When I did my graduate work to become a psychotherapist I was introduced and trained in three theories of treatment.
1. Psychodynamic.
2. Family systems.
3. Cognitive Behavioral.
However, my undergrad major was social work. The basic tenets of social work do not rely on the above psychological beliefs. The beginnings of social work can be traced back to Jane Adams (September 6, 1860 – May 28, 1935) and her work in Chicago with immigrants and families who were impoverished. The basic necessities such as food, clothing, shelter, hygiene were paramount to survival. In 1943, Abraham Maslow wrote the paper, “A Theory of Human Motivation.” In this paper, he proposed that humans have a “Hierarchy of Needs” starting with the basic needs mentioned above. This was further defined in his book, “Motivation and Personality.” Once these needs are met, individuals can go to the next level, which according to Maslow is Safety, then Social, Self Esteem, and Self Actualization. At any point in a person’s life, they may have to descend the hierarchy to reclaim the original needs. For example, the loss of a job puts in jeopardy the ability to obtain basic necessities. This doesn’t mean that an individual regresses in their personal growth, but their priorities change. Another example is when
you lose a close friendship or have to move and lose the community you had developed for your social needs.
William Glasser, MD defines Reality Therapy as, “…A therapeutic approach that focuses on problem-solving and making better choices in order to achieve specific goals. …Reality therapy is focused on the here and now rather than the past.” (https://www.crchealth.com/types-of-therapy/reality-therapy/). Reality Therapy-borrowing from Maslow’s hierarchy-uses problem solving to help the client address the specific blocks that are hindering their ability to resolve the current dilemma they are facing.
In my practice, I blend the different psychological approaches to address the difficulties my clients are facing. Reality therapy techniques are used when an obvious solution is visible or a client is stuck in faulty or fantasy beliefs. An example of the use of reality therapy is in the couple’s work I do. On rare occasions, I will have a partner who is emotionally abusive or controlling their partner. Many times, the may not recognize how they are abusive. Directly addressing the abusive behavior is essential in these cases in order to save the relationship.
There are two basic tenets of Psychotherapy. The first one is the Hippocratic Oath which is summed up in the phrase, “Do no harm.” The second tent is, “Meet the client where they are at.” When a client seeks counseling they are at various stages in their life. From developmental to psychological, to specific circumstances. Understanding and having empathy for a client is paramount to developing a therapeutic “healing” relationship. In the initial stages of therapy, it is usually not effective to be using reality therapy until trust has formed. For some, their ego or sense of self is not stable sufficiently to use problem-solving skills as it may overwhelm them. An example is when someone has recently lost a loved one. Problem-solving is not effective during the initial stages of grief. Developing a safe, nurturing environment during the sessions allows a client to gradually address concreate problems. However, in an urgent or crisis period, the client must change, avoid, or remedy specific dilemmas or their emotional or physical health may be threatened if not injured.
Reality therapy can be as simple as gently pointing out how a person communicates to others may be considered inappropriate. Or, it may be as complex that it needs to be addressed in specific concrete steps laid out in a logical order to achieve the desired outcome.
The most effective way to use the techniques of reality therapy is with compassion, empathy, and timing so that it can be heard and utilized by the client. Unfortunately, there are times when I have had to be blunt with a client because their actions are hurting the physical or emotional wellbeing of others around them. Or their actions are seriously hurting themselves. This is the most difficult time for a client. And once the intervention is completed, a return to empathy and compassion can negate the sharp edge of reality.
Throughout my training, I was told that I must not induce my opinions or emotions into the session. This is sound advice for 95% of all therapeutic issues. However, when I see a client drinking themselves to death, or their hostile actions are hurting those around them, it is my belief that it would be unethical to not confront it with the force directly needed to alter the actions of the client. This is the hardest part of the job. I have seen many a therapist avoid and thus collude with the negative behaviors. An example of this is when a husband berates or belittles their spouse in the session and the therapist sits back without intervening.
In short, reality therapy is a technique that is used when appropriate for the clinical situation. It needs to be delivered if at all possible with caring compassion. Timing is critical. It does not replace the use of other therapeutic modalities but rather blends in with them to enhance the effectiveness of the client’s work.
