Reality Therapy Training Efficiency in Helping Participants to Better Their Relationships and Improve Their Psychological Wellbeing

The aim of this study was to investigate Choice Theory/Reality Therapy (CT/RT) training

efficiency for improving one important relationship and psychological wellbeing of the

trainees.

The aim of this study was to investigate Choice Theory/Reality Therapy (CT/RT) training

efficiency for improving one important relationship and psychological wellbeing of the

trainees. The data was collected at a 5th European Reality Therapy Conference in Bled,

Slovenia. Total of 104 conference participants filled an anonymous questionnaire designed

in four parts. While first part addressed general information, the second part of the

questionnaire contained questions on perceived quality of one chosen relationship in terms

of happiness, closeness and needs’ satisfaction. Participants were instructed to recall and

estimate the relationship prior to CT/RT training and “lately”. The questionnaire also

contained the 2-factor scale measuring hedonistic and eudemonistic aspect of wellbeing

before the training and currently. Fourth part of the questionnaire was related to attribution

of perceived change to the CT/RT training. We found that participants: 1) report to have a

better relationship with a chosen person now than before CT/RT training; 2) assess their

well being to be higher now than before CT/RT training; 3) attribute changes in relationship

and wellbeing to the effects of CT/RT training. We discuss some possible improvements of

the methodology used and give proposals for further research in training efficiency

regarding personal growth of trainees.

Introduction – Rationale and Definitions

Social relationships are well related with psychological well-being. People who tend to

interact more with others experience more positive affect than those who do not. Also,

people who spend more time with others are happier than those who spend a lot of time

alone (Lucas, 2006).

Reality Therapy (RT) training incorporates different modules aimed at different stages of

development for participants, but the core of the training consists of learning and teaching

Choice Theory (CT). One of the 10 axioms of the Choice Theory states that “All long-lasting

psychological problems are relationship problems” (Glasser, 1998). That may mean that if

people have better relationship with significant others, they would suffer less problems or

less psychological distress (Umberson, Chen, House, Hopkins, Slaten, 1996). However, low

psychological wellbeing doesn’t imply mental illness or psychological distress. Advocates of

mental health like Dr. William Glasser in his early work (1962), and later (2005), as well as

authors in the field of positive psychology such as Keyes (2002), assert that mental health

and mental illness may not be part of the same continuum.

Even some current definitions of mental health recognise that mental health is not merely

an absence of mental illness. According to World Health Organisation – WHO (2014), mental

health is defined as a state of well-being in which every individual realizes his or her own

potential,… not merely the absence of disease…”. Happiness, mental health and well-being

are very similar terms in Choice Theory (Glasser, 1998). They practically mean the same

thing. Choice Theory postulates that happier people have better relationships, and better

relationships mean more happiness. That is why in our investigation we are interested both

in well-being and relationships.

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 112

In the Reality Therapy training, especially during the first year, a lot of time is spent

teaching and learning about relationships. Participants are encouraged to monitor a

relationship that is important to them and make an action-plan for improving that

relationship. They make self-evaluations about effectiveness of the action-plan and are

evaluating their behaviour in that relationship.

Participants are also often asked to make a self-evaluation about their relationship in the

training group. They are monitoring how they are behaving, and how connected they feel to

other participants in the group. This introspective method facilitates learning about

relationships which is one of the aims of Reality Therapy training. Teaching clients about

relationships and improvement in relationships is something most Reality Therapy

practitioners are interested in.

In the broader context of psychotherapy, relationship is understood to have a very

important role. Extensive research done by Norcross and Lambert (2010) provides evidence

that therapy relationship accounts for why clients improve (or fail to improve) as much as

the particular treatment method. In Reality Therapy, relationship has a special role and a lot

of training content is aimed at learning about quality relationships both in practitioner’s

private life and with their clients.

Even though Reality Therapy supervisors and instructors get feedback from their

participants that participating in the training helped them to change their relationships,

there has been little effort among researchers to look closer into this matter. In order to

better understand how the training can support participants in their relationship and

wellbeing, there needs to be more studies in this field.

Also, Choice Theory practitioners like to think that learning Choice Theory helps people

improve their wellbeing. There is some recent empirical work to support this: Reality

Therapy was found useful for people who, by learning Choice Theory improved their

psychological wellbeing (Casstevens, 2011; Turkdogan & Duru, 2012). We wanted to check

whether training itself can be helpful to people to improve their psychological wellbeing.

Participating in the training cannot guarantee relationship change. Nor can it improve the

psychological wellbeing. But, participants who learn Choice Theory and apply it in their lives,

often change their beliefs and change their behaviour. The changes they make are

important for their relationships and wellbeing.

That is why it’s important how one defines and measures mental health or psychological

wellbeing. If we measure psychological wellbeing by asking about problems and lack

thereof, we do not measure the same thing as when we measure levels of happiness and

vitality. It is also important how we define relationships. Is it the number of persons one

interacts with, or a number of interactions with the same person? Is a good relationship a

level of happiness around someone; sense of closeness with that person, needs satisfaction,

etc?

For the purpose of this study, the following definitions of relationship and psychological

wellbeing are used:

 Relationship is a (total) behaviour of one person around another person. For the

purpose of this investigation, we will define the “improvement” in relationship as

higher level of happiness with relationship, higher sense of closeness and higher

needs satisfaction level linked with the relationship.

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 113

 Psychological wellbeing is a sense of feeling good in general (hedonistic aspect) and

having sense of meaning and motivation in life (eudaimonistic aspect).

Hypotheses

H1: Participants have a better relationship with a chosen person now than before their

CT/RT training – in terms of higher:

a. level of happiness,

b. level of closeness,

c. needs satisfaction level.

H2: Participants attribute changing relationship with the chosen person to their CT/RT

training.

H3: Participants assess their well being to be higher now than before their CT/RT training.

H4: Participants attribute change in their psychological wellbeing to their CT/RT training.

Method

Research participants

The study included participants of the Fifth European Reality Therapy Conference in Bled,

Slovenia. Participants filled out the questionnaires during four conference days: From 18th

to 21st April 2013. There were over 160 people in attendance at the conference from many

different countries: Australia, Bosnia & Hercegovina, Croatia, Finland, Ireland, Korea, Malta,

Slovenia, UK and USA.

Not all conference attendees have returned the questionnaire, but N=104 participants have

filled it in (male N=14, female N=81, data missing for gender N=9). The participants

completed different phases of CT/RT training, some had one year of CT/RT training (N=3),

some had two years of training (N=2), and some had certified (N=22). There were third-

year RT psychotherapy/counselling students (N=34), fourth year students (N=6), and RT

psychotherapists who completed five years of training (N=12), (missing data about the

training, N=23). Among the 104 study participants there were 30 participants with the

CT/RT faculty status.

Questionnaire

A questionnaire called “Self Evaluation Questionnaire: Reality Therapy Training Effectiveness

for Improving Relationships (RTTE)” have been developed for the purpose of this study.

Before administering the questionnaire has been translated into three languages – English,

Croatian and Slovenian. The questionnaire consists of four parts (see appendix 1):

Part 1 – General information about gender, level of completed CT/RT training and faculty

status of the participant.

Part 2 – Relationship satisfaction – participants remember one relationship which was

important to them prior to the beginning of their Reality Therapy training and is important

to them now. Then they assess their level of happiness, closeness and needs satisfaction in

that relationship. Participants answered questions about happiness, closeness, and needs

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 114

satisfaction using a 5-point scale and each element was assessed separately “before the

training” and “lately”.

Part 3 – Psychological well-being – We used a 2-factor psychological well-being scale

(Koštrun, 2004), which we adapted for the purpose of this study. Original scale measures

hedonistic and eudaimonistic factor of psychological well-being at the moment of

measurement. Our adaptation consists of addition of the same scale for assessing

psychological well-being before the training. So, participants filled out the same scale twice

– once for the time “Before the training”, and another scale for “Currently”.

Part 4 – Questions about attribution of the change – We asked participants to assess to

what extent they attribute the change(s) they marked on the scales (if any) to their Reality

Therapy knowledge and Choice Theory internalisation. For this purpose, a five-point scale

was used. The attribution question was introduced twice in the questionnaire – once for

participants to attribute changes in relationship to their CT/RT training and second time to

attribute changes in their wellbeing to what they learned in the CT/RT training. We also

asked participants to name the parts of Choice Theory that were particularly helpful in that

sense.

Results

H1a: relationship happiness with a chosen person, before and after training:

Different measures of comparison, based on mean, variance, or non-parametric measures,

all show statistically significant difference in answers, more positive after training. For

purpose of this paper, we are showing results of the T-tests we used to test the “H1”

hypotheses.

T-test (H1a: happiness with the relationship before the training and lately):

Mean (before)=2.80, st.dev=.99

Mean (lately)=4.45, st.dev=.68

Mean difference=-1.65, st.dev.=0.93, T =-18.09, p <0,01**.

H1b: Closeness with person,

T-test (H1b: level of closeness before the training and lately):

Mean (before)=3.33, st.dev=1.23

Mean (lately)=4.53, st.dev=.65

Mean difference=-1.20, st.dev.=1.04, T =-11.82, p <0,01**.

H1c: Needs’ satisfaction in the relationship

T-test (H1c: needs’ satisfaction before the training and lately):

Mean (before)=2.71, st.dev=.91

Mean (lately)=4.29, st.dev=.69

Mean difference=-1.58, st.dev.=.85, T =-18.98, p <0,01**.

Since there is significant difference between mean estimates of the three aspects of

relationship measured, it’s evident that our study participants have been able to

significantly improve the relationship in question during the monitored period of time. They

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 115

are happier with that relationship, experience higher level of closeness, and are able to

satisfy their needs better in relating with the chosen person.

H2: Effectiveness of Reality Therapy Training for Changing Relationship – before

and now

Participants marked their attribution of the relationship change to their CT/RT training on a

five-point scale ranging from “1-not at all” to “5-very much”.

On a sample of N=104, Mean=4.44, st.dev.=.62.

The study results indicate that the participants tend to attribute the changes in their

relationship to what they have learned in the training.

H3: Participants who learn Choice Theory and Reality Therapy improve their

psychological well-being. They assess their well-being to be higher now than

before their Reality Therapy training.

Different measures of comparison, based on mean, variance, or non-parametric measures,

all show statistically significant difference in answers, more positive after training.

Results of the T-tests for wellbeing (difference before the training and currently):

T (awake)= -9.65, p<0.01**

T (energetic)= -8.87, p<0.01**

T (happy)= -13.67, p<0.01**

T (content)= -15.25, p<0.01**

T (energised)= -11.70, p<0.01**

T (pleasant)= -13.08, p<0.01**

All measures of psychological wellbeing in the 2-factor scale have been found different for

“before” the training and “lately”. Our participants indicate to be more awake, energetic,

happier, more content, energised and feel more pleasant lately than before they started the

CT/RT training.

Hypothesis 4: Participants attribute change in their psychological well being to

their Reality Therapy training.

To inspect this hypothesis we calculated the mean and standard deviation of the five-point

Likert-type scale.

Mean: 4.49, st.dev.: 0.61.

Our participants attribute the change in their wellbeing to be an effect of their CT/RT

training. They indicate very high and highest level of attribution of their change in all six

measures of wellbeing to their CT/RT training with 96% of the answers being “quite a lot”

(42%) and “very much” (54%).

Discussion

Our results show significant difference in perceived quality of relationship measured in three

different ways (H1a: happiness, H1b: closeness, H1c: needs’ satisfaction).

Participants estimate that they are happier with their relationship lately than they were

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 116

before their CT/RT training. They also assess that they are closer to that person lately than

before they started the CT/RT training. And they assess their needs’ satisfaction level

around that particular person better lately than before the training.

Our study participants assessed their current wellbeing and estimated (recalled) their

wellbeing before their training (H3: difference in wellbeing). They did so by indicating

how they feel currently (awake, energetic, happy, content, energised, pleasant) on a 5-

point Likert-type scale. We found differences in mean for all six measures of wellbeing.

Since the scale used measures two different factors of wellbeing (hedonistic and

eudaimonistic factor of wellbeing), we found that our study participants indicate

improvement on both factors (now compared to the time before their RT training).

Further, we found that our study participants attribute their changes in relationship (H2:

attribution of the relationship change to the RT training) and wellbeing (H4:

attribution of wellbeing change to the RT training) to their Reality Therapy training.

Mostly our participants attribute their improvement to the training in terms of “quite a lot”

and “very much”. We could conclude that our study provides evidence that participants

value their RT training to improve their wellbeing and relationships.

To understand the results of the data obtained within Choice Theory framework, it’s

important to look at Dr. Glasser’s (2004, 2005) ideas about mental health and

wellbeing. The mental health is directly connected with happiness which again is connected

to quality of relationships with significant others. Thus, eudaimonistic factor of the 2-factor

scale we used (Koštrun, 2004) may serve as a measure of fulfilment which cannot be

achieved without quality relationships. Through relationships, humans develop profound

sense of meaning and motivation in life (eudaimonistic aspect of wellbeing). The other

(hedonistic) aspect of wellbeing can be linked to Dr. Glasser’s concept of satisfaction which

can be achieved (short term) without a relationship. Satisfaction can be well described as a

sense of being content or happy in the moment. Our participants report general

improvement in all these areas of their life: relationship, meaning and motivation, and

general satisfaction, and they attribute the reported change to the benefits from their CT/RT

training.

While personal development of future counsellors and psychotherapists is considered to be

an inseparable part of psychotherapy training, the effectiveness and importance of different

modes are still being debated (Malikiosi-Loizos, 2013, Moller, 2013).

Personal growth of trainees in terms of learning, accepting and applying CT beliefs in own

life is emphasised during CT/RT training. Change in perception of one’s role in a relationship

with significant others is considered, among other issues, to be successful education.

Perceiving relationship as own behaviour around others, trainees are equipped to improve

every relationship, including the one they chose to evaluate for the purpose of the study.

Therefore we expected the results to support our hypothesis. However, for a better insight

in participants’ understanding of relationship and wellbeing improvement process,

limitations of this study and future methodology adjustments should be considered.

Study Limitations and Possibilities for Further Research

It’s important to emphasise that estimates about the relationship and wellbeing: „before the

training” have been made retrospectively. We asked participants to recall and estimate their

relationship before the training at the same time as we asked for the estimates about

relationship and wellbeing “lately”. But beginning of their CT/RT training happened for the

participants some time ago. The results would have been methodically more valid if

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 117

participants gave their estimates of the relationship before they start the training or during

the first few weeks of the training, also if they could do the same estimate when they

complete (after) the training. Hence, possible future studies could involve administering the

same questionnaire in the beginning of the training and again when the training is complete,

and then comparing the two results.

In Choice Theory Dr. Glasser (1998) introduces the concept of total behaviour. The Total

Behaviour contains emotions as one of the four components (thinking, acting, feeling and

physiology). These components are inseparable and happen simultaneously – being

produced by the same human organism. However, in the current study we have used the 2-

factor scale asking the participants how they feel, and never asking them about the other

components of the Total Behaviour. For the purpose of further research, theoretically, it

would be more valuable to introduce other components of the Total Behaviour in the

questionnaires as well. Then it would be interesting to learn what our participants are

thinking, what actions are they performing and what physiological processes they can report

about when they say they feel energetic, energised, happy, content, pleasant or awake. It

would also be interesting to learn how they would name this Total Behaviour that they are

describing.

Furthermore, for deeper investigation into the participant’s motives for the behaviour they

are describing, it would be plausible to think about questions about the beliefs connected

to that behaviour. For example, someone may feel happy because people around them

are greeting them with smiles. Such a person may believe that their wellbeing is connected

to what other people are doing – to the outside world. Another person (who may report to

be as happy) may believe their happiness is coming from the inside. They may say they feel

happy because they are greeting others with a smile. In the world of Choice Theory, there is

a lot of difference between the two persons we’ve just described. One believing happiness

(or wellbeing) is coming from the outside and other believing that they are creating their

own happiness (and wellbeing) which is coming from the inside. The latter is behaving from

the Choice Theory beliefs.

From our study-design, and results, it is not clear what our participants believe about

their wellbeing and relationship in that sense. Even though they attribute the changes in

their relationship and wellbeing to their CT/RT training, it’s still unclear whether they think

they are responsible for the change. Or maybe they think training is some outside-world

circumstance which has changed them – being imposed onto them, or the other person

have changed their behaviour, hence relationship improved? The latter not being compatible

with the current theoretical thinking it the CT/RT circles.

We can see how these theoretical questions may steer similar future research. In the future

research we would like to see a focus on inspecting beliefs and attributions of the feelings

and states as parts of Total Behaviour, that people are reporting about.

One issue we could not control in the particular study design is the fact that all our

participants were those who attended the Reality Therapy conference. One could

hypothesise with a lot of certainty that the study participants were satisfied with their CT/RT

training and wanted to learn more, hence participating in an RT conference. So, our study

could not include those who were not satisfied with their training, and were not

interested in attending the European conference. For higher validity, future studies should

include training participants who stop their training before reaching their initial goal

(whether it’s a Certification – 2 years, Counsellor certificate – 4 years, Psychotherapy

diploma – 5 years, etc.). Such participants could complete the questionnaire whenever they

decide to stop their training.

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 118

Conclusion

Based on our results, we can conclude that participants at the RT conference find their

CT/RT training to be effective for improvement both their relationships and their

psychological wellbeing.

References:

Casstevens, W.J., (2011). A pilot study of health and wellness program development in an

International Center for Clubhouse Development (ICCD) Clubhouse: procedures,

implementation, and implications. Psychiatric Rehabilitation Journal, Vol 35(1), 2011, 37-43

Glasser, W. (1962). Mental Health or Mental Illness? Psychiatry for Practical Action. NY:

HarperCollins.

Glasser, W. (1998). Choice theory: A new psychology of personal freedom. NY:

HarperCollins.

Glasser, W. (2004). Warning: Psychiatry Can Be Hazardous to Your Mental Health. NY:

HarperCollins.

Glasser, W. (2005). Defining mental health as a public health issue. Los Angeles: William

Glasser Inc.

Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in

life. Journal of Health and Behavior Research, 43, 207–222.

Koštrun, S. (2004). Hedonistički i eudemonistički aspekt psihološke dobrobiti: adaptacija

dvofaktorske skale. Diplomski rad. Filozofski fakultet u Zagrebu, Odsjek za psihologiju.

http://darhiv.ffzg.unizg.hr/142/1/SlavenKo%C5%A1trun.pdf

Lucas, R.E. (2006). Does the Existence of Social Relationships Matter for Subjective Well-

Being?: Self and relationships: Connecting intrapersonal and interpersonal processes.

Dyrenforth, P. S. Vohs, K. D. (Ed); Finkel, E. J. (Ed), New York, NY, US: Guilford Press, 254-

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Malikiosi-Loizos, M, (2013) Personal Therapy for Future Therapists: Reflections on a Still

Debated. The European Journal of Counselling Psychology, 2013, Vol. 2(1),

doi:10.5964/ejcop.v2i1.4

Moller, N. P. & Rance, N. (2013): The good, the bad and the uncertainty: Trainees’

perceptions of the personal development group. Counselling and Psychotherapy Research:

Linking research with practice, 13 (4), 282-289.

Norcross, J.C., Lambert, M.J. (2011) Evidence-Based Therapy Relationships: Evidence-

Based Therapy Relationships, Norcross, J.C. (Ed), 1-5

Turkdogan, T., Duru, E. (2012). The Role of Basic Needs Fulfillment in Prediction of

Subjective Well-Being among University Students. Educational Sciences: Theory & Practice –

12(4), Autumn, 2440-2446.

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Umberson, D., Chen, D. M., House, J. S., Hopkins K., Slaten E. (1996). The Effect of Social

Relationships on Psychological Well-Being: Are Men and Women so Different?. American

Sociological Review, Vol 61, (October: 837-857)

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INSTRUMENT/QUESTIONNAIRE

Self-Evaluation Questionnaire: Reality Therapy Training Effectiveness for

Improving Relationships

Gender: M F

When did you start your CT/CT training? Year ________

Training you have completed:

year 1 year 2 Certificate WGI 3rd year PCP 4th year PCP 5th year PCP

Endorsement for:

Supervisor BIW Instructor Senior Instructor RTP ECP

Please name one of your important relationship that you have followed since the

beginning of the training till today: (You can use the box to specify the person you chose:

child, friend, partner, co-worker, etc.)

For the purpose of this survey it’s important to choose a relationship that you had prior the

CT/RT training, and still have it today.

How old is that person now? ____ years old

Please tick the box below to indicate how happy you were with that relationship before

your CT/RT training:

UNHAPPY ———– ———– ———– ———– HAPPY

How happy are you with that relationship lately?

UNHAPPY ———– ———– ———– ———– HAPPY

What was your level of closeness with that person before your CT/RT training?

(Please mark the level of closeness on the scale below):

———— ———— ———— ————

far neither far very

away nor close close

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 120

What is your current level of closeness?

———— ———— ———— ————

far neither far very

away nor close close

On the scale below please mark your needs’ satisfaction level with that person before

your CT/RT training:

———— ———— ———— ————

bottom highest

level level

On the scale below please mark your needs’ satisfaction level with that person lately:

———— ———— ———— ————

bottom highest

level level

To what extent do you attribute the change in that relationship to your RT knowledge and

Choice Theory internalisation?

NOT AT ALL —- A LITTLE BIT —- AVERAGE —- QUITE A LOT —- VERY MUCH

What elements of RT / CT do you think were the most important in that change:

________________________

In the table below please answer the questions: “How did you feel before the CT/RT

training?“ and “How do you feel recently?“ by marking the appropriate number. You can

assess the frequency by using the 5-point scale where 1 equals “very rarely“ and 5 equals

“very often”.

Before Training Currently

I feel… very very

rarely often

very very

rarely often

AWAKE 1—-2—-3—-4—-5 1—-2—-3—-4—-5

ENERGETIC 1—-2—-3—-4—-5 1—-2—-3—-4—-5

HAPPY 1—-2—-3—-4—-5 1—-2—-3—-4—-5

CONTENT 1—-2—-3—-4—-5 1—-2—-3—-4—-5

ENERGIZED 1—-2—-3—-4—-5 1—-2—-3—-4—-5

PLEASANT 1—-2—-3—-4—-5 1—-2—-3—-4—-5

If you have marked the difference between before the training and currently, then could

you assess to what extent you think the RT / CT training has helped you change?

NOT AT ALL —- A LITTLE BIT —- AVERAGE —- QUITE A LOT —- VERY MUCH

International Journal of Choice Theory and Reality Therapy • Spring 2018 • Vol. XXXVIII, Number 1 • 121

Brief Biography

Leon Lojk, psychologist, psychotherapist, senior instructor at William Glasser International,

and a founder of the Training and Counseling Centre in Slovenia (1996) established the

evidence that Choice Theory Psychology as well as Reality Therapy has its foundations in

science and philosophy. His “Scientific Argument for Reality Therapy” was the basis of

Reality Therapy recognition in Europe as scientifically grounded psychotherapeutic

approach.

In 1999 Leon established European Association for Reality Therapy (EART). Under his

leadership EART gain full acceptance as a regular member of the European Association for

Psychotherapy (EAP) by the EAP in Brussels, 2008.

Moreover, in 2009 the Training and Counseling Centre was in 2009 established as the

European Institute for Reality Therapy (EIRT). EIRT at the moment provides the reality

therapy psychotherapy training in Croatia, Bosnia& Herzegovina, Finland, Malta and

Slovenia.

Sadly, Leon passed away on 17th November 2014.

Danko Butorac is a psychologist and psychotherapist working at the „Family centre“ – a

state-funded counseling service in Senj, Croatia. In his daily practice he works with

individuals, couples, families and groups. As the member of the European Institute for

Reality Therapy faculty board, he is involved in providing training programs – supervising

and teaching Choice Theory. Currently president of the European Association for Reality

Therapy (EART). Happily married, father of five wonderful children.

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