Theory Outline

Mr. Mistor D. Williams

PCN-500-O102 Counseling Theories

1/18/12

Professor Nichelle Gause

I. Theory: Cognitive

a. Key Concepts i. To understand the nature of an emotional episode or disturbance it is

essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts.

ii. Automatic thoughts: personalized notions that are triggered by particular stimuli that lead to emotional responses

iii. Cognitive therapy is a comprehensive system of psychotherapy, and treatment is based on an elaborated and empirically supported theory of psychopathology and personality.

b. Key Theorists i. Aaron Beck M.D.

ii. Judith Beck (daughter) M.D.

c. Appropriate Populations for the Theoryi. ADULTS:

ii. Angeriii. Anxietyiv. Agoraphobia and Panic Disorder with Agoraphobiav. Dental Phobia

vi. Generalized Anxiety Disordervii. Geriatric Anxiety

viii. Obsessive-Compulsive Disorderix. Panic Disorderx. Post-Traumatic Stress Disorder (PTSD)

xi. Social Anxiety / Social Phobiaxii. Withdrawal from Anti-Anxiety Medications

xiii. Attention Deficit Disorderxiv. Atypical sexual practices/sex offendersxv. Bipolar Disorder (in combination with medication)

xvi. Body Dysmorphic Disorderxvii. Borderline Personality Disorder

xviii. Caregiver distressxix. Depressionxx. Geriatric Depression

xxi. Relapse Preventionxxii. Dissociative Disorders

xxiii. Eating Disordersxxiv. Anorexiaxxv. Binge-eating Disorder

xxvi. Bulimiaxxvii. Gambling (in combination with medication)

xxviii. Habit disordersxxix. Marital discord

xxx. Schizophrenia (in combination with medication)xxxi. Seasonal Affective Disorder

xxxii. Somatization Disorderxxxiii. Substance Abusexxxiv. Alcohol abusexxxv. Cocaine abuse (CBT relapse prevention is effective)

xxxvi. Opiate dependencexxxvii. Smoking cessation (Group CBT is effective, as well as CBT that has

multiple treatment components in combination with relapse prevention)xxxviii. Suicide attempts

xxxix. Medically related disordersxl. Asthma with Coexisting Panic Disorder (in combination with asthma

education)xli. Cancer pain

xlii. Chronic back painxliii. Chronic fatigue syndromexliv. Chronic pain (CBT, in combination with physical therapy, is effective for

chronic pain in many medical conditions)xlv. Colitis

xlvi. Erectile dysfunction (CBT is effective for reducing sexual anxiety and improving communication)

xlvii. Fatigue and functional impairments among cancer survivorsxlviii. Fibromyalgia

xlix. Geriatric sleep disordersl. Gulf War Syndrome

li. Hypertension (CBT is effective as an adjunctive treatment)lii. Hypochondriasis, or the unsubstantiated belief that one has a serious

medical conditionliii. Infertility (anovulation)liv. Insomnialv. Irritable-bowel syndrome

lvi. Migraine headacheslvii. Non-cardiac chest pain

lviii. Obesity (CBT is effective in combination with hypnosis)lix. Pain with no known cause (Idiopathic pain)lx. Physical complaints not explained by a medical condition (Somatoform

disorders)lxi. Pre-menstrual syndrome

lxii. Rheumatic disease pain (CBT that has multiple treatment components is effective)

lxiii. Sickle cell disease pain (CBT that has multiple treatment components is effective)

lxiv. Sleep disorderslxv. Somatization Disorder

lxvi. Temporomandibular Disorder painlxvii. Tinnitus

lxviii. Vulvodynialxix. CHILDREN AND ADOLESCENTS:lxx. Anxiety disorders

lxxi. Avoidant disorderlxxii. Chronic pain

lxxiii. Conduct disorder (oppositional defiant disorder)lxxiv. Depression (among adolescents and depressive symptoms among

children)lxxv. Distress due to medical procedures (mainly for cancer)

lxxvi. Obsessive-compulsive disorderlxxvii. Overanxious disorder

lxxviii. Phobiaslxxix. Physical complaints not explained by a medical condition (Somatoform

disorders)lxxx. Post-traumatic stress disorder

lxxxi. Recurrent abdominal painlxxxii. Separation anxiety

lxxxiii. COGNITIVE BEHAVIORAL THERAPY IS ALSO USED FOR:lxxxiv. Aginglxxxv. Family therapy

lxxxvi. Grief and losslxxxvii. Group therapy

lxxxviii. Low self-esteemlxxxix. Psychiatric Inpatients

xc. Relationship difficultiesxci. Separation and Divorce

xcii. Stressxciii. Work problems & procrastination

d. Inappropriate Populations for the Theory (Explain why.)i. CT does not suit everyone and it is not helpful for all conditions. A client

will need to be committed and persistent in tackling and improving your health problem with the help of the therapist. It can be hard work. The homework may be difficult and challenging. The client may be taken 'out of their comfort zone' when tackling situations which cause anxiety or distress.

e. Therapist’s Rolei. Insight-focused therapy which emphasizes changing negative thoughts and

maladaptive beliefs with a theoretical assumption that people’s internal communication is accessible to introspection.

f. Client’s Rolei. Clients’ beliefs have highly personal meanings wherein these meanings

can be discovered by the client rather than being taught or interpreted by the therapist.

g. Theory Strengthsi. To change the way clients think by using their automatic thoughts to reach

the core schemata and begin to introduce the idea of schema restructuring.ii. Cognitive therapy examines the client’s pattern that triggers depression:

iii. 1. Client holds negative view of themselvesiv. 2. Selective abstraction: Client has tendency to interpret experiences in a

negative mannerv. 3. Client has a gloomy vision and projections about the future

h. Theory Limitationsi. Firstly, the foundations on which it rests are not as secure as some of its

proponents would have us believe. The National Institute of Mental Health study of depression, the largest of its kind in the world, is now 20 years old, although its findings are still being digested.9 In this study, cognitive behavior therapy fared less well than the two other main treatment arms, interpersonal therapy and clinical management plus antidepressants.

ii. Secondly, there is still much to learn about the impact of different psychotherapies, including cognitive behavior therapy, on the long term course of psychiatric illnesses. Thus, depression is increasingly seen as a relapsing chronic illness, and without long terms comparative follow up studies it is surely premature to champion any one therapy.

iii. Thirdly, there is continuing uncertainty about the effectiveness of different psychotherapies (that is, their clinical relevance) as opposed to their efficacy (ability to produce change under “laboratory” conditions). Cognitive behavior therapy works well in university based clinical trials with subjects recruited from advertisements, but the evidence about how effective it can be in the real world of clinical practice is less secure. In the London depression trial, for example, couple therapy performed better than antidepressants for treating severe depression in patients living with partners, but cognitive behavior therapy came nowhere, having been discontinued early in the trial because of poor compliance from a particularly problematic (but clinically typical) group of patients.10

iv. Fourthly, as the Department of Health's guidelines suggest,5 absence of evidence is not the same as evidence of absence. Most studies show absolute rather than relative efficacy—that is, cognitive behavior therapy is usually compared with waiting list controls, no therapy at all, or some sort of bland pseudotherapy rather than with another form of psychotherapy. As in drug trials, comparing good treatments with those that may be better is a much greater research challenge that demonstrating that a treatment is better than nothing.

v. Finally, and perhaps most important, there are signs that leading cognitive behavior therapists themselves are starting to question aspects of their discipline and recognize some of its limitations. Linehan argues that standard cognitive behavior therapy for patients with conditions as complex as borderline personality disorder is unlikely to be effective.11

Her integrative therapy, dialectical behavior therapy, combines acceptance and acknowledgement of defenses (a psychoanalytic idea laced with Zen Buddhism) with cognitive and behavioral techniques for change. Similarly, Teasdale questions the “zap the negative cognitions” approach in major depressive disorder, believing that “mindfulness techniques” such as meditation are also needed to help patients divorce themselves from their emotional pain.12 In the treatment of personality disorder Young argues for a “schema-based” approach,13 taking account of transference, which looks increasingly psychoanalytic in flavour.14 We are entering a “post-cognitive behavior therapy” world, which goes beyond brand name therapies to considering the active ingredients of therapy, specific competencies and techniques, and the similarities and differences between different approaches at both theoretical and practical levels.15

vi. In sum, it is hard to escape the suspicion that cognitive behavior therapy seems so far ahead of the field in part because of its research and marketing strategy rather than because it is intrinsically superior to other therapies.

i. Key Terms (Write a short definition for each.)i. Arbitrary inferences

ii. Selective abstractioniii. Overgeneralizationiv. Magnification and minimizationv. Personalization

vi. Labeling and mislabelingvii. Polarized thinking

j. Is this theory research based? Evidenced based? (Justify your rationale.)i. It has been found to be effective in more than 400 outcome studies for a

myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders. It has also been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia.

ii. Cognitive therapy has been extended to and studied for adolescents and children, couples, and families. Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, non-cardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders.

k. Special training requirements i. In the mid-1960s, Dr. Aaron T. Beck developed cognitive therapy as a

time-sensitive, structured therapy that uses an information-processing model to understand and treat psychopathological conditions. The theory is based, in part, on a phenomenological approach to psychology, as

proposed by Epictetus and other Greek Stoic philosophers and more contemporary theorists such as Adler, Alexander, Horney, and Sullivan. The approach emphasizes the role of individuals’ views of themselves and their personal worlds as being central to their behavioral reactions, as espoused by Kelly, Arnold, and Lazarus. Cognitive therapy was also influenced by theorists such as Ellis, Bandura, Lewinsohn, Mahoney, and Meichenbaum.

ii. The Beck Institute offers training in the following core areas which both Dr. Beck(s), including their training staff, will provide training services and one-on-one interaction:

iii. Level I: Depression and Anxiety, iv. Level II: Personality Disorders and Challenging Problemsv. Specialty: CBT for Substance Abuse

vi. Specialty: CBT for Children and Adolescentsvii. Level I: Depression and Anxiety - Students and Faculty

viii. Level I: La Depresión y La Ansiedad (en español)ix. Specialty: CBT for Schizophreniax. Specialty: CBT for PTSD

II. Theory: Cognitive Behavioral

a. Key Concepts i. Individuals tend to incorporate faulty thinking, which leads to emotional

and behavioral disturbances. Cognitions are the major determinants of how we feel and act. Therapy is primarily oriented toward cognition and behavior, and it stresses the role of thinking, deciding, questioning, doing, and re-deciding. This is a psycho-educational model, which emphasizes therapy as a learning process, including acquiring and practicing new skills, learning new ways of thinking, and acquiring more effective ways of coping with problems. (Gerald, 2005)

ii. Although psychological problems may be rooted in childhood, they are perpetuated through re-indoctrination in the now. A person's belief system is the primary cause of disorders. Internal dialogue plays a central role in one's behavior. Clients focus on examining faulty assumptions and misconceptions and on replacing these with effective beliefs. (Gerald, 2005)

b. Key Theorists i. Albert Ellis, Ph.D, Alfred Adler, Aaron Beck, M.D., Maxie C. Maultsby,

Jr., M.D., Michael Mahoney, Ph.D., Donald Meichenbaum, Ph.D. (Stress Inoculation Therapy) and David Burns, M.D., Aldo Pucci, Psy.D. (Rational Living Therapy), Michael Mahoney, Ph.D., Marsha Linehan, Ph.D., Arthur Freeman, Ed.D.

ii. Rational Emotive Behavior Therapy, Cognitive Therapy, Rational Behavior Therapy, Rational Living Therapy, Schema Focused Therapy, and Dialectical Behavior Therapy - each approach has its own developmental history but fall within the sphere of CBT.

c. Appropriate Populations for the Theoryi. Mood Disorders, Anxiety Disorders, Personality Disorders, Anger / Guilt,

Child / Adolescent Issues, Eating Disorders, Difficult & Challenging Clients, Overcoming Resistance, Martial / Family Problems

ii. Panic disorder; agoraphobia; simple phobias; generalized anxiety disorder, Clinical Depression (mild to moderate severity, practice not chronic); obsessive-compulsive disorder; social phobia, Bulimia nervosa; post-traumatic stress, sex therapy; pain in physical illness; hypochondriasis; chronic, fatigue syndrome; schizophrenia and other psychoses, Personality disorder; low self-esteem; benefit at present chronic depression/dysthymia; anger; insomnia; anorexia nervosa; problem -drinking; drug dependence; physical illness (arthritis, diabetes, asthma, eczema, hypertension, obesity)

d. Inappropriate Populations for the Theory (Explain why.)i. Severe depression (psychomotor retardation); organic illness (e.g.

delirium, dementia); heavy substance use (alcohol, benzodiazepines)

e. Therapist’s Rolei. Using a Socratic dialogue, the therapist assists clients in identifying

dysfunctional beliefs and discovering alternative rules for living. The therapist promotes corrective experiences that lead to learning new skills. (Gerald, 2005)

f. Client’s Rolei. Clients gain insight into their problems and then must actively practice

changing self-defeating thinking and acting. (Gerald, 2005)

g. Theory Strengthsi. To challenge clients to confront faulty beliefs with contradictory evidence

that they gather and evaluate. To help clients seek out their rigid beliefs and minimize them. To become aware of automatic thoughts and to change them. (Gerald, 2005)

h. Theory Limitationsi. Tends to play down emotions, does not focus on exploring the

unconscious or underlying conflicts, and sometimes does not give enough weight to client's past. CBT might be too structured for some clients. (Gerald, 2005)

ii. Cognitive-behavioral therapy may not be suitable for some patients. Those who do not have a specific behavioral issue they wish to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic therapy. Patients must also be willing to take a very active role in the treatment process.

iii. Cognitive-behavioral intervention may be inappropriate for some severely psychotic patients and for cognitively impaired patients (for example, patients with organic brain disease or a traumatic brain injury), depending on their level of functioning.

i. Key Terms (Write a short definition for each.)i. A number of different techniques may be employed in cognitive-

behavioral therapy to help patients uncover and examine their thoughts and change their behaviors. They include:

ii. Behavioral homework assignments. Cognitive-behavioral therapists frequently request that their patients complete homework assignments between therapy sessions. These may consist of real-life "behavioral experiments" where patients are encouraged to try out new responses to situations discussed in therapy sessions.

iii. Cognitive rehearsal. The patient imagines a difficult situation and the therapist guides him through the step-by-step process of facing and successfully dealing with it. The patient then works on practicing, or rehearsing, these steps mentally. Ideally, when the situation arises in real life, the patient will draw on the rehearsed behavior to address it.

iv. Journal. Patients are asked to keep a detailed diary recounting their thoughts, feelings, and actions when specific situations arise. The journal helps to make the patient aware of his or her maladaptive thoughts and to show their consequences on behavior. In later stages of therapy, it may serve to demonstrate and reinforce positive behaviors.

v. Modeling. The therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.

vi. Conditioning. The therapist uses reinforcement to encourage a particular behavior. For example, a child with ADHD gets a gold star every time he stays focused on tasks and accomplishes certain daily chores. The gold star reinforces and increases the desired behavior by identifying it with something positive. Reinforcement can also be used to extinguish unwanted behaviors by imposing negative consequences.

vii. Systematic desensitization. Patients imagine a situation they fear, while the therapist employs techniques to help the patient relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether. For example, a patient in treatment for agoraphobia, or fear of open or public places, will relax and then picture herself on the sidewalk outside of her house. In her next session, she may relax herself and then imagine a visit to a crowded shopping mall. The imagery of the anxiety-producing situations gets progressively more intense until, eventually, the therapist and patient approach the anxiety-causing situation in real-life (a "graded exposure"), perhaps by visiting a mall. Exposure may be increased to the point of "flooding," providing maximum exposure to the real situation. By repeatedly pairing a desired response (relaxation) with a fear-producing situation (open, public spaces), the patient gradually becomes desensitized to the old response of fear and learns to react with feelings of relaxation.

viii. Validity testing. Patients are asked to test the validity of the automatic thoughts and schemas they encounter. The therapist may ask the patient to defend or produce evidence that a schema is true. If the patient is unable to meet the challenge, the faulty nature of the schema is exposed.

ix. Automatic thoughts — Thoughts that automatically come to mind when a particular situation occurs. Cognitive-behavioral therapy seeks to challenge automatic thoughts.

x. Cognitive restructuring — The process of replacing maladaptive thought patterns with constructive thoughts and beliefs.

xi. Maladaptive — Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.

xii. Psychodynamic therapy — A therapeutic approach that assumes dysfunctional or unwanted behavior is caused by unconscious, internal conflicts and focuses on gaining insight into these motivations.

xiii. Relaxation technique — A technique used to relieve stress. Exercise, biofeedback, hypnosis, and meditation are all effective relaxation tools.

Relaxation techniques are used in cognitive-behavioral therapy to teach patients new ways of coping with stressful situations.

xiv. Schemas — Fundamental core beliefs or assumptions that are part of the perceptual filter people use to view the world. Cognitive-behavioral therapy seeks to change maladaptive schemas.

j. Is this theory research based? Evidenced based? (Justify your rationale.)i. Cognitive behavior therapy works well in university based clinical trials

with subjects recruited from advertisements, but the evidence about how effective it can be in the real world of clinical practice is less secure. In the London depression trial, for example, couple therapy performed better than antidepressants for treating severe depression in patients living with partners, but cognitive behavior therapy came nowhere, having been discontinued early in the trial because of poor compliance from a particularly problematic (but clinically typical) group of patients.10

ii. Fourthly, as the Department of Health's guidelines suggest,5 absence of evidence is not the same as evidence of absence. Most studies show absolute rather than relative efficacy—that is, cognitive behavior therapy is usually compared with waiting list controls, no therapy at all, or some sort of bland pseudotherapy rather than with another form of psychotherapy. As in drug trials, comparing good treatments with those that may be better is a much greater research challenge that demonstrating that a treatment is better than nothing.

iii. Finally, and perhaps most important, there are signs that leading cognitive behavior therapists themselves are starting to question aspects of their discipline and recognize some of its limitations. Linehan argues that standard cognitive behavior therapy for patients with conditions as complex as borderline personality disorder is unlikely to be effective.11 Her integrative therapy, dialectical behavior therapy, combines acceptance and acknowledgement of defences (a psychoanalytic idea laced with Zen Buddhism) with cognitive and behavioural techniques for change. Similarly, Teasdale questions the “zap the negative cognitions” approach in major depressive disorder, believing that “mindfulness techniques” such as meditation are also needed to help patients divorce themselves from their emotional pain.12 In the treatment of personality disorder Young argues for a “schema-based” approach,13 taking account of transference, which looks increasingly psychoanalytic in flavour.14 We are entering a “post-cognitive behavior therapy” world, which goes beyond brand name therapies to considering the active ingredients of therapy, specific competencies and techniques, and the similarities and differences between different approaches at both theoretical and practical levels.15

k. Special training requirements i. The Beck Institute offers training in the following core areas which both

Dr. Beck(s), including their training staff, will provide training services and one-on-one interaction:

ii. Level I: Depression and Anxiety, iii. Level II: Personality Disorders and Challenging Problemsiv. Specialty: CBT for Substance Abusev. Specialty: CBT for Children and Adolescents

vi. Level I: Depression and Anxiety - Students and Facultyvii. Level I: La Depresión y La Ansiedad (en español)

viii. Specialty: CBT for Schizophreniaix. Specialty: CBT for PTSD

III. Theory: Reality

a. Key Concepts i. Based on choice theory, this approach assumes that we are by nature

social creatures and we need quality relationships to be happy. Psychological problems are the result of our resisting the control by others or of our attempt to control others. Choice theory is an explanation of human nature and how to best achieve satisfying interpersonal relationships. The basic focus is on what clients are doing and how to get them to evaluate whether their present actions are working for them. People are mainly motivated to satisfy their needs, especially the need for significant relationships. The approach rejects the medical model, the notion of transference, the unconscious, and dwelling on one's past. (Gerald, 2005)

b. Key Theorists i. William Glasser

ii. Glasser's path has been one of a continuing progression from private practice to lecturing and writing and ultimately culminating in the publication of over twenty books. After writing the counseling book, Reality Therapy (1965), he published his first book on education, Schools without Failure (1969).

iii. In the late 70’s, Glasser was introduced to control theory systems through the writings of William T. Powers. In consultation with Powers, Dr. Glasser applied Powers’ knowledge of how systems work to the field of human behavior. That theory of why and how we behave is now called Choice Theory.

iv. n his next key book, Choice Theory (1998), Glasser greatly expanded the understanding of motivation and behavior. He and then added, Warning: Psychiatry Can Be Hazardous to Your Mental Health (2003), to help people improve their mental health and happiness. In 2005 he produced a booklet, Defining Mental Health as a Public Health Issue to provide a new resource for mental health professionals. Finally, in 2007, Eight Lessons for a Happier Marriage, which he co-authored with his wife, Carleen, became his third book to help couples learn important tools for improving their relationship.

v. Dr. Glasser’s approach is non-traditional. He does not believe in the concept of mental illness unless there is something organically wrong with the brain that can be confirmed by a pathologist.

vi. By 1980, he had begun to form the idea that led to choice theory: why so many people are unhappy in their relationships. Unlike all other living creatures, only human beings are genetically driven by the need for power. We try to satisfy that need by using what he calls, external control psychology – literally trying to force people to do what we want them to do. This struggle has led to the symptoms described in the DSM-IV. Dr. Glasser teaches that if we can't figure out how to satisfy our power need by respecting each other, our days on earth are numbered. He offers choice

theory to replace external control and has dedicated the remainder of his life to teaching and supporting this idea.

vii. In 1967, he founded The Institute for Reality Therapy. Since that time, over 75,000 people worldwide have taken Intensive Training to gain knowledge on how to apply his ideas in their professional life. They have discovered that by using choice theory, their personal relationships have improved as well.

c. Appropriate Populations for the Theoryi.

d. Inappropriate Populations for the Theory (Explain why.)i.

e. Therapist’s Rolei. A therapist's main function is to create a good relationship with the client.

Therapists are then able to engage clients in an evaluation of all their relationships with respect to what they want and how effective they are in getting this. Therapists find out what clients want, ask what they are choosing to do, invite them to evaluate present behavior, help them make plans for change, and get them to make a commitment. The therapist is a client's advocate, as long as the client is willing to attempt to behave responsibly. (Gerald, 2005)

f. Client’s Rolei.

g. Theory Strengthsi. To help people become more effective in meeting their needs. To enable

clients to get reconnected with the people they have chosen to put into their quality worlds and to teach clients choice theory. (Gerald, 2005)

h. Theory Limitationsi. Discounts the therapeutic value of exploration of the client's past, dreams,

the unconscious, early childhood experiences, and transference. The approach is limited to less complex problems. It is a problem-solving therapy that tends to discourage exploration of deeper emotional issues. It is vulnerable to practitioner who wants to "fix" clients quickly. (Gerald, 2005)

i. Key Terms (Write a short definition for each.)i. Choice theory, with the Seven Caring Habits, replaces external control

psychology and the Seven Deadly Habits. External control, the present psychology of almost all people in the world, is destructive to relationships. When used, it will destroy the ability of one or both to find satisfaction in that relationship and will result in a disconnection from

each other. Being disconnected is the source of almost all human problems such as what is called mental illness, drug addiction, violence, crime, school failure, spousal abuse, to mention a few.

ii. Relationships and our Habitsiii. Seven Caring Habits Seven Deadly Habits iv. 1. Supporting 1. Criticizingv. 2. Encouraging 2. Blaming

vi. 3. Listening 3. Complainingvii. 4. Accepting 4. Nagging

viii. 5. Trusting 5. Threateningix. 6. Respecting 6. Punishingx. 7. Negotiating differences 7. Bribing, rewarding to control

xi. The Ten Axioms of Choice Theory xii. The only person whose behavior we can control is our own.

xiii. All we can give another person is information.xiv. All long-lasting psychological problems are relationship problems.xv. The problem relationship is always part of our present life.

xvi. What happened in the past has everything to do with what we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future.

xvii. We can only satisfy our needs by satisfying the pictures in our Quality World.

xviii. All we do is behave.xix. All behavior is Total Behavior and is made up of four components: acting,

thinking, feeling and physiology.xx. All Total Behavior is chosen, but we only have direct control over the

acting and thinking components. We can only control our feeling and physiology indirectly through how we choose to act and think.

xxi. All Total Behavior is designated by verbs and named by the part that is the most recognizable.

xxii. Reality Therapy is the method of counseling that Dr. Glasser has been teaching since 1965. Reality therapy is firmly based on choice theory and its successful application is dependent on a strong understanding of choice theory. Reality therapy training is available to anyone...the first step in learning this tool is to enroll in a Basic Intensive Training.

xxiii. Since unsatisfactory or non-existent connections with people we need are the source of almost all human problems, the goal of reality therapy is to help people reconnect. To create a connection between people, the reality therapy counselor, teacher or manager will:

xxiv. Focus on the present and avoid discussing the past because all human problems are caused by unsatisfying present relationships.

xxv. Avoid discussing symptoms and complaints as much as possible since these are the ways that counselees choose to deal with unsatisfying relationships.

xxvi. Understand the concept of total behavior, which means focus on what counselees can do directly - act and think. Spend less time on what they cannot do directly; that is, change their feelings and physiology. Feelings and physiology can be changed, but only if there is a change in the acting and thinking.

xxvii. Avoid criticizing, blaming and/or complaining and help counselees to do the same. By doing this, they learn to avoid some extremely harmful external control behaviors that destroy relationships.

xxviii. Remain non-judgmental and non-coercive, but encourage people to judge all they are doing by the choice theory axiom: Is what I am doing getting me closer to the people I need? If the choice of behaviors is not working, then the counselor helps clients find new behaviors that lead to a better connection.

xxix. Teach counselees that legitimate or not, excuses stand directly in the way of their making needed connections.

xxx. Focus on specifics. Find out as soon as possible who counselees are disconnected from and work to help them choose reconnecting behaviors. If they are completely disconnected, focuses on helping them find a new connection.

xxxi. Help them make specific, workable plans to reconnect with the people they need, and then follow through on what was planned by helping them evaluate their progress. Based on their experience, counselors may suggest plans, but should not give the message that there is only one plan. A plan is always open to revision or rejection by the counselee.

xxxii. Be patient and supportive but keep focusing on the source of the problem - the disconnectedness. Counselees who have been disconnected for a long time will find it difficult to reconnect. They are often so involved in the symptom they are choosing that they have lost sight of the fact that they need to reconnect. Help them to understand, through teaching them choice theory and encouraging them to read the book, Choice Theory: A New Psychology of Personal Freedom, that whatever their complaint, reconnecting is the best possible solution to their problem.

j. Is this theory research based? Evidenced based? (Justify your rationale.)i. A study was done on reality therapy by Masters and Laverty in 1977. This

is probably the best designed and most thorough of the studies on reality therapy that have been done. Five matched pairs of schools were randomly assigned to an experimental or a control group. Experimental groups were evaluated after their first and second years of reality therapy, and were compared to the control groups at the end of their first year. The results were only mildly in favor of using reality therapy.

ii. A result of the study found after doing a teacher evaluation, was that there was more acceptance of student ideas, but not of student feelings. Also, teacher scales that measured attitudes that followed the reality therapy philosophy revealed significant differences between the pretest and the posttest. Effects on students, however, were not found by the researchers.

Achievement and attitude tests revealed no differences between the control and the experimental groups. A significant difference was also found in the rate of discipline referrals between the groups, although this result could have several different interpretations (Moles, 1990, chap. 7).

k. Special training requirements i. Reality therapy was developed by Glasser, William a psychiatrist, who

was trained in (but later rejected) the concepts of psychoanalysis and views of behavior developed by Freud, Sigmund. Glasser holds the view that people who are behaving in inappropriate ways do not need help to find a defense for their behavior. Instead, they need help to acknowledge their behavior as being inappropriate and then to learn how to act in a more logical and productive manner.

ii. The bare bones of Glasser's theory are that people are required to live in a world full of other human beings, and every individual must learn to satisfy his own needs in a way that does not encroach upon on another person's needs (Wolfgang, 2004).

iii. Present reality therapy theory is based on the concept that our brain works as a control system. Therefore, if the brain is a control system, then all of our behavior is to fulfill needs built into the genetic structure of that system. This means that we, as well as all living organisms, spend our lives attempting to act upon, or more accurately, to control the world around us to fulfull powerful needs built into our structure.

iv. Therefore, we are not only completely internally motivated in contrast to the concepts of most psychological systems which are some variation of externally motivated behaviorism, but all of our behavior is for the purpose of fulfilling needs built into the system...Reality therapy attempts to help people control the world around them more effectively so that they are better able to satisfy their needs. (Corsini, 1984, p.321)

v. Choice theory forms the foundation of what we teach and is based on the belief that we choose every aspect of our lives. If you are a person who interacts with others, then this training is for you! Our participants come from all aspects of life, from business people, parents, counselors, educators, probation officers, hair stylists just to name a few. Registering for Basic Intensive Training will teach you the value of relationship building.

vi. CEU's and academic credits are available to individuals who take the Intensive Training. (learn more about CEU's)

vii. Practitioners will learn how to:viii. Maintain healthy relationships by practicing the seven habits that bring

people closer together.ix. Apply choice theory and reality therapy to a variety of life situations.x. Develop a more thorough understanding of mental health as it applies to

education, management and marriage.

xi. Although this training has been designed for people who work with people professionally, and is educational in purpose, participants have found the study of choice theory, reality therapy and lead-management to be extremely useful as husbands and wives, mothers and fathers, grandparents, friends and colleagues. You will learn how to use the seven habits that can improve every relationship in your life. You will begin the skillful use of the questions that promote change and begin to see a difference in your own life.

xii. The first step in learning the tools that can change every relationship in your life, including with yourself, is to register for Basic Intensive Training.

xiii. Basic Intensive Trainings are usually 4 days in length, however at times they are taught over 3 days via the William Glasser Institute.

References

Gerald, C. (2005). Therory and practice of counseling and psychotherapy. Retrieved from http://www.pembertoncounseling.com/School/HS101/Theories_summary.pdf