Reality Therapy

3 Stages of Therapy

  • exploration

  • insight

  • action

William Glasser - Choice Theory

  • expanded upon by Bob Wubbolding

  • was a rebuke to the medical/diagnostic approach that dehumanized/disempowered clients

  • not a ton of research - not a lot of people practice it

  • anti-trauma informed → your choice, not the bad experiences in your past

10 Axioms of Choice Theory

  • the only person whose behavior you can control is our own

  • all we can give or get from other people is information

  • all long-lasting psychological problems are relationship problems

  • the problem relationship is always part of our present lives

  • what happened in the past that was painful has a great deal to do with what we are today, but revisiting this painful past can contribute little or nothing to what we need to do now; improve an important, present relationship

  • we are driven by five genetic needs: survival, low and belonging, power, freedom, and fun

  • we can satisfy these needs only by satisfying a picture or pictures in our Quality Worlds

  • all we can do from birth to death is behave. all behavior is Total Behavior and is made up of four inseparable components: acting, thinking, feeling, and physiology

  • all Total Behavior is designated by verbs, usually infinitives and gerunds, and named by the component that is most recognizable

  • all Total Behavior is chosen but we have direct control over only the acting and thinking components

Choice Theory (Cont.)

  • Quality World

    • images of key, significant people, relationships, events, etc.

    • Akin to archetypes

    • “pictures of reality”

  • Perceived World

    • what  we actually are experiencing

    • phenomenological approach

  • “Comparing Place”

    • where we compare quality and perceived worlds

    • if they align, we feel positive, if not, we feel frustration

      • if they don’t align, it’s because we’re not behaving in ways that fulfill our needs

Choices & Behavior

  • choices are often made without awareness

  • choices lead to behaviors

    • creative behaviors can lead to positive or negative consequences

  • “all behavior is purposeful” - glasser

    • all our behavior is our best attempt at that time, given the available resources (AKA our choices!)

Total Behavior

  • acting/doing

    • active behaviors

  • thinking

    • voluntary or involuntary thoughts

  • feeling

  • physiology

    • bodily reactions

  • humans have significant control over acting and thinking, but less over feeling and physiology

  • all types of total behavior are deeply intertwined

Keys to Change

  • for Glasser, the key to changing behavior is in change our doing and thinking

    • these will bring about changes in emotion and physiological responses

  • choices end up propelling or blocking change

  • presenting issues and disorders are a result of choices that take place outside of our awareness

Example - choosing to depress

  • all behavior is done to accomplish some end, including choosing to depress

    • may keep anger (angering) under control

    • may get others to support/help them

    • can excuse someone’s unwillingness to be effective

    • can help individuals gain power over others

The Basics of Reality Therapy

  • symptoms are the result of choices we’ve made in our lives

  • we can choose to think, feel, and behave differently

  • emphasis is on personal responsibility

  • considers how mental health issues are usually based in current relationships

  • rejects the notion of psychological disorders as an “illness”, but are rather a symptom of a mind demonstrating its “unhappiness”

  • we often mistakenly choose misery in our best attempt to meet our needs

  • we act responsibly when we meet our needs without keeping others from meeting their needs

Therapeutic Relationship

  • therapist’s function is to keep therapy focused on the present

  • clients must feel supported to make positive changes

    • counselors are highly positive

  • however, choice of goals and follow-through is on clients

    • discussion can focus on any area worth changing

    • counselor is a friendly helper in the process

  • encourages client exploration of wants, needs, perceptions, actions

  • emphasis on doing over feeling

Goals

  • basic goal of reality therapy is to help individuals meet their psychological needs

  • work is to try and meet these goals in such a way that they do not infringe on the needs of others

  • goal is assessed by asking clients what they “really want” for their futures

    • superficial answers are not accepted

  • use WDEP system to help explore goals and blockages to their achievement

WDEP system

  • “radio station WDEP”

  • wants

    • what do you want to be and do?

    • elicit a commitment from clients to their true ‘wants’

  • doing & direction

    • what are you doing?

    • where do you want to go?

  • evaluation

    • does your present behavior have a reasonable change of getting you what you want?

  • planning

    • “SAMIC3”

      • akin to smart goals

        • wubbolding (1991)

Techniques

  • directed toward focusing on strengths/accomplishments and changing behaviors

  • less of a focus on specific techniques, however…

    • use of many open questions

    • restatements of client metaphors

      • when i was late, the world fell apart

    • use of humor and positivity

    • confrontation is used to push people when plans are not followed

    • reorienting around strengths and positivity

    • paradoxical techniques deals with resistance

    • many check-outs to determine the accuracy of client thoughts

Paradoxes

  • when clients are reluctant to carry our plans or resist making plans, sometimes paradoxical techniques can be used

  • they are among the most difficult techniques for therapists to use because they are counterintuitive

  • types

    • reframing/relabeling/redefinition

      • making one’s depression a friend

      • changing the way a client perceives a topic

    • prescription

      • telling an anxious person to schedule times when they are anxious

Reality Therapy & Other Theories

  • present focused (gestalt)

  • goal-oriented (CBT)

  • encouraging (adler)

  • non-pathologizing (person-centered)

  • non-technical (existential)

  • makes use of substantial subjective assessment (CBT)

Limitations

  • critics argue it was developed as a rebuke to the medical model and traditional western psychology and therefore goes too far

  • clinicians may have trouble viewing all psychological disorders (including serious mental illness) as behavioral choices

  • some feel it does not adequately address important psychological concepts such as insight, the unconscious, dreams and transferences

  • there is a danger for the therapist of imposing his or her personal views on clients by deciding for the client what constitutes responsible behavior

  • reality therapy is often construed as simple and easy to master when in fact it requires much training to implement properly

  • more empirical support is needed