Adlerian Therapy and CBT: A Personal Counseling Orientation

Introduction: Two Guiding Theories

Two main theories have largely influenced my counseling practicum as a nurse: Adlerian therapy and cognitive behavioral therapy (CBT). The two theories are almost entirely distinct from one another, yet I have used both separately and in combination to guide my practice.

Adlerian therapy is an offshoot of psychoanalysis and is psychodynamic in character. It incorporates theories about family dynamics and the constellation of factors affecting client behavior, as well as ideas about the client's need to achieve meaning through work and social contribution. CBT, by contrast, takes a more general stance and uses cognition as its base. It asserts that thought and behavior direct the individual, and therefore the counselor helps the client investigate the thoughts driving their actions. The client is then assisted in shaping their environment and implementing behaviors that lead to more constructive outcomes.

CBT is thus almost entirely distinct from Adlerian therapy. The counselor is also more directive in Adlerian therapy, whereas in CBT the counselor shows the client how thoughts and environment are affecting them and then helps the client modify these — but the actual work of change remains the client's responsibility.

The way I see these two approaches helping me is that Adlerian therapy provides background theory about the workings and motivations of the client, while CBT provides parameters and a practical guideline for the counseling process. Although Adlerian therapy also offers strategies, I find that integrating Adlerian ideas with CBT strategies is the approach that works best for my orientation toward clients.

Theorists Who Shaped This Orientation

The two theories that have most influenced my development as a counselor are Adlerian therapy, created by Alfred Adler — a student of Freud — and cognitive behavioral therapy, developed largely, though not exclusively, by Aaron Beck and premised on a behavioral tradition.

Adlerian therapy holds that the individual is largely guided and propelled by feelings of self-esteem, and that a lack of self-esteem can result in mental illness (Slavik & King, 2007). Cognitive behavioral therapy, on the other hand, integrates behavioral and cognitive components, asserting that thought and behavior direct the individual. The counselor therefore helps the client investigate the thoughts driving their actions.

Views of Human Nature and the Change Process

Adlerian psychology holds a psychodynamic view of human nature — that certain aspects of the individual are beyond their control and shaped by circumstances such as abusive parenting, disability, social factors, and so forth (Ehrenwald, 1991). CBT, on the other hand, takes a more optimistic attitude, seeing the client's future as lying within their own efforts. All the client needs to do is decide their direction, control their thoughts, negotiate and reframe them to meet their goals, and engineer their environment and actions accordingly (Robertson, 2010). CBT is therefore inherently more optimistic and less deterministic than Adlerian psychology. Both approaches, however, view the human being as essentially good, open and willing to change, and driven toward a life of meaning.

Adlerian psychology is more deterministic in its view of change, seeing the individual as a product of society, family constellations, and historical circumstance. It regards the person as partially able to change, but also subject to forces beyond their control. Adler sees the child or individual as primarily led by feelings of inferiority and a striving for perfection — which can itself result in further feelings of inferiority through overcompensation. The person in Adlerian psychology needs community and a style of life that nurtures their sense of significance (Slavik & King, 2007).

Fate plays a greater role in Adlerian psychology than it does in CBT, where the therapist views the client as someone who has been led astray by erroneous thoughts but, given motivation and the ability to recognize cognitive errors, can pursue meaningful change. The client can also engineer their actions and environment — rewarding constructive behavior, deliberately extinguishing negative behavior, and thereby creating and shaping their own conditions according to their will. The therapist is there to guide the process, but the client can largely shape their own destiny.