Chapter 7 (Reality Therapy)

Glasser

Contrib to dev of reality therapy; Worked as psychiatrist for a girl’s prison school which led to his disagreement with psychoanalysis + dev of reality therapy

Believed that probs of the girls was a result of them not taking responsibility

Glasser Childhood

Difficult; Lots of family conflict that led to his belief of personal responsibility

Glasser View on Girl’s in Prison School Issues

The probs of the girls were a result of them not taking responsibility

Wubbolding

Played an important role in dev + promoting reality therapy; Adapted choice theory + reality therapy to diverse populations

Who did Wubbolding adapt choice theory + reality therapy to?

Diverse populations

Reality Therapy

Comprised of cog + behav principles but is more philosophical than CBT; Based on choice theory + control theory → Assumes that ppl should take resp + not make excuses for difficulties

Most important parts of approach are choice + behav

Choice Theory

Suggests that ppl’s own thoughts, feelings, + behavs impact their quality of life

Reality Therapy

Control Theory

Suggests that ppl have inner control systems that guide behavs + emotions

Reality Therapy

Main Assumption of Reality Therapy

Assumes that ppl should take responsibility + not make excuses for difficulties; Self-determination gives ppl the choice to meet their needs + accomplish their goals

Self-Determination

Gives ppl the choice to meet their needs + accomplish their goals

Most Important Parts of Reality Therapy

1. Choice

2. Behavior

Basic Question in Reality Therapy

Are ppl choosing + behaving in ways that meet their needs + wants?

What does Reality Therapy emphasize?

Childhood dev + views ppl as self-determining + capable of overcoming difficulties

Cause of Mental Illness according to Reality Therapy

Mental illness is the result of ppl not meeting needs in an effective way; Disease model not used in this approach

Is disease model used in Reality Therapy?

No

5 Basic Human Needs

1. Belonging

2. Power/Achievement

3. Fun/Enjoyment

4. Freedom/Independence

5. Survival/Self-Preservation

Needs

Universal but unique life circumstances + degree of satisfaction varies per person

Purpose of Behav in Reality Therapy

Fulfill all five basic needs

Total Behav

Overall functioning that includes:

1. Acting

2. Thinking

3. Feeling

4. Physiology

All total behav is CHOSEN + is named by verbs

Quality Worlds

Contains personal wants + subjective perceptions; Unique to each person → Ppl can choose what is in their quality worlds in order to achieve wellness

Axioms of Choice Theory

Human behavior is internally motivated, purposeful, and directed toward fulfilling five basic genetic needs; 10 principles that guide choice theory

1. The only person whose behav we have control over is our own

2. Counselors + other ppl can best help by giving info

3. All long-lasting psych difficulties are due to relationship probs

4. Problematic relationships are part of present life

5. Ppl can only satisfy their basic needs in the present moment + future

6. Ppl can only satisfy their needs by satisfying their quality world

7. What ppl do can best be described as behaving

8. Total Behav is made up of acting, thinking, feeling, physiology

9. All total behav is chosen

10. Total behav is named by verbs

WDEP System

Helps individuals take personal responsibility and change their behavior

W → Wants

D → Direction and Doing

E → Evaluation

P → Planning

W in WDEP System

Wants; Exploration of what the clients want + what pictures are in their quality world → Focus on what clients want that theyre getting, what they are getting that they dont want, + what they want that they are not getting

D in WDEP System

Direction + Doing; Exploration of clients total behav (actions, thoughts, feelings, physiology) - description of goals + impacts on behav

E in WDEP System

Evaluation; Evaluation of goals, actions, perceptions, + conseq → Det if behav + perceptions are realistic + helpful or not

P in WDEP System

Planning; Reflects desired changes in wants, total behav, + goals → plan to replace ineffective behavs

Total Behavior Car Metaphor

Glasser proposed that all human behavior is "total behavior," meaning it consists of four inseparable components that happen at the same time → acting, feeling, thinking, physiology

Front Wheels of Car → Acting + Thinking; These are the wheels you steer; Just as a driver turns the front wheels to direct the vehicle, you have direct control over your actions and your thoughts (all behav is total behav)

Back Wheels of Car → Feeling + Physiology; These wheels do not have a steering wheel attached to them; they simply follow wherever the front wheels go - You do not have direct control over your feelings or bodily reactions, instead, they are pulled along by what you choose to do and think (all behav is chosen)

Steering → Wants

Overall Goal of Reality Therapy

To help ppl have greater control over their lives by making better choices

What do good choices include?

• Help ppl meet their wants + needs

• Responsible

• Realistic

Therapist Responsibility in Reality Therapy

Responsible for direction + success of counseling

Client Responsibility in Reality Therapy

For their choices

What are therapists in Reality Therapy?

Teachers; Provide info + skills in a way thats warm, caring, respectful, + optimistic

Friendly Involvement

What therapists should do in reality therapy; Casual interactions to dev rapport while maintaining ethical + professional behav

What kinds of interventions are used in Reality Therapy?

Cog + behavioral interventions

Metaphors

Used to give clients powerful messages + identify themes in clients’ experiences

Reality Therapy Techniques

Relationships

Therapists encourage clients to seek healthy + pos relationships

Reality Therapy Techniques

Questions

Used to det what does + does not need to change in clients’ lives

Reality Therapy Techniques

WDEP + SAMI2C3 Purpose

Strat used to move towards change; One of the most important techniques

Reality Therapy Techniques

SAMI2C3

Represents the key qualities required to build effective, viable action plans in reality therapy

S → Simple

A → Attainable

M → Measurable

I2 → Involved + Independent

C3 → Controlled, Committed, Consistent

Reality Therapy Techniques

Positive Addictions

Encouraging clients to engage in pleasant behavs that provide energy, confidence, + wellness

Reality Therapy Techniques

Using Verbs + ‘ing’ Words

Used to show that clients have control over their lives; Emotions are described as actions that are changeable rather than fixed states

Ex. Anxietying

Reality Therapy Techniques

Reasonable Conseq

Allowing natural conseq from behavs to occur

Ex. If colored on wall, telling child that they cannot play till they scrub it off

Ex. If they spill a drink, telling them to clean it

Reality Therapy Techniques

Paradoxical Interventions

Relabeling/reframing to promote choice

Reality Therapy Techniques

Paradoxical Prescriptions

Choose symptom rather than avoid, doing the opposite of whats not working, etc; Imagine the worst thing that could happen + find ways to cope, etc

Reality Therapy Techniques

Development of Skills

Therapists teach skills like assertiveness, rational thinking, + planning that help clients fulfill their needs + wants in responsible ways

Reality Therapy Techniques

Research on Reality Therapy

Not much due to the approach’s stance that diagnosing is harmful

Who can Reality Therapy be useful for?

Incarcerated indivs, ppl who misuse substances, ppl with depression, + low self-esteem

What situations can Reality Therapy help?

Bullying, domestic violence, + fam conflict

When should Reality Therapy be used with caution?

For those with severe or long-standing conditions or those with belief in a higher power or predetermination; Should be combined with other approaches

Where can Reality Therapy be used?

Can be used in schools, rehab settings, mental health settings, correctional institutions, groups, fams, + indivs

Reality Therapy + Multicultural Groups

Applicable to diverse populations due to respect for culture + indiv differences, but should be flexible + aware bc basic needs can be met in diverse ways

Does Reality Therapy address discrimination?

No; Therapists should understand that ppl do not choose to be oppressed - diverse clients may not have as much control over their lives due to barriers that exist

Pros of Reality Therapy

• Clear, straightforward, structured

• Positive, respectful, empowering

• Helpful in school settings

• Easily integ with other approaches

Cons of Reality Therapy

• Minimizes importance of past → therapists may overlook barriers

• Therapists may overlook experiences that limit ppl’s choices

• May focus too much on symptoms than gaining full understanding

• Not diagnosing isnt congruent with prof guidelines

• Disregards psychotropic meds

Therapists showing Caring Confrontation

Therapists share discrepancies in what clients are saying in respectful + warm ways when hey are in their client’s best interest

3 Parts of Caring Confrontation

1. An introduction that identifies what the client presents with that led to the therapist’s guess of a discrepancy

2. Therapists sharing the issue or discrepancies with the client

3. An invitation for the client to respond, such as ‘what do you make of that?’ or ‘would you be willing to explore that with me?’

Wubbolding’s 3 Perception Filters

3 filters through which input passes

1. Total Knowledge Filter (lower level)

2. Relationship Filter (middle level)

3. Valuing Filter (upper level)

Total Knowledge Filter

Recognizes + labels perceptions; Lower level

Wubbolding’s 3 Perception Filters

Relationship Filter

Sees the relationship b/w an obj + its function (eg. perceiving a chair as something to sit on); Middle level

Wubbolding’s 3 Perception Filters

Valuing Filter

Evaluates perceptions as positive/need-satisfying, negative or neutral

Wubbolding’s 3 Perception Filters

SAMI²C³

S → Simple

A → Attainable

M → Measurable

I → Immediate

I → Involving (the therapist)

C → Controlled (by client)

C → Consistent

C → Committed

5 Levels of Client Commitment

1. I dont wanna be here

2. I want the outcome, but not the effort

3. I’ll try/I might

4. I will do my best

5. I will do whatever it takes

7 Deadly Habits

Destroys relationships

1. Criticizing

2. Blaming

3. Complaining

4. Nagging

5. Threatening

6. Punishing

7. Bribing/Controlling with rewards

7 Caring Habits

Builds relationships

1. Caring

2. Listening

3. Supporting

4. Contributing

5. Encouraging

6. Trusting

7. Negotiating Differences

ABCDEFG Approach for Therapists

Guidelines for therapist interactions

A → Always

B → Be

C → Courteous

D → Determined

E → Enthusiastic

F → Firm

G → Genuine

Train + Track Metaphor

Choice theory is the train track (provides direction/theoretical framework) + reality therapy is the train (delivers the practical product/interventions)

Why did Glasser rename ‘Control System Theory’ to ‘Choice Theory"‘?

To emphasize internal choice over external conflict

Early 8 Steps of Reality Therapy

1. Build rapport

2. Ask ‘What are you doing?’

3. Collab in eval behav

4. Help make a plan

5. Commit to plan

6. Accept no excuses

7. Do not interfere with reasonable conseq

8. Do not give up

Most Essential Need + Most Difficult Need to Satisfy according to Glasser

Belonging/Love, since it req the cooperation of others

Crazy Creativity

Hallucinations + delusions in psych disorders are forms of crazy creativity chosen by clients to exert control over an environment where they feel powerless

Glasser vs Wubbolding on Choosing

Glasser → We choose everything we do, including the misery we feel

Wubbolding → We choose MUCH of what we do

Glasser vs Wubbolding on Meds

Glasser → Opposed meds; Good psychotherapy doesnt need drugs

Wubbolding → Emphasized that taking prescribed meds is the standard + compatible with reality therapy

Criteria for Positive Addiction

Must be:

1. Noncompetitive + capable of being done alone

2. Easy to accomplish without excessive effort

3. Personally valued

4. Believed to lead to self-improvement

5. Done without self-criticism

Does Reality Therapy focus more on process or outcome? Why?

Process; Reduces feelings of failure if an immediate outcome isnt reached

3 Part Structure of Caring Confrontation

1. Introduction

2. Body

3. Invitation

Introduction (Caring Confrontation)

Identifies the client’s statements/actions prompting the intervention

Body (Caring Confrontation)

Gently points out discrepancy

Invitation (Caring Confrontation)

Invites client eval (what do you make of that?)

Quality School Model + Learning Teams

Uses learning teams (2-5 students with mixed abilities) to satisfy need for belonging; Elims traditional letter grades, bells, + coercion → uses open classrooms + daily self eval

Japanese Culture Nuance

Direct questions like “what do you want?” can be offensive, so therapists ask things like “what are you seeking?” instead; A client saying “ill try” signifies a strong commitment rather than hesitation

Fatalism/Predestination

Caution must be used in cultures emphasizing external locus of control or higher power predetermination

Does Reality Therapy address social probs directly?

No; Creates a danger that therapists may blame clients for lack of progress while ignoring real environ barriers

Neuroplasticity Support on Reality Therapy

Recent neuroscience on neuroplasticity supports Glasser’s belief that psychotherapy creates bio/cellular changes in brain without drugs