Diagnosis

In order to help you to discover the “fictions” your lifestyle is based upon, Adler would look at a great variety of things — your birth-order position, for example. First, he might examine you and your medical history for any possible organic roots to your problem. A serious illness, for example, may have side effects that closely resemble neurotic and psychotic symptoms.

In your very first session with you, he might ask for your earliest childhood memory. He is not so much looking for the truth here as for an indication of that early prototype of your present lifestyle. If your earliest memory involves security and a great deal of attention, that might indicate pampering; If you recall some aggressive competition with your older brother, that might suggest the strong strivings of a second child and the “ruling” type of personality; If your memory involves neglect and hiding under the sink, it might mean severe inferiority and avoidance; And so on.

He might also ask about any childhood problems you may have had: Bad habits involving eating or the bathroom might indicate ways in which you controlled your parents; Fears, such as a fear of the dark or of being left alone, might suggest pampering; Stuttering is likely to mean that speech was associated with anxiety; Overt aggression and stealing may be signs of a superiority complex; Daydreaming, isolation, laziness, and lying may be various ways of avoiding facing one’s inferiorities.

Like Freud and Jung, dreams (and daydreams) were important to Adler. He took a more direct approach to them, though: Dreams are an expression of your style of life and, far from contradicting your daytime feelings, are unified with your conscious life. Usually, they reflect the goals you have and the problems you face in reaching them. If you can’t remember any dreams, Adler isn’t put off: Go ahead and fantasize right then and there. Your fantasies will reflect your lifestyle just as well.

Adler would also pay attention to how you express yourself: Your posture, the way you shake hands, the gestures you use, how you move, your “body language,” as we say today. He notes that pampered people often lean against something! Even your sleep postures may contribute some insight: A person who sleeps in the fetal position with the covers over his or her head is clearly different from one who sprawls over the entire bed completely uncovered!

He would also want to know the exogenous factors, the events that triggered the symptoms that concern you. He gives a number of common triggers: Sexual problems, like uncertainty, guilt, the first time, impotence, and so on; The problems women face, such as pregnancy and childbirth and the onset and end of menstruation; Your love life, dating, engagement, marriage, and divorce; Your work life, including school, exams, career decisions, and the job itself; And mortal danger or the loss of a loved one.

Last, and not least, Adler was open to the less rational and scientific, more art-like side of diagnosis: He suggested we not ignore empathy, intuition, and just plain guess-work!

Therapy

There are considerable differences between Adler’s therapy and Freud’s: First, Adler preferred to have everyone sitting up and talking face to face. Further, he went to great lengths to avoid appearing too authoritarian. In fact, he advised that the therapist never allow the patient to force him into the role of an authoritarian figure, because that allows the patient to play some of the same games he or she is likely to have played many times before: The patient may set you up as a savior, only to attack you when you inevitably reveal your humanness. By pulling you down, they feel as if they are raising themselves, with their neurotic lifestyles, up.

This is essentially the explanation Adler gave for resistance: When a patient forgets appointments, comes in late, demands special favors, or generally becomes stubborn and uncooperative, it is not, as Freud thought, a matter of repression. Rather, resistance is just a sign of the patient’s lack of courage to give up their neurotic lifestyle.

The patient must come to understand the nature of his or her lifestyle and its roots in self-centered fictions. This understanding or insight cannot be forced: If you just tell someone “look, here is your problem!” he or she will only pull away from you and look for ways of bolstering their present fictions. Instead, A patient must be brought into such a state of feeling that he likes to listen, and wants to understand. Only then can he be influenced to live what he has understood. (Ansbacher and Ansbacher, 1956, p. 335.) It is the patient, not the therapist, who is ultimately responsible for curing him- or herself.

Finally, the therapist must encourage the patient, which means awakening his or her social interest, and the energy that goes with it. By developing a genuine human relationship with the patient, the therapist provides the basic form of social interest, which the patient can then transfer to others.
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