What is reality therapy?

Introduction

William Glasser, the founder of reality therapy, believes that people are motivated to fulfill five basic needs: belonging, power, freedom, fun, and survival. When these needs are not met, problems begin. Individuals lose touch with the objective reality of life (what is appropriate behavior and what is not) and often stray into patterns of behavior that are self-defeating or destructive. The reality therapist attempts to help such people by teaching them more appropriate patterns of behavior. This, in turn, will enable individuals to meet their basic needs more effectively.

Reality therapy differs from conventional theories of counseling or psychotherapy in six ways. Reality therapy rejects the concept of mental illness and the use of diagnostic labels; it works in the present, not the past; it rejects the concept of transference (the idea that clients relate to the therapist as an authority figure from their past); it does not consider the unconscious to be the basis of present behavior; the morality of behavior is emphasized; and, finally, reality therapy teaches individuals better ways to fulfill their needs and more appropriate (and more successful) ways to deal with the world.

Therapy Process

In practice, reality therapy involves eight steps. First the therapist gains makes friends with or establishes a rapport with the client and asks the client what he or she wants. Then the client is asked to focus on his or her current behavior. With help, the client makes a realistic evaluation of his or her behavior. Therapist and client make a plan for the client to do better, which consists of finding more appropriate (realistic) ways of behaving. The therapist gets a commitment from the client to follow the plan that has been worked out. The therapist accepts no excuses from the client if the plan is not followed. No form of punishment is used, however, if the client fails to follow through. Finally, the therapist must never give up on the client.

Paramount to the success of reality therapy is the planning stage, consisting of discovering ways to change the destructive or self-defeating behavior of the client into behavior oriented toward success. Success-oriented behavior leads to a success identity: the feeling that one is able to give and receive love, feel worthwhile, and meet one’s needs appropriately. Glasser states that putting the plan into writing, in the form of a contract, is one way to help ensure that the client will follow through. The client, not the therapist, is then held accountable for the success or failure of follow-through. Commitment is, in many ways, the keystone of reality therapy. Resolutions and plans of action become meaningless unless there is a decision (and a commitment) to carry them out.

Role of Therapists

Reality therapists usually see their clients once weekly, for between forty-five minutes and one hour per visit. Therapists come from a variety of disciplines, including psychiatry, psychology, counseling, and social work. It is important in applying reality therapy that the therapist adopt no rigid rules. The therapist has a framework to follow, but within that framework he or she should be as free and creative as possible.

Like behavior therapists, reality therapists are basically active, directive, instructive, and oriented toward action. Reality therapists use a variety of techniques, including role-play, humor, question-and-answer sessions, and confrontation. They do not employ some commonly accepted therapeutic techniques, such as interpretation, insight, free association, analysis of transference and resistance, and dream analysis. In addition, reality therapists rarely recommend or promote the use of drugs or medications in treatment.

Confrontation is one technique of special consideration to reality therapy. Through confrontation, therapists force clients to evaluate their present behavior and to decide whether they will change it. Reality therapy maintains that the key to finding happiness and success is accepting responsibility. Thus the therapist neither accepts any excuses from the client for his or her self-defeating or destructive behavior nor ignores the reality of the situation (the consequences of the client’s present behavior). The client is solely responsible for his or her behavior. Conventional psychotherapy often avoids the issue of responsibility; the client (or “patient”) is thought to be “sick” and thus not responsible for his or her behavior.

Throughout reality therapy, the criterion of what is “right” plays an important role in determining the appropriateness of behavior; however, the therapist does not attempt to state the morality of behavior. This is the task and responsibility of the client. Clients are to make these value judgments based on the reality of their situation. Is their current behavior getting them what they want? Does their current behavior lead to success or to failure? The basic philosophy of reality therapy is that people are ultimately self-determining and in charge of their lives. People are, in other words, free to choose how they act and what they will become.

Strengths and Weaknesses

The strengths of reality therapy are that it is relatively short-term therapy (not lasting for years, as classical psychoanalysis does), consists of simple and clear concepts that can be used by all types of helpers, focuses on present behavioral problems, consists of a plan of action, seeks a commitment from the client to follow through, stresses personal responsibility, can be applied to a diverse population of clients (including people in prison, people addicted to drugs and alcohol, and juvenile offenders), and accepts no excuses, blame, or rationalizations.

The weaknesses of reality therapy are that it fails to recognize the significance of the unconscious or of intrapsychic conflict, minimizes the importance of one’s past in present behavior, appears overly simplistic (problems are rarely simplistic in nature), may give the therapist an inappropriate feeling of power or control, minimizes the existence of biological or biochemical factors in mental illness, and fails to recognize the significance of psychiatric drugs in the treatment of mental illness.

Practical Applications

Reality therapy can be applied to individuals with many sorts of psychological problems, from mild to severe emotional disorders. It has been used in a variety of counseling situations, including individual and group counseling, marriage and family counseling, rehabilitation counseling, and crisis intervention. The principles of reality therapy have been applied to teaching, social work, business management, and community development. Reality therapy is a popular method of treatment in mental hospitals, correctional institutions, substance abuse centers, and facilities for delinquent youth.

Marriage therapy is often practiced by reality therapists; the number of sessions ranges from two to ten. Initially, it is important to clarify the couple’s goals for marriage counseling: Are they seeking help to preserve the marriage, or have they already made the decision to end the relationship? In marriage counseling, Glasser recommends that the therapist be quite active, asking many questions while trying to understand the overall patterns of the marriage and of the interrelationship.

Evaluation of Current Behavior

Reality therapists stress current behavior. The past is used only as a means of enlightening the present. The focus is on what a client is doing now. Through skillful questioning, clients are encouraged to evaluate current behavior and to consider its present consequences. Is their current behavior getting them what they want or need? If not, why? As this process of questioning and reflecting continues, clients begin to acknowledge the negative and detrimental aspects of their current behavior. Slowly, they begin to accept responsibility for these actions.

Once responsibility is accepted, much of the remaining work consists of helping clients identify specific and appropriate ways to fulfill their needs and wants. This is often considered the teaching stage, since the therapist may model or teach the client more effective behavioral patterns.

It is difficult to discuss the application of reality therapy to specific problems, since reality therapists do not look at people as objects to be classified according to diagnostic categories. Reality therapists, like others in the holistic health movement, believe that most ailments—whether physical or psychological—are manifestations of the way people choose to live their lives. Glasser has stated:
It makes little difference to a reality therapist what the presenting complaint of the client is; that complaint is a part of the way the client is choosing now to deal with the world. . . . When the client begins to realize that instead of being the victim of some disease or diagnostic category he is a victim of his own ineffective behavior, then therapy begins and diagnosis becomes irrelevant.

Case Study

The following example shows how the eight steps of reality therapy can be applied to a real-life situation. The client’s name is Jim; he is thirty-five years old. For years, Jim has been unable to hold a job. He is twice divorced and is subject to angry outbursts. He has been arrested three times for disorderly conduct. Recently Jim has lost his driver’s license because of alcohol intoxication; he has been referred by the court for counseling.

In step one, the therapist makes friends and asks the client what he or she wants. Here the reality therapist, David, will make himself available to Jim as a caring, warm individual but not as someone whom Jim can control or dominate. David will ask, “What is it that you want?” Jim says, “Well, what I want is a job.” Once the client states what he or she wants, the therapist can move to step two, asking the client to focus on his or her current behavior. Together David and Jim talk about Jim’s behavior—his tendency for angry outbursts, his arrests, and his problems with alcohol.

The third step attempts to get clients to evaluate their present behavior and to see whether what they are now doing is getting them what they want. David asks Jim whether getting in fights is helping him find a job. As this step unfolds, Jim begins to understand that what he is doing is not helping him to become employable. Paramount at this step is that the clients see that their current behavior is within their control: They “choose” to act this way.

Once clients begin to see that what they are doing is not working (not getting them what they want), then the next step (step four) is to help them make a plan to do better. Once Jim realizes that getting in fights and drinking is ineffective and self-defeating, then David will begin to talk with him about a plan to change his behavior and find more appropriate ways of behaving. They plan a course of action. To “cement” this plan, a contract is made. The contract might state that Jim will not get in fights, Jim will control his anger, and Jim will stay out of bars and refrain from alcohol. David may also advise Jim on how to get a job: where to look for work, whom to contact, even what to wear and say during a job interview. Throughout this job search, which may be long and frustrating, David needs to be encouraging and supportive.

Step five involves getting a commitment from the client to follow through. David now asks Jim, “Are you going to live up to the contract? Are you going to change your behavior?” David needs to stress that commitment is the key to making this plan a success. David also must accept only a yes or no answer from Jim. Reality therapy does not accept excuses or reasons why plans are not carried through; this is step six. David’s response to excuses should be that he is not interested in why Jim cannot do it; he is interested in when Jim will do it.

Step seven holds that David needs to be “tough” with Jim, but must not punish him if he does not follow through. Instead of finding ways to punish Jim, David may ask instead, “What is it that will get you to follow through?” Reality therapy recognizes that punishment is, in the long run, rarely effective. Step eight is simply never giving up. For most people, change does not come naturally, nor is it easy. A good therapist, like a good friend, does not give up easily. David needs to persevere with Jim. Through perseverance, Jim’s life can change.

Contributions of Glasser

The tenets of reality therapy were formed in the 1950s and 1960s as a reaction to the dominant psychotherapeutic approaches of the times, which were closely based on Freudian psychoanalysis. Glasser, the founder of reality therapy, was trained as a physician and psychoanalyst, but during his psychiatric training in the early 1950s, he became more and more dissatisfied with the psychoanalytic approach. What disturbed him was the insistence of psychoanalysis on viewing the patient as a victim of forces beyond his or her control. In other words, the person was not considered responsible for his or her current behavior.

In 1956, Glasser became a consultant to a school for delinquent female adolescents in Ventura, California, developing a new therapeutic approach that was in sharp opposition to classical psychoanalysis. In 1962, he spoke at a meeting of the National Association of Youth Training Schools and presented his new ideas. The response was phenomenal; evidently many people were frustrated with the current mode of treatment.

Initially Glasser was hesitant to state his dissatisfaction with the conventional approach to treatment, psychoanalysis; however, his faculty supervisor, G. L. Harrington, was supportive. This started a long relationship in which Harrington helped Glasser formulate many of the ideas that became reality therapy.

In 1965, Glasser put his principles of counseling into a book entitled Reality Therapy: A New Approach to Psychiatry. Since then, he has written extensively, including Schools Without Failure (1968), The Identity Society (1972), Positive Addiction (1976), Stations of the Mind: New Directions for Reality Therapy (1981), Control Theory: A New Exploration of How We Control Our Lives (1985), and The Quality School (1990). The Institute for Reality Therapy, in Canoga Park, California, offers programs designed to teach the concepts and practice of reality therapy. The Journal of Reality Therapy publishes articles concerning the research, theory, and application of reality therapy. Reality therapy has seen remarkable success since its conception, and many consider it one of the important approaches to counseling and psychotherapy.

Bibliography

Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. 9th ed. Belmont: Brooks, 2013. Print.

Ellsworth, Laura. Choosing to Heal: Using Reality Therapy in Treatment with Sexually Abused Children. New York: Routledge, 2007. Print.

Glasser, Naomi, ed. What Are You Doing? How People Are Helped Through Reality Therapy. New York: Harper, 1986. Print.

Glasser, William. Control Theory: A New Explanation of How We Control Our Lives. New York: Perennial Lib., 1990. Print.

Glasser, William. Quality School. 3d ed. New York: Harper, 1998. Print.

Glasser, William. Reality Therapy: A New Approach to Psychiatry. 1965. Reprint. New York: Harper, 1989. Print.

Glasser, William. Reality Therapy in Action. New York: Harper, 2001. Print.

Glasser, William. Stations of the Mind: New Directions for Reality Therapy. 1981. [S.I.]: Harper, 2014. Digital file.

Wubbolding, Robert E. Reality Therapy. Washington, DC: APA, 2012. Digital file. Theories of Psychotherapy.