Reality Therapy: Widely Applicable in the Field of Mental Health

Reality Therapy Reality therapy is a cognitive and behavioral method that helps people take more effective control of their lives and develop the psychological strength to handle the stresses and challenges of life. Although widely applicable in the field of mental health, the ideas and skills have also been successfully applied to the work domain (in coaching, managing, consulting, supervision and education), where it is referred to as ‘lead management’.

The ideas and skills focus not only on helping people find solutions to presenting problems and behaviors (the shorter-term, more solution-focused approach), but more importantly, to clearly identify and focus on the underlying cause(s) (rather than continually deal with behavioral symptoms), so that significant and lasting change can emerge. The core of reality therapy is the idea that regardless of what has ‘happened’ to us, what we may have done, or how our ‘needs’ may have been unmet or violated in the past, we can redirect our lives and choose more effective (‘needs-satisfying’) behaviors both today and in the future.

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Reality therapy was founded by the psychiatrist William Glasser MD in the mid-1960s in two settings: a psychiatric hospital and a correctional institution, both in Los Angeles. Early in his career, Glasser began putting his therapeutic emphasis on the ‘here and now’, helping clients to focus on what he referred to as the ‘current reality’ of their lives, and in particular on helping them better satisfy what he claimed to be ‘the two most important psychological needs that psychiatry should concern itself with today: the need to love and be loved and the need to feel that we are worthwhile to ourselves and others’ (Glasser 1965).

Glasser (1998) argued that the continued failure to meet these two human ‘needs’ satisfactorily is the basis of most long-term psychological problems, unhappiness, an array of health-related problems, and much of what is referred to as mental illness. Additionally, from his own extensive observation and practice, Glasser found that by enabling clients to take responsibility for their own behavior, rather than accepting they were victims of their own impulses, their past history, or other people or circumstances around them, they were able to make dramatic changes.

Although these concepts of ‘need-satisfaction’, responsibility, choice, and the focus on ‘current reality’ are still fundamental to reality therapy, both the theory and practice have been developed and refined considerably and have since been applied to virtually every area of counseling/psychotherapy within North America, Asia, Australasia, the Middle East, and in several European countries (Wubbolding, 1999). ; most notably in Ireland where, over the past 20 years, realty therapy has become by far the most counselor-favored approach.

It is surprising then that training in reality therapy, and its certification process, have only been available in the UK over the last 10 years or so. However, during this time it has attracted interest from a wide variety of practitioners, agencies and organizations and is now included in a number of UK counseling certificate, diploma and degree courses. The purposes of undergoing psychotherapy are generally to gain insight, to see connections, and to reach a higher level of self-awareness. The primary goal of reality therapy is neither insight nor resolution of unconscious conflicts.

Rather, the desired outcome is behavioral change resulting in greater need satisfaction. People enter psychotherapy because they feel that something has gone wrong in their lives. The reality counselor believes such people are not fulfilling their needs effectively, and thus they feel discomfort, anxiety, depression, guilt, fear, or shame. Others act negatively or develop psychosomatic symptoms. If they are comfortable with their behavior, but others believe they have problems, they are often coerced into therapy. Often such a person does not want to change, at least in the beginning of the therapy process.

Yet, through the skillful use of reality therapy, it is possible to help a person evaluate whether behavioral change is desirable and possible and whether adjusting to the demands of the “real world” would be appropriate and satisfying. If clients decide that change is beneficial to them, they are helped to make better choices designed to maintain or increase their need fulfillment. Reality therapy is based on control theory, a system of brain functioning (Powers, 1973). Glasser (1981, 1985) adapted this theory to the clinical setting and formulated it in a way that makes it useful to counselors, counselors, and others.

Control theory states that the human brain functions like a thermostat that seeks to regulate its own behavior (much like a furnace or air conditioner) in order to change the world around it. Adding to the highly theoretical work of William Powers (1973), Glasser saw the human being as motivated by five internal forces. These human needs are innate, not learned; general, not specific; and universal, not limited to any specific race or culture. All behavior is aimed at fulfilling the four psychological needs of belonging, power, fun (or enjoyment), and freedom, as well as the physical need for survival.

Effective satisfaction of these needs results in a sense of control that other theories refer to as self-actualization, self-fulfillment, or becoming a fully functioning person specific; and universal, not limited to any specific race or culture. All behavior is aimed at fulfilling the four psychological needs of belonging, power, fun (or enjoyment), and freedom, as well as the physical need for survival. Effective satisfaction of these needs results in a sense of control that other theories refer to as self-actualization, self-fulfillment, or becoming a fully functioning person.

Reality therapy introduces the concept of total behavior which explains that all behavior is made up of four different but inseparable components: acting, thinking, feeling and physiology. (Glasser, 1997). According to this model of therapy, “acting and thinking are directly under our control and it is these components therapists focus on when they practice reality therapy. Focus is not on how people feel or on the physiology of their brains because none of us have direct and predictable control over these two components” (Glasser, 1997).

If we want to change how we feel–and almost all clients want to feel better–we have to make more effective acting and thinking choices such as finding a friend if we are painfully lonely (Petersen, 2005). If we find one and we are happy, this choice will also change our brain chemistry from the chemistry of loneliness, (usually the chemistry associated with choosing to depress) to the normal chemistry of satisfying our need to love and belong (Glasser, 1997; Howatt, 2003; Jones, 2005).

Among the philosophical underlying principles of reality therapy are the following: “People are responsible for their own behavior; human beings–not society, not heredity, not history–determine their own choices; People can change and live more effective lives; People need not remain victims of external forces, neither do they need to wait for the rest of the world to change before being able to satisfy their own needs; People generate behavior and make choices for a purpose: to mold their environment–as a sculptor molds clay–to match their own inner pictures (quality world) of what they want in order to satisfy the five needs described above” (Glasser, 1997). Reality therapy concentrates on the client’s needs and getting them to confront the reality of the world.

Client needs consist of survival, power, love, freedom, and fun. • Survival includes the things that we need in order to stay alive, such as food, clothing and shelter. • Power is our sense of achievement and feeling worthwhile, as well as the competitive desire to win. • Love and belonging represent our social needs, to be accepted by groups, families and loved ones. • Freedom is our need for our own space, a sense of independence and autonomy. • Fun is our need to enjoy ourselves and seek pleasure. “We seek to fulfill these needs at all times, whether we are conscious of it or not” (Glasser, 1997; Howatt, 2003; Jones, 2005; Loyd, 2005; Petersen, 2005).

Choice theory, a theory of how our brain functions that supports reality therapy, directly challenges the belief system that says we have no choice and therefore can blame others and society for our problems (Loyd, 2005). I contend that when we are unable to figure out how to satisfy one or more of the five basic needs built into our genetic structure that are the source of all human motivation, we sometimes choose to behave in ways that are currently labeled as mental illness. Moreover, choice theory explains that, not only do we choose all our unhappy behaviors, but every behavior we choose is made up of four components, one of which is how we feel as we behave (Howatt, 2003).

What is common to these ineffective and unsatisfying choices, no matter what they may be, is unhappiness: there is no happiness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When we choose a behavior that satisfies our needs, immediately or eventually, we feel good. When we choose a behavior that fails to satisfy our needs, sooner or later, we feel bad. But the choice to be unhappy is certainly not mental illness. Our society is flooded with people who are choosing anxious, fearful, depressive, obsessive, crazy, hostile, violent, addictive and withdrawn behaviors. All of them are seriously unhappy; there is no shortage of unhappy people in the world (Turnage, Jacinto, Kirven, 2003).

However, many mental health practitioners reject therapy as useless or time-consuming. There are clearly identifiable interventions that constitute the essence of reality therapy. Glasser (1990a) said, “the art of counseling is to weave these components together in ways that lead clients to evaluate their lives and decide to move in more effective directions. ” Wubbolding (1991a, 1992) has formulated these components into the WDEP system, with each letter representing a cluster of skills and techniques for assisting clients to take better control of their own lives and thereby fulfill their needs in ways satisfying to them and to society. W = WANTS: ‘What do you want? Asking clients about their wants/goals, needs and perceptions (as applicable to their situation) includes asking them to clarify such wants as what they want from this counseling/coaching session; from the group; from their partner; from friends, family, the organization, their colleagues, job/career; and, most importantly, from themselves. Clarification of wants is an ongoing process that is revisited throughout counseling. D = DOING: ‘What are you doing? ’ This explores all four components of ‘total behavior’: the specific actions, thinking, feelings and, as appropriate, the physiology that the client has been generating/ choosing – in connection to the issue at hand or the presenting problem. The aim is to help clients raise their awareness of their specific current total behaviors, so that the next, and most important, aspect of the WDEP system can be facilitated.

E = EVALUATION (self evaluation). ‘Is what you are doing (actions, thoughts/self-talk, feelings, and, if appropriate, physiology/health) helping or hurting you get what you say you want? ’ Helping clients to conduct a searching inner self-evaluation is the keystone of reality therapy. It is based on the fact that people do not voluntarily change their behavior until they evaluate that what they’re doing isn’t working. So the reality counselor/lead manager asks such evaluation questions as: ‘Is what you want attainable? ’; ‘Is what you’re doing getting you closer to the people you need? ’; ‘Does it help you to repeatedly go over your past mistakes? ; ‘What impact does your behavior have on your partner/family/colleagues/friends? ’; ‘If nothing outside you changes – such as at work or other people – what will you do? ’ And, ‘what other choices do you have right now? ’ P = Planning – helping the client to make a plan of action. The focus here is on ‘action’ because this is the component of ‘total behavior’ over which we have the most direct control. The axiom of ‘you can act your way to a new way of thinking easier than you can think your way to a new way of acting’ is most certainly applicable to reality therapy. Glasser identified five needs that guide individuals through life and motivate people to seek deep and lasting relationships.

These genetically coded needs are survival, love and belonging, power or achievement, freedom or independence, and fun. While each individual has varying degrees of each need, they are present and need an opportunity to be experienced and lived in life. Reality therapy sees individuals as being social creatures both needing to receive and provide love. The therapist’s responsibility is to help the individual prioritize needs, deciding what is most important and how to make the required changes necessary to enable greater happiness and responsibility for choices and outcomes. This is considered Choice theory, which Glasser integrated into Reality therapy in recent years.

Individuals develop a concept of what they want for their life and store this information in a scheme he termed their quality world. It is this concept that counselors must tap into using both the sense of ownership and responsibility for themselves as well as incorporating choice therapy to make decisions and follow through to experience happiness. When understanding behavior in the perspective of reality theory, four identifiable components work together towards understanding one’s experience of happiness, acting, thinking, feeling, and physiology. Glasser looks at how an individual feels or behaves as being active rather than simply constant states of being.

Rather than saying an individual is depressed, Glasser would identify the individual as depressing, or rather than being angry, the individual would be seen as angering. These active verb forms place the individual in a position to change. Rather than something that is happening to them, they are instead experiencing a state of being that they have the control and responsibility to change. During therapy, the counselor works with the client to determine the relationships that the client wants to become more connected with or to reconnect. This happens with the understanding that the only person the client can change is himself or herself. The focus remains on the present with an understanding that while individuals are products of their past, they are not victims unless by choice.

The therapist functions in the role of establishing a good relationship between himself and the client. This provides a foundation where the client is safe and able to move towards people and activities that are satisfying and bring happiness. An essential component of reality therapy is for the counselor to convey to the client that no matter how bad things are with the circumstances, there is always hope. Once this foundation is set, implementing specific procedures to establish change in behavior begins. But no matter what the setting, the practitioner creates an environment that is firm, friendly, and conducive to change. Sometimes this is accomplished quickly, but more often it is the result of continued effort.

A system of therapeutic interventions, in which the client sees the counselor as a need-satisfying person, is built upon this foundation, and these basic principles comprise the essence of the practice of reality therapy (Wubbolding, 1991a). The School Counseling Curriculum program component is used to impart guidance and counseling content to students in a systematic way. Activities in this component focus on student’s study and test-taking skills, post-secondary planning, understanding of self and others, peer relationships, substance abuse education, diversity awareness, coping strategies and career planning (ASCA, 2006). Guidance lessons are usually presented to students in regular classroom settings.

School counselors work with the Steering Committee and the School Community Advisory Committee to decide on the competencies (knowledge and skills) students should acquire at each grade level (Gysbers & Henderson, 2006). This curriculum allows counselors to be proactive rather than reactive in their attempt to meet student needs. School counselors are actually responsible for the development and organization of the school counseling curriculum (Wittmer & Clark, 2007); however, the cooperation and support of the faculty, staff, parents and guardians are necessary for its successful implementation. This is one of the reasons why Reality Therapy practitioners can be most effective in schools.

Reality Therapy emphasizes the importance of the personal qualities of warmth, sincerity, congruence, understanding, acceptance, concern, openness and respect for each individual that counselors must possess. These characteristics that pave the way for school counselors to develop positive therapeutic relationships with students also help them to gain respect, cooperation, and support from parents, guardians and those who work within the schools. When deciding on specific lessons and activities for the school counseling curriculum at each grade level. Reality Therapy practitioners consider the five basic needs that all humans possess (survival, love and belonging, power or achievement, freedom or independence, and fun).

Special attention is always given to love and belonging which Glasser (1998) believes is the primary need. These basic needs make up the Quality World for each individual. This personal world consists of specific images of people, activities, events, beliefs, possessions and situations that fulfill individual needs (Wubbolding, 2000). People are the most important component of the Quality World. For a successful therapeutic outcome, the counselor must be the kind of person a client would consider putting in his/her Quality World. As Reality Therapy practitioners interact with students, their personal characteristics enable them to appeal to one or more of each student’s basic needs.

Before focusing on the importance of academic achievement, personal/social development and career information; Reality Therapy practitioners work at involving, encouraging and supporting all students to help them feel that they are cared for and actually belong to this specific group and this particular school. This interaction helps to build trust. It is through this relationship with the counselor that clients begin to focus and learn from them. As guidance lessons are presented from the structured curriculum, school counselors at each grade level focus on the underlying characteristics of reality therapy (Corey, 2009). They begin by emphasizing choice and responsibility.

Students are taught that they choose all that they do and are responsible for what they choose. Reality counselors challenge students to examine and evaluate their own behavior. Students are encouraged to consider how effective their choices are with regard to their personal goals for academic achievement, personal/social adjustment and career development. After class discussions, students are taught to make better choices -choices that will help them to meet their needs in more effective ways as they strive to develop better relationships, increased happiness and a sense of inner control of their lives (Wubbolding, 1988). Most psychotherapies originated in the western hemisphere, many of them in North America.

Reality therapy began as an American theory applied to the many cultures of the United States and Canada. It is now taught, studied, or practiced in varying degrees in many countries. Because of its application to many other cultures, the practice and teaching of reality therapy needs to be adjusted when people’s values, wants, and manner of expression are quite different and usually more indirect than in North America. On the surface, reality therapy is a very direct method, yet it needs to be used more indirectly in “indirect cultures. ” In some cultures in the Pacific Rim, for example, psychotherapists are seen not as partners but as authority figures.

Maintaining a delicate balance between practicing and teaching the theory accurately and authentically, on one hand, and adapting it to “other” cultures requires sensitivity to the culture as well as knowledge of the social, economic, historical, political, and psychological processes of the individual culture. For example, in helping an American student evaluate her own behavior, the counselor might emphasize questions such as, “Is what you are doing helping or hurting you? ” “Do your current actions have a reasonable chance of getting you what you want? ” In counseling a Chinese youth in Singapore, it would be appropriate to ask similar questions, but more emphasis should be placed on questions such as, “What does your family think about your actions? ” “Do they approve or disapprove? “Do your actions bring shame or honor to your parents? ” Reality therapy requires specific skills and procedures, as summarized in the WDEP system. Nevertheless, these should be seen as flexible and adaptable to the style and personality of the user as well as the experience, manner of expression, thought patterns (total behavior), and specific wants of members of various cultures. Because reality therapy is a clear delivery system, it lends itself to the human tendency of wanting to “fix the problem” to correct other people’s behavior and to impose one’s own values on them (Wuddolding, 2007). Reality therapists are not immune to this tendency.

While acknowledging that human beings have more control over actions than cognitions and feelings, they apply the concept of choice to phobias, depression, and other DSM diagnoses involving emotions as well as to everyday emotions such as sorrow and guilt. However, there may be limitations to the choices people have. Thus, changing actions, especially in relationships, might be insufficient for eliminating pain caused by some past events, such as early childhood trauma or current environmental restraints, such as discrimination and other forms of social rejection. Reality therapy is a comprehensive system of treatment that can be used by any person who deals with others: psychotherapists, counselors, teachers, corrections officers, youth workers, group leaders, parents, business managers and supervisors, administrators, and many others.

It is comprehensive because it is based on the way all human beings relate to each other and to the world around them in a free and conscious way. Because of its down-to-earth nature, it is taught to persons whose professional allegiance is to help at any level. Because it is based on universal human needs, it is a multicultural approach that allows for the indirectness of some cultures as well as the direct, assertive behavior of North Americans. It can be adjusted to work with clients from indirect cultures and does not require that “other” cultures adjust to it. Its uncomplicated language makes reality therapy appear to be simpler than it is.

To incorporate the system into professional behavior requires time, practice, and effort. In its thirty years of use, reality therapy has undergone major changes. Not only has it been applied to virtually every kind of interaction, but it has acquired a theoretical base and will probably undergo changes in the future. The expression of the procedures as a WDEP system puts flesh and blood on the theory and renders it accessible to people at nearly every level of society. Therapies that survive in the future will need to be based on solid theory as well as proven effectiveness. Long-term psychotherapy systems have lost much of their popularity and with the growth of managed care are becoming accessible only to the rich.

Those systems that will flourish will provide measurable outcomes in relatively few sessions and be applicable to people from all socioeconomic levels of society. These systems must be taught and used by persons other than psychotherapists: teachers, group workers, drop-in center employees, and so on. Reality therapy offers a results-centered approach that can be learned by people who deliver mental health services in virtually any setting. References American School Counselor Association. (2006). Role statement: The school counselor. Alexandria, VA: Author. Corey, G. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Thomson Brooks/Cole.

Glasser W. (1965). Reality therapy. New York: Harper Collins. Glasser, W. (1981). Stations of the mind. New York, NY: HarperCollins. Glasser, W. (1985). Control theory. New York, NY: HarperCollins. Glasser W. (1998). Choice theory: a new psychology of personal freedom. New York: Harper Collins. Gysbers, N. , & Henderson, P. (2006). Developing & managing your school guidance and counseling program. Alexandria, VA: American Counseling Association. Howatt, W. (2003). Choice theory: A core addiction recovery tool. International Journal of Reality Therapy, 22(2), 12-14 Jones, L. & Parish, T. (2005), Ritalin vs. choice theory and reality therapy.

International Journal of Reality Therapy, XXV, 1, 34-35 Loyd, B. (2005). The effects of reality therapy/choice theory on high school students’ perception of needs, satisfaction and behavioral change. International Journal of Reality Therapy, XXV, 1, 5-9 Peterson, C. (2005). Reality therapy and individual or adlerian psychology: A comparison, International Journal of Reality Therapy, XXIV, 2, 11-14 Powers, W. (1973). Behavior: The control of perception. New York, NY: Aldine Press. Turnage, B. , Jacinoto, G. , Kirven, J. (2003). Reality therapy, domestic violence survivors, and self-forgiveness. International Journal of Reality Therapy, XXII, 1, 7-11 Wittmer, J. , & Clark, M. A. (2007).

Managing your school counseling program: K-12 developmental strategies. Minneapolis, MN: Educational Media Corporation. Wubbolding, R. (1988). Using reality therapy. New York: Harper & Row. Wubbolding, R. (1990). Evaluation: The cornerstone in the practice of reality therapy. Omar Psychology Practitioner Series, 2, 6–27. Wubbolding, R. (1991a). Understanding reality therapy. New York, NY: HarperCollins. Wubbolding, R. (1992). Reality therapy training manual. Cincinnati, OH: Center for Reality Therapy. Wubbolding R, Brickell J. (1999). Counseling with reality therapy. Bicester: Speechmark Publishing. Wubbolding, R. (2000). Reality therapy for the 21st century. Philadelphia, PA: Brunner Routledge.

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