Clients With Serious Mental Health Issues

From the point of view of reality therapy, the diagnostic labels described in the Diagnostic Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000) are not static conditions. They are negative symptoms (i.e., behaviors generated for a purpose – to fulfill wants and needs). As goal-directed behaviors, they can be replaced by more effective behaviors (i.e., positive symptoms). Seligman (2004) stated that reality therapy might be applied to disorders such as conduct disorder, oppositional defiant disorder, substance abuse, impulse control, and some personality disorders. The skilled reality counselor or therapist spends little time discussing diagnostic symptoms such as hallucinations, compulsions, psychoses, or depression (W. Glasser, 1998, 2003, 2005). Rather, the counselor and client search for specific solutions related to effective need and want satisfaction especially directed toward a better sense of belonging and healthier relationships.

Consequently, in the application of reality therapy, medication can assist clients to make more effective choices. The theory began in a mental hospital and a correctional institution and is widely used in corrections. Though not describing diagnostic categories, Lojk (1986) demonstrated that reality therapy is still used successfully with correctional clients. B. Bratter, Bratter, Maxym, Radda, and Steiner (1993) successfully used reality therapy for delinquent youth whose diagnoses ranged from attention-deficit/hyperactivity disorder and conduct disorder to affective disorders, both depression and bipolar. T. Bratter (2008) added, "Since the first class graduated in 1987 all graduates have attended college . . . all but one of the class of 2006 made the Dean's List. The lowest average was 3.3" (p. 2). In further describing the success of the reality therapy program, T. Bratter, Esparat, Kaufman, and Sinsheimer (2008) stated that members of the 2008 class had been admitted to such universities as Brandeis, Oberlin, Sarah Lawrence, and the University of Chicago.

The reality therapy counselor treats all behaviors as if some element of choice is present. In this way, clients feel both hope and empowerment. They realize that a better life is accessible and they are not irretrievably doomed to a life of mental illness.

Cross-Cultural Considerations

Reality therapy is an imminently cross-cultural method. Based on universal psychological principles, the method has been applied to cultures as diverse as Asian, Middle Eastern, South American, African, European, as well as those represented in North America. Instructors indigenous to various cultures have adapted the principles to their respective clients (Wubbolding et al., 2004). Practitioners using the principles of reality therapy are aware of their own beliefs and attitudes about their own culture and the cultures of their clients.

Their application of the WDEP system is based on their knowledge of the particular group they are working with, and like any counselor need to be aware of their own biases as well as the strengths and cultural differences of the individual clients (Arrendondo et al., 1996).

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