Choice Theory and Reality Therapy

Choice Theory and Reality Therapy were not discussed much in my MFT Masters program. It wasn't until my second semester in practicum that I had a part time professor discuss Dr. William Glasser and his theory. I fell in love with it immediately and have found it to be useful with the at-risk youth I work with. I like Choice Theory because it focuses on what can be changed in the here and now, rather than placing blame for what's happened in the past. It also stresses the importance in understanding that all behavior is a choice, even if it doesn't feel like it at times. It's hard to think that someone would choose to be depressed or angry, but the truth is, we do. I highly recommend Dr. Glasser's books for further reading. Here is a brief overview of Choice Theory and Reality Therapy...


The Ten Axioms of Choice Theory

1. The only person whose behavior we can control is our own.
2. All we can give another person is information.
3. All long-lasting psychological problems are relationship problems.
4. The problem relationship is always part of our present life.
5. 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.
6. We can only satisfy our needs by satisfying the pictures in our Quality World.
7. All we do is behave.
8. All behavior is Total Behavior and is made up of four components: acting, thinking, feeling and physiology.
9. 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.
10. All Total Behavior is designated by verbs and named by the part that is the most recognizable.
    

Click here to read more on Choice Theory



Reality Therapy... based on Choice Theory

In my own words, these four steps are how I can best describe how to use Reality Therapy...

1. Help the client identify what they want right now... not what they want to change about the past, because we all know that no one can change the past.
2. Determine whether or not the current behaviors are rational and effective in getting the client closer to what they want.
3. Most often the behaviors are not rational or effective. Help the client identify behaviors that would be more effective and develop a plan on how to implement those behaviors.
4. The client must commit to trying the new behavior. Written contracts can be helpful here.
   

You can read more about Reality Therapy at the following links:

William Glasser Institute
Choice Theory Website

Understanding Vicarious Traumatization

Most anyone that works in a helping profession understands the term "burnout". It's something that we all must be aware of and pay attention to. Re-living traumatic events with our clients on a daily basis can be very overwhelming and starts to take it's toll on even the most seasoned therapists. I would like to share this article that I read on Vicarious Traumatization (also known as Compassion Fatigue) because I feel it does an excellent job in summarizing what Vicarious Traumatization is, signs to look out for, and how to cope.

Vicarious Traumatization of the Mental Health Professional
http://www.apa.org/apags/profdev/victrauma.html

Anne Ranee Farrar, MA
Seton Hall University

(This article was first published in the Winter 2002 issue of the APAGS Newsletter.)

Vicarious traumatization is also referred to as a secondary trauma. It can be experienced by a clinician who works with traumatized individuals, whether they work with victims of child maltreatment, domestic violence, victims of torture, or victims of large-scale disasters. Pearlman and Saakvitne (1995) emphasize the need for the therapist to be aware of vicarious traumatization and its impact on the therapist. "Vicarious traumatization is the process through which the therapist’s inner experience is negatively transformed through empathic engagement with clients’ trauma material" (p. 279). For example, a therapist may experience nightmares related to events in which they have heard graphic details. They may experience fear, may have concerns about their own safety, or they may feel compelled to question own their life experiences or their own vulnerabilities after hearing the stories of survivors.

Pearlman and Mac Ian (1995) reported that therapists who work with trauma victims and who have a personal trauma history show more negative effects from their work than those therapists without a personal trauma history. McCann and Pearlman (1990) suggested that vicarious traumatization among professionals working with victims result from the inability of the therapists to process the traumatic clinical material in which they hear. Brady, Guy, Poelstra, and Brokaw (1999) reported that vicarious traumatization has symptoms which are similar to Post Traumatic Stress Disorder (PTSD) and may disrupt the cognitive schemas reported by the therapist.

In a study of international relief and developmental personnel (Erisson, Vadne Kemp, Gorsuch, Hoke, & Foy, 2001) reported that 10% of returning staff who worked in the field with trauma survivors met full criteria for PTSD, reporting at least moderate symptoms such as re-experiencing the event, hyperarousal, as well as avoidance.

Friedman (1996) reported that therapist self-care is essential when working with patients who suffer from PTSD because this work can be functionally disruptive and psychologically destabilizing for the mental health professionals. Kinzel and Nanson (2000) found that educating and debriefing volunteers (mental health professionals) were two strategies, which they found to prevent the onset of compassion fatigue and also to reduce the resignation of the volunteers. They indicated that debriefing was found to help many of the volunteers cope and deal with processing the traumatic events which they heard.

For those who are volunteering their time it is important to take care of one’ self and to reduce stress. Mitchell and Everly (1998) indicate that stress management is "a personal process" (p. 23). They note that there is no one "right" answer to stress management but that the most important element is consistency and that it should become part of one’s lifestyle, not just some techniques which are utilized by a person when they feel stressed. Different methods of management techniques can be proper sleep and nutrition, progressive muscle relaxation, imagery, meditation, and physical exercise.

The question at all times remains, "How can we help someone else, if we first can’t help ourselves?" The only way for a mental health professional to help others is that they must first be as psychologically healthy as possible. We all have limits of what we can do. There is nothing wrong with taking time off to be alone, or spend time with family and/or friends, and to not volunteer. Follette, Polusny, and Millbeck (1994) report that peer support networks, employee assistance programs, and personal therapy represent some possible methods for reducing the negative impact of work related stressors.

The American Red Cross (2001) reported, "Most disaster workers are dedicated individuals who also tend to be perfectionists. Because of this, they are at risk of pushing themselves too hard and of not being satisfied with what they have accomplished" (p. 1). One of the most important recommendations the American Red Cross (2001) made is that as difficult as it might be when your shift is over "leave and take time to recharge" (p. 2).

If you are interested in learning more about Vicarious Trauma and what you can do to combat it, I have found an excellent article for additional reading. You can download it at the following link:

Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors

Maybe So, Maybe Not

Working as a therapist is a much more challenging career than many people realize. Exposing ourselves to other people's problems on a daily basis can start to take a toll after some time. I personally have found that my view of the world started to skew to the negative after working with the families I do. I've seen so many hardships, heard so many heart breaking stories, that my attention started to focus primarily on unpleasant, negative thoughts and experiences. A very wise friend once told me to think of our daily thoughts and experiences as fruit that is bore from the tree of life. During our days, we pick various pieces of fruit from the tree and collect them in a basket [our minds]. We can either pick the sweet juicy ripe fruit [positive thoughts/experiences], or the rotten fruit [negative thoughts/experiences] to fill our baskets... the choice is yours.

This story that I am about to share with you is one that I now remind myself of on a daily basis. It has helped me to remember that things aren't always what they seem, and that some experiences we initially perceive as "bad" can in fact be a blessing in disguise. I am unsure as to where this story originated, but the excerpt that follows was taken from the book "Don't Sweat the Small Stuff" by Richard Carlson.

"There once was a village that had among its people a very wise old man. The villagers trusted this man to provide them answers to their questions and concerns.

One day, a farmer from the village went to the wise man and said in a frantic tone, "Wise man, help me. A horrible thing has happened. My ox has died and I have no animal to help me plow my field! Isn't this the worst thing that could have possibly happened?" The wise old man replied, "Maybe so, maybe not." The man hurried back to the village and reported to his neighbors that the wise man had gone mad. Surely this was the worse thing that could have happened. Why couldn't he see this?

The very next day, however, a strong, young horse was seen near the man's farm. Because the man had no ox to rely on, he had the idea to catch the horse to replace the ox - and he did. How joyful the farmer was. Plowing the field had never been easier. He went back to the wise man to apologize. "You were right, wise man. Losing my ox wasn't the worst thing that could have happened. It was a blessing in disguise! I never would have captured my new horse had that not happened." The wise man replied once again, "Maybe so, maybe not." Not again, thought the farmer. Surely the wise man had gone mad now.

But, once again, the farmer did not know what was to happen. A few days later the farmer's son was riding the horse and was thrown off. He broke his leg and would not be able to help with the crop. Oh no, thought the man. Now we will starve to death. Once again, the farmer went to the wise man. This time he said, "How did you know that capturing my horse was not a good thing? You were right again. My son is injured and won't be able to help with the crop. This time I'm sure that this is the worst thing that could have possibly happened. You must agree this time." But, just as he had done before, the wise man calmly looked at the farmer and in a compassionate tone replied once again, "Maybe so, maybe not." Enraged that the wise man could be so ignorant, the farmer stormed back to the village.

The next day troops arrived to take every able-bodied man to the war that had just broken out. The farmer's son was the only young man in the village who didn't have to go. He would live, while the others would surely die.

The moral of this story provides a powerful lesson. The truth is, we don't know what's going to happen-we just think we do. Often we make a big deal out of something. We blow up scenarios in our minds about all the terrible things that are going to happen. Most of the time we are wrong. If we keep our cool and stay open to possibilities, we can be reasonably certain that, eventually, all will be well. Remember: maybe so, maybe not."