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MARGARITA: A CASE STUDY APPLYING THE REALITY THERAPY APPROACH

Margarita: A Case Study Applying the Reality Therapy Approach

Cindy Ransom
COUN 5239
U09a1 Theoretical Framework and Application

6544 Balboa Blvd. Unit 3

Van Nuys, CA 91406
Email: [email protected]
Instructor: Professor Victoria Gamber
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MARGARITA: A CASE STUDY APPLYING THE REALITY THERAPY APPROACH

Abstract

There are numerous approaches and theories that therapists have to choose from in order

to provide their clients with the best interventions to help them one of which is reality

therapy. Reality therapy provides a delivery system for helping individuals take more

effective control of their lives (Corey, 2013). In relationship therapy, each person is asked

to examine his or her own wants, behavior, and perceptions, evaluate them, and make

more effective plans (Glasser & Wubbolding, 2013). This paper discusses a brief

development history of the approach and also how it lends itself to the positive

psychology movement. Evidence based support and the application towards working with

a diverse population is also examined. Finally, this approach will be applied to a

theoretical case study discussing case goals, strengths and limitations.

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Each client that a counselor is presented with has their own unique situation in

which they seek assistance. There are numerous approaches and theories that therapists

have to choose from in order to provide their clients with the best interventions to help

them one of which is reality therapy. Reality therapy provides a delivery system for

helping individuals take more effective control of their lives (Corey, 2013). In this paper

we will discuss the reality therapy approach and apply it to a case study for a Puerto

Rican woman named Margarita.

Reality Therapy

Reality therapy, developed by Dr. William Glasser, is founded on the principles

of choice theory and has developed into a widely popular and recognized therapy form.

Reality Therapy suggests that all human issues derive from a lack of fulfilling

relationships with others. The goal of this therapy is to provide a connection for people,

beginning with the therapist-client connection (Good Therapy, 2013). Reality therapy

helps clients to assume personal responsibility for what they do and the choices they

make instead of placing blame on outside occurrences or influences (Corey, 2013).

When clients begin to assume responsibility for their actions they become inspired to

make better choices for themselves in the future.

Reality therapy is based on choice theory. Choice theory posits that we are born

with five genetically encoded needs that drive our lives: Survival, love and belonging,

power, freedom and fun (Corey, 2013). These needs provide reality therapists with a

model for establishing trusting client/helper relationships. In a helping relationship, the

helper must create an environment where it is possible for the person being helped to feel
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safe; to feel connected to the helper in some way; to be listened to and respected; to have

some choices; and to have some fun or learning with the helper. After creating this need-

satisfying environment and working hard to maintain it throughout the relationship, the

helper can move on to the actual problem (Reality Therapy Central, 2013). Reality

therapy helps clients to identify their unmet needs and encourages them to become

empowered to find ways to satisfy them.

Reality therapists are viewed more in a mentoring perspective where they help to

teach their clients ways to empower themselves. Reality therapists teach clients how to

engage in self-evaluation by challenging them to examine what they are doing. Corey

(2013) wrote, Reality therapists assist clients in evaluating their own behavioral direction,

specific actions, wants, perceptions, level of commitment, possibilities for new

directions, and action plans. Clients then decide what to change and formulate a plan to

facilitate the desired changes. Together they can creatively address a range of concerns

and options.

The Connection Between the Reality Therapy Approach and Positive Psychology

The Positive Psychology field is founded on the belief that people want to lead

meaningful and fulfilling lives, to cultivate what is best within themselves, and to

enhance their experiences of love, work, and play (University of Pennsylvania - Positive

Psychology Center , 2007). This parallels with Glasser’s needs of love and belonging and

fun. Both philosophies focus on the present and encourage clients to take responsibility

for their actions in order to achieve self-awareness and happiness.

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Limitations and Evidence Base Support

According to many sources, one limitation to this approach is that it does not take

into account any of the client’s past childhood experiences and the effects that they may

have in their adulthood or dreams. Because reality therapy focuses almost exclusively on

consciousness, it does not take into account factors such as repressed conflicts and the

power of the unconscious influencing how we think, feel, behave, and choose (Corey,

2013). Another limitation is the notion that people “choose” a psychosis or chronic

depression. Corey (2013) wrote, People suffering from chronic depression or

schizophrenia are struggling to cope with a real illness. In reality therapy these people

may have additional guilt to carry if they accept the premise that they are choosing their

condition.

A modification that could be suggested for counselors who use this approach is to

adapt to the client’s unique background and take into consideration these limitations

when assessing a client’s psychological state. Competent reality therapists have a

thorough understanding of choice theory and have mastered the art of applying reality

therapy procedures to working with diverse clients with a range of clinical problems

(Corey, 2013). Allowing some flexibility on choice theory for people with real mental

conditions can allow counselors to provide a more holistic approach for the presenting

issues their clients bring.

Reality therapy has been proven to be quite effective in a variety of settings but

most particularly with children and in schools. Choice Theory, and it's delivery tool,

Reality Therapy, is very effective when working with children and young people who
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have emotional and behavioural difficulties, as well as with other types of 'client group'.

During the past few years there has been a significant increase of practitioners beginning

to use Reality Therapy as their preferred method of counseling and supporting clients.

Practitioners find that Reality Therapy fits nicely into their 'bag of tools' used within the

counseling environment, and that the processes fall in line with current national and

organisational professional and ethical guidelines (European Association for Reality

Therapy, 2008). In particular schools and school counselors have found reality therapy to

be quite effective because of its natural mentorship application. Mason & Duba (2009)

cited;

Counselors are able to develop positive relationships with clients when

they possess the personal qualities of warmth, sincerity, congruence,

understanding, acceptance, concern, openness, respect for the client and

the willingness to be challenged by others (Corey, 2009). These

characteristics allow school counselors to function as advocates who are

able to instill a sense of hope in students. Once the therapeutic relationship

has been established, the counselor assists students in gaining a deeper

understanding of the consequences of their current behavior. At this point,

students are helped to understand that they are not at the mercy of others,

are not victims, and that they have a range of options to choose from.

Although mostly associated with helping students and children, reality therapy contains

many concepts and techniques that can be truly effective for struggling adults as well as

diverse clientele.
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Addressing Diversity in the Reality Therapy Approach

Reality therapy has some strengths and drawbacks when it comes to its

multicultural application. Some of the drawbacks for reality therapy is it’s lack of taking

into account some very real environmental forces that operate against diverse clients.

Discrimination, racism, sexism, homophobia, heterosexism, ageism, negative attitudes

toward disabilities, and other social injustices are unfortunate realities, and these forces

do limit many individuals in getting what they want from life. It is important that

therapists acknowledge that people do not choose to be victims of various forms of

discrimination and oppression (Corey, 2013). In order for therapists to help their clients

succesfully address their problems they must also take into account some of these

environmental limitations so that clients do not get frustrated with their progress.

A stength of reality therapy is it’s universal applicability to diverse and

multicultural clients. Jusoh & Ahmad (2009) cited;

Choice theory and reality therapy have universal attributes, and these can

be interpreted in any religion or culture. Choice theory through its basic

concepts can be used with anyone all over the world (Glasser, 1998;

2000a, 2001; Glasser & Glasser, 1999; Wubbolding, Al-Rashidi et al.

1998). Wubbolding, Al- Rashidi et al. 1998 stress that counselors,

supervisors or the users of reality therapy should have the capability and

be able to handle counseling sessions with awareness of multicultural

issues, including knowledge and experience on clients' culture. What is

important in therapy is to understand and respect the surrounding of

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clients so that it is challenging for a counselor to use reality therapy as an

approach to help clients.

Reality therapy focuses on giving the clients the tools that they need in order to facilitate

the changes they wish to make in their lives. When counselors educate themselves on a

variety of cultures, religions and diverse backgrounds they can be better informed on how

to help their clients appropriately and effectively without offending them.

Case Study: Margarita

Margarita is seeking counseling due to reported, "anger outbursts." She states that

she becomes so angry with her husband that she thinks of physically harming him,

although she does not remember anything that he does specifically to provoke her anger.

She denies any physical violence but has gone as far as grabbing a knife and threatening

him. She does respond to his verbal attempts to calm her. She reports feeling relief after

the "explosion." Margarita does admit that she is fearful that her husband will leave her

due to her behavior. She reports that they do not communicate well, he maintains the

house, and they rarely experience intimacy or sex (Capella University, 2013)

Margarita has an MBA and is very intelligent. Margarita also discusses feeling

depressed most of the time, but she has to put on a "game face" to do her work. Her

husband and her parents are the only ones who see her depressed side. She also reports

that she often experiences anxiety in social situations, avoids going places where she may

be socially judged, and has no friends, but she does feel confident in structured work

projects where she is in charge. She reports having panic attacks on occasion and has had
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thoughts of suicide. She truly wants to have quality friendships, is always in a mode of

self-doubt, and admits to constant negative internal dialogue (Capella University, 2013)

Following her intake session, Margarita made a commitment to six sessions of

therapy with this counselor. She responded well to the counseling interventions during

the first three sessions, and we see evidence of establishing a good rapport. She has

reported that she continues to feel overwhelmingly strong anger at times, and she still

feels quite despondent about this and her life in general, although she strongly denies

suicidal intentions. In the second session, we initiate a discussion about cultural

differences giving her an opportunity to articulate how she might be concerned about this

counselor’s understanding of her. She replies that she is confident that this counselor can

understand her, based on our interactions so far, but if she develops concerns she will let

you know. At the end of the third session, this counselor and Margarita identified some

specific goals that she would like to work on to "move the ball forward" in her life. We

then prioritized these goals and this counselor asked her to think about them before our

next session to be sure they were the best fit for what she most wants to change (Capella

University, 2013).

Therapeutic Case Goals

After having effectively created a conducive counseling environment with Maria,

one of the first therapeutic goals would be to help her realize what are some of the things

happening that are under her control. Focusing on the current behavior of the client,

rather than on past history or the on-slaughts from the client’s external world, helps

clients become aware of their actions—the component of their behavior over which they
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have most control. Depending on the style of the therapist, they are asked intermittently

to make judgments on their wants. They are then asked to make plans that fulfill the

characteristics of effective planning. Simple planning sheets are frequently used (Glasser

& Wubbolding, 2013). Using a planning sheet will help to list some of the factors that

Maria faces and be able to clearly see which ones she is able to change through her

actions. For example, Maria mentioned that she doesn’t seem to remember reasons as to

how or why her husband makes her angry before one of her fits. Her anger would fall

under the category of things that are under her control. This counselor could then make

suggestions to help Maria become more self-aware of the next time she feels angry and

choose a different outlet than having an “outburst”.

This counselor would apply the WDEP system to Maria’s case in order to help her

have a better understanding of the role she plays on her situation. The WDEP system can

be used to help clients explore their wants, possible things they can do, opportunities for

self-evaluation, and design plans for improvement. Each of the letters refers to a cluster

of strategies: W=wants and needs; D=direction and doing; E=self-evaluation; and

P=planning (Corey, 2013). By following this system we can better understand Maria’s

presenting issues and collaborate on effective interventions to make change.

This counselor would first focus on assisting Maria in discovering her wants and

needs through questioning. Clients are given the opportunity to explore every facet of

their lives, including what they want from their family, friends, and work. Relevant

questions help clients gain insights and arrive to plans and solutions (Corey, 2013). One

of her wants, for example, could be to have the ability to control her “anger outbursts”.

Inspired by this desire, this counselor would then focus on what direction Maria is going
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and what she is doing. Reality therapy focuses on gaining awareness of and changing

current total behavior.

Reality therapists encourage clients to take action by changing what they are

doing and thinking (Corey, 2013). When discussing Maria’s anger outbursts we could

focus on what she is thinking at the time that she gets mad and what she does. For

example, when arguing with her husband perhaps she begins to think she is not being

heard. This eventually leads to a feeling that she is being ignored or undermined. It could

then possibly result in feeling like she needs to physically make herself seen (using

threatening posture) in order to get her point across. These are hypothetical steps that

could result in an “anger outburst”. It is important for this counselor to always relate the

feelings that Maria is experiencing back to what she is doing and thinking in order to be

productive in an effort for change.

The self-evaluation process would be the next step for Maria. Evaluation involves

the client examining behavioral direction, specific actions, wants, perceptions, new

directions, and plans. It is the counselor’s task to assist the clients in evaluating the

quality of their actions and to help them make responsible choices and devise effective

plans (Corey, 2013). The self-evaluation process is critical for the client in order to assure

that they make changes to their attitudes. This counselor would ask Maria questions to

help her in her self evaluation such as “Are your anger outbursts helping or hurting

you?”, “Is this behavior helping your relationship with your husband and family?”, and

“Do you really have no control over your angry reactions?” The hope is that the answer

to these questions will help to elicit some kind of self-reflection for Maria in deciding to

change her angry reactions.

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Once Maria has decided that this is something that she wants to change about

herself and is ready to explore alternative behaviors, this counselor would assist in the

planning and action step of the WDEP system. The process of creating and carrying out

plans enables people to begin to gain effective control over their lives. The plan gives the

client a starting point but plans can be modified as needed. Clients are helped by a

therapist who does not easily give up beleiving in their ability to make better choices,

even when they are not always succesful in completing their plans. (Corey, 2013). This

counselor would adopt a nurturing and supportive stance throughout this phase in order to

help Maria continue to gain confidence in her choices.

When helping Maria to devise a good plan of action this counselor would follow

Wubboldings’ acronym, SAMIC, to their initial attempt. In order for a plan to be

effective it must be simple, attainable, measurable, immediate, involved, controlled by

the planner, committed to and consistently done (Corey, 2013). For Maria’s case in

addressing her “anger outburst” this counselor, along with Maria, could devise alternative

actions for when she begins to feel irate. For example, every time Maria begins to get

perturbed she could write down what she is feeling first before confronting her husband.

Another suggestion could be for her to physically replace it with an action, such as going

for a walk or making herself a cup of tea. Whatever we conclude that Maria feels could

be a natural diversion can be applied for the week before she returns to therapy and then

the results could be discussed at the following session.

The counselor continually urges the client to be willing to accept the

consequences for his or her own choices and actions (Corey, 2013). If for whatever

reason Maria still has an ager outburst, which is sure to happen, this counselor would use
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it as an opportunity to see the lesson that could be learned from the endeavor in which

she was not so successful. Also, the reasons why it may not have worked can be

discussed and a new approach could be created.

From a cultural standpoint, Latina women experience many different types of

unique conflicts. Sue & Sue (2013) cite;

For [Latina] women, conflicts may involve (a) expectations associated

with traditional roles, (b) anxiety or depression over not being able to live

up to these standards, and (c) inability to express feelings of anger (Lopez-

Baez, 2006; Zanipatin, Welch, Yi & Bardina, 2005). Latina immigrants

are often socialized to feel inferior and to expect suffering or martyrdom.

With greater exposure to the dominant culture, such views may be

questioned.

Margarita may be experiencing a conflict of the gender roles as her husband tends to be

more nurturing and maintains the house. She also expresses putting on a “game face”

which stems from culturally being unable to express emotions to “outsiders”. It is

important for her counselor to understand what importance or emphasis Margarita places

on these cultural traditions and roles and how it affects her self-perspective.

Strengths and Limitations of Reality Therapy in Margarita’s Case Study

One strength in applying the reality therapy approach to Maria’s case is that it

allows Maria to focus on her actions and essentially gives her control of her situation.
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Reality therapy allows Maria to become empowered, respected and also provides the

insight into empowering and respecting others. Human beings seek power in the form of

achievement, competence and accomplishment. The need for power does not imply the

exploitation of another person. Satisfying the need for power involves accomplishment or

achievement. Another goal of psychotherapy is to assist clients to fulfill their needs for

power without diminishing anyone else’s right to do the same (Glasser & Wubbolding,

2013). Not only can reality therapy help Maria with controlling her anger but it can also

provide her with the perspective to see how it affects her husband. By choosing to make

changes in her behavior she can simultaneously strengthen her marriage as well.

A limitation for her case using this approach could be her cultural background and

must be tackled initially when establishing a therapeutic relationship. Some clients are

very reluctant to directly verbally express what they need (Corey, 2013). The Latino

culture is known to be more collective by nature and is sometimes hesitant to share too

much personal information with strangers. In working with people with these values,

counselors must “soften” reality therapy somewhat. If reality therapy is to be used

effectively with clients from other cultures, the procedures must be adapted to the life

experiences and values of members from various cultures (Corey, 2013). By

personalizing the approach to Maria’s personality and specific background this counselor

will attempt to avoid her shutting down and not wanting to share her experiences.

Conclusion

Because the theory and practice of reality therapy are based on conscious

behavior, wants, needs, and perceptions of human beings, they are applicable in virtually
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every setting. In an age of equality between genders, wants and behaviors related to the

power need become more evident and pronounced. In relationship therapy, each person is

asked to examine his or her own wants, behavior, and perceptions, evaluate them, and

make more effective plans (Glasser & Wubbolding, 2013). Counselors have the esteemed

privilege to help clients, such as Margarita, to travel down the path of self-understanding,

reflection and behavior change. These changes are beneficial to leading happier and more

fulfilling lives.

 
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