Week 8

Question 1

Main themes

Answer 1

Underlying the reality perspective is the choice theory view of human nature, which posits that we are social creatures and need to both receive and give love. According to this approach, we are genetically predisposed to the drives for survival, love and belonging, power, freedom, and fun. Our need for love and belonging is both the most important need and the most difficult to satisfy. Unhappiness and other psychological issues arise when any of these needs are not met sufficiently, and counsellors assist their clients by helping them to identify unsatisfied needs and work towards resolving them.

Key concepts and themes

Choice theory and reality therapies emphasise the role of the brain as a control system that monitors our efforts to satisfy our needs through the feelings associated with these needs. Although we may not be aware of our needs at any given moment, and we do not satisfy them directly, when these needs are left unsatisfied the pain arising from this state of dissatisfaction drives our want to feel better. Central to this process is the development of our quality world and inner picture album. These are explained in View of human nature (section 11-2a of your eText).

Instead of focusing on what the client cannot control (which is considered to be of minimal value), reality therapy focuses on what the client can control. Reality therapy seeks to provide clients with the means to recognise their ineffective behaviours that have led to their unsatisfied wants, and adopt more effective behaviours. Complaining, blaming, and criticising are seen to be the least effective behaviours the client can adopt to achieve their wants, and counsellors highlight this by asking their client to consider how effective their behavioural choices have been, particularly with respect to their meaningful connections to others. Underlying this process used in reality therapy are five key principles, which are outlined in the interactive activity below. Select each of the tabs to explore these principles.

Emphasise choice and responsibility: A central premise of reality therapy is that the client is held responsible for their own choices. Rather than blaming or punishing clients for these choices, counsellors emphasise that clients have greater control over what they do than they often believe. By focusing on areas where the client has a choice, they can develop an awareness of where better choices can be made, such as engaging themselves in meaningful activities and bringing them closer to those they need.

Reject transference: As one of the goals of reality therapy is to assist clients in developing more effective ways of relating to others, it is important for both client and counsellor to be aware of who they are and owning what they are doing right now. In contrast to some of the previous approaches discussed, reality therapy considers transference to be unrealistic and a way of avoiding responsibility. As such, counsellors that adopt this approach strive to be themselves and encourage their clients to do the same.

Keep the therapy in the present: While past circumstances are considered to have led to a client’s current situation, a much greater emphasis is placed on what can be achieved in the present, with the understanding that the past is not the problem and previous mistakes are no longer pertinent to one’s current experience. From this view, focusing on the past only leads to avoidance of the future. Instead, clients are encouraged to focus on what can be done now to move forward. The past cannot be changed and does not determine our destiny, but the choices made now will continue to shape our future, despite these being limited by our external world.

Avoid focusing on symptoms: As with a focus on past experiences, the reality respective views that focusing on symptoms leads to avoidance of responsibility, which acts as a protection against the reality of unsatisfying relationships. Rather than viewing these experiences as things that have happened to them, a client’s symptoms are an indication that their needs are not being met by their chosen behaviours and are typically symbolic of a present unhappy relationship. Problems occurring in the present, particularly those related to interpersonal concerns, become the focus to assist clients to develop more effective total behaviour.

Challenge traditional views of mental illness: Counsellors adopting the reality perspective avoid using the traditional system of diagnosis and reject the notion that physical and psychological symptoms characterise mental illness. While some may use this system creatively to assist in identifying a client’s currently unsatisfied needs, others insist that the reliance on the traditional view of mental illness and the use of medication can be hazardous to both physical and mental health. Instead, clients are encouraged to continue their search for more effective choices by reframing their perspective on diagnostic categories and negative behaviours.

Question 2

Techniques

Answer 2

With the primary aim of reality therapies to assist the client in becoming connected or reconnected to the important people in their lives, the counsellor takes on the role of mentor and advocate to teach their clients how to behave more effectively in satisfying their wants and needs. Clients learn to engage in a process of self-evaluation to reflect on their behaviours and how effective these are in achieving their wants. Rather than provide the evaluation themselves, counsellors challenge their clients with questions, such as “Is what you are choosing to do getting you what you want and need?”, leading the client to re-evaluate their behaviours and implement a plan to achieve the desired changes. Through this process, the client can start to identify their basic needs, discover their quality world, and understand how they have chosen their total behaviours that have resulted in their present symptoms.

Through a supportive yet mildly confronting, i.e. approaching the issue directly, therapeutic relationship, counsellors provide a safe space for their client to identify their ineffective behaviours and implement new strategies to satisfy their wants. Whilst all reality therapy is based on the same principles and ultimately aimed toward developing the client’s sense of connectedness and improving unsatisfying relationships, the actual process may differ depending on the counsellor’s style and personal characteristics, as well as what the client identifies as meaningful. By making clients aware of the control they have over their own behaviours and how their total behaviour may be reflected in the symptoms, feelings etc. that brought them to therapy, reality therapy can instil a greater sense of hope for the future.

Applying reality therapy to group and multi-cultural counselling

The inherent focus on the need for love and belonging in reality therapy is well-suited to a group therapy setting, providing members with an opportunity to explore new ways of satisfying their needs through the relationships developed with other members. Utilising the WDEP approach, members learn to evaluate their total behaviours and implement new plans to change unsatisfactory aspects of their life with the assistance of the group leader. Members devise and implement their own homework to complete in between sessions that will assist them in achieving their goals. Plans that fail to come to fruition are discussed with the group leader to help members establish what prevented them from doing so—such as unrealistic goals or unwillingness to engage in the steps necessary to implement the plan. From this view, insight alone is not sufficient to implement change, as change requires members to do something different rather than waiting for those around them to change.

Multicultural counselling from a reality therapy perspective can also assist clients to recognise how to integrate aspects of the dominant culture in which they live while retaining their ethnic identity. Clients can learn to recognise how they respond to their own culture through the focus on evaluating total behaviour, which provides them with an opportunity to identify how well these behaviours satisfy their wants and needs.

Question 3

Limitations

Answer 3

Now that you have explored this week’s approach and applied it to two case studies, it is time to consider the limitations of choice theory/reality therapy. Remember that for Assignment 2: Essay you will be asked to critically evaluate the strengths and limitations of the two approaches you have chosen in the treatment of a client.

The approach of reality therapy has been criticised for its lack of focus on psychological aspects such as insight, the unconscious, dreams and transference. Some psychological disorders cannot be viewed as behavioural choices, such as serious mental illness, and there is a danger that the counsellor may impose their views of what constitutes responsible behaviour onto the client. Despite being seen as simple and easy to master, reality therapy also requires a great deal of training to implement effectively, and there is currently a lack of empirical evidence to support the effectiveness of such an approach.

Question 4

We store information inside our minds and build a file of wants, called our quality world.

Answer 4

True

Question 5

Reality therapy is based on choice theory.

Answer 5

True

Question 6

A good way to change behaviour is for us to be self-critical.

Answer 6

False

Question 7

It is important to explore the past as a way to change current behaviour.

Answer 7

False

Question 8

One of the therapist’s functions is to make judgments about clients’ present behaviour.

Answer 8

False

Question 9

The focus of reality therapy is on attitudes and feelings.

Answer 9

False

Question 10

A key strength of reality therapy is that it provides clients with tools to make the changes they desire.

Answer 10

True

Question 11

Reality therapy is grounded on some existential concepts.

Answer 11

True

Question 12

The basic human needs serve to focus treatment planning and setting both short- and long-term goals.

Answer 12

True

Question 13

Appropriate punishment is an effective way to change behaviour.

Answer 13

False

Question 14

When working with clients from certain ethnic groups, reality therapy exposes shortcomings. Which of the following is not a shortcoming?

Answer 14

It provides clients with tools to make the changes they desire.

Question 15

According to this approach, insight:

Answer 15

is not sufficient for producing behaviour change on its own.

Question 16

Choice theory explains the view of human nature as we are born with five genetically encoded needs that drive us all our lives. Which of the following is not one?

Answer 16

discipline.

Question 17

Which is not a key concept of reality therapy?

Answer 17

Unconscious motivation.

Question 18

Which of the following is not true of reality therapy?

Answer 18

Working through the transference relationship is essential for therapy to occur.

Question 19

Regarding the goals of reality therapy:

Answer 19

it is to help clients learn better ways of fulfilling all of their needs.

Question 20

In reality therapy, our quality world is likened to:

Answer 20

a picture album

Question 21

Which statement is not true of reality therapy?

Answer 21

It focuses on attitude change as a prerequisite for behaviour change.

Question 22

Reality therapy was designed originally for working with:

Answer 22

youth offenders in detention facilities.

Question 23

Which of the following is a technique used by a reality therapist?

Answer 23

The WDEP System.

Question 24

Which of the following statements is true as it applies to choice theory?

Answer 24

We are motivated completely by internal forces, and our behaviour is our best attempt to get what we want.

Question 25

According to Glasser, all of the following are basic psychological needs except for:

Answer 25

competition

Question 26

An axiom of choice theory is that:

Answer 26

although the past may have contributed to a current problem, the past is never the problem.

Question 27

Sometimes it seems as though people actually choose to be miserable (depressed). From Glasser’s perspective, which of the following does not imply passivity and lack of personal responsibility:

Answer 27

being understood

Question 28

All of the following are procedures in reality therapy that are said to lead to change except for:

Answer 28

The therapist’s evaluating of the client’s behaviour.

Question 29

Textbook Notes

Answer 29

Reality Therapy/Choice Therapy Believes the underlying problem for many clients is the same: they are either involved in a present unsatisfying relationship or lack what could even be called a relationship. Many clients problems are caused by their inability to connect, to get close to others, or to have a satisfying or successful relationship with at least one significant person in their life. The therapist guides clients toward a satisfying relationship and teaches them more effective ways of behaving. Few clients understand that their problem, which is unhappiness, results from the way they are choosing to behave. Glasser 2003 maintained that clients should not be labelled with a diagnosis except when it is necessary for insurance purposes. From Glassers perspective, diagnoses are descriptions of the behaviours people choose in their attempt to deal with the pain and frustration that is endemic to their unsatisfying present relationships. Glasser limits mental illness to conditions like Alxheimers, conditions associated with tangible brain damage. Glasser’s view is that they should be treated primarily by neurologists. Reality therapy is based on choice theory as it is explained in several of Glassers books. Choice theory is the theoretical basis for reality therapy; it explains why and how we function. Reality therapy provides a delivery system for helping individuals take more effective control of their lives. If choice theory is the highway, reality therapy is the vehice delivering the product. Reality therapy has been used in a variety of settings. The approach is applicable to counselling, social work, education, crisis intervention, corrections and rehabilitation, institutional management and community development. 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 five genetically encoded needs that drives us all over lives; survival, or self-preservation, love and belonging power (inner control), freedom (independence), fun (enjoyment). Glasser believes that need to love and belong is the primary need because we need people to satisfy the other needs. 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. Choice theory teaches that we do not satisfy our needs directly. We store information inside our minds and build a file of wants, called our quality world, which is at the core of our life. In our quality world we develop an inner picture album of specific wants as well as precise ways to satisfy these wants. Part of the process of reality therapy is assisting clients in prioritising their wants and uncovering what is most important to them. People we are closes to and most enjoy being with are the most important component of our quality world, and we most want to connect with these people. Getting into the clients quality world is the art of therapy. It is from this relationship with the therapist that clients begin to learn how to get close to the people they need. Choice Theory Explanation of Behaviour – choice theory explains that all we ever do from birth to death is behave and with some exceptions, everything we do is chosen or at least generated from within ourselves. Total behaviour teaches that all behaviour is made up of four inseparable but distinct components – acting, thinking, feeling and physiology – that necessarily accompany all of our actions, thoughts and feelings. Choice theory emphasies thinking and acting, which makes this general form of cognitive behaviour therapy. Our behaviours come from the inside and thus we choose our destiny. From Glasser perspective, to speak of being depressed, having a headache, being angry, or being anxious implies passivity and lack of personal responsibility and its inaccurate. It is more accurate to think of these as parts of total behaviours and to use the verb forms despressing, headaching, angering and anxietying to describe them. The behaviour of the person is the best effort, ineffective as it is, to satisfy needs. Wubbolding 2017 has added a new idea to choice theory. He believes that behaviour is a language and that we send messages by what we are doing. Characteristics of Reality Therapy – the role of meaningful relationships in fostering emotional health is receiving increased attention in contemporary reality therapy which quickly focuses on the unsatisfying relationship or the lack of relationship. When clients complain about how other people are causing them pain, reality therapists ask clients to consider how effective their choices are, especially as these choices affect their relationships with significant people in their lives. Reality therapists spend little time listening to complaining, blaming and criticising for these are the most ineffective behaviours in our behavioural repertoire. Emphasise Choice and Responsibility – reality therapists see clients as being responsible for their own choices as they have more control of their behaviour than they often believe. This does not mean people should be blamed or punished. Choice theory changes the focus of responsibility to choice and choosing. Reality therapists deal with people as if they have choices. Therapists focus on those areas where clients have choice, for doing so gets them closer to the people they need. Reject Transference – reality therapists strive to be themselves in their professional work. By being themselves, therapists can use the relationship to teach clients ho to relate to others in their lives. Wubbolding claims that not all reality therapists would accept Glassers perspective on transference. Keep the Therapy in the Present – many therapeutic models teach that to function well in the present people must understand and revisit their past. Glassers 2001 disagrees with this assumption and contends that what ever mistakes were made in the past are not pertinent now. To function effectively, people need to live and plan in the present and take steps to create a better future. The reality therapists does not totally reject the past. 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. Wubbolding contends that history is not destiny. Although, the past has propelled us to the present, it does not have to determine our future. Avoid focusing on symptoms – in traditional therapy a great deal of time is spent focusing on symptoms by asking clients how they feel and why they are obsessing. Ther are reluctant to accept the reality that their suffering is due to the total behaviour they are choosing. Their symptoms can be viewed as the bodys way of warning them that the behaviour they are choosing is not satisfying to 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. According to Glasser, if clients believe that the therapist wants to hear about their symptoms or spend time talking about the past, they are more than willing to comply. Glasser, maintains that almost all symptoms are cause by a present unhappy relationship. Challenge Traditional Views of Mental Illness – choice theory rejects the traditional notion that people with problematic physical and psychological symptoms are mentally ill. Wubbolding takes strong stand against using the DSM 5, warned people to be cautious of psychiatric which can be hazardous to boths ones physical and mental health. Glasser challenges the traditionally accepted views of mental illness and treatment by the use of medications, especially the widespread use of psychiatric drugs that often results in negative side effects both physically and psychologically. Wubbolding contends that reality therapy is a mental health system rather than a mental disorder system. Therapeutic Goals – primary goal of contemporary reality therapy is to help clients get connected or reconnected with people they have chosen to put in the quality world. Help clients learn better wats of fulfilling of their needs, including achievement, power or inner control, freedom or independence and fun. Serve to focus treatment planning and setting both short and long terms goals. Assist clients in making more effective and responsible choices related to their wants and needs. These individuals often engage in violent behaviour, addictions, and other kinds of antisocial behaviour. It is essential for counsellors to do whatever they can connect with involuntary clients. Therapists Function and Role – therapy is often considered as a mentoring process in which the therapist is the teacher and the client is the student. Reality therapies teach clients how to engage in self-evaluation, which is done by raising the question – is what you are choosing to do getting you want and need. The role of the reality therapist is not to make the evaluation for clients but to challenge clients to examine what they are doing. Clients then decide what to change and formulate a plan to facilitate the desired changes. It is the job of the therapists to convey the idea that no matter how bad things are ther is hope. Clients Experience in Therapy – clients are not expected to backtrack into the past and get sidetracked into talking about symptoms. Reality therapists will gently, but firmly challenge clients. They 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? Clients can expect to experience some urgency in therapy. Relationship Between Therapist and Client – emphasises an understanding, supportive, and trusting relationship. This therapeutic alliance is the foundation for an effective outcome. Wubbolding emphasises the necessity for the couselor to be present physically, emotionally, mentally, and behaviourally. Although the therapeutic relationship is paramount it is not an end in itself, and it is not automatically curative or healing. Identifies specific ways for counsellors to create a climate that leads to involvement with clients. For therapeutic interventions to work effectively, a fair, firm, friendly and trusting environment is necessary. Once involvement has been established the counsellor assists clietns in gaining a deeper understanding of the consequences of their current behaviour. The practice of Reality Therapy – the practice of reality therapy can best be conceptualised as the cycle of counselling which consists of two major components, 1. Creating the counselling environment, 2. Implementing specific procedures that lead to changes in behaviour. The art of counselling is to weave these components together in ways that lead clients to evaluate their lives and decide to move in more effective directions. The cycle of counselling begins with creating a working relationship with clients and proceeds through an exploration of clients, wants, needs and perceptions. The cycle of counselling includes following up on how well clients are doing and offering further consultation as needed. The concepts of reality therapy may seem simple as they are presented here but being able to translate these principles into therapeutic practice takes considerable skill and creativity. The are of practicing reality therapy involves fare more than following procedures in a step by step cookbook fashion. With choice theory in the background of practice, the counsellor tailors the counselling to what each clients presents. Wubbolding has played a major role in the development of reality therapy and has extended the practice of reality therapy through development of the WDEP system. Wubboldings chart which diagrams the WDEP model. It describes counselling, coaching, managing, supervising, and parenting and highlights issues and tasks to be accomplished throughout the cycle of counselling. The counselling Environment – the practice of reality therapy rests on the assumption that a supportive and challenging environment allows clients to begin making life changes. Clients generally being to appreciate the caring, accepting, noncoercive choice theory environment. Procedures that lead to change – reality therapist operate on the assumption that we are motivated to change, 1. When we are convinced that our present behaviour is not meeting our needs and 2. When we believe we can choose other behaviours hat will get us closer to what we want. In the first session, a skilled therapist looks for and defines the wants of the client. When clients begin to realise that they can control only their own behaviour, therapy is under way. Wubbolding 2011 points out that clietns can learn they are not at the mercy of others are not victims, are capable of gaining a sense of inner control, and have a range of choices open to them. In short clients in reality therapy often acquire a sense of hope for a better future. Reality therapists explore the tenets of choice theory with clients, helping them identify basic needs, discovering their quality world, and finally helping clients understand that they are choosing the total behaviours that are their symptoms, In every instance when clients make change its their choice. The WDEP System: Wants – reality therapists assist clients in discovering their wants and hopes. Part of counselling consists of exploring the picture ablum, or quality world, of clients and how their behaviour is aimed at moving their perceptions of the external world closer to their inner world of wants. This exploration of wants, needs and perceptions. Questions – if you were the person that you wish you were, what kind of person would you be? Perception Questions – how do you look at the situation? It is the art for counsellors to know what questions to ask, how to ask them, and when to ask them. In this phase of counselling clients begin to commit to making changes in their behaviour. Direction and Doing – the focus on the present is characterised by the key question asked by the reality therapist. Early in counselling it is essential to discuss with clietns the overall directions of their lives, including where they are doing and where their behaviour is taking them. Reality therapy focuses on gaining awareness of and changing current total behaviour. Listening to clients talk about feelings can be productive, but only if it is linked to what they are doing. From a choice theory perspective, discussions centering on feelings without strongly relating them to what people are doing and thinking are counterproductive. Self-Evalutating – the cornerstone of reality therapy proceddures is self-evalutation. Conducting a searching and fearless self-evalutation is the royal road to behaviour change. Wubbolding believes that clients often present a problem with a significant relationship which is at the root of much of their dissatisfaction. Artful questioning assist clients in evaluating their present behaviour and the direction this is taking them. Questions – is what you are doing helping or hurting you? Asking clients to evaluate each component of their total behaviour is a major task in reality therapy. Individual will not change until they first decide that a change would be more advantageous. Without an honest self-assessment, it is unlikely that clients will change. The process of evaluation of doing, thinking, feeling and physiological component of total behaviour is withn the scope of the client responsibility. Reality therapist may be directive with certain clients at the beginning of treatment to help clients recognize that some behaviours are not effective. As they grow and continue to interact with the counsellor they learn to make evaluations with less and less help from the counsellors. Planning and Action – much of the significant work of the counselling process involves helping clients identify specific ways to fulfill their wants and needs. Throughout the planning phase, the counsellor continually urges the client to be willing to accept the consequences for his or her own choice and actions. Wubboling discusses the central role of planning and commitment. Although, planning is important it is effective only if the client has made a self-evaluation and determined that he or she wants to change the behaviour. - The plan is within the limits of the motivation and capacities of the client. Skillful counsellors help clients identify plans that involve greater need fulfillin payoffs. - Good plans are simple and easy to understand - The plan involves a positive course of action, and it is stated in terms of what the client is willing to do. - Cousellors encourage clients to develop plans that they can carry out independently of what others do - Effective plans are repetitive and ideally are performed daily - Plans are carried out as soon as possible - Plans involve process centered activites - Before clients carry out their plan, it is a good idea for them to evaluate it with their therapist to determine whether it is realistic and attainable and whether it relates to what they need and want - To help clients commit themselves to their plan, it is useful for them to firm it up in writing Resolutions and plans are empty unless there is a commitment to carry them out. Asking clients to determine what they want ofr themselves, to make a self-evaluation and to follow thgh with action plans includes assisting them in determining how intensely they are willing to work to attain the changes they desire. Clients are helped by a therapist who does not easily give up on believing in their ability to make better choices even if they are not always successful in completing their plans. Application to Group Counselling – with the emphasis on connection and interpersonal relationships, reality therapy is well suited for various kinds of group counselling. Groups provide members with many opportunities for exploring ways to meet their needs through the relationships formed with the group. This model lends itself to expecting the members to carry out homework assignments between the group meetings. Memebers also take the lead in deciding what kinds of homework tasks they will set for themselves as a way to achieve their goals. Once the members make some changes, reality therapy provides the structure for them to formulate specific plans for action and to evaluate their leve of success. Strengths from a Diversity – the core principles of choice theory and reality therapy have much to offer in the area of multicultural counselling. In cross-cultural therapy, it is essential that cousellors respect the differences in world view between themselves and their clients. With this focus no thinking and acting rather than on exploring feelings many clients are less likely to display resistance to counselling. Wubbolding asserts that principles underlying choice theory are universal, which makes choice theory applicable to all people. Based on the assumption that reality therapy must be modified to fir the cultural context of people other than north americans, ie Japanese clients – changing the way the questions are asked, ask clients to make a plan and stick to it. A key strength of reality therapy is that it provides clients with tools to make the changes they desire. Reality therapy needs to be usef artfully and to be applied in different ways with a variety of cleints. Shortcomings – working with clients from certain ethnic groups is that it may not take fully into account some very real environment forces that operate against them in their everyday lives. It is important that therapists acknowledge that people do not choose to be the victims of various forms of discrimination and oppression. Some reality therapists may make the mistake of too quickly or too forcefully stressing the ability their clients to take charge of their lives. On this point, Wubbolding maintains hat because of oppression and discrimination some people have fewer choices available to them yet they do have choices. Another shortcoming, associated with reality therapy is that some clients are very reluctant to directly verbally express what they need. Contributions – among the advantages of reality therapy are its relatively short term focus and the fact that it deals with conscious behavioural problems. With the emphasis on responsibility and choice, individuals can acquire a sense of self-direction and empowerment. Too often counselling failts because therapists have an agenda for clients. The reality therapist helps clients conduct a searching inventory of what they are doing. Reality therapy has been eeffectively used in addiction treatment and recovery programs for more than 30 years. Reality therapy is an effective, short term approach, often requiring 10 sessions or less, that can enable people to make life changes without prolonged therapy. Limitations – that it does not give adequate emphasis to the role of the following aspects of the counselling process; the unconscious, the power of the past and the effect of traumatic transference. Dealing with dreams is not part of the reality therapist repertoire. Have a difficult time accepting Glassers view of transference as a misleading concept, for I find that clients are able to learn that significant people in their lives have a present influence on how they perceive and react to others. Wubbolding admits that reality therapy can lend itself to focusing on problem solving, and inexperienced or inadequately trained counsellors may impose their own values on clients. Finally, because reality therapy is easily understood, it may appear to be easy to implement. This is not the case, Effective practice of reality therapy requires practice, supervision and continuous learning.