Assignment task:
As a reality therapist, I am guided by the key concepts of choice theory to identify Stan's behavioral dynamics, to provide a direction for him to work toward, and to teach him about better alternatives for achieving what he wants. Stan has not been effective in getting what he needs-a satisfying relationship.
Stan has fallen into a victim role, blaming others and looking backward instead of forward. Initially, he wants to tell me about the negative aspects of his life, which he does by dwelling on his major symptoms: depression, anxiety, inability to sleep, and other psychosomatic symptoms. I listen carefully to his concerns, but I hope he will come to realize that he has many options for acting differently. I operate on the premise that therapy will offer the opportunity to ex- explore with Stan what he can build on-successes, productive times, goals, and hopes for the future.
After creating a relationship with Stan, I am able to show him that he does not have to be a victim of his past unless he chooses to be, and I assure him that he has rehashed his past miseries enough. As counseling progresses, Stan learns that even though most of his problems did indeed begin in childhood, there is little he can do now to undo his childhood. However, he can adopt a different perspective on his past experiences and the meaning they hold for him today. He eventually realizes that he has a great deal of control over what he can do for himself now. I have Stan describe how his life would be different if he were symptom-free. I am interested in knowing what he would be doing if he were meeting his needs for belonging, achievement, power, freedom, and fun. I explain to him that he has an ideal picture of what he wants his life to be, yet he does not possess effective behaviors for meeting his needs. I talk to him about all of his basic psychological needs and how this type of therapy will teach him to satisfy them in effective ways. I also explain that his total behavior is made up of acting, thinking, feeling, and physiology. Even though he says he hates feeling anxious most of the time, Stan learns that much of what he is doing and thinking is directly leading to his unwanted feelings and physiological reactions. When he complains of feeling depressed much of the time, anxious at night, and overcome by panic attacks, I let him know that I am more interested in what he is doing and thinking because these are the behavioral components that can be directly changed. I help Stan understand that his depressing is the feeling part of his choice. Although he may think he has little control over how he feels, over his bodily sensations, and over his thoughts, I want him to understand that he can begin to take different actions, which is likely to change his depressing experience. I frequently ask this question, "Is what you are choosing to do getting you what you want?" I lead Stan to begin to recognize that he does have some, indirect control over his feelings. This is best done after he has made some choices about doing something different from what he has been doing. At this point he is in a better place to see that the choice to take action has contributed to feeling better, which helps him realize that he has some power to change.
Stan tells me about the pictures in his head, a few of which are becoming a counselor, acting confident in meeting people, thinking of himself as a worthwhile person, and enjoying life. Through therapy, he makes the evaluation that much of what he is doing is not getting him closer to these pictures or getting him what he wants. After he decides that he is willing to work on himself to be different, the majority of time in the sessions is devoted to making plans and discussing their implementation. We both focus on the specific steps he can take right now to begin the changes he would like.
As Stan continues to carry out plans in the real world, he gradually begins to experience success. When he does backslide, we talk about this and together help him fine-tune his plan. I am not willing to give up on Stan even when he does not make major progress, and Stan lets me know that my support is a source of real inspiration for him to keep working on himself.
I teach Stan about choice theory and encourage him to do some reading that can stimulate his thinking about changes in his life. Stan brings some of what he is learning from his reading into his sessions, and eventually, he is able to achieve some of his goals. The combination of working with a reality therapist, his reading, and his willingness to put what he is learning into practice by engaging in new behaviors in the world assist him in replacing ineffective choices with life-affirming choices. Stan comes to accept that he is the only person who can control his destiny.
1. If Stan complains of feeling depressed most of the time and wants you to "fix" him, how would you proceed?
2. If Stan persists, telling you that his mood is get- ting the best of him and that he wants you to work with his physician in getting him on an antide- pressant drug, what would you say or do?
3. What are some of Stan's basic needs that are not being met? What action plans can you think of to help Stan find better ways of getting what he wants?
4. Would you be inclined to do a checklist on alcoholism with Stan? Why or why not? If you determined that he was addicted to alcohol, would you insist that he attend a program such as Alcoholics Anonymous in conjunction with therapy with you? Why or why not?
5. What interventions would you make to help Stan explore his total behavior?