Alice is a school counselor in her early 30s who has a severe drinking problem, which leads often to the neglect of her children. She also has a strained relationship with her husband, an airline pilot who is often not home. Alice is constantly aggravated and stressed, often stemming from her husband’s controlling, co-dependent behavior which she wishes to push away from. According to reality therapy, there is no specific mental disorder that leads to these problems; these human anxieties are all part of the human condition. Alice’s motivation for her behaviors may stem from the four basic needs for survival that are valued in reality therapy – the need to be loved and to love, the need to have power, the need for freedom and the need for fun. With Alice, she feels neglected when her husband Michael is not home, and powerless when he is home (since he takes the role of dominance in the relationship). Alcohol fuels her need for fun and freedom, which is often why she neglects her children (she needs to feel free to not have those responsibilities). While Alice’s need for survival is being met, her alcoholism is a way for her to forget her loneliness and the feeling of powerlessness and obligation she feels as a mother and wife.
When performing reality therapy on Alice, there are a few things I would still like to know about her that I could not glean from the film. I would like to know her feelings on the birth of her children, and the circumstances surrounding them – I believe it would give me great insight into her feelings towards her children as related to how she drinks (since she does abuse and neglect them when she is drunk). I also would like to ask her what level of freedom she would like out of an idealized relationship; this would allow me to see what she feels is missing from her marriage to Michael.
My primary goal in our therapy sessions would be to ensure that Alice felt that she was talking to someone that she could trust. The main goal of reality therapy is to establish a cooperative therapeutic relationship, tweaking my environment to make me seem as “responsible” as possible and likable. Alice needs to be able to trust me in order to open up and confide in me. My demeanor would be informal yet authoritative, so that Alice felt both open enough to relate to me on a peer level and trust me as an authority. In terms of driving therapy, I would ask questions that ask about her feelings about certain behaviors, to get her to understand her thought processes and emotions, not unlike cognitive-behavioral therapy. I would also ask her why she is doing the things she is doing at that moment in her life, to maintain the exploration of her immediate present that is central to reality therapy.
Among the three treatment goals I would have for Alice would include her taking responsibility for her own actions; this is a central tenet of reality therapy, as it would give her the agency and freedom she may feel is lacking in her life, and also put the onus on her to solve her problems – this would include active and guided rehabilitation for her alcoholism. I would also ask her to make a concrete decision about her relationship with Michael as to its level of satisfaction; if she is unsatisfied, she should choose to leave. My final goal would be to have her make every decision based on what gets her closer to her needs; I would help her establish and develop new behaviors that can lead to a greater level of satisfaction with her life.
Corsini, R. & Wedding, D. (2008) Current Psychotherapies (8th ed.). Belmont, CA:
Mandoki, L (dir.). (1994). When a man loves a woman (film). Perf. Andy Garcia, Meg Ryan,
Lauren Tom. Buena Vista Pictures.