Reality Therapy

Who is William Glasser?

William Glasser was born on May 11th, 1925 in Cleveland Ohio.  He earned an undergraduate degree in chemical engineering, a Masters in Clinical Psychology, and finally his MD.  He completed his Psychiatric training in 1957.  He was married 47 years until his wife’s death and had two children.

What Glasser Believed

“Very early Glasser rejected the Freudian model, partly due to his observation of psychoanalytically trained therapists who did not seem to be implementing Freudian principles. Rather, they tended to hold people responsible for their behavior, (Corey, 2015, p. 315).”  William Glasser developed Reality Therapy to address a key problem with psychoanalysis: that it taught people to blame others for their behaviors (Sharf, 2015, p. 417).  In Glasser’s Reality Therapy, he sought to develop an approach to therapy that  that reflected his  clinical experience.    As a result of this experience, “Glasser became convinced that it was of paramount importance that clients accept personal responsibility for their behavior. (Corey, 2015, p. 315).”  In many respects, Reality Therapy appears to be similar to REBT as a practical cognitive and behavioral approach (Rosenthal, 2005).  However there are a few key differences.  While Glasser focuses on relationships and an awareness of one’s choices, Ellis is focused on irrational beliefs and behavioral change.  Additionally, while it contains techniques that reflect behaviorism, he ultimately disagreed with Skinner.

Criticism & Praise

Rosenthal, (2005) notes that since this theory is practical, straightforward “and not cloaked in theory, it is attractive to social workers, case-workers, teachers, juvenile workers, rehabilitation specialists, (Rosenthal, 2005).”   However, some have also criticized this method is overly simplistic and ignores the unconscious as irrelevant to his approach (Rosenthal, 2005).

Characteristics of Reality Therapy

The Problem & It’s Solution

“Reality therapists believe the underlying problem of most clients is the same: They are either involved in a present unsatisfying relationship or lack what could even be called a relationship…Few clients understand that their problem is the way they are choosing to behave. What they do know is that they feel a great deal of pain or that they are unhappy…(Corey, 2015, p. 316).”

As the above quote states, reality therapists define the goal as unsatisfying relationships and poor behavioral choices that cause unhappiness.  In contrast, REBT focuses on irrational beliefs while psychoanalytic theorists state answers lie in the unconscious.  Consequently, Reality Theorists are not interested in helping client’s gain insight into their irrational behaviors or resolving unconscious conflict. (Wubolding, 2013, p. 293).  Instead Glasser aims to help clients make better behavioral choices since he defines problems as involving poor behavioral choices (Corey, 2015; Wubolding, 2013).   By helping clients make better behavioral choices, they can become more successfully fulfill basic human needs such as love, belonging, freedom, achievement, etc. (Corey, 2015).

Thoughts on Diagnosis…

Glasser’s theory rejects the traditional DSM-based perspective of diagnosis except when absolutely necessary (i.e. insurance coverage purposes), (Corey, 2015).  He rejected the notion of a label that defined someone as mentally ill and that the primary solution involved medication.  Instead, in Glasser’s view, the problems ultimately came down to the behaviors people choose to engage in when attempting “to deal with the pain and frustration that is endemic to unsatisfying present relationships, (Corey, 2015, p. 317).”

Choices Not Symptoms

“Reality therapy helps people examine their wants and needs, evaluate behaviors, and make plans for fulfilling needs (Wubolding, 2013, p. 293).”  Glasser rejected other approaches on the basis that they allowed clients to blame others for their behavior (Sharf, 2015).  Instead, reality therapy is based on the notion that “the only person you can control is yourself, (Corey, 2015, p. 315)”.  Rather than complaining about external circumstances or criticizing others, reality therapy is focused on oneself.  Symptoms of a mental illness are instead conceived as consequences of our behavioral choices.  The symptoms represent the problem while our choices reflect our solution.

Emphasis on Self-Responsibility

“If we choose all we do, we must be responsible for what we choose. This does not mean we should be blamed or punished, unless we break the law, but it does mean the therapist should never lose sight of the fact that clients are responsible for what they do (Corey, 2015, p. 315).”

Click Here To Read My Post Titled: “Accepting Responsibility: “Shame, Blame, Resentment”  

Focused On The Present

While Glasser does believe that we are products of our past history, the solution lies in the present.  If we focus on the past, (Corey, 2015).  In this respect, while Reality Therapy appears to acknowledge our problems are often associated with a multifactorial cause, the workable solutions lie in our behavioral choices.  When we focus on things beyond our control like the past we become a victim.  When we focus on the choices we’ve made, we become empowered with a realistic and remediable solution.

Rejection of 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 (Corey, 2015, p. 320).”  In other words, since transference issues pertain to unconscious memories of past events, they aren’t relevant to the solution.  From a reality therapy perspective, focusing on transference issues in order to uncover unresolved issues within our unconscious is a waste of time.  Instead, Glasser believes we can only be what we are in the present (Corey, 2015).

Basic Concepts

Control Theory

Glasser developed Reality Therapy in the 60’s as a result of his years of experience at a “state institution for delinquent adolescent girls, [in which a] focus on friendliness and responsibility was found to be helpful (Sharf, 2015 p. 417).  Later in 1981, Glasser wrote a book titled “Choice Theory” which emphasized the phenomenological pictures we create in our mind.   This phenomenological experience of our world determines our behavioral choices.  Consequently, we”behave to control the world…[it] does not control us (Rosenthal, 2005).”  The solution we desire ultimately lie within.

The Thermostat Analogy

file5331257892459Glasser describes the brain as an internal thermostat, that functions to assess how effective our behaviors are in responding to our environment (Corey, 2015; Wubolding, 2013).  This process begins when we utilize our senses to observe the world outside ourselves.  We choose how to respond based on these perceptions and how they correlate to our basic human needs (Wubolding, 2013).  In other words, the brain assesses the effectiveness of our behavioral responses to our environment. Psychiatric symptoms are best understood from this perspective according to reality therapy.

A picture of reality

img_2878“Glasser (1981, p. 126) makes the point that we do not live ‘to any extent in the real world’ (Sharf, 2015, p. 419).”  In other words, it is ultimately our perception of reality that determines our behavior.  Do we see reality as it is?  Wubolding, (2013) notes “The input desired from the world enters the brain first through the sensory system and then through two filters: the total knowledge filter, by which the perception is first recognized, and the valuing filter, by which the person makes a positive or negative judgment about the perception, (p. 295).  Our innate human drive to fulfill certain elemental needs like love, and belonging, create the motivational force underlying our valuations of the external world.  In this respect, our perceptions often act as self-fulfilling prophecies, until we understand where our choices lie.

A View of Human Nature

“Choice theory posits that we are not born blank slates waiting to be externally motivated by forces in the world around us….Rather, we are born with innate human needs such as survival, love and belonging…that drive us all our lives, (Corey, 2015 p. 317).”  In this respect, reality therapy conceives all behavior as purposeful in nature (Wubolding, 2013).  We are driven by our innate human needs….

…On the surface, this perspective of human behavior sounds much like Skinner’s mechanistic view of human nature.  However, Reality Therapy notes that we respond to this drive by making behavioral choices that correlate with our perceptual understanding of reality (Wubolding, 2013).

Explanation of Human Behavior

According to choice theory, all behaviors are a reflection of the personal choices we make to fill personal needs (Wubolding, 2013).  Additionally, Glasser states that: “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, (Corey, 2015, p. 318).”  Wubolding, (2013) adds that behaviors can be thought of a form of communication, wherein we inform others of our underlying motivations.

“Physiology refers to both voluntary and involuntarily bodily mechanisms, (Sharf, 2015, p. 421).”  EXAMPLE: I experience physiological anxiety.
“Thinking includes both voluntary and involuntary thoughts, (Sharf, 2015, p. 421).”  EXAMPLE:  I think about our mounting debt.
Feelings include an endless array of both positive and negative emotions, (Sharf, 2015). EXAMPLE:  I feel frustrated about paying it off.
“Doing refers to active behavior…voluntary or involuntary, (Sharf, 2015, p. 421).”  EXAMPLE:  I bitch and whine endlessly.
“behavior is a language, and that we send messages by what we are doing, (Covey, 2015 p. 319). EXAMPLE:  I communicate a lack in faith that we can get through this.  

Additionally, Glasser utilizes a diagram as an analogy to describe how he conceives human behavior (Sharf, 2015).  Our needs exist as the engine or motivate fuel that drives our behavior while our individual wants are much like a steering wheel by providing us some direction (Sharf, 2015).  Now if we have a front wheel drive car, actions and thoughts are the front wheels, while feelings and physiology are the back wheels (Sharf, 2015).  This analogy is keeping with Glasser’s assertion that innate needs are essential as a point of understanding human behavior, while describing how we can gain control of the vehicle.

Basic Human Needs

Glasser believes that our conceptions of our external world are defined by an innate desire to satisfy our innate human needs (Sharf, 2015).  Consequently, reality as we experience is a subjective creation and not an objective fact.  “For example, a woman with anorexia may have a picture of herself as fat, (Sharf, 2015, p. 420).”   These needs provide motivation for our behavioral choices and are universal in nature since they are innate rather than learned (Wuboldt, 2013).  Glaser describes five basic needs:

SURVIVAL: “Taking care of oneself by eating, drinking, seeking shelter, & resisting illness, (Sharf, 2015, p. 420).
BELONGING:  A basic  desire for love &acceptance from others as well as a feeling of cooperation in significant relationships, (Sharf, 2015).  
POWER:  A need to “be better than others often conflicts with our need for belonging, (Sharf, 2015, p. 420).”  This esteem or feeling worthwhile by achieving our personal goals. 
FREEDOM:  A desire to live life on our own terms and have control over how we choose to express ourselves (Sharf, 2015).  
FUN:  a need to engage in experiences and activities one finds enjoyable (Sharf, 2015). 

The Nature of Choice

“When a person perceives that he or she is getting what is desired from the external world, the five needs are satisfied. But when there is a difference between what is desired and the input one receives by way of the perceptual system, the person is motivated to generate a choice, a behavior in the external world, (Wubolding, 2013, p. 295).”

How does reality therapy address the issue of illogical human behavior? In other words, why would we choose for ourselves a state of being that is displeasurable?  Glasser describes in his theory for reason why a person would choose an unwanted state of being (like anxiety or depression)

FIRSTLY:  Individuals sometimes choose to be anxious or depressed because it is a preferable to displays of anger (Sharf, 2015).  (EX – I vacillate between anger & depression in response to the money issues rather than lashing out in anger.)
SECONDLY:   Individual’s sometimes choose to be angry or depressed because it yields a more helpful response from others.  (EX – when my husband sees me becoming anxious about our debt, he watches the budget closely, and the kids whine less about shopping).
THIRDLY:  “Individuals choose pain and misery to excuse their unwillingness to do something more effective (Sharf, 105, p. 422).”  (EX – For example, I choose to remain in an abusive relationship for promises of acceptance, rather than heal older traumas from my childhood).
FOURTHLY:  Sometimes people opt for anxiety and depression because it can help them gain control of other’s responses (Sharf,  2015).  
In other words, “when people choose misery…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. (Corey, 2015 p. 319).”

In this sense, Glasser does not view illogical behavior as a matter of mental illness, but instead as a “creative solution” to a complex problem (Sharf, 2015).  The key question for therapists then would be: What purpose does this behavior serve?  Answering this question will require utilizing Glasser’s Car Metaphor for perspective since individual’s may not directly choose these behaviors.  “People do not choose pain and suffering directly; rather, it is an unchosen part of their total behavior, (Corey, 2015, p. 319).”

EXAMPLE ONE: A person can play victim because it gives them a sense of control over others and they can feel a sense of validation and self-righteousness that their hurt was in fact caused by other people.  An unchosen part of this total behavior is that they become helpless.  Solutions can only be defined in terms of others
EXAMPLE TWO:  When I become depressed I start focusing on regrets from my past (i.e. unforeseen illness and mounting medical bills).  I use these past experiences to predict future events, and see nothing about the same in my future.  This causes heightened anxiety as I begn thinking in terms of worst case scenarios.  This helps me feel prepared for the worse, however renders me helpless.  All I can do is worry and complain.  

A Theory of Personality

“Reality therapy teaches that human beings choose behaviors. When choices are made, people discover that the result attained is desirable or undesirable. They thus discover whether their behaviors are effective or ineffective in satisfying their needs. They also discover whether particular aspects of the external world are pleasurable (need-satisfying), painful (not need-satisfying), or neutral, (Wubolding, 2013, p. 299).”

According to Glasser, personality development begins with a basic understanding of our needs, and how to best fulfill them.  Life experiences accumulate to create a perspective that we utilize to understand our world.  Since all behaviors are designed to fill our needs, our identity is based on how successful we are at meeting them (Wubolding, 2013)….

Success Identity

A success identity can be thought of as “a responsible individual who develops a high degree of self-esteem, personal strength, and [successful in meeting their] needs, (Rosenthal, 2015).”  In order to develop a success identity we need to be willing to develop a “repertoire of skills for meeting the fiveneeds of belonging, power, fun, freedom, and survival in positive ways, (Wubolding, 2013, p 301).”  A resource I found for this post describes three key elements necessary for the development of a successful identity (Wubolding, 2013):

“(1) a desire to fulfill human needs effectively without infringing on the rights of others; (2) elements of a positive life direction include the following positive symptoms such as “altrusim…effective thinking…self-confidence…effective behaviors; (3) and a positive addiction for meditation and noncompetitive exercise (Wubolding, 2013, p. 301).”

Failure Identity

A failure identity “is characterized by faulty perceptions and irresponsible behaviors, (Rosenthal, 2015).” Their behavioral responses are ineffective in meeting their life needs.  In contrast, the development of a failure identity is byproduct of three factors:

“(1) giving up…(2) [engaging in]…ineffective behaviors such as antisocial actions…negative thoughts [and] feelings; (3) and unhealthy addictions, (Wubolding, 2013, p. 301).”

The Reality Therapy Process

Rosenthal (2005), completes his discussion of reality therapy by providing an overview of the process in eight key steps:
“(1) establishing a relationship; (2) Focusing on current behavior; (3) Requesting client participation in evaluation process; (4) developing a plan for change: (5) committing to therapy; (6) accepting responsibility; (7) avoid punishment & while utilizing judgment to ascertain willingness to change; (8) finally, remain persistent, (Rosenthal, 2005).

Facilitators of Change

How does Reality Therapy make change happen?  Wubolding, (2013) states that Reality Therapy provides hope to clients in the form of a realistic solution.  Corey, (2015) states that change happens “when [clients] 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, (p. 325).”

  1. Reality therapy facilitates change because it helps us understand how we are behaving from moment-to-moment throughout our lives, (Wubolding, 2013).
  2. Reality therapy facilitates change by helping us find effective solutions to gain control over our lives and increase our overall effectiveness in meeting our needs, (Wubolding, 2013). 
  3. The therapeutic relationship facilitates change by [roviding the client a friendly and safe environment in which to examine their total behaviors.
  4. Reality therapy facilitates change by helping improving their ability to engage in honest self-evalaution (Wubolding, 2013).  

Assessment

Reality Therapy does not utilize assessment for diagnostic purposes, but instead as a facilitator of change (Sharf, 2015).  Wubolding (2013) notes that “all change, great and small, is preceded by the client’s judgment that life is not as it could be and that a better, more rewarding future is possible, (p 310).  In other words, helping a client understand how change is possible, itself is a huge step.  Sharf, (2015) notes two key elements focused upon in a Reality Therapy approach include: an assessment of wants and total behaviors:

ASSESSMENT OF WANTS & NEEDS:  What does one want and how do these wants represent the five human needs Glaser has discussed?  How can they describe the need between what they want and what they have?
ASSESSMENT OF TOTAL BEHAVIOR:  Utilizing the metaphor of the car, what are your actions, thoughts, behaviors, and physical symptoms.  How can you describe your responses to difficult life situations, in this matter?  

WDEP System

“the WDEP system…represent[s] 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, (Wubolding, 2013, p. 304).”  Each letter represents a different step in the overall therapy process which naturally begins with the establishment of a therapeutic relationship (Sharf, 2015).

“WDEP…refers to W = Wants, D = Direction & Doing, E = evaluation, & P = Planning, (Sharf, 2015, p. 424).”
STEP ONE “As client’s what they want, (Wubolding, 2013, p. 304)” This means examing one’s personal wants and how they influence their perceptions of reality.
STEP TWO“Ask clients what they are doing and their overall direction, (Wubolding, 2013 p. 305).”  This is can help clients examine the motivations underlying their behavior and what changes they can make.
STEP THREE“Ask clients to conduct a searching self-evaluation, (Wubolding, 2013, p. 305).”  For example, how realistic are their needs and are their behaviors taking them in the direction of their goals?
STEP FOUR “Ask clients to make Plans to more effectively fulfill their needs…. The plan should have SAMIC characteristics—i.e., it should be Simple, Attainable, Measurable, Immediate, and Committed to, (Wubolding, 2013, p. 306).”

Therapist Attitudes

“The following are attitudes that counselors adopt when handling difficulties in exploring total behavior, evaluating the behavior, making plans, and committing to plans: (1) No excuses for failure to follow through on plans are accepted…(2) The counselor does not criticize, argue with, or punish the client… (3) The counselor does not give up on the client, but persists, (Sharf 2015 p. 428).”

Therapeutic Strategies

Finally, before I end this post, I think its useful to list a few therapeutic strategies listed in Sharf’s (2015) textbook.  He begins by noting that this method is not “technique focused” (Sharf, 2015, p. 430).”

  1. QUESTIONING:  Developing a variety of ways to ask clients about their inner world is useful in exploring the elements of one’s total behavior.
  2. BEING POSITIVE:  “The reality therapist focuses on what the client can do. Opportunities are taken to reinforce positive actions and constructive planning, (Sharf, 2015, p. 431).”
  3. METAPHORS:  Glasser seems to describe the use of metaphor as a way of utilizing the client’s language to describe their needs and total behaviors.  This can be useful in talking about things in a manner which is congruent with their own experience (Sharf, 2015, p. 432).
  4. CONFRONTATION:  As stated earlier, one essential therapeutic attitude involves the refusal to accept excuses from your clients, (Sharf, 2015).  Confronting the client doesn’t necessarily mean that you’re rejecting the client or being negative.  Instead it means a firm line is drawn that forces the client to accept responsibility.
  5. PARADOXICAL TECHNIQUES:  “Paradoxical techniques are those that give contradictory instructions to the client, (Sharf, 2015, p. 432).”  This method appears similar to Viktor Frankl’s paradoxical intention technique that involves having the client engage in a highly exaggerated and inappropriate level of a specific behavior they hope to extinguish.  For example, this can involve reframing how we think about a topic, or prescribing a schedule for certain maladaptive behaviors in order to control them better (Sharf, 2015).

References

Corey, G. (2015). Theory and practice of counseling and psychotherapy. Retrieved from: http://bk.unesa.ac.id/wp-content/uploads/2015/09/Theory_and_Practice_of_Counseling.pdf
Glasser, W. (1981). Station of the mind: New direction for reality therapy. New York: Harper & Publisher.
Reality Therapy / Choice Theory: Chapter 8. (n.d.) Retrieved from:  http://www.willamette.edu/~regray/cm/CH%208%20Reality%20Therapy.pdf
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Sharf, R. S. (2015). Theories of psychotherapy & counseling: Concepts and cases. Cengage Learning.
Wubbolding, R. E. (2013). Reality therapy for the 21st century. Routledge.

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