William Glasser, M.D., is a world-renowned psychiatrist who lectures widely. His numerous books have sold 1.7 million copies, and he has trained thousands of counselors in his Choice Theory and Reality Therapy approaches. He is also the president of the William Glasser Institute in Los Angeles.

Counseling with Choice Theory

Quill

Chapter One

Jerry

... it is what you choose to do in a relationship,
not what others choose to do, that is the heart
of reality therapy.

In the movie As Good As It Gets, the lead character, Melvin Udall, portrayed by Jack Nicholson, is a textbook illustration of what is known as the mental illness obsessive-compulsive disorder, over which he has no control. But, following choice theory, I do not believe that Melvin is suffering from a mental illness or that he has no control over what he is doing. I believe he is choosing to obsess and compulse to deal with what is so obvious from the beginning of the film: He has no satisfying close relationships. To have any chance to lead a rewarding life, he, like all of us, needs at least one satisfying relationship.

When we fail in the effort to connect with other people, as Melvin surely has, we suffer because the need to do so is as much built into our genes as the need to survive. Almost all the pain or abnormality associated with the choices that are commonly called mental illness are a genetic warning: We are not involved in a relationship that satisfies what our genes demand.

When we suffer any pain, mental or physical, our brain does not let us sit idly by and do nothing; we must try to do something to reduce the pain. What is called mental illness is a description of the ways in which huge numbers of people, such as Melvin Udall, choose to deal with the pain of their loneliness or disconnection. In Melvin's case, the choice is mostly to obsess and compulse, a choice so commonplace it has been wrongly labeled a mental illness for at least a hundred years.

But, inadequate as obsessing and compulsing (or any other symptom we choose) may be to help us reconnect, it is always our best choice at the time to fulfill one or more of five needs built into our genetic structure: survival, love and belonging, power, freedom, and fun. At the moment we choose any behavior, we believe that any other choice would be less effective; what we choose is the best choice at the time we choose it. When we say we shouldn't do it and then go ahead and do it, we suspect it won't be effective -- but not enough to stop us from choosing to do it.

Choice theory explains the whole mechanism of genetic needs, the pain associated with their frustration, and the choices we make to deal with this frustration. In this book that theory is put into practice as reality therapy. I have been teaching and continuing to improve this method of counseling since I first developed it in 1962. In 1965 I wrote the book Reality Therapy, a method of counseling now taught all over the world.

But the 1965 book did not have a theoretical base; this book explains that choice theory is that theoretical base. It includes many improvements over the original, an important step in keeping the process current. For variety, throughout this book I use the terms counseling, therapy,and psychotherapy interchangeably because I believe they are different ways of describing the same activity.

As stated, to cope with the pain of his disconnected life, Melvin is choosing an assortment of obsessive and compulsive behaviors that are his attempt -- often unsuccessful -- to restrain the anger that he immediately chooses whenever he has to deal with people he finds frustrating. When the movie begins, he seems unaware of this anger and its danger to both himself and others. But he surely knows that he, like all of us, needs love and belonging because he plays a character who writes bestselling romantic novels.

His symptoms are classic for the compulsive person he chooses to be. Melvin is so afraid of germs that he uses a new bar of soap each time he washes his hands, and he washes them many times a day. He also has a compulsive routine he goes through each time he locks and unlocks the four locks that secure the front door to his apartment. But the most obvious of his symptoms is the huge effort he makes to avoid stepping on cracks, which in a city like New York is almost a full-time occupation. He is also a particularly nasty man who verbally abuses anyone who frustrates him.

In a believable way, the movie shows him trying to relate to Karen, a lonely single mother, played by Helen Hunt, who is burdened with an asthmatic seven-year-old son. Karen maintains a strong front, but it is clear that she sees her life going down the drain socially and sexually. Even before they get involved, Karen knows a lot about Melvin. She is "his" waitress in a restaurant near his apartment where he eats every day and where he is both obnoxious and weird whenever he is frustrated, which is almost all the time. For example, Melvin brings his own sterilized plastic tableware; he won't use the knife, fork, and spoon the restaurant provides. And he insults anyone who is sitting at "his" table when he comes into the restaurant to eat. He doesn't care about the awful scenes he creates.

In a short time Melvin and Karen fall in love. The movie ends happily with Melvin and Karen in each other's arms. His choice to obsess and compulse has diminished to the point where it is implied that he and she have a good chance for a normal life together. Again, in fiction, love conquers all. But don't get me wrong, I like happy endings. I wouldn't want the movie to end any other way.

As we walked out of the theater, I said to my wife, "I give that relationship a week before they start having serious problems." In my mind the best hope for Melvin is psychotherapy.