherwise we may waste a lot of time and not get as much done”. What
would you prefer we do? “Would you rather I annoy you or waste your time?”
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- Demetrios N Peratsakis, MSEd, SDSAS, LPC, ACS, CCTP; WTCSB Executive Director

In many regards, Adler’s Psychology, is the progenitor of modern-day psychotherapy.
He “has been called the father of ego psychology, the father of humanistic psychology, the father of cognitive
therapy, and the father of family therapy.” (Jerome Wagner, Ph.D.).
His influence is evident in the traditions of counseling, social work, and school guidance;
the systems they are predicated on; and the theorists that founded them, including
“Abraham Maslow, Carl Rogers, Karen Horney, Rollo May, Erich Fromm and Albert Ellis.” (VerywellMind).
To this, should be added other, noted neo-Adlerians, including
Harry Stack Sullivan, Victor Frankl (Logotherapy), and Eric Berne (Transactional Analysis).
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Admittedly, Alfred Adler’s Individual (Indivisible) Psychology
can be difficult to master.
It is, however, well worth the effort.
It is a philosophy of human nature and pathology.
It is a powerful way of understanding social interactions,
as well personality development and motivation.
Most importantly, it provides a psychology of mind
and a different way of “seeing” human behavior.
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1. Social Meaning: people interpret, influence, create and share events within a social context (constructionism). The
world is seen from the client’s subjective frame of reference: how one views reality, including their childhood
experiences, the past and the present matters more than what actually exists or has transpired.
2. Private Logic: One’s perceptions regarding self, others, and the world (personality) each person, at an early age,
develops core concepts about being in the world. It includes the Self Concept (who I am), the Self Ideal (who should I
be to excel), the World (what others and life demand of me) and Ethical Beliefs, our sense of right and wrong.
Collectively, this shapes our manner of interpreting.
3. Style of Life: the Private Logic characterizes the individual’s interpretations and, in turn, their behaviors, emotions and
actions. It tends to stay relatively constant and is called character, personality or Style of Life (Life Style).
4. (Final) Fictional Goal: behavior is not random it is goal directed, with a continuous movement toward the Self Ideal
(imagined Final Fictional Goal). This line of movement, or striving, is often called “self actualization”. It is a
purposeful striving from the felt sense of helplessness and vulnerability of childhood (inferiority) to an idealized sense
of mastery or excellence that shapes our ideal of adulthood (superiority). It is intentional and colors every goal,
behavior, emotion and action with meaning. Adlerians, regard this teleological striving as purposive (Purpose).
5. Social Interest: To be human, purposiveness, or self-actualization, must occur in a social context. Developing
community feeling and the capacity to cooperate, share and contribute with others and to be concerned with their
welfare and the common good is what is meant by socialization, the process of becoming human(e). It requires
meaningful socialization, social cooperation, social acceptance, and a continuous cultivation of intimate relationships
with friends, community and lovers. This relies on the ability to develop trust, compassion, empathy and concern for
the welfare of others. Adlerians call this Social Interest and believe it to be the binding force of society.
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6. Encouragement/Discouragement (Social Interest vs Self Interest): Social Interest is innate, but like speech or language, it must be learned in
childhood and practiced into adulthood, to thrive. It necessarily requires encouragement -or the cultivation of courage to approach the
challenges and disappointments of social interaction. These two factors, Social Interest and Encouragement, are the two single greatest
determinants of Self Worth, or Self Esteem. Achievement, in socially meaningful ways breeds a sense of belonging and pride in the value one
has to others.
7. Family System: first social context of learning and enculturation; the individual’s attitude and approach to life is shaped by Encouragement
and Discouragement and is affected by
a) Family Constellation: membership how the family functions and is organized
b) Family Atmosphere/Family Values: attitude and approach to challenges, others, life, life’s tasks
c) Birth Order/Sibling or Ordinal Position: role and position with others of meaning
8. Tasks of Life: The “human community sets three tasks for every individual” –R. Dreikurs,
a) Work: contributing to the welfare of others and usefulness to the common good
b) Friendship: building social relationships with friends and relatives
c) Love/Sex: establishing and maintaining emotional and sexual intimacy with a partner
9. Safeguarding: Psychologically healthy individuals have developed social interest, commit to life-tasks without excuses, have a sense of
belonging, feel accepted, have positive self-esteem, and are able to accept their imperfections. They approach obstacles with resoluteness and
courage, successfully reconciling the maturational demands of life. Psychologically unhealthy individuals are greatly discouraged and develop
poor self-esteem or a lower sense of self-worth (Worthlessness). As compensation, and in order to protect the self-esteem, individuals develop
methods of self protection, ways of mitigating their sense of inadequacy or failure from themselves and others (Safeguarding)
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Degree of Discouragement

10. Aggressive Avoidance: Misbehavior and antisocialism are forms of pervasive discouragement and fear of rejection. This
includes active avoidance of the challenges and demands of life; acting as if one is depressed, inferior or inadequate;
aggression and violence toward others; or developing symptoms, methods of excusing one’s risk of failure or controlling
others. There is no greater “defense” than “offense”; no greater sense of “superiority” then placing another on one’s service.
11. Psychopathology occurs when an individual experiences “exaggerated feelings of inferiority”. This occurs when 1) an
individual that has a rigid, inflexible lifestyle, and b) diminished Social Interest, c) anticipates -or actively experiences,
failure before a hardship or task that appears insurmountable. A “psychopathology” emerges to counter discouragement and to
protect the self-esteem of the individual and their relationship system (Safeguarding).
“When individuals are discouraged, they often resort to fictional means to relieve or mask -rather than overcome, their
inferiority feelings.” (Stein, & Edwards, 1998). Safe-Guarding behavior, includes
1. Safeguarding Tendencies, include
a) Mistaken Beliefs, including Prejudice, Sexism, and Bigotry
b) Symptoms, from those that excuse or rationalize to those that passive-aggressively control or even punish others
c) Aggression, Suicide, Misbehavior, Criminal Tendencies, Addiction, Hesitancy (laziness, procrastination)
d) Depression, Guilt and Anxiety
2. Safeguarding Childhood Profiles: when children are discouraged, early in life, from thriving as a social beings, from
developing social interest in the welfare of others, they seek to control and nurture their own self interest at the expense of
others. Their life-style becomes characterized by problematic interactional motivations, depending on the level of historic
discouragement: 1) Attention Seeking; 2) Power; 3) Revenge; 4) Inadequacy
3. Safeguarding Adulthood Profiles: discouragement results in characteristic patterns of interacting with the world or
personalities dominated Self Interest and extreme self-protection:
1) Symptom Neurosis (Neurosis); 2) Character Neurosis (antisocialism; sociopathalogy); 3) Psychosis
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Degree of Discouragement

12. Treatment
In its simplest terms, Adlerian Psychotherapy includes
1) attaining insight as to one’s style of life and the mistaken beliefs and safeguarding tendencies that protect the self-worth;
2) encouragement to problem-solve the demands of life and advance in each life task (Work; Friendship; Love); and
3) increasing Social Interest.
Four Phases of Therapy (courtesy of Gerald Corey)
Phase 1: Establishing the Proper Therapeutic Relationship
 Supportive, collaborative, educational, encouraging process
 Person-to-person contact with the client precedes identification of the problem
 Help client build awareness of his or her strengths
Phase 2: Exploring the Individual’s Psychological Dynamics
 Lifestyle assessment (subjective interview; objective interview; family constellation; early recollections; basic
mistakes)
Phase 3: Encouraging Self-Understanding & Insight
 Interpret the findings of the assessment
 Hidden goals and purposes of behavior are made conscious
 Therapist offers interpretations to help clients gain insight into their private logic and lifestyle
Phase 4: Reorientation and Re-education
 Action-oriented phase; emphasis is on putting insights into practice
 Clients are reoriented toward the useful side of life
 Clients are encouraged to act as if they were the people they want to be
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13. Techniques (common Adlerian tactics & techniques)
 Early Recollections, Empty Chair and Other Projective techniques
 Increasing Social Interest, Encouragement and Acceptance
 Active Listening (validation of feelings; differentiation of self from others’ feeling and thoughts)
 Cognitive Restructuring of Mistaken Beliefs
 Teaching Problem-solving and Conflict-resolution Skills (actively reconciling conflicts)
 Making the Covert, Overt to expose intent and hidden power-plays
 “Acting As If”, Role Play and Behavior Rehearsal
 Paradoxical Intention (ie. “You deserve to feel sorry for yourself, in fact, you need to start feeling even more
sorry for yourself to finally be rid of it…”)
 Emotional Regulation (use of Guided Imagery and Fantasy work)
 Spitting in One’s Soup (similar to Covert, Overt, pointing out the real motive or purpose of client’s behavior
(e.g., you’re trying to make me feel sorry for you) to weaken its power
 Push-Button Technique (imagine pleasant situation and note accompanying feeling • Now imagine your
distressing situation & note feelings)
 Miracle Question, Guided Imagery and Fantasy work
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Why have humans always found inspiration in the collective good?
A private meaning is in fact no meaning at all.
Meaning is only possible in communication:
a word which meant something to one person only would really be meaningless.
It is the same with our aims and actions;
their only meaning is their meaning for others.
Every human being strives for significance;
but people always make mistakes if they do not see that their whole significance
must consist in their contribution to the lives of others.
— Alfred Adler

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- Adlerian Pschology; Rudolf Dreikurs, 1949

- Adlerian Pschology; Rudolf Dreikurs, 1949
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Consciousness, is more than some static state of beingness.
It is a striving toward an idealized end or ideal
that we call “self-actualization”.
Its attainment comes through Social Interest,
progressive movement toward empathy
and a deliberate regard for the welfare of all things.
This striving, is what gives meaning and purpose to Life.
- Demetrios Peratsakis, 2021
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“All failures
– neurotics, psychotics, criminals, drunkards, problem
children, suicides, perverts, and prostitutes
– are failures because they are lacking in social interest.”
- Alfred Adler

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Intimacy: an agreement (Trust) to risk hurt and pain (Vulnerability) in order to experience
unconditional acceptance (Love) and belonging in a meaningful way (Worth).
1. Intimacy increases belonging in a meaningful way
2. Belonging in a Meaningful Way = Self-Worth = Mental Health
3. Trauma, unresolved, mars our capacity for love. It makes us self-protecting,
reducing our willingness to risk intimacy due to it’s potential for pain.
Psychological injury is damage to our sense of self-worth
The secret to improving Self Worth:
a) meaningful involvement, in b) meaningful activity, with c) meaningful others.

Maslow’s Self-actualization
(fulfilling one’s inherent potential)
versus
Adler’s Fictional Goal
(Fictionalism; or
moving toward one’s imagined
Self Ideal)
Anti-social
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Self Concept
or “Private Logic”
Is expressed as
our “Personality”,
“Character” or
“Life Style”
Self Ideal
or “Final Goal”
Line of Movement:
All behavior, emotion and activity is consistent with moving
one’s Self Concept toward one’s Self Ideal.
This, is “Purposiveness”.
The Self Ideal is the ultimate –or final,
“fictional goal” toward which we strive.
This Guiding Fiction gives meaning to our behavior.
The Self Concept is an amalgam of our Self
Image, Self Esteem, and Self Ideal.
Every individual develops a Worldview from which they derive a guiding final goal or Self Ideal.
They then create a Life Style -or collection of “fictions”, as a means of achieving that goal.
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Self Ideal
(final fictional goal)
Real Goals/Fictional Goals
(steps toward the ideal)
The Style of Life or Life Style, is our road toward our Self Ideal, our final fictional goal. Our view of ourself, others
and the world is or “Private Logic”, the set of beliefs, ethics and aspirations that guide and mark our movement forward.
The “road” we travel
is called our Life Style
Private
Logic
Private
Logic
Private
Logic
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Core beliefs and Assumptions that Drive Interpretation

“The beliefs, myths, ideas, attitudes, rules, and object projections that underlie the problem
behaviors and perceptions of the problem within the system give purpose to the behavior.
Within this internal framework of logic, the behavior both makes sense and is useful.
The beliefs include goals to be attained that are anticipated, consciously or unconsciously,
to yield either satisfaction and growth through connection, cooperation, and assertion, or
greater safety through aggression, manipulation, or avoidance.
The behavior constitutes the line of movement toward those goals.”
- Robert Sherman (1991)
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Core concepts, the individual’s values and central beliefs about themselves, others
and the world around them are developed early in the life of the family. It is shaped
by the family’s members and their organization (family constellation), attitudes
toward each other and the world (family atmosphere) and the political and ideological
tenets of its kinships (shared narratives) and culture (legacies, myths, morays).
Within this context, each individual develops a characteristic manner of viewing,
interpreting and interacting, called character, personality or style-of-life. It is
comprised of central themes that remain relatively unchanging and that in tandem
comprise the individual’s mind-set or Private Logic.
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“I should be…”
“I should not be…”
“The World is…”
“Life is…”
“People are…”
“Men/Women are…”
“It is good to…”
“It is right to…”
“It is bad to…”
“It is wrong to…”
“I am…”;
“I am not…”
Self
Concept
Ethical
Convictions
(Moral Code)
Self Ideal
Weltbild
The set of convictions one develops about how to belong in a meaningful way with others
We customarily refer to this as personality or character.
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 I am……………. (self-image; self-concept)
 Life is …………… The world is ……………. . People are ……………. . World expects….
(environmental evaluation, environmental scan)
 I should be ………. I should not be ……. (self-ideal)
 I should ……………. (ethical convictions)
 Therefore, I …………. . (my method of operations, based on my conclusions)
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“How do I, seeing myself as I do, in a world such as I view it and
people being what I see them to be, deal with life?”

Private Logic
Presenting
Problem/
Symptoms
Mistaken
Beliefs
Safeguarding
Tendencies
Family of Origin
Myths, Values &
Intergenerational
Legacies
Early
Recollections &
Other Projective
Material
 How I View Myself?
 How I View the World?
 How I view Men?
 How I View Women?
 How I View Sex?
 How I View “Marriage”?
A symbol or metaphor for the
adversity or hardships of one’s life
Genogram: Progenitor of one’s core convictions
and “mistaken” beliefs. The family atmosphere
(temperament and values) and family constellation
(structure, sibling position, nodal events)
Methods of excusing or avoiding failure.
“Yes, but…”;z “If only…”; “It isn’t fair
when…”
Cognitive distortions, prejudices,
bigoty and narratives that reaffirm
one’s interpretation of events.
Selective “Snap-shots”, re-collections,
dreams, fantasies and other vagaries that
we fill in a manner consistent with our
private logic.
There are several tools for building a comprehensive assessment of the individual’s Life Style. A working model -or “snap shot”,
however can be obtained through a close examination of those themes expressed in the individual’s beliefs, emotions and actions.
These are revealed in all projective material, including Early Recollections, dreams, daydreams, artwork, narratives, and stories.
.

“Among the psychological expressions some of the most revealing are individual
memories. Memories are reminders we carry with us of our limits [and strengths]
and the meaning of circumstances. The memory represents the story of my life, a
story I repeat to myself to warn me…and to prepare me by means of past experience
so that I will meet the future with an already tested style of action.”
- Alfred Adler (1931)
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Early Recollection, is a projective technique used to evoke responses that may reveal facets of the individual’s private logic, including currently held
convictions, evaluations, attitudes and biases.
We selectively recall events in a fashion that is consistent with our currently held beliefs and interpretations of ourselves and our relationship with others.
1. ERs should be recalled memories, from before the age of 10 or 12, and not be self-reports;
2. Typically, 5-8 ERs are collected early in the counseling process;
3. The themes are explored with the client for relevance to their current circumstance and outlook on life.
The therapist opens with a simple directive, such as
 “Think back to the earliest thing in your life that you can remember…”
 “Can you remember the first time in your life that you felt this way?”
 “When was the first time that you recall being able to do this?”
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Step 1: Relaxation exercise (Optional)
Step 2: Directive: Early Recollection or Guided Imagery (eyes open of closed)
1. “Let’s try something that many people find helpful…”
2. “Take out a piece of paper and a pen or pencil and put it off to the side.”
3. Now, “I want you to relax (shake off the long day) and think back to the earliest thing in
your life that you can remember; the very first memory you have…”
Alternatives: “Can you remember the first time in your life that you felt this way?”;
“When was the first time that you recall being able to do this?”
Step 3: Exploration
1. “I want you to look around; what do you see?”
2. “Look at where you are and what you are doing”
3. “If others are present, look at where they are and what they are doing”
4. “Do you notice any sounds or smells, colors or impressions?”
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Step 4: Wrap-up
1. “Now I want you to write the memory down”.
2. “This memory has a feel to it, what is the mood or feel of the memory?
What feeling tone does it have?”
3. “If this memory was a story, what Title would it have? Write the title down
above your memory”
4. “To the side, write down how old are you in the memory”
Step 5: Here & Now
“ I want you to imagine that it is a story of you and of your life at this very
moment. Tell me how this memory is true today, right now.”
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Age of Recollection_________ Mood of Recollection:_____________
( Title of Recollection )
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________________________________ .
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Age of Recollection_________ Mood of Recollection:_____________
( Title of Recollection )
Questions:
1. What stands out to you most?
2. How were you feeling at the time? Why was that?
3. Describe how you would like the memory to be. If you could change the memory, what would you change?
4. How is this memory true today?
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Courtesy of Marion Ballla, M.Ed, MSW, RSW, Adlerian Centre, Ottawa,
Ontario
Common Interpretive Questions
1. Attitude towards life
2. Direction of the person’s striving
3. Hints at why a particular movement was chosen
4. Perceived dangers to be avoided
5. Indications of compensatory devices developed to cope with felt inadequacies.
6. Evidence of courage or its lack, thereof
7. Strategies developed for living in the perceived world
8. Preference for direct or indirect methods of coping
9. Type of interpersonal transactions preferred
10. Presence or absence of social interest
11. Values given to affiliation, competence, behavior, status, rebellion, compliance,
security
12. Core wants, needs and motivators
1. Is he/she an observer or participant?
2. Is he/she giving or taking?
3. Does he/she go forth or withdraw?
4. What is his/her physical posture or position in relation to what is around him?
5. Is he/she alone or with others?
6. Is his/her concern with people, things, or ideas?
7. What relationship does he/she place him/herself into with others? Inferior?
Superior?
8. What emotion does he/she use?
9. What feeling tone is attached to the event or outcome?
10. Are detail and color mentioned?
11. Do stereotypes of authorities, subordinates, men, women, old, young, etc.
reveal themselves?
12. Look for interaction with others, what they are doing with each other and with
the viewer.
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111
1. Data Collection
2. Demographics
3. Developmental Milestones
4. Cultural Influences
5. Academic History
6. Spiritual Religious Experiences
7. Family Constellation
8. Nuclear Family Constellation
9. Description of Childhood
10. Family Values
11. Family Atmosphere
12. Parenting Style
13. Gender Models
14. What does intimacy look like
15. Early Recollection
Note: A sample Lifestyle Assessment Worksheet is included in Supplemental Materials slides

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1. Adlerian Life Tasks Inventory- A measures designed to measure an individual's life tasks in relation to cooperation, respect, and responsibility
as well as a person's character development.
2. Adlerian Parenting Education Knowledge Measure- A measure developed to look at parents' perceptions of Adlerian parenting skills and their
application of them to their children as well as to identify how well they relate to their children. This measure was created with two accompanying
subscales to look at knowledge acquisition based on the STEP program which are: Family Values-Parent Version and Family Values-Adolescent
Version.
3. Adlerian Social Interest Scale-Romantic Relationships (ASIS-RR)- This measure was created to look at the construct of social interest as it
applies specficially to the life task of love as well as their interest in belonging to society.
4. BASIS-A- This measure was created as a way to look at an individual's style of life as well as current psychological functioning based on their
early childhood memories of experience.
5. Comparative Feeling of Inferiority Index (CFII)- The CFII is a measure that looks at one's feelings of inferiority based on perceptions that they
have about the self as well as in relation to others. This measure is good for deriving empirically driven conclusions as it relates to inherent
feelings of inferiority based on childhood experiences to support subjective data about the individual.
6. Early Recollections Rating Scale (ERRS)- The ERRS was developed as a way to measure personality traits and variables elicited from Early
Recollections in an objective manner. It can also be used as a way to look at a person's individual beliefs and perceptions based on their lifestyle.
7. The Five Factor Wellness Inventory (5F-Wel)- The 5F-Wel is a measure that was designed for counselors to use to identify and track one's
overall state of well-being. The measure is based on the construct of the life tasks proposed by Adler and used in part to help with identifying
decreases in wellness as well as possible burnout among counselors in training.
8. Kern Lifestyle Scale- This measure was developed as a way to gather information in a quick an efficient manner. It looks at lifestyle information
based on five scales that are linked to Adlerian typologies.
9. Langenfeld Inventory of Personality Priorities (LIPP)- This instrument was developed as a way to look at lifestyle in a different perspective.
The LIPP looks at the lifestyle through personality priorities that a person either adopts or avoids.
Adlerian Assessment Measures

113
10. Life Tasks Self-Esteem Inventory- The Life Tasks Self-Esteem Inventory was developed as a measure to assess one's self-esteem
based on Adler's three primary life tasks of social, work, and love.
11. Lifestyle Personality Inventory (LSPI)- The LSPI is an empirically driven instrument that looks at an individual's personality based
on data that would be derived from the Lifestyle Inventory. The measure itself is a measure that is based on the stability of personality at
a young age and has since its inception been adapted into the formation of the BASIS-A.
12. Manaster-Perryman Early Recollections Manifest Content Scoring Manual (MPERSM)- This manual was developed as a way to
evaluate and gain a deeper depiction of early recollections elicited by an individual in an empirical fashion.
13. Marriage Assessment Instrument- The Marriage Assessment Instrument was developed and designed to be used in marriage
counseling for couples that is based on the Lifestyle Inventory and used to help with understanding the nature of the relationship among
the couple and how to best approach therapy.
14. Organizational Lifestyle Analysis Tool (OLSA)- The OLSA is a measure that is based on the concept of Lifestyle and used for
business and organizational purposes in order to understand how and if a business/organization is functioning the way that it was
intended to. It is a tool that is used to help understand the true structure and belief system of the organization as a whole.
15. Positive Discipline Parenting Scale- The Positive Discipline Parenting Scale was developed and designed to be used as a measure that
evaluates the effectiveness of Positive Discipline Parenting program as well as the impact it has on the parents that take the program and
their overall parenting style.
16. Social Interest Index (SII)- The SII is a measure designed to look at the level of social interest has attained based specifically on the
life tasks of work, love, friendship, and self-significance.
17. Social Interest Index, Short Form (SII-SF)- The SII-SF is a shortened version of the SII developed in effort to look at social interest
with more reliable and valid results. This version of the SII looks at a global level of social interest of an individual.

114
18. Social Interest Scale (SIS)- The SIS was developed as a way to look at social interest based on
specific personality traits and variables that an individual possesses. It is also used as a way to look
at an individual's interest in the welfare, or well-being, of others.
19. Sulliman Scale of Social Interest (SSSI)- This scale was developed to look at the level of social
interest that an individual has based on their present perceptions and beliefs. The SSSI has been
linked to identifying the possibility of pathology being present among an individual.
20. Tasks of Life Questionnaire- This questionnaire was designed as a way to measure the three
primary life tasks (i.e. love, work, and friendship) among an individual. Specifically, it is set up to
get an idea of their level of participation and involvement in each of the life tasks.
21. White-Campbell Psychological Birth Order Inventory- The White-Campbell Psychological Birth
Order Inventory is a measure that was developed as a way to identify and look at one's place within
the family structure based on psychological birth order. The measure itself is a good predictor of
psychological brith order as it pertains to one's perceptions and mode of navigating life based on the
four categories of the only child, first born, middle born, and youngest child.

The Origins of Psychopathology

Ideology: The mistaken belief
that your beliefs are neither beliefs nor mistaken.
-Eric Jarosinski
116

Mistaken convictions that result in faulty adaptation or diminished success in meeting the challenges of life.
Research suggests that people develop cognitive distortions as a way of coping with adverse life events. The more prolonged and
severe those adverse events are, the more likely it is that one or more cognitive distortions will form. Cognitive distortions, or
Mistaken Beliefs, also serve a means of safeguarding the individual and relationship systems sense of worth and self-esteem.
-from The Individual Psychology of Alfred Adler: A systematic presentation in selections from his writings.
(H. L. and R. R. Ansbacher, Eds.). © 1964, Harper & Row, Publishers, Inc; page 183:
“Each . . . (individual) organizes himself according to his personal view of things, and some views are more sound, some less sound. We must
always reckon with these individual mistakes and failures in the development of the human being. Especially must we reckon with the
misinterpretations made in early childhood, for these dominate the subsequent course of our existence.”
117

Advanced Methods in Counseling & Psychotherapy July 2023.pptx

Advanced Methods in Counseling & Psychotherapy July 2023.pptx

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