Choice theory reality therapy


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  • The quality world is our personal Shangri-la --- the ideal of what we want our life to be. It fulfills our most basic needs by placing the actual people we want to love in our quality world. People who come to counseling either have no one in their quality world or are experiencing conflict between their quality world and their “real” world.
  • Quality World—made up of the people we want to be with, the things we want to experience, & the belief systems that govern our behavior.
  • Metaphors: For example, the client statement “I’m out on a limb with this situation” might be rephrased to “What does it look like out on the limb?” or What would being off the limb be like for you?” or “What can you do today to begin to get yourself safely off that limb?”
  • The methodology employed in reality therapy consists of establishing an appropriate environment or psychological atmosphere and then applying the procedures that lead to change. Getting a Commitment: 5 Levels 1. “I don’t want to be here.” = client is reluctant and resistant; no commitment at all. 2. “I want the outcome but not the effort.” = Client wants to change but is not taking responsibility; will result in no change. 3. “I’ll try; I might.” = Millde level of commitment; workable 4. “I will do my best.”= Such commitment allows the possibility of failure. 5. “I will do whatever it takes.” = outcome centered on a no-excuses level of commitment; most desirable
  • Glasser wrote a book in 1980 called “What are you doing?” where each word in the question serves as a sign-post for the practitioner. What = the counselor asks for precise details; client must be specific Are = emphasizes the importance of stressing the present rather than indulging in endless discussions of past behaviors that are beyond client’s control You = focus on the client rather than on other people, excuses, and uncontrollable events. Doing = connotes total behavior: the exploration of direction, specifications, thoughts, feelings, and physical symptoms accompanying client’s choices
  • May be more appropriate for men Silverberg (1984) argues that historically men have been more reluctant than women to seek therapy….and the emphasis that reality therapy gives to development of self-control, autonomy, and independence are particularly appealing to men. Further, the emphasis on specific behaviors and on productivity in sessions that have planning as a component would be appropriate for men whose outlook toward life is achievement oriented. Men who have a negative feeling toward examining their feelings and emotions may find reality therapy an attractive approach.
  • Choice theory reality therapy

    1. 1. Choice Theory
    2. 2. Figurehead & Roots <ul><li>William Glasser </li></ul><ul><li>Theory Development </li></ul><ul><ul><li>Control Theory </li></ul></ul><ul><ul><li>Reality Therapy--1965 </li></ul></ul><ul><ul><ul><li>Reality Therapy: A New Approach to Psychiatry </li></ul></ul></ul><ul><ul><li>Choice Theory--1990s </li></ul></ul><ul><ul><ul><li>Choice Theory: A New Psychology of Personal Freedom </li></ul></ul></ul><ul><ul><ul><li>Counseling with Choice Theory: The New Reality Therapy (2001) </li></ul></ul></ul>
    3. 3. Major Premise <ul><li>People are responsible for their own choices, decisions, goals, and the general degree of happiness in their lives. </li></ul><ul><ul><li>An internal control psychology, it explains why and how we make the choices that determine the course of our lives. </li></ul></ul><ul><li>This video clip contains a brief introduction to choice theory: </li></ul><ul><li>CLICK HERE </li></ul>
    4. 4. CT and Human Nature <ul><li>Phenomenological </li></ul><ul><li>People have freedom to make choices </li></ul><ul><li>People must take responsibility for choices </li></ul><ul><li>Behavior should be considered in its totality </li></ul><ul><li>The capacity to change is in ourselves (we are only victims if we choose to be) </li></ul>
    5. 5. Key concepts of CT: <ul><li>All we ever do is behave (good or bad) </li></ul><ul><li>We are externally motivated by the world around us. </li></ul><ul><li>If we are sad, unhappy, or depressed, it is because we choose to feel and behave that way. </li></ul><ul><li>We are not victims of our past unless we choose to be. </li></ul><ul><li>We are constantly seeking to live in our “quality world.” </li></ul>
    6. 6. Choice Theory Basic Concepts <ul><li>Quality World (People, Things, and Beliefs) </li></ul><ul><ul><li>Relationships </li></ul></ul><ul><ul><ul><li>Existing </li></ul></ul></ul><ul><ul><ul><li>Desired </li></ul></ul></ul><ul><ul><li>Material Goods </li></ul></ul><ul><ul><li>Systems of Belief </li></ul></ul><ul><ul><ul><li>Religious </li></ul></ul></ul><ul><ul><ul><li>Political </li></ul></ul></ul><ul><ul><ul><li>Personal </li></ul></ul></ul><ul><li>The quality world is our personal Shangri-la --- the ideal of what we want our life to be. It fulfills our most basic needs by placing the actual people we want to love in our quality world. </li></ul><ul><li>People who come to counseling either have no one in their quality world or are experiencing conflict between their quality world and their “real” world </li></ul>
    7. 7. Choice Theory Basic Concepts <ul><li>Total Behavior </li></ul><ul><ul><li>Acting </li></ul></ul><ul><ul><li>Thinking </li></ul></ul><ul><ul><li>Feeling </li></ul></ul><ul><ul><li>Physiology </li></ul></ul><ul><ul><li>We can control acting and thinking. </li></ul></ul><ul><ul><li>Feeling and physiology will follow. </li></ul></ul><ul><li>We choose our behaviors. </li></ul><ul><li>The only behavior an individual can control is his or her own. </li></ul>
    8. 8. Choice Theory Basic Concepts <ul><li>The Language of Choice Theory </li></ul><ul><ul><li>Headaching </li></ul></ul><ul><ul><li>Angering </li></ul></ul><ul><ul><li>Depressing – most common choice </li></ul></ul><ul><ul><ul><li>Restrains anger of frustrating relationships </li></ul></ul></ul><ul><ul><ul><li>Asking for help without begging </li></ul></ul></ul><ul><ul><ul><li>Avoidance of responsibility through self-chosen mental illness </li></ul></ul></ul>
    9. 9. Choice Theory Basic Concepts <ul><li>Control/Choice Theory – Five Needs: </li></ul><ul><ul><li>Survival (Work) </li></ul></ul><ul><ul><li>Love and Belonging </li></ul></ul><ul><ul><li>Power (Self-Determination or Autonomy) </li></ul></ul><ul><ul><li>Freedom </li></ul></ul><ul><ul><li>Fun (Leisure) </li></ul></ul><ul><li>When these needs are not met… </li></ul><ul><ul><li>Psychological problems result </li></ul></ul><ul><ul><li>When an individual is unable to fulfill a basic need, he or she will often choose a symptom behavior as a way to cope. </li></ul></ul>
    10. 10. Basic Concepts of Choice Theory: 10 Axioms <ul><li>The only person whose behavior we can control is our own. </li></ul><ul><ul><li>External Control—When individuals try to control others, it is at the expense of an effective working relationship. </li></ul></ul><ul><li>All we can get from other people is information. How we deal with that information is our choice or their choice. </li></ul><ul><li>All long-lasting psychological problems are relationship problems . </li></ul>
    11. 11. Axioms of Choice Theory (cont.) <ul><li>The problem relationship is always part of our present lives. </li></ul><ul><li>What happened in the past that was painful has a great deal to do with what we are today, but revisiting this painful past contributes little, if anything to what we need to do now --- improve an important relationship. </li></ul><ul><li>We can only satisfy our needs by satisfying the pictures in our Quality World. </li></ul>
    12. 12. Axioms of Choice Theory (cont.) <ul><li>7. All we do is behave </li></ul><ul><li>8. All behavior is Total Behavior and is made up of four components: acting, thinking, feeling and physiology. </li></ul><ul><li>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. </li></ul>
    13. 13. Axioms of Choice Theory (cont.) <ul><li>10. All Total Behavior is designated by verbs and named by the part that is the most recognizable. </li></ul>
    14. 14. Therapeutic Frame of Reference <ul><li>Focus is on the present </li></ul><ul><li>Avoid discussing the past because most human difficulties are believed to be rooted in current relationship problems. </li></ul>
    15. 15. Role of Therapist <ul><li>Responsible for establishing a counseling environment in which client can embrace change. </li></ul><ul><li>Work as a collaborator with the client </li></ul><ul><li>Help the client to understand how she/he is doing </li></ul><ul><li>Role expectation—must define who you are as a counselor </li></ul><ul><li>Very conversational & interactive </li></ul><ul><ul><li>This can lead to boundary issues if counselor does not adhere to strict professional conduct—onus of responsibility lies with counselor </li></ul></ul>
    16. 16. Effective therapists: <ul><li>Qualities: </li></ul><ul><li>Congruence </li></ul><ul><li>Energy </li></ul><ul><li>Empathy </li></ul><ul><li>Having a positive view of human nature </li></ul><ul><li>Belief in the potential for change </li></ul><ul><li>Characteristics: </li></ul><ul><li>Ability to reframe </li></ul><ul><li>Ability to communicate hope </li></ul><ul><li>Ability to define a problem in solvable terms </li></ul><ul><li>Ability to use metaphors </li></ul><ul><li>Being ethical </li></ul><ul><li>Being culturally sensitive </li></ul>
    17. 17. Therapeutic Objective <ul><li>To help an individual to determine whether his or her current actions and decisions will lead them to the goals or success he or she wants for himself or herself. </li></ul><ul><li>Teaching process—Seeks to teach clients better ways to meet their needs. </li></ul><ul><li>To help clients understand & take responsibility for the choices they make. </li></ul><ul><li>To help clients strengthen their relationships through personal change in a safe environment. </li></ul>
    18. 18. Function of Symptoms <ul><li>Symptoms and complaints are viewed as creative ways individuals choose to deal with current relationship problems. </li></ul>
    19. 19. External Control <ul><li>“ coercing, controlling, relationship-destroying psychology (used when) having difficulty getting along with someone else” (Glasser, 2003) </li></ul><ul><li>1 st False Belief – We are made to behave. </li></ul><ul><li>2 nd False Belief – You can control someone. </li></ul><ul><li>3 rd False Belief – We know what’s right for all. </li></ul>
    20. 20. Seven Deadly Habits of External Control <ul><li>Criticizing – most deadly </li></ul><ul><li>Blaming </li></ul><ul><li>Complaining </li></ul><ul><li>Nagging </li></ul><ul><li>Threatening </li></ul><ul><li>Punishing </li></ul><ul><li>Rewarding to control </li></ul>
    21. 21. Alternatives to the Seven Deadly Habits <ul><li>Supporting </li></ul><ul><li>Encouraging </li></ul><ul><li>Listening </li></ul><ul><li>Accepting </li></ul><ul><li>Trusting </li></ul><ul><li>Respecting </li></ul><ul><li>Negotiating Differences </li></ul>
    22. 22. Key Concepts in Change Process <ul><li>Present orientation : we are not controlled by past history, just the present </li></ul><ul><li>Emphasis on choice: </li></ul><ul><li>Behavior is a result of choices and counselors help present choices to client. </li></ul><ul><li>Control of Action: </li></ul><ul><li>We help a client change actions so that they will change behaviors </li></ul><ul><li>Importance of Connection: Establish an empathic, genuine relationship with others </li></ul>
    23. 23. Process & Techniques <ul><li>Begin by developing a supportive environment </li></ul><ul><ul><li>NEVER take for granted that your client is comfortable </li></ul></ul><ul><li>What do you want? </li></ul><ul><ul><li>Define what they want to get from you & counseling relationship. </li></ul></ul><ul><ul><li>What do they want for themselves </li></ul></ul><ul><li>What are you doing to get it? </li></ul><ul><ul><li>Define present behaviors that are getting client where they hope to be—or are they? </li></ul></ul><ul><li>Is it working? </li></ul>
    24. 24. Process and Techniques, cont <ul><li>How can you change what you are doing to be more effective at getting what you want? </li></ul><ul><ul><li>What could the client do differently to increase the probability that he or she will get what he or she wants? </li></ul></ul><ul><li>Develop a plan </li></ul><ul><ul><li>First goal should be easily achievable </li></ul></ul><ul><ul><li>Counselor must help client to understand how he or she is progressing/doing. </li></ul></ul><ul><li>Make a commitment/plan/agreement about how to change </li></ul><ul><li>Follow-up </li></ul><ul><ul><li>Evaluate progress towards goals </li></ul></ul><ul><ul><li>Reevaluate plan & change as needed </li></ul></ul>
    25. 25. The WDEP system (Wubbolding, 1985) <ul><li>Wants : </li></ul><ul><li>Discussing wants, needs and perceptions </li></ul><ul><li>Sharing wants and perceptions (disclose) </li></ul><ul><li>Commitment to Counseling (5 levels): </li></ul><ul><li>1. “I don’t want to be here.” </li></ul><ul><li>2. “I want the outcome but not the effort.” </li></ul><ul><li>3. “I’ll try; I might.” </li></ul><ul><li>4. “I will do my best.” </li></ul><ul><li>5. “I will do whatever it takes.” </li></ul>
    26. 26. WDEP System (cont.) <ul><li>D = Discussing Behavioral Direction and Doing (Total Behavior) </li></ul><ul><li>WHAT ARE YOU DOING? </li></ul>
    27. 27. WDEP System: E = Evaluation <ul><li>Evaluation of behavioral direction </li></ul><ul><li>Evaluation of specific actions </li></ul><ul><li>Evaluation of wants </li></ul><ul><li>Evaluation of perceptions or viewpoints </li></ul><ul><li>Evaluation of new direction </li></ul><ul><li>Evaluation of plans </li></ul>
    28. 28. WDEP System: P=Planning(SAMI C) <ul><li>S imple: The plan is uncomplicated </li></ul><ul><li>A ttainable: Should be realistic </li></ul><ul><li>M easurable: Precise and exact </li></ul><ul><li>I mmediate: Carried out as soon as possible </li></ul><ul><li>I nvolved: Counselor involved as much as appropriate </li></ul><ul><li>C ontrolled by the client </li></ul><ul><li>C ommitted to: counselor helps client pledge to put plan into action </li></ul><ul><li>C onsistent: Plan is repetitious </li></ul><ul><li>PERSISTENCE IS THE COMMON DENOMINATOR! </li></ul><ul><li>DON’T GIVE UP!! </li></ul>
    29. 29. Questions for Sessions <ul><li>For client: </li></ul><ul><ul><li>Will what I’m about to do bring me closer to these people (people in your quality world) or move us further apart? </li></ul></ul><ul><li>For therapist: </li></ul><ul><ul><li>Are we on track? </li></ul></ul><ul><ul><li>How is it coming along? </li></ul></ul>
    30. 30. Contributions of Glasser’s Work <ul><li>Short-term focus </li></ul><ul><li>Deals with conscious behavioral problems </li></ul><ul><li>Client responsible for self-evaluation as well as commitment; pressure off counselor! </li></ul><ul><li>Change is measurable and overt </li></ul><ul><li>Counselor is encouraging and empathetic; confrontive, yet gentle </li></ul>
    31. 31. Research and RT <ul><li>In 1993, more than 400 persons worldwide completed the 18-month training program and were certified in RT. </li></ul><ul><li>Research has not been a major focus because Glasser has focused on implementing RT in human service and educational institutions </li></ul>
    32. 32. Research (cont.) <ul><li>There is evidence that RT has been used effectively with a wide variety of issues: eating disorders, child abuse, marriage issues, aging, elective mutism, career satisfaction, study habits, self-esteem, assertive behavior, etc. </li></ul>
    33. 33. Limitations <ul><li>Not useful for clients who want to gain insight into past or early life conflicts </li></ul><ul><li>Counselor should have some training prior to using RT </li></ul><ul><li>Easy to understand, harder to practice </li></ul>
    34. 34. Corey’s concerns (worth consideration): <ul><li>Lack of consideration for unconscious (dreams, etc.) </li></ul><ul><li>Denying transference seems “narrow” </li></ul><ul><li>Too simplistic to argue that all mental illness (except brain pathology)is the result of an individual’s unsatisfying relationships; adds guilt to people who are already struggling with coping </li></ul><ul><li>The “evaluation” component puts the counselor in the role of expert; may impose values----what is “responsible” behavior? </li></ul>
    35. 35. Gender Issues <ul><li>Both men and women can learn they have power over their own lives (may be more of an issue for women) </li></ul><ul><li>Emphasis on holding people responsible for their behavior ignores historical and social discrimination </li></ul><ul><li>Glasser’s work to improve school systems was not gender biased; considered the unique wants & needs of boys and girls </li></ul><ul><li>May be more appropriate for men </li></ul>
    36. 36. Multicultural Issues <ul><li>Criticism: Does not take into account environmental forces such as discrimination and racism that affect people from different cultures; also is not sensitive to sexual orientation. </li></ul><ul><li>Compliment: Reality therapists typically respect individual cultural differences and include cultural considerations as a component of the “plan” </li></ul><ul><li>Reality therapy has been used with a wide variety of cultures and has been applicable world-wide. </li></ul>
    37. 37. The Bottom Line……CT asks: <ul><li>What is it that you want? </li></ul><ul><li>Is your behavior getting you what you want? </li></ul><ul><li>If not, what are you willing to do to change it? </li></ul><ul><li>Goal is to get what you want: improved relationships and enhanced living. </li></ul>