Motivation and emotion/Book/2019/Choice theory

Overview
Consider the following statements:

“My job is making me depressed.” “This bad weather has ruined my whole day.” “I won’t be happy until my partner starts behaving differently.” “I’m never going to get ahead in life because nothing goes my way.”

How often might you find yourself saying something similar?

Engaging in negative thought patterns and behaviours can leave us feeling depressed and unmotivated. Placing blame for our emotions and behaviours on external sources that we can’t control limits our capacity to change anything. Glasser's Choice Theory provides a framework in which individuals can understand that all thoughts and behaviours are chosen and the only person we can control is ourselves. By understanding and applying the principles of Choice Theory individuals can learn to develop an internal locus of control, change behaviours and emotions and improve their lives.


 * Focus questions:
 * 1) What is Glasser's Choice Theory?
 * 2) What are the core concepts of Choice Theory?
 * 3) What is Reality Therapy?
 * 4) Do research findings support the application of Choice Theory?

What is Glasser's Choice Theory?


Choice Theory is a universal framework developed by American Psychiatrist Dr. William Glasser (1925-2013) which explains motivation and human behaviour (Robey, Burdenski, Britzman, Crowell, & Cisse, 2011). In the early 1960’s, Glasser began to develop Choice Theory during psychiatric residency at The University of California, Los Angeles. This was in response to what he believed were inadequacies in the psychoanalytic approach of the time (Bradley, 2014). Glasser believed the long-lasting changes his patients required could not be achieved through insight alone. He emphasised that in order to make changes and lead more effective lives, patients should cease putting blame on others and take total personal responsibility for their behaviour. Detrimental behaviours become less frequent and intense and as a consequence, interpersonal relationships are strengthened and overall life satisfaction is increased (Robey et al., 2011).

Choice Theory offers an alternative to external control psychology, which currently dominates human thinking and reasoning. In external control psychology, individuals believe they have no control over what happens and that external variables such as other poeple or uncontrollable events are responsible for their unhappiness (Wubbolding et al. 2004). Glasser blamed much of human distress on external control psychology, stating that the forceful and punishing way in which people go about trying to control others is destructive to their relationships and results in disconnection from the people they care about. Glasser believed that disconnectedness was the reason for almost all dysfunction and psychopathology (The Glasser Institute for Choice Therapy, 2019).

Glasser published his first book Reality Therapy in 1965 (as cited in Wubbolding et al. 2004) and continued to practice, teach and refine Choice Theory until his death in 2013. Although the concepts of Choice Theory were established in the first publication, the phrase “Choice Theory” was not recognised until the realease of Glasser's 1998 book, Choice Theory: A New Psychology of Personal Freedom (as cited in Wubbolding et al., 2014). This is the primary text used for all that is currently taught by The Glasser Institute for Choice Theory. The institute, which was developed by Glasser over 50 years ago provides learning and certification of Choice Theory to both individuals and therapists (The Glasser Institute for Choice Theory, 2019a).

Basic needs
Glasser proposed that our life choices are driven internally by five genetically encoded basic needs:


 * 1) Survival
 * 2) Love and belonging
 * 3) Power
 * 4) Freedom
 * 5) Fun

Choice Theory suggests that all human behaviour is purposely driven, either consciously or unconsciously by the choices we make. Every choice we make, whether functional or dysfunctional is motivated by our best attempt to satisfy one or more of our basic needs and get what we want (Bradley, 2014). Unlike Maslow's framework (Fig 2.) the basic needs in Choice Theory are not hierarchical. They can change over time and circumstance and between individuals (Bradley, 2014). Our needs are often satisfied through our relationships with other people and by the things which bring us closer to our ideal life (Robey et al., 2011).

These needs are satisfied through relationships with others and through the things that lend value to people’s lives.

Survival
Survival is the only need that is experienced universally among all creatures. It represents our need for self-preservation and reproduction (can drive sexual desire). When a person finds themselves in a situation where their safety or survival is threatened or perceived to be threatened, they will experience a physiological response. This is often characterised by activation of the fight-or-flight response and release of the stress hormone cortisol by the mid-brain. When the body is focused actions necessary for survival, energy is taken from elsewhere. For example, reproduction, digestion and bladder control are disrupted and this can lead to negative effects such as indigestion, weakened immunity, cardiovascular issues, depression and/or anxiety (Marlatt, 2014).

Love and belonging
Because we rely on other people to meet our other needs, Glasser considered this to be the primary psychological need. Biologically, when we experience feelings of love, the brain releases dopamine similarly to when we are eating food. Because our survival depends on food and the brain doesn't differentiate, love is perceived to be just as important to our survival (Marlatt, 2014). Love can be sexual, romantic or platonic (friendship). According to Choice Theory, power or the desire to control others can derail our love relationships. Glasser stated that to keep love going between two people, the friendship component must not be lost because people are much less likely to experience feelings of ownership over their friends (Bradley, 2014). Humans are social by nature and our need to feel valued and accepted within our community, family or among peers is also biologically driven (Marlatt, 2014).

Power
The need for power has both negative and positive components. Positively, it represents feelings of accomplishment, competence, achievement, respect, success and recognition. Negatively it it can manifest in two extremes. Because the primary human need is love and belonging, people make try to exert power over their partner in romantic relationships. The switch back to external control can result in selfish, controlling or manipulative behaviours which will ultimately lead to disconnection. Either the pursuit for power over others or experiencing oneself as powerless may cause unhappiness and result in the need for counselling. Because of our innate need to experience feelings of power, we will experience distress if we don't have power over ourselves (Bradley, 2014).

Freedom
This is our need to be independent, autonomous and able to express ourselves creatively. When we perceive that our freedom is threatened or we are unable to express ourselves we may choose to channel our creativity in a destructive manner (Bradley, 2014).

Fun
Glasser stated that our need for fun is linked to learning through play. Ultimately if we are not having fun or feeling like we are enjoying life, we are most likely not going to fell happy or fulfilled. We may seek out unhealthy behaviours instead to try to fulfill the need, such as substance abuse (Bradley, 2014).

Quality world pictures
Quality world pictures are the individually unique mental representations of everything that we ideally want. The quality world we hold in our minds represents the people, ideas and things that upon having would fulfill all of our needs. Unlike our needs, our quality world is shaped after birth through our influences and experiences. It continuously changes throughout life as we move through different stages of development and experience (Walter, Lambie & Ngazimbi, 2008). Our relationships and interpersonal connections are the most important part of our Quality World. We also have a 'perceived world' which represents the perception of our current reality. Our 'comparing place' exists between the two and is where we are constantly comparing what we want (quality world) with what we have (perceived world). If the two are out of balance, we can feel frustrated or distressed and start to behave in ways that will help us to get what we want. When the two worlds closely match, we feel good (The Glasser Institute for Choice Theory, 2019b).

Relationship habits
These habits represent the different ways in which we can choose to behave in response to the people around us. The 'connecting relationship habits' emphasise self-control. Practicing these healthy habits in our daily lives will increase our ability to make better choices and improve our relationships. In contrast, the 'disconnecting habits' represent external control. Engaging in disconnecting habits will ultimately lead to disconnection, resentment and the breaking down of our relationships (The Glasser Institute for Choice Theory, 2019b).

Table 1.

Side-by-side comparison of Choice Theory connecting and disconnecting relationship habits (The Glasser Institute for Choice Theory, 2019b).

Ten axioms of Choice Theory

 * The only person whose behavior you can control is our own.
 * All we can give or get from other people is information.
 * All long-lasting psychological problems are relationship problems.
 * The problem relationship is always part of our present lives.
 * What happened in the past that was painful has a great deal to do with what we are today, but revisiting this painful past can contribute little or nothing to what we need to do now: improve an important, present relationship.
 * We are driven by five genetic needs: survival, love and belonging, power, freedom, and fun.
 * We can satisfy these needs only by satisfying a picture or pictures in our Quality Worlds.
 * All we can do from birth to death is behave. All behavior is Total Behavior and is made up of four inseparable components: acting, thinking, feeling and physiology.
 * All Total Behavior is designated by verbs, usually infinitives and gerunds, and named by the component that is most recognizable.
 * All Total Behavior is chosen, but we have direct control over only the acting and thinking components.

Source: Choice Theory: A New Psychology of Personal Freedom by William Glasser, M.D. (as cited in The Glasser Institute for Choice Theory, 2019b).

What is reality therapy?
Reality Therapy is a method of counselling which utilises the principles of Choice Theory. Like Choice Theory, Reality Therapy states that behaviour is not caused by an external stimulus, but by what a person wants the most in the present moment. It was developed by Glasser in 1965 while he was working in a correctional institution. Reality Therapy can be seen as the practical application of choice theory and can be used therapeutically across a number of settings (Wubbolding et al. 2004). The primary objective of Reality Therapy is to assist people to connect with and move closer towards their Quality World and it functions within a number of key guidelines (The Glasser Institute for Choice Theory, 2019b):


 * Reality therapists have the job of helping people evaluate their current ability to achieve a particular want.
 * The therapist creates a supportive environment so that the client feels secure and can begin to make changes.
 * Clients are taught to accept responsibility and consequence for all behaviour and emotion, without excuse.
 * The focus is on what the client can do in the present. Clients are discouraged from dwelling on past events.
 * The client is encouraged to take action in the now and make better choices when they realise present behaviours are not getting them what they want.
 * Practical and efficient techniques, like goal setting are used to assist the client to change and track behaviour.
 * Individuals are assisted to evaluate their current situation and then to choose their own goals and follow through with them.
 * Responsibility and choice are the focus.

Robert Wubbolding contributed to the teaching and practice of Reality Therapy through the development and implementation of various techniques and guidelines (Wubbolding, Casstevens, & Fulkerson, 2017). He developed the WDEP (wants, doing, evaluation, and planning) system of Reality Therapy which provides a practical framework which can facilitate person-centered planning:


 * Wants: "What do you want?" The client is asked to identify and prioritise their wants.
 * Doing: "What are you doing to get what you want?" The client is asked to identify the results of their current choices and where the choices are taking them.
 * Evaluation: "Is it working?" The client is asked to evaluate if their current choices are going to get them to where they really want to go.
 * Planning: "If not what can you do to meet your needs?" The client is assisted to create their own plan to fulfill their wants in an efficient and productive way that will not result in them hurting themselves or others.

This model is designed to challenge the client and inspire self-evaluation. This will lead to the client making a plan which is designed to initiate positive change, which then leads to needs being met and connection in relationships bringing the person closer to their quality world.


 * Case study: The Use of Reality Therapy With a Depressed Deaf Adult

Jerry was a 19-year-old male who lost his hearing at the age of four due to Otitis Media. He was self-referred for outpatient psychotherapy due to depression and identity issues negatively affecting his level of confidence and self-esteem. Jerry was seen by a clinician on 3 separate occasions. On the first occasion, the clinician implemented a WDEP method of therapy based around the following questions: "what do you want?, "what are you doing to get what you want?" "Is it working?" "If not what can you do to meet your needs?" Asking the client these questions helped him to investigate his quality world, and understand how to meet his own needs internally rather than externally. During session two, Jerry developed a plan as to how to achieve his treatment goals. In session three, he focused on the “doing” aspect of reality therapy and started implementing new choices, taking responsibility to change his own behaviour. After 12 sessions he ended up terminating the therapy, stating that he was no longer depressed, could identify confidently with the deaf world and planned to start pursuing a career as a certified horticulturalist (Bhargava, 2013).

Do research findings support the application of Choice Theory?
The application of Choice Theory through Reality Therapy protocols has been well researched across a large number of settings.

School disciplinary problems
Class disruption, suspensions and detentions increase the amount of time students with behavioural issues are unsupervised and removing them from class may have an alienating effect on students, effecting their sense of belonging to a group or class (Walter, Lambie & Ngazimbi, 2008). Therefore according to Choice Theory, traditional disciplinary strategies may produce a negative cycle of student behaviour which results in further disengagement. Students who exhibit behavioral issues are at higher risk for depression, antisocial patterns in adulthood, gang involvement, and incarceration (Walter, Lambie & Ngazimbi, 2008). Implementing effective methods to address the behavioral problems of students early on is crucial. School-based Reality Therapy interventions teach students to develop a sense of personal responsibility and shift from an external to internal locus of control, allowing them to see how their chosen behaviours can directly affect their personal outcomes (Walter, Lambie & Ngazimbi, 2008). An example of this is in a study conducted in a middle school in the U.S.A. in which a protocol based on Choice Theory was implemented to a group of 6 students displaying ongoing behavioural issues (Walter, Lambie & Ngazimbi, 2008). The students were academically low achievers, who frequently blamed and criticised their teachers, peers and school for their behaviours. Based on the principles of Choice Theory, the school counsellor formed a "leadership group" from the students who were given the goal of making tangible improvements to the school over the course of 10 sessions. The purpose of this was to encourage the students to work together, forge connections and a support network and to enhance their individual social and emotional skills. The first 3 sessions focused on establishing trusting relationships between the students and counsellor and to establish individual roles within the group. The students decided as a group to organise a fun social event for the school, which would be their sole responsibility. The next five sessions were based around planning and implementing the event, with the counsellor's primary role to observe, support, and listen. In the final 3 group meetings the counsellor led the group in discussions where the students could share their thoughts about what the group did that worked, what they would do differently in future, how they felt about their individual contribution and what the project meant to them. During their time in the group, none of the students required disciplinary interventions and their teachers reported improvements to their overall behaviour and class engagement. This study showed that implementing a framework based on Choice Theory meant that the students could shift the ways in which they seek to satisfy their needs for belonging, fun and power and actively engage in a tasks in which they could practice making positive behavioural choices (Walter, Lambie & Ngazimbi, 2008). Some students with more extreme behavioural issues and less developed social skills may not be suitable for group work in this context. A case study written by a school counsellor looked at the effective use of a Choice Theory based therapy framework on a high-school student who was referred to them due to ongoing disruptive physical and verbal altercations with other students and teachers (Shillingford & Edwards, 2006). It was determined during two therapy sessions with the school counsellor that the student's negative behaviours were stemming from anger that he felt due to his father being incarcerated and bullying from his peers about the incarceration. Based on Choice Theory, the school counsellor hypothesised that the disconnection the student felt from his father and peers was the primary cause of his behavioural issues (Shillingford & Edwards, 2006). The school counsellor taught the student to recognise his needs and taught him that he was in control of his thoughts, behaviours and choices. The counsellor used modelling to represent positive habits and role-play to help the student practice implementing positive behaviours. He was also given homework tasks to help him practice choosing connecting relationship habits instead of disconnecting habits. This assisted the student to have more positive social interactions within the school which then led to enhanced feelings of connectedness. As a result of this therapy, the student's relationships with teachers and peers improved and he engaged in fewer altercations as the year progressed.

Addiction
Addictions tend to occur more frequently in individuals who have experienced emotional, physical or sexual abuse or have a dysfunctional family history. As a result of the trauma, these individuals may start using drugs or alcohol (for example) which eventually becomes integrated into their quality world (Mottern, 2002). Satisfying the addiction becomes a way to feel that their needs are being met. For example, drinking or using drugs with friends may fulfill the individual’s need for love and belonging or fun, and eventually relieving the addiction may fulfill the need for survival. Reality Therapy based treatments for addiction focus on teaching the individual to identify their own needs and start to make more appropriate choices to fulfill their needs and take responsibility for their own recovery. A 2014 study on female prison inmates used Reality Therapy to achieve better recovery from substance addiction (Law & Guo, 2014). They were split into a control group and an experimental group with 24 inmates in each group. Before the experiment, all participants were asked to complete a questionnaire designed to measure the inmate's sense of self-control. Questions included: "I am willing to take responsibility for making the effort toward the goals and plans I have set up for recovery," and "I believe I have the ability to refuse the temptation of drugs" among others. The participants in the experimental group then received 2-hour sessions of group-based Reality Therapy treatment once per week for a total of 12 weeks. The inmates in the control group did not receive any treatment, however were told they were on a waiting list for the same treatment program in another term. After the 12th session, the inmates completed the same questionnaire. When results were compared between the groups, the study found that the inmates in the experimental group significantly enhanced their sense of self-control and sense of self-determination. Enhancing self-control and self-determination may empower addicts to make healthier choices in line with their personal goals and learn to fulfill their needs more appropriately (Law & Guo, 2014). Similar studies have investigated Reality Therapy protocols for the treatment of other addictions. Kim (2008) investigated the efficacy of a Reality Therapy based group treatment for college students with internet addiction disorder. 25 participants (20 male and 5 female) were randomly assigned into two groups- a control group of 13 participants and an experimental group of 12 participants who received 2 sessions of Reality Therapy based group counselling per week for 5 weeks (10 sessions in total). A 40-item questionnaire was administered to both groups before and after the study to measure the level of internet addiction based on the participants self-reported internet use. The study found that the participants in the experimental group displayed a significantly lower internet addiction level and internet usage than the control group at the end of the 5 weeks. Most addiction studies have been consistent with these findings. Both of these studies show that enhancing client's awareness of their behaviours and needs and encouraging client responsibility to choose more effective behaviours may be useful as a treatment for addictions. They also show that Reality-Therapy based group work may be more powerful than individual therapies in treating addiction as the accountability towards the other members encourages clients to stick to their commitments. Building connections with others with a similar experience to their own may enhance an individual's feelings of love and belonging, meaning that they are less inclined to seek out their addiction to fulfill their need (Kim, 2008). Further, group Reality Therapy in addicts has been shown to reduce depression, anxiety and stress and increase self-esteem (Massah et al., 2015).

Relationship counselling
The WDEP framework can also be used to improve outcomes for couples seeking counselling. The breakdown of communcation is often cited as the most prevalent presenting problem for couples in therapy. The WDEP gives therapists a framework in which instead of merely working to improve communication skills, couples are encouraged to establish goals together which focus on making changes in the relationship based on replacing the disconnecting habits with connecting relationship habits (Mahaffey & Wubbolding, 2016). People may also seek to blame their partners for ongoing relationship issues, this blame as well as the desire to control others can derail our love relationships. Reality Therapy seeks to put the responsibility back on the individual to change what is within their control and encourages them to stop focusing on the faults of their partners, who we cannot change (Bradley, 2014).

Criticisms of Choice Theory
There are a few criticisms of Choice Theory. Perhaps one of the most controversial is the premise that our behaviours and relationships are the cause of all symptoms of mental illness. Choice Theory ignores the biological and environmental components of mental illness and instead blames our behaviour for all symptoms of mental illness. Secondly, Reality Therapy is focused entirely on the present and avoids any focus on a person's past. However, there may be value in visiting a patient's past experiences to give insight to determine what has led to the development of a mental disorder or what we might need to change. Not focusing on the past means that a patient may not be able to appropriately deal with past traumas. Lastly, Reality Therapy ignores the benefits of psychopharmacological interventions which have been shown to be useful in many cases to help reduce mental health symptoms. In Reality Therapy there is no diagnosis of mental health conditions as outlines in the DSM-V (APA, 2013) which could be detrimental for patients who are in need of appropriate therapies for example, anti-psychotics (Wubbolding et al., 2017).

Conclusion
Choice theory states that all human behaviour is a choice geared towards the fulfillment of our universal and genetically based human needs. Reality Therapy, which is based on choice theory, as well as WDEP techniques, give therapists a practical and usable system for developing goal specific treatment plans. Helping individuals to identify their goals and needs, examine their behaviours and evaluate the efficacy of those behaviours towards meeting their wants and needs gives individuals a framework in which they are called to action in the here and now to make choices which align better with their goals and will greatly enhance their life and their connections. Choice Theory, Reality Therapy and WDEP protocol can be utilised across a number of different settings to assist people to live happier and more fulfilling lives.

Quiz
{Reality therapy rejects the past and focuses on the present only - False + True
 * type=""}

{The primary goal of reality therapy is to connect or reconnect people with what they consider their quality world - False + True
 * type=""}

{The basis of Reality Therapy is choice theory - False + True
 * type=""}