PSYC 441 Theories of Psychotherapy

1. PSYC 441 Theories of Psychotherapy Reality Therapy William Glasser Dean Owen, Ph.D., LPCC METU-NCC Spring 2013 #9

2. This presentation has been created for the sole purpose of assisting students enrolled in PSYC 441, Theories of Psychotherapyduring the Spring Semester of 2013 atMiddle East Technical University, Northern Cyprus CampusAll of the material in the presentation isdrawn from the course textbook, Theory and PracticeofCounseling and Psychotherapyby Gerald Corey

3. Explain the Reality Therapy view of human nature. • Explain the nature and origin of anxiety and psychological disturbance according Reality Therapy • Be able to define the goal of Reality Therapy. • Recall the techniques used in Reality Therapy. PLOsPrimary Learning Objectives for today’s lesson

4. Reality Therapy William Glasser 1925-

5. Reality Therapy William Glasser Ultimately I must deal with the world as it is…not as I wish it to be.

6. Reality Therapy William Glasser, M.D. is a Jewish American psychiatrist born in Cleveland, Ohio, in 1925. Developer of Reality Therapy and Choice Theory. His ideas, which focus on personal choice, personal responsibility and personal transformation, were initially considered controversial by mainstream psychiatrists, who focus instead on classifying psychiatric syndromes, and who often prescribe psychotropic medications to treat mental disorders.

7. Reality Therapy Glasser is also notable for applying his theories to broader social issues… EDUCATION MANAGEMENT MARRIAGE REHABILITATION

8. Reality Therapy Like Thomas Szasz, before him, Glasser notably deviates from conventional psychiatrists by warning the general public about the potential detriments caused by the profession of psychiatry in its traditional form because of the common goal to diagnose a patient with a mental illness and prescribe medications to treat the particular illness when, in fact, the patient may simply be acting out of unhappiness, not a brain disorder. Glasser advocated the consideration of mental health as a public health issue.

9. Thomas Szasz (1920-2012)

10. Reality Therapy If you talk to God, you are praying; If God talks to you, you have schizophrenia.Thomas Szasz People often say that this or that person has not yet found himself. But the self is not something one finds, it is something one creates. Thomas Szasz

11. Reality Therapy These are ideas that, in many ways, reflect the idea of REALITY THERAPY for RT stresses personal responsibility and the need to actively create events in life There is a total absence of “Magical” thinking….it is logic, decision, and rational activity.

12. Reality Therapy Principle Emphasis To help clients make more responsible choices in their lives and to become more responsible in their own behavior.

13. Reality Therapy Its success caused it to be widely adopted in schools, agencies, parenting, management and virtually every form of human interaction.

14. Reality Therapy: Selected Books • Mental Health or Mental Illness? Psychiatry for Practical Action, Reality Therapy, • The Effect of School Failure on the Life of a Child, The Identity Society, • Schools Without Failure, Positive Addiction, • Stations of the Mind, T ake Effective Control of Your Life, • Control Theory, Control Theory in the Classroom, • Control Theory in the Practice of Reality Therapy: Case Studies, The Quality School, • The Quality School Teacher, Reclaiming Literature, • The Control Theory Manager, Staying Together, • Choice Theory, Choice Theory in the Classroom Revised, • Choice: The Flip Side of Control, The Quality School Teacher: A Companion Volume to The Quality School, • Teoria de La Eleccion, Reality Therapy in Action, • Counseling with Choice Theory, Fibromyalgia: Hope from a Completely New Perspective, • Unhappy Teenagers: A Way for Parents and Teachers to Reach Them, • For Parents and Teenagers: Dissolving the Barrier Between You and Your Teen, • WARNING: Psychiatry Can Be Hazardous to Your Mental Health,

15. Reality Therapy Reality is based on a system of brain functioning known as control theory or control system theory.

16. Source of human behavior is not past conflicts, external stimuli, or rational thinking but an attempt to fulfill one of 5 basic needs.

17. Reality Therapy Power and achievement Human behavior is an attempt to fulfill a need for: Survival Freedom and Independence Fun and enjoyment Belonging

18. Reality Therapy Through Reality Therapy a client learns to see life as a series of choices and gradually learns to recognize and choose the most effective options leading toward a goal. You are largely the product of all of the choices you have made Some good Some OK Some not so good.

19. Major Components of Control Theory  1. Human beings are born with five needs: a. Belonging b. Power (competence, achievement, recognition, self-esteem, etc.) c. Fun or enjoyment d. Freedom/independence (autonomy) e. Survival  2. The difference between what a person wants and what he/she is getting is the immediate source of specific behavior at any point in time.

20. Major Components of Control Theory 3. All human behaviors are composed of doing, thinking, feeling, and physiology. 4. Human behavior, originating from within, means that humans are ultimately responsible for their own behavior.  5. Human beings see the world through a perceptual system that functions as a set of lenses.

21. Major Constructs of Reality Therapy

22. People are responsible for their own behavior (determines own choice) (Capuzzi, 1999)

23. People can change and can live more effective lives (Capuzzi, 1999)

24. People generate behavior and make choices for a purpose (remember the 5 needs?) Why do people do what they do? • It’s working for them….it’s getting them what they need! • Negative attention is better than no attention at all……..

25. Why do people do what they do? • They don’t know any other way to be • The therapist’s job is to teach them…… • 3 choices • Increase an existing behavior • Decrease or eliminate an existing behavior • Teach an entirely new behavior

26. Major Constructs (cont.) • Acting is the behavior we can control the most • To change what we are feeling emotionally, or physically, we MUST change what we are doing. • If you can not change what you are doing, CHANGE what you are Thinking. (Capuzzi, 1999) (The William Glasser Institute, 2008)

27. Example You have been frustrated most of the day So you are feeling? ANGRY thinking? I Hate my Job! physiologically? TENSE acting? COMPLAINING

28. Example -Let’s change the acting component- Take a brisk walk. WHAT WILL MOST LIKELY HAPPEN?

29. Help the client to fulfill their needs which will ultimately make the client select better choices that will lead them in the direction of taking effective control of their lives - Self-Empowerment Goals of Reality Therapy (Capuzzi, 1999)

30. Techniques WDEP • W= define and clarify their WANTS • D= Centers on feelings, effective or ineffective, self talk & especially actions/DOING • E= searching & self EVALUATION • P= Using the self evaluation to develop an attainable PLAN for improvement (SAMIC3) (The Centre for Reality Therapy, 2008) (Capuzzi, 1999)

31. Procedures that Lead to Change • Help people realize all behavior is a choice 2. Help person clarify his or her Quality World in this specific situation 3. What are you currently doing to get it? 4. Is what you are doing helping you get what you want (now or in the long run) 5. Would you like to try something different? (Capuzzi, 1999) (The Centre for Reality Therapy, 2008)

32. Procedures that Lead to Change • Make a plan SAMIC3 7. Get a commitment -I’ll try, I will do my best 8. Follow up. Never Give Up!! Persistence is Crucial (The Centre for Reality Therapy, 2008) (Capuzzi, 1999)

33. The procedures or direct interventions can be expressed by the abbreviation W-D-E-P W : Explanation of clients wants, goals, perceptions, and commitment to change. D : Doing or total behavior, which consist of actions, thinking, and feelings. E : inner evaluation by the client. Evaluate current behavior to determine effectiveness toward achieving goals and helping them fulfill wants and desires. Evaluation of attainability and appropriateness of wants. P : Plans are formulated to achieve the desired goals and wants.

34. Characteristics of Reality TherapyTreatment Plan SAMI2C3 S. Simple: The plan is uncomplicated A. Attainable: If the plan is too difficult or too long range the client will become discouraged and not follow through. M. Measurable: The plan must be precise and exact and involve observable activity. I. Immediate: The plan must be carried out as soon as possible. I. Involved: The therapist should be involved as long as the involvement is within the bounds of ethical standards and facilitates independence.

35. Characteristics of Reality TherapyTreatment Plan SAMI2C3 C. Controlled by the client: An effective plan is not contingent upon the actions of another. C. Committed to: The therapist helps the client to pledge firmly to put the plan into action. C. Consistent: The ideal plan is repetitious. A single plan can be a start, but the most effective plan is one that is repeated.

36. Regressive Stages in Mental Health Stage 1: "I give up." Attempts at fulfillment are unsuccessful. Individuals see themselves as "failures" Stage 2: Negative symptoms include: Actions: Individuals chooses actions which are personally harmful or harmful to others. Thinking: Cognitive disturbances are also attempts to control others and may include chronic pessimistic or negative thinking or even severe psychotic conditions. Feelings: Severe depression, chronic aggravation and habitual anger or rage. Physiology: Development of physical ailments. Stage 3: Negative addictions: Use of drugs, alcohol, gambling, and work represent ineffective attempts to fill needs.

37. Positive Stages in Mental Health Stage 1: "I'll do it."; "I want to improve." Such implicit statements represent the first positive movement toward change. Stage 2: Positive symptoms include: Actions: Effective choices include both assertive and altruistic behaviors. Thinking: Rational thinking including a realistic view of what can be changed and what cannot. Emphasis is on responsible behavior...not all childhood traumas must continue to victimize an individual. Feelings: Patience, tolerance, sociability, acceptance, enthusiasm, trust and hope are among the emotions of healthy persons. Physiology: Attempts to lead a healthy life-style including exercise, and diet. Stage 3: Positive addictions: Running and meditation are two examples which contribute to positive mental health.

38. Reality Therapy Originally it was based on an eight step process but has evolved into two major components. a. a friendly, firm, and trusting environment b. a series of procedures that lead to change

39. Reality Therapy Therapist Attending Skills: AB-CDEFG Always be courteous Always be determined Always be enthusiastic Always be firm Always be genuine

40. Reality Therapy Techniques a. suspend judgment b. do the unexpected c. use humor d. be yourself e. share yourself

41. Reality Therapy Techniques

42. Reality Therapy Techniques f. listen to metaphors 1. "I feel like a floor mat." 2. "Cleaning my desk is like climbing Everest." 3. "It sounds like warfare in your house." 4. "I don't know if I'm going up or down." 5. "Our relationship has gone sour." 

43. Reality Therapy Techniques g. listen for themes h. summarize and focus I. allow or impose consequences j. allow silence k. be ethical l. be redundant or repetitious m. create suspense and anticipation n. establish boundaries

44. Reality Therapy Overview Key Figure: Founder, William Glasser. A reaction against psychoanalytic therapy, it is a didactic approach that stresses problem solving and coping with the demands of reality in society. It focuses on the present and on the person's strengths as a way of learning more realistic behavior.

45. Reality Therapy Overview Philosophy and Basic Assumptions: Based on a growth‑motivation model, the approach is antideterministic. The individual who has a need for identity, can develop either a "success identity" or a "failure identity."

46. Reality Therapy Overview Key Concepts: The approach rejects the medical model of mental illness. It does not emphasize the past, nor does it stress awareness of the unconscious. It does stress moral and value judgments and equates mental health with acceptance of personal responsibility. It does not deem insight and attitude change crucial but instead focuses on behavior change.

47. Reality Therapy Overview Therapeutic Goals: The goals are to guide the individual toward making value judgments about present behavior and to assist the individual in deciding a constructive plan of responsible action to implement behavior change leading to a "success identity."

48. Reality Therapy Overview Therapeutic Relationship: The therapist's job is to get involved with the client and to encourage the client to face reality and make choices that will fulfill his or her needs in a socially acceptable way. The client decides specific changes, plans are formulated, commitment to follow through is established, and results are evaluated. The relationship is personal. The therapist avoids punishment but does not accept blaming or excuses on the client's part.

49. Reality Therapy Overview Techniques and Procedures: The approach is an active, directive, didactic, cognitive behavior‑oriented therapy. The contract method is often used, and when the contract is fulfilled, therapy is terminated. The approach can be both supportive and confrontational. "What" and "how", but not "why", questions are used.

50. Reality Therapy Overview Applications: Designed originally for working with youthful offenders in detention facilities, the approach can be applied to individual therapy, group therapy, marriage counseling and sex therapy. It is widely used by educators in elementary and secondary classrooms.