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Never Giving Up: Using a Reality Therapy Approach to Clinical Mental Health Counseling

By Chantrelle Varnado–Johnson, Southern Region Liaison , AMHCA Graduate Student Committee, University of New Orleans

“It is almost impossible for anyone, even the most ineffective among us, to continue to choose misery after becoming aware that it is a choice.”  —William Glasser, MD

As a licensed professional counselor, I find that reality therapy appeals to me because it emphasizes choice—clients choose what they do. I embrace reality therapy because of the idea that counseling promotes an opportunity for the client to focus on improving relationships and sense of control. As a multicultural-competent counselor, I believe counselors have to consider the choices the clients make that are consistent with their cultural values. We have to appreciate cultural differences. In addition, a reality therapist invites the client to think about whose behavior they can control. 

Reality therapy is a cognitive behavioral approach to treatment based on the work of psychiatrist William Glasser. This approach is present-oriented. In reality therapy, the counselor challenges the client to behave in more effective ways and not to dwell on their major symptoms, and teaches clients to seek better choices. 

Initially of course, the counselor establishes rapport with client and creates a safe and supportive therapeutic environment. Then the counselor teaches the client to accept responsibility for total behavior; not to accept excuses. Throughout the helping relationship, the reality therapist challenges clients to examine their behaviors by asking themselves questions such as, “Is what I am doing getting me what I want and need?” 

Unlike some forms of therapy, in reality therapy, the counselor is actively involved in working with the client. The counselor teaches and models for the client concepts on making better and more effective choices and gaining more effective control. I really like how reality therapists develop a healthy relationship with the client by actively listening and by taking a nonjudgmental and accepting stance. This approach instills hope and promotes the concept of “never giving up,” even when the client falls short. The counselor continues to encourage the client and fosters trust. Basically, the counselor displays both genuineness and empathy to collaboratively work with the client to focus on present problems.

At the core of reality therapy is recognition of the five basic needs that drive us all: belonging and love, survival, power, freedom, and fun. The counselor explains to the client that if they feel “bad,” a need is unmet. So, a client has to work to satisfy needs in a more effective manner. 

Reality therapy focuses on behavior. Reality therapy is straightforward. Also, it can be used in a variety of clinical mental health settings. Plus, reality therapy can be relatively brief and flexible. I strongly encourage you to incorporate reality therapy into your counseling repertoire.