Sunday, January 9, 2011

Reality Therapy




Founder – William Glasser
Very early he rejected the Freudian model and put together what became known as reality therapy by 1962.  By 1996 Glasser changed the name to choice theory to reflect all that he had developed and changed regarding the theory.  Glasser (1998, 2000, 2003) outlines the basics on his updated theory, which he calls the “new reality therapy.”
Introduction:
Reality therapy is based on choice theory as it is explained in Glasser’s most recent books.  Reality therapists believe the underlying problem of most clients is the same:  They are either involved in a present unsatisfying or lack what could even be called a relationship.  Many of the problems of clients are caused by their inability to connect, to get close to others, or to have a satisfying or successful relationship with at least one of the significant people in their lives.  The therapist guides clients toward a satisfying relationship and teaches them to behave in more effective ways than they are presently behaving.  The more clients are able to connect with people, the greater chance they have to experience happiness.
Reality therapists recognize that clients choose their behaviors as a way to deal with the frustration caused by the unsatisfying relationship.  Glasser contends that clients should not be labeled with a diagnosis except when it is necessary for insurance purposes.  From Glasser’s perspective, all diagnoses are descriptions of the behaviors people choose in their attempt to deal with the pain and frustration that is endemic to unsatisfying present relationships.  He believes mental illnesses are conditions such as Alzheimer’s disease, epilepsy, head trauma, and brain infections – conditions associated with tangible brain damage.  As Glasser forcefully states, using drugs to treat symptoms of unhappiness is counter-productive and rarely helps anyone who is suffering.
Therapy consists mainly of teaching clients to make more effective choices as they deal with the people they need in their lives.  Because choice theory explains how to choose to behave in ways that improve relationships, teaching choice theory to clients is part of reality therapy.  The approach is applicable to counseling, social work, education, crisis intervention, corrections and rehabilitation, institutional management, and community development.
View of Human Nature:
Choice theory posits that we are born with five genetically encoded needs – survival, love and belonging, power or achievement, freedom or independence, and fun – that drives us all our lives.  Each of us has all five needs but they vary in strength.  Choice theory is based on the premise that because we are by nature social creatures we need to both receive and give love.  Glasser believes the need to love and to belong is the primary need because we need people to satisfy the other needs.  It is also the most difficult need to satisfy because we must have a cooperative person to help us meet it.
Our brain functions as a control system.  It continually monitors our feelings to determine how well we are doing in our lifelong effort to satisfy these needs.  Whenever we feel bad, one or more of these five needs is unsatisfied.  Although we may not be aware of our needs, we know that we want to feel better.  Driven by pain, we try to figure out how to feel better.  Reality therapists teach clients choice theory so clients can identify the frustrated need and try to satisfy it.  When clients succeed, they are rewarded with good feelings.
Choice theory explains that we do not satisfy our needs directly.  What we do, beginning shortly after birth and continuing all our lives, is to keep close track of anything we do that feels very good.  This is our quality world which is at the core of our lives.  It is the world we would like to live in if we could.  It is completely based on our needs but unlike the needs, which are general, it is very specific.  The therapist’s job is to assist clients in prioritizing their wants and deciding what is most important to them.
People are the most important component of our quality world.  It contains the people we are closest to and most enjoy being with.  Those who enter therapy generally have no one in their quality world, or more often, someone in their quality world that they are unable to relate to in a satisfying way.
Choice Theory Explanation of Behavior:
Choice theory explains that all we ever do from birth to death is behave and, with rare exceptions, everything we do is chosen.  Total behavior teaches that all behavior is made up of four inseparable but distinct components – acting, thinking, feeling, and physiology – that necessarily accompany all of our actions, thoughts, and feelings.  Behavior is purposeful because it is designed to close the gap between what we want and what we perceive we are getting.  Specific behaviors are always generated from this discrepancy.
Glasser says that to speak of being depressed, having a headache, being angry, or being anxious implies passivity and lack of personal responsibility, and it is inaccurate.  It is more accurate to think of these as parts of total behaviors and to use the verb forms depressing, headaching, angering, and anxietying to describe them.  When people choose misery by developing a range of “paining” behaviors, it is because these are the best behaviors they are able to devise at the time, and these behaviors often get them what they want.  People do not choose pain and suffering directly.  Rather, it is an unchosen part of one’s total behavior.  The behavior of the person is the best effort, ineffective as it is, to satisfy needs.
Characteristics of Reality Therapy:
Contemporary reality therapy focuses quickly on the unsatisfying relationship or the lack of a relationship, which is often the cause of clients’ problems.  When clients complain about how other people are causing them pain, the therapist does not get involved with finding fault.  Reality therapy focuses on what clients can control in the relationship.  The basic axiom of choice theory, which is crucial for clients to understand, is this:  The only person you can control is yourself.  When clients point out correctly that this is unfair, the therapist may agree and say, “There is no guarantee that life is fair.  You are the only person who can change.  Complaining may feel good for a time but it is a completely ineffective behavior.”  Reality therapists do not listen very long to complaining, blaming, and criticizing, because these are the most ineffective behaviors in our behavioral repertoire.
Emphasize choice and responsibility:
If we choose all we do, we must be responsible for what we choose.  Clients are responsible for what they do.  Choice theory changes the focus on responsibility to choice and choosing.
Reality therapists deal with people “as if” they have choices.  Therapists should focus on those areas where clients have choice, for doing so gets them closer to the people they need.  As clients begin to feel good about themselves, it is less necessary for them to continue to choose ineffective and self-destructive behaviors.
Reject Transference:
Glasser contends that transference is a way that both therapist and client avoid being who they are and owning what they are doing right now.  Assume the client claims, “I see you as my father or mother and this is why I’m behaving the way I am.”  In such situations a reality therapists is likely to say clearly and firmly, “I am not your mother, father, or anyone but myself.”
Keep the therapy in the present:
Glasser grants that we are products of our past but argues that we are not victims of our past unless we choose to be.  Glasser contends that whatever mistakes were made in the past are not pertinent now.  We can only satisfy our needs in the present.
If the client wants to talk about past successes or good relationships in the past, the therapist will listen because these may be repeated in the present.  Reality therapists will devote only enough time to pat failures to assure clients that they are not rejecting them.  As soon as possible, the therapists tell clients:  “What has happened is over; it can’t be changed.  The more time we spend looking back, the more we avoid looking forward.”
Avoid focusing on symptoms:
Glasser contends that people who have symptoms believe that if they could only by symptom-free they would find happiness.  Whether people are depressing or paining, they tend to think that what they are experiencing is happening to them.  They are reluctant to accept the reality that their suffering is due to the total behavior they are choosing.  Their symptoms can be viewed as the body’s way of warning them that the behavior they are choosing is not satisfying their basic needs.  The reality therapist spends as little time as he or she can on the symptoms, because they will last only as long as they are needed to deal with an unsatisfying relationship or the frustration of basic needs.  Getting rid of long journeys into the past or exploring symptoms is a way to focus on present problems and shorten most therapy considerably.
Challenge traditional views of mental illness:
Choice theory rejects the traditional notion that people with problematic physical and psychological symptoms are mentally ill.  Glasser paints a picture of biological psychiatrists who diagnose individuals with a wide range of mental illnesses and who attempt to convince their patients that brain pathology is the cause of their problems.  People who exhibit symptoms of anxiety and depression are often told that their condition is due to an imbalance in their brain chemistry.  These psychiatrists treat individuals they view as having some form of mental illness by prescribing psychiatric drugs.  Glasser is critical of traditional psychiatry that tends to discourage psychotherapy or the idea that there is anything that people with symptoms can do for themselves to alleviate their disabling symptoms.  Glasser admits that he has never prescribed a brain drug, no matter how severe the symptoms of the psychological problem.
Therapeutic Goals:
A primary goal of contemporary reality therapy is to help clients get connected or reconnected with the people they have chosen to put in their quality world.  A basic goal of reality therapy is to help clients learn better ways of fulfilling all of their needs, including power or achievement, freedom or independence, and fun.
There are clients who actively resist therapy.  They often engage in violent behavior, addictions, and other kinds of antisocial behaviors.  If they once had responsible people in their quality world, they have removed them.  As soon as a counselor recognizes that he or she is dealing with a disconnected, pleasure-seeking person, it is best to give up all the usual goals of counseling and focus on just one thing – doing whatever is possible to get connected with this person.  If the counselor can’t make a connection, there is no possibility of providing significant help.  If the counselor can make a connection with this client, then the goal of teaching the client how to fulfill his or her needs can slowly begin.
Therapist’s Function and Role:
The first function of therapists is to create a good relationship with their clients.  Another key function of reality therapists is to teach clients how to engage in self-evaluation.  This is done by raising the question, “Are your behaviors getting you what you want and need?”  The role of the therapist is not to make the evaluation for clients but to challenge them to evaluate themselves.
It is the job of therapists to convey the idea that no matter how bad things are there is hope.  The therapists functions as an advocate, or someone who is on the client’s side.
Client’s experience in Therapy:
Clients will most likely find therapists to be gently, but firmly, confronting.  Reality therapists will often ask clients questions such as these: “Is what you are choosing to do bringing you closer to the people you want to be closer to right now?”  “Is what you are doing getting you closer to a new person if you are presently disconnected from everyone?”  These questions are part of the self-evaluation process, which is the cornerstone of reality therapy.
Clients can expect to experience some urgency in therapy.  Time is important, as each session may be the last.
Relationship Between Therapist and Client:
Reality therapy emphasizes an understanding and supportive relationship.  An important factor is the willingness of counselors to develop their own individual therapeutic style.  Sincerity and being comfortable with one’s style are crucial traits in being able to carry out therapeutic functions.
For involvement between the therapist and the client to occur, the counselor must have certain personal qualities, including warmth, congruence, understanding, acceptance, concern, respect for the client, openness, and the willingness to be challenged by others.  Involvement is also promoted by talking about a wide range of topics that have relevance for clients.  The counselor assists clients in gaining a deeper understanding of the consequences of their current behavior.
Choice theory takes all the mystery and uncertainty out of what the therapist is trying to do.  Therapy is always a mentoring process in which the therapist is the teacher and the client is the student.
The Practice of Reality Therapy:
The practice of reality therapy consists of two major components:  (1) creating the counseling environment and (2) implementing specific procedures that lead to changes in behavior.  The art of counseling is to weave these components together in ways that lead clients to evaluate their lives and decide to more in more effective directions.
Establishing a working relationship with clients’ typically proceeds through an exploration of clients’ wants, needs and perceptions.  Clients explore their total behavior and make their own evaluation of how effective they are in getting what they want.  If clients decide to try new behavior, they make plans that will lead to change, and they commit themselves to their plan.  This includes the therapist following up on how well clients are doing and offering further consultation as needed.
Actual therapeutic practice takes considerable skill and creativity.  The manner in which they are applies does vary depending on the counselor’s style and personal characteristics.  The principles of reality therapy are applied in a progressive manner but they are not discrete and rigid categories.  The counselor tailors the counseling to what the client presents.  The counselor is prepared to work in a way that is meaningful to the client, the move toward satisfying relationships remains in the foreground.
The Counseling Environment:
It is from this mildly confrontive yet always noncriticizing, nonblaming, noncomplaining, caring environment that clients learn to create the satisfying environment that leads to successful relationships.  In this coercion-free atmosphere, clients feel free to be creative and to begin to try new behaviors.
Some of the approaches to establishing a therapeutic environment include using attending behavior, suspending judgment of clients, doing the unexpected, using humor appropriately, being oneself as a counselor; engaging in facilitative self-disclosure, listening for metaphors in the client’s mode of self-expression, listening for themes, summarizing and focusing, and being an ethical practitioner.  The basis for therapeutic interventions to work rests on a fair, firm, friendly, and trusting environment.
Procedures that lead to change:
Reality therapists begin by asking clients what they want from therapy.  They also inquire about the choices clients are making in their relationships.
In the first session a skilled therapist looks for and defines the wants of the client.  The therapist also looks for a key unsatisfying present relationship – usually with a spouse, a child, a parent, or an employer.  The therapist might ask, “Whose behavior can you control?”  This question may need to be asked several times during the next few sessions to deal with the client’s resistance to looking at his or her own behavior.
When clients begin to realize that they can control only their own behavior, therapy is under way.  The rest of therapy focuses on how clients can make better choices.  There are more choices available than clients realize, and the therapist explores these possible choices.  They can choose to change – even if the other person in the relationship does not change.
Reality therapists explore the tenets of choice therapy with clients, helping clients identify basic needs, discovering clients’ quality world, and finally, helping clients understand that they are choosing the total behaviors that are their symptoms.
Through this process, clients learn that things don’t just happen.  We are not at the mercy of others, and we are not victims.  According to Glasser, humans are motivated to change (1) when they are convinced that their present behavior is not getting them what they want and (2) when they believe they can choose other behaviors that will get them closer to what they want.
The WDEP system:
Wubbolding uses an acronym, WDEP, in the practice of reality therapy.  Each of the letters refers to a cluster of strategies that are designed to promote change: 
• W=wants and needs
• D=direction and doing
• E=self-evaluation
• P=planning
Wants and needs:  Reality therapists ask, “What do you want?”  Through the therapist’s skillful questioning, clients are encouraged to recognize, define, and refine how they wish to meet their needs.  The skilled reality therapist counsels in a noncritical and accepting way so that clients will reveal what is in their special world.
Some useful questions to help clients pinpoint what they want:
• If you were the person that you wish you were, what kind of person would you be?
• What would your family be like if your wants and their wants matched?
• What would you be doing if you were living as you want to?
• Do you really want to change your life?
• What is it you want that you don’t seem to be getting from life?
• What do you think stops you from making the changes you would like?
Direction and doing:  The focus is on the present in reality therapy and is often characterized by the question:  “What are you doing?”  Even though problems may be rooted in the past, clients need to learn how to deal with them in the present by learning better ways of getting what they want.  The therapist’s challenge is to help clients make more need-satisfying choices.
The overall direction of clients’ lives, including where they are going and where their behavior is taking them is discussed followed by a subsequent evaluation of whether it is a desirable direction.  The therapist might ask, “What do you see for yourself now and in the future?”  It often takes some time for this reflection to become clear to clients so they can verbally express their perceptions.
When clients talk about problematic feelings, most reality therapists affirm and acknowledge these feelings.  Yet, rather than focusing mainly on these feelings, counselors encourage clients to take action by changing what they are doing and thinking.  It is easier to change what we are doing and thinking than to change our feelings.  According to Glasser, what we are doing is easy to see and impossible to deny; thus, it serves as the proper focus in therapy.
Evaluation:  The core of reality therapy is to ask clients to make the following self-evaluation: “Does your present behavior have a reasonable chance of getting you what you want now, and will it take you in the direction you want to go?”  Additional questions to ask clients include:
• Is what you are doing helping or hurting you?
• Is what you are doing now what you want to be doing?
• Is your behavior working for you?
• Is what you are doing against the rules?
• Is what you want realistic or attainable?
• How committed are you to the therapeutic process and to changing your life?
• After you examine what you want carefully, does it appear to be in your best interests and in the best interest of others?
Asking clients to evaluate each component of their total behavior is a major task in reality therapy.  It is the counselor’s task to get clients to evaluate the quality of their actions and to help them make effective choices.  Individuals will not change until they first decide that a change would be more advantageous.  Reality-therapists are relentless in their efforts to help clients conduct explicit self-evaluations of each behavioral component.  When therapists ask a depressing client if this behavior is helping in the long run, they introduce the idea of choice to the client.  The process of evaluation of the doing, thinking, feeling, and physiological components of total behavior is within the scope of the client’s responsibility.
Reality therapists may be directive with certain clients at the beginning of treatment.  Clients such as alcoholics and children of alcoholics, need direction early in the course of treatment, for they often do not have the thinking behaviors in their control system to be able to make consistent evaluations of when their lives are seriously out of effective control.
Planning and action:  Once clients determine what they want to change, they are generally ready to explore other possible behaviors and formulate an action plan.  If the plan does not work, for whatever reason, the counselor and client work together to devise a different plan.  The plan gives the client a starting point, a toehold on life, but plans can be modified as needed.  Throughout this planning phase, the counselor continually urges the client to be willing to accept the consequences for his or her choices and actions.  The essence of a good plan includes that it is:  simple, attainable, measurable, immediate, involved, controlled by the planner, committed to, and continuously done.
Asking clients to determine what they want for themselves, to make a self-evaluation, and to follow through with action plans includes assisting them in determining how intensely they are willing to work to attain the changes they desire.  Commitment is not an all-or-nothing matter; it exists in degrees.  It is essential that those clients who are reluctant to make a commitment be helped to express and explore their fears of failing.  Clients are helped by a therapist who does not easily give up believing in their ability to make better choices, even if they are not always successful in completing their plans.
Contributions to Multicultural Counseling:
Counselors demonstrate their respect for the cultural values of their clients by helping them explore how satisfying their current behavior is both to themselves and to others.  Once clients make this assessment, they can formulate realistic plans that are consistent with their cultural values.  It is a further sign of respect that the counselor refrains from deciding what behavior should be changed.  Through skillful questioning on the counselor’s part, ethnic minority clients can be helped to determine the degree to which they have acculturated into the dominant society.  Glasser contends that reality therapy can be applied both individually and in groups to anyone with any psychological problem in any cultural context.  This is not always true.  For example, North Americans are inclined to say what they mean, to be assertive, and to be clear and direct in asking for what they want.  In Japanese culture, assertive language is not appropriate between a child and a parent or between an employee and a supervisor.  Ways of communicating are more indirect.
Limitations for multicultural counseling:
Discrimination and racism are unfortunate realities and these forces do limit many minority clients in getting what they want from life.  Some clients are very reluctant to say what they need.  Their cultural values and norms may not reinforce them in assertively asking for what they want.  They may be socialized to think more of what is good for the social group than of their individual wants.
Contributions of Reality Therapy:
Advantages of reality therapy include:  its relatively short-term focus and the fact that it deals with conscious behavioral problems.  The client’s self-evaluation, a plan of action, and a commitment to following through are the core of the therapeutic process.  The existential underpinnings of choice theory are a major strength of this approach.  People are not viewed as being hopelessly and helplessly depressed.  Instead, people are viewed as doing the best they can, or making the choices they hope will result in fulfilling their needs.
Limitations and Criticisms:
One of the main limitations of reality therapy is that it does not give adequate emphasis to the role of these aspects of the counseling process:  the unconscious, the power of the past and the effect of traumatic experiences in early childhood, the therapeutic value of dreams, and the place of transference.  It does not take into account factors such as repressed conflicts and the power of the unconscious in influencing how we think, feel, behave, and choose.
Finally, it is simplistic to view all psychological disorders as behavioral choices.  Biochemical and genetic factors are associated with certain forms of behavioral disorders, and Corey has trouble accepting the notion that all mental illness is chosen behavior.  People suffering from chronic depression or schizophrenia are struggling to cope with a real illness.  In reality therapy these people may have additional guilt to carry if they accept the premise that they are choosing their condition.

Dr. Rebecca Curtis

8 comments:

  1. It is amazing that Gerald Corey did not write this first? Hmmm. . .amazing

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    1. lol this is taken directly from gerald corey's book, theory and practice of counseling and psychotherapy. it's chapter 11 on reality therapy...

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    2. I just noticed the same thing...and Corey's book is open to chapter 11 right now next to me---I was looking for "something more online"---guess I didn't find it here. Dr. Rebecca Curtis should cite her work. Tsk, tsk....

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  2. I wondered the same thing...

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    1. I believe that Corey's approach is more Humanistic. His approach is less directive than a Reality Therapist. The emphasis on personal responsibility plays a major role in Choice Theory.

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  3. Excellent sharing! Clinical Psychologists have university training in providing this kind of therapy, and are experts in this area.

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