marlier.proReality Therapy: outlined example of practical application
October 3, 2003
“Unhappy people need compassionate therapists, not prescriptions.” (Glasser).
Two months ago, Mary, a retired woman in her late sixties, was the victim of a natural disaster (fire in the South of France during Summer 2003) during which she lost her house in a pine wood fire. All her belongings were burnt including family souvenirs, photographs, letters, her car. She was rescued, as well as her cat, by the firemen who helped people evacuate the area.
Since the event, the patient has been living at her son’s and daughter-in-law in the nearby city. She now feels somewhat detached, as if anaesthetized, cut from the world. She looks absent-minded and does not take care of her grand-children as she did before; she looks somewhat indifferent to them. She cannot recall either how she was rescued by the firemen: “Everything went so fast,” she says.
Every night, she dreams that she, or her cat, is caught in the flames and after waking up, cannot go back to sleep until the morning.
The family doctor has prescribed some Temesta (Lorazepam) to help relieve her anxiety. Her children suggest that she should seek help from a Reality therapist and she agrees with them because she does not feel she is making progress under the medication.
The therapist first works with the patient to explain what the basic needs are: Survival, love and belonging, power, freedom and fun, and whether her basic needs are satisfied. They agree that of course she is now secure and that she has a shelter at her children’s where she is loved and well taken care of. Money is not an issue as her retirement benefits allow her to live decently and the insurance company will repay for her house and her car. At her son’s, though, in addition to the normal mourning about the loss of her house and souvenirs, she has the feeling of being treated much like a child herself, not as an adult person. She is missing her own home where she was free to decide and show initiative, and she is also missing her neighbors with whom she used to meet and play cards.
The therapist stresses that the patient shouldn’t blame anyone for this situation. The fire was “the fact of God” and the fact that she is now living in her children’s house was something good immediately after the fire, but that she can decide to live alone again to regain her lost independence; that she can choose to remain in the area of her children’s house to keep a close relationship with them and her grandchildren.
As for her nightmares, the therapist suggests that she could attend relaxation sessions, rather than taking medicines to relieve her anxiety.
Her son and daughter-in-law will not decide for her. Nor will the therapist. She has to give these ideas some thought, imagine how she wants to feel and live; she needs to create an image of the Quality World she wants for herself and decide to give herself the means to achieve it, with the help of the therapist.
Although the patient’s feelings are currently hurt, she is in good health and she was able to have normal caring relationships with friends and family before the event. From the four wheels of Glasser’s allegory of Behavior, one rear wheel is not working well, the feelings, and that wheel is currently preventing Mary from living well in her Quality World. But she can control her front wheels, thought and action. And these front wheels can drag the whole Behavior car. Mary worked on these ideas, she gave them some thought and recognized that only half of her Basic Needs were fulfilled. That she had the option of renting a small house two blocks from her children’s place. In fact at the same time she new she could do it, she already wanted to do it. But this was a big step and she first decided to register with the local amateur theater group, a thing she couldn’t have done where she lived before because of the distance from the city. She was a member of the theater group in high school and this new activity rejuvenated her, gave her the fun she had been lacking and also some obligations, since she had to learn her parts and couldn’t miss rehearsals and shows. Simultaneously she attended yoga classes where she learned relaxation techniques and she was able to stop taking Lorazepam (on which she had not been for long). Her nightmares disappeared. Her interest in life and people came back. At that point she decided to rent this small house which had been vacant for months. She moved in (with the cat), did some home improvement. Then she decided she did not need a new car since she was in a small city with a good network of public transportation.
This kind of therapy may be quite rapidly effective on acute stress disorder in healthy people, but I doubt it would work without the help of medicines on a seriously depressed patient who is unable of deciding anything, even less acting to put her decisions into practice.
October 3, 2003
“Unhappy people need compassionate therapists, not prescriptions.” (Glasser).
Two months ago, Mary, a retired woman in her late sixties, was the victim of a natural disaster (fire in the South of France during Summer 2003) during which she lost her house in a pine wood fire. All her belongings were burnt including family souvenirs, photographs, letters, her car. She was rescued, as well as her cat, by the firemen who helped people evacuate the area.
Since the event, the patient has been living at her son’s and daughter-in-law in the nearby city. She now feels somewhat detached, as if anaesthetized, cut from the world. She looks absent-minded and does not take care of her grand-children as she did before; she looks somewhat indifferent to them. She cannot recall either how she was rescued by the firemen: “Everything went so fast,” she says.
Every night, she dreams that she, or her cat, is caught in the flames and after waking up, cannot go back to sleep until the morning.
The family doctor has prescribed some Temesta (Lorazepam) to help relieve her anxiety. Her children suggest that she should seek help from a Reality therapist and she agrees with them because she does not feel she is making progress under the medication.
The therapist first works with the patient to explain what the basic needs are: Survival, love and belonging, power, freedom and fun, and whether her basic needs are satisfied. They agree that of course she is now secure and that she has a shelter at her children’s where she is loved and well taken care of. Money is not an issue as her retirement benefits allow her to live decently and the insurance company will repay for her house and her car. At her son’s, though, in addition to the normal mourning about the loss of her house and souvenirs, she has the feeling of being treated much like a child herself, not as an adult person. She is missing her own home where she was free to decide and show initiative, and she is also missing her neighbors with whom she used to meet and play cards.
The therapist stresses that the patient shouldn’t blame anyone for this situation. The fire was “the fact of God” and the fact that she is now living in her children’s house was something good immediately after the fire, but that she can decide to live alone again to regain her lost independence; that she can choose to remain in the area of her children’s house to keep a close relationship with them and her grandchildren.
As for her nightmares, the therapist suggests that she could attend relaxation sessions, rather than taking medicines to relieve her anxiety.
Her son and daughter-in-law will not decide for her. Nor will the therapist. She has to give these ideas some thought, imagine how she wants to feel and live; she needs to create an image of the Quality World she wants for herself and decide to give herself the means to achieve it, with the help of the therapist.
Although the patient’s feelings are currently hurt, she is in good health and she was able to have normal caring relationships with friends and family before the event. From the four wheels of Glasser’s allegory of Behavior, one rear wheel is not working well, the feelings, and that wheel is currently preventing Mary from living well in her Quality World. But she can control her front wheels, thought and action. And these front wheels can drag the whole Behavior car. Mary worked on these ideas, she gave them some thought and recognized that only half of her Basic Needs were fulfilled. That she had the option of renting a small house two blocks from her children’s place. In fact at the same time she new she could do it, she already wanted to do it. But this was a big step and she first decided to register with the local amateur theater group, a thing she couldn’t have done where she lived before because of the distance from the city. She was a member of the theater group in high school and this new activity rejuvenated her, gave her the fun she had been lacking and also some obligations, since she had to learn her parts and couldn’t miss rehearsals and shows. Simultaneously she attended yoga classes where she learned relaxation techniques and she was able to stop taking Lorazepam (on which she had not been for long). Her nightmares disappeared. Her interest in life and people came back. At that point she decided to rent this small house which had been vacant for months. She moved in (with the cat), did some home improvement. Then she decided she did not need a new car since she was in a small city with a good network of public transportation.
This kind of therapy may be quite rapidly effective on acute stress disorder in healthy people, but I doubt it would work without the help of medicines on a seriously depressed patient who is unable of deciding anything, even less acting to put her decisions into practice.
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