Interpersonal manifestations of lifestyle: Individual Psychology integrated with Interpersonal Theory.

This article integrates the counseling theories of Individual Psychology and Interpersonal Theory. This integration provides a social/interpersonal approach to conceptualize clients' problems and address them in counseling. The integrated approach to counseling presents a structure for assessment of clients' developmental experiences as well as a counseling approach that allows the counselor to address these issues in the counseling relationship. Finally, a clinical example is provided to demonstrate the integration of theories.

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The importance of theory in mental health counseling practice has received sustained attention (e.g., Bauman & Waldo, 1998; D'Andrea, 2000; Ellis, 2000; Hershenson, Power & Seligman, 1989; McBride & Martin, 1990; Messina, 1999; Pistole, 1999; Weinrach, 1991). Some authors have argued that adherence to a specific theory could limit counselors' versatility and effectiveness (Kelly, 1991; Nance & Meyers, 1991), while other authors have expressed reservations about eclecticism, asserting that it potentially results in sloppy, haphazard thinking and thus reflects poorly on the profession (Blocher, 1989; Ginter, 1989; MacDonald, 1991). One approach to expanding theory-based practice beyond the limitations potentially inherent in the use of only one theory is to combine two or more theories. The danger of creating a "hodgepodge" of apples and oranges (Ginter, 1988, p.6) can be avoided if the theories are compatible, carefully integrated, and if they reflect the basic characteristics of mental health counseling. Those characteristics include focusing on clients' assets and development, taking into account clients' interpersonal and environmental context, and employing the counseling relationship as a central mechanism for promoting change (Ginter, 1989; Ginter & Bonney, 1993; Hershenson & Power, 1987).

Traditional Individual Psychology (Adler, 1929; 1958) and Interpersonal Theory (Sullivan, 1953), which has been expanded on by followers of Sullivan (e.g., Leary, 1957; Meyer, 1957, Teyber, 2000), are two compatible theories that together fully address the essential values of mental health counseling. The theories have complimentary descriptions of personality and human nature. Individual Psychology describes humans as being social in nature, having a desire to belong, and striving for significance in their social environment to avoid inferiority (Dreikurs, 1956; Shilling, 1984). Interpersonal Theory describes human beings as motivated by interpersonal anxiety to avoid rejection and to maintain self-esteem (Sullivan). According to Interpersonal Theory and Individual Psychology, each individual must be viewed in the context of his or her social environment. Both theories view difficulties and solutions from a social/interpersonal perspective. Together they explain and guide use of the counseling relationship to foster clients' positive development within their social context.

In this article, the basic concepts of Individual Psychology and Interpersonal Theory are reviewed. The review does not attempt to provide a thorough description of either theory. Instead, summaries of the theories are provided, focusing on the aspects of each theory which contribute to their integration. Following summaries of the basic concepts, each counseling approach is briefly described, and a method for integrating the two approaches is proposed. Finally, a case example of counseling that integrates Individual Psychology and Interpersonal Theory is reported.

BASIC CONCEPTS

The theories of Alfred Adler's Individual Psychology and Harry Stack Sullivan's Interpersonal Theory have similar histories and basic concepts (Ellenberger, 1970; Teyber, 2000). Both theories assume a relational focus in psychotherapy in contrast to Freud's established theory of psychoanalysis. Adler agreed with Freud's concept of the purposefulness of symptoms; he also agreed with Freud about the importance of early childhood experiences. However, Adler disagreed with Freud's emphasis on psychosexual development (Corsini & Wedding, 1995). Instead, Adler stressed the importance of early social interaction through which children form rules to help them manage their world and understand life (Sweeney, 1975). Similarly, Sullivan broke from Freudian Psychoanalytic Theory by arguing that the basic propositions of Freud's theory could be understood through an examination of relationships and that interpersonal anxiety (rather than libido) is the primary motivational force (Teyber).

According to both Individual Psychology and Interpersonal Theory, individuals develop patterns early in life through interactions with their families, most importantly their parents. Adler described the patterns that individuals follow through their lives as their lifestyle (Sweeney, 1975). A lifestyle, according to Individual Psychology, is the characteristic way in which individuals learn in their families of origin to pursue social significance in interpersonal relationships. Similarly, Interpersonal Theory depicts individual development as an interpersonal process in which individuals learn to avoid or manage anxiety and maintain self-esteem in interpersonal relationships (Sullivan, 1953; Teyber, 2000). Painful anxiety arises when individuals anticipate rejection by parents, others, and oneself (Grey, 1988; Teyber). Through repeated parent-child interactions, a child forms a self-other relational pattern designed to minimize or avoid anxiety and maintain self-esteem (Sullivan). Both Individual Psychology and Interpersonal Theory suggest that children develop patterns of interaction to function in their social (family) environments and that the style of interaction continues when they become adults. Furthermore, both theories suggest that this interaction style could impede social or interpersonal functioning.

Individual Psychology and Interpersonal Theory assume that humans are social beings, and human behavior can only be understood as a function of individuals' perception of their social context (Shilling, 1984; Sherman & Dinkmeyer, 1987). Adler held a holistic and phenomenological perspective on human experience (Sweeney, 1981). Similar to Individual Psychology, Interpersonal Theory offers a holistic view of humans acting as an organism or personality (Mullahy, 1970) and views behavior as "inclusive of the subjective and behavioral activities of all participants" (p. 556), as opposed to outside the individual (Grey, 1988).

Individual Psychology posits that social significance is productively achieved through the development of social interest, for example, contributing to society (Sweeney, 1975). Furthermore, Individual Psychology views social interest as the criterion for mental health, as opposed to feelings of inferiority leading to the need for self-protection (Ansbacher, 1991). According to Adler (1964) "all neurotic symptoms have as their object the task of safeguarding the patient's self-esteem" (p. 263). Sullivan (1956) had a similar view regarding the fundamental importance of interpersonal relations to well-being. Sullivan (1953) stated that "one achieves mental health to the extent that one becomes aware of one's interpersonal relations" (p. 26), and uses that information to improve one's relationships.

As indicated above, the basic concepts of Individual Psychology and Interpersonal Theory are very similar. Both theories view behavior as interpersonal in nature. Individual Psychology describes behavior as purposeful, striving for significance and belonging in interpersonal relationships, and avoiding feelings of inferiority. Interpersonal Theory describes behavior as purposeful, avoiding anxiety, and maintaining self-esteem in interpersonal relationships. These explanations can be seen as two sides of the same coin. In fact, striving for significance can be seen as a way of avoiding anxiety over rejection and maintaining self-esteem, and fear of lack of significance or inferiority can be seen as the source of anxiety. Both theories take an ideographic view, attempting to understand people in their contexts from their viewpoints. Integrating the concepts from both theories, behavior can be viewed as a purposeful pursuit of social significance through specific lifestyles or self-systems. The basic concepts of Individual Psychology and Interpersonal Theory are highly congruent with mental health counseling (Hershenson & Power, 1987), focusing on clients' strengths and development and acknowledging the critical role of their social context.

COUNSELING PROCESS

In the attempt to apply an integration of Individual Psychology and Interpersonal Theory to counseling process, the stages of counseling described by Individual Psychology will be summarized and integrated with the ideas and concepts of Interpersonal Theory. A major goal of an approach that integrates Individual Psychology and Interpersonal Theory is insight into self-defeating behaviors, relationship patterns, and interpersonal defenses. After clients achieve insight into these patterns, they can choose if they want to adjust their lifestyle and relational patterns in and out of the therapeutic setting.

The first stage of counseling, relationship, consists of establishing a supportive collaborative relationship between the mental health counselor and client. Empathy is stressed in this stage, as the counselor attempts to understand the client's subjective world and demonstrate that understanding (Shilling, 1984). From the onset of counseling, clients are encouraged to become active learners (Corsini & Wedding, 1995). The application of Interpersonal Theory during this stage suggests that mental health counselors are active participants in the process which they are observing (Chapman, 1978). The mental health counselor's purpose, according to Interpersonal Theory, is to encourage the client "to study the here and now with special attention to what is happening between them at those moments when their communication is disrupted by anxiety" (Grey, 1988, p. 554). Sullivan viewed the counselor as a participant observer in a respectful, active dialogue with the client (Chapman). The integration of Individual Psychology and Interpersonal Theory recommends that a collaborative, empathic bond be formed that allows the client and counselor to focus on their immediate relationship during the session.

The second stage of counseling, according to Individual Psychology, is understanding. Employing an integrated approach, this stage focuses on identifying client's dynamics, including life-style, goals, private logic, and parataxic distortions. Sweeney (1975) described different strategies for gathering lifestyle data, including investigating the family constellation, discussing early recollections and important life turning points, and conducting a psychological interview. As counseling progresses, the mental health counselor's job is to synthesize the information which has been gathered about the client's underlying process. Acknowledgment of the underlying process allows clients to become aware of their interpersonal patterns. Interpersonal Theory offers direction on examining how clients relate to their counselors within the therapeutic relationship. Examining the client-counselor relationship helps identify the clients' lifestyles (personality priority/interpersonal style) because clients' lifestyles should be evident in their relational style with their counselors. It is important for the mental health counselor to use process comments to provide the client with insight into how maladaptive relational patterns are being played out in the counseling relationship (Sullivan, 1953). The counselor's process comments help establish an internal focus for the client so that the client will begin to explore his or her internal and interpersonal responses. Interpretation of these maladaptive patterns not only increases understanding but also offers a way in which mental health counselors participate with clients in the pursuit of growth (Levenson, 1978).

The third stage of counseling, insight, consists of mental health counselors and clients confronting clients' mistaken goals and self-defeating beliefs. The confrontation is offered through interpretation, persuasion, and encouragement (Dinkmeyer, Pew, & Dinkmeyer, 1979). Adlerian counselors facilitate insight mainly through interpreting the purpose of clients' behaviors, beliefs, and goals (Corsini & Wedding, 1995). Interpersonal Theory suggests a process for promoting insight through interpretations which correct parataxic interpersonal distortions (Sullivan, 1940). Parataxic distortions are inappropriate ways of reacting to others and are based on previous experiences, usually in the family of origin (Sullivan, 1953). Sullivan believed parataxic distortions can be corrected through consensual validation. Consensual validation occurs by comparing one's interpersonal evaluations with those of others (Yalom, 1995). Consensual validation is provided by the mental health counselor during counseling and by others (family, friends) outside of counseling. The overriding goal is to help clients understand the purpose of their interpersonal behavior so they are in a position to change those behaviors that are not working for them (Yalom; Dinkmeyer et al.).

The fourth and final stage of counseling, reorientation, involves the clients in identifying alternatives to self-defeating behaviors (Dinkmeyer et al., 1979). Individual Psychology focuses on translating insight into action (Shilling, 1984). In this stage, the clients are responsible for instituting change. Based on an understanding of their behavior, clients decide which new behaviors they wish to attempt (Sweeney, 1975). Throughout the process, mental health counselors offer clients encouragement to commit to change (Corsini & Wedding, 1995; Dinkmeyer et al.; Shilling; Sweeney). Interpersonal Theory offers guidance on how insight-based changes can be made within the immediate context of the counseling relationship. The client and mental health counselor can relate to each other in new, different, and more effective ways. For example, if a client avoids being assertive, the mental health counselor could point this out and provide an environment where assertiveness is accepted and encouraged. This process is designed to provide a corrective emotional experience (Alexander & French, 1946; Teyber, 2000). Clients become aware of their interpersonal patterns and learn that they do not have to respond in the same familiar way. Clients can then generalize their learning to improve relationships outside of counseling.

The stages of counseling described above parallel the description of the mental health counseling process offered by Hershenson and Power (1987). Hershenson and Power depict the helping process in mental health counseling as based on a relationship between a mental health counselor and a client which involves mobilizing clients' assets to develop needed skills. The major components of mental health counseling process are pronounced in Interpersonal Theory's use of the relationship between clients and mental health counselors to identify clients' strengths and initiate change. As indicated above, there is a high degree of correspondence between Individual Psychology and Interpersonal Theory; the theories augment and inform each other. An integration of the two theories offers an approach which embraces and actualizes fundamental values in mental health counseling. The next section of this paper offers an example of how the two theories have been integrated in mental health counseling practice.

CLINICAL EXAMPLE

An example of a counseling approach that integrated Individual Psychology and Interpersonal Theory in mental health counseling practice is offered below. Each stage of the integrated approach is discussed. To ensure confidentiality and to save space, a few details in the case are changed and only summaries of the content of the sessions are offered.

Brian (fictional name), a White male, presented at a college counseling center with relational difficulties and symptoms of anxiety and depression. Brian was in his early 20s and entering his third year at a southwestern university. The counselor, a White male in his late 20s, had been at the Center for less than one year and held a Master's degree from a graduate program accredited in Mental Health Counseling.

The Relationship

In the initial sessions, a collaborative relationship was established, as the mental health counselor utilized empathy to understand Brian's subjective world. Brian reported difficulties forming relationships with others. For instance, he became overly attached to the people in his life, but acted in such a way that he sabotaged or did not communicate in those relationships. Brian was motivated to attend counseling because of an incident where he felt his best friend was no longer there for him. Brian revealed that, leading up to the incident that brought him to mental health counseling, he was continually criticizing and distancing himself from his best friend. He stated that he was unsure of the reason for this, but it was typical of the way he felt he sabotaged his relationships. Brian reported that when he noticed his best friend focusing on other friendships, he felt abandoned and became "uncontrollably angry." The mental health counselor focused on understanding Brian's feelings of "desperation and abandonment" related to this incident.

Understanding

A lifestyle analysis was conducted in which Brian reported being raised by a single mother who was emotionally distant. He also reported feeling alone and unconnected at a very young age. Through the lifestyle analysis Brian identified the major turning points in his life as abandonment by the people he felt closest to and reported that he had a hard time trusting others or opening up. He stated that he becomes numb when he starts to feel emotions. At this time, Brian's relational style with the counselor was flat with little or no affect. Brian presented emotionally loaded material, such as his mother moving away to another town and leaving him when he was in high school, as information that was distant from him. The counselor responded with empathy, focusing on creating awareness. Process comments were made focusing on Brian's affect in his relationship with the counselor. For example, "when you talk about painful experiences it seems like you become more distant," and "although you are sharing a lot, it seems like you are avoiding opening up to me or allowing yourself to feel emotions in session." These process comments were used to facilitate Brian's understanding of his lifestyle/interpersonal behavior in the moment of the relationship with the mental health counselor.

Insight

In the next stage of counseling, a lifestyle interpretation was conducted. A collaborative review of Brian's lifestyle was generated; the mental health counselor and Brian agreed that he had a lifestyle that encouraged him to distance himself from others. This lifestyle could be conceptualized as the personality priority (Kutchins, Curlette, & Kurn, 1997) of detaching. The mental health counselor and Brian explored how this detaching happened in sessions, and through the use of process comments, how it happened immediately in that session. For example, when discussing a recent painful interaction with his mother, the mental health counselor noted that Brian was not showing the hurt he was feeling. Brian was then able to bring into awareness the process of numbing himself, which he uses when painful events happen. He described the topic as causing him anxiety and stated that he numbs himself as a protection. The anxiety Brian felt in interpersonal relationships was due to his fear of becoming too close to others and facing potential abandonment. How this occurs in relationships outside of counseling was discussed as well as how it happened with the mental health counselor.

Reorientation

In the next session, Brian decided that he would begin to try to express more emotions. He referred to this effort as "riding his emotions out, instead of shutting them off." Brian practiced this new behavior in a session in which he discussed an important person in his life that had recently passed away. When Brian began to shut off his grief and numb himself, he was able to stop himself; and with the mental health counselor's support, he let himself cry over the loss. This emotional expression also allowed Brian to share an important emotional event with the mental health counselor. The mental health counselor reacted differently than significant others in Brian's life by remaining involved and supportive. Having experienced this reaction from the mental health counselor, Brian recognized he did not need to distance himself from his emotions in order to maintain a relationship. The next step was for him to share more of his emotions with people in his life. With the mental health counselor's support and encouragement, Brian revealed to his friend, John, his long held fear that John was bored with their relationship and was looking for a way to avoid him. His friend made it clear he remained invested in the relationship and had no intention of avoiding Brian. This revelation disconfirmed two of Brian's long held parataxic distortions: First, that others will reject him; and second, that he dare not bring up his fears and insecurities. This change in perspective about himself opened the door for a more meaningful relationship. After completion of ten sessions of mental health counseling, a successful termination was conducted focusing on the changes Brian made and applying them to future relationships. Brian was able to end the counseling relationship without feeling abandoned and with a sense of accomplishment related to his positive experience of his relationship with the mental health counselor.

CONCLUSION

There are a number of limitations in the integrated approach as well as core differences in Individual Psychology and Interpersonal Theory. The integration approach appears ideally suited for insightful clients and may be less effective with clients who are less insightful or those with pathology that may get in the way of examining the interpersonal relationship. Although the integration of theories addresses contextual and interpersonal processes which make it well suited for multicultural clients, it does not provide a process to address discrimination or oppression. In other words, the integrated approach addresses the contextual issues of the individual as opposed to societal issues. For example, in the clinical example, counseling addressed the impact of Brian's social relationships, but would not have addressed societal oppression should he have been from a minority group. Also, there are a number of theoretical differences in the two approaches to mental health counseling as well. First, the difference between (a) the focus on the purposefulness of behavior to strive for superiority or against inferiority of Individual Psychology in contrast to (b) the need to avoid anxiety in Interpersonal Theory may be viewed as differing perspective motivation for interpersonal behavior. Additionally, the differences between the examination of lifestyle in session contrasts with the immediate here and now focus of Interpersonal Theory. Future empirical studies could confirm if these differences increase or reduce the effectiveness of these theories, especially when used in an integrated approach as described here.

Overall, integrating Individual Psychology and Interpersonal Theory can provide mental health counselors with a view of their clients in their social contexts. It allows for use of the structure of Individual Psychology to understand the clients' developmental experiences through lifestyle analysis. Lifestyle analysis explains how clients gained their beliefs and interpersonal style. The integrated approach also allows for an investigation of how clients are striving for significance within their social contexts and how their approach to pursuing this goal is immediately affecting their relationships with the mental health counselors. Interpersonal Theory provides a theoretical approach to utilize the counselor-client relationship to create insight and change. This immediate and supportive personal context also can assist in overcoming the anxiety which arises as the mental health counselor challenges the clients' lifestyle (Prochaska, 1984). Finally, the integrated approach allows the therapeutic relationship to encourage, support, teach, and heal. In addition to the collaborative teaching relationship fostered in Individual Psychology, the therapeutic relationship actually becomes an intervention itself, fostering clients' use of their strengths to improve their functioning within their social context. In this way, an integrated approach embodies mental health counseling's core values and preferred process.

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Jonathan P. Schwartz, Ph.D., is an assistant professor, Department of Psychology, Louisiana Tech University, Ruston, LA. E-mail: [e-mail] Michael Waldo, Ph.D., is a professor, Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces