The Comparison of Reality Therapy and Existential Theory in Addiction Counseling: The Case of Jack
The case of Jack illustrates a number of dilemmas faced by addiction counselors; namely, his resistance to treatment and external locus of control. Jack not only denies his need for counseling, but also denies that his alcohol use is any fault of his own. Thus, this paper will serve to analyze and evaluate two therapeutic approaches that emphasize personal responsibility and internal locus of control.
First, reality therapy may prove effective with Jack because it frames problems as goals, and also does not believe in the power of outside forces and the past (Miller, 2010). Jack has demonstrated an ability to identify problems, at least, the problems as he defines them. He identifies the unfairness of the war and his wife’s “yelling” at him. Framed as goals, Jack wants to find justice in the world and to have a more stable relationship with his wife. It is notable that both of Jack’s identified problems demonstrate an external locus of control; that is, he believes that his difficulties are caused by past events and by outside forces (ie, the war, his wife, his doctor). Obviously, Jack is able to identify and describe his “quality world,” and which is quite dissonant from his world as it is. According to reality theory, this dissonance disallows Jack from reaching internal homeostasis (Ingram, 2006), and his choice to drink likely stems from an attempt to dull the distress caused by the dissonance and hence reach a temporary equilibrium.
The strengths of reality therapy include its ability to simultaneously empower the individual and also rectify an external locus of control. It is also therapist-led, at least initially, and focuses less directly than other theories on emotion. Though these characteristics could also be seen as weaknesses of the theory, they may be helpful with Jack because he has low
investment in therapy and he is not directly demonstrating motivation to change. Leading Jack to identify the discrepancy between his chosen behaviors and his “quality world” may engender more overt investment and motivation. A weakness, at least in the case of Jack, may be reality theory’s lack of interest in past events and outside forces. Similarly, these characteristics can also be strengths of the theory; however, Jack has experienced significant trauma (the loss of his legs in the war and his recent medical news) that may hinder his ability to recognize the role of his individual behaviors in his addiction. These weaknesses do not discount the possible success of reality therapy with Jack, but may make success more gradual.
The significant trauma and suffering that Jack has experienced may also be addressed through an existential approach. Existential theory acknowledges that life is challenging, unfair, and (according to most theorists) devoid of intrinsic meaning (Frankl, 1985). This tenet validates Jack’s overt anger towards his wife and the loss of his legs. However, existential theory also posits that, though life can be challenging, individuals are autonomous in their decision to suffer. So, Jack’s unhappiness (and resultant addiction) is not the direct result of past traumatic events, but of his negative perspective and subsequent behaviors. This tenant can both empower and discourage clients; on one hand, the client is able to escape their self-imposed entrapment stemming from life’s struggles, on the other hand, the client becomes aware of their responsibility in their suffering.
Strengths of existential theory include its ability to turn suffering into meaningful achievement and focusing on the “here-and-now.” Thus, Jack’s past suffering and the suffering that he will surely endure should he cease alcohol use are not only potentially useful, but also not something that must be deeply explored in therapy. This is not to say that these experiences are irrelevant, but they are only as meaningful to the extent that they impact the present moment. However, weaknesses include lengthier courses of treatment and a lack of structure or specific techniques. Given Jack’s lack of investment and awareness, an existential approach to therapy may not be effective.
Thus, I would utilize reality therapy with Jack. Both approaches have their strengths and weaknesses, but I believe that Jack would be better served by a less confrontational approach, at least at first. He already seems to feel pressured and persecuted by his wife and doctor, and thus may interpret any confrontation as ill will. The reframing of problems as goals and solution-focused nature of reality therapy is more likely to increase Jack’s investment and motivation to change, as it allows him to initially avoid emotional exploration and does not require a great deal of internal insight. Instead of ceasing alcohol use because of his wife or doctor, he can quit because it facilitates the integration of his quality world into his current reality.
Frankl, V. E. (1985). Man’s search for meaning. Simon and Schuster.
Ingram, B. (2006). Clinical case formulations : matching the integrative treatment plan to the client. Hoboken, N.J: John Wiley ; Sons.
Miller, G. (2010). Learning the language of addiction counseling. Hoboken, N.J: Wiley.