Therapy

Get Real: The Useful Insights of Reality Therapy

Is what you’re doing getting you closer to the people you need?

Posted May 11, 2020

Reality Therapy, a form of therapy developed by Cleveland-born psychiatrist William Glasser in the 1960s, is a creative mash-up of humanistic and cognitive-behavioral concepts with a touch of Midwestern can-do spirit. Glasser himself was quite the maverick, a sort of anti-psychiatry psychiatrist who rejected the field’s rush to label as diseases, and medicate, psychological problems.

Pixabay
Source: Pixabay

For Glasser, diagnostic labels are merely descriptions of irresponsible behavioral choices. Such behaviors are not a product of illness. Rather, the so-called illnesses are products of such behaviors. His Choice Theory, used to guide the process of Reality Therapy, rejected the notion that behavior results from external conditions, past events, or brain malfunction. He argued instead that individuals choose most of their behaviors and direct them at satisfying five universal human needs: survival, love and belonging, power, freedom, and fun.

Among these, only survival is seen as a physiological need. The other needs are psychological, and chief among them is the need for love and belonging, which Glasser saw as a precondition for the other needs. This need to belong is also the most difficult to satisfy because it requires the cooperation of others. Thus, psychological problems mostly involve difficulties with satisfying the need to belong; in other words, they are relationship problems. Glasser argued, in a nutshell, that people’s main problem is unhappiness. Unhappiness is the result of inadequate relationships. Inadequate relations are the result of ineffective behavior. The goal of therapy therefor is to enact behavior change that will lead to more and better relationships.

The basic needs In Glasser’s system are not organized hierarchically (like for example, Maslow's needs). Rather, they are active concurrently and can shift over time in strength of expression. Our behavior aims to satisfy any of these needs that are unmet at a given time. The basic needs tend to manifest in people’s lives in the form of “wants” that are unique to each individual (for example, the need for fun makes you want to play gulf and makes me want to play basketball). Reality therapy employs certain questions to discover a client’s need-specific ‘wants.’ For example:

“Are you happy with the relationships you have? (Belonging)

“Are you getting what you want from the world around you?” (Power)

“When was the last time you did something you really enjoyed?” (Fun)  

“What choices can you make about your behavior that will help get you where you want to go?” (Freedom)

Reality Therapy looks to identify the most important needs in a person’s life and the best ways to satisfy them. To that end, clients are asked about their ‘Quality World’—a storage of information, based on experience, pertaining to the things they want and like; an image of their happy place. The therapist may also consult the client’s  ‘Inner Picture Album’—a collection of specific ‘wants’ and the ways to satisfy them, mostly involving people and relationships.

For Glasser, all behavior is purposeful, aimed at satisfying needs. Thus, behaviors that appear maladaptive are in fact chosen as a means, albeit misguided, toward need satisfaction. If I’m continuously procrastinating on assignments, I’m doing this to maintain my self-perception as a competent writer, which may be undermined if my finished assignments are evaluated negatively.

Since human problems are caused by unsatisfying present relationships, therapists focus on the present and avoid discussing the past. Likewise, the focus in Reality Therapy shifts from the symptoms themselves to the chosen behaviors that bring them on, just as your physiotherapist may focus on treating your back, rather than your backache. Moreover, Glasser proposed the concept of ‘total behavior,’ which includes one's actions, thoughts, feelings, and physiology--all of which tend to happen at the same time as we act on the world around us. 

Reality Therapy focuses on those aspects of total behavior that clients can control directly, namely actions and thoughts, while less time is spent on what clients cannot control directly: their feelings and their physiological states. Therapists remain non-judgmental and non-coercive; they refrain from criticizing or laying blame. Instead, they encourage clients to assess their behavior by Choice Theory’s central question: “Is what I am doing getting me closer to the people I need?” Once a course of action is chosen and committed to, therapist and client collaborate on creating specific workable plans on how to reconnect with people; progress is evaluated regularly, and ineffective plans are modified along the way.

Glasser’s theory is not without flaws; chief among them perhaps is its overarching claim about the universality of motives. Time and science have not been kind to universality claims in psychology. Reality Therapy too is, at the end of the day, a vehicle of limited capacity, primarily given our developing knowledge about the undeniable role of biology, unconscious processing, and past experiences in shaping behavior.

Moreover, in looking to account for and modify human behavior, it is no longer tenable to focus on ‘personal responsibility’ alone without acknowledging ‘contextual responsibility’ as well. No person exists independently of context. And context qualities matter as much as personal qualities in determining one’s life outcomes. To wit: Whether you are wealthy or not has something to do with your personal behavioral choices, but the best predictor of whether you’re rich or poor is your place and family of birth.

Glasser’s ideas are flawed. Yet flawed does not imply bad or useless—as you can surely tell by looking at the people in your life. Reality Therapy, with its call to accountability and emphasis on the values of connectedness and commitment, may constitute a useful heads-up in the lives of many clients. One useful technique that embodies the practical spirit of Reality Therapy is called the “Questioning Process.” It calls for the client to ask the following questions, in sequence:

What do I want?

What am I doing in order to get it?

Is it working?

What else can I do?

You don’t have to enter therapy to benefit from this kind of questioning. If you’re honest with yourself about the process, you may find it possesses considerable power to clarify the way forward toward improved mental health.