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While the field of adventure education has grown and diversified in many ways over the past four decades, there has been an increasing call for advances in program theory, research, and evaluation (Baldwin et. al, 2004; Gass, 2007; Priest & Gass, 2005). One aspect of adventure education, adventure therapy, is showing promising results, but is under increasing pressure to further demonstrate its “positive impacts.” This is an important time for this field to develop its theory and practice to help achieve more consistent outcomes (Neill, 2003).
One aspect of adventure therapy that is increasingly facing this pressure is the field of wilderness therapy. While there is continued growth in this type of treatment (among a variety of populations) there is also pressure to “prove” its effectiveness. The current state of affairs for the wilderness therapy field is summarized concisely by Russell (2001). After reviewing a number of theories, research, and definitions, he concludes that “…wilderness therapy is still viewed in the mental health profession with great trepidation because of loosely defined treatment approaches and inconsistent research” (p.78). This is combined with less than ideal qualifications for field instructors and, in some cases, lack of adequately trained staff (Russell, 2001).
In hopes of offering a promising tool for wilderness therapists, as well as a more specific treatment approach, this paper explores the theories presented by Dr. William Glasser (1965, 2001, 2007). Reality Therapy and Choice Theory offer a framework for therapy that involves strong client-therapists relationships, focuses on the present, is solution-oriented, and centers on the “five needs” that Glasser claims all humans constantly work to fulfill. While I am not an expert on wilderness therapy or Glasser’s theories, my experience working in the field with a variety of student groups has shown me that this tool can be an effective framework to help wilderness therapy improve both practice and results.
Research and program evaluation in the field of wilderness therapy has shown positive effects on client outcomes despite a lack of definitive evidence (Neill, 2003). Neill feels that these initial positive results suggest a need to continually develop more effective practices for even stronger outcomes.
While wilderness therapy programs hold promise for effective change, one of the biggest deficits is a common understanding of which therapeutic techniques will be most effective with these clients (Russell, 2007). This is complicated by the fact that many programs do not employ adequately trained staff. Russell (2001) explains that the “Kimball and Bacon” model of wilderness therapy makes no mention of staff certifications to act as wilderness therapists, nor does it recommend a specific therapeutic approach. He goes on to point out that Berman and Berman state that primary care staff “need not be certified as counselors because ‘this goal is both unrealistic and unnecessary’” though they do argue for the need for trained and licensed supervisors.
The combination of lacking a clearly defined treatment modality, and the reality that many field staff are not trained therapists, causes some to look at the field of wilderness therapy with caution. Reality Therapy and Choice Theory may prove to be a useful tool for the field of wilderness therapy, helping to mitigate these problems. It is a relatively simple and present- and future-focused method that emphasizes client choice and possibility. While training in this method is necessary, it may prove to be more accessible and user-friendly to a field staffed with many inexperienced instructors. Additionally, it is a method frequently used in more formal settings with demonstrated effectiveness. Adopting this method has the potential to ease some of the fears that mental health professionals hold around the concept of wilderness therapy.
As the field of wilderness therapy continues to define and refine itself, it is important to look to developments in the traditional therapy field for effective tools. The concept of Reality Therapy holds promise for use in wilderness therapy programs (Ostrishko, 1997). Identifying a well known, and relatively straightforward, treatment method has the potential to help this field implement more effective therapeutic practices, develop more consistency between programs, and provide a framework from which to assess the effectiveness of interventions. Additionally, the core components of Reality Therapy and Choice Theory align closely with the theoretical framework of wilderness therapy, making this a natural fit. Lastly, Reality Therapy is a practical and accessible tool which can be useful for the typically young, inexperienced field staff that might not currently have adequate clinician guidance.
Below is a summary of some of the main concepts of Reality Therapy. By no means is this a complete picture of this method, and I do not claim to be an expert on the topic. Rather, I aim to highlight some of the components that could prove useful to the field of wilderness therapy and attempt to link related components of these fields. While I do not propose that Reality Therapy is the cure all for adventure therapy’s woes, I do feel that it can be a useful tool for some clients in some settings.
Reality Therapy is a way to help people improve the quality of their lives that differs significantly from traditional modes of psychotherapy. This theory was developed by Dr. William Glasser in the mid 1960’s. In the original version of Reality Therapy (1965), Glasser describes individuals that need psychiatric care as persons who are suffering because their needs are not being met. “We believe that, regardless of how he expresses his problem, everyone who needs psychiatric treatment suffers from one basic inadequacy: he is unable to fulfill his essential needs” (p.5). At this time, the basic needs were identified as the need for relatedness (the need to love and be loved) and the need for respect (the need to feel worthwhile to ourselves and others). These could be accomplished through doing what is “responsible, realistic, and right.” Glasser also recognized the importance of being “involved” with someone who we care about and who cares about us in return in order for us to get our needs met.
A foundation of Reality Therapy is the rejection of traditional mental illness diagnoses and a move towards categorizing individuals as either “responsible” or “irresponsible.” Glasser states that a responsible person has “…the ability to fulfill one’s needs, and to do so in a way that does not deprive others of the ability to fulfill their needs…a responsible person can give and receive love…A responsible person also does that which gives him a feeling of self-worth and a feeling that he is worthwhile to others” (1965, p.13). The inability to fulfill these needs in this way is considered “irresponsible” and these behaviors are often diagnosed as a mental illness. “Reality Therapy advocates dispensing with the common psychiatric labels, such as neurosis and psychosis, which tend to categorize and stereotype people…We hope that the reader will try to substitute responsible for mental health and irresponsible for mental illness and its many subcategories” (Glasser, 1965, p.15). This rejection of the traditional medical model has received criticism from many in the field of psychology. While these criticisms deserve focused attention as we think about implementing this type of therapy, this discussion is beyond the scope of this article.
In the original framework, Glasser (1965) described “three separate, but intimately interwoven procedures” for the successful implementation of this model.
Over the past 42 years, Reality Therapy has evolved and grown. Additionally, the concept of Control Theory has developed and has been renamed Choice Theory. Today, Glasser sees the concepts of Reality Therapy and Choice Theory as being inextricably linked. In Counseling with Choice Theory; The New Reality Therapy (2000), these links are further explained. (All information about Reality Therapy and Choice Theory in this section was obtained from The William Glasser Institute web page unless otherwise noted. Glasser citations from 2007 are from the article “Reality Therapy and Choice Theory” from this web page. This article was previously published in an unidentified source and this information could not be obtained from the Institute).
In this newer version, Glasser (2007, p.1) claims that the “underlying problem of all clients is the same: they are either involved in a present unsatisfying relationship, or lack what could even be called a relationship.” He goes on to explain the new mission of Reality Therapy as guiding “the client to a satisfying relationship, and literally teach(ing) him/her to behave in ways that they are presently unwilling or unable to do.” This therapy sees dysfunctional behavior as a means of dealing with the frustration of not having a good relationship. It is believed that as the therapist aids the client in developing and maintaining better relationships, the client will eventually start choosing better behaviors. One can see direct connections between this focus on involvement and wilderness therapy’s focus on redefining the therapist-client relationship (Russell, 2007). Many clients in a wilderness therapy program have had difficulties dealing with family members, authorities, or peers. By entering the therapy with patience and support, the therapists has a better chance of connecting with the client, modeling what a healthy relationship can look like.
Glasser (2001) describes the client’s main problems as being unhappy. The “causes” of unhappiness guide the specific components of Reality Therapy and Choice Theory. Adventure therapists will likely recognize many similarities between the actions listed below and behaviors they have seen clients present in an adventure setting. Glasser explains that unhappiness is associated with the following factors:
While Reality Therapy has many interrelated components, some of the main characteristics include (Glasser, 2007):
1. Focusing on the unsatisfying relationship or lack of relationship.
§ Reality therapy clients identify their relationship issues and are taught that the only person they can control is themselves. This gets clients away from the “external control psychology” that negatively affects many relationships.
§ In wilderness therapy this is best accomplished through talking with the client and working to build a trusting relationship. This “involvement” is the most important component of successful therapy. Once a trusting relationship is developed (with the therapist as well as with the rest of the therapy group), progress can be made on the behavioral level.
2. Emphasis on Responsibility
3. Present Focused / Choice Focused
4. Counseling Environment
A unique aspect of today’s Reality Therapy has a direct link to the populations often served in the field of wilderness therapy. Glasser sees Reality Therapy as an effective means of “…working with the large group of people who now seem so resistant to psychotherapy that it seems impossible to get them involved. Characteristically, these are the people who do not want to see the therapist and actively resist therapy” (2007, p.7). Many of the students in a wilderness therapy program may have also:
…disconnected themselves from responsible people: at present, they have no people who could or would care about them in their quality worlds… there are millions of people, some as young as ten years of age, who have given up on responsible caring adults because they have not been able to relate to them successfully. They have no responsible adults in their quality worlds. These people can't give up on pleasure, as that is impossible. Our genes will not let us do that. They have given up on love and belonging, and on finding pleasure with people. When they do, many turn to their need for power and seek pleasure by destroying things or hurting people. They become dedicated to violence, or seeking pleasure directly through addicting drugs or sexual pleasure that has nothing to do with satisfying another person.
What also differentiates these people from most people is that they have become especially sensitive to external control. They see the law, the rules, and the rights of others as an affront to them. Their code is, as long as it feels good, do it. They see a counselor as someone who is trying to make them follow rules they hate and this makes them very hard to counsel. Our whole correctional system is filled with this group of people and right now the main way to deal with them is punishment. But punishment confirms what they already believe—all the people in power care about is control. They don't care about what I want or need. As far as they're concerned, the whole world sucks (Glasser, 2007, p.7).
Recognizing these characteristics in the wilderness therapy population is an important component of deciding which treatment method might be most effective. A reality therapist tries to address these issues by working to build a strong and healthy relationship with the client and then teaching the client the components of Choice Theory. While it would take years of training to become an expert in this therapeutic method, it is relatively simple in theory. Young, inexperienced wilderness therapy instructors may find success using this process in almost any setting with a variety of student populations.
Glasser describes the role of the therapist as being quite straight-forward and open. Essentially, the therapist needs to focus on just one thing; doing whatever is possible to get connected with the client. There is no possibility in helping a client if the therapist cannot connect with them. In addition to trying to connect with the client, it is important that the reality therapist “be in touch with reality himself and be able to fulfill his own needs within the world” (1965, p.7). It is not enough for a client to have a relationship with just anyone (like a fellow gang member or an abusive parent), rather every person needs to be “involved” with some responsible person (someone who can effectively get their needs met without inhibiting others from doing the same). For some students, the reality therapist (or wilderness instructor/ therapist) might be the only responsible person in the client’s life. This can be a very powerful position as the therapist acts as a role model for the client. Similarly, Kimball and Bacon (1993, p.33) express “By encouraging autonomy, by treating students with respect, and by listening to them, the wilderness staff becomes powerful modeling influences.”
Glasser goes on to recommend that the therapist should not come across as someone who is trying to change the client in any way, just as someone who is trying to get to know them. Once this “involvement” happens, then the actual therapy, the goal of teaching them how to create other satisfying relationships, can begin. The role of the therapist in wilderness therapy has been described in a similar manner. Russell (2001, 1999) describes the therapeutic relationship as “nurturing, caring, and empathetic” (2001, p.74). He goes on to describe the wilderness therapy approach as not forcing change but allowing the environment to “influence client response through natural consequences” (2001, p.74).
In examining the typical stages of the wilderness therapy process, (cleansing, personal and social responsibility, and transition/aftercare; Russell, 2001), one can make connections between the “cleansing phase” and the growing involvement between the client and the therapist. As the client is removed from their ineffective environment and unsatisfying relationships, they are able to take on a new image and build a healthy relationship with the therapist, and ideally with peers in the wilderness therapy group.
Before getting into the specifics of the application of Reality Therapy, it is important to mention the concept of group therapy. While most therapy sessions traditionally involve one-on-one interactions between the client and the therapist, wilderness therapy sessions mainly happen in group settings. Kimball and Bacon (1993, p. 22) state that the “group process lies at the core of wilderness therapy.” They go on to express the importance of a cooperative community and see interdependence as a key factor in the success of this method. This corresponds to Russell’s explanation of the therapeutic social group as a means of enhancing therapeutic effectiveness (2007).
Glasser (1965) also saw the benefits of conducting Reality Therapy in a group. Even though a group setting might lead to the therapist being slightly less involved with each client, it increases the likelihood that the client will become involved with peers, and this increased involvement may speed up the pace of the therapy. He also explains that peers are quicker to confront each other and offer suggestions on how to cope with “reality.”
Once the therapist develops a strong, trusting relationship with the client (or group as in wilderness therapy sessions), it is important to start teaching the core components of Choice Theory. Now that the client is “involved” with a responsible adult, they can begin to take accountability for their thoughts and actions as well as getting their needs met. As previously stated, Glasser sees our “needs” as driving our actions in life.
The modern version of Choice Theory describes our 5 genetically encoded needs. This is an evolution from the original needs of relatedness and respect (Glasser, 1965). Reality therapists must educate clients in this “needs” framework to build a foundation for the rest of therapy.
2. Love and Belonging
It is important to note that Reality Therapy describes all of our actions as attempts to satisfy these needs. Unfortunately, the actions we “choose” may not always be “responsible” (allowing others to also get their needs met). If our needs are not met, we experience pain. The purpose of Choice Theory is to help identify the needs that are not being responsibly met and try to make choices that will better address that need in a responsible way.
Alvarez and Stauffer (2001, p.89) speak directly to these needs when contributing a new definition for adventure therapy. They claim that the conditions of “safety, freedom, belonging, effective communication, and enjoyment or fun” are fostered in adventure therapy settings and are necessary for optimal growth. They go on to suggest that facilitators need to focus on issues related to these beliefs and bring them to the attention of the group.
The next step in the Choice Theory involves the Quality World. Throughout life we keep track of all the things that feel good to us. This can include the people we most enjoy being with, those we wish we could be with, and anything else that give us pleasure. Essentially, this is the ideal world that we would live in if we could. In Reality Therapy, people are the most important component of this Quality World (Glasser, 2007). It is important for the therapist to be someone that the client wants to have in their Quality World. For the therapist, this means taking the time to find out what is important to the client and what types of people the client respects. In order for therapy to be effective, the client must accept the therapist into their Quality World. Prenzlau (2006) explains that the therapist is helping the client to identify their Quality World and try to find ways for the client to achieve this. Once the therapists enters the clients Quality World, they are trusted and can help the client to confront chosen behaviors that are preventing the client from getting their needs met (including the behaviors that are preventing important people from staying in their Quality World).
In the field of adventure education (and therapy), we often ask students to identify their Quality World when we invite students to co-create their group culture and norms. While there are a certain number of policies and guidelines that programs ask students to follow (no drugs and alcohol, no fighting, etc) many programs ask students to contribute to the development of their “group contract.” Whether this is called a Full Value Contract or a Positive Learning Environment, we can find success asking students to identify what kind of group culture they want to live in. This gives students hands-on experience identifying the components of their Quality World and increases the amount of ownership they have in the group culture.
The last main component of Choice Theory is called Total Behavior (Glasser, 2007). In this model, it is believed that almost all that we do in life is chosen. “Total Behavior teaches that all behavior is made up of four inseparable but distinct components: acting, thinking, feeling, and the physiology” (Glasser, 2007, p.3). Acting and thinking can be most directly changed, whereas feeling and physiology are less directly changed. Throughout Reality Therapy the therapist and client should avoid focusing on the things that cannot be directly changed.
Many clients tend to focus on the feelings they are experiencing. Therapists change this paradigm to look at the behaviors clients are choosing that are leading to the feelings they are experiencing. This changes “depressed” as a feeling to “depressing” as an action. By choosing to “depress,” our feelings feel “depressed.” This attempts to place “the responsibility for the behavior where it belongs, because the client is choosing it” (Glasser, 2007, p.4). As Glasser (1965) mentioned in the original version of Reality Therapy, the therapist does not place a value judgment on the client’s behaviors. Instead, the therapist challenges the client to decide if their behaviors are resulting in their needs being met in a responsible way.
Again, the stages of the wilderness therapy process (Russell, 2001) can be applied to this framework. As clients learn about their needs, identify their Quality Worlds, and see the natural consequences of their actions, they begin to recognize that they can choose their actions; that they have “personal and social responsibility.” In many wilderness expedition situations, even if a Positive Learning Environment was established, clients often find it difficult to constantly live up to these standards. Rather than rejecting the client, a trusting, Reality Therapy based environment challenges students to ask, “What behaviors are we choosing that are preventing us from getting our needs met? What behaviors are we choosing that are causing us to be angry at each other, to not make it to camp before dark, or not have any fun?” These are questions that arise because of the natural consequences of the students decisions, not because the instructor is presenting their personal agenda. Rather than the therapist making judgments on the behavior of clients, students are faced with the immediate feedback from other course members and nature. This allows “staff to step back from traditional positions of authority to which the client is accustomed” (Russell, 2001, p.74). As Alvarez and Stauffer (2001) point out, this orientation allows the therapist to view and assess client behavior from an experiential perspective. Seeing how clients act in real life situations allows therapists to more effectively “provide corrective life experiences that will move toward healthier functioning” (p.88).
The final “transition or aftercare phase” of wilderness therapy (Russell, 2001) involves helping clients to prepare for their upcoming transition, whether they are returning home or continuing to more treatment. As “preparation for this challenge is facilitated by therapists through intense, one-on-one counseling and group sessions with peers” (p.75) it is clear to see that the components of Reality Therapy and Choice Theory can again prove useful. While the natural consequences encountered in the wilderness setting may not be directly relevant to the post-treatment setting, the core components of Reality Therapy can be useful in all settings. Glasser states “As long as clients continue to use the choice theory they learned in counseling, the therapy never ends” (2000, p.22). The therapist can work with individual students to continually redefine their Quality Worlds (as the client may want to incorporate successes from the wilderness therapy experience), and to help them develop a plan that will allow them to develop satisfying relationships, and choose the Total Behaviors that will help them to get their needs met in a responsible way. While this plan may not work at first, just as the students struggle to live up to the plan laid out in the group culture, clients will now have a simple framework to help them assess their problems and recognize their power in choosing behaviors that might help improve the quality of their lives. Reality Therapy challenges clients to continually assess if their needs are being met and to change their “plan” as necessary, just as clients “leave wilderness therapy knowing that they have only just begun the journey and need to continue their own personal growth process…Wilderness therapy helps clients understand changes they need and want to make after wilderness therapy.” (Russell, 2001, p.75).
More than just finding a therapeutic model that aligns with the basic components of wilderness therapy and is useful for instructors with a wide range of experience, it is important that this model has shown effectiveness in a variety of settings. Glasser (1965) cites numerous examples of when Reality Therapy has been successful. Specifically, he offers examples of the use of Reality Therapy in the treatment of seriously delinquent adolescent girls, psychotic patients in a hospital setting, in an office treatment environment, and in a public school setting.
Recently, a number of studies have been conducted demonstrating the effectiveness of this approach with various populations. A study by Prenzlau (2006) demonstrates the effectiveness of Reality Therapy in treating patients with Post Traumatic Stress Disorder. She concludes that “This study provides some empirical evidence to suggest that the intervention of Reality Therapy is an effective means of reducing somatization and rumination behaviors associated with PTSD…” (p.28). Lawrence (2004, p.9) found “partial evidence that group counseling using a reality therapy framework can be helpful in increasing some factors associated with self-determination for persons with developmental disabilities.” Lloyd found that
…high school students; exposure to Choice Theory principles had a positive sustaining effect on their perception of satisfaction in 3 of the 4 psychological needs. This study could prove beneficial to educators; teaching students to satisfy their needs in appropriate and effective methods may help decrease disruptive and destructive behavioral choices, and may increase behavioral choices that effectively satisfy their needs (2005, p.5).
Specific to the field of wilderness therapy, Barker (1995) assessed the effectiveness of a program using a Reality Therapy based peer group culture. Findings suggest that the program helped students communicate with their families, control their tempers, and stay out of legal trouble. There were no significance differences between genders. Barker states that “Adolescents in placement as well as their families believed that they benefited from treatment through the wilderness programs” (p.1).
While the field of adventure therapy is making strides in the areas of research and evaluation, much work is still needed to find measurement tools that will adequately assess the changes proposed in our field. As Neill (2003, p.320) states, “In the absence of specific adventure therapy tools, researchers should be considering well-developed and readily available mental health instruments.” The field of Reality Therapy has begun to make progress on this front. A psychometrically sound measure of the “Five Basic Needs” was developed by Burns, et al (2006). The Student Needs Survey assesses each of the five basic needs and has high reliability and validity. A coefficient alpha of .92, test-retest reliability of .96, and goodness of fit index of .94 show that this tool is a psychometrically sound measure to help assess the effectiveness of the Reality Therapy and Choice Theory framework in a school setting.
As the field of adventure therapy continues to grow and diversify, it is important to maintain focus on theoretical foundations and effective practices, not just outcomes. Although there is evidence demonstrating the effectiveness of wilderness therapy programs in many areas of positive development, there is still a need to identify and implement effective, proven therapeutic models to further increase the validity of this therapeutic application. In addition, it is important to identify therapeutic models that are relatively simple to administer given the large number of field staff that are not licensed therapists.
There are a number of limitations and criticisms of Reality Therapy and Choice Theory, and it is important to consider the implications of all aspects of these theories (i.e. rejection of the traditional view of mental illness) before blindly implementing them. On the other hand, there is growing support for this type of treatment with the clients that frequently attend wilderness therapy programs and my experience has shown me that, despite these criticisms, Glasser’s theories can be very successful for working with a variety of populations in a number of “therapeutic” settings. The emphasis on effective relationships, client responsibility and choice, Quality Worlds, and dealing with situations “in the present” align closely with many of the characteristics of modern wilderness therapy. While Reality Therapy and Choice Theory may not work for every client in every situation, it may prove to be a useful tool for the growing fields of wilderness therapy and Outdoor Behavioral Healthcare.
Alvarez, A. G., & Stauffer, G. A. (2001). Musings on Adventure Therapy. The Journal of Experiential Education, 24(2), 85-91.
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Burns, M. K., Vance, D., Szadokierski, I., Stockwell, C. (2006). Student Needs Survey: A Psychometrically Sound Measure of the Five Basic Needs. International Journal of Reality Therapy, 25(2), p.4-8.
Gass, M. (1993) Adventure Therapy: Therapeutic Applications of Adventure Programming. Dubuque, IA: Kendall-Hunt.
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Glasser, W. (1965). Reality Therapy. New York: Harper & Row.
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Glasser, W. (2007). Reality Therapy and Choice Theory. Obtained October, 2007 from http://wglasser.officewebsiteonline.com/images/articles/reality_choice.pdf.
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Lloyd, B. D. (2005). The Effects of Reality Therapy/Choice Theory on High School Students’ Perception of Needs Satisfaction and Behavioral Change. International Journal of Reality Therapy, 25(2), 5-9.
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Ostrishko, G. (1997). The Reality of Experience. In Deeply Rooted, Branching Out, 1972-1997. Annual AEE International Conference Proceedings, 1-8.
Prenzlau, S. (2006). Using Reality Therapy to Reduce PTSD-Related Symptoms. International Journal of Reality Therapy, 25(2), 23-29.
Priest, S, & Gass, M. A. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
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Russell, K. (2007). Summary of Research from 1999-2006 and Update to 2000 Survey of Outdoor Behavioral Healthcare Programs in North America. (Technical Report #2). Minneapolis, MN: University of Minnesota College of Education and Human Development.
Correspondence concerning this article should be addressed to Jesse Beightol; UNH NH Hall, 124 Main St; Durham, NH, 03824.
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Good article n This article has helped increase my knowledge about outdoor education and experiential learning.thanks Jesse.
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