“What is labeled mental illness…are the hundreds of ways people choose to behave when they are unable to satisfy basic genetic needs, such as love and power.”

These are the words of William Glasser, and some of the first words that I actually found sense in during my training as a psychologist. As a young graduate student, I was memorizing mental disorders in the DSM-IV (Diagnostic and Statistic Manual of Mental Disorders), probing clients about their pasts, and practicing the prescribed listening techniques, including prolonged silences and phrases such as “And how does that make you feel?”.  And I was quickly becoming disillusioned. 

I had chosen the profession, among other reasons, in order to understand the world, people, and the nature of life, as well as to make sense of my own life circumstances and to heal my own self.  But in my classes and sessions, I felt more like I was training to become a diagnostic machine for whom full understanding was superfluous, and it really disturbed me.  I wasn’t satisfied to simply diagnose and “follow procedure”.  I wanted to relate to the humans in front of me, and I really wanted to help them.  But my growing knowledge base of diagnostic disorders and techniques seemed to be decreasing my real chances.

Dr. Glasser’s work was a lifeline for me.

Through his Choice Theory, he shared his vision that most behaviors diagnosed as mental illness are, in fact, expressions of unhappiness rather than categorical brain disorders.  Using the DSM as a guide, the truth was that I recognized some level of the “symptom behaviors” in my own self and in everyone around me – not just in case studies and clients.  I had a hard time believing, as it was commonly taught, that clients with “disorders” were fundamentally different from me.  I felt an inexplicable internal resistance to treating “patients” by mentally categorizing them based on arbitrary rules that barely separated us.  Rather, I saw an overarching meaning in the fact that we were all, at some level, expressing the same dysfunctional behaviors, and I believed in my heart that there was something more universally adaptive about the behaviors – that they were expressions or messages of something meaningful and important in our development, rather than just random “chemical brain constructions”.

Choice Theory helped me understand my hunch.  After our basic physical survival needs are met, it described four basic human psychological needs groupings, defined as:

1. The need to belong, to connect to others, and to love and be loved

2. The need to feel powerful, significant, and competent

3. The need for freedom and autonomy

4. The need to have fun and continue learning

Dr. Glasser’s work showed how our dysfunctional behaviors are maladaptive ways of trying to meet these needs.  And he offered a solution: If we can realize that we are trying to meet our needs in dysfunctional ways, we can choose to change the ways we go about it.

Let’s translate this into a real-life example: panic and anxiety (common presenting problems in therapy and coaching).  Panic and anxiety can be seen as an attempt to meet the basic psychological needs of feeling powerful, autonomous or free.  After all, panic does offer us some feeling of control over suffocating or overwhelming relationships and situations, as well as a sense of freedom or escape from the situation, however momentary.  But panic does not solve our need for a general sense of personal power, autonomy or freedom.

So, rather than diagnosing an anxious person with “Panic Disorder” and treating him with medication, Glasser suggested that we instead intervene by helping him to consciously identify and acknowledge his need for power, autonomy and freedom in life and relationships; then by collaboratively strategizing so that he can consciously choose and master effective behaviors to meet these basic needs.

Dr. Glasser’s therapy sessions really did seem more like collaborative strategizing than typical prescriptive doctor-patient conversations.  He was incredibly compassionate and creative, and surprisingly direct and practical with patients.  And contrary to popular approaches to psychotherapy, he focused very little on the past.  He acknowledged that what happened in our past has everything to do with who we are today, but he was also unequivocally clear that we can change nothing in the past; we can only satisfy our basic needs right now, in this moment, and plan to continue satisfying them in the future.

Glasser believed that none of us are helpless victims, rather we are individuals who are responsible for meeting our own needs.

And this means meeting our own needs in our relationships too!  While he held that all long-lasting psychological problems are relationship problems, and that a good majority of our unhappiness is caused by failing or failed relationships with those we care about most, he was also adamant that the only person whose behavior we can control is our own.  Our “problem relationship(s)” is always part of our present life, but it is up to us to let go of the desire to manipulate and control others.  Relating, for Glasser, did not include psychological games or manipulative strategies.  His goal was to help patients choose to behave differently – without becoming a victim of their difficult relationships – in ways that would improve their overall ability to relate, love and belong.

No less important, Glasser talked a lot in his work about the importance of differentiating happiness from pleasure.  Where pleasure can be found in sex, for example, sex can also be separate from a satisfactory relationship, and a satisfactory relationship is a precondition for lasting happiness in life.  He was careful about his reasoning, held a high standard for his patients and challenged them to think, analyze and realistically choose behavior that would lead to lasting happiness.

I had the pleasure of attending one of his talks during my first year of graduate school, and to this day, I can still remember the twinkle in his eyes and the feeling of being in his presence, with his signature combination of warmth, wit, and humanity.  He translated his theories into a real-life example that I knew as a young student I could enthusiastically follow.  Thanks to him, my goals as a training therapist were quickly redirected from “diagnosing and treating” to truly helping by finding basic goodness in all people, dropping the lens of “expert-patient”, going directly to the heart of the matter, insisting on personal responsibility and believing in personal possibility.  This approach has continued to shape my own life and my work with clients in ever-more beautiful ways.

Thank you Dr. Glasser.

About Dr. Glasser’s career: He worked for over 50 years applying his theories to broader social issues including parenting, management, and, together with his wife Carlene, marriage.  He worked tirelessly in the field of education to promote a functional educational system where youth could only succeed (see Quality Schools). He warned the general public about the problems he saw in conventional psychiatry and promoted self-responsibility and potential.

For more information, see: http://www.wglasser.com/

Recommended reading: Choice Theory: A New Psychology of Personal Freedom, William Glasser