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Ask the Mental Health Expert Archives 2001-2004

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Reality Therapy

Q. What's your opinion of Reality Therapy? What are its strengths and short comings? Do you have any information on Dr. William Glasser?

A. "Reality Therapy" was a form of psychotherapy developed in the the mid-sixties by William Glasser MD, an American Psychiatrist. In 1967 William Glasser founded the Institute for Reality Therapy and in 1996, this was renamed The William Glasser Institute. The essence of Reality Therapy is the idea that regardless of what has happened in our lives, or what we have done in the past, we can choose behaviors that will help us meet our needs more effectively in the future.

Glasser has also developed what he calls "choice theory". This holds that the only person whose behavior we can control is our own. Choice Theory maintains that what we do is not determined by external causes, but by what goes on inside of us. A summary of Dr Glasser's ideas on therapy, management and education is found in his book "Choice Theory" published in 1998 by Harper-Collins.

Personally, I find much in "Reality Therapy" to applaud. Many of its tenets are similar to those of "Rational Emotive Therapy" (or "Rational Emotive Behavioral Therapy") as developed by Dr. Albert Ellis, also in the early 1960s. RET, in turn, has much in common with cognitive-behavioral therapy (CBT), as developed by Aaron Beck MD and others. All these schools emphasize the role of individual responsibility; a "here-and-now" orientation (rather than unconscious factors); and practical strategies for change. On the plus side, I think such therapeutic approaches are relatively easy to learn; provide a clear framework for the patient; and can often lead to important change over relatively brief periods of time (weeks to months, rather than years).

However, not all patients take to such directive approaches. Some patients experience them as too manipulative, or too confrontational. Some patients simply are more comfortable with more psychoanalytic or supportive approaches. That said, I do think that there is an overwhelming amount of empirical data supporting the benefits of CBT for a wide range of psychiatric disorders; e.g., anxiety disorders, depression, post-traumatic stress disorder, etc. To my knowledge, Reality Therapy per se has less empirical support (in terms of controlled studies), but does operate on principles quite similar to those of RET and CBT.

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January 2002

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