This is a brief presentation on two well-known theoretical orientations in mental health counseling practice, with a focus on the use of these approaches in the treatment of alcohol use disorder. The theoretical approaches of Alfred Adler and Carl Rogers to the psychological conceptualization of the disorder are discussed, together with a sketch of the general shape of the treatment program prescribed by each of these counseling theories. This presentation might be useful as an specific application of the Adlerian and Rogerian approaches to psychotherapeutic treatment, particularly within an undergraduate or lower-level graduate course in psychology, mental health counseling, or addiction counseling.

1. Counseling for Alcohol Use Disorder
Adlerian and Rogerian Approaches
Jeffrey A. Ahonen

2. Counseling for Alcohol Use Disorder
• Alcohol use disorder is a common mental disorder in the United States
Adult men -- 12.4% Adult women -- 4.9%
Children (12-17) -- 4.6% Seniors (65+) -- 1.5%
(APA, 2013, p. 493)
• Certain mental disorders are frequently comorbid with alcohol use disorder
Bipolar disorder Antisocial personality disorder
Anxiety disorders Depressive disorders
(APA, 2013, pp. 496-497)
Every mental health counselor might expect to encounter a client
who presents with symptoms of alcohol use disorder

3. Counseling for Alcohol Use Disorder
• Sharf’s (2016) survey of major counseling theories illustrates the use of
techniques from a range of theoretical orientations for treating alcohol use
disorder
Cognitive therapy (Sharf, 2016, pp. 413-415)
Existential therapy (Sharf, 2016, pp. 194-195)
Gestalt therapy (Sharf, 2016, pp. 274-275)
Rational-emotive behavioral therapy (Sharf, 2016, pp. 369-370)
Reality therapy (Sharf, 2016, pp. 460-461)
As a supplement to this textbook material, this presentation considers
the approaches of Adlerian therapy and Rogerian therapy

4. Adlerian Therapy
• Alfred Adler believed that personality is formed through social interaction with
family and community members (Sharf, 2016, p. 7).
• The style of life is directed toward “becoming” a better person, by overcoming
inferiority from earlier life and achieving mastery (Sharf, 2016, p. 129).
• The lifestyle also strives for development of the social interest, in which the
person’s attitudes and interests are oriented toward advancing not merely the
self, but the whole of the society (Sharf, 2016, p. 130).
• Adlerians’ dual emphases on the individual as a whole person and on the
individual’s interconnection with his society view the individual as a creative
and goal-directed individual who is responsible for his own fate (Sharf, 2016,
pp. 128-129).

5. Adlerian Therapy – Alcohol Use Disorder Conceptualization
• In the classic Adlerian conception, alcohol use disorder arises from a
perceived inferiority within the person, experienced as sense of
incompleteness and lack of fulfillment. The person’s drive to create impels
him to strive toward that which he believes brings about completion and
fulfillment (Pienkowski, n.d., “Inferiority Feeling”).
• This striving, which may start with a superiority complex featuring a longing
for power, seeks out an “illusion of significance” in order to overcome the
inferiority feeling, rather than striving for genuine significance (Pienkowski,
n.d., “Striving for Significance”).
• At this point, the person suffering the disorder has a very narrow view of
community, which is quite self-centered and does not extend far beyond the
self (Pienkowski, n.d., “Feeling of Community”).

6. Adlerian Therapy – Alcohol Use Disorder Conceptualization
• Further, the addicted person’s view of the final goal is vain and unrealistic,
and he is guided toward achieving an unreachable goal without the requisite
work and pain (Pienkowski, n.d., “Fictional Final Goal”).
• The afflicted person’s style of life typically is self-indulgent, and features all-
or-nothing thought patterns that lead to avoidance of personal responsibility
(Pienkowski, n.d., “Style of Life”).
• This person’s view of the self and the world limits the ability to make realistic
judgments, while simultaneously directing motivation toward the fictional final
goal and maladaptive style of life (Pienkowski, n.d., “Antithetical Scheme of
Apperception”).

7. Adlerian Therapy – Alcohol Use Disorder Conceptualization
• The person’s maladaptive lifestyle affects organic functions within the body,
since these are dominated by the style of life (Pienkowski, n.d., “Organ
Inferiority”).
• Similar to a child’s need to develop a feeling of security, the addict develops a
scheme for rigidly classifying self, others, and experiences in response to a
feeling of entitlement that justifies the addictive behavior (Pienkowski, n.d.,
“Private Logic”).
• Social interest – the capacity for generating cooperation and interconnections
with others – is limited by the lack of the addict’s contribution to society
(Pienkowski, n.d., “Cooperation/Social Interest”).

8. Adlerian Therapy – Alcohol Use Disorder Treatment
• The therapeutic task begins with the identification of the client’s specific
inferiority feeling and guidance toward recognizing and conquering it
(Pienkowski, n.d., “Inferiority Feeling”).
• To address the “illusion of significance,” the therapist works with the client to
find a genuine significance to overcome the inferiority feeling (Pienkowski,
n.d., “Striving for Significance”).
• The self-centered and narrow view of community is expanded to extend the
feeling of community to encompass everyone (Pienkowski, n.d., “Feeling of
Community”).

9. Adlerian Therapy – Alcohol Use Disorder Treatment
• The view of the final goal is lowered to a realistic, achievable level.
(Pienkowski, n.d., “Fictional Final Goal”).
• The therapist works with the client to displace the present style of life with
one featuring self-discipline and acceptance of responsibility (Pienkowski,
n.d., “Style of Life”).
• The person’s “black-or-white” pattern or perception is transformed as the
client is taught to perceive “greyness” and nuance (Pienkowski, n.d.,
“Antithetical Scheme of Apperception”).

10. Adlerian Therapy – Alcohol Use Disorder Treatment
• Organic inferiorities within the body are addressed through abstinence from
alcohol, together with improvements in diet and exercise regimens
(Pienkowski, n.d., “Organ Inferiority”).
• Feelings of self-entitlement are replaced through the development of a sense
of obligation toward others (Pienkowski, n.d., “Private Logic”).
• The final therapeutic goal is the development of an unlimited, unconditional
social interest, manifested in the client’s believing and acting that his sobriety
is not only in his best interest, but in the best interest of society at large
(Pienkowski, n.d., “Cooperation/Social Interest”).

11. Rogerian Therapy
• The Rogerian approach, also called Person-Centered Therapy, eschews
diagnosing patients and dispensing advice to them; instead, it advocates
unconditional acceptance of the client and an atmosphere of trust in which
the client is given responsibility for making positive change in his life (Sharf,
2016, pp. 7-8).
• The core of Rogerian therapy is the implementation of the six necessary and
sufficient conditions for bringing about personality or psychotherapeutic
change, developed by Rogers (1957), who opined that change would occur in
the client of all six of the following conditions were met (Sharf, 2016).

12. Rogerian Therapy
1 Psychological contact – The counselor and client are capable of having a
therapeutic impact on each other (Sharf, 2016, p. 219).
2 Incongruence – The client’s perception of himself and his actual
psychological experience are not in harmony, the awareness of which opens
the client to the therapeutic experience (Sharf, 2016, p. 219).
3 Congruence/Genuineness – The therapist’s perception of himself and his
actual psychological experience are in harmony, and the therapist
is able to be empathic and to communicate that to the client with real feelings
and attitudes toward the client in play (Sharf, 2016, pp. 219-220).

13. Rogerian Therapy
4 Unconditional positive regard or acceptance – The therapist must have no
conditions for acceptance of the client, accepting and appreciating the client
as he presently is, with positive regard (Sharf, 2016, pp. 220-221).
5 Empathy – The therapist is able to enter into another person’s life and world
without the influences of his own viewpoints and values, yet maintain the
separation between the selves of therapist and client (Sharf, 2016, p. 222).
6 Perception of empathy and acceptance – It is important for the therapist not
only to unconditionally accept and empathically understand the client, but
also to communicate clearly to the client that she is understood and accepted
(Sharf, 2016, pp, 222-223).

14. Rogerian Therapy – Alcohol Use Disorder Conceptualization
• In Rogerian therapy, a client presenting with symptoms of alcohol use
disorder would not be diagnosed as such (Sharf, 2016, p. 218).
• For the Rogerian therapist, assessment of the client and his condition occurs
as the therapist empathically understands the experience and needs of the
client (Sharf, 2016, p. 218).
• This takes place in a nondirective way, which Rogers considered very
important to the therapeutic process, with the therapist reflecting on the
client’s experiences rather than asking questions or making suggestions
(Sharf, 2016, p. 219).

15. Rogerian Therapy – Alcohol Use Disorder Treatment
• Rogers (1961) identifies several stages of a client’s therapeutic progress,
ranging on a spectrum from closed, not self-aware, not open to experience,
open to experience, self-aware, and positive self-regard (Sharf, 2016, pp.
225-226).
• Patients often proceed at different rates on different issues, being quite open
to some and less open to others (Sharf, 2016, p. 226). Individuals at the
beginning stages of openness to change are unlikely to express feelings or
take responsibility for them; at advanced stages, they are able to experience
and express feelings to the therapist (Sharf, 2016, p. 226). Throughout the
process, clients grow more congruent, that is, more aware of their own
feelings (Sharf, 2016, p. 226).

16. Rogerian Therapy – Alcohol Use Disorder Treatment
• With progress in therapy, addicts come to understand how they have
contributed to their own problems and ought not to blame others for them
(Sharf, 2016, p. 226). Experiencing genuineness, acceptance, and empathy
from the counselor leads to changes in how the client relates to others (Sharf,
2016, p. 226).
• As the addiction client progresses, he approaches Rogers’s conception of the
fully functioning person, able to share openly his shame, fears, and anxieties
in the presence of the therapist (Sharf, 2016, p. 226). He learns to trust his
own experience, feel a sense of richness in his life, become physiologically
more relaxed, and experience life more fully – free of the bottle (Sharf, 2016,
p. 226).

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

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

19. References
American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Pienkowski, D. (n.d.). Substance abuse from a classic Adlerian perspective.
Retrieved from http://www.adlerian.us/aa-1.htm
Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic
personality change. Journal of Consulting Psychology, 21, 95-103.
Sharf, R. S. (2016). Theories of psychotherapy and counseling: Cases and
counseling (6th ed.). Boston, MA: Cengage Learning.