Compassionate Counseling

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Compassionate Counseling

Reality Therapy and Choice Theory

by Padraig O'Morain

(Padraig O'Morain is an Irish thinker and counselor who has won awards for his journalism and poetry. His column, That's Men, has been appearing in The Irish Times for a decade. His books include Light Mind, Mindfulness for Daily Living (Veritas). He is accredited as a counsellor by the Irish Association for Counselling and Psychotherapy. His explanation of Reality Therapy and Choice Theory is especally easy to understand and integrate with so much other wisdom on human emotional health.)

Reality Therapy is an approach to counselling developed by Dr William Glasser in the United States in the 1950s and 1960s. Choice Theory explains why Reality Therapy works. People often assume that Reality Therapy has something to do with giving people “a dose of reality.'' In fact the approach is far more people-friendly than that.  

Our Five Basic Needs

Almost all approaches to psychology assume that people have certain basic needs and, indeed, there is broad agreement on what these needs are.

In Choice Theory they are classified under five headings:  

· Power (which includes achievement and feeling worthwhile as well as winning).

· Love & Belonging (includes groups as well as families or loved ones).

· Freedom (includes independence, autonomy, your own 'space').

· Fun (includes pleasure and enjoyment).

· Survival (includes nourishment, shelter, sex).

One of the core principles of Choice Theory is that, whether we are aware of it or not, we are all the time behaving to meet these needs.

But we don't necessarily behave effectively. Socialising with people is an effective way to meet our need for belonging. Sitting in a corner and crying in the hope that people will come to us is generally an ineffective way of meeting that need – it may work for a while, but it is painful and carries a terribly high price for ourselves and others. Most of our troubles are linked to problems in relationships.

If you keep the basic needs in mind you can help clients identify the areas of their lives that are out of control or are not getting enough attention. You can also help the client to realise that wanting more freedom or fun, for example, in his or her own life is not selfishness but is based on a basic human need.

The key is what we want

Nobody ever gets up in the morning and says, “I must meet my Love & Belonging need today.''

We are more likely to say something along the lines of, “I wonder if Mary is free for lunch today'' or “Maybe we can get the gang together on Friday night.'' We want to have lunch with Mary or to marry John or to go out with our pals on Friday night or we want "our" football team or "our" political party to win.

So what really drives us as social beings is our wants. We don't think of our needs as such. We think of what we want, behave to get what we want, fantasise about what we want and so on.

A workable plan

The counsellor in Reality Therapy helps the client to make workable plans to get what he or she wants.

A workable plan is a plan YOU can implement – in other words, it concentrates on the things that are in YOUR control to do:

· Maybe you can't make your spouse speak to you but you can speak to your spouse;

· Maybe you can't make your teenage son treat you with respect but you can decide that you will no longer provide a catering service to a son who treats you with contempt;

· Maybe you can't make the company give you a promotion but you can look for a promotion, and apply for the job when it comes up;

In this way, Reality Therapy empowers the client by emphasising the power of doing what is in the client’s control to do.

Doing: the heart of Reality Therapy

Doing is the heart of Reality Therapy.

Emotions are a wonderful, immediate and “alive'' source of information about how we are doing and whether we are happy with what is going on in our lives. But it is very, very hard to change our emotions directly.

It is easier to change our thinking: to decide, for example, that we will no longer think of ourselves as victims or to decide that in our thoughts we will concentrate on what we can do rather than what we think everybody else ought to do.

But to practitioners of Reality Therapy changing what we do is the key to changing how we feel and to getting what we want.

Indeed, we are sometimes so caught up in anger, depression or resentment that even changing how we think becomes an impossible task – in such situations a positive change in what we do may be the best we can manage.

The issue of control is also of great importance in Reality Therapy. Indeed, the theory underpinning Reality Therapy was, until recently, called Control Theory: it is now called Choice Theory.

The key issue of control  

To meet their needs human beings need control: one person seeks control through position and money; another wants to control his or her physical space, like the teenager who bans all parents and parent-like persons from her room; another wants to chair the committee; another wants an office with a corner and two windows; another wants two lamb chops, Heinz beans and three boiled potatoes on the table at precisely 6.30 pm.

Control gets us into trouble in two primary ways: when we try to control other people, and when we use drugs and alcohol to give us a false sense of control.

At the very heart of Glasser's Choice Theory is the idea that the only person I can really control is myself. If I think I can control others I am moving in the direction of frustration. Trying to control other people is a mug's game: it is a never-ending battle, alienates us from others and causes endless pain and frustration. Even the most frightening dictator can never rest – those whom he is trying to control are always liable to rebel.

Similarly, if I think others can control me, and so are to blame for all that goes on in my life, I tend to do nothing effective and again head for frustration. This is not to deny that we can be subjected to violent and coercive situations but while we are alive we have choices even in these situations. In the worst situations these choices may not be enough to save us or they may be painful or they may be choices we wish we never had to make. For instance a person in an abusive situation may have to choose whether to stay or go, though both choices are painful – there is, nevertheless, a choice and that realisation may empower the person to choose to get away.

Unfortunately, we can get an instant sense of control from alcohol and some other drugs. But our lives are never more out of control than when we are drunk or drugged. There are very few people in this world who ever woke up with a hangover to find that they had fewer problems than they had when they started drinking the night before.

Excessive drinking and the use of drugs have to be replaced by doing something else – and that something else has to have a fair chance of getting us what we want in life. Many people working in the addiction field have found this approach useful.

The solution is in the present and the future

Counselling is often thought to involve delving into the past. Practitioners of Reality Therapy also visit the past but probably to a lesser extent than those who use other therapies – this is not a criticism of those who use other therapies, it is simply a way in which Reality Therapy is different.

In Reality Therapy the past is seen as the source of our wants and of our ways of behaving. Not only are the bad things that happened to us there but our successes are there too. The focus of the practitioner of Reality Therapy is to learn what needs to be learned about the past but to move as quickly as feasible to empowering the client to satisfy his or her needs and wants in the present and in the future.

This is because it is our present perceptions that influence our present behaviour and so it is these perceptions that the Reality Therapy practitioner helps the client to work through. It is very much a therapy of hope, based on the conviction that we are products of the past but we do not have to go on being its victims.

Differences

There are many ways to meet our needs for survival, belonging, freedom, fun and power. People differ in how they meet these needs. We all need to eat but I want a steak and you want a pizza. We even differ in the details: if we both want steak I may want mine medium and you want yours rare. I want a government which will pay for social services for people on low incomes; you want a government which will cut welfare and taxes. To the extent that we can respect the fact that other people – including those nearest and dearest to us – want different things than we want, we can live in harmony. If we cannot respect these differences, then we must live in conflict.

In Choice Theory all the things a person wants are described as making that person’s Quality World. For any two people some of the things in their Quality World will overlap (i.e. they want some of the same things) but many, perhaps most, will be different. We must be willing to allow these differences if we are to have harmony in our relationships.

Total Behaviour

To get what we want, we behave. We are engaging in one behaviour or another from the time we are born to the time we die. But this behaviour has components and when these are put together we can think of them as constituting Total Behaviour.

At any time, four things are happening for us: what we are doing, what we are thinking, what we are feeling and what is going on in our bodies.

Sometimes these activities work in harmony. For instance, if we are pleased we may be smiling (doing), thinking positive thoughts, feeling content and physically relaxed. If we are angry we may be shouting (doing), thinking angry thoughts, feel that we are in a rage and have our hearts beating quickly and our muscles tensed up.

Often, the four activities are going in different directions. If you are sitting in a dentist’s waiting room and you hear the drill starting up, your feelings may tell you to run but your thinking may tell you to stay. Your body may be tensed up with heart racing and adrenaline pumping. And what you are doing may be thumbing idly through an out of date copy of Hello! magazine.

You could say that at any one time we are behaving in each of these four ways: feeling, thinking, doing, physiology. We can call this combination our Total Behaviour. If we can change one of these, then we have a good chance of changing the others.

It is hard to change our feelings directly. It is easier to change what we are thinking and easiest of all to change what we are doing.

So the golden rule is: if you want to change how you feel, begin by changing what you are doing or what you are thinking.

Changing How I Feel

Consider the four components of behaviour: Doing, Thinking, Feeling, Physiology.

Which of these leads me from one moment to another? If I am led by my feelings I may be in difficulty: if I feel angry I may lash out at someone or I may become depressed to suppress the anger.

Moreover, if there is something I need to do, it would be a mistake to wait until I feel right about it before I do it. Suppose there's an important phone call I have to make but which I never actually feel like making when the time comes to do it. If I am led, on a moment-to-moment basis, by how I feel, there is a good chance I will never make the call, or that I will postpone it until I am in trouble and cannot put it off any longer.

But I can change my focus so that I am purpose-led instead of feelings-led. I am still very aware of my feelings – they are the warm, beating heart of my life – but my purpose is my moment to moment guide and my orientation is towards doing.

So now I make my telephone call, even though I don't feel like making it at this particular moment. With the phone call made, I – hopefully – feel relief, a return of energy, perhaps even a little elation.

Paradoxically, by focusing on what I can do rather than on what I feel, I arrive at a point where my feelings become pleasant and positive.

Sometimes the good feeling takes longer to arrive. If I am grieving over the end of a relationship or over a death, I will, hopefully, get to the point where I am doing things I want to do – seeing friends, taking a break and so on – but it may be a long time before this "feels" right and before I start to feel good. But I will get there, if I have the courage to keep working at it – and it will help greatly if I have friends to help me along the way.

This raises an important point about the things we want: Sometimes I cannot move ahead unless I change what I want.

Suppose I want the renewal of a relationship and that I want this more than anything else, but that I know it simply isn't going to happen. For a time, part of the pain I am in comes from wanting something I can never have or can never have again. This wanting and this pain is part of grieving. But eventully, to be able to get on with my life, I must be willing to give more of my attention to other needs and wants in my life. This is so even though when I start to do this I will still be in pain. It is a bit like taking a picture and moving it to the back of your album instead of keeping it at the front.

So in order to bring about change in our lives, we must do something different or change what we want. If I want to be a good athlete but I spend my mornings in bed, I must change what I do – get up and start running instead of snoozing – or change what I want – perhaps decide that what I really want out of life is to be a couch potato.

We can also change what we think and this is helpful but sometimes our emotions are so strong – with grief or depression for instance – that all we can change is what we do, and our thoughts have to follow afterwards.

Everybody Needs Control

We try to control ourselves, people and situations to meet our needs or to get what we want. Everybody needs a certain amount of control to meet their needs for power, belonging, freedom and fun.

The most important word to notice here is "everybody". You need a certain amount of control but so does your partner. The boss needs a certain amount of control but so does the worker. The parent needs a certain amount of control but so does the child.

When people fail to recognise that the other person also has a need for control, the stage is set for conflict. If, however, we are willing to negotiate and compromise we can find ways to cooperate and create a better life.

Sometimes we ask for what we want. This respects the sense of control of both parties. (If you don't believe asking is an attempt to gain some control consider the outrage in the workhouse when Oliver Twist "asked for more." To the authorities in the workhouse these children were not entitled to try to exercise any control over what happened to them and even asking for more porridge was a breach of that rule.)

Sometimes instead of asking, we demand what we want. But demanding what we want ignores the other person's sense of control and they will want to resist us.

Control is all around us. Here are two examples: If I'm scared to go to work and stay in bed instead, I am controlling my situation at least to the extent of not going to work. A better way to control that situation might be to talk to my boss or my union or to look for another job. If I buy a lottery ticket I am trying to exercise a little bit of control over my future, however poor the chances of winning. I might achieve the same objective, more surely, if I put money into a savings account or pension plan.

Here are the two key points about control:

1. Regardless of how we feel we almost always have some control over what we do.

2. If you do something that is better than what you are doing now, there is a good chance that your thoughts and feelings will also change in a more positive direction, even though the change may not come straight away.

Conflict in Choice Theory and Reality Therapy

People seem to fight over everything from how a country should be governed to how the living room should be decorated. It is as if conflict arises from very fundamental aspects of how our minds work. Some causes of conflict, from the point of view of Choice Theory and Reality Therapy, are these:

    Differences in what we want. Each of us has many thousands of ideas or pictures of what we want. We may want a particular belief , such as socialism, dictatorship, Catholicism or Islam, to prevail. We may want to have a certain person all to ourselves. We may want to live in a certain part of a certain city. Attempts to get what we want can bring us into conflict with other people, especially if we refuse to accept and tolerate the fact that others want different things than what we want. I want to play my music loud and you want peace and quiet. I want to drink and you want me to clean the house. I want one party to win the election and you want another. I want to dress casually and you want to dress formally.
    The conflict does not have to be between me and another person. It can be in me alone. I may want to overeat and want to be slim at the same time, for instance, or I may want to have an income but not want to work.


2. Satisfying our fundamental needs. Satisfying my need for power will bring me into conflict with other people who have an equally strong need for power. Satisfying my need for freedom will bring me into conflict with people who have a strong need for power or belonging (in the case of belonging I may be mistreating a loved one by indulging my need for freedom). Satisfying my need for fun may bring me into conflict with other people too.  

Generally speaking, conflicts can be thought of as true or false. A true conflict has no satisfactory solution, at least in the short term. A false conflict has a solution but it may be one which we don't feel like implementing.  

True Conflicts

In a true conflict there is no single solution which will satisfy both sides. In a false conflict there is a solution, often tough and unpalatable, which will resolve the issue.

Mary insists that she wants to live in Dublin, John insists that he wants to live in London. Neither is willing to live anywhere outside of one of these cities. This is a true conflict. There is no solution which will satisfy both. How might they handle this conflict? Here are some possibilities good and bad, satisfying and unsatisfying, from the perspective of Reality Therapy and Choice Theory:

1. Keep the conflict going. One way is to keep the conflict going for a long time. This could include fighting, threatening, coaxing, sulking resenting, depressing (getting depressed), getting sick or drinking to name but a few. This may be ineffective and painful and could destroy the relationship.

2. Turn it over to time. In other words, postpone a decision and get on with doing things which both find meet their needs. The things which meet their needs may not be the same for each of them – what matters is that each can put his or her energies into satisfying activities in which they are not in conflict, while postponing a decision on the major conflict. Perhaps Mary wants to do an evening course which will take three months. Perhaps John wants to join a health club and get into shape.

The world never stands still and something may happen in the meantime to resolve the situation that they are most in conflict about – which city to live in.

3. Try it and see. A third approach is to agree to try one solution for a time and then to assess whether it is acceptable to both parties. So John might agree that they will live in Dublin for four months and then look at the situation again. This approach is common in industrial relations – usually where the union agrees to try out a new work arrangement and the management agrees to a joint review after six months or a year.

Grieving over someone who has died or over a relationship which has irrevocably ended or over a situation which has changed for the worse (perhaps children grieving because their parents have split up) is an example of a true conflict. There is a conflict between wanting the old situation and having to live in the new. There is no immediate solution which will resolve the conflict in a satisfactory way. Only time, and doing other things which are satisfying, will heal the grief.

False Conflicts

There is no true conflict between maintaining my weight at its present level and eating all I like – so long as I am willing to run many miles a day.

There is no true conflict between working and studying for a degree – so long as I am prepared to spend my evenings studying and my money on fees instead of other things.

If there is a single behaviour which would resolve it, then the conflict is a false conflict.

Very often when we are "stuck", "in a rut", "not able to move forward", we are in a false conflict.

We may be letting our family exploit us, we may be in a job we don't want to be in, we may be in a bad relationship: but we stay there, although there is a tough alternative.

Perhaps we stay because we are afraid of failure if we try to go it alone, or for the sake of someone else caught in the same bad relationship or because we need the money to educate our children. So there are good and bad reasons for staying in a false conflict. Good reasons often reflect our values: doing our best for our children, for instance. Bad reasons may have to do with fear, a poor self-image or a habit of blaming the rest of the world for our problems.

Choice Theory, Reality Therapy and Depression

In Reality Therapy and Choice Theory, depression is seen as a way of dealing with the gulf between what we have and what we want. Because depression is seen in this way, Choice Theory always holds out the possibility of overcoming depression. And, as is clear below, Choice Theory does not see depression as being bad all the time. Sometimes it is better than the alternatives – what is important is not to trap ourselves in depression. What is more important is to know that the path out of depression begins with changing what we want or changing how we behave.

Depression can do four things for us and knowing what these are can help us to begin the climb out into the light. These four things can be thought of under the letters ACHE.

A for Anger

Depression is often considered an alternative to anger and sometimes it can be better to choose depression than anger. If you make a habit of lashing out when anything goes wrong, you can alienate other people and often make matters worse. Consider how many relationships anger has destroyed. Consider how many lives anger has destroyed. Anger has its place, and it often gives us the energy for change, or the energy to stand up for ourselves. But it can be destructive too. Depression can be a safe, temporary alternative to anger. It becomes unsafe when it goes on for too long.

C for Control

Depression gives us a certain amount of control over people and situations. It may help us to avoid taking risks, to stay in a safe environment. To a certain extent, people will try to avoid upsetting us when we are depressed. If we are absolutely devastated by something that has happened, depression may give us the only control over our lives that we can handle at the time. The price for this control, however, can be high because of the suffering that comes with depression. By definition, nobody enjoys depression – if we did, it would not be depression.

H for Help

Depression brings us a certain amount of help. This may be help from friends, from a doctor or from an institution. Some people need this help for a time. Again, if it goes on too long people may stop helping us and in any event depression is a high price to pay for the help we get. But why don't we just ask for help? For many of us, it isn't such an easy thing to do, to say "I am in a bad way, please help me." Many of us have the tendency, when asked "What's wrong?" to reply, "Nothing," even though there may be a great deal wrong. Depression can get us help without us having to ask for it.

E for Excuse

Depression can excuse us for not doing what we should do. It can be a way of avoiding pain. If I am depressed, how can I be expected to get out and about, dress well, work, face my problems etc? Yet, very often, it is only by doing these things – even, at an extreme, by doing something, anything at all – that I can start to climb out of a depression.

So if I am depressed Choice Theory would say that I can begin to climb out of the depression by taking action.

I have no direct control over the feeling of depression. I may, if I am in the depths of depression, have little or no control over my thoughts. All I can control is what I do. Maybe all I can do is get out of bed and sit by the window, or get out of bed and go downstairs and that may be enough to start getting the depression to lift.

When I can do a little more, I should try to do something more. Ideally I should focus on small things that I want and that I can get.

Maybe I want my children back living with me, but I can't get that, they've grown up and flown the nest: but maybe I can telephone or write to them, maybe I can spend more time with my friends or more time doing something else that I want to do and that is unattainable.

I may also need to change what I want – in this case to accept that my children will never return to live with me.

Is this easy? No, sometimes it's very difficult and takes a long time. Our feelings, thoughts and actions are linked but sometimes we have to do something for quite a long time before our feelings follow and become positive. But though this work can be slow, and though we don’t feel like getting started, it will be worth it in the long run.

Medication and Depression

Dr William Glasser, who developed Reality Therapy, has a great deal to say about medication in his books. He has the qualifications to discuss medication. I do not, and my attitude is that I have nothing useful to contribute on the topic. But I believe that, whether you are on medication or not, the practice of Choice Theory can make your life better.