The founder of reality therapy, American psychiatrist Dr. William Glasser, was born in Cleveland, Ohio in 1925. He studied medicine, received his master’s degree in clinical psychology and specialised in psychiatry. He practiced psychiatry in a hospital for war veterans, in a reform school for girls, in a psychiatric hospital and in private practice with clients almost until the end of his life in 2013. The American Psychotherapy Association awarded Glasser the title of master psychotherapist. He wrote close to thirty books.
Unsatisfied with the effectiveness of psychiatry at that time, Glasser developed reality therapy during the 1950s and 1960s based on the knowledge he gained in his psychiatric practice. Prior to that, psychiatry in the US had been predominated by traditional psychoanalysis. Glasser himself was educated in that discipline. In his work with psychotic people, he noted that he and his colleagues had at least as much success through direct, candid relationships with patients in their everyday hospital life than they did with methods and techniques that were used in agreed therapeutic sessions with patients. Glasser felt that reticence in relationships with patients was unhelpful and that the opportunity to develop genuine relationships with them was missed. He found that his patients were stuck in the past, avoided the reality in which they live and denied it, were disconnected from important people in their lives, were incapable of satisfying their needs in a realistic way and clung to less realistic ways in their unsuccessful attempts to satisfy their needs. Glasser believed that therapy can only be successful if it is based on genuine relationships with patients, if it focuses on successfully grappling with the tangible and intangible aspects of the real world, and if patients are made aware that reality exists and that they should satisfy their needs within such a framework and connect with others. He believed that people are internally motivated and not victims of their past or circumstances and that they decide on their own behaviour. He also believed that mental health is a reflection of the satisfaction experienced when people satisfy their internal needs. He thus returned to the individual responsibility for their own behaviour and consequently their own mental health. He first described his view and work method in the 1960 book Mental Health or Mental Illness? and in the 1965 book Reality Therapy: A New Approach to Psychiatry.
To quote Glasser: “In their unsuccessful effort to fulfil their needs, no matter what behaviour they choose, all patients have a common characteristic: they all deny the reality of the world around them. Therapy will be successful when they are able to give up denying the world and recognise that reality not only exists but that they must satisfy their needs within its framework. A therapy that leads all patients toward reality, towards grappling successfully with the tangible and intangible aspects of the real world mighty accurately be called a therapy toward reality, or simply reality therapy.”
His opposition to conventional approaches did not impress experts at that time; they said that he had no theoretical basis to support his assertions. Glasser thus focused on researching and developing a theory for his approach. He found similarities to his thinking in the theory of William Powers, author of the book Behaviour: The Control of Perception, which he read in 1977. Working with Powers inspired Glasser to write the 1981 book Stations of the Mind, in which he provided the theoretical basis of his idea in the form of control theory, with an emphasis on levels of perception.
In 1984, Glasser published Control Theory: Take Effective Control of Your Life, in which he described his theoretical ideas in a simplified and more applicable manner. While Stations of the Mind was intended for experts, Control Theory was intended for both experts and the general public. In contrast to his previous book, Control Theory focused more on his ideas in practice.
Glasser’s ideas also have an anthropological importance. At the time he presented his ideas, psychiatry was mostly psychoanalytically oriented. The belief was widespread that personality develops in early childhood and that this was the basis for the current behaviour of an individual. It was also widely held that a change in behaviour is only possible through prior insight into past events, which requires long-term psychotherapy. Glasser’s clinical experiences indicated something different: the more we dig into the past, the less clear it is to us and the more we have to interpret. He believed that all past experiences influence current behaviour, and that the past takes on new meaning when we change our behaviour. Change is possible through the self-evaluation of current behaviour and a change in one’s life in the present. He also believed that psychotherapy could be short-term. Very present in the US until that time was behaviourism, which interpreted behaviour as the result of external stimuli and past events. It was thus believed that behaviour could be managed from the outside. Glasser believed that behaviour is always purposeful: that it is not a reaction but a proaction – an attempt to satisfy needs.
From 1995 on, Dr Glasser experienced a very intensive path of self-development. He called his interpretation of human behaviour prior to that time choice theory. The book Choice Theory was published in 1998 and emphasised the importance of interpersonal relationships for human happiness. To that end, Glasser defined the term mental health. He began to describe his clients’ less realistic ways of satisfying needs, which he discussed in the book Reality Therapy: A New Approach to Psychiatry, as attempts by people to achieve something they cannot in order for others to satisfy their own needs. They thus assume the role of victim of their circumstances or attempt to achieve what they want by force. He called such understanding of human behaviour external control psychology and thus clearly distinguished what choice theory advocates. We will give more attention to such understanding later in this book.
Similar to Harrington, Szasz, Rowe, Laing and others later, Glasser rejected the biological interpretation of mental issues and the declaration of those issues as mental illnesses because he believes that people are not sick in the medical sense of the word.
He also warned of the development of biotechnology, which is exploited by the pharmaceutical industry, and was opposed to the treatment of mental issues with psychopharmaceuticals. In the book published in 2000, Reality Therapy in Action, Glasser talked about the real risk of modern psychiatry abandoning psychotherapy in favour of various chemical substances that improve the mood of clients. The cause of problems is supposed to be a chemical imbalance in the brain that can be treated with medicine and thus resolves the client’s problems. “The confusion of cause and effect,” said Glasser. In his book Warning: Psychiatry Can Be Hazardous to Your Mental Health from 2003, Glasser wrote, “What the present psychiatric establishment has done that can harm your mental health extends far beyond the psychiatrist’s office. Now almost all health professionals are caught in this neurochemical ‘web’. Brain drugs dominate the entire ‘mental health’ landscape.”
He equated mental health with a positive connection with others that is based on the belief that we are free beings who as such forge our own happiness. Because he defined as one of the goals of reality therapy the client’s opportunity to replace external control psychology beliefs with the choice theory beliefs on which mental health is based, Glasser did not make a distinction between counselling and psychotherapy. He believed that people are unhappy due to the external control psychology beliefs that they follow, regardless of how that unhappiness manifests itself.
As a practitioner, Glasser was most interested in spreading his ideas to as many people as possible. The focus of his opus was therefore on the general public. He also applied his ideas in the areas of education and management, and wrote a number of books in that regard. He wrote those books in simple, understandable language, without the intention of giving his ideas a scientific basis. That is probably why we can find most of his books on shelves reserved for self-help literature.
He established the Institute for Reality Therapy (later renamed the William Glasser Institute) in Los Angeles in 1968 in order to popularise his ideas and to educate those who desired to learn a new approach to human problems. His institute gradually attracted a number of experts from all around the world, including European experts who developed an approach for teaching reality therapy. Glasser did not involve himself in that development. His colleagues therefore assumed that role. The exception was his attempt to explain the therapist’s approach to work with clients, which he systemised into eight steps. That explanation was later used for many years as a teaching method that Glasser frequently opposed.
Slovenian psychologist Leon Lojk was one of Glasser’s closest colleagues and monitored the development of the author’s ideas and searched for the justification of those ideas in philosophy and the achievements of modern science.