Adlerian Therapy: Clinical Applications and Evidence
Adlerian therapy is a brief psychodynamic psychotherapy primarily used for treating personality disorders, eating disorders, low self-esteem in adolescents, and as a preventive intervention in at-risk populations, with demonstrated efficacy in improving quality of life and reducing symptoms in these conditions. 1, 2, 3
Core Therapeutic Framework
Adlerian therapy, also called Brief Adlerian Psychodynamic Psychotherapy (B-APP), operates on three fundamental paradigms 1:
- The individual represents a psychosomatic unity integrated within their social context 1
- Individuals need to build and regulate their self-image 1
- Bond patterns regulate human relationships and represent the symbolic thread connecting elements of one's life-style 1
Primary Clinical Indications
Personality Disorders
B-APP is specifically developed for treating personality disorders in public mental health services, with evidence showing decreased mentalization problems and improved therapeutic outcomes over a 40-session treatment program. 4
- Treatment focuses on improving mentalization—the capacity to understand behaviors in terms of intentional mental states 4
- Patients show significant reduction in mentalizing imbalances across early, middle, and late treatment phases 4
- The most critical therapeutic changes occur between sessions 5 and 10, during the initial treatment phases 4
Eating Disorders
Adlerian Parental Counseling (APC) demonstrates significant efficacy when integrated into multimodal treatment for eating disorders 3:
- Patients whose parents received APC showed significantly greater improvement on Clinical Global Impression scales compared to those without parental counseling 3
- The intervention improves family dynamics and reduces discrepancies in family functioning perception among family members 3
- Mothers showed reduced sense of inadequacy, decreased anxiety symptoms, and improved relationship preoccupation 3
- Fathers demonstrated improved social trust and reduced introverted anger 3
Self-Esteem Enhancement in Adolescents
Adlerian therapy significantly increases self-esteem in female adolescents with low self-esteem, though solution-focused brief therapy shows superior effectiveness for this specific outcome. 2
- Treatment consists of eight weekly 50-minute sessions 2
- AT proves substantially more effective than no treatment for enhancing self-esteem 2
- The approach is particularly suitable for preventive interventions in at-risk adolescent populations 1
Treatment Structure and Duration
The standard B-APP protocol includes 1:
- 15 sessions subdivided into 5 distinct phases 1
- Each session typically lasts 50 minutes 2
- The possibility of identifying a meaningful therapeutic focus is fundamental for treatment success 1
Additional Clinical Applications
B-APP is suitable for 1:
- Preventive interventions in at-risk subjects 1
- Somatopsychic disorders and liaison psychiatry 1
- Treatment of emotionally disturbed children 1
- Severe personality disorders requiring structured brief intervention 1, 4
Therapeutic Objectives and Outcomes
The primary treatment goals include 1:
- At least partial resolution of the focus problem 1
- Decrease or stabilization of symptoms 1
- Global increase in quality of life 1
- Results depend on both intrapsychic and relational changes 1
Common Pitfalls and Clinical Considerations
The early treatment phases (sessions 5-10) are critical, as the most significant relationships between patient mentalization, therapist techniques, and emotional responses occur during this period. 4
- Therapists must monitor their countertransference, as disengaged countertransference decreases while positive countertransference increases over successful treatment 4
- The approach uses both psychodynamic-interpersonal and cognitive-behavioral interventions, with psychodynamic techniques predominating but both increasing over time 4
- Indications are more relative than absolute—careful patient selection based on ability to identify a meaningful focus is essential 1