Contemporary Growth Therapies
by Howard J. Clinebell, Jr.

Chapter 2: Growth Resources in Traditional Psychotherapies, Alfred Adler and Otto Rank

Alfred Adler was born in a suburb of Vienna in 1870. He trained in medicine at the University of Vienna and practiced general medicine for a while. His relationship with Freud began in 1902, when he wrote a defense of Freud's book on dreams after it had been ridiculed in the press.(1) Freud invited him to join a small psychoanalytic discussion group that met at his home each week. From the beginning the two had disagreements over dream analysis and the role of early sexual trauma in mental illness. In 1911, after a series of disagreements, Adler left Freud's circle, taking nine of the group's twenty-three members with him. A year prior to this split, Adler gave up general medicine to practice psychiatry full time. Within a year after the split he named his theories "Individual Psychology" to emphasize the distinctiveness of each individual's experience and growth.

After World War I, Adler set up the first child-guidance clinic in cooperation with the Vienna school system. Adler was fun-loving and affable, enjoyed good food, companionship, and music, particularly opera. He abhorred technical jargon. He believed in the application of insights from therapy to the everyday life of people and spent much of his professional time writing and lecturing to nonprofessional persons. In 1935 he left Vienna because of the fascist wave that was sweeping over Europe. He settled in New York, where he practiced psychiatry and taught medical psychology at the Long Island College of Medicine. He died in Aberdeen, Scotland, in 1937 while on a lecture tour.

Adler believed that human beings possess remarkable positive potentials and the ability to mold their heredity and their environment intentionally and creatively. His system offers much to growth-oriented counselors, therapists, and teachers. It is noteworthy that Abraham Maslow includes Adler among the pioneers of the "third force," the human potentials approach to psychology.

In contrast to Freud, Adler saw human beings as essentially creative (rather than impulse driven and destructive). He emphasized the active, integrating self (rather than the frail, victimized ego); held to a "soft" (rather than a "hard") determinism; had a strong interest in future, goal-directed strivings (rather than origins); emphasized the organism as a whole centered in the self (rather than a conflict view of personality); regarded the striving for worth and power (rather than sexual striving) as the central dynamic in mental health and illness; emphasized the possibilities for continuing change in the later years (rather than regarding the early years as utterly decisive) (2) It is clear from these motifs in Adler's thought that his vision of human beings was positive and growth-centered.

Adler believed that everyone has a will-to-power as a result of the early experience of being a helpless infant surrounded by powerful adults. He declared: "Just to be human is to feel inferior." (3) In the struggle to master one's environment, issues of worth and power become central. A great variety of compensatory devices -- healthy and unhealthy -- are developed by persons in their struggles to overcome feelings of powerlessness and inferiority. In facilitating growth work in counseling and therapy there is something reassuring, even liberating, about Adler's view that everyone suffers, to some degree, from inferiority feelings. This awareness can help free persons from the fallacious assumption that most other people have no self-esteem problems, while they themselves suffer from feelings of low self-worth.

Early in life each individual, according to Adler, learns a particular life-style -- a structured pattern of behaving and responding, the aim of which is to maintain the minimal self-esteem and feelings of power that everyone must have to cope with life. The life-style of persons is the key to understanding all their behavior -- dreams, attitudes, actions, perceptions, memories, fantasies, feelings, and so on. Behind one's life-style is one's life goal. Adlerian therapy aims at identifying the malfunctioning life goal, reeducating the person toward a new, more constructive goal, and thus making the life-style more constructive. Adler's emphasis on the functioning of the person-as-a whole is a valuable perspective in counseling and therapy. Watching for patterns in counselees' ways of feeling, perceiving, behaving, and relating to others often allows one to identify the pattern by which persons are sabotaging their own lives.

Adler believed that all human beings have and need to develop the germ of the capacity for loving, cooperative relationships. (This contrasts sharply with Freud's view that individual strivings are essentially selfish and antisocial and that all adjustments to society are concessions by the instincts to the demands of social reality.) All people have a striving for superiority, to overcome ubiquitous feelings of inferiority, but they also have a deep need for human togetherness and cooperation. Adler called this need Gemeinschaft-geflihl, usually translated "social feeling" or "social interest." The German word expresses a passionate need for relationships of closeness,

mutual caring, and active social concern. (This concept is close to what I have described as the will-to-relate, which is the fundamental human drive since it is only in relationships that people can satisfy most of their basic psychological needs.)

In Adler's understanding, the healthy means to compensate for feelings of inferiority and satisfy the human need for power and esteem are ways that include the welfare of others. Adler stated: "Finding an avenue through which he can struggle toward objectives of social as well as personal advantage is the soundest 'compensation' for all the natural weaknesses of individual human beings."(4) Social interest first appears in the early interaction with the mother. It grows as a person matures. Neurosis occurs when, because of defects in parental attitudes (pampering or rejection) or physical defects, a child's social interest is distorted or stunted. In such persons, the striving for superiority becomes grandiose. They try to satisfy their need for power at the expense of others and in ways that isolate them from others. Adler called this an erroneous solution"(5) to feelings of inferiority. Self-centeredness, aggressions, and sadism are not inherent in human nature; they are learned responses to unfortunate early-life experiences that produce a maladaptive life goal and life-style.

Adler's emphasis on the human need for feelings of worth and power is very useful in facilitating growth work. Feelings of powerlessness and low self-worth are present in nearly everyone who seeks therapeutic help, though often these feelings are well hidden behind their defensive "pride." As trust develops in therapeutic relationships, people usually begin to relax their defenses, revealing their underlying feelings of self-rejection. The chronic, mutually damaging power struggles that bring people for marriage counseling almost always stem from hidden feelings of powerlessness and low self-esteem in both persons. Only as they can learn new ways to satisfy

their legitimate need for power and worth in ways that support rather than stymie the other's feelings of power and worth will the destructive cycles be replaced by more mutually satisfying marital relating. To do this they must discover how to use power with and for (the other and themselves) rather than over or against. More often than not, the presenting problems that bring a couple with a dysfunctional marriage to counseling -- money, sex, child-rearing conflicts, and so on -- are power struggles stemming from underlying feelings of impotence and self-deprecation.

The awareness that compensation for handicaps, losses, and feelings of inferiority can be constructive is a potentially growth-enabling insight. Enabling troubled people to "own" their feelings of inadequacy and then use them as a challenge to develop personally and socially useful compensation is a healthy way to help them transform minuses into partial pluses.

One of Adler's significant contributions was his illumination of growthful ways to parent children. He recognized that the general attitudes and feelings of parents and the relationships among the siblings determine the growth climate of a family. He helped parents see that discipline and training should have a positive, not a repressive character. Through his lectures, books, and work in child guidance centers, he encouraged parents to nurture their children's budding social interest, self-confidence, responsibility, and concern for others. A close collaborator of Adler in the child-guidance clinic movement in Vienna was child psychiatrist Rudolf Dreikurs. Later he became director of the Alfred Adler Institute of Chicago. Through his writings (see Children: The Challenge), he has made Adler's approach to children readily available to parents.

Ader anticipated by several decades some of the key insights of feminist psychologists and therapists He saw that our male-dominated society saddles women generally with an additional burden of inferiority by treating them as inferior. To compensate for this, some women adopt what Adler called a "masculine protest," rejecting their special strengths as women and joining the male success rat race in an effort to feel worthwhile. Adler held that compulsive goal-striving (on the part of both women and men) is directly related to the polarization of the sexes. It was clear to Adler that rigid sex-role stereotyping is a way of keeping women in a less powerful place in relationships and in society. Forcing human beings into narrow, rigid categories impoverishes

self-actualization for both women and men.(6)

Adler's belief that inappropriate power strivings are involved impersonal, relationship, and institutional problems makes him an ideological foreparent of what eventually became radical

therapy. His concept of social interest carried him into the arena of concern for social and institutional change. Adlerian Heinz Ansbacher declares:

With his concern for social justice, Adler worked actively to change oppressive institutional practices and structures, particularly in education and through the creation of a network of child-guidance clinics. He was an ardent socialist. His Russian wife was a friend of Trotsky, who visited their home frequently. Adler is a refreshing example of a therapist who refused to focus exclusively on intrapsychic factors, ignoring the relational and societal context that mold intrapsychic development.

I find many of Adler's major insights useful for understanding pathogenic religion and for facilitating spiritual growth.(8) To illustrate, Carl, a young adult in a growth-oriented therapy group, struggled to resist the nostalgic attraction that he felt for the rigid, authoritarian, but comfortable religion of his childhood. Although he no longer found most of this belief system intellectually acceptable, he still felt pulled back toward it emotionally. In the group, he gradually became aware of the crippling impact that his old religion had had on his spiritual life. He discovered the ways in which the old beliefs had given him a sense of undeserved and derivative (from God) worth and power to compensate temporarily and ineffectively for his personal feelings of unworthiness and powerlessness. As he grew he gradually claimed more of his own real strengths and developed more of his competencies. As his awareness of his inner power and value increased, his spiritual life also changed. He reported feeling more in touch with people and with a Spirit who affirmed him as a valuable person.

The break between Freud and Adler was unfortunate for both sides. Each tended to ignore important dimensions of the truth about people and therapy that the other had discovered, while overemphasizing and overgeneralizing his own insights. Much of Adler's approach seems to have developed as an antithesis to Freud's. He rejected Freud's valuable findings regarding infantile sexuality and the unconscious. He rejected the very concept of inner conflicts, seeing all conflict as being between environmental forces and inner strivings for superiority. All this impoverished his understanding of the complexities of the human situation. His refusal to admit that the house of the human psyche is often divided against itself resulted in intellectual contortions, particularly when he tried to give a cogent explanation of the dynamics of psychosis. His important emphasis on the growth- oriented, freely responding side of human beings often seems like superficial optimism because it is not balanced by awareness of the dark, trapped, destructive forces on which Freud had concentrated his attention. Freud likened the ego, as described by Adler, to "the clown who claims to have himself accomplished all the difficult feats of the circus."(9) Adler is a vivid illustration of the need for any viable growth approach to have a depth dimension that includes a robust awareness of the powerful resistances to change and growth within persons. In spite of these serious limitations, Adler is a significant foreparent of contemporary growth-oriented therapies who contributed valuable insights that deserve to be rediscovered by teachers, parents, counselors, and therapists.

Growth Resources from Otto Rank

Otto Rank was born in 1884 in Vienna, the son of an emotionally absent, alcoholic father and a gentle, responsible mother. When he first encountered Freud's writings in 1904 his response was as if he had had a religious revelation. He said, "Now I see everything clearly. The world process _ no longer a riddle."(10) Rank was a brilliant engineering student when, in 1905, he first met Freud. His creativity, talents, and enthusiasm impressed Freud greatly. Rank became one of his closest associates for nearly twenty years, apparently forming a strong but ambivalent transference relationship with Freud, as a substitute father figure. Rank became an outstanding lay (non-medically trained) analyst. In 1921 Freud hailed him as the greatest living analyst.

In 1924 Rank published The Trauma of Birth, which made birth (a mother-centered event) rather than the Oedipus complex (a father-centered experience in Freud's thought) the key to anxiety. The book was dedicated to Freud, but its main point constituted a devastating attack on Freud's thought. With an intense interest in mythology, art, and literature, Rank came to reject Freud's biological reductionist understanding of human personality. He found classical psychoanalytic theory therapeutically inadequate, so he began to experiment with more active and briefer methods. He called his approach "psychotherapy" and eventually "will therapy" rather than "psychoanalysis." He came to understand neurosis as a philosophical and moral problem rather than as a medical problem. The troubled person needs a new Weltan-schauung, a new world view. The unorthodox development in his concepts and methods eventually led, when Rank was forty, to a painful break with Freud. Beginning in 1926, Rank lived in Paris. He commuted frequently to the United States for lecturing until he moved to New York in 1935. He died of an infection in 1939 a month after Freud's death. The timing of his death was probably not a coincidence.

Rank's views had, as Ruth Monroe makes clear, "profound influence on the development of psychiatric social work, psychotherapy, counseling, education and other non-medical fields in which deep psychological insight is required."(11) Rank anticipated thrusts that eventually became central in client- centered therapy, reality therapy, and assertiveness training. In a sense he was a foreparent of the whole growth trend in contemporary psychotherapies. I feel drawn to Rank by his dynamic concern for human potentializing, his emphasis on intentionality, and his awareness of the strong, healthy side that is in persons generally, even the most disturbed.

There are rich resources in Rank for use by growth-oriented teachers, counselors, and therapists. Like Adler, he emphasized the healthy dimensions of personality. His understanding of persons was essentially hopeful. He highlighted human freedom and potentials. With Adler, Jung, and Homey, he understood the self holistically. According to Rank, there is in all persons a positive striving toward wholeness, which he called the "will-to-health."(12) Rejecting Freud's determinism, Rank, like Assagioli (the creator of psychosynthesis), regarded will as the very core of human personality. Rank wrote, "I understand by will a positive guiding organization and integration of the self which utilizes creativity as well as inhibits and controls the instinctual drives."(13) As the creative expression of the total personality, the will distinguishes each person as unique from all others.

The neurotic suffers mainly from an inability to function as an integrated, asserting, purposeful self. The goal of therapy (and personal growth in general) is to activate and strengthen the will so that people learn to live intentionally. Effective therapy puts us in the driver's seat of our own life!

In reflecting on the power of the will as it relates to the concept of the unconscious, Rank observed: "It is astonishing how much the patient knows and how little is unconscious if one does not give him this convenient excuse for refusing responsibility."(14)

Rank describes a variety of ways in which human beings evade responsibility. In animism, responsibility is avoided by projecting human will onto the physical world, peopling nature with spirits. Theists escape responsibility by projecting a part of their will onto an all-powerful deity to whom they must submit. Similarly, scientists introduce determinism into their understanding of persons, to escape from affirming the responsible will. Thus animism, religion, and science can all be used to evade the responsible exercise of will. According to Rank, many people use psychoanalysis, focusing on explaining behavior by probing the past, to avoid living responsibly in the present. In a viewpoint that anticipates by several decades a similar emphasis in Fritz Peris, Rank points out that explanations are about as helpful in psychotherapy as in appendicitis.

Will, in Rank's understanding, is ambivalent from the beginning. Birth, the loss of a perfect union between mother and child, is the basic source and prototype of all subsequent anxiety. All anxiety is separation anxiety. The trauma of birth is more than being ejected from the pleasure and safety of the intrauterine garden of Eden; it is the feeling of no longer being whole in oneself. But birth is also the prototype of all experiences of rebirth, of dying to the safety and integration of one life stage or experience to be reborn into the next. The will motivates persons to strive toward autonomy and independence, but this is in conflict with their "life fear," the fear of independence and nonunion. The fundamental human polarity is between separation and union, between the risk of moving into the future to become one's potential self and the risk of returning to the womb of the past and of conformity. Constructive living involves satisfying the need for both separation and union. Positive will has the capacity to integrate these two dichotomous needs. Rank uses the term "artist" to describe the person who achieves creative integration of these two poles.  

Most people, according to Rank, achieve a dull quieting of this basic conflict by conforming and thus renouncing their striving toward creative autonomy. Rigid conformists may function satisfactorily in a stable society but in a period of lightning-fast social change (like ours), their security and their virtues may evaporate almost overnight. Neurotics cannot conform like most people, nor can they move ahead purposefully. Rankian therapy aims at helping people overcome their womb-returning tendencies through strengthening their wills by actively exercising them (as in assertiveness training). Psychotherapy focuses, as it does in Adlerian and gestalt therapy, mainly on the present. The problems that bring people to therapy have to do with their inability to deal intentionally with the present. Too much involvement with either the past or the future can be used to avoid responsibility in the present.

The therapist is seen as a warm human being whose task is to accept and affirm the wills of persons until they can develop strength in exercising their own wills. The therapist seeks to create a permissive atmosphere within which persons have the space to exercise and strengthen their own wills. The responsibility of changing themselves into self-directing persons must stay with them. If persons are to grow, the therapist must resist their efforts to project responsibility by saying, in effect, "I am weak, confused, helpless. Tell me what to do or do it for me." To yield to this request is to reinforce their basic problem. The will is only strengthened as it is exercised! Therapy is seen as a microcosm of life. Therapists must stay flexible and in tune with the struggles and creativity of their clients, but also they must be willing to engage clients in a confrontation of wills that can strengthen the clients wills. There is an egalitarian thrust in Rank's view of the therapist-patient relationship. "The therapeutic experience is characterized by the fact that both

patient and therapist are at once creator and creature. The patient may not be only creature, he must also become creator; while the therapist plays not only the creator role, but at the same time must serve the creative will of the patient as material."(15) There is in Rank a deep respect for the personality of the disturbed person, conflicts and all. Their conflicts, as expressions of will, are affirmed. Therapy does not eliminate all conflicts but rather enables persons to live creatively and intentionally with the conflicts that are a part of everyone's experience.

The central Rankian theme -- the primacy and ambivalence of the will -- is relevant and useful in both educational and therapeutic growth work. All of us have experienced the powerful conflicts between the striving toward becoming the unique, authentic selves we potentially are and the pull

toward safe, comfortable belonging and conformity. We all know the "life fear," the anxiety about nonconformity and assertiveness. The dependence-autonomy conflict often is strongest during

adolescence, but it continues in different expressions throughout all the life stages. The seductive pull of the past is powerful, particularly during times of insecurity. There are many "wombs" around, inviting comfortable escape from growth. The search in many marriages today (including my own) for a mutually acceptable balance between autonomy and growth, on the one hand, and relational growth and closeness, on the other, is a variation on the same theme. How can couples maintain a creative relationship within which the needs of each of us for distance, autonomy, and personal growth are balanced with our need for intimacy? The key to transcending the dependence-independence polarity is creative interdependency.

Rank's central working concept, separation anxiety, is very useful in coping with grief. As the French proverb put it, "Every parting is a little death." All growth work also includes grief work. Each new stage of our growth requires leaving the security of the past stage, within which we have learned to cope with some comfort and competence. Rank emphasized rebirth as the key to growth in loss experiences. Thus, growth becomes a series of deaths and rebirths.

One practical application of the concept of separation anxiety is Rank's discovery that end-setting, early in therapy, allows people the opportunity of dealing, in the therapeutic relationship, with their ambivalence about separation and union, dependence and autonomy. Setting a tentative time for terminating a counseling or therapy relationship has a variety of growth-enabling effects, in my experience. It tends to diminish dependency and encourage development of clients' own strengths and will by reminding them that the counselor-therapist is available only for a limited time. Awareness of the ending, even if it is still several weeks or months off, tends to motivate more responsible growth work by clients. As the agreed-upon termination approaches it is not unusual for clients to become aware of unfinished grief work associated with previous losses. The ambivalence toward being in therapy -- wanting the security and dependency of the relationship and yet wanting to be free and autonomous -- is resolved growthfully when it is confronted and resolved in favor of purposeful autonomy. Tentative termination dates can always be renegotiated, of course, if it becomes evident that further therapeutic work is essential for the person's growth.

One of the strengths in Rank's thought was his view that human beings are inherently social. Of the inner world and the outer world of relationships, he wrote: "The harmonious balancing of the two spheres needs to be the presupposition of therapy so that both spheres are worked upon simultaneously. Both worlds are real or unreal. What we seek in the outer world is what we have found in the inner." (16)

Rank criticized Freud's patriarchal assumptions and his view of women as derivative from and inferior to men. By making the mother-child relationship the key to human development and therefore to the psychic life of persons, Rank moved away from Freud's father-centered psychology of persons. In his description of the psychological differences in men and women he observed that men have sought their strength in creating and in controlling by their masculine ideology and by their wills. Rank believed that women find power and a kind of immortality in motherhood. Many men, he held, have not accepted their mortality and therefore have never really accepted themselves. Because women have accepted patriarchal ideology, they need constant reassurance that they are acceptable to men and are living up to their ideals. Women conceal much of their psychology both because they need it as a weapon against the male world, which dominates them, and as a refuge for their injured self. (17) a discussion of the meaning of equality between women and men, Rank declared that the only real equality is "the equal right of each individual to become and to be himself, which actually means to accept his own difference and have it accepted by others."(18)

The main thrusts of Rank's theory are particularly useful when counseling with persons caught in severe independence-conformity conflicts (such as some adolescents) those who are paralyzed about finishing a project or chapter of their lives (e.g, pre-graduation anxiety attacks) and in danger of sabotaging the successful completion of something they really value; those who are afraid to make decisions or try something new which they want but which may mean giving up old securities; couples who are struggling to find satisfying closeness without either of them losing their identity and autonomy heir lives (e.g., pre-graduation anxiety attacks) and in danger of sabotaging the successful completion of something they really value; those who are afraid to make decisions or try something new which they want but which may mean giving up old securities; couples who are struggling to find satisfying closeness without either of them losing their identity and autonomy.

For counselors and therapists interested in facilitating spiritual growth, Rank offers a variety of resources. His writings deal extensively with the psychology of religion. His insights about how religion can be used to foster conformity and avoid personal responsibility can help identify pathogenic, growth-blocked religious beliefs and systems. There is a constant temptation to use religion as a comfortable womb rather than a stimulus to rebirth. Dependency-creating ministers, childish belief systems, and exclusivistic conceptions of religious truth ("My way is the truth") can all function as seductive, growth-inhibiting wombs.

The death-rebirth theme in Rank has obvious affinities with the dying-resurrection motif in the New Testament. In working with persons going through the deep waters of painful mid-years crises, it is often growth-enabling to help them face the fact that the values and priorities by which they have been living are no longer viable. Their old philosophy of life will not provide creative guidelines for the second half of their lives. A rebirth is urgently needed. Such an awareness can lead to a painful but freeing revision of their guiding values. Religion is growth-enabling only if it encourages continuing rebirth to new dimensions of oneself, one's relationships, and one's experience of nature and of spiritual reality.

Although I resonate to Rank's positive emphasis on human strengths and potentialities, the depth dimension found in Freud and Jung is underemphasized in his thought. In spite of his interest in myth and art and his exploration of the psychic life in some depth (for example, in The Myth Birth of the Hero) seems be little awareness of the "demonic" or the "shadow side" in personality. The important resources of his approach, to be used most growthfully, must be integrated with complementary resources from the depth therapies.

For Further Exploration of Growth Resources in the Therapy of Alfred Adler

Adler, Alfred. The Individual Psychology of Alfred Adler, ed. L. Heinz and R. R. Ansbacher. New York: Harper, 1956. Two persons who studied with Adler did what he himself was unable to do — systematically organized his thoughts on critical issues. The book consists of direct quotes from Adler, with comments by the Ansbachers interspersed.

Dreikurs, Rudolf. Children: The Challenge. New York: Hawthorn Books, 1964. Presents a practical application of Adler's insights and approach to creative parenthood.

Fadiman, James, and Frager, Robert. "Alfred Adler and Individual Psychology," Personality and Personal Growth. New York: Harper, 1976, pp. 92-110. succinct overview of Adler's major concepts and his understanding of human growth.

For Further Exploration of Growth Resources in the Therapy of Otto Rank

Rank, Otto. The Trauma of Birth. New York: Harcourt, Brace, 1929. Rank discusses birth both as the origin and prototype of the fundamental dependence-autonomy struggle.

---l Therapy, and Truth and Reality. New York: Alfred A. Knopf, 1945. A description of Rankian therapy.

Notes

1. The biographical data were drawn mainly from Elizabeth Hall, "Alfred Adler, A Sketch," Psychology Today, February, 1970, pp. 45, 67.  

2. This list comparing Adler's and Freud's position is from Heinz Ansbacher and R. R. Ansbacher, eds., The Individual Psychology of Alfred Adler (New York: Harper, 1956), pp. 4-6.

3. Ibid p. 115.

4. Ibid., p. 154.

5. Ibid., p. 250.

6. Ibid., p. 248.

7. Heinz Ansbacher, "Alfred Adler, Individual Psychology," reprinted from Psychology Today magazine, February, 1970, p. 66. Copyright, 1970 Ziff-Davis Publishing Company.

8. Adler's views on the psychology of religion are set forth in the book edited by the Ansbachers, pp. 460 ff.

9. Ernest Jones, The Life and Work of Sigmund Freud, vol. II (New York: Basic Books, 1955), p. 131.

10. Franz Alexander, et al., eds., Psychoanalytic Pioneers (New York: Basic Books, 1966), p. 38.

11. Ruth Monroe, Schools of Psychoanalytic Thought (New York: The Dryden Press, 1955), p. 576.

12. Rank, Will Therapy and Truth and Reality (New York: Alfred A. Knopf, 1945), p. 17.

13, Ibid., pp. 111-12.

14. Ibid., p. 24.

15. Ibid., p. 89.

16. Ibid., pp. 196-97.

17. See Patrick Mullahy, Oedipus, Myth and Complex (New York: Grove Press, 1948), p. 198.

18. Beyond Psychology (New York: Dover Publications, 1941), p. 267.