… one woman had been attending the clinic for three years and had spent most of that time blaming her nervousness and depression on her now-dead grandfather. Glasser told her that he would see her only if she would never again mention her grandfather. She was shocked and responded, “If I don’t talk about my grandfather, what will I talk about?”
– Frew, J., & Spiegler, M. D. (2012). Contemporary Psychotherapies For a Diverse World., pg. 298, London: Routledge.
William Glasser MD, the founder of “Reality Therapy”, died August 23, 2013 of respiratory failure. He was eighty-eight years old.
Raised in Cleveland, OH, and initially educated as a chemical engineer, Glasser trained in conventional psychoanalysis. At his first residency, he quickly lost faith in Freud. Attributing clients’ behavior to external factors irked him. He could see their insights weren’t leading to change. He noticed his effective sessions were those focused on action in the present. He decided we weren’t motivated by conflicts or drives, but by needs: survival, freedom, power, belonging and fun. In his view, everything we do is a choice we make to obtain those essentials. Mental illness is nothing but coping through negative choices – including unhappiness. Change comes when we turn away from daydreams and unrealistic hopes, commit to a plan of making better choices and follow through.
Such anti-analytical thinking sat poorly with management. Glasser’s residency ended with the conspicuous lack of a job offer. He moved on to the Ventura School for Delinquent Girls in Ojai, CA, where the most insightful analysis had failed young offenders. His new theories, applied as part of a warm, validating relationship, helped them change.
Glasser was working in the late 1950’s and early 1960’s, a time when great minds were thinking minimally. Artists like Frank Stella and Agnes Martin painted with the simplest of lines, shapes and colors. Composers like Phillip Glass and Steven Reich overlapped tape loops of speech to make music without musicians or instruments. The inspiration was writers like Samuel Beckett, architects such as Ludwig Mies van Der Rohe and designers like the De Stijl school. The challenge was to create an emotional response with as little stimulus as possible. By stripping away Freudian conflicts, Pavlovian associations and Skinnerian reinforcers, Glasser created a minimalist therapy.
Reality Therapy (RT) was simple enough to help others through a paperback book. With small adjustments, it translated well to other cultures. (In China, therapists don’t ask, “Is this behavior bringing you closer to your goal?” but, “Do your actions bring shame or honor to your parents?”) Unlike Skinner’s operant conditioning, it addressed the fact that people have innate needs. RT, which Glasser later refined into Choice Theory, can be viewed as an ancestor to ‘activation therapies’, like ACT and Dialectical Behavioral Therapy. Since the therapist’s job is to help the client generate better choices, it’s like an empty apartment – one that can be furnished with any therapeutic intervention that helps the client choose more wisely.
At times, Glasser’s reductionism went too far. To claim that all mental illness consists of poor choices is to ignore the reality of delusions and hallucinations. Telling someone with Post-Traumatic Stress Disorder to focus on the present and move forward does nothing for their nightmares and flashbacks. In 1998, Glasser wrote, “We choose everything we do, including the misery we feel.” By then, neurology had already demonstrated that our rational mind’s personal agency is something less than 100%.
Since Glasser’s principles could be surprisingly subtle, they were also easy to misuse. When an adult tells a child with AD/HD, “You can choose to raise your hand before speaking, or you can choose to stay after school,” they’ve twisted ‘personal responsibility’ into a passive-aggressive head game – one that lets them escape the responsibility to properly assess the child’s needs. Glasser stressed, “No blaming, no punishment,” in dealing with clients; it’s ironic to see his “success identity” concept corrupted into, “I chose to be successful. Others chose to be losers. Therefore, they don’t deserve any help or sympathy.”
Glasser’s reductionism was a route to an effective therapy – not the definition of everything involved. He knew no one consciously decides, “I feel like feeling depressed today.” By reframing emotions as actions, he helped agitation seem more controllable. He understood no one leaps into changes in behavior. By repeatedly returning to, “What’s your plan?” he focused the Ventura School students on small steps towards new habits. The girls there had been told their upbringing meant they were not responsible for their criminal acts. In a compassionate, understanding way, he told them that they were. Neurology, environment and abuse all played a role in his clients’ problems. Glasser succeeded in helping them change, because he ignored everything except what a reform-school kid could control.
Minimalist art sometimes created a minimal impression. Glasser’s therapy provided clients with a more-than-minimal level of control.
@ 2013 Jonathan Miller All Rights Reserved