Quality Counseling: An Examination of Choice Theory and Reality Therapy

Originally published in the International Journal of Choice Theory and Reality Therapy spring of 2015


Abstract

The aim of this journal article is to conduct an overview of Choice Theory and Reality Therapy. It examines the theory’s primary concepts, view of human nature, and cause of psychopathology. It also looks at clinical approaches and evaluation strategies. It examines the nature of CT/RT’s theoretical origins and methodology, an exploration of therapist-client relationship conducted and expanded in the form of ‘Quality Counseling.’


Introduction

The first counseling approaches focused on the inner and sexual life of clients. These orientations, namely the psychoanalytic or Freudian traditions, examined past history and early childhood experiences. They explored unconscious and repressed thoughts then allowed clients to relive them. They sought to expose defense mechanisms and impart clients with life-changing insights. This school of thought, however, touted a dark view of human nature.

The psychoanalysts viewed humans as automatons, shambling forward in an unaware and hypnotic manner fashioned hopelessly by deterministic forces. Nearly every school of psychology that followed Freudianism railed in defiance to this bleak picture. As a result, many theorists remade the Freudian ideas by piecing them back together in a more optimistic and versatile manner; nevertheless, they maintained the purity and integrity of their own distinct ideas about human psychology.

Dr. William Glasser’s Choice Theory/Reality Therapy represents one such idea. It arrived in the 1960’s as “Control Theory.” In June of 1996, Glasser changed the name to “Choice Theory”; the new name belabored a more accurate description of its conceptual framework (Wubbolding, 2000).

It also portrayed human nature under a new light. Whereas psychoanalysis pushed the deterministic perspective, Choice Theory maintained an opposing view. It acknowledged that humans possess free will and purpose. In teaching one client about Choice Theory’s ideas concerning purpose and free will, Glasser said, “All anyone can do from birth to death is behave” (Glasser, 1998, p.71).

This implied that people control most aspects of mind and body. Glasser labeled this concept “Total Behavior.” He elaborated – in a similar vein as Abraham Maslow – that all human behavior moves toward satisfaction of needs: survival, love and belonging, power, freedom, and fun (Wubbolding, 2000).

He also said people construct a mental “Quality World.” This quality world contains a unique picture of perfection or utopia. Furthermore, since Choice Theory suggests that all that people do is behave—and behavior is an attempt to match their quality world pictures, they often act irrationally and dangerously. They try to control others: manipulate, mislead, force and coerce people. Glasser referred to this as “external control psychology” (Glasser, 1998).

This paper examines these concepts: how control Theory views psychopathology, its clinical approach, and client evaluation, “Quality Counseling” which expands on the therapeutic alliance within Reality Therapy, and reviews how the terms Choice Theory and Reality Therapy are related. In conclusion, this paper explains how Choice Theory developed as a model of human psychological functioning.

Definitions and Concepts

Reality Therapy is the counseling process that Dr. Glasser used from the 60s with the publication of Reality Therapy (1965). This process provides specific therapeutic skills and techniques for counseling and may be applied to education, business, and social programs (Wubbolding, 2000).

Control Theory was based on the work of William Powers which explained behavior as a negative feedback loop whereby individuals could only behave to seek to maintain a balance between what they want and what they are perceiving they have. Although a perfect match is impossible, an analogy offered is that of a thermostat which seeks to regulate its own behavior (furnace or air conditioning) with the desired result of changing the world around it (Wubbolding, 2000, p.10) or reaching the desired temperature. In 1996 Dr. Glasser decided to change the name ‘control theory’ to that of ‘choice theory’ because he believed it reflected more of what he wanted to teach, that individuals choose almost all that they do.

Dr. Glasser taught that the five basic needs are genetic; however, they cannot be satisfied directly but met indirectly by individuals attempting to reduce the gap between what they truly wanted [Quality World pictures] and what they perceived they were getting.

The first need is survival. All people desire shelter, water, and food and the need to reproduce. Without these things, people die and life ceases.

Humans, most importantly, strive for love and belonging. According to Glasser, relationship problems bring the most people to counseling, because people need each other (Glasser, Choice Theory, 1998). Humans are social animals. Even the most stoic individuals desire interaction, community and love. Almost everyone becomes close to others and it is the management of their relationships that determines healthy or unhealthy functioning.

Glasser said that early humans focused on survival, whereas modern humans—through technological and medical advancement—have overcome focus on survival (Glasser, Choice Theory, 1998).

Therefore, people tend to their happiness and efficacy through love and belonging. Even people who lead lives of solitude suffer from loneliness and alienation. They often display this through depressing and other behaviors that are less effective for them. In one phrase: without others we suffer, even if we prefer only our own company. Cameron in Regret, Choice Theory and Reality Therapy (2009) said it best, “we need to have positive relationships and when we damage our most significant relationships we are unable to get our other needs met” (p.40).

Power represents another important requirement. People gain meaning from life when they feel in control of their environment. If they perceive themselves as stronger in interacting with others, they feel safe and happy; however, in modern society, some people easily achieve power without asserting unhealthy external control. Individuals readily accomplish this through work (Glasser, Choice Theory, 1998).

When people enter into careers with leadership hierarchies, they may satisfy their need for power in acceptable or more effective ways. They often satisfy this need less effectively through controlling or hurting others aggressively. For instance, if a person enjoys stealing, assaulting, or engaging in unwanted sexual advances—that person may be seen as meeting this need in a less effective and destructive fashion.

Another important human need is freedom; it may be the most important. Freedom acknowledges that people desire total independence. They do not appreciate feeling forced or coerced or threatened. Individuals want to live uninhibited lives. They do not want to suffer from external control psychology. However, for the need of freedom to be fully realized, individuals have to be aware. They must perceive their own urge to dominate others. There is a problem, though. Many people believe that controlling others allows society to function. Dr. Glasser explains why this is so.

He says the need for freedom is evolution’s attempt to provide the correct balance between “your need to try to force me to live my life the way you want and my need to be free of that force” (Glasser, 1998, pp. 39-40).

Lastly, people require fun. Humans are imbued with a desire to play. This fun, however, can be achieved in a variety of ways. Every person is unique and all the images or pictures in that person’s quality world are important to that individual. As a result, people often choose behaviors that hurt themselves and others and these may result in psychological harm.

Dr. Glasser described the picture album as one that contains people’s ideal existence.

It contains people, animals, ideas, surroundings, objects, and beliefs that are important to them.

Quality Worlds may have pictures that others perceive as harmful, criminal, or unrealistic. When people with these pictures attempt to match their quality world pictures, they hurt others and also themselves. Dr. Glasser’s Choice Theory explains psychopathology through his axiom that ‘all behavior is total.’

Total behavior is comprised of four components: thinking, acting, feeling, and physiology (Wubbolding, 2000). People have more direct control over their thinking and acting with less control over their feeling and physiology.

Dr. Robert Wubbolding described this concept through the metaphor of a suitcase. He explains, “The handle of the suitcase of total behavior is attached to the action ingredient. Transporting a suitcase is most dexterously accomplished by lifting the handle” (Wubbolding, p. 22). Feelings indicate the ‘state’ of the system. Individuals need to focus and change their thinking and acting if they wish to perceive a change in their feelings and physiology.

Psychopathology

The previous example also alludes to how Choice Theory treats psychopathology. From the start, Choice Theory dispels psychiatric dogma. It treats psychiatric labels as mythological and does not consider people diseased. Individuals are not seen as being disabled by a broken brain (Glasser, 1998). The problems do not lie outside of the person. The individual creates his own problems through total behavior (unless they have a legitimate brain disease).

Glasser claimed that psychopathology surfaces due to people’s creative systems overcompensating for emotional and physiological distress (Glasser, 1998). For instance, when people fail to meet their needs in productive and acceptable ways, their creative systems adopt pathological behaviors that fall within what the DSM refers to as Schizophrenia or as a Bi-Polar disorder (Glasser, 1998).

Through the lens of Choice Theory, a person chose their behaviors indirectly through over-productive creative systems. These behaviors are not symptomatic of an underlying disease or condition.

The implications of this idea are staggering and many will raise objections; however, the evidence for mental illness is scanty. Brain scans do not have the capacity to diagnose mental illness alone. Mental illness is diagnosed on behavioral patterns and not on the discovery of disease processes. Therefore, it is not surprising that Glasser claimed that people choose their behavior, including alleged mental illness. Glasser suggested that people are depressing or anxietying or phobicking (Glasser, 1998).

Using verbs to express the fact that people choose their diseases further helps in teaching that people are not externally afflicted. The common use of nouns and adjectives to describe ‘depression’ and other ‘mental illnesses’ prevents huge numbers of people from ever thinking that they can do something more than suffer (Glasser, 1998, p.77).

This means that people continue life with the self-fulfilling prophecy that they are doomed to sickness unto death; and this begs the question, how does Choice Theory handle clinical approach and client evaluation?

Clinical Approach and Evaluation

Reality Therapy offers ways of setting the environment and follows procedures that lead to change. This process interrelates with choice theory in ascertaining the quality world pictures, needs, total behavior, and evaluation emanating from perceiving to what degree the person has matched their pictures to get he needs. Some questions may be: What do you want out of life? What do you want out of your relationship? What do you desire out of your friends? Out of work? Out of play? Out of power?

Wubbolding used and Reality Therapy and streamlined counseling procedures (Wubbolding, 2000). He provided the acronym WDEP which allows counselors not only to ground themselves in a coherent framework but to expand into a myriad of questions within the process (Wubbolding, 2000). This process is intended for clinicians to follow a path within the counseling session. First they obtain what the client wants, what he is doing to achieve it. Then they help the client evaluate current behavior, and assess the plan.

Within this framework, counseling comes to a quick close. This occurs because clinicians ignore past history, unconscious activity, and transference. They focus mainly on thinking and acting (hand and handle) aspects of total behavior.

The Freudian concepts do not fit into this model because focusing on emotion and past history is fruitless except to elucidate the present and this is a decision made by the counselor. If reviewing the past only allows clients to relive painful experiences, then this would not be within the realm of reality therapy. Reality Therapy operates in the present moment with present relationships (Glasser, 1998).

Client evaluation, then, is based on client wants, their behaviors and their plan to achieve what they really want. The clinician listens to the client’s story and gathers pertinent data; however, the clinician does not make a mental health diagnosis outright. That said, a diagnosis is ethically mandatory even if Choice Theorists disagree with the DSM. He stated that a pathological diagnosis is only necessary for insurance purposes (Glasser, 1998).

Therapeutic Alliance: Quality Counseling

Given a Choice Theory view on clinical assessment, what does the therapeutic alliance between client and counselor look like? In my perspective, scholars and researchers have failed to elaborate on the importance of the therapeutic and working alliance. They emphasize the importance of a good helper-client relationship but they do not delve much further than previous theoretical orientations. The counselor just assumes that he should develop a good working rapport. No theoretical input is suggested. Counseling sessions just proceed via the counselor asking a series of questions and confronting their clients; however, I believe there is value in examining how counselors working from CT/RT may interact.

This is not to say that the older theoretical and ethical concerns are moot. I simply believe that given the rich theoretical world of Choice Theory, better, more significant explanation may be explored and applied. For the purpose of expanding the helper-client relationship within Choice Theory, I call this new interaction “Quality Counseling.”

Quality counseling demands that the therapist not only gather rapport but help the client place the counselor in his quality world. Glasser mentioned this but did not complete the process (Glasser, 1998). The ACT method helps further the position.

The A stands for accept. The counselor immediately accepts the client and withholds judgment and criticism. The C stands for care. The counselor develops rapport and uses empathy and reflection of feeling to develop trust. The T stands for transact. Once counselors have reached this level with the client, the counselor begins the WDEP process as elaborated by Wubbolding.

The helper-client role is then fully established and the healing transaction starts. This is the initial framework for how counselors using reality therapy based on choice theory can establish a true-to-life and authentic working therapeutic alliance. The ACT process ultimately leads the client to experiencing his first genuine relationship which is also devoid of external control psychology.

Conclusion

The above statement represents the virtues that Choice Theory and Reality Therapy extol: meeting needs through non-coercive healthy relationships. This psychological orientation emphasizes responsibility and action. It sees humans who enter this world encoded with basic needs and who choose, of their own volition, to meet those needs in purposeful ways to match pictures in their quality worlds.

By the same token, choice theory does not see people as sick or suffering from mental diseases. All behavior is purposeful and an attempt to meet needs through matching quality world pictures.

Overall, Choice Theory harbors an optimistic vision of human nature. It boasts a compact, simple and elegant understanding of human psychology. It is the theoretical orientation that does not see people as broken or doomed or as mere automatons. It is the psychology that bestows the utmost faith in the individual. It allows people to choose what they want out of life, to pull themselves up by the bootstraps. It is the psychological philosophy that establishes the most trust in the individual.

References

Cameron, A. (2009). Regret, Choice Theory and Reality Therapy.  International Journal Of Reality Therapy, 28(2), 40-42(1st edition). Philadelphia, PA: Routledge.

Clifton, D. (2011). ‘MINDING UP’ WITH CHOICE THEORY IN A RAPIDLY CHANGING 21st CENTURY. International Journal of Choice Theory and Reality Therapy, 30(2), 17-22. Retrieved from http://199.79.56.33/docview/1010819816?accountid=7087

Ezrina, L. B. (2014). “CHOICE THEORY AND REALITY THERAPY: OVERVIEW.”

International Journal of Choice Theory and Reality Therapy, 34(1), 6-13. Retrieved from http://199.79.56.33/docview/1625136609?accountid=7087

Glasser, William. M.D. (1998). Choice Theory: A New Psychology of Personal Freedom. New York: HarperCollins Publishers.

Wubbolding, Robert. (2001). Reality Therapy for the 21st century. Philadelphia, PA: Brunner-Routledge.

 

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One comment

  1. This brought up a lot of interesting stuff. I took a few psychology classes back in college, and this brought back some memories. I remember learning about Freud, and he had some interesting beliefs. I’m glad that counseling has really changed a lot since then. It’s also interesting that there are so many different approaches to therapy. Some types my be better for people in certain circumstances, so I can see how it would be good to know all of this stuff. The older stuff is interesting too, because you can see how counseling has changed over the years.

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