Cognitive Behavioral Therapy and Reality Therapy

The student will complete the discussion assignment in paragraph format, answering the questions given in the Discussion assigned week. The student will post one thread of at least 400 words. The student will answer each question thoroughly and must use a minimum of the three required scholarly journal articles published within the last three years.

· At least 400 words

· APA 7th Edition

· A minimum of three required scholarly journal articles published within the last three years.

Chapter 10

Reality Therapy

William Glasser (1925–2013) is the founder of reality therapy (W. Glasser 1965), an approach to therapy that focuses on the present and emphasizes a client’s strengths and ability to make choices and control their behavior. Reality therapy is based on choice theory as developed by Glasser and his revisions and modifications of control theory. Glasser asserts that people are responsible for choosing their own thinking and actions, which then directly affect their emotional and physiological functioning. According to choice theory, all human beings have five basic needs: survival, love and belonging, power or achievement, freedom or independence, and fun, with the need to love and to belong being the primary need (W. Glasser 2001, 2005).

Reality therapy helps clients to become more responsible and realistic and therefore more successful in achieving their goals and meeting their needs. Glasser was disappointed with the weaknesses and limitations of psychoanalysis. He developed reality therapy in the 1960s as a more rational and direct approach to therapy that also has existential and humanistic roots in its emphasis on one’s freedom and capacity to choose and also one’s responsibility to authentically make choices in personal life. Reality therapy has a basically positive view of human nature and potential for change.

Several therapeutic techniques often used in reality therapy include structuring, confrontation, contracts, instruction, role-playing, support, skillful questioning (e.g., asking, “Does your present behavior enable you to get what you want now? Will it take you in the direction you want to go?”), and emphasizing choice (e.g., by changing nouns and adjectives into verbs) (see Parrott 2003).

Biographical Sketch of William Glasser

William Glasser was born on May 11, 1925, in Cleveland, Ohio, the youngest of Ben and Betty Glasser’s three children. His father, who owned a small business, had emigrated to the United States as a child with his Russian Jewish family to escape persecution. Glasser has described his mother as very controlling and his father as the opposite, the personification of choice theory (W. Glasser 1998a, 90). He noted that despite such a basic incompatibility between his parents, they were consistently loving in their relationship with him.

Glasser went to college, like his older brother and sister, and majored in chemical engineering. He was still a student when he married Naomi Judith Silver, his first wife, who during forty-six years of marriage was also his professional collaborator until her death in 1992. Glasser enrolled in a PhD program in clinical psychology, but his dissertation was rejected. He graduated with a master’s degree in clinical psychology in 1948, after which he attended medical school at Case Western Reserve University and obtained his MD degree in 1953 at the age of twenty-eight.

Glasser moved to southern California for his psychiatric residency at UCLA and at the West Los Angeles Veterans Administration Hospital, which he completed in 1957. He was board certified in psychiatry in 1961. His supervisor and mentor at UCLA was a psychiatrist named G. L. Harrington, who supported Glasser’s serious struggles with traditional psychiatry and psychoanalytic theory and the subsequent development of reality therapy in the early 1960s (W. Glasser 1961, 1965).

Glasser also worked at the Ventura School for Girls, a residential institution for delinquent adolescent girls, in 1956. He conducted individual and group therapy and was also involved in training staff. Glasser focused on fostering a kind and respectful relationship with the girls at the school while expecting them to be responsible for their own choices and behavior. He also verbally praised them for appropriate behaviors. His new approach to helping them proved to be very effective, which prompted him to begin consulting in the California school system. Glasser has significantly impacted teachers and school systems here and abroad with the application of his reality therapy principles and methods, his choice theory, to the positive development and learning of students (see W. Glasser 1969, 1986, 1998b, 2000a). He founded an education training center as a further extension of the William Glasser Institute established in California. Glasser also kept a full schedule of teaching, lecturing, and conducting a private practice, in addition to consulting with school systems as he continued to further develop reality therapy. He published his classic book, Reality Therapy, in 1965.

In 1977 Glasser was exposed to the work of William Powers through his book Behavior: The Control of Perception (1973) and began using some of Powers’s ideas for further theoretical development of reality therapy by using control theory. Glasser wrote Stations of the Mind (1981) as a somewhat technical version of control theory and its applications to people’s lives. He published a more popular book, Control Theory: A New Explanation of How We Control Our Lives, in 1985. Glasser thus based reality therapy on control theory as he described it. The main theoretical idea he borrowed from Powers was the notion that “people’s choices are attempts to control their perception that their needs are being met in the world” (Fall, Holden, & Marquis 2004, 249).

However, Glasser eventually revised his theory and renamed it choice theory instead of control theory in the late 1990s (W. Glasser 1998a). He did not want people to misunderstand control theory by erroneously thinking that it involves controlling others when it really concerns self-control and making one’s own decisions in a responsible way. He therefore replaced the word “control” with “choice,” which better reflects reality therapy’s emphasis on making responsible choices for oneself; hence, choice theory is now the theoretical foundation for reality therapy. Glasser wrote several other books on choice theory and its applications, including Counseling with Choice Theory (2001); The Language of Choice Theory, with his second wife, Carleen, who was involved in the use of reality therapy in schools (W. Glasser & Glasser 1999); and Getting Together and Staying Together, also with Carleen (W. Glasser & Glasser 2000). A more recent book, Warning: Psychiatry Can Be Hazardous to Your Mental Health (W. Glasser 2003), advanced his critical view of the use of psychiatric medications in dealing with personal problems, based on his belief that such medications can adversely affect the process by which people make choices in a responsible way. Glasser’s first wife, Naomi, was involved in editing several of his books, as well as editing two significant texts herself on the practical applications of reality therapy (N. Glasser 1980), including case studies (N. Glasser 1989).

Glasser was involved in teaching choice theory and reality therapy around the world. He founded the Institute of Reality Therapy in 1967 but changed its name to the William Glasser Institute in 1996 since his development of choice theory and its applications went beyond reality therapy. Glasser even applied his ideas on choice theory to a community of twenty thousand people in Corning, New York, beginning in 1997. He was an energetic and visionary advocate for choice theory and reality therapy (see W. Glasser 2002, 189–190). He died in 2013. (For further biographical information on William Glasser, see Parrott 2003, 341–342; Sharf 2016, 437–439; J. Sommers-Flanagan & Sommers-Flanagan 2018, 229–230, 251; see also Roy 2014, 2017).

Major Theoretical Ideas of Reality Therapy

Perspective on Human Nature

Reality therapy has existential roots. Glasser was influenced by the ideas of Helmuth Kaisar, one of the earliest existential therapists in the United States (Prochaska & Norcross 2018, 95). However, since reality therapy also combines existential ideas such as the individual’s freedom to choose and ability to control their own behavior with practical behavioral techniques for implementing behavioral change and action, it is sometimes viewed as a behavioral therapy or an eclectic therapy. It is nevertheless unique in its emphasis on human freedom and choice and hence cannot be easily categorized as a behavioral or eclectic therapy. Reality therapy is probably best described as a unique therapy with existential roots (Wubbolding 2000, 2011).

Glasser himself strongly opposed behaviorism, the philosophical foundation of behavioral approaches to therapy, because of the focus on external control of behavior, which he critiqued as external control psychology (W. Glasser 1998a). He believed that such external control psychology is actually the cause of much of the human suffering and social problems today. In reality therapy or choice theory, Glasser advocated an internal-control psychology that emphasizes human choice. He also asserted that we can control only our own behavior, not the behaviors of others. Reality therapy therefore has a basically positive view of human nature and an individual’s capacity for change. It also focuses more on the present and emphasizes a client’s strengths.

Basic Theoretical Principles of Reality Therapy

Reality therapy is grounded in choice theory (W. Glasser 1998a, 2001), which is a revision of control theory (W. Glasser 1985). The following are the basic theoretical principles of reality therapy or choice theory: basic human needs, one’s quality world or inner picture album, total behavior, choosing behavior, and the Ten Axioms of Choice Theory (see Sharf 2016, 439–442; J. Sommers-Flanagan & Sommers-Flanagan 2018, 231–237).

Basic Human Needs

Glasser (1998a) believed that all human behavior is basically motivated or governed by five basic human needs that are genetically encoded in every individual:

1. Survival

2. Love and belonging

3. Power (achievement)

4. Freedom (independence)

5. Fun (enjoyment)

Survival is a basic human need that is mainly biological: a need for current survival as well as future survival. It can be met by engaging in behaviors that enhance an individual’s probability of survival, such as eating, exercising, and having adequate shelter, as well as those that increase the probability of the survival of the human race, such as sexual behavior.

Sidebar 10.1: Principles of Reality Therapy

1. Basic human needs

2. One’s quality world or inner picture album

3. Total behavior

4. Choosing behavior

5. The Ten Axioms of Choice Theory

Glasser (1998a) considered love and belonging to be the most important or primary of the five basic human needs, because we usually must first have relationships with others in order to meet the other four basic needs. This need for love and belonging is expressed in behaviors such as socializing with people, establishing deep and caring friendships, and being involved in sexually intimate relationships. However, choice theory notes that this primary human need for love and belonging can be adversely affected by another basic human need: the need for power.

The basic human need for power is often regarded as negative, but Robert Wubbolding (2000) has provided more-positive alternatives for describing it as a need for achievement, accomplishment, or internal control. The need for power can conflict with the need for love and belonging, especially in a close relationship such as marriage, in which a power struggle between the marital partners leads to a lack of compromise and an ultimate breakdown of a loving and caring relationship with each other (W. Glasser 1985, 1998a; W. Glasser & Glasser 2000). However, the need for power can be fulfilled in constructive ways such as getting good grades in college, doing well in athletic events, or effectively helping others. Nevertheless, Glasser warned against the excessive need for power that is still prevalent in Western culture; its destructive effects can be seen in the power struggles in almost every area of life as pecking orders are established (see W. Glasser 1998a, 38).

The basic human need for freedom (or independence) is a longing in every individual for autonomy and the ability to choose from a variety of possibilities, relatively unhampered by others. Especially adolescents often manifest this basic need for freedom by wanting to do things their own way, sometimes even rebelling against their parents’ external control. According to choice theory, human creativity is clearly connected to fulfilling the need for freedom. Without a sense of freedom, it is difficult to be creative in a constructive way. When the need for freedom is not met, other destructive behaviors can result, including symptoms of psychopathology such as hysteria.

Finally, the basic human need for fun involves the quest or longing for enjoyment and playfulness. Glasser (1998a) directly connected this need for fun to play and linked play to learning. People learn through play that is enjoyable or fun. He also viewed the need for fun as the easiest one to fulfill and noted that laughter is the best definition of fun. Usually fun is also closely connected with the primary human need for love and belonging.

All five basic human needs can be met in responsible and constructive ways or in irresponsible and destructive behaviors. Reality therapists help clients to fulfill these five basic needs in healthy, responsible, and constructive ways that do not harm others in the process of meeting one’s own needs. Clients are also reminded that they can control only their own choices and behaviors; they cannot control others, although they can influence them. When one (or more) of these five basic human needs is not fulfilled, people feel bad and are motivated to try to meet the unsatisfied needs.

One’s Quality World or Inner Picture Album

According to choice theory, shortly after birth and throughout our lives our basic needs are not directly satisfied. Instead, because we are only somewhat aware of our five basic needs in general, we keep track more specifically of whatever we do that makes us feel very good. Over time, we build our own mental list of specific wants and needs, a kind of inner picture album of specific memories and images of people, things, or experiences, and of beliefs that have made us feel good because they satisfied our basic needs (see W. Glasser 1998a; Wubbolding 2000). Reality therapists help clients to clarify and prioritize their wants and see what is crucial to them (Wubbolding 2011, 2017; Wubbolding & Brickell 2015).

This inner picture album is also called one’s quality world, a personal Shangri-la, an ideal world in which one would like to live if possible (see Corey 2021, 315). The quality world, the inner picture album, differs from person to person and also within a person over time. In other words, it can be revised as an individual has new experiences.

It is therefore crucial for reality therapists to empathically understand each client’s subjective quality world. They also need to enter into the client’s quality world by establishing genuine, caring, and respectful therapeutic relationships with them so that the client experiences love and belonging in therapy and allows the therapist to enter into that quality world.

Total Behavior

Choice theory emphasizes that the key characteristic of all human beings from birth to death is the fact that they behave. Such behavior is described by choice theory as total behavior consisting of four specific but connected parts that are always functioning simultaneously: acting, thinking, feeling, and physiology. Acting, which may be voluntary or involuntary, refers to specific behaviors such as walking, moving, talking, and eating. Thinking refers to all types of thoughts, voluntary or involuntary, including dreams. Feeling refers to emotional experience, both pleasant or painful, such as joy, sadness, anger, and satisfaction. Physiology refers to bodily functions, voluntary or involuntary, such as heart rate and sweating.

The total behavior of an individual in acting, thinking, feeling, and physiology has often been described by using Glasser’s car analogy (1990). The engine of the car contains the individual’s basic needs (survival, love and belonging, power, freedom, and fun), which provide the power for the whole system of the car. The wants of the person are like the steering wheel, moving the car in the direction of their quality world. Acting and thinking are like the two front wheels of the car, which an individual can directly control in order to satisfy certain wants and needs. Thoughts and behaviors are both chosen by a person, according to Glasser. Feelings and physiology are like the two rear wheels of the car, which can be indirectly controlled by an individual. Glasser (2000b) emphasized that one can directly choose only one’s actions and thoughts, but one can also indirectly control one’s feelings and physiology by choosing to change one’s actions and thoughts.

Choosing Behavior

Glasser held the radical view that so-called mental illness does not exist (see W. Glasser 1965, 85; 2002, 2) except for extreme conditions where there is obvious brain pathology, for example, brain trauma and Alzheimer’s disease. His critical view on mental illness echoes similar views voiced by other well-known psychiatrists such as Thomas Szasz (1970, 1971) and Peter Breggin (1991). Glasser instead believed that psychological disorder is due to an individual’s personal choice. He was also very critical of the use of psychiatric medications to treat psychopathology (W. Glasser 2003). Thus he held an extreme position that people choose their own behavior and are therefore fully responsible for their problems, whether behavioral, emotional, or physical.

Glasser advocated using active verbs to describe human suffering and problems. Instead of the usual way of saying “I am depressed” or “I have a headache” or “I am angry” or “I am anxious,” all of which reflect passivity and tend to be incorrect and to reinforce a denial of personal responsibility, Glasser preferred to use more accurate verb forms in saying “I am depressing,” “I am headaching,” “I am angering,” or “I am anxietying.” This way of speaking challenges clients to remember that they are choosing their own behavior, and hence they are actually depressing themselves, angering themselves, or making themselves anxious. They are thus held responsible for choosing their own suffering within a range of “paining” behaviors, the best behaviors they can manage to try to meet their wants and needs (Corey 2021, 315–316).

Glasser’s radical view of choosing behavior—including psychopathology and human suffering, as an all-pervasive freedom and responsibility for every human being—can sound harsh and may not be fully accepted by all therapists, including some reality therapists. However, this radical view of choice theory and psychopathology can still be communicated in an empathic way in the therapeutic process of reality therapy, which is based on the therapist having a caring, genuine, and respectful relationship with the client. Ultimately, reality therapy uses choice theory, empowering the client to make personal choices in a responsible and constructively fulfilling way (see J. Sommers-Flanagan & Sommers-Flanagan 2018, 234–237).

Glasser (1985) provided four main reasons for why individuals may choose pathological behavior or human suffering and misery. First, many people choose to make themselves anxious or depress themselves in order to control or restrain anger. For example, people usually achieve more control or power over others by depressing themselves than by angering. Second, individuals may choose to make themselves anxious or depressed in an attempt to get help from others. Depressing oneself can especially be an effective means of getting help and sympathy from others, including mental health professionals, as well as of controlling significant people in one’s life, thereby to meet one’s basic needs for love and belonging and also for power. Third, people may choose to depress themselves or make themselves anxious in order to avoid things that they do not want to deal with or face in their lives. It may be easier for someone who has been laid off from work to remain frozen in fear or to be anxious than to take difficult steps toward finding a job. Glasser would challenge people trying to avoid dealing with a difficult situation like this to either change what they want or to change their behavior (W. Glasser 1998a, 83). Fourth and finally, people may choose to make themselves anxious or depress themselves in order to achieve significant control over other people and get others to do things for them.

Glasser (1985, 2001) also viewed so-called crazy behavior, such as hallucinations and delusions, as creative yet desperate behavior, with the purpose of gaining control over one’s life.

Ten Axioms of Choice Theory

Glasser summarized the basic theoretical principles of reality therapy as the Ten Axioms of Choice Theory (1998a):

1. The only person whose behavior we can control is our own.

2. All we can give another person is information.

3. All long-lasting psychological problems are relationship problems.

4. The problem relationship is always part of our present life.

5. What happened in the past has everything to do with who we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future.

6. We can only satisfy our needs by satisfying the pictures in our quality world.

7. All we do is behave.

8. All behavior is total behavior and is made up of four components: acting, thinking, feeling, and physiology.

9. All total behavior is chosen, but we only have direct control over the acting and thinking components. We can only control our feeling and physiology indirectly through how we choose to act and think.

10. All total behavior is designated by verbs and named by the part that is the most recognizable (cited in J. Sommers-Flanagan & Sommers-Flanagan 2018, 237).

Therapeutic Process and Relationship

Glasser (1965) emphasized three major foundational principles of reality therapy: reality, responsibility, and right and wrong. He believed that when individuals choose to engage in responsible behavior within the limits of reality to meet their basic needs in ways that do not hurt others, their behavior is right or moral. They will then be able to give and receive love and have a deep sense of self-worth. Reality therapists help their clients have satisfying relationships with others so that their own basic needs for survival, love and belonging, power, freedom, and fun can be fulfilled in responsible and constructive ways.

The reality therapist functions like a mentor, teacher, or coach to the client and therefore often assumes a directive and educational role in therapy. However, it is still crucial for the reality therapist to establish a genuine, caring, and connected therapeutic relationship with the client. Reality therapy emphasizes the therapeutic alliance based on an empathic and supportive relationship with the client but does not view it as sufficient for effective therapy to occur. Reality therapists, following Glasser, believe a friendly therapeutic relationship that also includes firmness helps to provide an appropriate counseling environment for the client, who basically has unsatisfying relationships or no relationships with others. The reality therapist connects with the client by engaging in a genuine, caring, and supportive relationship and attempts to enter the client’s quality world. Specific techniques are then also needed to further help clients choose and change their behavior, in addition to establishing a friendly therapeutic relationship in what is called the cycle of counseling (see Sharf 2016, 444).

Glasser (1998a) provided more guidelines for establishing a good therapeutic relationship with the client by describing “seven caring habits” that reality therapists would do well to cultivate: supporting, encouraging, listening, accepting, trusting, respecting, and negotiating differences. Glasser (2002, 13) also listed “seven deadly habits” of harsh confrontation that should be avoided by reality therapists: criticizing, blaming, complaining, nagging, threatening, punishing, and bribing or rewarding to control (see J. Sommers-Flanagan & Sommers-Flanagan 2018, 240–241). Reality therapists, however, also do not accept excuses from clients, do not criticize or argue, and are persistent in caring for their clients and therefore do not give up easily. Instead, they always try to be courteous, determined, enthusiastic, firm, and genuine with their clients, to focus on the present, to use humor, and to appropriately use empathic confrontation (see Wubbolding 1988; Wubbolding & Brickell 1998).

The process of reality therapy has been further elaborated and described by Wubbolding (2000, 2011, 2017) using the WDEP system of reality therapy. The W stands for wants and needs, D for direction and doing, E for self-evaluation, and P for planning (see Corey 2021, 320–326).

In the W stage or component of reality therapy, the therapist helps the client to explore personal wants, needs, and perceptions. The key question that the reality therapist asks the client is “What do you want?” The client’s answers about personal wants will be related to the five basic human needs: survival, love and belonging, power, freedom, and fun. The reality therapist uses skillful questioning to encourage the client to explore their internal picture album and further clarify their deeper wants and needs, which may not be currently fulfilled.

In the D stage or component of reality therapy, the therapist helps the client to focus on the present, asking the key question: “What are you doing?” The reality therapist will also help the client to explore and clarify the future direction of their life, by asking another crucial question: “What do you see for yourself at this time and in the future?” The client therefore focuses on direction and doing, on present actual behavior and direction for the future, rather than dwelling on feelings or on the past.

In the E stage or component of reality therapy, the core part of therapy is covered, with the therapist helping the client to engage in the following crucial self-evaluation: “Does your present behavior enable you to get what you want now? Will it take you in the direction you want to go?” Usually the client is struggling with serious relationship problems that are causing much emotional pain. The reality therapist often asks the client another key question: “Is your present behavior

Cognitive Behavioral Therapy and Reality Therapy

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