The Philosophy and Practice of Clinical Outpatient Therapy

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

If anything, I define myself as an Adlerian Family Psychotherapist.
I was first introduced to Adler by Dr. Robert (Bob) Sherman, who guided my work from 1980 until his retirement and
relocation from New York City, in 1992. Sherman, was an AAMFT Clinical Supervisor, author, editor, and co-founder
of Adlerian Family Therapy. He was a long-time Fellow at the North American Society of Adlerian Psychology and
Chair of the Department of Marriage and Family Therapy (MFT) Programs at Queens College which he founded,
where I degreed in MFT, Guidance, and School Administration, and where I served on faculty in 1986 and 1987.
It was my good fortune to participate in small group instruction with the eminent Adlerians Kurt Adler (1980), Bernard
H. Shulman (1980), Harold Mosak (1980-1981) and Larry Zuckerman (1982-1983) and live-practice seminars with
family system theorists 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 and 1991), and Peggy Papp (1992). In 1990, I joined Dr. Richard Belson, Director of the
(Strategic) Family Therapy Institute of Long Island, in a two-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 on
the editorial board of the Journal of Strategic and Systemic Therapies (1981 to 1993).
We are indebted to these remarkable clinicians and the indelible mark they have left on our field.
I am especially grateful to Bob, for his training, his friendship, and for teaching me the miraculous power of “seeing.”
-Demetrios Peratsakis, MSEd, SDSAS, LPC, ACS, CCTP, Executive Director, Western Tidewater Community Services Board
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DISCLAIMER
The purpose of these materials is to help improve on 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 Community Services Board or Agency.
As such, the ideas presented herein are simply those that assist us in our work
and in our understanding of human motivation and pathology.
____________________ . ____________________

Understanding the nature of human behavior and pathology.

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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
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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)
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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.

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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

3. Trauma
ie. Tragedy, Loss, Betrayal
1. Difficulty Adjusting to
Significant Life Changes
(Life-Cycle Processes)
2. Interpersonal Conflict
(Power-Plays and Acts of Betrayal)
Depression
and
Anxiety
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Presenting Problems fall into one of three categories, often triggering one or both of the others
Presenting
Problems

Poor Adjustment
to Change Conflict Trauma
Depression &
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
Normative and para-normative developmental changes that occur across the life-span (Monica McGoldrick)

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
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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 B C
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.

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 Significant Injury Psychological Impact
1. Emotional Pain is fueled by Guilt, Anger and Shame (GASh)
2. It diminishes one’s sense of Worth, which is inextricably tied to others
3. The greatest injury is borne by the trauma of betrayal of a sacred trust
4. Psychological Injury is expressed in the symptoms we call Anxiety and Depression
5. Unresolved, we seek remedies that circumvent the pain but do not reconcile the injury (Avoidance)

Anger
Sadness
Fear
Depression/Anxiety
© 2014 Demetrios Peratsakis
Guilt
Shame
Symptoms of Depression & Anxiety (Biopsychosocial Spectrum Disorder)
 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 me, humiliate and blame me!”
 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 Guild, 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”
=
“Emotions”
“Thoughts”
Same ingredients, different temporal focus.
Ingredients: 3 Primary Emotions + 2 Thought Patterns
(Primary emotions, Anger/Disgust, Fear/Surprise, Sadness, and Joy, develop age 0-6 months).
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.

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
Work on Guilt and Shame
(may be used to negate need to change)
Tap into Anger
1. The guilt and shame must be reconciled,
and their underlying (cognitive)
distortions restructured
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 is: 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.

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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!

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).
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Symptoms
1. Difficulty Adjusting
to Significant Life Changes
(Life-Cycle Processes)
2. Interpersonal Conflict
(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.
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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.

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
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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.

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. Perform the pattern without the symptom
17. Change the sequence of the elements in the pattern
18. Interrupt or otherwise prevent the pattern from occurring
19. Add (at least) one new element to the pattern
20. Break up any previously whole elements into smaller
elements
21. Link the symptoms or pattern to another pattern or goal
22. Reframe or re-label the meaning of the symptom
23. Point to disparities and create cognitive dissonance
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Rule # 1: Narrow broad perspectives
Rule # 2: Broaden narrow perspectives
 Caution client to go slow; predict little or no change
 Predict that the desire to return may wane
 Predict residual anger at therapist for being “pushy”
 Recommend At Least 1 More Meeting
Note: 1-4, Minuchin/Fishman; 5-6, 22, 23, Adler;
7-21, O’Hanlon.
Pattern or element may represent a concrete
behavior, emotion, or family member
Sample methods for introducing doubt, alternative views and new possibilities

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
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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 prefer we do?
“Would you rather I annoy you or waste your time?”
34

“Trauma is a psychological injury or harm to one’s perceived sense of self 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 expressed as depression, inadequacy or failure. 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 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
36
Unresolved, anxiety and trauma result in chronic tension expressed as
“physiological symptoms, emotional dysfunction, social illness or social misbehavior” (M. Bowen).

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. 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).
40

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.
41
This is the beginning of “seeing” human behavior in a different way...

42
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)

Time for a Break!
Let’s Take 5!

- 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).
45

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.
46

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.
49

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)
50
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
51
Study Further!
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
52

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
53

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

61
What is the Purpose of Consciousness?
The desire to feel belonging to others is the fundamental motive in man.
- Adlerian Pschology; 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

The desire to feel belonging to others is the fundamental motive in man.
- Adlerian Pschology; Rudolf Dreikurs, 1949
62
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?

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
63

“All failures
– neurotics, psychotics, criminals, drunkards, problem
children, suicides, perverts, and prostitutes
– are failures because they are lacking in social interest.”
- Alfred Adler

66
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
68

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.
69

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
70

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)
72

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.
73

“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.
74

 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)
75
“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)
78

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?”
79

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?”
80

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.”
81

Age of Recollection_________ Mood of Recollection:_____________
( Title of Recollection )
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________________________________ .
82

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?
84

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.
85

86
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

87
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

88
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.

89
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
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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.”
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Mistaken beliefs -or cognitive distortions, were first described by Alfred Adler as erroneous or problematic
schema by which we make judgements as to who we are and how we should behave.
They shape
a) How we belong with others, family and community
b) Our feelings of worth and interpersonal significance
c) Our sense of safety and feelings of security
1. These develop early in childhood and surround such core conceptualizations as self-concept, self-ideal
and self-esteem. These concepts are fueled by intergenerational narratives, including myths, legends and
legacies. Typically, especially with religious or local customs, there exists a moral imperative attached to
the belief. Implied, is that to breach or violate the “rule” is tantamount to disloyalty or sin.
2. In great part, these very same beliefs can become fundamental impediments to change.
3. The purpose of therapy, therefore, is to challenge or unbalance the power, meaning or purpose of the
existing belief in order to introduce new possibilities. This expands the potential for more adaptive
problem-solving, remedial change, or more enduring growth.
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(Neo-Freudians Aaron Beck/David Burns)
1. All-or-Nothing Thinking / Polarized Thinking “Black-and-White” thinking; inability or unwillingness to
see shades of gray; views toward the extreme
2. Overgeneralization: taking one instance or example and generalizing it to an overall pattern.
3. Mental Filter: Similar to overgeneralization, focus is on a single negative and excludes all the positive
4. Disqualifying the Positive: acknowledging positive experiences but rejecting them instead of embracing
them
5. Jumping to Conclusions – Mind Reading: inaccurate belief, typically a negative interpretation, that we
know what another person is thinking
6. Jumping to Conclusions – Fortune Telling: the tendency to make conclusions and predictions based on
little to no evidence and holding them as gospel truth
7. Magnification (Catastrophizing) or Minimization: either greatly exaggerating or minimizing the
importance or meaning of things
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8. Emotional Reasoning: the acceptance of one’s emotions as fact. It can be described as “I feel it, therefore it must be true.”
9. Should Statements
Statements that you make to yourself about what you “should” do, what you “ought” to do, or what you “must” do. They
are applied to others also, imposing a set of expectations that will likely not be met. We are generally disappointed by the
failure resulting in guilt, perhaps even shame; others not meeting our expectations leads to our disappointment, anger and
resentment
10. Labeling and Mislabeling
Extreme forms of overgeneralization, in which we assign judgments of value to ourselves or to others based on one
instance or experience. Mislabeling refers to the application of highly emotional, loaded language when labeling.
11. Personalization
Taking everything personally or assigning blame to yourself for no logical reason to believe you are to blame. This
distortion covers a wide range of situations, from assuming you are the reason a friend did not enjoy the girl’s night out
because of you, to the more severe examples of believing that you are the cause for every instance of moodiness or
irritation in others.
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12. Control Fallacies
A control fallacy manifests as one of two beliefs: (1) that we have no control over our lives and are helpless victims of fate,
or (2) that we are in complete control of ourselves and our surroundings, giving us responsibility for the feelings of those
around us. Both beliefs are damaging, and both are equally inaccurate.
13. Fallacy of Fairness: contrary to popular belief (or hope) life is inherently unfair
14. Fallacy of Change: expecting others to change and tying our happiness to it
15. Always Being Right: that we must always be right, correct, or accurate.
16. Heaven’s Reward Fallacy: the belief that one’s struggles, one’s suffering, and one’s hard work will result in a just reward

Common Cognitive Distortions or Irrational Beliefs listed by Neo-Adlerian, Albert Ellis (REBT)
1. I must do well and get the approval of everybody who matters or I will be a worthless person.
2. Other people must treat me kindly and fairly or else they are bad.
3. I must have an easy, enjoyable life or I cannot enjoy living at all.
4. All the people who matter to me must love me and approve of me or it will be awful.
5. I must be a high achiever or I will be worthless.
6. Nobody should ever behave badly and if they do I should condemn them.
7. I mustn’t be frustrated in getting what I want and if I am it will be terrible.
8. When things are tough and I am under pressure I must be hopelessly miserable.
9. When faced with the possibility of something frightening or dangerous happening to me I must obsess
about it and make frantic efforts to avoid it.
10. I can avoid my responsibilities and dealing with life’s difficulties and still be fulfilled.
11. My past is the most important part of my life and it will keep on dictating how I feel and do.
12. Everybody and everything should be better than they are and, if they’re not, it’s awful.
13. I can be as happy as is possible by doing as little as I can and by just enjoying myself.
Ellis’ Irrational Beliefs
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Pillari described 7 different types of family myths, “fairly well-integrated beliefs that are shared by all family
members concerning their role and status in the family” (Pillari, V.; 1986 NY, Brunner/Mazel). Family Myths are
excellent examples of “shared” cognitive distortions.
1. Harmony: The use of denial, dissociation, avoidance, and somatization to gloss over or negate hostilities,
conflicts and disagreements to preserve a pretext of happiness.
2. Family Scapegoat: The selection of one member to serve as the family’s reservoir of distress and blame, the
source of the family’s main problems and target of their anger.
3. Catastrophism: The myth that in order to avoid dire and tragic consequences the members must collude to
limit information, keep secrets and restrict interaction lest dissolution occur.
4. Pseudomutuality: “Good” families agree and do not vary in their expressions or beliefs. Disagreement,
independence, and the development of individual identities is discouraged.
5. Overgeneralization: family members are defined by restricted or narrow roles that carry relatively
unchanging expectations irrespective of the circumstances. The “good” child is always “good”, the
“incompetent” one always wrong or inadequate despite the situation.
6. Togetherness: “Trust no one!” Others outside the family are inherently untrustworthy and unreliable; only
family can be relied on and “nothing is thicker than blood”.
7. Salvation & Redemption: Someone will come save us; some outside agent, event or person will help us,
relieve us from our pain or forestall our misery and lessen our hardship or trauma.
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1. Overgeneralizations
2. False or Impossible Goals
3. Misperceptions of Life and Life's Demands
4. Denial of One's Basic Worth
5. Faulty Values
- Harold H. Mosak and Rudolf Dreikurs (1973)
98

99
Bernard Shulman, MD (1973) categorized “mistaken” beliefs into
6 categories based on Alfred Adler’s work:
1. Distorted attitudes about Self (“I am less capable than others”)
2. Distorted attitudes about the World and People (“People are hurtful”; “Men will always
let you down”)
3. Distorted Goals (“I must be perfect”; “I must win at all cost”)
4. Distorted Methods of Operation (ie. excessive competition; procrastination; avoidance)
5. Distorted Ideals (“ a real man…..”; “women should always…”)
6. Distorted Conclusions (“Life is…”; “I am a Failure/Victim…”)

1. Look for rigidity and inflexibility in rules, expectations, and outlook
2. Look for conflict (guilt and shame) created between ideal vs actual performance
3. Look for extremes such as “Must” and “Should”, “Never” and “Always”
 Trace it in the family lineage (genogram); ie “Whose rule is that?”
 Examine Pluses and Minuses to broaden narrow perspectives
 Examine how it is used to reaffirm convictions that preserve one’s sense of
self, self-esteem or loyalty to family
 Examine what “breaking” the rule means and how that justifies retaining the
conviction
 Examine the purpose of the conviction or the benefit its conflict, shame or
guilt provides. Often, while negative, suffering can entail a sense of
“nobility”
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Goals & Developmental Context of Socialization

“The human community sets three tasks for every individual:
1. Work: contributing to the welfare of others;
2. Friendship: building social relationships with friends and relatives; and
3. Love: establishing (sexual) intimacy with a partner.
These three tasks embrace the whole of human life with all its desires and activities.
All human suffering originates from the difficulties which complicate the tasks”
- Rudolf Dreikurs, 1953
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The Tasks of Life are shaped by and, in turn, shape our Private Logic, which molds the Style of Life or our
movement toward our Self Ideal, our Final Fictional Goal. We can gain insight into the Private Logic and Life Style,
by examining the themes that shape our ideas, behaviors and emotions. Each is a reflection of both our immediate
goals and our final, fictional goal. We can always see “purpose” in the activity and its intended outcome.

The Tasks of Life provide opportunity for continuous socialization
and the development of meaningful, intimate relationships.
Intimacy, requires empathy, the driving conviction of Social Interest.
Improving empathy, will improve the development of meaningful
relationships and, in turn, success in the Tasks of Life.
10
3

The need to cooperate and build community, to belong and to share, for comfort, protection, resource
development, and a means of pooling information and innovation (culture). –evolutionary advantage.
1. Occupational Choice (who we are moves what we choose to do or to be known by others)
2. Occupational Preparation (being trained and training others builds worth and confidence)
3. Satisfaction (daily and career goals that shape movement toward our final goal or self-ideal)
4. Leadership
5. Leisure
6. Socio-vocational (relationships with colleagues is an important part of community)
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Cohesion, attachment and bonding. The creation and expansion of culture (innovation,
information) -evolutionary advantage
1. Belonging
The sense of being accepted and cared for by others, of being valued, is the
fundamental driving force of humankind. It is directly responsible for the abatement
of one’s sense of vulnerability and inferiority.
Belonging = 1
inferiority
2. Transactions
How we interact with others
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Intimacy, bonding and the foundation of procreation and parenting. This is the most demanding and
rewarding of adult relationships.
1. Sexual Sex Role Definition (What is Man? A Woman?)
2. Sexual Sex Role Identification (Masculinity; Femininity)
3. Sexual Development (puberty, secondary sexual characteristics, menstruation, masturbation, et al)
4. Sexual Behavior
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While Adler identified only 3 Tasks of Life, Mosak, Dreikurs and some neo-Adlerians
expanded this conceptual framework to include 2 others, the Self Task and the Spiritual Task.
107
The Spiritual Task
1. Relationship to God
2. Religion
3. Relationship to the Universe
4. Metaphysical Issues
5. Meaning of Life
The Self Task
1. Survival
2. Body Image
3. Opinion
4. Evaluation

Protecting the Self from Guilt & Shame

Constructive Coping Behavior
1. Direct Problem Solving
2. Compensation
a) Compensation within the same area
b) Compensation in a different area
c) Overcompensation
Unconstructive Coping Behavior
Patterns of protective behavior -called “safeguarding tendencies” that
secure the self-esteem against social rejection, ridicule or disgrace.
Protection against
a) Threat to the physical self;
b) Threat of de-valuation by others;
c) Loss of self-esteem
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Life is filled with challenges, obstacles and potential dangers that must dealt with and resolved.
The degree of our perceived success or failure adds or detracts from our sense of self esteem.

Safeguarding
 is often passive-aggressive
 conceals one’s true convictions and intent
 rationalizes one’s behavior and style of life
 upholds a pretext of nobility
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”
2. Aggression/Guilt -violence, belligerence, criticism or hostility toward self or others
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 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
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3. Withdrawal
Maturation is slowed or halted by avoiding the challenges and hardships of everyday life.
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.
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.
4. Symptoms
Symptoms 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)
111

According to Bernard Shulman, MD (1964) there
are 9 perceived dangers we protect against:
1. Being defective
2. Being exposed
3. Incurring disapproval
4. Being ridiculed
5. Being taken advantaged of
6. Getting necessary help
7. Submitting to order
8. Facing responsibility
9. Facing unpleasant consequences
Shulman, Mosak and Maniacci point to 17 defenses
1. Externalization
2. Blind Spots
3. Arbitrary Rightness
4. Elusiveness & Confusion
5. Retreat
6. Contrition and Self-disparagement
7. Suffering (manipulation; justification; self-
glorification/nobility)
8. Sideshows
9. Rationalization
10. Intellectualization
11. Identification
12. Buying Double Insurance
13. Literalism
14. Fantasy
15. Displacement
16. Doctrine of Balances
17. Reaction Formation
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1. Attention Seeking behavior
2. Power displays and Power-plays
3. Revenge (acts of punishment and vengeance)
4. Failure or Displays of Inadequacy
5. Partner Discord
6. Dysfunction in One of the Partners
7. Dysfunction in One or More of the Children
8. Emotional Cut-off , including expulsion, escape, or becoming the “black sheep”
* 1-4, Alfred Adler; 5-8, Murray Bowen
Symptoms, fueled by “mistaken” beliefs, develop as a means of protecting the self from harm
(safeguarding behavior) and may express as individual or relationship patterns of control and power.

Extreme Psychological Safeguarding

116
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

117
Healthy Approach to Life’s Demands
Plays by the Rules
The greater majority of people, despite periodic safe-guarding behavior. Healthy individuals continue to exercise social
interest over self-interest and see genuine value in problem-solving life’s challenges, seeking support and intimacy from
others, and working to support the common good. This takes cooperation and trust or vulnerability to hurt and betrayal
(love). Accepts disappointments and set-backs; accepts own foibles and imperfections yet strives to excel and improve.
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;
 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.

Extreme Safeguarding, from Symptom Neurosis to Character Neurosis to Psychosis

"Nobody adopts antisocial behavior
unless they fear that they will fail if they
remain on the social side of life.“
-Alfred Adler
119

120
We are social beings.
When we withdraw, isolate or are cutoff from social activation
it increases tension and mars our capacity to engage.
It is an aggressive form of avoidance!
The isolation is at once stress reducing and tension increasing.

Assuming that organicity has been ruled out, Adlerian Psychology sees neurosis and
psychosis as purposive syndromes created by the individual to protect themselves
from the risk of failure at the demands of life.
This, remarkable perspective normalizes our understanding of these conditions as
complex, safe-guarding strategies.
They protect a fragile sense of self wherein the individual does not believe they are
capable of successfully meeting the demands of life and either seek to be exempted
from the rules (symptom neurosis), defy the rules (character neurosis or
antisocialism/sociopathology), or negate the rules and substitute ones of their own
creation (psychosis).
121

Demetrios Peratsakis, LPC, ACS, CCTP; 2020
1. Failure results in feelings of guilt and shame; critique by others, in anger
2. Failure and shame increase avoidance
3. Avoidance helps mitigate responsibility for change and buffers feelings of failure and
shame.
4. Unfortunately, avoidance negates accomplishment and the nourishment and confidence
it provides, furthering the sense of worthlessness.
5. Shame results in fear of intimacy or the risk of exposure of one’s inadequacy
6. The greater the sense of failure the greater the tendency to avoid

123
Symptom Neurosis as Safeguarding
Symptom Neurosis - To be Exempt from the Rules
Approach to Challenges: “I know the rules but want to be excused from them, judged less harshly, or be seen in a more favorable light!”
Safeguarding through seeking distance and making excuses, blaming others or circumstances.
Often expresses as anxiety, depression, somatoform conditions, adjustment disorders, et al.
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!”
 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.

 Neurosis, is defined as a “Yes, but…” condition. The individual recognizes the requirements and
demands of living (“Yes, I see what is required of me…”) but seeks an exemption (“but I can’t or
don’t want to do it because…”) through various pretexts, including the development of symptoms.
Alternatively stated: “If only so-and-so was/wasn’t the case I would have faired much better”.
 Viewing behavior from this perspective provides the clinician with remarkable clarity into the control
and power issue that earmark such passive-aggressive conditions as addiction, depression or eating
disorders. A more aggressive stance is taken by those we term “character neurosis” or individuals
exhibiting antisocial or sociopathic behaviors. They acknowledge the demands of life but choose to
defy them as a false measure of their own control, power, or superiority over others. Character
Neurosis is a more complex syndrome, a more rigid form of neurotic tendency.
 At the core of such safeguarding tendencies is the need to mask a perceived sense of inadequacy. The
feelings of vulnerably and worthless are real, as is the acute suffering the individual experiences. It is,
in fact, this very experience that adds legitimacy to the individual’s plight and ties others into excusing
or enabling their conduct
124

125
Character Neurosis as Safeguarding
Symptom Neurosis
Exempt from Rules
“Yes, but…”
“If only…”
less harshly.
Character Neurosis
Defy the Rules
“F-You!”
 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.
Expulsion.
Character Neurosis - Defy the Rules!
The Goal is to feel that one has gotten over or gotten even or simply surpassed customary rules of conduct. This provides a false sense of superiority.
Approach to Challenges: “I’m above the rules; they don’t apply to me!”; “I must be important or special if I can circumvent the rules or control
others by the enforcement of my own.
Safeguarding through rigid, often antisocial control. Expresses as sociopathology, personality disorders (paranoid, borderline, narcissistic, schizoid),
histrionic disorders, addiction, criminality, behavior with high degree of Self Interest.

1. Character Neurosis (Antisocial/Sociopathic) Lifestyles appear to originate in family of origins characterized by a lack of
empathy and low tolerance for mistakes. This may arise out of neglect and abuse or else excessive “spoiling” – a parenting style
that conveys the child is special or somehow more important than others; that one may use or take from others without giving
(selfishness), that the negative consequences of one’s actions can be muted, or that one does not have to assume full
responsibility for their behavior, attitude and actions.
2. Character Neurotics strive for power, dominance and superiority over others as a means of over-compensating for feelings of
inferiority, inadequacy and worthlessness.
 The greater the intensity of these feelings the more aggressive the drive to control;
 It may express in passive-aggressive ways or as aggression, a striving for domination. The inherent defiance and arrogance
(vanity) is a coping method that falsely increases one’s sense of prestige and power: “If I can defy the rules, I must be
special”;
 Antisocial, thrill-seeking behavior may be present, including acts of immorality, illegality, predation, or violence against
others, as these increase the sense of omnipotence and may, for some, increase sexual arousal and pleasure. The pleasure-
seeking and excitement also reduce painful experiences of guilt and shame, as well as of self-loathing.
 The more antisocial, the greater the sense of worthlessness/greater the lack of “social interest” or empathy.
 Anger is misused to empower the self, control, and to justify victimization of others. It may deepen into prolonged rage and
express as either Revenge or Domination; men are enculturated to bravado and chauvinism and more greatly prone to
domination depending on their level of perceived inferiority.
 To retain the anger, the harm or emotional pain must continually be reactivated (rumination), often in the form of self-pity
or blame. The anger also creates emotional distance, staves off intimacy, and blunts impact to others.
 The Anger may express as abuse or sexual perversion or as a passive-aggressive power-struggle, such as depression, sexual
inadequacy, addiction, compulsions, or eating disorders.
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127
Psychosis . . . appears to us as the mental suicide
of an individual who does not believe himself adequate
to the demands of reality and to his own goals.
- Alfred Adler, Founding Theorist

128
Psychosis as Safeguarding
Symptom Neurosis
Exempt from Rules
“Yes, but…”
“If only…”
less harshly.
Character Neurosis
Defy the Rules
“F-You!”
 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.
Expulsion.
Psychosis -Negate the Rules
Approach to Challenges: “I will create my own rules so that I do not fail!”
The Goal is ostracism; to be left alone and isolated. Expulsion. Safeguarding through aggressive
avoidance, delusions, hallucinations, often antisocial behavior.
Safeguarding through seeking extreme distance, removing oneself from responsibility and creating a
world narrative wherein one’s own facts supersede those of others.

129
The goal of psychosis is to be left alone and, thereby, to escape responsibility for meeting the
demands of life. The isolation it creates limits the individual’s ability to belong with others in a
meaningful way. This, in itself, deepens one’s inability to meet these demands and the individual
becomes trapped in a world of their own creation.
 Psychosis, is defined as a “No!”, an abject refusal to participate in the demands of life. The
psychotic negates the common sense of the community and plays by their own rule-book. They
escape into a world of their own creation, continuously reinforcing its rules, roles and outcomes
through delusions and hallucinations. The individual does not believe themselves adequate to
the demands of reality and have developed a means by which to retreat from it.
 Neurosis and psychosis both mask a perceived sense of inadequacy. The feelings of vulnerably
and worthless are real, as is the acute suffering the individual experiences. It is, in fact, this very
experience that adds legitimacy to the individual’s plight and ties others into excusing or
enabling their conduct. Their sense of guilt, shame and sorrow, as well as their constant
experience of dread and fear of exposure, fuel their sense of inadequacy and while
“unwelcome” preserves their sense of control.

Mistaken Beliefs/
Shared Cognitive
Distortions
Stereotypes
Prejudice/Bigotry`
Over-valued Beliefs
Obsessions
Fanaticism
Delusions Hallucinations
1. Beliefs endure despite information to the contrary;
2. Delusions, Voices and Hallucinations are closed, feedback loops that continuously self-
reinforce the thematic convictions (rumination);
3. The underlying intent or purpose of the internal discourse (delusion) is to reaffirm the
individual’s safety protocols, or safe-guarding behavior,
4. While content contains the artifacts of the monologue, emotions convey the individual’s
state of affairs at any given time; the ‘voices’ are merely ‘activating events’ or triggers.
Demetrios Peratsakis, LPC, ACS © 2020
Distortions
may be
scaled by
degree

132
Rigid, concrete metaphoric communications (structures) similar to a pictorial
representation of a narrative: beliefs communicated as themes through “externalized voices”,
delusions and hallucinations inextricably tied with feelings and emotional tone.
1. Delusions and Hallucinations reaffirm belief structures
2. Delusions and Hallucinations amplify power and prestige
3. Delusions and Hallucinations are stress reducers
4. Chaotic behavior amplifies distraction from the experience of pain and serves as a
means of retaining or obtaining control. Similarly, disorganized behavior is a method
of controlling others as well as a means of avoiding responsibility for change.
5. Bizarre behavior assures isolation and lowers expectations from others.

1. I am important and powerful, even though I don’t feel so
2. I am stronger, more righteous and better than others
3. Others betray you; don’t trust others
4. I don’t matter; Don’t trust others; Others will hurt you
5. I don’t matter
133
1. Superior Achievement/Leadership:
Preoccupation with grandiosity, aggrandizement or
impressing others
2. Control/Dominance Aversion:
Preoccupation with religiosity; avoiding others’ attempts to
control or dominate them
3. Intimacy/Sexuality:
Absence of an intimate relationship or conflict and
jealousness, a belief that that one’s friend or lover has been
unfaithful or betrayed them
4. Social Alienation/Inferiority
Preoccupation with diminished sense of worth, persecution,
or being an outsider
5. Annihilation Anxiety
(preoccupation with death, injury or vulnerability)
Re-affirming Message
Category or Theme of Preoccupation
* Jakes, Rhodes and Issa, 2004
Why do most psychotic delusions seem to be about power, worth and omnipotence?

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