APPLICATION OF REALITY THERAPY IN CONFLICT

MANAGEMENT FOCUSING ON FAMILY, SELF-CONCEPT

AND LOCUS OF CONTROL IN INDIVIDUALS WITH
ALCOHOL DEPENDENCE SYNDROME

By

Moulisha Sarker
Under the guidance of
Dr. Jai Prakash
Additional Professor & Head of Department,
Department of Clinical Psychology, RINPAS

Ranchi Institute of Neuro-Psychiatry and Allied Sciences

(RINPAS), Kanke, Ranchi-6 (Jharkhand), India

Dissertation
Submitted to Ranchi University, Ranchi
For the partial Fulfillment of the Degree of
Master of Philosophy in Clinical Psychology
Ranchi University, Ranchi
Jharkhand, India
Session: 2016-2018
 DECLARATION

I, Moulisha Sarker, hereby declare that the present study entitled “Application of
Reality Therapy in conflict management focusing on family, self-concept and locus of control
in individuals with alcohol dependence syndrome” is an original work, conducted by me under
the guidance of Dr. Jai Prakash, Additional Professor & Head of Department, Department of
Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS),
Kanke, Ranchi-6 (Jharkhand), India.

I further declare that this is an original work and has not been submitted or published
in part or as a whole for the award of any other degree or diploma in any university or institution
earlier.

Place:

Date: (Moulisha Sarker)

 CERTIFICATE

This is certified that Ms. Moulisha Sarker, is a bonafide student of M.Phil in Clinical
Psychology in RINPAS, for the session 2016-2018. The study entitled “Application of Reality
Therapy in conflict management focusing on family, self-concept and locus of control in
individuals with alcohol dependence syndrome” has been carried out under my guidance and
supervision for the partial fulfillment of M.Phil in Clinical Psychology.

This work is a record of candidate’s personal efforts and has not formed the basis for
award of any other degree or diploma to the candidate.

Place: (Dr. Jai Prakash)

Date: Additional Professor,
Head of Department,
Department of Clinical Psychology,
RINPAS, Kanke, Ranchi-834006
Jharkhand, INDIA
 ACKNOWLEDGEMENT

This dissertation has received abundant support from various people, and in this
section, I would like to avail this opportunity and extend my heartfelt gratitude to them.

First and foremost, I would like to mention my supervisor, Dr. Jai Prakash, Head of
Department, Department of Clinical Psychology, RINPAS. He has been the guiding light for
me and my work. The value of his timely guidance, creative inputs and constant motivation is
insurmountable. Of special mention is his inherent zest and spirit which reflects his persona.
This zest is infectious and never has a conversation with him failed to ignite in me a fire to
explore various opportunities and challenge my potential at every step. His encouragement to
me to dive up into novel territories has broadened my horizons not only in terms of academics,
but life in general. This dissertation is my humble tribute to him.

I would also like to express my regard for Prof. Dr. Amool Ranjan Singh, Professor,
Department of Clinical Psychology, RINPAS. The warmth and patience with which he has been
by my side throughout this dissertation is worthy of applause. Despite his hectic schedule, he
was always available for my queries and doubts. Without his support this dissertation would
never have seen its end.

I would like to thank Dr. Subhas Soren, Additional Professor of Department of

Psychiatry, and Director, RINPAS for giving me the opportunity to be a part of, and conduct
my research at his prestigious institute.

Dr. Masroor Jahan, Additional Professor, Department of Clinical Psychology, RINPAS

has been the symbol of strength, resilience, dedication and discipline for me. Words would
never be enough to express the worth of the ideals and virtues I have attempted to imbibe from
her. Without her guidance and support, I would never have been able to complete my M.Phil
course. Her selfless attitude and concern towards all the students is un measurable. I will
forever hold her in my heart as someone who has shaped me into a better human being.

Dr. K. S Sengar, Additional Professor, Department of Clinical Psychology, RINPAS

deserves to be mentioned for his immense knowledge and counsel, which has been very
valuable. I am deeply moved by his concern for the welfare of the students. I would like to thank
him for gracing me with his presence, brilliance and guidance.

I would also like to thank Dr. P.K. Singh, Associate Professor, Department of Clinical
Psychology, RINPAS. His calm demeanor which stands true to his area of specialization, has
been essential in lending positive vibes to the atmosphere.
 I would like to mention Dr. Manisha Kiran, Assistant Professor, and Head Of
Department, Psychiatric Social work; and Dr, Jayati Simlai, Head, Department of Psychiatry
for giving me insightful knowledge from their perspectives. Also to be thanked are all the
faculty members, senior residents, and psychiatric social workers at RINPAS. Together they
create a holistic environment with open and healthy channels of communication.

My innumerable visits to library during the course of the research were met with
accurate help and warmth from Late Smt. Tara Prasad, Senior Librarian, RINPAS, and Nirmal
ji, and all the staff of the library for the same.

Deepak Ji, Laboratory Assistant, Department of Clinical Psychology, RINPAS,

Khalique Ji and Dinesh Ji have been very helpful in making all our administrative work easier
and I am thankful to them for their warm smiles and kind works.

My utmost gratitude goes to all my patients and their family members for allowing me
to work with them. Without their co-operation, my research work would have been incomplete.
It takes a lot of courage to trust another being to enter their psyche, and I would like to thank
them for considering me worthy enough for it.

My family has been my pillar of strength throughout my life and I would like to take
this opportunity to thank them for never doubting y potential and providing me with an
environment of unconditional love and support.

I would finally like to thank all my friends, batch-mates, seniors and juniors for making
my experience at this institute comfortable and for providing me with their valuable inputs in
my research work. Palak upadhyay, Shruti Mittra, Devdeep Roy Chowdhury have always been
there for me and I would like to thank them for helping me to alleviate any stress encountered
throughout the course and the dissertation work.

Moulisha Sarker
CONTENTS

INTRODUCTION 2
ALCOHOLISM 2
EARLY SIGNS 5
LONG-TERM MISUSE 6
WARNING SIGNS 6
ETIOLOGY 6
LOCUS OF CONTROL 11
SELF-CONCEPT 12
REALITY THERAPY 12
CORE IDEAS 14
CHOICE THEORY 16
THE ‘WDEP’ SYSTEM 23
RATIONALE OF THE STUDY 25
REVIEW OF LITERATURE 27
Studies on the application of reality Therapy intervention on psychiatric disorders and other
psychological issues. 27
Studies on the application and efficacy of different psychotherapeutic interventions on issues
with alcohol dependence syndrome. 33
Studies on the application and efficacy of Reality Therapy on issues with alcohol dependence
syndrome 35
Family and alcohol dependence syndrome 36
Self-concept, locus of control in alcohol dependence syndrome 36
METHODOLOGY 40
PROBLEM INVESTIGATED: 40
AIM 40
OBJECTIVES 40
RESEARCH DESIGN 40
SAMPLE 40
INCLUSION CRITERIA FOR THE STUDY GROUP 41
EXCLUSION CRITERIA FOR THE STUDY GROUP 41
TOOLS FOR ASSESSMENT 41
REALITY THERAPY: STAGES OF THERAPY 45
PROCEDURE 53
DATA ANALYSIS 54
RESULTS 57
CASE 1: DK 57
CASE 2: MM 63
CASE 3: MS 70
CASE 4: DS 77
CASE 5: GK 84
DISCUSSION 91
DISCUSSION OF METHODOLOGY 91
DISCUSSION OF CASE SUMMARIES 91
FAMILY AND ALCOHOL DEPENDENCE 94
SELF-CONCEPT AND ALCOHOL DEPENDENCE 94
LOCUS OF CONTROL AND ALCOHOL DEPENDENCE 95
SUMMARY AND CONCLUSION 98
AIM 98
OBJECTIVES 98
RESEARCH DESIGN 98
SAMPLE 98
INCLUSION CRITERIA FOR THE STUDY GROUP 98
EXCLUSION CRITERIA FOR THE STUDY GROUP 99
TOOLS FOR ASSESSMENT 99
PROCEDURE 99
DATA ANALYSIS 100
RESULTS 100
CONCLUSION 100
LIMITATIONS AND FUTURE DIRECTIONS 101
Limitations of the present research 101
Areas for focus in clinical practice and future research 101
CLINICAL IMPLICATIONS 101
REFERENCES 104
APPENDICES
 ABSTRACT

Alcohol dependence is one such psychiatric illness which is on rise and has debilitating
effects on physiological, psychological, psychosocial aspects of the individual. The current
study aims to identify the conflict areas pertaining to family, self-concept and degree of locus
of control in alcohol dependent individuals and resolve those identified conflicts with the
application of Reality Therapy. The methodology comprised of selection of participants
through purposive sampling. Using detailed interview, administration of Sack’s Sentence
Completion Test and Locus of Control Scale the areas of conflict were assessed and
accordingly Reality Therapy procedures and techniques were applied to bring a positive change
in the individuals. The nature of the study is qualitative and thematic analysis is used. The
results revealed satisfactory positive change in the participants after application of Reality
Therapy focusing on the conflict areas.
 CHAPTER 1

INTRODUCTION

1
INTRODUCTION

ALCOHOLISM

The term 'alcohol dependence' has replaced 'alcoholism' as a term in order that
individuals do not internalize the idea of cure and disease, but can approach alcohol as a
chemical they may depend upon to cope with outside pressures.

The contemporary definition of alcohol dependence is still based upon early research.
There has been considerable scientific effort over the past several decades to identify and
understand the core features of alcohol dependence. This work began in 1976, when the British
psychiatrist Griffith Edwards and his American colleague Milton M. Gross collaborated to
produce a formulation of what had previously been understood as ‘alcoholism’ – the alcohol
dependence syndrome.

In 2013 'alcohol dependence' was reclassified as alcohol use disorder (alcoholism)

along with alcohol abuse in DSM-5.

Chapter V of the International Classification of Diseases and Health Related Problems

(ICD-10;1992) defines the (alcohol) dependence syndrome as “a cluster of behavioral,
cognitive and physiological phenomena that develop after repeated (alcohol) use and that
typically include a strong desire to take (alcohol), difficulties in controlling its use, persisting
in its use despite harmful consequences, a higher priority given to drug use than to other
activities and obligations, increased tolerance, and sometimes a physical withdrawal state.”

Diagnostic guidelines A definite diagnosis of dependence should usually be made only

if three or more of the following have been present together at some time during the previous
year:

a. a strong desire or sense of compulsion to take the substance;

b. difficulties in controlling substance-taking behavior in terms of its onset,
termination, or levels of use;
c. a physiological withdrawal state when substance use has ceased or been
reduced, as evidenced by: the characteristic withdrawal syndrome for the
substance; or use of the same (or a closely related) substance with the intention
of relieving or avoiding withdrawal symptoms;

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 d. (d)evidence of tolerance, such that increased doses of the psychoactive
substance are required in order to achieve effects originally produced by lower
doses (clear examples of this are found in alcohol- and opiate-dependent
individuals who may take daily doses sufficient to incapacitate or kill
nontolerant users);
e. progressive neglect of alternative pleasures or interests because of psychoactive
substance use, increased amount of time necessary to obtain or take the
substance or to recover from its effects; (f ) persisting with substance use despite
clear evidence of overtly harmful consequences, such as harm to the liver
through excessive drinking, depressive mood states consequent to periods of
heavy substance use, or drug-related impairment of cognitive functioning;
efforts should be made to determine that the user was actually, or could be
expected to be, aware of the nature and extent of the harm.

Narrowing of the personal repertoire of patterns of psychoactive substance use has also
been described as a characteristic feature (e.g. a tendency to drink alcoholic drinks in the same
way on weekdays and weekends, regardless of social constraints that determine appropriate
drinking behavior).

It is an essential characteristic of the dependence syndrome that either psychoactive

substance taking or a desire to take a particular substance should be present; the subjective
awareness of compulsion to use drugs is most commonly seen during attempts to stop or control
substance use. This diagnostic requirement would exclude, for instance, surgical patients given
opioid drugs for the relief of pain, who may show signs of an opioid withdrawal state when
drugs are not given but who have no desire to continue taking drugs.

The dependence syndrome may be present for a specific substance (e.g. tobacco or
diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of different
substances (as for those individuals who feel a sense of compulsion regularly to use whatever
drugs are available and who show distress, agitation, and/or physical signs of a withdrawal
state upon abstinence).

The diagnosis of the dependence syndrome may be further specified by the following
five-character codes: Currently abstinent, currently abstinent, but in a protected environment
(e.g. in hospital, in a therapeutic community, in prison, etc.), Currently on a clinically
supervised maintenance or replacement regime [controlled dependence] (e.g. with methadone;

3
nicotine gum or nicotine patch), Currently abstinent, but receiving treatment with aversive or
blocking drugs (e.g. naltrexone or disulfiram), Currently using the substance [active
dependence], Continuous use, Episodic use [dipsomania]

Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking
of alcohol that results in mental or physical health problems. It was previously divided into two
types: alcohol abuse and alcohol dependence. In a medical context, alcoholism is said to exist
when two or more of the following conditions is present: a person drinks large amounts over a
long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great
deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage
results in social problems, usage results in health problems, usage results in risky
situations, withdrawal occurs when stopping, and alcohol tolerance has occurred with use.

The WHO calls alcoholism "a term of long-standing use and variable meaning", and
use of the term was disfavored by a 1979 WHO expert committee. The Big
Book (from Alcoholics Anonymous) states that once a person is an alcoholic, they are always
an alcoholic, but does not define what is meant by the term alcoholic in this context. In
1960, Bill, co-founder of Alcoholics Anonymous (AA), said:

We have never called alcoholism a disease because, technically speaking, it is not a

disease entity. For example, there is no such thing as heart disease. Instead there are many
separate heart ailments, or combinations of them. It is something like that with alcoholism. We
did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease
entity. We always called it an illness, or a malady—a far safer term for us to use. In professional
and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and
alcohol dependence, and sometimes is considered equivalent to alcohol dependence. Talbot
(1989) observes that alcoholism in the classical disease model follows a progressive course: if
a person continues to drink, their condition will worsen. This will lead to harmful consequences
in their life, physically, mentally, emotionally and socially.

Johnson's typologies

Johnson (1980) explores the emotional progression of the addict’s response to alcohol.
He looks at this in four phases. The first two are considered "normal" drinking and the last two
are viewed as "typical" alcoholic drinking. Johnson's four phases consist of:

4
 Learning the mood swing. A person is introduced to alcohol (in some cultures this can
happen at a relatively young age), and the person enjoys the happy feeling it produces. At this
stage, there is no emotional cost.

Seeking the mood swing. A person will drink to regain that feeling of euphoria
experienced in phase 1; the drinking will increase as more intoxication is required to achieve
the same effect. Again at this stage, there are no significant consequences.

At the third stage there are physical and social consequences, i.e., hangovers, family
problems, work problems, etc. A person will continue to drink excessively, disregarding the
problems.

The fourth stage can be detrimental, as Johnson cites it as a risk for premature death.
As a person now drinks to feel normal, they block out the feelings of overwhelming guilt,
remorse, anxiety, and shame they experience when sober.

Milam & Ketcham's physical deterioration stages

Other theorists such as Milam and Ketcham (1983) focus on the physical deterioration
that alcohol consumption causes. They describe the process in three stages:

Adaptive stage – The person will not experience any negative symptoms, and they
believe they have the capacity for drinking alcohol without problems. Physiological changes
are happening with the increase in tolerance, but this will not be noticeable to the drinker or
others.

Dependent stage – At this stage, symptoms build up gradually. Hangover symptoms

from excessive drinking may be confused with withdrawal symptoms. Many addicts will
maintain their drinking to avoid withdrawal sickness, drinking small amounts frequently. They
will try to hide their drinking problem from others and will avoid gross intoxication.

Deterioration stage – Various organs are damaged due to long-term drinking. Medical
treatment in a rehabilitation center will be required; otherwise, the pathological changes will
cause death.

EARLY SIGNS

The risk of alcohol dependence begins at low levels of drinking and increases directly
with both the volume of alcohol consumed and a pattern of drinking larger amounts on an

5
occasion, to the point of intoxication, which is sometimes called "binge drinking". Young
adults are particularly at risk of engaging in binge drinking.

LONG-TERM MISUSE

Alcoholism is characterized by an increased tolerance to alcohol–which means that an

individual can consume more alcohol–and physical dependence on alcohol, which makes it
hard for an individual to control their consumption. The physical dependency caused by alcohol
can lead to an affected individual having a very strong urge to drink alcohol. These
characteristics play a role in decreasing an alcoholic's ability to stop drinking. Alcoholism can
have adverse effects on mental health, causing psychiatric disorders and increasing the risk of
suicide. A depressed mood is a common symptom of heavy alcohol drinkers.

WARNING SIGNS

Warning signs of alcoholism include the consumption of increasing amounts of alcohol

and frequent intoxication, preoccupation with drinking to the exclusion of other activities,
promises to quit drinking and failure to keep them, the inability to remember what was said or
done while drinking (colloquially known as "blackouts"), personality changes associated with
drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking,
dysfunction or other problems at work or school, the loss of interest in personal appearance or
hygiene, marital and economic problems, and the complaint of poor health, with loss of
appetite, respiratory infections, or increased anxiety.

ETIOLOGY

Sociocultural factors and individual vulnerability both appear to play important roles in
the causation of alcoholism.

Sociocultural factors

These risk factors include male gender, lower education, lower income, marital
breakdown, certain occupations, cultural ambivalence about drinking, socially condoned
drunkenness, anomie/marginalization and social stress.

6
Individual vulnerability

1. Genetic influences An individual with alcoholic parents or siblings is twice as likely to

develop the disorder; the risk is threefold if second or third degree relatives are also
involved. Many twin studies have shown that there is greater concordance (i.e. the
occurrence of the disorder in both the twins) in identical twins (who have a common
genetic stock) than in fraternal twins (who only share 50% of their genes), thus strongly
suggesting a genetic basis to alcoholism. However, as 40-70% of identical twins of
alcoholics do not show the disorder, non-genetic causes are clearly implicated in the
aetiological process as well.
Adoption studies report an increased risk of the disorder in the children of alcoholics,
regardless of the family environment they grew up in, that is, their own or an adoptive
family. The evidence also suggests that the biological parents of alcoholic adoptees are
also more likely to show antisocial behavior in tandem with alcoholism.
2. Biological predisposition Individuals with a family history of alcohol problems appear
to be less sensitive to its effect, thus potentially predisposing them to heavier drinking
patterns. Biological markers of vulnerability to alcoholism appear to include lowered
serotonin levels, abnormal findings in neurophysiological tests like event-related
potentials (where a reduced amplitude and increased latency of the P300 brainwave is
found), and transketolase deficiency.
3. Molecular genetics The first genome-wide screens for alcoholism in humans have
identified several chromosomal regions linked to both vulnerability and resilience to
alcohol dependence.
4. Psychological factors
 Personality While more than half the alcoholic population do not share any
particular personality background, there is a significant minority which appears to
share certain distinctive traits. One such group scores low in novelty seeking and
high in harm avoidance, while another group can be characterized as natural thrill
seekers. Also, conduct disorder and antisocial behavior are strong predictors of
alcohol misuse.
 Psychodynamic processes: The self-medication hypothesis of addictions postulates
that deficiencies in self-care and self-esteem result in the individuals turning to
alcohol to alleviate their distress

7
  Learning Alcohol abuse is seen as a behavior that results from its association with
cues, and from the action of positive (pleasant effects) and negative (stress
reduction) behavioral reinforcement. Through social exposure, alcohol users learn
to accentuate the positive aspects of drinking and minimize the negative.
 Comorbid psychiatric disorders The risk of alcoholism appears to be elevated in
persons with depression, anxiety, bipolar mood disorder, schizophrenia, panic
disorder, social phobia, post-traumatic stress disorder, attention deficit
hyperactivity disorder, and antisocial and borderline personality disorders.
 Mood and anxiety disorders are especially prevalent among those dependent on
alcohol. These 2 conditions appear to share some genetic components, a feature
especially noted in women. In the majority of cases, depressive and anxiety
symptoms are secondary to the primary alcohol habit and abate when the alcohol
consumption is reduced. The mechanism by which this occurs is not well
understood but it is thought that dopamine and serotonin neurotransmitter pathways
in the brain may be involved. Also, psychosocial problems associated with alcohol
dependence, such as unemployment, poverty, relationship difficulties etc. may
increase the risk of comorbid depression and anxiety.

Jellinek used the Greek alphabet for labelling purposes and described five distinct types
of alcoholism: alpha, beta, gamma, delta and epsilon.

ALPHA ALCOHOLISM represents purely psychological dependence on the abusive

effects of alcohol. However the alpha alcoholic is nonetheless an abusive drinker and is often
very resistant to treatment. Because alpha drinkers are not physically addicted to alcohol, they
do not experience withdrawal symptoms if they temporarily stop drinking, nor do they progress
through stages.

BETA ALCOHOLISM on the other hand has physical complications (e.g., gastritis or
cirrhosis) related to alcohol consumption. There is no indication of physical or psychological
dependence or progression with Beta alcoholics, but heavy drinking often continues despite
medical complications.

GAMMA ALCOHOLISM involves physical addiction with withdrawal symptoms

(shakes and nausea when drinking is stopped), a definite progression from psychological to
physical dependence, and loss of control- uncontrollable drinking against the alcoholic’s own
wishes. The Gamma alcoholic experiences a physical craving for alcohol and undergoes

8
marked behavioral and personality changes. The damage to the alcoholic’s health and financial
and social standing is prominent than in other types of alcoholism.

DELTA ALCOHOLISM is similar to gamma variety, but in this case the drinker can
control his/ her intake in a given situation.

Finally EPSILON ALCOHOLISM refers to the periodic drinker who may drink
infrequently but does so in abusive binges.

Jellinek himself explained that of all the various types of alcoholism, only the Gamma
and Delta varieties could be considered diseases. He based this conclusion on the progressive
physical and behavioral changes that these alcoholics undergo.

Jellinek’s second major concept was that many alcoholics go through a series of ever
worsening stages or phases.

At the first stage, the pre-alcoholic symptomatic phase, the drinker begins to consume
alcohol for relief. As the prealcoholic increases his consumption to combat stress, other forms
of tension reduction are discarded, and soon alcohol becomes the major response to any stress.
Drinking becomes an almost daily habit, and an increase in tolerance is often noted.

The next phase is called prodromal and is characterized by five definite symptoms:

1. Blackouts or periods of memory loss while drinking

2. Surreptitious drinking, which involves sneaking drinks
3. Gulping drinks
4. Preoccupation with drinking and
5. Guilt associated with inappropriate behavior while intoxicated. At this phase, a
denial or alibi system is formulated.

The next stage, called the crucial phase, involves loss of control and signals physical
addition. Loss of control can be described as a chain reaction- one drink leads to the next.
Individuals drink to unconsciousness or until they are forced to quit, even though they know
the consequences will be negative. This phase may best be understood as the loss phase- loss
of job, friends, health, etc.

The final phase is called chronic and is the last phase before death. Alcoholics who
progress to the chronic phase have a total obsession with alcohol consumption and have often
lost their families, friends and jobs. Major symptoms of the chronic phase are a loss of tolerance
for alcohol, morning and day drinking, loss of memory and ethical or moral deterioration.

9
1. Alcohol related sociocultural problems:

Family violence: abuse

Child abuse is common in families with alcoholic parent. The connection between
physical abuse and alcohol can be seen in the isolation of alcoholic families and abusive
families. Many alcoholics were themselves abused as children and have physical abuse and
incest as part of their family history.

Family violence, however, is not limited to child abuse. The battering family is often
seen by professionals working with abuse in families. The husband who beats his wife may
beat his children, and this wife and the children may retaliate with violence against the husband
as well as each other (Scott, 1974).

Beating does not necessarily occur during intoxication, and often violence is part of
sober behavior (Roy, 1977). In families in which violence occurs during drinking episodes,
beatings do not stop when drinking stops. However, men often drink when they feel like beating
their wives because they are released of responsibility if they are drunk (Gelles, 1972).

As stress level increases in our society, violence seems to become the way to solve
problems. Similarly, as stress increases in the alcoholic family with alcohol abuse or sobriety,
the tendency to use violence to solve problems increases. Steinmetz and Straus (1974) found
that the more intimate the relationships of a group, the higher is the level if conflict. Because
the family is the most intimate group in society, the level of conflict is very high. They also
believed that conflict is an integral part of the family, but as long as society does not see family
conflict as wrong, there will be reluctance in the family to learn nonviolent ways to solve
problems. The problem of abuse in the family is multicausal. Poverty, negative family
circumstances, and occupational and emotional problems contribute to abuse along with
drinking behavior.

2. Workplace problems:

Alcohol consumption can affect work performance in several ways:

Absences - There is ample evidence that people with alcohol dependence and drinking
problems are on sick leave more frequently than other employees, with a significant cost to
employees, employers, and social security systems. In Costa Rica, an estimated 30% of
absenteeism may be due to alcohol. In Australia, a survey showed that workers with drinking
problems are nearly 3 times more likely than others to have injury-related absences from work.

10
 Work accidents - In Great Britain, up to 25% of workplace accidents and around 60%
of fatal accidents at work may be linked to alcohol. In India about 40% of work accidents have
been attributed to alcohol use.

Productivity - Heavy drinking at work may reduce productivity. In Latvia, 10% of

productivity losses are attributed to alcohol. Performance at work may be affected both by the
volume and pattern of drinking. Co-workers perceive that heavy drinkers have lower
performance, problems in personal relationships and lack of self-direction, though drinkers
themselves do not necessarily perceive effects on their work performance

Unemployment- Heavy drinking or alcohol abuse may lead to unemployment and

unemployment may lead to increased drinking.

3. Economic consequences

The economic consequences of alcohol consumption can be severe, particularly for the
poor.

Apart from money spent on drinks, heavy drinkers may suffer other economic problems
such as lower wages and lost employment opportunities, increased medical and legal expenses,
and decreased eligibility for loans. A survey in Sri Lanka indicated that for 7% of men, the
amount spent on alcohol exceeded their income.

LOCUS OF CONTROL

Locus of control is popular personality dimension that describes the degree to which
people perceive and expect that reinforcements or rewards are contingent upon their personal
action (Internal control) or upon the result of luck, fate, chance or the actions of powerful others
(external control) (Rotter, 1954).

When people have an internal locus of control, they expect they will determine their
own futures because of their own actions. If we were to imagine life as a sort of theatrical play,
these people would consider themselves the directors of their own lives. Conversely, when
people have an external locus of control they do not expect to have control over their futures.
Things just happen to them. From this perspective, they have no control or influence over their
lives.

11
SELF-CONCEPT

The term self-concept is a general term used to refer to how someone thinks about,
evaluates or perceives themselves. To be aware of oneself is to have a concept of oneself.

Baumeister (1999) provides the following self-concept definition:

"The individual's belief about himself or herself, including the person's attributes and
who and what the self is".

The self-concept is an important term for both social and humanistic psychology.

REALITY THERAPY

Reality therapy (RT) is an approach to psychotherapy and counseling. Developed by

William Glasser in the 1960s, RT differs from conventional psychiatry, psychoanalysis and
medical model schools of psychotherapy in that it focuses on what Glasser calls psychiatry's
three Rs: realism, responsibility, and right-and wrong, rather than symptoms of mental
disorders. Reality therapy maintains that the individual is suffering from a socially universal
human condition rather than a mental illness. It is in the unsuccessful attainment of basic needs
that a person's behavior moves away from the norm. Since fulfilling essential needs is part of
a person's present life, reality therapy does not concern itself with a client's past. Neither does
this type of therapy deal with unconscious mental processes. In these ways reality therapy is
very different from other forms of psychotherapy.

The reality therapy approach to counseling and problem-solving focuses on the here-
and-now actions of the client and the ability to create and choose a better future. Typically,
clients seek to discover what they really want and how they are currently choosing to behave
in order to achieve these goals. According to Glasser, the social component of psychological
disorders has been highly overlooked in the rush to label the population as sick or mentally ill.
Reality therapy attempts to separate the client from the behavior. Just because someone is
experiencing distress resulting from a social problem does not make him sick, it just makes
him out of sync with his psychological needs.

Reality therapy was developed at the Veterans Administration hospital in Los Angeles
in the early 1960s, by William Glasser and his mentor and teacher, psychiatrist Harrington. In
1965, Glasser published the book Reality Therapy in the United States. The term refers to a
process that is people-friendly and people-centered and has nothing to do with giving people a

12
dose of reality (as a threat or punishment), but rather helps people to recognize how fantasy
can distract them from their choices they control in life. Glasser posits that the past is not
something to be dwelled upon but rather to be resolved and moved past in order to live a more
fulfilling and rewarding life. By the 1970s, the concepts were extended into what Glasser then
called "Control Theory", a term used in the title of several 2 of his books. By the mid-1990s,
the still evolving concepts were described as "choice theory", a term conceived and proposed
by the Irish reality therapy practitioner Christine O'Brien Shanahan and subsequently adopted
by Glasser. The practice of reality therapy remains a cornerstone of the larger body of his work.
Choice theory asserts that we are self-determining beings because we choose our behavior and
we are responsible for how we are acting, thinking, feeling and also for our physiological states.
Choice theory explains how we attempt to control our world and those in it.

Reality Therapy is an approach to counselling developed by Dr. William Glasser in the

United States in the 1950s and 1960s.

In many ways, Reality therapy parallels existential therapy, person centered therapy
and Gestalt Therapy. Like these three theories, reality therapy is concerned with the
phenomenological world of the client and stresses the subjective way in which clients perceive
and react to their world from an internal locus of evaluation. Glasser stresses that it is not the
way the real world exists that influences our behavior, but the way we perceive it to exist. So
our behavior is always our best attempt to control our perceptions of the external world so they
fit our internal, need satisfying pictures.

In common with the existential approach, Reality Therapy is based on the assumption
that we do not have to be a victim of our past or present unless we choose to be. Nor are we at
the mercy of unconscious motivations. We have more control over life than most of us believe.
The more effectively we exercise our control, the more fulfilled we will be (Glasser, 1989).

The general aim of this therapeutic system, is to provide conditions that will help clients
develop the psychological strength to evaluate their present total behavior- specifically, its
doing, thinking, feeling, and physiological components. If it does not meet their needs, the
clients are assisted in developing more effective total behavior.

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CORE IDEAS

Action

Glasser believes that there are five basic needs of all human beings: survival, love and
belonging, power, freedom or independence, and fun. Reality therapy maintains that the biggest
reason a person is in pain and acting out is because he/she lacks that one important 'other being'
to connect with. Glasser believes the need for love and belonging is the primary need because
we need other people in order to satisfy all the other needs. Therefore, in a cooperative
therapeutic relationship, the therapist must create an environment where it is possible for the
client to feel connected to another 'responsible' person (the therapist) that they actually like and
would actually choose as a friend in their real life.

Reality therapy maintains that the core problem of psychological distress is that one or
more of the client's essential needs are not being met thereby causing the client to act
irresponsibly. The therapist then addresses this issue and asserts that the client assume
responsibility for their behavior. Reality therapy holds that we learn responsibility through
involvement with other responsible people. We can learn and re-learn responsibility at any time
in life". The therapist then focuses on realistic goals in order to remedy the real life issues that
are causing discomfort.

Glasser's choice theory is composed of four aspects; thinking, acting, feeling, and
physiology. We can directly choose our thoughts and our actions; we have great difficulty in
directly choosing our feelings and our physiology (sweaty palms, headaches, nervous tics,
racing pulse, etc.).

Emotions (feelings) are the client's self-evaluation is a critical and crucial first step. A
self-realization that something must change, realization and acceptance that change is, in fact,
possible, leads to a plan for making better choices—plans that are at the heart of successful
reality therapy. The therapist helps the client create a workable plan to reach a goal. It must be
the client's plan, not the counselor's. The essence of a workable plan is that the client can
implement it—it is based on factor under the client's control. Reality therapy strives to
empower people by emphasizing the power of doing what is under their control.

Doing is at the heart of reality therapy.

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Behavior

Behavior, in the real world is an immediate and alive source of information about how
we are doing and whether we are happy with what is going on in our lives. However, it is very
hard to choose and to change our emotions directly. It is easier to change our thinking- to
decide, for example, that we will no longer think of ourselves as victims or to decide that in
our thoughts we will concentrate on what we can do rather than what we think everybody else
ought to do. Reality Therapists approach changing "what we do" as a key to changing how we
feel and how we will work to obtain what we want. These ideas are similar to those in other
therapy movements such as Re-evaluation Counseling and person-centered psychotherapy,
although the former emphasizes emotional release as a method of clearing emotional hurt.

Control

Control is a key issue in reality therapy. Human beings need control to meet their needs:
one person seeks control through position and money, and another wants to control their
physical space. Control gets a client into trouble in two primary ways: when he or she tries to
control other people, and when he or she uses drugs and alcohol to give him or her a false sense
of control. At the very heart of choice theory is the core belief that the only person the client
can really control is him or herself. If the client thinks he or she can control others, then he or
she is moving in the direction of frustration. If the client thinks others can control him or her
and follows up by blaming them for all that goes on in his or her life, then he or she tends to
do nothing and heads for frustration. There may be events that happen to the client which is
out of his or her control, but ultimately, it is up to the client to choose how to respond to these
events. Trying to control other people is a vain naive hope, from the point of view of reality
therapy. It is a never-ending battle which alienates the client from others and causes endless
pain and frustration. This is why it is vital for the client to stick to what is in his or her own
control and to respect the rights of other people to meet their needs. The client can, of course,
get an instant sense of control from alcohol and some other drugs. This method of control,
however, is false, and skews the true level of control the client has over him or herself. This
creates an inconsistent level of control which creates even more dissonance and frustration.

Focus on the present

While traditional psycho-analysis and counseling often focus on past events, reality
therapy and choice theory solutions lay in the present and the future. Practitioners of reality

15
therapy may visit the past but never dwell on it. In reality therapy, the past is seen as the source
of the client's wants and his or her ways of behaving, not as a cause. A client's 'Quality World'
is examined as to what this person wants in his life and is it realistic. Supposedly each person
from birth has taken pictures or stored mental images that he wants in his Quality World. Also,
each person strives to attain these things that have given pleasure in the past. Everyone's quality
world is different, so naturally when people enter into a relationship their quality world most
likely will not match up with their new partner.

Choice Theory explains why Reality Therapy works.

CHOICE THEORY

The 1998 book, Choice Theory: A New Psychology of Personal Freedom, is the primary
text for all that is taught by The William Glasser Institute. Choice theory states that:

all we do is behave,

that almost all behavior is chosen, and

that we are driven by our genes to satisfy five basic needs: survival, love and belonging,
power, freedom and fun.

In practice, the most important need is love and belonging, as closeness and
connectedness with the people we care about is a requisite for satisfying all of the needs.

Choice theory, with the Seven Caring Habits, replaces external control psychology and
the Seven Deadly Habits. External control, the present psychology of almost all people in the
world, is destructive to relationships. When used, it will destroy the ability of one or both to
find satisfaction in that relationship and will result in a disconnection from each other. Being
disconnected is the source of almost all human problems such as what is called mental illness,
drug addiction, violence, crime, school failure, spousal abuse, to mention a few.

Relationships and our Habits

Seven Caring Habits Seven Deadly Habits

1.Supporting 1.Criticizing

2. Encouraging 2. Blaming

3. Listening 3. Complaining

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 4. Accepting 4. Nagging

5. Trusting 5. Threatening

6 .Respecting 6. Punishing

7. Negotiating differences 7 .Bribing, rewarding to control

The Ten Axioms of Choice Theory

1. The only person whose behavior we can control is our own.

2. All we can give another person is information.
3. All long-lasting psychological problems are relationship problems.
4. The problem relationship is always part of our present life.
5. What happened in the past has everything to do with what we are today, but we can
only satisfy our basic needs right now and plan to continue satisfying them in the future.
6. We can only satisfy our needs by satisfying the pictures in our Quality World.
7. All we do is behave.
8. All behavior is Total Behavior and is made up of four components: acting, thinking,
feeling and physiology.
9. All Total Behavior is chosen, but we only have direct control over the acting and
thinking components. We can only control our feeling and physiology indirectly
through how we choose to act and think.
10. All Total Behavior is designated by verbs and named by the part that is the most
recognizable.

Basic Needs and Feelings

1) Survival - Physiological Need – All living creatures struggle to survive & reproduce
the species. Also, humans look beyond present survival needs & make an effort to live in ways
that lead to longevity (exercise & eating healthy). Survival comes from the “old brain” – base
of the brain. As humans developed, cerebral cortex or “new brain” allows us to have needs
beyond survival. If survival was our only need, there would be no anorexia or suicide. Also
getting along better with each other would result in more survival and less death.

2) Love & Belonging - Psychological Need – It’s a 2-way street - “I need to receive
love, be involved & feel like I belong” , “I feel better if I am able to give love & acceptance to
others” – Most of psychotherapy in countries where survival needs are primarily met revolve

17
around this need – Either lack of love or deteriorating love are associated with, Suicide, Mental
Illness, Infidelity, Murder, Feelings of jealousy, abandonment, revenge & despair – External
control is used extensively here.

3) Power – Psychological Need – Distinctive human need – Includes feeling of

accomplishment, success, recognition, respect & being heard. For some, the need is insatiable.
For others, they are satisfied with the amount they have. For some, it comes at the expense of
their relationships with others (greed, external control over others). But for some, it may work
for the common good (saving lives or developing new treatments). We need to strive for the
latter rather than the former.

4) Freedom to express ideas, choices & ability to be constructively creativity –

Psychological Need – It concerns us most when we perceive that our freedom is threatened.
Need balance between “your need to try to force me to live my life the way you want & my
need to be free of that force – This balance is best expressed by the golden rule “Do unto others
as you would have others do unto you”. External control is the enemy of freedom – When we
lose freedom, we lose a defining human characteristic (creativity).

5) Fun – Psychological Need – The genetic reward for learning – We play all our lives
& as a result we learn all our lives. “Fun is best defined by laughter”. “People who fall in love
are learning a lot about each other, & they find themselves laughing almost continually”.
“Laughing & learning are the foundation of all successful long-term relationships.

Quality world

As people grow up & interact with environment, they find some parts of world satisfy
their needs & make them feel good & other parts do not. They take this information & build
into their memory pictures of people, things, beliefs or situations which seem to be the best
ways to satisfy one or more of the basic needs .The conglomerate of these wants is the world
in which we would like to live & is called our Quality World. It is dynamic as our experiences
grow. Anytime we feel good, we are choosing to behave so that something or someone in our
real world comes close to matching the image in our quality world Choice Theory (Quality
World).

Everyone has their own unique quality world. Total objectivity is a myth. It could only
exist if we all had exactly the same quality worlds. It’s just like jury trials – everyone sees
things from a different perspective. Only things that are not important to us can be seen as they

18
truly are. Luckily, there are enough of these unimportant things to almost all of us that we can
agree that what is out there is REALITY Choice Theory (Quality World). Besides being in
conflict with other’s quality world wants, our own quality world wants can be in conflict with
each other and/or they can be linked together. Advertises hope that consumers will put their
product into their quality world & link them to the images the consumers already have in their
minds (heroes, beauty, power, wealth, etc.). Pictures or wants exist in a priority & often it is
the therapist’s job to help clients to determine priorities about what is need satisfying in the
long term & not just for the moment Choice Theory (Quality World).

Besides being in conflict with other’s quality world wants, our own quality world wants
can be in conflict with each other and/or they can be linked together. It is the therapist’s job to
help clients to determine priorities about what is need satisfying in the long term & not just for
the moment.

Total Behavior Throughout the course of therapy, clients describe the various
components of their total behavior: physiology, emotions, thinking and actions. At various
times some level of the behavioral suitcase or wheel of the car needs more intense scrutiny than
the other components. Because actions are more explicitly chosen, most discussion centers on
them.

Physiology: reality therapists follow the standard practice of responding to physical

abuse, injury, and pain. They discuss physical symptoms as appropriate and especially their
link to mental health. The therapist’s awareness of pain symptoms, real or imagined, helps him
or her decide on the degree of immediacy for a referral to a medical professional. Some such
symptoms accompany feelings of distress and depression and impede social or occupational
functioning, which are more the province of psychotherapy.

Emotions or feelings: emotions are seen not as static conditions but as purposeful
behaviors generated to impact the external world or to send it a signal. Thus “-ing” words are
used to illustrate the lively nature of all feelings. Reality therapists acknowledge feelings and
empathize with them but encourage clients to discuss accompanying self-talk and actions.

Cognition or thinking: Wubbolding has extended the practice of reality therapy to

include the identification and discussion of cognition related to both ineffective and effective
actions.

Actions: The rationale for focusing on action is clear: Human beings have more direct
control over their actions than thoughts or feelings. Paradoxically, people are more aware of

19
their feelings and thoughts, but these elements of total behavior are less easily changed than
actions.

Therapeutic Environment The role of the reality therapist is to create a positive, trusting
environment that is need fulfilling. This must happen before change will typically occur.
Wubbolding (2000) identified several guidelines for establishing a counseling environment that
promotes positive change. These are referred to as the ABs (AB = Always Be). Always Be:

 Courteous
 Determined
 Enthusiastic
 Firm
 Genuine

The therapist should always role-model appropriate behaviors, and therefore be

courteous when clients are angry, unresponsive, or sarcastic. Clients then have an opportunity
to observe positive responses to their own negative behaviors. Being determined involves
helping clients recognize that situations can get better, while not giving up on the client’s
possibilities for change. Through an encouraging and optimistic approach, clients will begin to
explore new behavioral directions that will produce desirable outcomes. A therapist should
display a positive and upbeat enthusiasm. Clients do not need to be subjected to a therapist who
does not have effective control in his or her own personal life. It is therefore important for
therapists to be aware of and manage their personal issues. It is up to therapists to be firm and
clear with expectations and guidelines such as those regarding payment and reliable attendance
at sessions. Identification of boundaries regarding the therapeutic relationship that include
phone calls at home or between sessions should also be clearly defined. In addition, therapists
should be genuine by being honest and straightforward in their relationship with their clients,
thereby acting as role-models for clients to show them appropriate and healthy behavior.

A positive counseling environment is the most effective way to teach the Seven Healthy
Habits. Therapists who support, listen, encourage, and respect their clients, while avoiding
criticism and a judgmental attitude, facilitate a positive relationship in which clients can grow
in emotional terms. Therapists, however, should not encourage or allow excuses for client’s
behaviors, such as not following through with plans or spotty attendance at sessions. Therapists
can aid this process by avoiding “why” questions and asking “what” questions. For example,
if the therapist asks, “Why are your parents unhappy with you?” the form of the question

20
encourages excuse making and places the importance of what is happening on the parents. In
contrast, asking, “What is something you are doing that causes difficulties between you and
your parents?” or “How are you contributing to the problem?” places responsibility for the
behavior that is occurring on the client’s specific actions. It is crucial to teach clients that excuse
making only stands in their way of moving toward new and more productive decisions.

Many clients enter therapy with the perception that bad childhood experiences such as
abuse, poverty, parental alcoholism, and divorce are to blame for their behaviors. This belief
system allows clients to avoid responsibility for their life choices. Reality therapy techniques
help clients realize that they are no longer helpless victims, unless they want and choose to
continue to view themselves as such. The suffering and pain of these experiences is not
minimized. Clients are encouraged to make a choice to stop suffering and choose coping
behaviors that empower and strengthen them. Victims of trauma and abuse do not choose the
crimes committed against them but they do choose how they cope. Choice theory emphasizes
focus on the here and now; therefore when using reality therapy a counselor does not have
clients relive the abuse and trauma. Two exceptions of reviewing the past exist when,

1. client has not told their story before and been supported, or
2. client wants to verbalize the story in order to deal with shame issues. Care should
be taken to avoid having the client become stuck in the past and thus avoid
responsibility for their current behaviors.

Additional elements utilized within the counseling relationship that result in a need-
fulfilling environment include:

Use of humor: acceptable and age-appropriate humor and storytelling helps reduce
stress and promotes fun.

Self-disclosure: Clients often connect positively with the therapist when they perceive
their issues are understood on a personal level (see chapter 8 for more information on self-
disclosure).

Establishment of professional boundaries: Safe and ethical behaviors by the therapist

are necessary for clients to establish trust and not feel victimized (see chapter 8 for more
information on ethics).

Encouragement of creativity: Have clients explore various ways to communicate their

thoughts and behaviors, such as using art, poetry, or music to allow for individualized
approaches to treatment.

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 Focus on strengths: Have clients identify and build on areas in which they have
experienced empowerment.

Procedures and Interventions

Reality therapy helps clients focus on wants, evaluate total behavior, and make
commitments to change. Cockrum (1999) established a chart that displays the flow of reality
therapy. The first goal in treatment is to establish rapport and a caring environment with clients.
This must occur for the development of trust by clients so that the examination of the quality
world “wants,” behaviors, and plan development can begin. This atmosphere of trust is to be
maintained throughout the therapy process in order for change to occur. In addition, therapists
encourage, ask for, and sometimes share their evaluations during the client’s exploration of
wants, behaviors, and plan making.

Figure 1: Bob Cockrum’s Reality Therapy Flow Chart (The top and bottom bands flow around
and through all the other elements.)

Build and Maintain a Positive Client/Counselor Relationship

↓ ↓ ↓

Explore wants Explore behaviors Make plans

↑ ↑ ↑

Encourage, ask for, and sometimes share evaluations

Figure 2: The perceptual process

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 Real world “All that exists world”

Perceptual
process

Perceived world “All that I know World”

Comparing
Place

Quality world “My ideal world”

A popular reality therapy intervention to help clients understand how wants and
behaviors interact is to discuss “scales” and weighing what clients want against the perception
of what they have. The scales signal the person as to whether a change in behavior is needed.

Perceptions are each person’s internal reality. They are the information from which
each person operates. These are processed through “filters” of sensory systems, available
knowledge, cultural influences, and values or held beliefs. A perception of what a person wants
is then weighed against awareness of what they have. People then choose behaviors to get the
desired perception. For example, politicians speak the words we hear. A person assigns a value
to the politician that is positive, negative or neutral. Even though the politician says the same
words, they can be interpreted differently by separate individuals. The person’s perceptions
then influence their voting behavior.

Questions are a valuable way to obtain information about what exists in the client’s
quality world. Through this process the therapist helps clients identify, clarify, prioritize, and
evaluate their pictures. Identifying the client’s wants is crucial in the questioning process.

THE ‘WDEP’ SYSTEM

The WDEP was developed by Robert Wubbolding (Justice, 2003) and sums up much
of Glasser’s philosophy in a summary form.

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 i. W = wants (exploring wants, needs, and perceptions) ‘What do you want?’ is a
major question that the reality therapist asks the Client. therapists assist clients to
explore their quality world and ‘how their behavior is aimed at moving their
perception of the external world closer to their inner world of wants’ (Corey, 2001:
240). A non-critical and accepting therapist helps the client to reveal what is in her
quality world. This exploration will involve many sides of the client’s life and will
include expectations she has of the therapist and of herself. This investigation of the
wants, needs, and perceptions should continue throughout the counselling process
as the client’s quality world changes. To identify what the client may want the
question, ‘What kind of person would you be if you were the person that you wish
you were? could be asked.
ii. D = direction and doing According to Justice, ‘the person being helped describes
the current situation and related details’ therapist stresses current behavior and
therefore, asks the question, What are you doing now? What did you do during the
past week? What would you want to do differently this last week? What stopped
from doing what you say you wanted to do? Even if most problems are rooted in
the past, the past is only discussed if that helps to plan a better tomorrow. Early in
therapy, it is desirable to discuss with clients the overall direction of their lives:
What do you see for yourself now and in the future? It may take some time before
this perception of the future becomes clear but it needs to be worked on. Therapist
aims to change total behavior not just attitudes and feelings. Listening to a client
talk about feelings is only productive if it leads to change in what he is doing. To
use an analogy of oil red warning light on a car’s dashboard: We don’t immediately
assume that the light is at fault but that the oil level in the car’s engine is too low.
Similarly, inappropriate emotional displays are an indication that something needs
to be changed in the thinking and doing areas of life. We try to change thinking and
doing because these functions can be controlled relatively easily.
iii. E = evaluation ‘The core of reality therapy, as we have seen, is to ask clients to
make the following evaluation: “Does your present behavior have a reasonable
chance of getting you what you want now, and will it take you in the direction you
want to go?”’ This process of evaluation is considered central to the success or
otherwise of therapy. Corey presents a list of other questions that are helpful in
assisting clients to evaluate their present behavior. Example, ‘Is what you are doing
helping or hurting you?’ Is what you are doing what you want to be doing? Does

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 your behavior match up with what you believe? Is your behavior against the rules?
Is what you want in your best interests and in those of others? Confrontation is
important at this point of evaluation so that the consequences of behavior are clearly
understood by clients. ‘The process of evaluation of the doing, thinking, feeling,
and physiological components of total behavior is within the scope of the client’s
responsibility’. Reality therapists may be more directive with clients who are in
crisis, alcoholics, and children of alcoholics as these clients seem to lack the
thinking behaviors to make evaluations of ‘when their lives are out of effective
control’. Such clients often do not know what their wants are and whether their
wants are realistic. However, with time spent in therapy they learn to make the
needed evaluations with less therapeutic intervention.
iv. P = planning and commitment Once what the client has identified what she wants
to change there is need to develop an action plan of some sort. If a plan doesn’t
work then another can be substituted. Rigidity is outlawed in RT; flexibility is a
necessary virtue. Wubbolding uses the acronym SAMIC3 to elucidate the
characteristics of a good plan: (A) simple easy to understand (B) attainable client
should be able to do what is specified (C) measurable Immediate (to be carried out
as soon as possible. (D) involving for the client (E) the 3 Cs controlled by the
planner, committed to (plans are useless if there is no commitment to carry them
out), & continuously practiced (Corey, 2001).

RATIONALE OF THE STUDY

It is often seen that there is an array of reasons behind people consuming alcohol such
as personal factors including relationship issues, conflicts in family, external locus of control,
distorted self-image and low self-esteem etc. thus it is necessary to focus on these factors to
effect a positive change in the client. A management plan is necessary to help the individuals
bring a about a change concerning these domains.

Thus this study focuses on the application of reality therapy to help individuals self-
evaluate themselves, recognize their maladaptive actions leading to conflicts and make
necessary plans to transform into a better adjusting individual.

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 CHAPTER 2

REVIEW OF LITERATURE

26
REVIEW OF LITERATURE

2.1 Studies on the application of reality Therapy intervention on

psychiatric disorders and other psychological issues.

Zakaria, et al., (1996) studied reality Therapy Group Counseling Approach on

Metacognitive Awareness in Mathematics. The aim of this study was to identify the effect of
Reality Therapy Group Counseling (RTGC) and metacognitive levels on student who failed
their Mathemathics subject. Metacognitive Awareness Inventory (Schraw and Dennison, 1994)
was used to measure students’ metacognitive level. The study conducted on 120 Form Four
students who failed their Mathematics in their Form Three examination. This study utilized a
quasi- experimental with pre-test and post-test group design. The treatment group received
eight sessions of RTGC with 90 minutes per session in two months while control group did not
received any treatment. The results showed treatment group had a higher mean
(mean=134.817; SD=31.708) after intervention compare to the control group (mean=116.283;
SD=26.175) for metacognition and all the dimensions in metacognition (declarative
knowledge, procedural knowledge, conditional knowledge, planning, information management
strategies, comprehension monitoring, debugging and evaluation). These finding shows that
RTGC contributed as an important treatment in increasing metacognitive student who failed
their Mathematics subject.

This experimental study aimed to examine the effect of reality therapy group counseling
of RTGC reality structured approach between the treatment group who received RTGC
sessions and the control group that did not receive any treatment against metacognitive
students. The results showed that RTGC have a higher mean (mean=134.817) compared to the
control group (mean=16.283). In conclusion, this study has managed to raise the level of
students’ metacognition RTGC treatment group. The analysis showed that (i) there is a
significant difference between the treatment group and the control group of metacognition (ii)
there is a significant difference between the treatment group and the control group for the
dimension declarative knowledge, procedural knowledge, conditional knowledge, planning
and information management strategies (iii) There is no significant difference between the
treatment group and the control group for dimensional comprehension monitoring, debugging
and evaluation strategies. The changes apply to the control group may be due to extraneous
factors under control. During the three-month intervention periods, the sample in the control

27
group involved with school programs such as Mathematics workshop, i-think program focuses
on how to learn and make notes, group and individual counseling sessions, mentor mentee
program, PISA program and study skills workshops. Hawthorne effect which samples in the
control group also feels that they also receive treatment such as the treatment groups may also
affect the result (Gay and Airasian, 2003).

Daniel, (2004) conducted a study to see the effects of reality therapy group counseling
on the self-determination of persons with developmental disabilities. The purpose of this study
was to evaluate the effects of group counseling employing a reality therapy or a mutual support
group model on the self-determination of adults with developmental disabilities. A two-group,
pretest posttest design was utilized. Participants (n=30) were randomly assigned to either the
reality therapy group or the mutual support group. The group counseling consisted of six, one-
hour, sessions using methodologies created for this study. Results indicated a statistically
significant difference for the reality therapy group when compared to the mutual support group
at posttest. Statistically significant increases were observed within the reality therapy group
from pretest to posttest. This study provides 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.

Mottarella (2004) interviewed for adolescent substance abuse using the reality therapy
orientation. The author is in the Department of Psychology at the University of Central Florida
in Orlando. This brief paper discusses how a reality therapist can maximize use of the clinical
interview to assess for adolescent substance abuse while simultaneously using the interview as
a powerful tool to introduce the adolescent to the underlying principles of reality therapy. The
focus of this style of clinical interviewing, which includes exploration of the client's current
unmet needs and unhealthy choices, begins the process of suggesting to the adolescent that
he/she can make healthier choices that lead to need-fulfillment.

Interviewing for Adolescent Substance Abuse Using a Reality Therapy Perspective The
reality therapy model has demonstrated success in treating adolescent substance use and other
behavioral problems (Glasser, 1984). For the specific assessment of substance abuse, however,
no one standardized instrument has been adopted for widespread use (Evans, 1998), and
consequently the traditional clinical interview remains paramount (Naaken, 1989). The reality
therapist views this interview as a valuable opportunity to introduce the adolescent to the
principles of reality therapy. In the clinical interview as well as the subsequent therapy process,
the reality therapist focuses a great deal on present events. The past is explored, but only to put

28
the client's present into its context. Unlike many other treatment approaches, the primary focus
even in the clinical interview is on the present because the reality therapist emphasizes that
what the client can change is now. Unlike other treatment approaches, the interview also
focuses primarily on the client's behavior and cognitions, more so than on exploration of
feelings (Glasser, 1965). When the adolescent reports unhealthy choices including substance
use, the therapist does not convey criticism or punitive messages because these only reinforce
the adolescent's defeating ways of being. Instead the therapist continues to probe how behavior
fits with the adolescent's expressed goals and needs.

Maintaining present and future-orientations, the clinical interview begins the process
of exploring what the adolescent is doing currently, and whether present ways are working for
him/her: "Does your present behavior have a reasonable chance of getting you what you want
now, and will it take you where you want to go?" These questions are introduced in the clinical
interview, and subsequently repeated and re-phrased throughout the therapy process so that the
client begins to identify the behavior and choices that are not getting him/her where he/she
wants to be (Abbott, 1980; Wubbolding & Brickell, 1998). The interview process determines
what needs of the client are not being met; and based on this, allows for formulation of a plan
for change with the client. Thus, a young client's substance use is seen as a choice that reflects
unmet needs (Mainous, et al., 1996), and the clinical interview helps identify what these needs
are.

Thus, from the reality therapy perspective, the clinical interview has dual purposes.
While it is a crucial tool to gain valuable information about the nature and extent of substance
use for treatment planning, the interview also serves as a powerful means to introduce the client
to the reality therapy principles. Even in the clinical interview, the reality therapist emphasizes
the present. This focus, which includes exploration of the client's current unmet needs and
unhealthy choices, begins the process of suggesting to the adolescent that he/she can make
healthier choices that lead to need fulfillment.

Loyd, (2005) studied the effects of Choice Theory/Reality Therapy principles on high
school students' perception of needs satisfaction and behavioral change. This study investigated
the extent to which exposure to Choice Theory/Reality Therapy principles increased high
school students' perceived satisfaction in 4 psychological needs-belonging, power, freedom,
and fun-and how these principles affected behavioral change. Research has shown that a lack
of needs satisfaction contributes to disruptive and self-destructive behaviors, low academic
motivation and performance, and unsatisfying social relationships in the lives of some high

29
school students. Pete's Pathogram was used to assess the self-perceived level of need
satisfaction. A quasi-experimental, nonrandomized pretest/posttest design was used. For 5
sessions, the treatment group received exposure to Choice Theory principles. After the first
posttest, the control group also received exposure to Choice Theory principles. A second
posttest was administered to each group. A 2 x 3 with repeated measures ANOVA was
conducted on all data concerning the perceived satisfaction of each of the 4 psychological needs
after the end of the second exposure. The repeated measures suggested that exposure to Choice
Theory principles had a sustaining positive effect on students' perception of needs satisfaction
in 3 of the 4 psychological needs. Interviews were conducted with students from the treatment
group, whose satisfaction scores significantly increased at the .05 level, in at least 1 of the 4
psychological needs. The interviews suggested that exposure to Choice Theory principles
influenced the students' perceptions, which, acting as precursors, were the catalysts to
observable behavioral change. 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. By incorporating Choice Theory principles in curriculum
instruction, schools could equip students with values that are consistent with internal choice
and motivation, quality work, personal responsibility, and needs satisfaction.

Kim, (2005), studied effectiveness of Reality Therapy Program for Schizophrenic

Patients. The present study aims to verify the effectiveness of the reality therapy for patients
with schizophrenia. It is designed as a quasi-experimental study by which a nonequivalent
control group pretest-posttest is conducted. The test was conducted with 30 patients with
schizophrenia who were hospitalized at a mental hospital in South Korea. Fifteen of the patients
participated in the reality therapy program while another 15 in the control group. The effects
are measured by marking scores in the areas of the locus of control, self-esteem, and problem-
focused stress coping of each participant. The general characteristics and dependent variables
related to outcome variables were controlled to be equal between the two groups. It turns out
that the internal locus of control, self-esteem, and problem focused stress coping are
statistically significant. Findings show that the reality therapy caused positive changes in terms
of the internal locus of control, self-esteem, and problem-focused stress coping of the observed
schizophrenic patients.

According to the present study, Reality Therapy proved its effectiveness for developing
patients’ problem focused coping skill which is an important factor in managing stress. This

30
particular result is also in line with the findings of some other research including Woo’s study
on mothers with disabled children (Woo, 1994), and Yun’s study on parent education program
focused on the reality therapy (Yun, 2000). However, it is proved to be slightly different from
that of Kim who conducted a rehabilitation program focused on Reality Therapy (Kim, 2001).
The difference can be accounted for by the fact that the present research revised and adapted
by Kim’s program, which set out to deal with the situational factors. Problem-focused coping
is designed in an effort to go to the roots of stress by changing patients’ troublesome behaviors
or troubling conditions. The method endeavors to deal with tensions between problem-solving
efforts and environmental conditions (Han, 1996). It is likewise said to be effective for
symptom management and prevention of relapse in the case of chronic patients (Mynors-
Wallis, 1996). It can be considered from the above findings that Reality Therapy could assist
patients with schizophrenia to have a high internal locus of control and more effective behavior
choice. At the same time, it could help those patients who suffer from social withdrawal due to
low self-esteem, frustration and failure to recover self-esteem with an improved image and
understanding of self. On the other hand, Reality Therapy could enable those patients who have
led passive and dependent lives to explore their inner needs and desires. Reality Therapy can
also enable people learn how to achieve self- worth, cultivate trust in their ability and potential
thus empowering them confidence to grow, and motivating them cope with stress.

Ken (2006) applied Choice Theory and Reality Therapy to Coaching Athletes. Looks
at applying the principles of Choice Theory (CT) and Reality Therapy (RT) to a specialized
segment of learning the coaching of athletes. Coaching athletes using CT and RT introduces
the concept of winning as a total life process, and enhances the development of a dynamic team
environment. A Choice Theory Coach eliminates as much external control as possible in order
to promote personal choices and to give his players much of the responsibility for their
experience. Actual case histories of current and former coaches provide a close look at how the
principles of CT and RI have been integrated into the athletic arena to provide a successful
experience in the field of competition, but more importantly as an outflow, building character
and teaching values and life skills that last a lifetime. Finally, this specific learning experience
offers an expanded vision that enhances the classroom version of a Glasser Quality School.

Shery (2006) used Reality Therapy to Reduce PTSD-Related Symptoms. A client with
a long history of somatization and rumination behaviors and a previous diagnosis of Dysthymic
Disorder and Somatization Disorder was reassessed for a possible re-diagnosis of PTSD. The
intervention of Reality Therapy (Glasser, 1998) was introduced, and a single system design

31
was used to measure the results on a self-anchored PTSD Rumination Scale and compare them
with a baseline phase. A reduction of almost 50% was noted in the mean percentage of these
behaviors during the intervention phase following the intervention of reality therapy. Statistical
and Inferential analysis were used to examine the statistical significance of the results. This
study therefore suggests that the intervention of Reality Therapy was an effective means of
reducing somatization and rumination behaviors associated with PTSD, and should be studied
further with additional subjects and symptoms, as well as different circumstances of PTSD.
This study also strongly suggests the re-evaluation and re-assessment of clients with past (and
often long) histories of somatization and Rumination Behaviors (as described in this study), for
a possible DSM IV rediagnosis of PTSD if a history of traumatic events can be obtained, even
if a previous diagnosis has been recorded as Dysthymic Disorder (DSMIV 300.4) or
Somatization disorder (DSMIV 300.81).

Kim (2007) conducted a study on Reality Therapy Group Counseling Program as an

Internet Addiction Recovery Method for College Students in Korea.College students
worldwide are vulnerable to Internet addiction because the Internet is becoming more easily
accessible with colleges, and a majority of college students now use the Internet as part of their
educational tools. In Korea, college students are the highest level of Internet addictive users.
Glasser (1985) has used Choice Theory to explain addiction. Recently, Lewis et al., (2003) and
Howatt (2003) have taken advantage of Reality Therapy for a core addiction recovery tool. In
this way, Reality Therapy can be used widely as a treatment for addictive disorders such as
drugs, sex, food, and work as well as Internet. Group counseling appears to be the predominant
modality for treating addiction (Fisher et al., 1997). The support, confrontation, and insight
gained from other individuals experiencing similar cognition and emotions facilitate
therapeutic recovery. Thus, this article explores the application of Choice Theory and Reality
Therapy as an Internet addiction recovery vehicle, and develops a group counseling program
that group counselors can use when working with college students with Internet addictive
disorders.

Schoo, et al., (2008) studied choice theory and emotional intelligence’s effectiveness
in learning to improve performance. There is an increasing awareness of the role of leadership
and team development in organizational development, for example in health care where change
is needed to manage the chronic disease burden (Dunbar et al., 2007) and utilizing and retaining
a dwindling workforce (Schoo, et al., 2005). This is forcing leaders and their teams to work as
smart as they can with resources that are available to them. Positive leadership has been

32
associated with outcomes that include happy relationships, teamwork, learning, recognition,
staff retention, and health and wellbeing. There is evidence that emotionally intelligent leaders
in workplaces are able to bring about these positive out- comes because they are attuned to the
emotions that move people around them (Goleman, et.al, 2002). In this sense, emotion can be
defined as aroused energy that takes a direction (Hunt, 2004a) (Latin: e = from, movere = to
move). Valerie Hunt regards emotion as the metronome of life (Hunt, 2004b). Although
emotion can be a feeling state (e.g., fear, anger, joy, hate or sorrow) associated with action, its
energy is, according to Hunt, directed to action, to behave (Hunt, 2004b). Negative thoughts
and emotions such as excitement and anger have been found to increase gut motility, cancer
risk and arterial plaque formation which can lead to a heart infarct (Pert, 1997), whereas
positive emotions seem to do the opposite.

Joe Alexander, et al., (2016) studied digital choices and fulfillment of choice theory’s
four basic psychological needs. The present study sought to understand how people fulfill basic
psychological needs while engaging in console-based video games. Results were intended to
influence how future clinicians could use video games as possible interventions, but also as a
connection to better understand their clients. William Glasser suggested the idea that people
are motivated by four basic psychological needs: (a) love/belonging, (b) power, (c) freedom,
and (d) fun (Glasser, 1998). These needs would be one of the tenets of choice theory. While
these needs are constant throughout people’s lives, the way they are met are continuingly
augmented to fit the culture in which they fit. Data collected via interviews with game playing
participants suggested that each of them met at least one basic psychological need, as viewed
through the choice theory lens.

2.2 Studies on the application and efficacy of different psychotherapeutic

interventions on issues with alcohol dependence syndrome.

Bien et al., (1993) studied brief interventions for alcohol problems. Relatively brief
interventions have consistently been found to be effective in reducing alcohol consumption or
achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen
randomized trials of brief referral or retention procedures, and 32 controlled studies of brief
interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health
care and treatment settings across 14 nations. These studies indicate that brief interventions are
more effective than no counseling, and often as effective as more extensive treatment. The

33
outcome literature is reviewed, and common motivational elements of effective brief
interventions are described. There is encouraging evidence that the course of harmful alcohol
use can be effectively altered by well-designed intervention strategies which are feasible within
relatively brief-contact contexts such as primary health care settings and employee assistance
programs. Implications for future research and practice are considered.

Morgenstern et al., (2000) studied the mechanism of action of cognitive–behavioral

treatment for alcohol dependence. The review examined support for the hypothesis that
cognitive-behavioral treatment (CBT) for alcohol dependence works through increasing
cognitive and behavioral coping skills. Method. Ten studies were identified that examined the
hypothesized mechanisms of action of CBT. These studies involved random assignment (or its
near equivalent) of participants to CBT and at least one comparison
condition. Results. Although numerous analyses of the possible causal links have been
conducted to evaluate whether CBT works through increasing coping, the results indicate little
support for the hypothesized mechanisms of action of CBT. Conclusions. Research has not yet
established why CBT is an effective treatment for alcohol dependence. Negative findings may
reflect methodological flaws of prior studies. Alternatively, findings may indicate one or more
conceptual assumptions underlying CBT require revision.

White, et al., (2002) studied alcoholism/addiction as a chronic disease: from rhetoric to

clinical reality. Although characterized as a chronic disease for more than 200 years, severe
and persistent alcohol and other drug (AOD) problems have been treated primarily in self-
contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a
sustained recovery management model will require rethinking the natural history of AOD
disorders; pioneering new treatment and recovery support technologies; restructuring the
funding of treatment services; redefining the service relationship; and altering methods of
service evaluation. Recovery-oriented systems of care could offer many advantages over the
current model of serial episodes of acute care, but such systems will bring with them new
pitfalls in the personal and cultural management of alcohol and other drug problems.

Imel, et al., (2008) conducted a study on direct comparisons of psychotherapies for

alcohol use disorders. To estimate the relative efficacy of alcohol use disorder treatments, the
authors meta-analyzed studies that directly compared 2 bona fide psychological treatments.
The authors accommodated problems with the inclusion of multiple treatment comparisons by
randomly assigning a positive/negative sign to the effect size derived from each comparison
and then estimating the extent to which effect sizes were heterogeneous. The authors' primary

34
hypothesis was that the variability in effect sizes of bona fide psychological treatments for
alcohol use disorders that were directly compared would be zero. For both alcohol measures
and measures of abstinence, analyses indicate that effects were homogenously distributed about
zero (I² = 10.61, 0.00, respectively), indicating that different treatment comparisons yielded a
common effect size that was not significantly different from zero. Analyses also indicate that
allegiance accounted for a significant portion of variability in differences between treatments.

2.3 Studies on the application and efficacy of Reality Therapy on issues

with alcohol dependence syndrome

Smith et al., (2011) assessed the efficacy of a choice theory-based alcohol harm
reduction intervention on college students. The United States National Institute on Alcohol
Abuse and Alcoholism (NIAAA) has formally recommended a four-tier model of empirically
validated strategies aimed at reducing hazardous alcohol consumption patterns on college
campuses (NIAAA, 2002). Tier One recommendations propose intervening with high-risk or
problem drinkers utilizing interventions demonstrating efficacy with college students,
including cognitive-behavioral skills training and motivational enhancement interventions. As
alarming rates of alcohol use and related negative consequences on American college campuses
persist, innovative approaches to addressing this issue are vital. The current study explores a
novel intervention based on Choice Theory (CT), an explanation of human motivation
proposed by William Glasser, M.D., against a pre-existing Motivational Interviewing (MI)
intervention, already well-established as an effective collegiate harm reduction intervention.
Over the course of the 2009-2010 academic year, college students from Loyola Marymount
University (Los Angeles, CA) who had been sanctioned for campus alcohol policy violations
were randomly assigned to attend either a CT (N = 93) or MI (N = 98) group alcohol
intervention. Findings demonstrate that the CT intervention was similarly effective in
significantly reducing alcohol consumption (68% reduction in average weekly drinking) and
negative alcohol-related negative consequences (8% decrease in the experience of past month
consequences) as the established and verified MI intervention, thus providing promising
support for the potential of a novel CT based intervention approach to reducing problematic
drinking on college campuses.

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2.4 Family and alcohol dependence syndrome

Saatcioglu et al., (2006) studied role of family in alcohol and substance abuse.Abuse is
a family disease, which requires joint treatment of family members. Family is an important part
of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and
substance is a response to fluctuations in the family system. In consideration of interactions
within the system, it seems an important requirement that the clinician involves, and maintains
the presence of, the family in its entirety in the treatment process. A family often needs as much
treatment as the family member who is the abuser of alcohol or a substance. In this regard,
participation of the family in the treatment process as group members and by assuming a
supportive role are assets in terms of preventing relapse, and extending clean time, and also
very important for solving conflicts that give rise to abuse of alcohol or substances.
Accordingly, it is important to know the family structure and its role in the treatment process.
This article covers a review of family systems separately in terms of alcoholism and substance
abuse.

2.5 Self-concept, locus of control in alcohol dependence syndrome

Gossop M. (1976) studied drug dependence and self-esteem. A number of recent studies
have dealt with variables related to self-esteem, but despite suggestions in the literature, there
are few empirical studies concerned with the association between self-esteem and drug
dependence. In an investigation of self-esteem, 71 subjects completed semantic differential
forms for their self and ideal-self concepts. Four hypotheses were investigated. It was predicted
that differences in self-esteem (as measured by the discrepancy between self and ideal-self
concepts), would be found between inpatient and outpatient groups, males and females,
intravenous and oral users, and between drug-dependent subjects and a control group. No
differences were found between inpatients and outpatients, or between intravenous and oral
groups. However, females who were dependent upon drugs were found to have lower self-
esteem than males in terms of the evaluation factor. No such sex differences were found
between all drug groups and the control group on the evaluation and potency factors. It is
suggested that the results show considerable deficiencies of self-esteem among drug-dependent
patients, and that female addicts are especially deficient in this respect. In terms of etiology,
this association between drug dependence and low self-esteem may indicate that those
individuals with a deficient self-image who are exposed to drugs may be at risk; this may carry

36
implications also for alcohol and nicotine dependence. It is suggested that self-image therapy
may be of value for certain drug-dependent patients, especially females.

Frone et al., (1993) studied relationship of work‐family conflict, gender, and alcohol
expectancies to alcohol use/abuse. Numerous studies have documented a positive relationship
between work‐family conflict and both psychological distress and somatic symptoms. Little
research, however, has explored the relationship of work‐family conflict to alcohol use/abuse.
Consequently, this study investigated the relationship of work‐family conflict to several
indicators of abusive alcohol consumption. In addition, the moderating influence of gender and
tension‐reduction expectancies was examined. Data were obtained through household
interviews with a random sample of 473 employed adults. As hypothesized, work‐family
conflict was positively related to abusive alcohol consumption. In addition, there was strong
support for the moderating influence of tension‐reduction expectancies. As anticipated, the
positive relationship between work‐family conflict and abusive alcohol consumption was
found almost exclusively among individuals who believe that alcohol use promotes relaxation
and tension reduction. In contrast, the hypothesis that gender moderates the relationship
between work‐family conflict and alcohol use/abuse was not supported. Implications for future
research and intervention efforts aimed at reducing alcohol abuse in the workforce are
discussed.

Peterson et al (1998) studied the effects of reality therapy and choice theory training
on self-concept among Taiwanese university students. Changing cultural expectations and
constant academic pressures may have negative effects on the self-concept of todays
Taiwanese university students. The teaching of choice theory and the use of reality therapy
as interventions were considered to assist these students in developing and maintaining a
positive self-concept. Taiwanese university students (n = 217) were subjected to either choice
theory teaching or reality therapy group counselling. The findings suggest that both of these
strategies were effective in facilitating more positive self-concept when compared to the
control group. Additional counselling implications were addressed.

Izquierdo et al., (2001) studied Self-concept, self-esteem, the locus of control and self-
efficacy related to alcohol dependence. This article focuses on the evolution of the self-concept,
the self-esteem, the locus of control and the self-efficacy related to the alcohol dependence.
Moreover, it also takes on account which of these variables best foresee the outcome and the
withdraw maintenance. The group which was to be analized was composed of 98 men and 62

37
women. Therefore this group had to face The Situational Confidence Questionnaire (SCQ-39),
The Self-concept Questionnaire Form 5, The Internal-External Control Scale, and finally The
Self-esteem Questionnaire (Rosenberg). Moreover, they were to be supervised at the beginning
of the detoxification, then at the fifteenth day, at the third month, the another one taking place
at the sixth month and finally the last one turning up at the twelveth month. According to the
results obtained, it becomes apparent that the most consistent variable throughout time is the
self-efficacy and we could point out the fact that the evolution of the others variables stick to a
development which is different depending on the sex of the subjects. As far as the men are
concerned we could assert that the positive values of the variables turn up in the following
order: the self-efficacy, the self-esteem, the positive self-concept and the locus of control. As
for the women the order would be: the self-efficacy, the locus of control, the positive self-
concept and the self-esteem. All the variables, which have been studied here, have had a great
influence on the outcome and the withdraw maintenance, nevertheless the self-efficacy is the
variable which better predicts.

Rohsenow et al., (2009) studied locus of control research on alcoholic population.

Research literature dealing with the relationships of locus of control to alcoholism and the
treatment of alcoholism is reviewed. The review includes a discussion of some of the scales
used in this research, the relative locus of control of alcoholics compared with controls, the
change in locus of control during treatment of alcoholics, and the relationship of locus of
control to treatment success. Much of the research is inconclusive. Research on the control
orientation of alcoholics compared to controls has had equivocal results, but the better designed
studies tend to find no difference or externality in alcoholics. Most studies find that alcoholics
become more internal over treatment, but the relationship of locus of control to treatment
success is unclear. Methodological difficulties have included problems with sampling,
selecting appropriate controls, assuming homogeneity of alcoholics as a group, and assuming
linearity and unidimensionality of the scales.

38
 CHAPTER 3

METHODOLOGY

39
METHODOLOGY

PROBLEM INVESTIGATED:

Application of Reality Therapy in conflict management focusing on family, self-

concept and locus of control in individuals with alcohol dependence syndrome

3.1 AIM

To examine the application of Reality Therapy in management of conflict focusing on

life partner in individuals with Alcohol Dependence.

3.2 OBJECTIVES

The following objectives were taken into consideration for the study.

 To evaluate locus of control of individuals with Alcohol Dependence Syndrome after

application of Reality therapy.
 To study the magnitude of conflict with family members in individuals with alcohol
Dependence Syndrome after application of Reality Therapy.
 To study the magnitude of conflict in self-concept in individuals with alcohol
Dependence Syndrome after application of Reality Therapy.

3.3 RESEARCH DESIGN

For the present study, the design employed is a variant of the single subject/case
research design called the concurrent multiple baseline design across subjects. In this design,
each participant serves as his own control.

3.4 SAMPLE

The sample consisted of 5 patients with Alcohol Dependence Syndrome receiving

medical treatment for the illness during their stay in the deaddiction ward in RINPAS. However
initially a total of 12 male participants suffering from Alcohol Dependence Syndrome were
selected from the deaddiction ward of RINPAS after detailed clinical workup and
administration of AUDIT ( all the participants score 13 and above on the scale).

40
 Purposive Sampling Method has been used for the purpose of sample selection.

The selection of participants was done on the basis of the inclusion criteria and
exclusion criteria mentioned below.

3.5 INCLUSION CRITERIA FOR THE STUDY GROUP

 The following inclusion criteria has been considered for the study
 Participants who were diagnosed with Alcohol Dependence Syndrome as per ICD-10
CDDG
 Participants who were within the age group of 25 to 50 years.
 Participants who had a minimum level of education at matric level
 Participants who were receiving medical treatment for their condition.
 Participants who had been admitted in de-addiction ward for their condition.
 Participants who are residents of Ranchi.

3.6 EXCLUSION CRITERIA FOR THE STUDY GROUP

The following exclusion criteria has been considered for the study.

 Participants who are unmarried.

 Participants who does not have severe co-morbid psychiatric disorders like
schizophrenia, multiple substance dependence or substance dependence other than
alcohol, bipolar affective disorder, obsessive compulsive disorder, organic brain
syndrome or mental retardation.
 Participants who obtained a score of 3 or above on General Health Questionnaire- 12.

3.7 TOOLS FOR ASSESSMENT

The following tools were used for data collection

 Sociodemographic and clinical data sheet

 General Health questionnaire- 12 (GHQ-12)
 Alcohol Use Disorders Identification Test (AUDIT)
 Locus of Control Scale (Hindi adaptation)
 Sacks Sentence Completion Test

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  Therapeutic plan: stages of therapy

Socio-demographic Schedule

A semi structured pro forma was designed for the present study in order to collect
detailed clinical history of each participant including information related to the following areas:

Socio-demographic details including name, age, sex, marital status, religion, education,
occupation, socio-economic status, income, residence, number of family members.

Duration of illness and other additional information.

General Health Questionnaire- 12 (GHQ-12)

The test was developed by Goldberg and Williams (1988). The general health
Questionnaire was designed to be a self-administered test aimed at detecting psychiatric
morbidity in community setting or among general medical outpatients. It is a designated
screening instrument used to evaluate current mental well-being of an individual for the past
few weeks. It mainly measures two classes of phenomena- inability to carry out one’s normal
‘healthy’ functions, and appearance of new phenomena of a distressing nature. In the
construction of the GHQ, items were selected as to cover four main areas. These were
depression, anxiety, social performance and somatic complaints. GHQ 12 contains 12 items
and is derived from a factor analysis of GHQ-60.

GHQ-12 was used to identify the participants with psychiatric morbidity. And the score
of 2 and below was taken to be normal and those individuals were not included in the study.

The questionnaire was designed to be easy to administer, acceptable to the respondents,

fairly short and objective in the sense that it did not require the person administering it to make
subjective assessments about the respondent. The respondent was asked to rate how they felt
in the past few days using a simple four-point response scale: better than usual, same as usual,
less than usual, and much less than usual, and scored as 0,0,1,1 respectively. Scores on GHQ
can be interpreted in three ways. First, they can be regarded as a measure of the severity of
psychiatric disorder. Second, they can be used to estimate the prevalence of psychiatric
disorders. And thirdly, they can be regarded as an indicator of morbidity. The correlation of
GHQ-12 with other self-report measures was found to be +0.48 to +0.78.The reliability co-
efficient of the test by split-half method was found to be +0.83, and by test-retest method to be

42
+0.73. There have been some validity studies of the 12- item version of the GHQ. The
sensitivity ranges from 71% as the criterion to 91% with a median value of 86%.

Alcohol Use Disorders Identification Test (AUDIT)

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool
developed by the World Health Organization (WHO) to assess alcohol consumption, drinking
behaviors, and alcohol-related problems. The items for the AUDIT were derived from a cross-
national data set and only those items that could be translated literally and idiomatically were
included. This suggest that the AUDIT may be used with a range of cultures. In a comparison
of AUDIT scores and diagnoses based on a comprehensive structured interview, physical
examinations and laboratory findings, two cutoff points of 8 and 10 produced maximal
sensitivity and specificity (Saunders et al., 1993). At a cut off point of 11, sensitivity of the
AUDIT was 0.84 and specificity was 0.71 in detecting alcohol abuse.

The AUDIT is a self- report measure. The pen and paper version takes about 2-5
minutes to administer. It is scored by adding each of the 10 items. Items 1 to 8 are scored on a
0-4 scale, items 9 and 10 are scored 0, 2, 4. A score of 10 or above is suggestive of alcohol
problems. A score of 13 or more is likely to indicate alcohol dependence.

Locus of Control Scale (Hindi Adaptation)

The concept of locus of control was found and developed by Rotter (1954). Locus of
control is a construct embedded in social learning theory of Rotter. Hindi adaptation was done
by Hasnain and Joshi in 1992. It has 36 items. It is rated in 3 point rating scale system (always,
sometimes and never). Score of 2, 1 and 0 are given to the positive items, for always, sometimes
and never respectively. The scoring on negative items is done in a reverse order. It measures
internal locus of control and external locus of control. The positive items are related with
internal locus of control, higher the score on the scale the more internally oriented the
individual will be. The highest score on the scale is 72 and the lowest is 0. The internal
consistency co-efficient was found to be +0.55 and temporal stability was found to
be+0.76.Tthe validity of the scale was found to be +0.76. The purpose of using the scale of
locus of control is to assess the same, either external or internal, both before and after the
application of therapeutic intervention.

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Sacks Sentence Completion Test

The test is designed to obtain significant conflicts in four representative areas of

adjustment. It was developed by Sack and other psychologists of New York Veterans
Administration Mental Hygiene Services. The four areas covered by the test are: Family, sex,
interpersonal relationship and self- concept.

Further the family area includes three sets of attitudes, those towards mother, father and
family. Each of these is represented by four incomplete open ended sentences. Total 12 items
are there in family area. The participant has to complete the sentence. Sex area includes attitude
towards women and toward heterosexual relationship. There are four incomplete sentences in
each area. The area of interpersonal relationship includes attitude towards friends,
acquaintances, superior persons at college/school/work, supervisors, co-workers. There are
total 20 incomplete sentences in this area. Self-concept area involves guilt feelings, attitudes
towards one’s own abilities, past, future and aim. Overall 60 incomplete sentences are there in
this test and which is to be completed by the participant.

The reliability and validity of the test was determined when various psychologists rated
the degree of disturbance of a hundred subjects on the basis on their responses on the test. The
psychiatrists who treated these subjects made independent ratings in terms of the degree of
disturbance of each subject, based on their clinical impression. Correlation in the ratings of
psychologists and psychiatrists revealed contingency co-efficient of 0.48 to 0.57 with standard
error of 0.02 and 0.02 each. This indicates that the ratings of both psychologist and psychiatrist
have significantly positive relationship. Thereafter interpretive summaries of subject’s
responses were submitted to psychiatrists where they rated their agreement on those clinical
findings. 77% of the statements were rated in agreement of the clinical findings (Edwin, 1950).

A rating sheet has been devised for the SSCT which brings together, under each attitude,
the four stimulus items and the participant’s responses to them. A rating is then made of the
subject’s degree of disturbance on each item then in each subarea e.g. Attitude towards father
(a sub area of family). The disturbance ratings are as follows:

Severely disturbed (rate2): emotional conflicts are there but appears that these cannot
be handled without therapeutic aid.

Mildly disturbed (rate 1): emotional conflicts are there but appears that these can be
handled without therapeutic aid

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 No significant disturbance (rate 0)

Unknown insufficient evidence

3.8 REALITY THERAPY: STAGES OF THERAPY

When implementing choice theory, reality therapists and clients explore its various
components: needs, wants, scales, choice, four components of total behavior, purpose of their
behaviors and perceptions, including how they perceive the world around them. The
therapeutic alliance, the relationship between therapists and clients, forms the foundation for
successful psychotherapy. In the language of choice theory, therapists become the part of the
client’s quality worlds. When the therapeutic alliance is strong enough, reality therapists ask
clients to reflect on their behavior, evaluate it, and change it.

CREATING THE ENVIRONMENT: THERAPEUTIC ALLIANCE

Establishing a safe but challenging environment requires the conventional skills and
personal qualities common to most theories: empathy, congruence and positive regard. The
therapist sees the world from the point of view of the client, possesses communication skills
that are both direct and respectful, and maintains an attitude that values the client.

Toxic behaviors: counterproductive to a firm, fair and friendly environment are the
ABCs that create poisonous relationships. Arguing increases resistance and un-cooperation.
Blaming and belittling worsen guilt and shame. Criticizing, coercing and demeaning diminish
self-esteem and independence.

Tonic behaviors: the therapeutic relationship is nurtured by reality-centered behaviors

initiated by the therapist. Some of these suggestions can be directly taught to clients, both
individually and in group therapy, but they are all intended for use by the therapist when
deemed helpful. Whenever they are used, they should be employed with the intent to promote
a bonding between client and therapist.

AB-CDE represents suggestions for therapist to use with clients as well as ideas for
teaching alternatives to toxic behaviors: Always be Courteous, Determined and Enthusiastic.

Other behaviors helpful in establishing and maintaining the environment of the

therapeutic alliance include suspending judgement, employing paradoxical techniques when
appropriate, doing the unexpected, maintaining a sense of humor, clarifying boundaries, and
using metaphors.

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INTERVENING WITH REALITY THERAPY PROCEDURES: THE WDEP
SYSTEM

Many of the skills for establishing a constructive atmosphere in the therapeutic

relationship are common to other theories and are characteristics of healthy human
relationships. Consequently, they serve as an appropriate foundation for reality therapy
interventions based on choice therapy. Most typical of reality therapy is a systematic series of
interventions summarized by the acronym WDEP (Wubbolding, 1989, 1991, 2000a, 2008c).
Each letter represents a cluster of possible ways to help clients become increasingly aware of
the various elements of their internal control systems, examine a broader spectrum of
opportunities, and thereby make more effective choices.

EXPLORING WANTS

The key question under the W of the WDEP system is:

WHAT DO YOU WANT?

The user of reality therapy is aware of the theoretical concept of the quality world. Its
contents are everything highly valued: core beliefs, ideas and treasured possessions and
relationships. In exploring the quality world, the therapist assists clients to formulate, clarify
and prioritize the pictures in their mental picture albums- that is, their wants. This process
serves as the foundation for other interventions based on the WEDP system and requires much
attention in the therapeutic process. Its importance is illustrated in the well-known caution to
“be careful what you wish for.”

Level of Wants: because of the primary importance of wants, the quality world is often
referred to as the “world of wants”. Everything in the quality world appears desirable.
However, these wants are not constant or standardized. They exist at various levels of
desirability and are changeable.

Nonnegotiable demand. Some wants, such as the desire for oxygen, nourishment, or the
freedom from torture, are so intensely desired that they cannot function without them.

Pursued goal. Clients expressing the positive symptoms “I want to improve” formulate
goals that are backed up by behaviors.

Wish. Some effort is made to achieve the wish, but its satisfaction requires little
exertion.

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 Weak whim. Fulfilling this want is slightly desirable but of little importance.

Double bind. Sabotaging a want with ineffective behaviors sends the signal “I want it
but I don’t want it”.

Reluctant passive acceptance. Clients on their own or through therapy learn to accept
the inevitable. While not desired, many people gain an acceptance of a disease, handicap
situation or event.

Non-desired active acceptance. People often formulate clearly defined wants knowing
that a side effect or consequence of its fulfillment will be an undesirable result.

Fantasy dream. Even though there is overwhelming evidence that the attainment of the
dream is impossible, a person may fantasize about unattainable dream.

Though it is not necessary to categorize precisely every want during the process of
therapy, it is useful to help clients determine the degree of intensity of a want. Helpful questions
include “How intensely do you want it?” “Is your want a nonnegotiable desire or a weak
whim?”

For many people recovering from addictions and members of codependent families, all
wants appear to be equally important and urgent. A major part of the reality therapy process
with such individuals entails helping them realize that some wants are of greater consequence
than others.

Level of commitment. Wubbolding (2000a) has identified five levels of commitment.

“I don’t want to be here. Leave me alone. Get off my back.” This level, in fact,
represents no commitment. Yet it is commonly heard by practitioners, probation officers, child
care workers, and practitioners in university counselling centers when clients have experienced
an intervention and are sent to receive help.

“I want the outcome, but I don’t want to make the effort.” Failing to exert effort places
this behavior at this second level of commitment. Though slightly higher than the first level, it
contains resistance to action planning. The reality therapist helps clients evaluate this level of
commitment and its lack of efficacy in effecting want and need fulfillment.

“I’ll try.” “I might.” “I could.” “maybe.” “probably.” The middle level of

commitment shows some willingness to take more effective control of one’s own behavior.
However, change is not immutably linked to an “I’ll try” commitment.

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 “I’ll do my best.” It represents a step beyond mere wanting or trying and a willingness
to choose positive symptoms.

“I will do whatever it takes.” Efficacious choices and follow-through behaviors

characterize the highest level of commitment. Clients consistently follow through on plans and
even accept the responsibility for less than desired outcomes.

Exploring perceptual system: contained in the perceptual system are two components.
Three perceptual filters comprise the first component, whereby human beings acknowledge the
world, see relationships, and place a value on incoming information. The second component is
the perceived world, a storehouse of perceptions of self and the external world.

Connected with this is the discussion of locus of control. First formulated by the social
learning theorist Rotter (1954), the notions of internal place of control versus a sense of external
control coincides with the principles of internal control psychology, more specifically choice
theory.

Choice theory does not teach that changing perceptions from external to internal is easy,
nor is the perception of internal control is easily accessible. Therefore, a principle of internal
control congruent with choice theory is: Human beings (clients) have more control than they
often perceive.

In helping clients move from a sense of external control or victimization to the

perception that they have at least some control and that choices are available to them, the use
of metaphors can be eye opening. Rather than arguing with a client who refuses to take any
responsibility for his or her plight, the reality therapist might discuss the client as feeling like
a floor mat and ask, “Would you like to get off the floor and sit in a chair for a while?”

Using metaphors with clients in this manner externalizes the problem, making it more
manageable. This process helps clients see choices previously unknown and come to the life-
changing realization that they are more in control than previously perceived.

The W of the WDEP system includes an exploration of the quality world, the wants.
How clients see themselves in the world, what connections they make between their behavior
and their perception, how they perceive locus of control, and how much change they believe is
possible- these and other perceptions constitute part of the W.

EXPLORING DOING, OR TOTAL BEHAVIOR

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 Throughout the course of therapy, clients describe the various components of their total
behavior: physiology, emotions, thinking and actions. At various times some level of the
behavioral suitcase or wheel of the car needs more intense scrutiny than the other components.
Because actions are more explicitly chosen, most discussion centers on them.

Physiology: reality therapists follow the standard practice of responding to physical

abuse, injury, and pain. They discuss physical symptoms as appropriate and especially their
link to mental health. The therapist’s awareness of pain symptoms, real or imagined, helps him
or her decide on the degree of immediacy for a referral to a medical professional. Some such
symptoms accompany feelings of distress and depression and impede social or occupational
functioning, which are more the province of psychotherapy.

Emotions or feelings: emotions are seen not as static conditions but as purposeful
behaviors generated to impact the external world or to send it a signal. Thus “-ing” words are
used to illustrate the lively nature of all feelings. Reality therapists acknowledge feelings and
empathize with them but encourage clients to discuss accompanying self-talk and actions.

Cognition or thinking: Wubbolding has extended the practice of reality therapy to

include the identification and discussion of cognition related to both ineffective and effective
actions.

Ineffective self-talk (IST) includes: “no one is going to tell me what to do” “I’m
powerless to do anything to change” “I can control other people” “even though my present
behavior is not getting me what I want, I will continue to choose it”.

Effective self-talk (EST) includes: “I am happy when I live within reasonable

boundaries” “I am in control of my actions. I choose my behavior. I can change. I am in charge
of my life” “I cannot control other people’s behavior” “if what I am doing is not helping me,
I’ll stop doing it and try another course of action”.

After identifying IST statements, the therapeutic goal is to replace them with EST. this
is accomplishes by asking clients to evaluate their thinking, whether holding fast to IST is
helping them.

Actions: the key question under the D of the WDEP system is: WHAT ARE YOU
DOING?

WHAT implies specificity, being exact and precise. The therapist helps clients describe
what happened within a definite time frame. The rationale for focusing on action is clear:

49
Human beings have more direct control over their actions than thoughts or feelings.
Paradoxically, people are more aware of their feelings and thoughts, but these elements of total
behavior are less easily changed than actions.

ARE implies emphasizing current or recent behaviors, past behaviors as they relate to
the present, and past successful in-control choices. Endless discussions of past ineffective
behaviors leads clients to unnecessarily highlight their perception of out-of-control behaviors
and puts them at a level of undeserved importance.

YOU implies emphasizing client’s controllable behaviors rather than the uncontrollable
behaviors of other people. Clients victimized by circumstances, by history, or by other people
often wish to discuss behaviors that are out of control.

DOING implies discussing all aspects of total behavior: action, thinking, feeling and
physiology, with emphasis on the first and most controllable component.

An accumulation of therapy interventions focusing on “what are you doing?” can

precede or follow a discussion of “What direction are you taking in your life?” “If you continue
to do what you’re doing, where will be your current system of choices- your suitcase of
behavior- take you?” “Are you headed in a desirable direction?” This final question contains
the seed of self-evaluation.

EXPLORING EVALUATION

The key question under the E of the WDEP system are:

IS WHAT YOU ARE DOING HELPING YOU?

IS WHAT YOU WANT ATTAINABLE?

The foundation for practicing reality therapy is establishing a safe environment in

which clients freely and spontaneously self-disclose. Incorporating the principles of empathy,
reality therapists attempt to see the world as the clients see it as well as how clients see
themselves in relation to the world around them.

When discussing the central place of self-evaluation in choice theory and in the practice
of reality therapy, Wubbolding (1998) emphasizes that questions focusing on self-evaluation
need to be explicit and precise. Therapists cannot assume that people voluntarily seeking help
have evaluated their behavior and wants. Many people desire an outcome but do not see that
their behavior is ineffective. Effective self-evaluation rests on the inner assessment made by
clients and on relevant and targeted questions asked by the therapist. Through this interactional

50
process, clients make specific judgements about their total behavior, quality world, and other
components in their choice systems.

SELF EVALUATION AS JUDGEMENT

Self-evaluation is more than a mere description of behavior. The heart of this procedure
lies in an internal judgement facilitated by the therapist. Consequently, clients restructure their
thinking, which is a necessary prerequisite for more need-satisfying behavioral changes. This
contemplation is more than temporary idle musing; it is an ongoing process learned by clients
and practiced until it becomes habitual.

LEVELS OF SELF-EVALUATION

Self-evaluation is a judgement. And like all judgements, it is made with varying levels
of insight. Some people seem to have very little insight and evaluate their behaviors as helpful
when an outside observer can clearly judge the ineffectiveness and destructiveness of the other
person’s behaviors. Individuals do not self-evaluate in a vacuum. Information serves as a
foundation for effective want and need satisfaction. Consequently, there are levels of insight
and judgement that aid in a person’s self-evaluation.

Level 1: Self-evaluation with little or no information. Therapists help clients become

more circumspect in their self-evaluations. They help them see their behavior in a new light
and form a new perspective. Therapists’ questions for focusing on self-evaluation aim at
helping clients make each year better than the previous one.

Level 2: Self-evaluation with knowledge and information. When people deepen their
level of information and knowledge about their own behavior or the attainability of their wants,
they achieve a more cultivated level of self-evaluation. The person receiving the information
can weigh its value and relevance. Information alone does not ensure change, but the
willingness to view change as useful can lead to better human relationships, the preeminent
goal of the practice of reality therapy.

Level 3: Self-evaluation based on feedback and a standard. Information, feedback and

standards provide the basis for the highest level of self-evaluation. Self-evaluation is part of
the development process of mental health. It is a pathway from negative and ineffective
behaviors characterized by “I give up” negative symptoms, and addictions to the effective
behaviors of “I’ll do it” positive symptoms, and positive addictions. The self-evaluation “What
I’m doing is not working” is a prerequisite for change. Skilled reality therapists have in their

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suitcase of behavior a range of questions that help clients evaluate their behavior and make
judgements about it that serve as a foundation for action planning.

INDIRECT SELF-EVALUATION

Straightforward direct questioning is the most prevalent form of self-evaluation.

However, a subtler example of self-evaluation helps clients externalize a problem and see it
from a different perspective. A technique borrowed from Erickson and his followers consists
of the use of metaphors, narratives or stories. For instance, an anecdote beginning with “your
situation reminds me of someone I heard about who was faced with a similar challenge”
followed by a description of a comparable problem happily resolved, helps the client gain a
sense of hope in that others have made effective and helpful choices. It also allows the client
to look at his or her own behavior and view it as helping or impeding progress. Wubbolding
(1991) describes metaphors that can be applied to self-evaluation.

PLANNING FOR CHANGE

The key question under the P of the WEDP system is:

WHAT IS YOUR PLAN?

Enhancing mental health and moving from ineffective symptoms to effective symptoms
happens when clients decide to improve their lives and then make plans for satisfying their
wants and needs. The reality therapists facilitates plan making and instructs clients on the
characteristics for successful planning:

Simple, not overly complicated, easy to understand, geared to client’s developmental

level.

Attainable, not grandiose or out of reach. The client sees it as realistic and feasible.

Measurable, not vague or abstract.

Immediate, not unnecessarily delayed. The client sometimes rehearses the plan during
the therapy session.

Involved. The therapist does not leave the client on his or her own and can be involved
I the plan as appropriate.

Controlled by the planner, and not dependent on others’ behavior. The client regulates
execution of the plan.

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 Committed to, not characterized by, “I’ll try” or “Probably”. Plan is firm and fixed.

Consistent or repetitive, not whimsically or occasionally carried out. The most effective
plan is repeated often until it is habitual.

The language of planning includes tactful and careful wording of questions based on
the perceived receptivity and readiness of the client. A hasty rush to action planning can result
in client resistance. The gentle phrasing of questions such as, “could you” is often acceptable
to clients. With appropriate timing, reality therapists follow this question with “would you”
and “will you?”

3.9 PROCEDURE

For the present study, the sample was collected from Ranchi Institute of Neuro-
Psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi.

Initially 12 indoor patients from deaddiction ward, only male, who are suffering from
Alcohol Dependence Syndrome were selected. All the participants have been receiving
treatment for their illness from RINPAS. AUDIT were administered on all the participants and
everyone scored above 13.

Then, the participants were screened for some general health problems with the use of
General Health Questionnaire-12 (GHQ-12) and 4 of them were screened out (by assessing and
selecting those who obtained a score of 3 or above in GHQ-12). Out of the 8 remaining
participants, 3 of them got discharged while the therapy was midway and thereafter they were
unwilling to come to RINPAS outdoor to continue with the therapy.

Purposive sampling method has been used for the purpose of sample selection.

Each participant was clinically interviewed in detail about their health problems and
psychological distress, according to inclusion and exclusion criteria.

Finally work was started with 5 remaining participants. All the participants were
appraised about the study and informed consent was taken from them. Participant
confidentiality and scrutiny was ensured.

In the first two sessions rapport was established and tests were administered (Locus of
Control Scale and Sacks Sentence Completion Test) to assess the conflicts. Simultaneously,
observation and interview techniques were employed for detailed understanding of the
participants.

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 In the intermediate phase of therapy (session 3,4 and 5) the clients were asked questions
about their needs/wants, actions (total behavior) and self-evaluation. These were correlated
with the results indicated in the test. The client were helped to clarify the state they are in at
present and what their goals are. Whether they are attainable goals or are they trying to achieve
something which is beyond their potential and abilities. The clients were also helped to become
aware of the level of self-evaluation they are presently engaging in and what needs to be done
to attain a higher level of self-evaluation which will help them resolve their personal conflicts.

Finally, in the last phase of therapy (sessions 6,7 and 8) planning was done as how to
change their maladaptive total behavior and adhere to the plan. Each session was conducted
for about 50-60 minutes for each participant. Termination was done in the final session
(sessions 9 and 10).

The participants were again reassessed on the same tests that were administered on the
first session after completion of one month post therapy sessions. During this time, the
participants’ family members were called upon and information was gathered about the present
functioning of the client.

Throughout the entire procedure of the study, participant confidentiality and security
was ensured. Written permission was obtained from the participants for audio-taping the
sessions. The audio-tapes were kept in a secure place accessible only to the researcher. The
notes, tapes, transcriptions, and any other recorded material were destroyed after the
completion of the research.

3.10 DATA ANALYSIS

Qualitative analysis was done to see the application of reality therapy on management
of conflicts with the family members and self-concept. Thematic analysis was done done for
each individual separately.

In order for each participant to serve as his own control, stable baseline for each
participant was established with the purpose to measure the effect of intervention once the
intervention was administered. In the present study each participant was assessed at a baseline
level through structured interview, observation method, administration of Locus of Control
Scale (Hindi adaptation) and Sacks Sentence Completion Test (SSCT).

54
 Qualitative analysis was done both during the intervention as well as after the
intervention through thematic analysis.

THEMATIC ANALYSIS: Thematic analysis is a method of analyzing the data

obtained. It entails the identification, analysis, and reporting of patterns or the elicited themes
within data. It also is a process of organizing and describing the data in detail (Barun & Clarke,
2006). However it comprises of the interpretation of various aspects of the pertaining research
topic (Boyatzis, 1998). Barun and Clarke mentioned sis systematic phases of thematic analysis.
They are not very crisp in the sense that they overlap during the procedure, but they enable a
systematic approach towards handling data. The phases include, familiarizing oneself with
data, generating initial codes or ideas about what is interesting in the data, searching by themes
by sorting codes, reviewing themes for coherent patterns and validity in relation to the entire
data set, defining and naming themes and lastly producing report by writing sufficient evidence
that tells the overall story of the data. In the data collected in the study themes derived from the
recorded transcripts are reflective of their course of illness and cognitive distortions.

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CHAPTER 4

RESULTS

56
RESULTS

This chapter includes elaborate details about five cases.

The sample consisted of 5 patients with Alcohol Dependence Syndrome receiving

medical treatment for the illness during their stay in the deaddiction ward in RINPAS. The
participants are within the age range of 20-50 and their minimum level of education was at
matric level.

The first phase deals with the description of details of case study of the participants
taken for the present investigation.

The second part deals with the test administration and related therapeutic application of
Reality Therapy on that particular case. This phase also includes the assessment, recognition,
therapeutic application and planning for change regarding various conflict areas concerning
family and self- concept.

In the third and the final phase, results of pre and post therapeutic evaluation are
discussed on the basis of the scores of the participants on two psychological tests viz., Sack’s
Sentence Completion Test and Locus of Control Scale. Feedback of the client as well as the
family members during the follow up session are also discussed in the end of this section.

4.1 CASE 1: DK

4.1.1 CLINICAL HISTORY

DK is a 37 year old married, Hindu, Hindi speaking male. He lives in Daltongunj and
is educated upto class XI. He left his studies midway and joined his father in his catering
business. The business was not running well so the client left the job and presently he is
working as a carpenter in a shop in Daltongunj. The client, his brother and two sisters had a
difficult childhood. The client’s parents got separated when he was 8 years old. Following the
separation, the client and one of his sisters were allotted to stay with his father and the rest of
his siblings stayed with their mother. During their stay with father the client had regular fights
with him and often he used to come back to his mother. When the client was 13 years old his
mother expired and he with his siblings shifted to his maternal grandmother’s house. His
grandmother took good care of him and he was satisfied staying with her. In 2016 the client
got married to a girl whom he loved. Following his marriage he shifted and started staying with

57
his father. 6 months after he got married the client’s father married a girl. The client was staying
with his wife, father, stepmother and his two brothers. With each passing day conflicts and
arguments started arising with his stepmother and wife. He seldom speaks to his stepmother
but she keeps complaining to him about his wife after he returns home during night. The client
started taking alcohol when he was in school and presently takes approximately 100ml a day
in the form of beer or hadiya. The client was admitted in RINPAS by his brothers with the chief
complaints of diminished sleep and appetite, excessive intake of alcohol, not returning home
after work, anger outbursts, aggressiveness and using abusive languages, irritability,
restlessness and initiating fights.

There is no history indicating mental retardation, epilepsy, significant head injury or

persistent high fever.

Presently he has been diagnosed with Mental and behavioral disorders due to use of
alcohol (dependence syndrome).

4.1.2 OVERVIEW OF THE THERAPEUTIC SESSIONS

Total 10 sessions were given to DK.

4.1.2.1 INITIAL PHASE OF INTERVENTION

DK was selected for the present study after detailed review of his CRF. He was called
for interview. The client was oriented to time, place and person. He looked tidy, his dress was
clean and beard was shaved. Rapport could be established within the initial two sessions. The
client was cooperative while discussing his problems which indicated that he was very much
motivated for change.

The therapist explained to him that she was there to help him gain insight into his
problems and deal effectively with the life issues he is facing at present and for which he had
been admitted in RINPAS. After ensuring his consent in the therapy process, the therapist
proceeded further.

This phase consisted of making a good therapeutic alliance with the client which would
help in free flow of communication between the therapist and the client. The therapist tried to
instill hope in the client by making him understand that he will learn to make better choices
and in doing so, gain better control of their lives. The following is an excerpt of the instructions
given to the client:

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 For all practical purposes, we choose everything we do, including the misery we feel.
Other people can neither make us miserable nor make us happy. All we can get from them or
give them is information. But by itself information cannot make us do or feel anything. It goes
into our brains and then we decide what to do. We are much more in control of our lives than
we realize.

One move towards wholeness by identifying with ongoing experience, being in contact
with what is actually happening, identifying and trusting what one genuinely feels and wants
and being honest with self and others about what one is actually willing and able to do – or
not willing to do.

The above instruction was translated in hindi while delivering for lucidity of language
and better understanding for the client.

The second session consisted of administering the locus of control Scale and Sack’s
Sentence Completion Test. Along with this the client was thoroughly interviewed regarding
the conflicts and problems he is facing with in his family. The client was repeatedly given
assurance that his problems will be kept confidential and help will be provided to resolve the
problems as much as possible.

Thorough analysis of the SSCT protocol reveals that he has significant conflict with his
stepmother and wife. Statements like “ zyadatar gharo ko dekhte huye mera vichaar hain kaash
mera family bhi aisa hota.” “ meri maa mujhse bolti hain kaam karne ke liye” “baivahik
Jeevan ke baare mein meri bhavna achhi hoti agar meri wife mera saath deti” “ main apni
maa k otoh chahti hoon lekin maa mujhe nehi chahti hain” “meri maa aur main aksar muh
pholaphuli hota hain” corroborates the fact.

Test findings also includes conflict in the area of self concept. Statements like “ main
uss samay ko bhulane ke liye kuch bhi karunga jab ki main sharaab peeke biwi ko maara tha”
“ meri sabse badi bhool thi ki maine love marriage kiya” “ sabse bura kaam jo maine kiya
who hain ghar chod ke chale jaana” reveals feelings of guilt and low self concept.

Apart from test findings detailed interview was taken from the client which reveals his
basic needs for love and belongingness which he is constantly seeking for but unable to achieve.

How the client perceives his world around himself gives an idea of the locus of control.
The client has fairly external locus of control where he attributes various situations in his life
into outside factors and thinks that he has no control over them and that he is controlled by
external forces.

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4.1.2.2 INTERMEDIATE PHASE OF THERAPY

This phase mainly consists of four sessions with the goal to identify the total behavior
of the client as well as how they evaluate themselves regarding his problematic behavior.

The following is an excerpt of the conversation between therapist and the client in the
session.

The therapist probed into instances where he adopted a maladaptive behavior while
communicating with his stepmother.

Client: Meri sauteli maa mujhse humesha wife ke baare mein complain karti hain.

Therapist: Ek aisa situation bataiye.

Client: Jab raat ko thak kar ghar paunchta hoon toh meri maa list banake mujhe bolti
hain ki meri biwi kya kya galti kiya.

Therapist: Tab aap kya karte ho?

Client: Itna kaun karta hain? Main kaun lagta hoon? Gussa ho jaata hoon aur maa ko
daant deta hoon.

Therapist: Phir?

Client: Zyada gussa aane pe glass aur cup uthake fek deta hoon.

Therapist: Maa kya bolti hain tab?

Client: Maa darr jati hain. Yeh saaman girana bas teen char baar hi huya hain. Nahito
maa ko dant deta hoon ya ghar se bahaar nikal jaata hoon.

Therapist: Kyun?

Client: Mujhe yeh sab maamlo mein nehi rehna hain. Mujhe yeh sab nahi sunna hain.

Therapist: lekin aap kya chahte ho?

Client: Main chahta hoon mil baant ke rahe sab.

Therapist: aap jo kar rahe ho kya ussesab theek ho jayga?

Client: Nahi. Sayad main hi zyada gussa karta hoon.

The behavior of the client indicates his lack of understanding the seriousness of the
situation and he wants to escape it by overreacting to the situation. The client himself is also
least bothered about the concerns of his mother.

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 The client also described other situations where he rudely and chose to aggress his
stepmother rather than setting the situation.

The client most of the time blames his wife for the situation he faces. The client has
beaten up his wife for not conforming to him. He would often create problems regarding food
and blames his wife for not preparing food he likes. The client also heavily criticized his wife
for wanting to visit her parents’ house as he feared that in her absence it will be difficult to
manage the household chores.

In evaluating his own behavior it was noticed that the client was not well informed.
Different aspect of a single situation were discussed and helped him see their behavior in a new
light and new perspective.

The client is taught to gain insight regarding his incapabilities and assess himself
internally about what he is doing is right or wrong.

The client realized that what behaviors he is adopting at present will not get him where
he wants to go that is to experience a feeling of love and belongingness from his family. He
came to the decision that he himself is blocking the flow of love from his mother and wife by
his own maladaptive behaviors.

4.1.2.3 FINAL PHASE OF THERAPY

In the final three sessions of therapy, planning was done for solutions regarding his
problems.

The goal was to reduce conflicts with the client’s stepmother and wife. The therapist
discussed with the client the progress of therapy and asked him to describe the areas where he
was ineffective in handling situations and adopted maladaptive patterns of behavior. A review
was done of his needs, conflicts that engendered from his unmet needs, his total behavior and
locus of control.

In the final phase of therapy clients were taught to make effective control over their
behavior and choose more wisely.

The client was made to understand that it is within his control how to deal effectively
in a situation. And it is his actions which will determine the final outcome. Every actions has
its own consequences and if he wants a positive outcome then he must act accordingly. With
the consent and approval of the client planning was done to change his ineffective total
behaviors.

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 In the instance where his stepmother complained about his wife the client was instructed
to listen carefully. Behaving in an aggressive way should not be the option he should choose,
rather he should choose to be patient with his stepmother and try to solve out the problematic
situation through elaborative discussion and planning.

The problem he has with his wife was also judged and before he took any action or
commented anything he should judge the situation by thinking from the perspective of his wife.

Lastly the client was motivated for changing his behavior and make genuine
commitment to the plans that has been made.

The final session was terminated by assuring the client that change will definitely be
noticed if he abide by his plan that was made to change him and choose more adaptive ways of
behaviors. It was also conveyed that the therapist would be available for the client anytime and
contact number was shared.

4.1.3 PRE AND POST THERAPY ASSESSMENT REPORT AND FOLLOWUP

REPORT

The client was again interviewed and tests of Locus of Control Scale and Sacks
Sentence Completion Test were administered to assess the progress.

TEST PRE INTERVENTION POST INTERVENTION

Locus of Control scale 38 57

Fig 1: Locus Of Control Scale

The difference in scores indicates that the client has learnt to take responsibilities and
acknowledges the consequences of his behavior which helps him to choose his behaviors
carefully.

Fig 2: Sacks Sentence Completion Test

Sacks Sentence Completion Test Pre Intervention Post Intervention

Family Attitude towards mother 6 3

Attitude towards life partner 5 2

Self- Concept Guilt feelings 4 3

Poor Self-esteem 7 4

62
 SSCT
8
7
6
5
4
3
2
1
0
attitude towards attitude towards life guilt feelings poor self-esteem
mother partner

pre intervention post intervention

The client, his stepmother and wife were interviewed after a gap of one month for
follow-up.

The client reported that he has grown more patient towards his stepmother. He listens
to her patiently and tries to solve her problems which has resulted in development of mutual
trust and bonding between them. He has grown more accepting towards his wife, respects her
and taker her opinion in consideration before taking any actions.

The client’s wife and stepmother were interviewed which revealed that he seems to be
functioning better in terms of relationships, has become more patient towards his family. The
feelings of warmth and acceptance by his family helped him in boosting up his self- esteem
too.

Overall the client and his family members were satisfied with the results of therapy
process.

4.2 CASE 2: MM

4.2.1 CLINICAL HISTORY

MM is a 48 year old male, married, Hindu, Hindi speaking, educated up to matric and
currently runs a stationary shop. After passing matric he joined his father in his stationary
business. The client started taking alcohol since then. But then he took alcohol occasionally
and in the form of Mahua. The client got married when he was 27 years old. Presently his daily
routine consists of getting up 8 in the morning and going to the shop which is just outside his
house. In the afternoon, he comes back, has his lunch and again goes to his shop and sits there

63
till 9pm. After that he goes out and drinks with his friends and comes back home at around
10.30pm. This is his everyday routine for the last 2 years. Presently he is having a land dispute
with his brothers. He has 3 brothers and 2 sisters of whom the client is the oldest one. The client
has 5 daughters and presently his most debilitating concern is about getting his daughters
married. His brothers are into good business and maintains good standard of life. But according
to the client they are having conflicts over land and it is important for him to win the case as
that land will provide money for marrying off his daughters. The client’s oldest daughter is
now in college and the youngest daughter is 9 years old who is a school going kid. Apart from
problems with his brother, the client has frequent fights with his wife too regarding household
matters. His wife blames him for not being enough responsible towards family. The client was
brought to RINPAS OPD by his wife and was admitted in the indoor ward with chief
complaints of diminished sleep and appetite, trembling of hands, and anger outbursts. He has
not been treated before and it is the first time he has been admitted in psychiatric hospital.

There is no history indicating mental retardation, epilepsy, significant head injury or

persistent high fever.

Presently he has been diagnosed with Mental and behavioral disorders due to use of
alcohol (dependence syndrome).

4.2.2 OVERVIEW OF THE THERAPEUTIC SESSIONS

Total 10 sessions were given to DK.

4.2.2.1 INITIAL PHASE OF INTERVENTION

DK was selected for the present study after detailed review of his CRF. He was called
for interview. He came readily and sat comfortably. His posture was drooping with several fine
lines in his forehead. The client was kempt and tidy, his hair was groomed and beard was
shaved. Rapport could be easily established with the client. Initially he was apprehensive about
his stay in RINPAS.

The therapist explained to him that she was there to help him gain insight into his
problems and deal effectively with the life issues he is facing at present and for which he had
been admitted in RINPAS. After ensuring his consent in the therapy process, the therapist
proceeded further.

This phase consisted of making a good therapeutic alliance with the client which would
help in free flow of communication between the therapist and the client. The therapist tried to

64
instill hope in the client by making him understand that he will learn to make better choices
and in doing so, gain better control of their lives. The following is an excerpt of the instructions
given to the client:

For all practical purposes, we choose everything we do, including the misery we feel.
Other people can neither make us miserable nor make us happy. All we can get from them or
give them is information. But by itself information cannot make us do or feel anything. It goes
into our brains and then we decide what to do. We are much more in control of our lives than
we realize.

One move towards wholeness by identifying with ongoing experience, being in contact
with what is actually happening, identifying and trusting what one genuinely feels and wants
and being honest with self and others about what one is actually willing and able to do – or
not willing to do.

The above instruction was translated in Hindi while delivering for lucidity of language
and better understanding for the client.

The second session consisted of administering the locus of control Scale and Sack’s
Sentence Completion Test. Along with this the client was thoroughly interviewed regarding
the conflicts and problems he is facing with in his family. The client was repeatedly given
assurance that his problems will be kept confidential and help will be provided to resolve the
problems as much as possible.

Thorough analysis of the SSCT protocol reveals that he has significant conflict with his
brothers. Statements like “ mere upar ke log jo mere bhailog hain who mera kharab chahte
hain” “ mujhe who log pasand nahi aate jo dusre log ko insult karte hain” “jin logo ko main
apne se uncha samajhta hoon wohlog izzat ke haqdar nahi hain” indicates the client’s
disappointment and conflict with his brothers.

Test findings also indicates conflict in the area of self-concept. He is not optimistic
about his future and is under the impression that he will be a failure in every aspect of his life.
This is indicated by statements like “ mujhe aage aane wala samay ke liye chinta bana rehta
hain” “ main aasaha lagaye hoon ki aage kuch buran a ho mere saath” “kisi din main bhaaut
mushkil mein na padh jaoon”.

The client has well defined goals but is not hopeful about them. This is revealed in
statements like “ main humesha yeh chaha ki aage badhu lekin ho nahin raah hain” “ main
poori tarha se khush ho sakta agar mera kaamna poora ho jata”.

65
 Scores from Locus of Control Scale indicates external locus of control which further
hampers his relationship with his brothers.

The following is an excerpt from the discussion between the therapist and the client:

Client: Mujhe darr rehta hain ki aage meri betiyon ki shaadi kaise hoga?.

Therapist: Aisa darr kyun rehta hain?.

Client: Main bass chota sa dukaan smbhalta hoon. Meri kamaai bhi zyada nshi hain.
Ghar chalane mein mushkil hota hain.

Therapist: Iske liye kya soche hain?

Client: Mere pitaji ke bahaut zameen hain. Agar batwara ho jata hain toh koi dikkat
nahi rehega.

Therapist: toh batwara to equal hisse mein hoga aapke bhsilog ke saath.

Client: lekin mere sab bhai bahaut achha business karte hain.bahaut paisa hain unke
paas..

Therapist: aap sabki pitaji ke zameen hain. Samaan batwara hona chaiye.

Client: jisko zaroorat hain unko zyada milna chahiye na?

Therapist: iske baare mein aapke bhailog kya bolte hain?

Client: bada bhai nahi maante hain. Unko apna hissa poora chahiye. Unko sunte huye
mera baaki bhai bhi wohi chahte hain. Iss dauraan jhagra bhi hota hain.

It is noticed that the client blames his brothers for his problems, ignoring the fact that
it is his own inefficiency to run his family peacefully.in this context he often fights with his
wife, accusing her of giving birth to five daughters which has increased his burden as a father.

The client perceives his surrounding environment as unsupportive and constantly

exploitative of his resources where he lacks his sense of power and fulfillment.

4.2.2.2 INTERMEDIATE PHASE OF THERAPY

This phase mainly consists of four sessions with the goal to identify the total behavior
of the client as well as how they evaluate themselves regarding his problematic behavior.

The following is an excerpt of the conversation between therapist and the client in the
session.

66
 The therapist probed into various actions he adopted a while in a difficult situation.

Therapist: jab bhailog se behes ho jaata hain tab kya karte ho?.

Client: main uttejit hoo jaata hoon. Mujhe bahaut tension ho jaata hain.

Therapist: jab tension hone lagta hain toh kya karte ho?

Client: main dhamki dene lagta hoon. Hatapai bhi ho jaata jain kabhi kabhi.

Therapist: bhailog kya karte hain?

Client: bada bhai gussa karte hain. Chote bhailog rokne ki koshish karte hain.

Therapist: phir jab dekhte ho ki bhailog nahi maan rahe hain tab kya khayal aata hain?

Client: pehle toh darr lagne lagta hain ki aage aane wala timepe kya hoga? Who sochke
frustration hone lagta hain aur main apna gussa sambhal nahi paata hoon.

Therapist: toh kuch hal huya iss problem ka?

Client: abhi tak cse chsl raha hain. Kuch suraha nahi hoo raha hain..

Therapist: abhi tak koi fayda hua?

Client: bass har bar unlogo se jhagda ho jaata hain. Ab toh lagta hain unlogo se kabhi
theek nahi hoga kuch bhi. Iss liye abhi sharaab zyada peene laga hoon.

“main apna rishta khud hi bigar raha hoon lekin mere paas aur koi raasta bhi toh nahi
hain.. Agar paisa nahi ayega toh betolog ke shadi bhi theek se nahi kar paunga.”

In the process of self -evaluation information was provided to him so that he could
assess the overall picture of the situation. He accepted that he displaces his frustration over his
wife and brothers by behaving aggressively and finding faults in everything. The client accepts
the fact that he does not take care of his shop thus escaping from his responsibilities. His
pessimistic orientation towards his family further demotivates him and he indulges in intake of
alcohol following which his behavior becomes more unacceptable.

4.2.2.3 FINAL PHASE OF THERAPY

In the final three sessions of therapy, planning was done for solutions regarding his
problems.

The goal was to reduce conflicts with the client’s brothers and change his orientation
towards his future. The therapist discussed with the client the progress of therapy and asked
him to describe the areas where he was ineffective in handling situations and adopted

67
maladaptive patterns of behavior. A review was done of his needs, conflicts that engendered
from his unmet needs, his total behavior and locus of control.

In the final phase of therapy clients were taught to make effective control over their
behavior and choose more wisely.

The client was made to understand that it is within his control how to deal effectively
in a situation. And it is his actions which will determine the final outcome. Every actions has
its own consequences and if he wants a positive outcome then he must act accordingly. With
the consent and approval of the client planning was done to change his ineffective total
behaviors.

Since the client was being selfish over the land dispute, planning was made so that he
stops blaming his brothers and wife for his misfortune. He must take the responsibility of his
own family and should not depend on external source of money to sustain his family. As a
result he should focus more on how to increase his income to maintain a standard of life. He
was made to realize that his brothers have equal rights to his father’s land as him irrespective
of their standards in society. The client used to spend majority of his time brooding over the
past and indulging in alcohol without serious attempts to analyze his problems and brainstorm
ways to resolve them.

The client was extremely laid back in his attitude towards work. It was planned that he
would be more active and patient in dealing with customers. Earlier he used to leave his shop
at odd times and behaved rudely with his customers as a result of which people deliberately
avoided his shop.

Apart from that he should multiply his source of income by establishing other shop or
making partnerships in his business with others.

Equal distribution of land would solve the problems with his brothers.

Lastly the client was motivated for changing his behavior and make genuine
commitment to the plans that has been made.

The final session was terminated by assuring the client that change will definitely be
noticed if he abide by his plan that was made to change him and choose more adaptive ways of
behaviors. It was also conveyed that the therapist would be available for the client anytime and
contact number was shared.

68
4.2.3 PRE AND POST THERAPY ASSESSMENT REPORT AND FOLLOWUP
REPORT

The client was again interviewed and tests of Locus of Control Scale and Sacks
Sentence Completion Test were administered to assess the progress.

TEST PRE INTERVENTION POST INTERVENTION

Locus of Control scale 26 48

Fig 1: Locus Of Control Scale

The difference in scores indicates that the client has learnt to take responsibilities and
acknowledges the consequences of his behavior which helps him to choose his behaviors
carefully.

Sacks Sentence Completion Test Pre Intervention Post Intervention

Family Family cohesiveness 6 4

Self- Concept Attitude towards future 7 3

Future goals 5 2

Fig 2: Sacks Sentence Completion Test

Sacks Sentence Completion Test

8
7
6
5
4
3
2
1
0
family cohesiveness attitude towards future future goals

pre intervention post intervention

69
 The client and his wife were interviewed after a gap of one month for follow up.
Although his brothers were called in the follow up session they refused to attend the follow up
session which indicates that the differences of the client with his brothers have not subsided
completely and more initiative should be taken by the client to remove the differences.
Although the client reported that he has come into a unanimous decision about the land with
his brothers. He also reported that he has become more responsible towards his family and
fights less with his wife.

Interview with his wife revealed that he has become more productive in his business
although he needs to work more to secure their future. He has set definite goals and works
towards achieving them. But the problems surface occasionally when he starts shouting.

But overall the client and his wife was satisfied with his progress.

4.3 CASE 3: MS

4.3.1 CLINICAL HISTORY

MS is a 30 year old male, married, Muslim, Hindi speaking, educated up to matric and
currently working in a cloth shop. The client lives in the urban area of Ranchi. He lives in a
joint family consisting of his parents, 2 younger brothers, wife, 2 daughters and an uncle. He
works in a wholesale cloth shop in Upperbazar. He goes to his shop at around 10 am in the
morning and works until late at night. In between he has his lunch which he gets from home.
According to the client there is heavy work pressure but his work environment is jovial. 4 years
ago he got married to his cousin sister (“mausi ki beti”). Problems started emerging after 2
years of his marriage when his daughter was born. According to him, his wife started accusing
him when he increased his drinking habit and started staying outside for late hours. He would
drink around 200-300ml alcohol in the form of beer or whiskey every day. The client complains
that his wife does not attend him properly when he goes back home and ignores him. She does
not make good food and always fights with him. The client spends majority of the money that
he earns into buying alcohol. Presently he complains that along with his wife his mother has
also started complaining against him. The client feels that his mother does not respects him and
is manipulated by his wife. He often fights with his mother as his mother is strongly against
him regarding his intake of alcohol. There are instances where the client after drinking alcohol
have misbehaved with his mother and wife, has behaved aggressively and has also beaten up
badly. Earlier at the end of a month he used to give his whole salary to his mother. But presently

70
he keeps it to himself and expends from there according to his need. The client was brought to
RINPAS OPD and was admitted in the indoor ward with chief complaints of diminished sleep
and appetite, trembling of hands, aggressiveness and using abusive languages, initiating fights
with brothers and not coming home at night. He has not been treated before and it is the first
time he has been admitted in psychiatric hospital.

There is no history indicating mental retardation, epilepsy, significant head injury or

persistent high fever.

Presently he has been diagnosed with Mental and behavioral disorders due to use of
alcohol (dependence syndrome).

4.3.2 OVERVIEW OF THE THERAPEUTIC SESSIONS

Total 10 sessions were given to MS.

4.3.2.1 INITIAL PHASE OF INTERVENTION

MS was selected for the present study after detailed review of his CRF. He was called
for interview. The client was oriented to time, place and person. He looked tidy, his dress was
clean and beard was shaved. Rapport could be established within the initial two sessions. The
client was cooperative while discussing his problems which indicated that he was very much
motivated for change.

The therapist explained to him that she was there to help him gain insight into his
problems and deal effectively with the life issues he is facing at present and for which he had
been admitted in RINPAS. After ensuring his consent in the therapy process, the therapist
proceeded further.

This phase consisted of making a good therapeutic alliance with the client which would
help in free flow of communication between the therapist and the client. The therapist tried to
instill hope in the client by making him understand that he will learn to make better choices
and in doing so, gain better control of their lives. The following is an excerpt of the instructions
given to the client:

For all practical purposes, we choose everything we do, including the misery we feel.
Other people can neither make us miserable nor make us happy. All we can get from them or
give them is information. But by itself information cannot make us do or feel anything. It goes
into our brains and then we decide what to do. We are much more in control of our lives than
we realize.

71
 One move towards wholeness by identifying with ongoing experience, being in contact
with what is actually happening, identifying and trusting what one genuinely feels and wants
and being honest with self and others about what one is actually willing and able to do – or
not willing to do.

The above instruction was translated in Hindi while delivering for lucidity of language
and better understanding for the client.

The second session consisted of administering the locus of control Scale and Sack’s
Sentence Completion Test. Along with this the client was thoroughly interviewed regarding
the conflicts and problems he is facing with in his family. The client was repeatedly given
assurance that his problems will be kept confidential and help will be provided to resolve the
problems as much as possible.

Thorough analysis of the SSCT protocol reveals that he has significant conflict with
mother and wife along with pessimistic attitude towards his future.

Statements like “ mujhe maloom hain ki yeh bevakoofi hain lekin main maa se darta
hoon” “meri maa kaash mujhe pyar karti” “ mari maa aur main aksar ladhte aur jhagarte
hain” “main apni maa ko chahta toh hoon lekin yeh zaroori hain who bhi mujhse pyar kare”
“ baivahik Jeevan ke baare mein meri bhaavna theek nahi hain” corroborates the fact.

Test findings also indicates pessimistic attitude towards his future and goals given by
statements like “ mujhe aage aane wala samay kuch theek nahi lagta hain” “ main aasha
lagaye hoon ki ab jo theek nahi hain who theek ho jaye” “ kisi din main chahta hoon sab
mujhse acche bartav karein lekin sayad who nahi hoga” “maine humesha yeh chahha sab
kaam ache se ho jaye” “ main poori tarha se khush ho sakta agar meri parivaar khushaal
hote”

Apart from test findings detailed interview was taken from the client. Through the
process of interview it was revealed that there is significant conflict with his wife. His wife
accuses him of various things, mainly about money. The client reports that his wife is extremely
dissatisfied with him for the fact that he spends a lot of money for his own needs mainly to
consume alcohol. As a result, it becomes very difficult to bear the expenses for the family as
she has to look after their two daughters. The client also returns home late. After his work is
over every day he goes out and drinks with his friends. As a result he does not fulfill the
responsibilities he should for his family.

72
 The following is an excerpt of the conversation between therapist and the client in the
session.

Client: halaat bahaut mushkil ho chukka hain. Jhagda chalta I rehta hain..

Therapist: kis baat pe itna jhagda hota hain?

Client: raat ko Thakkar jab ghar aata hoon biwi gussa karti hain.

Therapist: kis baat pe who gussa karti hain?

Client: sharaab peene mein paisa kharch hota hain. Isliye ghar pe zyada paisa nehi de
paata hoon. isliye

Therapist: maa kya bolti hain?

Client: ma bhi gussa karti hain kyun ki mera parivaar chalane ke liye kabhi kabhi ma
paisa deti hain. Aur ghar ke halaat aisa nehi hain ki apne hisse se koi apka kharch uthaye.

Therapist: iss baare mein aap kya sochte hain? Aage kya karenge?

Client: pata nahi kya hoga. Mujhe kuch bhi sahi nahi lagta hain. Sayad biwi humare
bachho ko leke apne maikechali jayegi.

All these indicates the client’s basic needs for love, belongingness and fun which he is
constantly seeking for but unable to achieve.

How the client perceives his world around himself gives an idea of the locus of control.
The client has fairly external locus of control where he attributes the reasons for his problems
mainly to his family members and perceives his surrounding environment as unloving and
rejecting.

4.3.2.2 INTERMEDIATE PHASE OF THERAPY

This phase mainly consists of four sessions with the goal to identify the total behavior
of the client as well as how they evaluate themselves regarding his problematic behavior.

The following is an excerpt of the conversation between therapist and the client in the
session.

The therapist probed into instances where he adopted a maladaptive behavior .

Therapist: ghar lautne mein itna raat kyun hoti hain?.

Client: sharaab pene jaata hoon doston ke saath aur ghat lautke toh who hi pareshaani
hain..isliye der se lautta hoon

73
 Therapist: mushkil kyun hota hain?

Client: maa ur biwi ki baat bilkul achhi nahi lagti hain.

Therapist: lekin wohlog to kuch galat nahi bolte hain. Aap ghar ki kaunsi zimmedaari
uthate hain?

Client: main kamata toh hoon aur time time pe biwi ko paisa deta hoon.

Therapist: ghar ka kaunsa kaam karte ho?

Client: subhe uth ke paani bhar deta hoon.

Therapist: aur biwi kya karti hain?

Client: who sab kaam karti hain.

Therapist: toh biwi jab yeh bolti hain ki aapko aur thoda zimmedari len achahiye toh
kya galat hain?

Client: nahi who log sahi hain. Lekin wohlog humesha mera sikayat karti hain.

Therapist: aap jaise chal rahe ho who bhi toh sahi nahi hain. Hain na?

Client: ha manta hoon. Sharaab peen eke chakkar mein ghar mein time bhi nehi de
paata hoon.

Therapist: aur?

Client: main bina soche hi gussa karta hoon. Ujhe apni parivaar ke liye aur bhi
zimmedari uthana chahiye.

The behavior of the client indicates his lack of realization about his behaviors that gives
rise to the problems which he attributes to his family

The client also described other situations where he was rude and chose to aggress his
wife.The client most of the time blames his wife for the situation he faces. The client has beaten
up his wife for not conforming to him.

In evaluating his own behavior it was noticed that the client was not well informed.
Different aspect of a single situation were discussed and helped him see their behavior in a new
light and new perspective. He was helped to realize how his behavior is affecting the attitude
and behavior of his mother and wife towards him and how his mother and wife have to take all
responsibilities, as he is evasive in all his duties. The client’s pessimistic attitude about his
future concerning the family further demotivated him to take actions.

74
 The client is taught to gain insight regarding his incapabilities and assess himself
internally about what he is doing is right or wrong.

The client realized that what behaviors he is adopting at present will not get him where
he wants to go that is to experience a feeling of love and belongingness and fun from his family.

4.3.2.3 FINAL PHASE OF THERAPY

In the final three sessions of therapy, planning was done for solutions regarding his
problems.

The goal was to reduce conflicts with the client’s mother, wife and infuse positive
attitude towards his future. The therapist discussed with the client the progress of therapy and
asked him to describe the areas where he was ineffective in handling situations and adopted
maladaptive patterns of behavior. A review was done of his needs, conflicts that engendered
from his unmet needs, his total behavior and locus of control.

In the final phase of therapy clients were taught to make effective control over their
behavior and choose more wisely.

The client was made to understand that it is within his control how to deal effectively
in a situation. And it is his actions which will determine the final outcome. Every actions has
its own consequences and if he wants a positive outcome then he must act accordingly. With
the consent and approval of the client planning was done to change his ineffective total
behaviors.

Planning was done mainly to alter the behavior of the client in to more responsible
effective ones. He was made to understand where he was lacking in taking initiative, for
example, he should take up the work of grocery shopping every alternate days which was earlier
used to be done by his wife.

About money matters, planning was done to save money each month and keeping aside
some amount which could be used for family expenses. Increased responsibility results in
securing the future of family and promises the cooperation of his mother and wife.

Lastly the client was motivated for changing his behavior and make genuine
commitment to the plans that has been made.

The final session was terminated by assuring the client that change will definitely be
noticed if he abide by his plan that was made to change him and choose more adaptive ways of

75
behaviors. It was also conveyed that the therapist would be available for the client anytime and
contact number was shared.

4.3.3 PRE AND POST THERAPY ASSESSMENT REPORT AND FOLLOWUP

REPORT

The client was again interviewed and tests of Locus of Control Scale and Sacks
Sentence Completion Test were administered to assess the progress.

TEST PRE INTERVENTION POST INTERVENTION

Locus of Control scale 30 62

Fig 1: Locus Of Control Scale

The difference in scores indicates that the client has learnt to take responsibilities and
acknowledges the consequences of his behavior which helps him to choose his behaviors
carefully.

Sacks Sentence Completion Test Pre Intervention Post Intervention

Family Attitude towards mother 7 4

Attitude towards life partner 6 2

Self- Concept Attitude towards future 5 3

Attitude towards goals 5 4

Fig 2: Sacks Sentence Completion Test

Sacks Sentence Completion Test

8
7
6
5
4
3
2
1
0
attitude towards attitude towards lif attitude towards future attitude towards goals
mother partner

pre intervention post intervention

76
 The client, his mother and his wife were interviewed after a gap of one month for follow
up.

The client reported that he can control his anger now as he is more thoughtful and
cautious about his actions, commitment to his plan has helped him become more patient with
family members. They exhibit warmth and love towards each other now which has helped him
to grow more oriented towards his family.

The client’s mother and wife reported of increased cohesiveness within the family
which were lacking earlier due to the client’s careless attitude. Presently the client has become
more restricted in spending money, returns home early, looks after the needs of the family
whenever necessary. The client and his family members were happy with his improvement.

4.4 CASE 4: DS

4.4.1 CLINICAL HISTORY

DK is a 25 year old, married, Hindu, Hindi speaking male.

He is educated up to class X and presently runs a grocery business. The client was born
and brought up in Kenduadih, Dhanbad, a semi-urban region. He started the grocery business
after his matric and has been carrying out the business since then. The client is the oldest among
his siblings. He has two younger sisters who have been married and two younger brothers who
are educated and presently pursuing college. The client was married 4 years ago through
arranged marriage and has a daughter who is presently 2 years of age. According to him he
started taking alcohol when he was 15 years old and by then he was earning from his grocery
business and bought alcohol out of his own money. He was introduced to alcohol by one of his
friend in business and since then he had been taking it. According to him he was not dependent
on alcohol initially but gradually with passing years and increased family burden his alcohol
intake increased and at present he cannot pass a day without consuming alcohol. He consumes
“hadiya” and “mahua” as these are the forms of alcohol present in the market where he lives.
Presently each day he takes about 200-300ml of alcohol approximately. The client becomes
aggressive often while interacting with his father. He is upset with his son taking alcohol
regularly and prefers his other two sons over him.

The client was brought to RINPAS in December 2017 by his brothers following an
episode where his sleep and appetite was low, got easily angry, beat up his wife, initiated fights

77
and used abusive languages. A year ago in July 2016 he was admitted in RINPAS for similar
symptoms.

There is no history indicating mental retardation, epilepsy, significant head injury or

persistent high fever.

Presently he has been diagnosed with Mental and behavioral disorders due to use of
alcohol (dependence syndrome).

4.4.2 OVERVIEW OF THE THERAPEUTIC SESSIONS

Total 10 sessions were given to MS.

4.4.2.1 INITIAL PHASE OF INTERVENTION

DS was selected for the present study after detailed review of his CRF. He was called
for interview. The client came by himself and asked for his discharge from RINPAS. He was
instructed to sit and he followed the instructions. He was maintaining eye contact with the
examiner, was tidy and looked appropriate to his stated age. Initially he was reluctant about
speaking out his problems and said only said that he had done mistake by consuming alcohol
which led to numerous conflicts with his wife and his family members and he vowed not to
take alcohol henceforth. Rapport could be established within the initial two sessions.

The therapist explained to him that she was there to help him gain insight into his
problems and deal effectively with the life issues he is facing at present and for which he had
been admitted in RINPAS. After ensuring his consent in the therapy process, the therapist
proceeded further.

This phase consisted of making a good therapeutic alliance with the client which would
help in free flow of communication between the therapist and the client. The therapist tried to
instill hope in the client by making him understand that he will learn to make better choices
and in doing so, gain better control of their lives. The following is an excerpt of the instructions
given to the client:

For all practical purposes, we choose everything we do, including the misery we feel.
Other people can neither make us miserable nor make us happy. All we can get from them or
give them is information. But by itself information cannot make us do or feel anything. It goes
into our brains and then we decide what to do. We are much more in control of our lives than
we realize.

78
 One move towards wholeness by identifying with ongoing experience, being in contact
with what is actually happening, identifying and trusting what one genuinely feels and wants
and being honest with self and others about what one is actually willing and able to do – or
not willing to do.

The above instruction was translated in Hindi while delivering for lucidity of language
and better understanding for the client.

The second session consisted of administering the locus of control Scale and Sack’s
Sentence Completion Test. Along with this the client was thoroughly interviewed regarding
the conflicts and problems he is facing with in his family. The client was repeatedly given
assurance that his problems will be kept confidential and help will be provided to resolve the
problems as much as possible.

Thorough analysis of the SSCT protocol reveals that he has significant conflict with his
father given by statements like “ mujhe lagta hain ki mera baap kabhi kabhi mujhse gussa karte
hain” “achha hota ki mere baap mujhse achh bartav karte” “mujhe lagta hain ki mere baap
mujhe nahi maante hain, mujhe apna nahi samajhte hain.”

Conflicts were also noticed in the areas of self concept where he wants to achieve
success in his future but is also guilty of his past where he took alcohol, became aggressive
towards his wife. “meri sabse badi bhool thi ki maine daaru peena shuru kiya” “meri sabse badi
kamzori daaru peena hain”. These statements reflect the guilt feelings the client has within
himself while statements like “jab bhagya mera saath nehi deta toh hospital aa jate hain”
reflects poor self esteem.

How the client perceives his world around himself gives an idea of the locus of control.
The client has fairly external locus of control where he attributes the reasons for his problems
mainly to his family members and perceives his surrounding environment as unloving and
rejecting.

4.4.2.2 INTERMEDIATE PHASE OF THERAPY

This phase mainly consists of four sessions with the goal to identify the total behavior
of the client as well as how they evaluate themselves regarding his problematic behavior.

The following is an excerpt of the conversation between therapist and the client in the
session.

79
 The client started talking about a typical day where his father’s attitude towards him
was revealed. Client: papa mujhe bilkul pasand nahi karte hain, mere sock ko nazarandaaz kar
dete hain.

Therapist: aisa kyun lagta hain?

Client: jab bhi kuch bolta hoon, papa mujhe daant dete hain.

Therapist: aur ma kaise bartav karti hain?

Client: ma se mera achha banta hain, ma mujhe dantti nahi hain magar papa ko rokti
bhi nahi hain.

Therapist: aap kya karte ho jab papa aisa bartaav karte hain?

Client: mujhe gussa aa jaata hain, gussa kar jaata hoon. Papa ko suna deta hoon. Mere
do bhai bhi mujhe kam samajhte hain..

Therapist: toh aap koshish nahi karte ho apni baat theek se samjhane ke liye?

Client: main toh ‘zero’ hoon, merebhailog ‘hero’ hain.

Therapist: aisa kyun soch hain aapki?

Client: mera do bhai bahaut padha likha hain. Unke tulna mein main kuch bhi nahi
hoon.

The behavior of the client indicates his lack of realization about his behaviors that gives
rise to the problems which he attributes to his family

The client also asked for money from his father to open a new fruit shop. The present
business is not going well and the client wants to set up a new business to secure his future but
his father won’t trust him and he thinks of him as useless.

In response to his father’s and brothers’ attitude the client feels frustrated thinking that
he has not enough potential and as a result behaves aggressively as his basic need for
belongingness and freedom is not achieved.

In evaluating the behavior, the therapist asked skillfully planned questions to help the
client self- evaluate.

Therapist: aapka yeh gussa hona aur marpit karne se aapko fayda kya ho raha hain?

Client: jab gussa ho jata hoon toh lagta hain maar doon, uske baad gussa thandaa ho
jaata hain.

80
 Therapist: maarpit karne ke baad ghar ka mahaul kaisa hota hain?

Client: sab pareshaan ho jaate hain. Sab gussa karne lagte hain.

Therapist: aur aap jo gaali dete ho uska kya asar hota hain?

Client: gharwale mere baare mein bura sochte hain. Biwi mere baare mein bura sochti
hain.

Therapist: aap apne parivaar se kya chahte ho?

Client: sab khush rahe aur mujhse ache bartaav karein.

Therapist: aapka aisa roop dekhne ke baad kya apka papa, bhai, ma, biwi aapko
pasand karenge?

Client: nahi..

In evaluating his own behavior it was noticed that the client was not well informed.
Different aspect of a single situation were discussed and helped him see their behavior in a new
light and new perspective. He was helped to realize how his behavior is affecting the attitude
and behavior of his family members towards him and how his father remains worried about
him regarding his ill habits.

The client is taught to gain insight regarding his incapabilities and assess himself
internally about what he is doing is right or wrong.

The client realized that what behaviors he is adopting at present will not get him where
he wants to go that is to experience a feeling of belongingness from his family.

4.4.2.3 FINAL PHASE OF THERAPY

In the final three sessions of therapy, planning was done for solutions regarding his
problems.

In the final phase of therapy clients were taught to make effective control over their
behavior and choose more wisely.

The client was made to understand that it is within his control how to deal effectively
in a situation. And it is his actions which will determine the final outcome. Every actions has
its own consequences and if he wants a positive outcome then he must act accordingly. With
the consent and approval of the client planning was done to change his ineffective total
behaviors.

81
 The therapist discussed with the client the progress of therapy and asked him to describe
the areas where he was ineffective in handling situations and adopted maladaptive patterns of
behavior. A review was done of his needs, conflicts that engendered from his unmet needs, his
total behavior and locus of control. The goal was to resolve conflicts with his father. As he
used to become angry and aggressive every time his father ignored him, planning was done so
that he could choose more adaptive ways to deal with his anger towards his father. In an
instance where his father ridiculed him about his opinion, planning was done so that the client
would be gathering evidence about the fact he is stating and then keep his viewpoint in an
assertive manner in front of his family. This would also make boost his self-esteem. Planning
was done mainly to alter the behavior of the client in to more responsible effective ones.

Lastly the client was motivated for changing his behavior and make genuine
commitment to the plans that has been made.

The final session was terminated by assuring the client that change will definitely be
noticed if he abide by his plan that was made to change him and choose more adaptive ways of
behaviors. It was also conveyed that the therapist would be available for the client anytime and
contact number was shared.

4.4.3 PRE AND POST THERAPY ASSESSMENT REPORT AND FOLLOWUP

REPORT

The client was again interviewed and tests of Locus of Control Scale and Sacks
Sentence Completion Test were administered to assess the progress.

TEST PRE INTERVENTION POST INTERVENTION

Locus of Control scale 28 31

Fig 1: Locus Of Control Scale

There is a slight difference in scores which indicates that the client could not fully
icorporate the planning that was made and his improvement is slow.

82
 Sacks Sentence Completion Test Pre Intervention Post Intervention

Family Attitude towards father 6 4

Self- Concept Guilt feelings 5 4

Self esteem 8 5

Fig 2: Sacks Sentence Completion Test

Sacks Sentence Completion Test

9
8
7
6
5
4
3
2
1
0
attitude towards father guilt feelings self-esteem

pre intervention post intervention

The client, his father and his wife were interviewed after a gap of one month for follow
up.

The client reported that he can control his anger better than before. He tries to
participate in family decision making sessions and contributes his views. But it is not easy that
the family members would start considering him fully overnight.

The client’s father and wife reported of increased peace within the family which were
lacking earlier due to the client’s instant aggressive attitude. Presently the client improved in
changing his aggressive attitude and tries to be patient with everyone but it is expected that he
will improve more with time.

83
4.5 CASE 5: GK

4.5.1 CLINICAL HISTORY

GK is a 42 year old male, Hindu, Hindi speaking, educated up to graduation, married

and works as a civil engineer.

Two years ago he had shifted to Tatanagar due to his job and set up his own nuclear
family. The client presently stays with his wife and two daughters. Every day he wakes up in
the morning, and goes to his work. The client intakes alcohol with his colleagues in his
workplace during free time. Everyday he takes about approximately 300ml of alcohol. The
client presently works in a construction site and supervises laborers. In 1985, the client’s father
died in a car accident when he was 11 years old. He used to work in Tata steel company. After
the death of his father, the job was given to his mother. The client has two more brothers. His
brothers are educated and are doing good jobs but lives separately. The client’s alcohol intake
has increased for the last two years after he had shifted to a nuclear family with his wife. He
has significant conflicts with his wife regarding responsibilities, money and daily chores.

The client was admitted in RINPAS with symptoms of diminished sleep and appetite,
lack of interest in doing activities, irritability, withdrawal tendency and aggressive outbursts at
times.

There is no history indicating mental retardation, epilepsy, significant head injury or

persistent high fever.

Presently he has been diagnosed with Mental and behavioral disorders due to use of
alcohol (dependence syndrome).

4.5.2 OVERVIEW OF THE THERAPEUTIC SESSIONS

Total 10 sessions were given to DK.

4.5.2.1 INITIAL PHASE OF INTERVENTION

DK was selected for the present study after detailed review of his CRF. He was called
for interview. The client was oriented to time, place and person. He looked tidy, his dress was
clean and beard was shaved. Rapport could be established easily. The client was cooperative
while discussing his problems which indicated his motivation for change.

84
 The therapist explained to him that she was there to help him gain insight into his
problems and deal effectively with the life issues he is facing at present and for which he had
been admitted in RINPAS. After ensuring his consent in the therapy process, the therapist
proceeded further.

This phase consisted of making a good therapeutic alliance with the client which would
help in free flow of communication between the therapist and the client. The therapist tried to
instill hope in the client by making him understand that he will learn to make better choices
and in doing so, gain better control of their lives. The following is an excerpt of the instructions
given to the client:

For all practical purposes, we choose everything we do, including the misery we feel.
Other people can neither make us miserable nor make us happy. All we can get from them or
give them is information. But by itself information cannot make us do or feel anything. It goes
into our brains and then we decide what to do. We are much more in control of our lives than
we realize.

One move towards wholeness by identifying with ongoing experience, being in contact
with what is actually happening, identifying and trusting what one genuinely feels and wants
and being honest with self and others about what one is actually willing and able to do – or
not willing to do.

The above instruction was translated in Hindi while delivering for lucidity of language
and better understanding for the client.

The second session consisted of administering the locus of control Scale and Sack’s
Sentence Completion Test. Along with this the client was thoroughly interviewed regarding
the conflicts and problems he is facing with in his family. The client was repeatedly given
assurance that his problems will be kept confidential and help will be provided to resolve the
problems as much as possible.

Thorough analysis of the SSCT protocol reveals that he has significant conflict with his
wife and he has significantly low self- esteem. Statements like “mujhe lagta hain ki ek sachha
mitra, meri patni honi chahiye” “agar mere sharirik sambandh hote to bahaut achha hota
lekin patni manti nahi hain” “vaibahik Jeevan ke baare mein meri bhavna shakaratmak hain”
“mera yaun Jeevan achhanahi hain” indicates his dissatisfaction with his wife.

Test findings also includes conflict in the area of self- concept. Statements like “ jab
mere din bure hote hain toh parivaar wale mujhe support nahi karte hain” “meri sabse badi

85
kamzoori hain sharaab peena” “jab bhagya mere saath nehi deta toh main bahaut kamzoor
ho jaata hoon” reveals feelings of low self-esteem.

Apart from test findings detailed interview was taken from the client which reveals his
basic needs for love and belongingness which he is constantly seeking for but unable to achieve.

He reports that there are frequent fights with his wife over petty things. He is not in
favor of fighting but according to him his wife makes the situation worse as she shouts in front
of their daughters and reports everything to his mother-in-law. The client is also disappointed
with his sexual life as his wife refuses to make any physical relationship with him.

How the client perceives his world around himself gives an idea of the locus of control.
The client has fairly external locus of control where he attributes various problem situations in
his life into destiny and thinks that he has no control over them and that he is controlled by
external forces.

4.5.2.2 INTERMEDIATE PHASE OF THERAPY

This phase mainly consists of four sessions with the goal to identify the total behavior
of the client as well as how they evaluate themselves regarding his problematic behavior.

The following is an excerpt of the conversation between therapist and the client in the
session.

The therapist probed into instances where he adopted a maladaptive behavior while
communicating with his wife.

Therapist: ghar mein problem kab hota hain?.

Client: meri patni humesha mujhe bahaut choti choti baton pe tokti hain. Lekin main
jaise karne ke liye bolta hoon toh who nahi karti hain.

Therapist: kaisi baton pe jhagda hota hain?

Client: main humesha mana karta hoon unchi unchi baat na bole. Jab gussa karti hain
aaspaas nahi dekhti hain.

Therapist: jab aisa hota hain tab aap kya karte ho?

Client: pehle toh main bhi chillane lagta hoon. Jab bahaut gussa aata hain toh haath
bhi uth jaata hain, maar deta hoon.

Therapist: phir kya hota hain?

86
 Client: haath ke saamne jo bhi milta hain patak deta hoon, todh phodh bhi karta hoon..

Therapist: iske baad kya hota hain?

Client: phir do teen din tak baat nahi hota hain biwi se, sharaab peena bhi badh jaata
hain. Jab sharirik sambandh ki chahat rakhta hoon toh patni hone nehi deti hain..

Therapist: aap jo kar rahe hain use kya ho raha hain?

Client: mahaul aur bhi kharaab ho jaata hain.

Therapist: aap apni patni se kya chahte hain?

Client: main mil jhul ke rehna chahti hoon aur chahta hoon ki patni mujhe pyar kare.

Therapist: aap jaise bartaav karte hain, gussa karte hain, kya aisa lagta hain halaat
theek hoga?

Client: nahi, agar dono milke hi jhagda karenge, agar dono hi nahi samjhenge toh
mushkil badhti jayegi..

Therapist: theek.

Client: lekin patni bhi tohjhagadne lagti hain. Meri koi baatnahi sunti hain.

Therapist: aapko aisa lagta hain ki gussa hone se, maarpit karne se who samjhegi?

Client: nahi mujhe hi dhairya rakhna padhega.

The total behavior of the client was assessed to be ineffective as he could have chosen
other ways to deal with his wife.

During the process of self-evaluation the client was made to realize the different aspect
of an event, he was made to look at different perspectives of a situation, and how it can be
evaluated. He accepts that he feels worthless at times and to prove himself he chooses to
aggress his wife which consoles him from inadequate feelings.

The client realized that what behaviors he is adopting at present will not get him where
he wants to go that is to experience a feeling of love and belongingness from his family. He
came to the decision that he himself is blocking the flow of love from his mother and wife by
his own maladaptive behaviors.

4.5.2.3 FINAL PHASE OF THERAPY

In the final three sessions of therapy, planning was done for solutions regarding his
problems.

87
 In the final phase of therapy clients were taught to make effective control over their
behavior and choose more wisely.

The client was made to understand that it is within his control how to deal effectively
in a situation. And it is his actions which will determine the final outcome. Every actions has
its own consequences and if he wants a positive outcome then he must act accordingly. With
the consent and approval of the client planning was done to change his ineffective total
behaviors.

The therapist discussed with the client the progress of therapy and asked him to describe
the areas where he was ineffective in handling situations and adopted maladaptive patterns of
behavior. A review was done of his needs, conflicts that engendered from his unmet needs, his
total behavior and locus of control. The goal was to resolve conflicts with his wife and to adopt
a more effective approach towards life. Planning was done accordingly. The client was
instructed to be more patient. He has always chosen to aggress his wife in difficult times but
now he must be patient. Instead of indulging into fights the client should assess the problem in
hand and try to make his wife understand through communicating assertively. The client should
also take responsibility for household task so that his wife is not burdened with pressure.

Lastly the client was motivated for changing his behavior and make genuine
commitment to the plan that has been made.

The final session was terminated by assuring the client that change will definitely be
noticed if he abide by his plan that was made to change him and choose more adaptive ways of
behaviors. It was also conveyed that the therapist would be available for the client anytime and
contact number was shared.

4.5.3 PRE AND POST THERAPY ASSESSMENT REPORT AND FOLLOWUP

REPORT

The client was again interviewed and tests of Locus of Control Scale and Sacks
Sentence Completion Test were administered to assess the progress.

TEST PRE INTERVENTION POST INTERVENTION

Locus of Control scale 38 50

Fig 1: Locus Of Control Scale

88
 There is a difference in scores which indicates that the client has tried well and
considers events to be the result of his own actions.

Sacks Sentence Completion Test Pre Intervention Post Intervention

Family Attitude towards opposite sex/wife 7 3

Self-concept Self esteem 5 3

Fig 2: Sacks Sentence Completion Test

Sacks Sentence Completion Test

8

0
attitude towards wife self esteem

pre interventions post interventions

The client and his wife were interviewed after one month for follow up.

The client reported that his relationship with his wife has improved. He claimed that
his wife has become more considerate and respects his opinions more than before. Although
there are still instances that the client cannot control his anger.

According to his wife she feels more relaxed now that the client controls his anger and
tries to listen to her. This has made things easy as there is less conflicts and fights. She also
reported that the client spends more time with her which has made them more close to each
other.

In a nutshell, the couple’s quality of life has improved and both of them are satisfied
with it.

89
CHAPTER 5

DISCUSSION

90
DISCUSSION

5.1 DISCUSSION OF METHODOLOGY

The objective of the current study is a qualitative enquiry into the various conflict areas
of the clients with alcohol dependence syndrome and to bring about a change in them through
the application of reality therapy. The includes the individuals with diagnosis of alcohol
dependence for the purpose to find and modify the specific relevant social and personal factors
that play a role in the manifestation of the disorder. The sample is chosen because of the ease
of availability of the disorder in the current setup. A sample size of 5 participants are chosen
as per the inclusion and exclusion criteria. The criteria were strictly adhered to, as they
facilitated the authenticity of the study.

The process of study is qualitative in nature. This ensured that the contexts of the
disorder is given emphasis in each individual and the research does not go in the direction of
generalizing of data and structured empirical evidences, as it may ignore the in-depth
understanding of the disorder.

The areas to be explored were predetermined viz. family, self-concept and locus of
control. Through detailed interview and administration of questionnaires the major conflict
areas within the above mentioned domains were explored. Conflicts in these areas can be
thought of as a maintaining factor for the illness. Thus resolving the conflicts would likely to
bring a positive change in the client. In this case reality therapy was applied in order to effect
a positive change in the client.

5.2 DISCUSSION OF CASE SUMMARIES

5.2.1 CASE 1:

The client CK was admitted in RINPAS by his brothers with the chief complaints of
diminished sleep and appetite, excessive intake of alcohol, not returning home after work, anger
outbursts, aggressiveness and using abusive languages, irritability, restlessness and initiating
fights. He had conflicts with his stepmother and wife and he used to manifest maladaptive
patterns of behavior represented by anger outbursts, frequent fights and impulsive behavior.
He also had distorted self-concept where he had low self-esteem coupled with guilt feelings.
In order to escape his inadequate feelings of self he engaged in aggressive, assaultive behavior

91
which in no way helped to gain the needs of love and belongingness. He felt threatened by his
environment and surroundings. Although the process of therapy helped in his self- evaluation
where he realized his ineffective choices about dealing with everyday problems with his wife
and stepmother. As a result he learned to take effective actions through goal directed choices.
The client was motivated throughout the therapy sessions so that he abides by the plans. A
follow up session after one month with client, his wife and stepmother reveals significant
improvement in the problem areas.

5.2.2 CASE 2:

The client was brought to RINPAS OPD by his wife and was admitted in the indoor
ward with chief complaints of diminished sleep and appetite, trembling of hands, and anger
outbursts. He has not been treated before and it is the first time he has been admitted in
psychiatric hospital. The client is mainly facing a conflict with his brother regarding a dispute
over land. The client claims majority portion of the land as he wants money to marry off his
daughter. As a result conflicts arose in the family which took a toll on the cohesiveness within
the family. He was not working hard and attributed his misery to his brothers. His attitude
towards future was also pessimistic. Through the process of therapy the client realized that
whatever he chose to do was not appropriate of the situation and how he dealt with his brothers
has led them to look down upon him more. Thus accordingly planning was made and the client
was motivated for change. The client tried to change himself and reported that he became more
tolerant towards his brothers. Becoming more active in his business had led to more customers
thus more income. Overall there was improvement in his actions although he needs to work
hard to show significant change.

5.2.3 CASE 3:

The client was brought to RINPAS OPD and was admitted in the indoor ward with
chief complaints of diminished sleep and appetite, trembling of hands, aggressiveness and
using abusive languages, initiating fights with brothers and not coming home at night. The
client had regular fights with his wife regarding his behavior. His lack of responsibility towards
his family has resulted in family discord in his family where his mother also criticizes him
heavily for not taking care. The client due to his external locus of control perceived his miseries
as a result of the family’s negativistic attitude towards him, discounting the facts that he himself
had brought upon. He was pessimistic about his future and chose to aggress when he
encountered any suggestion for change from his mother and wife. He strongly perceived his

92
family to be against him, unloving and rejecting thus engendering his needs for love and
belongingness. In the therapy session his motivation for change was noticed and appropriate
planning was made to bring about a change. A follow up with client, his wife and his mother
indicated significant change where the client had become more responsible towards his family
and attended to their needs when necessary.

5.2.4 CASE 4:

The client was brought to RINPAS by his brothers following an episode where his sleep
and appetite was low, got easily angry, beat up his wife, initiated fights and used abusive
languages. A year ago in July 2016 he was admitted in RINPAS for similar symptoms. The
major area of conflict in his family is with his father. His father looks down upon him and does
not respect him enough. The client’s brothers are well educated and he is excluded from most
of the family discussion where major decisions are made. This has led to his low self-esteem
and he considers himself ‘zero’. The client has fairly external locus of control where he
attributes the reasons for his problems mainly to his family members and perceives his
surrounding environment as unloving and rejecting. Planning was done accordingly in the
therapy sessions targeting his maladaptive patterns of behavior and was motivated to choose
more acceptable behaviors. A follow up session after one month with the client, his father and
wife revealed significant improvement in the client’s attitude which has made him more
responsible and patient towards others.

5.2.5 CASE 5:

The client was admitted in RINPAS with symptoms of diminished sleep and appetite,
lack of interest in doing activities, irritability, withdrawal tendency and aggressive outbursts at
times. He reports that there are frequent fights with his wife over petty things. He is not in favor
of fighting but according to him his wife makes the situation worse as she shouts in front of
their daughters and reports everything to his mother-in-law. The client is also disappointed with
his sexual life as his wife refuses to make any physical relationship with him. The client has
fairly external locus of control where he attributes various problem situations in his life into
destiny and thinks that he has no control over them and that he is controlled by external forces.
Through the intervention session it was assessed that he was highly motivated to bring change
in his current situation. With his consent and cooperation effective planning was done to change
his behavior into more responsible and effective one. In the follow up session after one month
his wife reveals that she feels more relaxed now that the client controls his anger and tries to

93
listen to her. This has made things easy as there is less conflicts and fights. She also reported
that the client spends more time with her which has made them more close to each other.

5.3 FAMILY AND ALCOHOL DEPENDENCE

Michael R. Frone, Marcia Russell and M. Lynne Cooper (1993) conducted a study to
see the relationship of work‐family conflict, gender, and alcohol expectancies to alcohol
use/abuse. As anticipated, the positive relationship between work‐family conflict and abusive
alcohol consumption was found almost exclusively among individuals who believe that alcohol
use promotes relaxation and tension reduction.

The system theory describes the family by explaining it in terms of boundaries, forcing,
and subsystems. These parts are more or less fluid and function together as a basic structural
unit or nucleus for the family members. Subsystems may consist of individuals, dual groups,
triads, or more (i.e. parents, brothers, sisters, male subsystems etc.). An effective part of the
system has an impact on other parts, thus operating to cause reorganization of the system in a
continuous manner, and trying to achieve a relative stability.

Alcoholism has the greatest impact on the family depending upon the type of family
systems (i.e. upwards, as in the case of parents and grandparents; or downwards, as in the case
of children). Alcoholics suffer from intense problems such as exploitation of spouses and
children, and domestic violence in their marriage and family structures. Crises in the family
may lead to catastrophic disorder in the system and organization of families.

The objective of the present work is to identify the various relationships in family which
leads to conflict in people with alcohol dependence and to resolve them. For the 5 cases it was
found that the patients either had conflicting relationship either with their father, mother,
brothers or wife. Thus reality therapy helped the clients to choose their own behaviors as warm,
positive and tolerant actions result in acceptance and cohesion among family members.

5.4 SELF-CONCEPT AND ALCOHOL DEPENDENCE

Self-concept is made up of one's self-schemas, and interacts with self-esteem, self-

knowledge, and the social self to form the self as whole. It includes the past, present, and future
selves, where future selves (or possible selves) represent individuals' ideas of what they might

94
become, what they would like to become, or what they are afraid of becoming. Possible selves
may function as incentives for certain behavior. Self-esteem lies at the core of self-concept.

Low self-esteem is one of the characteristics of the addictive personality. When people
first begin using alcohol or drugs it will increase their self-confidence. They become less
concerned with what other people think of them. The individual begins to rely on these
substances in order to cope with life. Addiction means that the person’s life begins to all apart
as their self-esteem hits an all-time low.

According to Gossop M. (1979) the association between drug dependence and low self-
esteem may indicate that those individuals with a deficient self-image who are exposed to drugs
may be at risk; this may carry implications also for alcohol and nicotine dependence. It is
suggested that self-image therapy may be of value for certain drug-dependent patients.

Not believing in oneself will limit one’s potential. A person may not be willing to put
in the necessary effort to achieve their dreams, because they not believe it will bring results.
Such people may be convinced that mediocrity is all they deserve.
Individuals with low self-esteem are far more likely to turn to alcohol or drugs as a means of
escaping their problems.

People with low self-esteem often end up in abusive relationships. This is because they
can inwardly feel like such relationships are all they deserve.

In the SSCT tool self-concept comprises attitude towards self-esteem, guilt feelings,
attitude towards past, attitude towards future and attitude towards goals. The objective of the
present study was to identify the problems in the client’s self-concept and work on the specific
themes to bring a positive change in them. Reality therapy purports that one should change
their actions after one has self-evaluated themselves. Through the process of self-evaluation
the individual comes to term with his own inner self, the attitude he holds towards self, his
future or goals. Once he identifies the maladaptive thinking he plans for change through
actions. Here lies the effectiveness of Reality Therapy in changing one’s defective self-concept.

5.5 LOCUS OF CONTROL AND ALCOHOL DEPENDENCE

Locus of control is popular personality dimension that describes the degree to which
people perceive and expect that reinforcements or rewards are contingent upon their personal

95
action (Internal control) or upon the result of luck, fate, chance or the actions of powerful others
(external control) (Rotter, 1989).

When people have an internal locus of control, they expect they will determine their
own futures because of their own actions. If we were to imagine life as a sort of theatrical play,
these people would consider themselves the directors of their own lives. Conversely, when
people have an external locus of control they do not expect to have control over their futures.
Things just happen to them. From this perspective, they have no control or influence over their
lives.

Individuals often attribute their problems into external sources like family members,
destiny etc. Similarly individuals rationalize their intake of alcohol as the results of conflicts,
emotional burden. Reality therapy tries to focus on this with the aid of self-evaluation. In the
process of self-evaluation the client recognizes and realizes his flaws in attribution which he
tries to change with suitable planning and action.

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 CHAPTER 6

SUMMARY AND CONCLUSION

LIMITATIONS AND FUTURE

DIRECTIONS

CLINICAL IMPLICATIONS

97
SUMMARY AND CONCLUSION

AIM

To examine the application of Reality Therapy in management of conflict focusing on

life partner in individuals with Alcohol Dependence.

OBJECTIVES

 To evaluate changes in locus of control of individuals with Alcohol Dependence

Syndrome after application of Reality therapy.
 To study the reduction of conflict with family members in individuals with alcohol
Dependence Syndrome after application of Reality Therapy.
 To study the reduction of conflict in self-concept in individuals with alcohol
Dependence Syndrome after application of Reality Therapy.

RESEARCH DESIGN

Single subject/case research

SAMPLE

The sample consisted of 5 patients with Alcohol Dependence Syndrome. Purposive

sampling was done for the present study.

INCLUSION CRITERIA FOR THE STUDY GROUP

 Age group of 25 to 50 years.

 Minimum level of education at matric level
 Diagnosed with Alcohol Dependence Syndrome in RINPAS.
 Receiving medical treatment for their condition.
 Admitted in deaddiction ward for their condition.
 Obtained a score of 3 or above on General Health Questionnaire- 12
 Residents of Ranchi.

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EXCLUSION CRITERIA FOR THE STUDY GROUP

 Participants who are unmarried.

 Participants who does not have severe co-morbid psychiatric disorders like
schizophrenia, multiple substance dependence or substance dependence other than
alcohol, bipolar affective disorder, obsessive compulsive disorder, organic brain
syndrome or mental retardation.

TOOLS FOR ASSESSMENT

 Sociodemographic and clinical data sheet

 General Health questionnaire- 12 (GHQ-12)
 Alcohol Use Disorders Identification Test (AUDIT)
 Locus of Control Scale (Hindi adaptation)
 Sacks Sentence Completion Test
 Therapeutic plan: stages of therapy

PROCEDURE

For the present study, the sample was collected from Ranchi Institute of Neuro-
Psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi. Initially 12 indoor patients from
deaddiction ward, only male, who are suffering from Alcohol Dependence Syndrome were
selected. AUDIT were administered on all the participants and everyone scored above 13.Then,
the participants were screened for some general health problems with the use of General Health
Questionnaire-12 (GHQ-12) and 4 of them were screened out (by assessing and selecting those
who obtained a score of 3 or above inGHQ-12). Finally work was started with 5 remaining
participants. In the first two sessions rapport was established and tests were administered
(Locus of Control Scale and Sacks Sentence Completion Test) to assess the conflicts.
Simultaneously, observation and interview techniques were employed for detailed
understanding of the participants. In the intermediate and final phase of therapy the participants
self-evaluated with the help of the therapist and planning was done for change. The participants
were again reassessed on the same tests that were administered on the first session after
completion of one month post therapy sessions. During this time, the participants’ family

99
members were called upon and information was gathered about the present functioning of the
client.

DATA ANALYSIS

Qualitative analysis to see the application of reality therapy on management of conflicts

with the family members and self-concept. Thematic analysis will be done for each individual
separately.

RESULTS

 There was a significant change from external to internal in locus of control in most of
the cases after application of Reality Therapy.
 There was a reduction of conflicts with the family members after application of Reality
Therapy.
 There was enhancement in overall self-concept of the participants after the application
of therapy.

CONCLUSION

Through the findings of the present investigation it is concluded that reality therapy is
helpful in reducing conflicts in alcohol dependent clients especially in the areas of family and
self-concept. It is also concluded that reality therapy helped to change the participants to change
their locus of control from external to internal. It can also be concluded that reality therapy is
an effective tool to apply within a short span of time to manage the conflicts of individuals with
alcohol dependence syndrome. Thus the aim of the present investigation has been fulfilled.

100
LIMITATIONS AND FUTURE DIRECTIONS

Limitations of the present research

 The sample size was small.

 Control group was not included.
 The participants only belonged to a particular city, all residing in Ranchi, Jharkhand.
 Due to time constraints, the duration of gap of the follow-up was short
 Only educated people were included as participants.

Areas for focus in clinical practice and future research

 A larger sample with a control group can be used to replicate the present study.
 The applicability of Reality Therapy can be examined for other substance use disorders.
 The applicability of Reality Therapy can be studied by using another psychotherapeutic
treatment method as an adjunct for the treatment of substance use disorder.
 The applicability of Reality Therapy can be examined for the treatment of other
psychiatric disorders and psychological issues.

CLINICAL IMPLICATIONS

The objective of the present research was to study and explore the applicability of
Reality Therapy on the management of conflicts concerning family and self -concept of
individuals with alcohol dependence Syndrome. After a two month intervention program,
comprising of 10 sessions, it was found that improvement had occurred in participants included
in the present research in the focused areas. All the participants reported improvement in those
areas in varying degrees. The areas under consideration were various conflicts within the family
either with siblings, parents or wife along with feelings of inadequacy in the area of self-
concept. Specific targets were specialized for each individual participant. The present research,
while operating on the principles of Choice Theory aimed to help enable clients to own their
responsibilities and choose their actions and behavior accordingly in order to achieve growth
and psychological wellbeing. They were helped to evaluate themselves about how they are
perceiving the world around them, their unmet needs and what actions are they actually

101
choosing to meet those needs, are those actions really helping them to achieve those needs or
creating an unfavorable situation for them.

The reality therapy approach to counseling and problem-solving focuses on the here-
and-now actions of the client and the ability to create and choose a better future. Typically,
clients seek to discover what they really want and how they are currently choosing to behave
in order to achieve these goals. According to Glasser, the social component of psychological
disorders has been highly overlooked in the rush to label the population as sick or mentally ill.
Reality therapy attempts to separate the client from the behavior. Just because someone is
experiencing distress resulting from a social problem does not make him sick, it just makes
him out of sync with his psychological needs.

The cornerstone in the practice of reality therapy is the self-evaluation by clients.

Counselors ask clients to examine the effectiveness of their choices especially as they impact
their relationships with people important to them. Clients also examine the attainability of
their wants, as well as their degree of commitment in attaining their wants. Included in the
process is realistic planning for need satisfaction especially for enhancing the clients'
interpersonal relationships. Multiethnic research has shown the multicultural efficacy of
reality therapy.

Participants were interviewed in detail and the therapy sessions were constructed on
the ideals of Choice Theory and employing techniques of Reality Therapy, with the aims of
changing their current maladaptive patterns of behavior into more effective behaviors which
would help them to achieve their unmet needs. The participants were assisted in self-
evaluation followed by specific planning and commitment which finally led them to adopt
more realistic and effective patterns of behaviors.

102
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 SOCIODEMOGRAPHIC DATA SHEET

Name: ___________________________________________________________________

Age: _____________________________________ Sex: __________________________

Religion: __________________________________ Occupation: ____________________

Socio-economic Status: (low/middle/high/others specify): __________________________

Domicile: (Rural/urban/semi-urban/others specify): _______________________________

Type of family: Joint/nuclear: _________________________________________________

Marital Status: _____________________________________________________________

Number of children: son/daughter specify: _______________________________________

Number of siblings: brothers/sisters specify: _____________________________________

Birth order: ________________________________________________________________

Occupation of father: ________________________________________________________

Occupation of mother: _______________________________________________________

Occupation of spouse: _______________________________________________________

Occupation of siblings: _______________________________________________________

Other earning members of the family, if any (specify): ______________________________

Diagnosis and duration of illness: _______________________________________________

Other additional information: __________________________________________________

112