Application of Reality Therapy to clients with marital problem

in a family service setting in Hong Kong

A practice-based report submitted in fulfillment of the requirements for the

Degree of Master of Social Sciences (Counselling)

The University of Hong Kong

June, 2005

TOMMY LIANG

Department of Social Work and Social Administration

Supervisor: Dr. Adrian Tong

ABSTRACT

This study investigates the psychological ramifications of receiving Reality

Therapy for clients with marital problem in the newly formed Integrated Family

Service Centre (IFSC) in Hong Kong. This report takes a practice research

perspective, in the form of a research project and a clinical practice, focusing on

process and outcome, serves as an integrated practice-oriented model. Three

standardized measures (perceived improvement, enhanced problem solving

capacity, empathy) and in-depth interviews are used to analyze data generated

from 5 clients in three cases. The literature review covers the concept of marital

power, local marriage counseling approaches, and the theory and practice of

Reality Therapy. The review suggests the application of Reality Therapy is not

only feasible to clients with marital problem but also accommodating to the

rationale of IFSC. The findings indicate significant changes in the participants:

perceived equity in the marital relationship increases; perceived improvement in

marital problem increases; there is part or all of three modes of communication;

sociability increases through the stages of counseling; control over the other

between the partners decreases; and enhanced problem solving capacity

increases. Based on the findings, the report concludes by calling for (i) an

effective therapeutic alliance in practice, (ii) a theoretical orientation focusing on

choice and responsibility, and (iii) an integration between clinical practice and

research.

2

To my colleagues,

My Dad and my Mom,

and my companion BLESS.

3

ACKNOWLEDGEMENTS

I am very grateful to Dr. Adrian Tong for his guidance and supervision in

every stage of my writing this report. From the beginning, he suggested to me the

way to maturity and professional growth. His profound knowledge and mastery

of counseling has been an important source of assistance to me.

To Dr. Ho-yee Ng, I wish to express my deep appreciation for her

instruction, which has deepened my interest in the study of Reality Therapy and

given me a new perspective in understanding myself. It is very privilege to be one

of her students.

I am indebted to my wife Bless for her companionship in every task I do. In

the work of this report, Mo, Margaret, the Timothys, the HeartOasis, and the

prayer trio have given me constant encouragement and support. I am also

thankful to my pastor, Dr. Ivan Yim, whose presence has helped me in time of

difficulty, and enabled me to accept my vulnerability.

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LIST OF TABLES

Title Page

Table 1 Service boundaries of Caritas IFSC - Aberdeen p.40

Table 2 Demographic characteristics of participants p.52

Table 3 Experience of marital problem p.52

Table 4 Ways to resolving marital problem before counseling p.53

Table 5 Anticipated reasons for marital relapse p.53

Table 6 Scale measures p.55

Table 7 Meaning of counseling p.61

Table 8 Role of social worker p.62

Table 9 No. of sessions needed to form therapeutic alliance p.62

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ABSTRACT p.2

ACKNOWLEDGEMENTS p.4

LIST OF TABLES p.5

TABLE OF CONTENTS p.6

CHAPTER ONE INTRODUCTION

1.1 Study Area p.8

1.2 Study Objectives and Methodology p.13

1.3 Chapter Organization p.15

CHAPTER TWO LITERATURE REVIEW

2.1 Marital Problem p.16

2.2 Marriage Counselling Approaches p.20

2.3 Reality Therapy and Choice Theory p.24

2.3.1 Theoretical concepts p.24

2.3.2 Treatment Approach p.27

2.3.3 Techniques p.33

2.4 Chapter Summary p.37

CHAPTER THREE FIELDWORK AND METHODOLOGY

3.1 Fieldwork Overview p.39

3.2 Study Questions p.41

3.3 Study Design p.42

3.3.1 Sample p.42

3.3.2 Procedures p.43

3.3.3 Operational Definitions p.45

3.3.4 Data Analysis p.46

3.4 Expected Outcomes p.47

3.5 Chapter Summary p.50

CHAPTER FOUR RESULT

4.1 Characteristics of participants p.51

4.2 Changes in Perception of Control p.53

4.3 Changes in Communication and Problem-solving Skills p.55

4.4 Experience of counselling p.61

4.5 Chapter Summary p.66

CHAPTER FIVE CONCLUSION

5.1 Appraisal of the study p.67

5.1.1 Interpretation of result p.67

5.1.2 Personal appraisal p.74

5.1.3 Limitations p.83

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5.2 Social Work implications p.84

5.3 Chapter Summary p.87

APPENDIX I: Caritas IFSC – Aberdeen p.88

APPENDIX II: Approval letter from Head of Family Service p.90

APPENDIX III: Consent form p.91

APPENDIX IV: General message stating the purpose of the interview p.92

APPENDIX V: IFSC Standardized measurements- USS (OS2) and

TPR (OS5)

p.93

APPENDIX VI: Empathy Scale (ES) p.94

APPENDIX VII: Semi-Structured Interview Guide p.95

APPENDIX VIII: Case profiles p.96

BIBLIOGRAPHY p.100

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CHAPTER ONE

INTRODUCTION

This first chapter gives an overview of the practice-based project report by

introducing the study topic and the major areas of concern, namely common marital

problems experienced by couples, the characteristics of marital dyads, and the nature

of family service setting in Hong Kong. Study objectives are then stated. A brief

discussion of the research methodology follows. Finally, an outline of the organization

of the whole report concludes the chapter.

1.1 Study Area

This study begins with a general description of marital problem and married

couples in Hong Kong. The newly formed Integrated Family Service Centre (IFSC) is

also introduced. A review of various counseling approaches to marital problem is

made in the next section. It is followed by an investigation of the psychological

changes from the counseling experience in clients receiving Reality Therapy from a

social worker of an integrated family service centre. The outcome of the study has

practical implications for social work practice so far as change in individuals or

couples is aimed at. For example, it provides an understanding of how changes in the

perception may be brought about and its subsequent impact on behaviour. Specific to

the marital problem, the study throws light on questions such as: how do people

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account for their marital problems? Can marital problems be solved? What should be

the aim and objective for marriage counseling? What role does the social work

profession have in it?

Common marital problem

In 1991, the Hong Kong Council of Social Services reported that about one-

fourth of an active counseling caseload of 9795 was identified as related to the marital

relationship (Hong Kong Council of Social Services, 1991). The council also

conducted a study on marital problem in 1994 and the results indicated that there were

1462 service users asking for help in their marital relationships. The main nature of

their marital problems was communication (17.6%), role performance (15.5%) and

extra-marital affair (35.3%) (Hong Kong Council of Social Services, 1997). The Hong

Kong Census and Statistics Department recorded that from 1991 to 2003, the number

of widowed and divorced or separated men and women had a 43.2% increase (Hong

Kong Census and Statistics, 2004). The Judiciary also reported that 6291 decrees

absolute were granted in 1991. By 2003 this had risen to 13829 (Hong Kong Census

and Statistics, 2004). Although these figures have not compared with those of many

other countries, regarding the detrimental impact on personal life, and the significant

number of spouses seeking help over difficulties in their marriage, the implications

9

are that marital issues in Hong Kong have assumed dimensions close to those

experienced elsewhere. To capture such impressions, the Hong Kong Marital Study

(Young, 1995) is used to guide the present investigation. The nature of evolving

spousal relationship is first introduced below.

Characteristics of marital dyads

In 1991, a study on marriage in Hong Kong was first conducted to gain

understanding of the pair relationship by interviewing husbands and wives for their

experiences (Young, 1995). According to the study, many of the most prominent

marriages are found to be marriages aiming for companionship with a familial

orientation. In these marriages, spouses are emotionally interdependent and

characterized by connections with their families of origin. In addition, they tend to

have joint participation in task and non-task activities. It is reported that the wives

found affection and companionship in experience-sharing and decision making, and in

acknowledging contribution to family life, whereas the husbands regarded affection

and companionship to be performing tasks for the partner, as in financial support and

practical help, and as being together or engaging in sexual activity with the partner. It

is therefore clear that couples in Hong Kong tend to regard expressive and

instrumental behaviour as meeting the different needs of both sexes. As it becomes

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apparent later, Glasser emphasizes people’s behaviour as arising from the gap

between what the person wants and what the person perceives he is getting. This

emphasis befits the same concern in counselling, and provides an entry point for

social work intervention in marital problem.

Counselling in an Integrated Family Service Centre

In the present attempt to investigate a counselling approach in the integrated

family service centres (IFSCs), this study first acknowledges the University of Hong

Kong Consultant Team’s final report on family services review in that IFSCs

“represented a more versatile, proactive, user-friendly, and responsive service,

tackling the multi-faceted needs of families” (HKU Consultant Team, 2004, p.58).

Hence, the focus on need-fulfillment in social work intervention is supported in this

study.

The IFSC is most commonly understood to be a strength-based practice

involving “non-deficit partnerships between participants and providers, flexible and

culturally sensitive services, and participant empowerment through involvement in

planning, governance and, increasingly, evaluation” (HKU Consultant Team, 2004,

p.4). Such practice may be viewed as a respectful way to help individuals regain

control of their lives.

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Following the work of HKU Consultant Team (2004), the effectiveness of social

work intervention has been indicated from various outcome standards: enhanced

social support, enhanced knowledge of community resources, enhanced problem

solving capacity, perceived improvement in the main problem, and user satisfaction

level. Despite such diversity in perspectives, counselling in an integrated family

service centre is seen as an experience that enables people to make choices by seeing

the world through perceptions in terms of knowledge and values in order to fulfill

their needs and wants.

While the IFSC concentrates on providing a continuum of services with

preventive, developmental, educational, supportive, empowerment and remedial

functions, it is a “concern from the field (that) the design of IFSC would discourage

the development of specialized intervention knowledge and skills for specific target

groups and needs” (HKU Consultant Team, 2004, p.90). In this study, it is argued that

the application of Reality Therapy, with the major theoretical base reviewed in

Chapter Two, is not only feasible but also accommodating to the rationale of IFSC.

1.2 Study Objectives and Methodology

Arising from an investigation of the changes that occur in married people

receiving counseling service from IFSC emphasizing the enhancement of problem-

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solving capacity and perceived improvement in the problem, this study explores the

impact of Reality Therapy on married people as exemplified in changes in perception

and their effect on behaviour. The central study question is:

What are the cognitive and behavioural ramifications of receiving Reality

Therapy for clients with reference to their marital problems?

When counselling is seen from an outsider’s perspective, client’s perception and

behaviour can be understood through investigating the taped sessions.

To provide indices on the outcome level related to the service standards

prescribed in the Funding and Service Agreement, standardized measurements are

used, namely the Users Satisfaction Survey (USS) and the Target Problem Rating

(TPR). The USS has four outcome standards (OS), namely the Satisfaction after

receiving IFSC service (OS1), the Enhanced problem solving capacity (OS2), the

Enhanced knowledge of community resources (OS3), and the Enhanced support

network (OS4). The TPR includes the Perceived improvement in the main problem

(OS5). In addition, the Empathy Scale (ES) developed by Burns (1989) is also used to

provide indices on the therapeutic relationship.

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Finally, the participants in the study are asked to respond to a set of open-ended

questions, with reference to their marriage and counseling experience.

The present study thus aims to provide an insider’s perspective on a marriage

counselling process. A sample of 5 participants from three cases were selected for this

purpose.

This study attempts to generate data in multiple ways so that both qualitative and

quantitative data may be able to complement each other.

The significance of the present study is seen to lie on two levels: first, specific to

marital problem, it throws light on questions regarding factors affecting marital

quality, coping and treatment issues, and, in particular, on the application of Reality

Therapy to marital problem in an IFSC. Second, from a wider perspective, to examine

the premise of choice and responsibility in social work practice. The implications of

the study is discussed in the final chapter.

1.3 Chapter Organization

There are five chapters in this report. Apart from this introductory chapter,

Chapter Two reviews the theories of marital problem and treatment approach. Chapter

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Three states the study questions and the design and methodology of the empirical

work. Chapter Four presents the data obtained. Chapter Five concludes the report by

discussing the results, sharing the investigator-practitioner experience, and

considering the implications of the study for social work.

CHAPTER TWO

LITERATURE REVIEW

This second chapter introduces the concept of power in the understanding of

marital problem by discussing the limitations of the current understanding of marital

problem. It then gives an overview of the marriage counselling approaches in Hong

Kong. A discussion of Reality Therapy and Choice Theory follows. Finally, a

summary concludes the chapter.

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2.1 Marital Problem

Looking at the literature on marriage, the confusion in understanding marital

problem becomes all the more apparent. At one extreme, Young (1993) reported that

problems in interpersonal processes within the marital relationships, in particular,

communication and conflict management, had the greatest impact on their marital

experiences, and on their responses in the transactions of everyday living. Difficulties

in communication may have several meanings. It can simply be a lack of

communication resulting from failure to form effective patterns. It can also be a

destruction of adequate communication patterns due to any changes in life events.

Perhaps it can also be a deficit of communication skills in the spouses. Conflict

management problems may include a mixture of conflict management styles, like

control and withdrawal, which are intended to maintain harmony at the expense of

personal growth. At the other extreme, local family theorists emphasize the

importance of marital satisfaction and marital intimacy in improving the quality of

marriage (Shek, 1993; Shek, 1995; City University of Hong Kong & Catholic

Marriage Advisory Council, 2001). Five areas of intimacy are identified, namely

emotional (having closeness of feelings), social (sharing friends and social networks,

intellectual (sharing ideas), sexual (sharing affection and/or sexual activity, and

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recreational (sharing hobbies or leisure pursuits). The significance of the five

components of intimacy differs for men and women. For men, maintaining

intellectual, emotional, and sexual intimacy with their wives are important to their

marriage. Yet for women, intellectual intimacy is of paramount concern. It shows that

sharing ideas between couples is vital to women’s marital satisfaction.

While there is considerable agreement regarding the significance of the

interactional relationship in marriage, there is much confusion about how to define it,

and even more concern over how to measure it. According to Gelles (1995), marital

relations and interactions are made up of patterns of choices and decisions. But how

can the process of decision-making be understood? Is decision-making a part of

conflict management or a reflection of marital intimacy? Does choice-making involve

a communication process? How does it lead to marital satisfaction?

The concept of marital power

According to Olson and Cromwell (1975), the concept of power is inextricably

related to a marriage system regarding the interactional relationship. Three aspects of

marital power are described: power bases, power processes, and power outcomes.

Power bases are basically the resources a partner possesses which may increase his or

her ability to exercise control in a given situation. These specific resources may

include the socioeconomic status of the partner. Power processes refers to the

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behaviours or skills which a partner employs in his or her attempts to gain control in

discussion, decision-making, problem-solving, conflict resolution, and crisis

management. It can be measured by counting the number of effective attempts which

a partner makes to change the behaviour of another (assertiveness) and the number of

effective attempts which a partner makes that actually changes the behaviour of

another (control). Power outcomes is defined as the perceived equity or control in

which the partner assesses subjectively his or her receiving equal relative outcome

from the relationship (Wong, 1992). It is usually measured by self-report methods,

such as questionnaires and interviews.

In operational terms, assertiveness consists of all power statements or attempts to

influence by a partner. Control consists of only those successful power statements.

Sociability is all residual communication not intended to control or modify the

behaviour of the other partner. It is nondirective and climate-setting.

In order to achieve a more global perspective of the power relationship, marital

power is better examined through the measure of both decision-making processes and

perceived control. The former measure, which includes communication and problem-

solving, is viewed as the more specific objective indicator of power relationship. The

latter measure is regarded as an effective indicator to tap the subjective feelings of

whether marital power is equitably distributed between spouses.

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In addition to marital power being a dynamic, relational, and reciprocal concept

in understanding power relationship, Lee and Tang (1997) and Chan (2000)

administrated studies on spousal abuse in Hong Kong. The results indicated that the

Chinese cultural values are associated with domestic violence. To specify, the Chinese

conceptions of masculinity and femininity, which are closely related to yi, face,

submissiveness, dependence, self-sacrifice, and domesticity, are associated to spousal

abuse. This sheds light on the understanding of marital power as a cultural

prescription.

While these two studies contributed to the cornerstone of the Chinese

conceptions of manhood and womanhood in spousal abuse in Hong Kong, they do not

have much discussion on the different perspectives and measurements of marital

power, such as communication, problem-solving, and perceived control. They also

give no special concern about the effect of marital power on the non-abusive couples

in Hong Kong. However, the knowledge about the cause and effect of marital power

is of great implication for social work practitioners. In particular, to understand how

the marital power will affect the marital relationship and what marriage counseling

approaches correspond to the newly formed IFSC. This study attempts to fill this

knowledge gap.

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2.2 Marriage Counselling Approaches

Given such a beginning recognition of the relevance of social work practice in

marriage counselling, what theoretical approaches do social workers adopt in Hong

Kong?

According to Yung (2001), there are four most common approaches adopted by

the local practitioners. They are Structural Family Therapy, Satir Model, Solution-

focused Brief Therapy and the Ackerman Approach.

The Practice Teams of the Department of Social Work of the University of Hong

Kong and the Chinese University are known for their adoption of Structural Family

Therapy in providing direct services to needy families, research, and training for

students and professionals. According to Structural Family Therapy, the structural

requirements for marital relationships are accommodation and boundary-making

(Nichols & Schwartz, 1998). To organize the relationship, each spouse needs to adjust

to the other’s expectations and wants. This is accommodation. In accommodating to

each other, a couple also needs to negotiate the nature of the boundary between them

and between themselves and the environment. This is the process of boundary-

making. In practice, structural family therapy changes behaviour by opening

alternative patterns of family interaction that can modify family structure.

The Hong Kong Satir Center for Human Development has been actively

involved in training and providing counseling services since Virginia Satir’s visit to

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Hong Kong in 1983. According to Satir (1967), family therapy is a form of marital

therapy even though the family therapist also deals with the couple in their parental

roles. Like most experiential family therapists, Satir Model therapists describe the

family as a place of sharing experience and consider flexibility and constructive

problem-solving as characteristic of a healthy family (Nichols & Schwartz, 1998).

Couples are encouraged to work on their intrapsychic issue and then move on to the

interpersonal issue between each other. When necessary, they are invited to deal with

their family-of-origin. In this approach, caring and acceptance are the keys to helping

people overcome their fear, open up to their experience, and open up to each other.

The Brief Therapy Teams of the Hong Kong Polytechnic University and Caritas

Family Service maintained close contact with Steve de Shazer and Insoo Kim Berg

for consultation and supervision and adopted Solution-focused Brief Therapy as their

practice and teaching model. Borrowing from constructivisim, Solution-focused Brief

Therapy rejects the idea that symptoms are the result of psychic or structural problem

such as incongruent hierarchies, covert parental conflicts, low self-esteem, deviant

communication, and repressed feelings, but focuses on the collaborative construction

of solution-oriented narratives (Nichols & Schwartz, 1998). Couples are helped to

resolve the presenting complaints by thinking or doing something different so as to

become more satisfied with their lives. In practice, couples are helped to shift their

21

language from talking about their problems to talking about solutions.

The Yang Memorial Methodist Social Service, in conjunction with Ackerman

Institute for the Family in New York, has been organizing the Yang-Ackerman family

therapy training program for helping professionals. Based largely on Bowenian

concepts, the Ackerman Approach traces the pattern of family problems to emotional

reactivity and interlocking triangles (Nichols & Schwartz, 1998). Emotional reactivity

is an unhealthy exaggeration of an instinctual need for others. Interlocking triangles

are a series of overlapping triangles, resulting from unresolved tensions in families in

which conflict between two people is detoured to a third person. The goal of marital

therapy is to decrease anxiety and increase differentiation of self by enhancing

rational understanding about family systems. In this approach, the ability to see and

regulate one’s own role in interpersonal processes is the primary mechanism of

change.

What have been brought out so far suggests that these four approaches provide

different vehicles for change under the broad goals of solving presenting problems

and reorganizing families. Solution-focused Brief Therapy, which is action-oriented,

concentrates on the former. The Ackerman Approach, which is cognition-based

concentrates on the latter. Structural Family Therapy, which is based on interactional

patterns, and Satir Model, which is emotion-focused, aim for both. Although previous

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reviews of different intervention approaches have concluded that the comparison

between different approaches showed no differences in respective effect sizes after

therapy, the challenge of IFSC has drawn the attention of social work practitioners to

the use of cost-effective treatment.

As far as the use of strength-based practice emphasizing enhanced problem-

solving capacity in IFSC is concerned, behavioral marital therapy has been found to

be effective in reducing marital distress in different cultural settings (Hahlweg &

Markman, 1988). In particular, when Reality Therapy is adopted to resolve marital

problem, it seeks to help the couple to adjust to each other’s expectations and wants

(as Structural Family Therapy does), to set marriage as a place of facilitating

constructive problem-solving (as Satir Model does), to resolve the presenting

complaints by doing something different to fulfill their needs (as Solution-focused

Brief Therapy does), and to increase differentiation of self by enhancing rational

understanding about marriage (as the Ackerman Approach does). Given such an

important recognition of Reality Therapy in marriage counselling, what specific role

can it play in IFSC? This will be discussed in the last chapter, given the insights

derived from the present study.

2.3 Reality Therapy and Choice Theory

Howatt (2001) describes Reality Therapy and Choice Theory as both mainstream

23

in the world of counseling, and being taught in many mainstream academic

counselling programs at colleges and universities around the world. The purpose of

this section is to explain how the basic assumptions of human behaviour provided the

basis for the therapeutic intervention.

2.3.1 Theoretical concepts

According to Howatt (2001), Glasser started out Reality Therapy before he had

Choice Theory for explaining human behaviour. The theory and method utilized in

Reality Therapy is based on the clinical assumption that human behaviour is

purposeful and originates from within rather than from external stimuli (Wubbolding,

1988). The followings are the major concepts regarding human behaviour:

Basic human needs

These internal drives are identified as the basic human needs. Glasser (1998) stated

that all people are born with five basic or genetic needs that are fixed at birth. They

are survival, love and belongings, power, fun, and freedom. Survival needs are the

essentials of life. They include food, shelter, safety, and health. Love and belongings

is defined by loving and being loved. It includes interactions and relationships with

people. Power, sometimes understood as achievement or self-worth, is the feelings of

accomplishment and self-esteem. Fun is the enjoyment of life. It includes the ability

24

to play, laugh, and leisure. Freedom is the ability to make choices and to live without

unnecessary constraints.

Needs and human bebaviour

Such needs are present in all human beings and therefore drive them to make choices.

Wubbolding (1988) identified five principles underlying Reality Therapy. First,

human beings are motivated to fulfill needs and wants. Second, the gap between what

human beings want and what they perceive they are getting from their environment

produces specific behaviours. For example, when we have a stomachache, we feel

painful. The gap between the want for relief and the perception of relief drives us to

move our hand to the stomach and massage it. Third, human behaviour is designed to

close that gap. Fourth, human behaviour, which is composed of inseparable aspects –

physiology, feeling, thinking, and acting (as in the case of stomachache), is generated

from within and is probably a matter of choice. This notion draws us to consider the

various aspects of behaviour as a dynamic condition and a result of perception. From

this, finally, human beings see the world through perceptions in terms of either

knowledge or values.

Human behaviour and problems

As far as the notion that human behaviour is a choice is concerned, mental health and

25

relationship problems are conceptualized in terms of problems in choices, need

satisfaction, and responsibility (Glasser, 1998). Problems previously known as illness,

fear and loneliness, helplessness, boredom, and depression are now termed as lack of

safety and security, lack of love and belongings, lack of power, lack of fun, and lack

of freedom. Regarding marital problems, in particular, Glasser (2000) views the use of

external control psychology on the spouse as the root of failure in marriage. By this,

he refers to the behaviours which the couple employs in their attempt to gain control

in problem-solving and conflict resolution, and the perception in which they assess

subjectively each of them receiving equal relative outcome from the relationship.

2.3.2 Treatment Approach

Reality Therapy as an action-oriented approach

Reality Therapy is active, directive, practical, and behavioral. A Reality

Therapist sees his task as helping clients clarify their wants and perceptions, evaluate

them, and then make plans to bring about change. This helping process involves the

goals of therapy, the therapeutic alliance, and the specific procedures leading to

change.

Goals of therapy

The goals of Reality Therapy differ according to the perspective one takes in

26

explaining human behaviour at different times. The first definition Glasser published

for Reality Therapy is as follows: “A therapy that leads all patients towards reality,

towards grappling successfully with tangible and intangible aspects of the real world,

might accurately be called a therapy towards reality, or simply reality therapy”

(Glasser, 1965, p.60). The goal of Reality Therapy was simply social rehabilitation. In

the last two decades, helping people regain control of their lives by making better

choices became the primary concern of Reality Therapy (Glasser, 1984). This was due

to the dominance of Glasser’s thinking that people have personal control over their

behaviour. When the use of Reality Therapy in marriage and family counseling was in

its early stage in the 90’s, Wubbolding (1988) described the goal of marriage

counselling as to help the spouses increase the commonality in needs, wants,

behavioral systems, and perceptual systems, thereby increasing family adjustment,

harmony and happiness. When Glasser published Choice Theory: A New Psychology

of Personal Freedom, he no longer uses the term control theory anywhere in his

writing. He started referring to what had been control theory as choice theory, an

internal control psychology that seeks to explain why and how people make the

choices that determine the course of their lives (Glasser, 1998). At about the same

time, Glasser (2000) states that the continuing goal of Reality Therapy is to enable the

client to improve the troubled relationship by experiencing a choice-theory

27

relationship between himself and the counsellor. When the goal of Reality Therapy is

seen as a way of making choices for responsible behaviour and better relationships, it

calls us to understand thoroughly the therapeutic alliance, process, and the

relationship enhancement techniques.

Therapeutic alliance

According to Glasser (1965), when Reality Therapy does not work, it is mainly

because the therapist is unable to get involved in a meaningful and persistent way

with the client. He views therapeutic alliance as the most essential factor in

counselling and believes that “the ability of the therapist to get involved is the major

skill of doing Reality Therapy” (Glasser, 1965, p.22).

Wubbolding (1988, pp11-27) suggests the following guidelines to achieve that

involvement:

- Use attending behaviours.

- Always be courteous, determined, enthusiastic, firm, and genuine.

- Suspend judgment.

- Do the unexpected.

- Use humor.

- Be yourself.

- Share self.

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- Listen for metaphors.

- Listen for themes.

- Summarize and focus.

- Allow or impose consequences.

- Allow silence.

- Be ethical.

- Do not accept excuses.

- Do not criticize or argue.

- Do not give up easily.

When necessary, therapists may also use consultation, continuing education, and

follow up to facilitate treatment.

Therapeutic process

According to Wubbolding (1988), the therapeutic process consists of the application

of the procedures of Reality Therapy to help the client meet his goals. They are

represented by the acronym WDEP, which includes four main elements: Wants,

Direction and Doing, Evaluation, and Planning.

W: Wants. It is used to explore the needs, wants, and perception of the clients. The

counsellor may ask the client a question like, “What do you want or what do you

really want?” to seek out the unfulfilled need.

D: Direction and Doing. It is used to examine how the clients attempt to fulfill needs

29

in a specific way. The counselor may ask the client, “What did you say to your wife

last night?” in order to help him realize who is choosing the behaviour he is now

presenting.

E: Evaluation. It is used to help clients reflect their value judgment on their

performance. The counsellor may ask the client, “Is what you are doing helping you

get what you want?”

P: Planning. It is used to fulfill client’s needs and wants with an action-oriented

commitment. The counsellor guides the client in making a time schedule to do a task

so as to meet his needs. A client gains more effective control over his life with plans

that have the following characteristics. They are represented by the acronym

SAMI2C3: Simple, Attainable, Measurable, Immediate, Involving, Controlled,

Consistent, and Committed.

Reality Therapy as a behavioral marital therapy

Reality Therapy, as a form of behavioral marital therapy, is basically a

relationship enhancement process. In one sense, its goal, like that of relationship

enhancement programs, is to teach attitudes and skills that will enable the clients to

relate to significant others in ways that will maximize satisfaction of emotional and

functional needs (Guerney, 1977). In another sense, marriage is a partnership. The

partners when agreeing to enter what Glasser (1998) called “the solving circle” should

30

take marriage as precedence over what each of them wants as individuals. The solving

circle is an imaginary circle in which each partner tells the other what he or she will

agree to do that will help the marriage. Negotiation and compromise can only be

allowed in this circle.

This relationship enhancement process can be viewed in the Structured Reality

Therapy Marriage Counselling. Glasser (1998, pp179-180) suggested the counsellor

to ask six specific questions in the first session that each partner responds to:

(1) Are you here because you really want help? Or are you here because you have

already made up your mind to divorce but want to be able to say you tried to get help?

(2) Very briefly, what do you believe is wrong with the marriage?

(3) Whose behaviour can you control?

(4) Tell me one good thing about the marriage as it exists right now.

(5) Think of and then tell me something that you are willing to do this coming week

that you believe will help your marriage. Whatever it is, it must be something you can

do yourself. It must not depend, in any way, on what your partner should or should

not do.

(6) During this coming week, are you willing to try to think of an additional thing

besides what you thought of here? And then do it following the same I-can-control-

only-what-I-do conditions as in the previous question?

31

In the subsequent sessions, the counsellor is suggested to follow the four levels of

intervention in building relationships (Wubbolding, 1988):

Level One is strengthening activities. It enables the person to feel effective control by

doing something alone regardless of others’ responses.

Level Two is strengthening joint activities by facilitating both parties to feel effective

control by doing something together alone.

Level Three is communication. This includes both listening-questioning skills and

assertive-responsible language skills.

Level Four is problem-solving. This includes skills training in resolving power

struggles, making compromise, and avoiding destructive arguments.

2.3.3 Techniques

This section reviews the various techniques in Reality Therapy in the literature.

Self-involvement

According to Glasser (1965, p22), “one way to attempt an understanding of how

involvement occurs is to describe the qualities necessary to the therapist.” He

identifies four qualities of an effective therapist. First, he should be very responsible.

Second, he should be strong but never expedient. Third, he should be accepting and

32

understanding. Finally, he should be emotionally involved with the client.

Metaphors

Glasser (1984) uses the analogy of a front-wheel drive car to illustrate that all aspects

of human behaviour are connected. On the front wheels are action behaviour and

thinking behaviour, and on the back wheels are feeling behaviour and physiology

behaviour. He postulates that if a client changes his scenery, either by going outside

for a walk or doing something else he enjoys, he will start to feel better. Wubbolding

(1988) also suggests that metaphors can come spontaneously from clients or the

counsellor to enhance human understanding and insight of the situation and to

intensify emotions.

Questioning

Wubbolding (1988) states four purposes of questioning specific to Reality Therapy.

First, in asking clients what they want and need, what they are doing and planning,

and so on, the therapist attempts to see the world as their clients see it. Development

of extensive methods to ask questions is strongly encouraged. Second, the collection

of information serves as an intermediate function for the therapist to help clients make

value judgments and effective plans. For example, “How long have you been talking

to him? Did your use of time work to your advantage?” Third, questioning serves a

33

paradoxical purpose in conveying an implicit message. For instance, “What do you

want to do tonight to change your relationship for the better?” the message that people

have control over their relationship is conveyed. Finally, what comes from the inside

helps clients take more effective control. Questioning enables clients to define wants

and to focus their perception on action behaviours.

Use verbs and “ing” words

Glasser (1998) states that verbs and “ing” words immediately bring people into

awareness of the idea that we are choosing what we are doing and are capable of

choosing something better. Therefore, feelings such as depression, anger, and anxiety

can be termed as depressing, angering, and anxietying.

Positive addiction

Positive addiction is a meditative state of mind in which it strengthens the

reorganization system and in doing so markedly enhances the ability of our behavioral

system to function (Glasser, 1981). By asking the clients to spend one minute each

day visualizing affirmative statements, such as “I am a responsible husband,” “I am an

attractive wife,” it helps them directly change their thinking behaviours (Wubbolding,

1988).

34

Paradox

Wubbolding (1988) describes two types of paradox. The first one is reframing. It

helps clients change the ways they think about a topic. For example, helping the

married couple see the extra-marital affair as a friend. The affair becomes a personal

friend who accompanies the clients, and can be discussed in the third person. As a

result, the clients are able to think of the affair as a choice rather than a cloud that

came over them. The second type is prescriptions. Clients are told to choose the

symptoms. For instance, asking the wife to indulge her angering and depressing the

next day at a specific time after being rejected by her husband. The client will

probably state that she is too busy to take the time to indulge.

Skill Development

Although Glasser (2000) demonstrates a variety of skills to solve individual and

marital problems, he explains a little about the concrete steps or procedures in using

the skills to improve communication and problem-solving. Glasser seems to open the

door of Reality Therapy to alternative skills-training methods. In this report, three

basic sets of verbal skills that facilitate effective communication and problem-solving

as identified by Guerney (1977) is adopted and summarized below. When a person

chooses to express himself to other, he is in an expressive mode. He is suggested to

follow the steps: (1) Chooses a topic, (2) Speaks according to own feelings and

35

perceptions, (3) Avoids talking about motives of partner, but focuses on behaviour and

resultant feelings, finally (4) Describes behaviours valued in partner and resultant

feelings. The next skill is the empathic mode. It is used to respond to the other after

receiving the message. Several points are noted. First, there should be no judgment of

other’s feelings; it is merely a desire to learn and understand his feelings. Second, one

should try to see the situation from the other person’s point of view. Third, it should

be a communication of acceptance and understanding. Finally, it does not lead with

questions or advice. The third skill is mode switching. It enables each partner to

express his or her own feelings and thoughts in appropriate portion and timing. It also

enhances problem-solving.

2.4 Chapter Summary

This chapter reviews different understanding of marital problem in the local literature.

Then the concept of marital power is addressed. Local practice of marriage

counselling have been traced and the rise of IFSC accounted for an expansion of the

role of Reality Therapy in marriage counselling is noted. Major theoretical concepts

that are unique to Reality Therapy and Choice Theory, such as five basic human

needs, four inseparable aspects of human behaviour, and the control model of marital

problem are introduced. Seeing Reality Therapy as an action-oriented approach and a

36

behavioral marital therapy shows a historical time line of Glasser’s work and how he

has arrived at his present thinking focusing on choice-making and relationship

enhancement.

CHAPTER THREE

FIELDWORK AND METHODOLOGY

This chapter presents the fieldwork setting, methodology and design of the study,

giving details of the whole operation of the investigation, as well as some of the

expected outcomes as derived from the relevant literature.

37

3.1 Fieldwork Overview

The implementation of IFSC in different districts is based on the

recommendations made by the HKU consultants. Taking into account the district

characteristics and the community needs, two IFSCs (one operated by SWD and the

other operated by Caritas – HK) were set up in the Southern District in 2004.

According to a joint meeting between SWD and Caritas – HK (Social Welfare

Department, 2004), the service boundaries of the Caritas IFSC in the Southern District

is based on the geographical distribution of the existing customers’ reported

addresses, the distribution of 284,567 residents in 17 constituency areas in 2003 and

the projected population in the district from 2003 to 2012. With the approval from

District Social Welfare Officer (Southern District), the boundaries of the Caritas IFSC

were as follows (Table 1):

Table 1

Service boundaries of Caritas IFSC - Aberdeen

Constituency Area Code Catchment areasEstimated Population as

at 30.6.03

D06 South Horizons East 14,615

D07 South Horizons West 15,700

D08 Wah Kwai 17,098

D09 Wah Fu I 14,759

38

D10 Wah Fu II 16,454

D11 Pokfulam 15,416

D12 Chi Fu 15,083

D13 Tin Wan 18,397

Total 127,522

(Social Welfare Department, 2004)

In line with the implementation of IFSC, the Caritas IFSC has started service

promotion to stakeholders including customers, District Councillors, Government

Departments, NGOs and local leaders in April 2004. Increasing numbers of referral

were reported since then.

The Caritas IFSC – Aberdeen (formerly known as Caritas Family Service –

Aberdeen) is located at 1/F, 22 Tin Wan Street, Tin Wan. It comprises three

components, namely Family Resource Unit (FRU), Family Support Unit (FSU), and

Family Counselling Unit (FCU). A continuum of preventive, supportive and remedial

services is provided with regular extended hour services (Appendix I). There are 14

social workers apart from a supervisor. Spousal conflict and child behavioral problem

were identified by the HKU Consultant Team and endorsed by the Task Group on

Assessment & Outcome Indicators as the two of the major problems that have been

receiving much social concern (HKU Consultant Team, 2004).

3.2 Study Questions

This study begins by examining the changes that occur in clients with marital

39

problem who undergo a counseling process in the form of Reality Therapy. The

counseling service is provided by a social worker of Caritas Integrated Family Service

Centre - Aberdeen. The central question here is what are the cognitive and behavioral

ramifications of receiving Reality Therapy for clients with reference to their marital

problem?

Arising from this study of on-going and post-intervention changes, questions

regarding the nature of marital problem, the goal of marriage counseling and the role

of social work profession are explored.

The research questions

To capture the changes that occur in these clients, the following research

questions are explored in relation to their counseling experience:

1. What are the cognitive changes that occur in the clients with specific reference to

changes in their perception regarding their locus of control?

2. What are the behavioral changes that occur in the clients with specific reference to

changes in their perception regarding their responsibility?

40

3. What is the counseling experience like for the clients?

4. What is the role of social worker in marriage counseling as perceived by the

clients?

3.3 Study Design

3.3.1 Sample

The size of the client population is unknown as the Hong Kong Council of Social

Services is only able to record in the membership list. Random sampling is not

feasible, as the factor of self-selection is inevitable when the study is concerned with

clients who come forward for service, as this study is. Thus convenient sampling best

describes the sample method of this study concerning a therapeutic approach for

clients with marital problem.

All participants are married, as marital status is significant in affecting the

experience of marital problem and motivation for treatment.

The sample consists of 5 participants who come from three cases identified in the

Caritas Integrated Family Service Centre – Aberdeen. They are designated as AC,

WC, L, H, and YL.

41

3.3.2 Procedures

Prior to the study itself was launched, a meeting was held with the centre-in-

charge of Caritas Integrated Family Service Centre – Aberdeen, for the purpose of

discussing the practice-based project with her. An approval letter was also received

from the Head of Family Service, Caritas – Hong Kong upon request (Appendix II). A

practice research approach was adopted for data collection. The investigator served

not only as a practitioner but also both a participant observer and an interviewer

throughout the process. This also facilitated rapport building with the participants.

Since the investigator was also a social worker in the centre, there was no liaison

problem with various staff members in the centre.

Two weeks prior to the investigation, a meeting was held with a clinical

supervisor assigned by the University of Hong Kong to review the investigator

experience as a practitioner and to prepare him for the project.

All participants were recruited in January 2005. They were the active cases who

had finished the crisis intervention period between July and December 2004 and who

had opted to receive marriage counseling. All interviews took place between the

period from January to May 2005 at the interview room at Caritas IFSC – Aberdeen.

42

To capture the process of practice research, the interview was tape recorded with the

consent of the participants (Appendix III). All participants except H and YL consented

to the interview being taped. Each interview lasted on average 1.5 hours.

All interviews were conducted in Cantonese. The purpose of the interview was

described clearly to the participants. The general message is shown in Appendix IV.

The interview consisted of three parts:

1. Standardized measurements of IFSC, namely the Users Satisfaction Survey (USS)

and the Target Problem Rating (TPR) were given to each participant individually

(Appendix V). In addition, the Empathy Scale (ES), designed by Burns (1989), was

also used (Appendix VI).

2. To capture the participants’ marriage experience and their experience in the

counseling process as they wished to tell, guided open-ended questions were asked in

the last session of investigation (Appendix VII).

3. The therapeutic interviews. Descriptions of the therapeutic approach have been

given in Chapter Two.

43

3.3.3 Operational Definitions

In answering Research Questions One and Two, two standardized measurements

were used to reflect cognitive and behavioral changes in the participants. The

descriptions of the two measures are as follows:

Enhanced problem solving capacity (OS2)

The Users Satisfaction Survey (USS) has four outcome standards (OS), namely

the Satisfaction after receiving IFSC service (OS1), the Enhanced problem solving

capacity (OS2), the Enhanced knowledge of community resources (OS3), and the

Enhanced support network (OS4). The USS has been reported to reflect well the

effectiveness of the services provided by IFSCs (HKU Consultant Team, 2004). For

the purpose of this study, the Enhanced problem solving capacity (OS2) was the

focus.

Perceived improvement in the main problem (OS5)

The Target Problem Rating (TPR) was designed to quantify the Perceived

improvement in the main problem (OS5). Its reflection of service effectiveness has

also been reported (HKU Consultant Team, 2004).

Empathy Scale (ES)

In line with the counseling experience of the clients (Research Question Three),

44

the Empathy Scale (ES) was adopted to quantify the therapeutic alliance between the

counselor and the client. It has also been claimed to provide significant information to

successful treatment (Burns, 1989).

3.3.4 Data Analysis

Each case is first analyzed on its own to identify particular patterns. It is then

cross-examined with other cases to further discover any similarities and differences.

This study also uses multiple sources of data which are regarded as

complimentary to one another. Any discrepancies are considered to be an indication

for changes in the participants. Ultimately, a negotiation between the standardized

measures and the individual reporting provides the most useful information on the

counseling experience of the clients.

3.4 Expected Outcomes

Expected outcomes are only given for the cognitive and behavioral measures

used in relation to research questions one and two. Essentially, the participants’

experience in relation to their marital problem and counseling are explored through

the insider’s perspective by way of their accounts of their own experiences.

In line with Olson and Cromwell’s (1975) emphasis on the concept of power in

45

understanding marriage system regarding the interactional relationship, this study

does not seek to establish causal explanations of the phenomenon of marital problem,

rather it seeks to understand what counseling means to the clients, and the changes in

their perceptual world. The understanding of Research Questions One and Two is

guided by certain anticipations of the directions of change in the clients, with

reference to relevant literature.

Cognitive changes

The investigation of cognitive changes in the clients is guided by Olson and

Cromwell‘s (1975) theory, and in particular, the use of power outcomes in studying

changes in perception about equity in the marital relationship. The study also makes

use of the measurement of perceived equity devised by Wong (1992) to map out the

changes. Operational definition of power outcomes is given in Chapter 2. It is

measured by self-reports and interviews in this study.

Based on the above observations in the literature, the following cognitive

changes are anticipated to occur in the counseling process:

1. Perceived equity in the marital relationship increases as the belief in external

locus of control weakens

2. Perceived improvement in marital problem increases as the perceived equity

46

increases

Behavioral changes

Power processes refers to the behaviours or skills which are employed to gain

control in discussion, decision-making, problem-solving, conflict resolution, and

crisis management. According to Cromwell, Klein, and Wieting (1975), the verbal

communication, that is the major subject of investigation in power processes, is

broken down into three dimensions. They are assertiveness, control, and sociability.

Operational definition of these three dimensions is given in Chapter 2. It is measured

by self-reports and interview in this study.

Besides, the three basic sets of verbal skills described in Chapter 2 are also used

as a checklist for effective communication and problem-solving.

Based on the above observations in the literature, the following behavioral

changes are anticipated to occur in the counseling process:

1. There is occurrence of part or all of the three modes of communication

2. There is an increase in sociability through the stages of counseling

3. The control over the other between the partners decreases as sociability

47

increases

4. Enhanced problem solving capacity increases as communication skills bring

about a new perspective to problem resolution

Personal accounts of the counseling experience

A thematic analysis of the clients’ responses to open-ended questions is

conducted. No anticipation of the meaning given to their experiences is made.

3.5 Chapter Summary

The research questions asked in this study, the design and methodology, and the

expected outcomes are introduced. Multiple methods are adopted..

48

CHAPTER FOUR

RESULT

This chapter presents two sets of data, namely the scale measures, and the

interview data. The presentation of the result is to prepare for a discussion of the

findings with reference to the study questions asked in this study.

4.1 Characteristics of participants

Details of the case profiles are given in Appendix VI. Table 2 below gives a

comparative view of the five participants. They all differ in age, schooling, sex, years

of marriage, age of first discovery of marital problem, and years of marital problem.

Their mean age is 47.2. The mean age of first discovery of marital problem is 37. The

average duration of marital problem is 10 years. As a whole, the participants tend to

experience marital problem as both a communication problem and a power issue of

control and withdrawal (Table 3). For example, most of the participants complained

their spouses for not listening to them or not expressing message clearly. Besides, all

49

female participants saw their husbands as keeping silent or avoiding the problems in

an irresponsible way, whereas all male participants considered their wives as forcing

them to make decisions in a disrespectful manner.

Table 2

Demographic characteristics of participants

AC WC L H YL

Age 45 37 35 61 58

Years of schooling 11 9 7 11 6

Gender F M F M F

Marital status Married Married Married Married Married

Years of marriage 16 15 15 33 33

Age of first discovery

of marital problem 43 25 34 49 34

Years of marital

problem 2 12 1 11 24

Table 3

Experience of marital problem

AC WC L H YL

Spouse unable to share the

burden of the family

* *

Spouse not understanding * * * *

Spouse controlling * * *

Spouse withdrawing * * *

Table 4 shows the ways of coping marital problem before counseling. It indicates

that most of the participants are found to be either avoidant or acting out in a

50

destructive manner. For example, AC, WC, and YL have been tolerating their marital

discord for many years before counseling. As a result, they all have mentioned about

ending the marriage. However, L and H have been showing their anger by nagging,

criticizing, and threatening. This has also led to mistrust and separation.

Table 4

Ways to resolving marital problem before counselling

AC WC L H YL

Non-intervening *

Tolerance * *

Explaining *

Grievances * *

Seeking divorce *

Table 5 reveals that the participants tend to believe that extra-marital affair is the

common reason for marital relapse.

Table 5

Anticipated reasons for marital relapse

AC WC L H YL

Extra-marital

affair

NA * * *

Child-related

problem

NA * *

Financial

problem

NA *

Communication

problem

NA *

51

4.2 Changes in Perception of Control

Perceived equity in the marital relationship increases as the belief in external locus of

control weakens

Seeing a reduction in the external locus of control in marriage increases the

perceived equity in the marital relationship of all the participants. Such a change

includes respect and understanding, which also meets the need of freedom in the

individual, as expressed by the following participants:

以前我係下面，宜家平架。甚至我有時我覺得我既思想會好過佢(丈夫)。唔好講學問，學問我唔夠佢黎。我會用平常人既心態諗野… 我冇諗過要操控邊個人既行為，其實冇一個人我可以控制得到… 以前唔會諗到。佢係一個個體，你唔可以控制佢、改變佢，但係你可以控制自己。你用控制自己黎靜觀其變，你唔可以改變佢。(AC)

以前我覺得我太過大男人，樣樣自己自以為是，一就一、二就二。宜家算啦，一人行一步，體諒下啦，就咁… 以前諗住控制係人地度，我比較自大。(宜家)自己聽下佢講下意見，自己又講下自己既意見，大家互相了解。思想上改觀左，冇以前咁執著。(WC)

未黎輔導，(丈夫)高的。宜家，差唔多平… 未黎之前，想控制佢。之後，發現只可以控制自己。我真係諗過想控制邊個，初初真係有咁既諗法架！(L)

思想上既改變，頭先話齋，人唔可以控制人，雖然我以前都知，但我宜家就要付諸實行多的。知同做係兩件事，宜家希望做多的，希望減少磨刷，溝通多的… 因為對方 明白到大家對自由既需要、活動既空間。大家付出相同，唔係好似以前咁一面倒，所以宜加係平等左… 譬如商量某一件、某種需要、某種活動都有講就唔係學以前咁單方面既指示，宜家會大家講下各方面既需要，討論然後參詳下，搵個最好既方法。(H)

我自己做番我自己的野，我就係咁樣。或者對方冇做到，我做番自己就算數，我唔理對方，我就係咁樣。我做番自己，佢做唔做佢既事… (宜家)佢都有幫手做，

52

都覺得好的(平等的)… 譬如去飲茶，有時佢提意見，有時我提意見。好似佢今朝出黎香 仔，我係屋企煮好哂飯，佢打電話番黎，七蚊兩斤菜芯喎，買唔買呀？我話好呀，你買囉。兩斤咁平，我話你買番黎啦。(YL)

According to the participants, changes in perception of control is seen to bring about

self-efficacy, self-understanding, empathy, perceived equity, respect, acceptance and

sense of responsibility for conflict resolution. It turns a controlling, self-righteous

person into one who thinks clearly of the needs of others.

Perceived improvement in marital problem increases as the perceived equity increases

Table 6 reveals an overall increase in the perceived improvement in marital

problem (OS5 scores) among the participants. Such a change also coincides with the

above individual narratives. It is noted that OS5 Score of each participant is derived

from the difference between the results indicated in the Target Problem Rating Scale

in two different points of time. In this case, the dates of the initial interview and the

last session for investigation.

Table 6

Scale measures

Scales AC WC L H YL

OS2 Score 3 4 5 3 4

OS5 Score +20% +80% +70% +40% +20%

ES Score 2.8 3.0 2.9 2.8 3.0

53

4.3 Changes in Communication and Problem-solving Skills

Occurrence of part or all of the three modes of communication over time

There is part or all of the three modes of communication in all the participants.

Such an observation includes speaking in regard to own feelings and perceptions,

trying to see the situation from other’s perspective, and enabling other to express

freely, which also meets the need of acceptance and understanding in the individual,

as expressed by the following couple:

28-01-05

我嗌佢老婆大人，佢話好耐冇嗌佢。（WC）

我係大陸上面，佢都有嗌過。嗌呢就覺得親切的。一落黎佢就冇嗌。我覺得(嗌呢)

幾好、幾尊重。我心覺得佢都會咁嗌我。（L）

佢都係為個家，盡心盡力，做左出黎，冇話我知。咁我自己的野，係出面做野，我又冇話佢知。 （WC）

04-02-05

好的，多野講小小，融洽番的。（WC）

我成日話，佢唔相信。係有人同佢講、解釋，佢先相信。我講左好多年，我都算好多野講既人，我雖然講野九唔搭八，有時講野，佢都唔相信。每一次我講野，佢當我耳邊風，第日又係嘈。呢個禮拜好似又唔同，又好的。（WC）

我諗野既角度闊左。即係應該都要諗下人...我以前係唔會睇人地，諗左自以為是，feel到人地應該知道我諗乜卦。宜家多左都要諗深一層，睇睇人地知唔知道自己...應該要諗下人地有乜諗法。有陣時要講出黎，唔好收埋，應該知卦。以前我真係冇咁諗，以前我真係唔會諗人地。（WC）

18-02-05

54

講真一句，亞梁生，可能見左你之後，我先夠膽望人、傾計。早十年雖然係街邊，我完全冇睇過人地、望人地一眼。唔夠膽望人地講野。宜家我可以夠膽望住你講野。我以前唔夠膽，百分之一百唔夠膽，我會面紅啦，講野口窒窒。咁呢兩三個月我可以望住你講野，個心好的。（WC）

...個心裡面放左小小。你又係人，我又係人... （WC）

我都唔知佢原來係咁喎，我唔知你以前係咁，宜家先知。幾好丫，幾開心丫，佢識得了解自己。（L）

30-03-05

我既猜疑你可以講出黎...好好架娜宜家，好犀利架娜宜家，我覺得自己。（L）

15-04-05

就算嗌兩句，咁會啋番，冇原來咁，話完就算數。溝通真係比以前好好多。宜家有時話兩句咁，又冇事咁傾番計。以前話兩句，成晚冇出聲，真係有架，三幾日唔出聲。宜家講完就算，話完就算數，當傾完咁，唔岩傾到岩。（WC）

According to the participants, changes in communication and problem-solving skills

is seen to bring about intimacy, respect, harmony, perspectives, courage, happiness,

self-worth, and relationship enhancement. It enables a mistrusting couple to enhance

the quality of marriage.

Increase in sociability through the stages of counselling over time

There is an increase in sociability in all the participants except AC. Such an

observation includes communication not intended to control or modify the behaviour

of another family member, as expressed by the following couple:

55

28-01-05

初頭點敢講佢聽，男人老狗，搞間屋都搞唔掂，好瘀嘛！ （WC）

04-02-05

（佢）多野講左，笑容多的，同的仔女傾下計...宜家（佢）番黎會叫下的細路，同人玩下，咁就開心的。（L）

30-03-05

以前就冇，宜家就乜鬼都講，開心唔開心都講...家庭既野，加埋自己出去做既野都有商有量，以前就冇。（WC）

29-04-05

間中都會訴下苦、講下...宜家好多野講，有講有笑。（WC）

According to the participants, changes in communication and problem-solving skills

is seen to bring about honesty, fun, and freedom.

.

Control over the other between the partners decreases over time

Control over the other between the partners decreases in all the participants.

Such an observation includes making less influence over the other and showing more

respect to the other, as expressed by the following couple:

28-01-05

少溝通丫嘛，多的同我傾計，我就冇乜野。我承認我小器。（L）

我成日咁話你，你又頂番轉頭...三句唔埋兩句將的仔黎鬧。（WC）

我未上去之前，好似都有野傾。番落黎就冇，煮左送又唔嗌我食。 （WC）

56

我以前番上大陸，番去剪下頭髮唶，你又話要搵個女跟住。打電話又問邊個打黎。 （WC）

我承認自己係有小小（呷醋）。我承認我思想係有的問題。對果樣野好大反應，我係控制唔到自己。 （L）

04-02-05

有人傾計，同冇人傾計，係差小小。真架，即係我成日係屋企，揍仔買送煮飯，冇乜人傾計，個心自然諗好多野。有時有人傾計，個心就冇咁多野諗。（L）

18-02-05

諗果的野真係少左好多。你個心諗住冇野就冇野。唔諗咁多囉，放心啦，相信你。呢兩個月黎你上去，我都冇諗太多。你唔駛諗喇，我冇會再呷醋。都十幾年，我應該放心。（L）

29-04-05

先自己深呼吸，然後慢慢放鬆。盡量放鬆，唔駛話忍住。忍住，死喇！越谷越犀利。我以前成日自以為是，好似睇得透人地，實際睇唔透人地...我以前係自我，自己想野岩喇就咁樣想。宜家會諗下人地既野。（WC）

According to the participants, changes in communication and problem-solving skills

is seen to bring about trust, relief of tension, and perspectives.

Enhanced problem solving capacity increases as communication skills bring about a

new perspective to problem resolution

Table 6 also shows an overall increase in the enhanced problem solving capacity

(OS2 scores) among the participants. It is noted that OS2 score of each participant is

derived from the result indicated on the Enhanced Problem Solving Capacity Scale in

the last session for investigation. Such a change includes a new direction, or a new

57

perspective to problem-solving as expressed by the following participants:

有 (唔同)，但溝通唔多。我曾經試過寫封信比佢，因為我講唔到。咁用書

信話比佢聽我要同佢離婚，但我都想離婚之後對的小朋友好的，唔好改

變其他野，因為我地對小朋友有責任，呢個我以往唔會做…因為我講野

直，書信可避免爭吵。( AC )

遷就、體諒、同埋關心。以前鑽牛角尖，小小野一陣就發脾氣，唔會講野。

宜家就算係老婆幫唔到，百分之九十會同老婆商量下，以前百分之一百

冇…平時行街，有時係屋企，多野講左。煩既時候發兩句脾氣一定有，唔

駛十分鐘講番野。以前一定冇，兩家都唔出聲。兩家相處比你地輔導左睇

開的。我知我老婆宜家可能就話算啦、發下脾氣唶。佢都會講番，我就識得

諗冇錯，大家傾番，唔同以前。接納左，佢又接納左我。( WC )

見左你地之後，好似禮拜六，我打電話比佢話小心的喇，上到去點樣做 ，

見到人地唔好啋人地。可以咁樣同佢講，以前唔會。佢都會加多句話小心

的囉。呢個改變真係幾大…最幫到個婚姻係溝通。大家多的溝通，有唔岩，

你講比我聽，佢唔岩，我講比佢聽。呢個都係好主要。你唔岩，講比我聽，

唔好岌住，要坦白、信任。( L )

58

我諗都係經過個 Course分析左，同埋講解左人與人之間既溝通、相處、表

達，令到每一個出席者吸收之後，然後去消化，從而達到改善個婚姻關

係…上左堂之後，我配偶同我既溝通變得明朗左，同埋多左一份欣賞，

多左諒解。咁呀衝突固然之係少左，咁係有一種改善。( H )

宜家講野首先諗清楚先。適當既時候，食飯、睇報紙，唔好去搔擾。大家有

大家工作個陣時就唔好去講，自己提醒自己，等人地停落黎，或者有乜

野需要，或者先至去講，宜家諗好晒先至講…好似上個星期四，黎呢度

同你傾完計走，同佢去香港仔忽然諗起鴨利洲好多魚賣，不如我地過鴨

利洲睇下買魚，咁佢話好呀。咁兩公婆落去鴨利洲買左好多魚囉番番黎整，

幫唔幫到就唔知，但係以前冇既。( YL )

According to the participants, changes in communication and problem-solving skills

is seen to bring about sense of responsibility, control of temper, negotiation, trust,

appreciation, acceptance, and mindfulness.

4.4 Experience of counselling

Table 7 below gives a comparative view of the 5 participants which indicates that

counseling is commonly understood as a helping process and a problem-solving

approach. This helping process includes the relief of stress, the improvement of self

59

and communication, and the provision of guidance.

Table 7

Meaning of counselling

AC WC L H YL

Problem-solving * * * *

Improving

communication

* *

Helping * * * * *

Guidance *

Self-improvement * *

Relieving stress * *

All participants consider the social worker as their confidant, regardless of their

gender (Table 8). Other major roles include tutor, mediator, and resource person.

Table 8

Role of social worker

AC WC L H YL

Tutor * * * *

Confidant * * * * *

Physician *

Mediator * * *

Resource

person

* * *

60

Crisis

manager

*

Table 9 indicates that the number of sessions needed to form therapeutic alliance

ranges from 1 to 3.

Table 9

No. of sessions needed to form therapeutic alliance

AC WC L H YL

Number of

sessions

3 2 1 3 MISSING

Individual narratives of participants

To highlight the experience of counselling in the participants, individual

narratives with reference to therapeutic alliance, process, and outcome are given

below. Of the 5 participants only one suggests that the social worker should be more

proactive in the initial contact with the client (H). Roughly three aspects of experience

have been mentioned:

1. Therapeutic alliance

In line with the experience of the clients with the counselor, Table 6 shows a high

score in the Empathy Scale (ES Score) among the participants. It is also noted that ES

score of each participant is derived from the total sum indicated on the Empathy Scale

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measured in the last session for investigation. Such a change includes the essential

conditions of effective therapeutic relationships as expressed by the following

participants:

社工可以令我好放心咁同佢傾計，我會好信任佢。我同佢傾既嘢係保密既，

絕對保密既。真係咩嘢都可以講囉。乜野開心既事都可以係度講。我絕對相

信。令你真係有個幫忙，從說話當中有個對象比你講、傾、或者發洩…都係

一個合作既關係。… 正如我頭先咁講，我好信任你，我就會將我發生咁多

咁多唔如意既事好坦白咁講你聽，豪無保留咁話你聽。( AC )

親切，比倒我地一種信任。對我有幾大幫助，一個真真正正既知己，對我

黎講。我有咩事你會同我解決，輔導我、聽我感覺同埋感受。…初初我覺得

緊張，中間個陣時好好既朋友、知己咁，宜加直成係真真正正既知己。

( WC )

初期接觸社工係心理上係唔同既個體黎，即係我發出求救，佢幫助我，同我解決困難。但係相處耐咗可以改變，社工可以逐漸逐漸變為親密啲，可以傾多啲說話，甚至乎可以當係朋友咁都得。… 如果要形容呢，就講得親密啲，就好似拍拖，初初同社工相識，就好似識個女朋友一樣，後期愈傾愈多就變咗比較信任多啲，講多啲，好似個女朋友講多啲心中說話。到最後，大家發生好感添！( H )

好似朋友咁，有乜野都傾得到，老友記咁樣。( YL )

According to the participants, therapeutic alliance is seen to bring about trust,

understanding, acceptance, intimacy, friendliness, patience, and cooperativeness. It

62

enables the counselor to get involved with the client in a meaningful and persistent

manner.

2. Therapeutic process

Such a journey includes a problem-solving approach and a relationship

enhancement process as expressed by the following participants:

你曾經同我講過，其實一家人不完整，鑒硬生活落去都冇意思，對啲細路仔冇好處，佢都做唔到一個稱職既爸爸，咁對於呢個婚姻黎講唔應該繼續落去，基於以上原因。而事實上，佢都唔係一個稱職既爸爸，又唔去搵野做，咁我哋點樣算。呢個係事實，你叫我點樣算呢？所以我義無反顧係呢一年做我以前從未做過既野，同埋去咗好多部門… 以前做決定乜嘢都問過老公，宜家做決定就自己去諗，係好唔同，以前就係佢話咁就咁，明明唔係想咁，聽多佢兩講，就算喇聽佢喇，但宜加樣樣都自己黎，因為呢幾年既生活都要自己黎，冇人幫你，真係冇人幫… (我係度)得到既係幫助，各方面既幫助，甚至係細路仔既情緒，我都會黎問你，你都會幫我分析，甚至經濟上面，都好全面。…(經過輔導)思想上冇咁夾窄。以前思想可能夾窄少少，完全冇諗過離婚，同埋冇嘢係唔得。…(宜家)

多左啲可能性，生活差之中可以對自己有要求。…係我主動咗，做嘢主動咗，以前做嘢被動。…好似自己搵番自己，以前就冇左自己。( AC )

開始時我將所有野冰冰拍拍咁講晒出黎，你就一步一步同我地一個一個問題慢慢咁解釋清楚，同埋比個方向我地，有個方向感。後尾，自己有信心。( WC )

幫助我地，分析我地之間婚姻問題，幫我地去面對、關心、明白我地既困難、開解我地。( L )

我冧都係經過個 Course分析咗，同埋講解咗人與人之間既溝通相處、表達，令到每一個出席者吸收到之後，然後去消化，從而達到改善個婚姻關係。( H )

多個人去幫助你解釋每個問題。( YL )

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According to the participants, therapeutic process is seen to be reality-based, action-

oriented, self-determined, procedural, goal-directed, analytical, educational, and

explanatory. It enables the client to follow a structured guidance to meet his goals.

3. Therapeutic outcome

Such a result includes a way of making choices for responsible behaviour and

better relationship as expressed by the following participants:

結果其實係好架。如果冇輔導，我今日唔知變左咩嘢，甚至乎我最好既朋友話如果你當初冇去輔導，你可能已經黏左線。我朋友同我講左幾次，我朋友同我講如果我過番以前的生活，我一定黏線。…有時同你講下我情緒控制唔到，我係街行下都會喊，個時既情緒好差。我睇番呢幾個月我叻左好多，冇呢個情形，但係早幾個月仲有，自己都唔知點解會係咁喊。但宜加既情緒係好穩定。( AC )

百份之一百好。兩公婆關係絕對好番。我發下脾氣，佢都識得體諒自己，我就識得體諒佢。加上自己出面做野平伏左，慢慢一步一步黎，就係咁，識得同人地講相處。…以前我就自大。宜加唔係冇，慢慢改善緊。( 宜加 ) 個人開心咗，識得同人相處，學緊。…我比自己既分數 80分度。唔係認真好滿意自己，仲要改善！…以前我習慣睇人，自己好似比較自大啲，唔識得，「你買唔買就算喇」。宜加識得開始學緊同人相處。… (呢樣野對婚姻)百份之一百有(幫助)。識得同老婆講下，佢宜家又識得安撫下我咁，幾好既！ ( WC )

見左之後就唔係。應該要信任，要信任佢，其實冇野既，自己諗啫，自己唔好諗咁多。見左你之後分析左，知道佢既情況對我點樣，其實就冇野既，其實自己諗啫，就開心左好多。係真呀，唔係假。個人好潮悴，個陣時候，好唔開心，見左之後，哪，自己唔駛諗咁多嘢。(L)

我既配偶既改變比我仲更多仲快。我本人亦都有作出同等既改變，但係我覺得個改變比較小。係我內心成日都有個課程既要求擺係個心度，我盡量控制自己。希望個溝通好啲，減少衝突。( H )

64

輔導既結果就唔係一個人或者同輔導員話就得既，大家要合作先至得，有任何結果，好既或者咩野迷合作。好似梁生你教左我去做，講野客氣或者尊重，講野睇下點樣唔清楚再講過，唔清楚能夠再問番人咁。結果都好，我學倒野。我學倒同人相處。(係夫婦既相處 )學左大家互相去禮貌，去尊重。學左費事去發脾氣，唔好去嬲。 ( YL )

According to the participants, therapeutic outcome is seen to be helpful to mental

health and psychological well-being, relationship improvement, and conflict

management.

4.5 Chapter Summary

The characteristics of participants and the answers to the research questions

asked in this study are presented. Both qualitative and quantitative results are shown.

Findings indicate significant changes in the participants according to the expected

outcomes.

CHAPTER FIVE

CONCLUSION

This last chapter concludes the report by discussing the results, reflecting on the

investigator-practitioner experience, and considering the implications of the study for

65

social work.

5.1 Appraisal of the study

This study begins with a general profile of marital problem and marital dyads in

Hong Kong. It is followed by an investigation of the psychological changes from the

counseling experience in clients receiving Reality Therapy from a social worker of an

integrated family service centre. This section sheds light on the significance of the

practice-based project by making the interpretation of the result, acknowledging a

reflective approach to the fieldwork experience, and identifying the limitations of the

study.

5.1.1 Interpretation of result

This section discusses the findings in relation to the research questions asked, the

major theme being to understand the psychological impacts of receiving Reality

Therapy for clients with reference to their marital problem.

Cognitive changes that occur in the clients with specific reference to changes in their

perception regarding locus of control

The basic goals of reality therapy are to help clients clarify what they really want

and why, to guide them toward making value judgments about their present behaviour,

66

and to assist them in deciding on a constructive plan of responsible behavioral change

that will lead to taking effective control of their lives. Findings from individual

narratives of the participants (Chapter 4. Section 4.2) indicate that changes in

perception of control has brought about the following cognitive changes in the clients.

Self-efficacy and sense of empowerment

AC, having learnt the basic human needs, has come to realize that she has never

thought of taking effective control of her own life before. When she began to reflect

on her permissiveness towards her husband and to evaluate its effectiveness on getting

what she wants, she became aware of the need of making an action-oriented

commitment to fulfilling her needs and wants. As she gained more control of herself

through a series of action plans, she started to see herself as being empowered in the

marital relationship although she has finally chosen to divorce.

Self-understanding, empathy, and perceived equity

WC and L were helped to focus on the improvement of marital relationship in

the first joint session. As they were challenged to reflect on the validity of external

control in marriage and were given an individual assignment on building relationship,

they began to understand that each partner should be responsible for his or her part in

67

helping the marriage. When they were facilitated to make action plans on joint

activities, they began to perceive each other receiving equal relative control from the

relationship. As they learned more effective communication skills, they gained more

understanding of self and other.

Respect, acceptance, and responsibility for conflict resolution

Although H and YL did similar tasks, they have chosen to construct their marital

relationship as a functional one. They built their marriage merely on the commitment

to companionship. Therefore, they focused on conveying the right message in their

everyday discussion. As they were always aware of the need for freedom, they

allowed a high degree of freedom and autonomy of each other only if both are

committed to the relationship. As companionship ruled over other dimensions in

marriage, they assumed responsibility for problem-solving.

Behavioral changes that occur in the clients with specific reference to changes in their

perception regarding responsibility

The analysis of individual narratives of the participants (Chapter 4. Section 4.3)

indicates that changes in clients’ perception of responsibility leads to a life style that

involves extensive modes of communication, increased sociability, and less control

over the partner.

68

Extensive modes of communication

The use of different modes of communication in response to different situations

reflects the willingness of a person to understand the other and to be understood.

When WC and L reported their changes in communication pattern from silence to

expression and empathy over the course of treatment, it is believed that the couple has

become more open and receptive to each other. They have also accepted the

ownership of self-disclosure and reception for better understanding of each other. For

this to happen, they must have experienced more love and belonging in their

relationship.

Increased sociability

Change in sociability is most clearly seen in the case of WC and L. As the couple

realized that they were not able to control the behaviour of each other, they felt less

defensive. Because of this, they became aware of the need of fun and freedom, which

had previously been suppressed. With the introduction of the concept of 5 basic

human needs, they have learned how the basic needs were related to their behaviour

and their problem. When they assumed the responsibility of need fulfillment for their

own, they started to arrange for activities characterized by fun and freedom.

69

Less control over the partner

When communication skills were taught, the couples started to learn a brand new

way of understanding people like never before. They learned to show respect, honour

individuality, and repeat what they had heard from the partner. They also needed to

clarify what had been unclear to them. By practicing these skills regularly, they were

able to understand and to accept their partner. This kind of skills-training has enabled

the clients to gain a sense of achievement and a higher self-worth. As a result, they did

not need to control their partner for more power. They have alternatives. They have

fulfilled the need of achievement and self-worth.

Counselling experience for the clients

Findings from ES score (Table 6), Table 7, Table 8, and individual narratives of

participants (Chapter 4. Section 4.4) indicate that all the participants have positive

experience of counseling.

The ES measures clearly indicate a very successful therapeutic alliance, and a

corresponding increase in perceived improvement in marital problem (OS5) is seen as

a function of helping process. The average-to-high scores in the enhanced problem-

solving capacity (OS2) also illustrate the problem-solving nature of counseling.

The analysis of individual narratives indicates that a trustful and working

alliance, a choice-theory based process, and a relationship-enhancement outcome all

70

lead to the positive experience of counseling.

When these findings are compared to what Glasser expects of the most essential

factor in counseling, it is not difficult to see that it is “the ability of the therapist

(counselor) to get involved” (Glasser, 1965, p.22). Therefore, it is believed that the

personal characteristics of the counselor, such as trustworthy, understanding,

accepting, friendly, patient, rational, realistic and directive have contributed to the

positive counseling experience.

Role of social worker in marriage counseling

Findings from Table 8 indicate that the dominant role of social worker in

marriage counseling is like a confidant and a tutor. This is true when the social worker

is seen as being fully present before the client. The results suggest that clients come

for marriage counseling may have experienced a certain degree of disrespect and

mistrust in their marriages. When the social worker actively listens to them and trusts

what they say, they will perceive him as if their soul-friend.

It is worth noting that the perceived role of social worker as a tutor corroborates

findings from Table 7, in which counseling is meant to be problem-solving. Because

of this, the social worker has a specific role in marriage counseling when the couple

has agreed to enter “the solving circle” (Glasser, 1998). In this respect, the social

worker is seen as part of this solving circle, particularly in the process of facilitating

71

communication and conflict resolution.

In sum, marital problem is perceived as a disability of understanding people and

making decision with the partner and a failure of perceived equity. The application of

Reality Therapy to clients with marital problem is seen as a helping process through a

problem-solving approach between an involving counselor and his choice-making

clients for the purpose of gaining better control of self and enhancing effective

communication and conflict resolution.

5.1.2 Personal appraisal

I have adopted a reflective approach (Fook, 1996) to honour multiple

perspectives of understanding the world and bridge the gap between theory and

practice. Here I share the experience of a counselor and the context of counseling in

the fieldwork so that a more realistic picture of counseling in IFSC may be shown to

the reader.

Experience as a counselor

My experience as a counselor includes my conversion story from a Satir Model

therapist to a Reality therapist, reflections on the essential conditions of effective

therapeutic alliance, and the experience of incorporating research elements into

72

clinical practice.

From Satir Model to Reality Therapy

I have long been putting much emphasis on the role of self-worth and emotions

in my personal life and professional development. But when I have made them my

first priority, I began to realize that I have neglected other important domains of

human experience, namely thinking and action. As a matter of fact, thinking, feeling,

and behaviour are the totality of human experience. Neither one should be neglected.

When one of them is neglected, there will be a discrepancy between human

consciousness and reality. The consequence is that it not only upsets the functioning

of an individual but also harms the relationships in a community.

Choosing Reality Therapy to be my practice model is a response to that worry

because it tries to include total human experience in its model. Another reason is that

it is the instruction of the programme coordinator. I was advised not to use the Satir

Model which I have been accustomed to. Rather, I shall expand my learning

experience by selecting a different model. After reviewing a number of intervention

models, I found that Reality Therapy is most compatible with Satir Model, which

offers my worldview of human dignity. Both Reality Therapy and Satir Model are

strength-based and they adopt a growth-oriented model. They focus on choice and

responsibility. They also seek to meet the yearnings of human being. The following is

73

my story of conversion:

Live with Reality Therapy

As I get myself used to Reality Therapy, I found it helpful to me in two aspects:

personal growth and professional development. First, personal growth. Last year, I

was diagnosed Thyroid Cancer and experiencing an undesirable working relationship

with my practicum teacher. These two experiences created a great impact on my self-

worth and emotions. However, they also became a precious opportunity for personal

reflections. It started off my search for meaning of life. Viewing self-esteem from the

Satir Model, I realized my self-worth had been built on achievement and performance.

To affirm my dignity, I had paid much attention to the perception of others rather than

the universal yearnings of human beings. I became arrogant. I lived in my false self.

When Reality Therapy came to my life, it opened my eyes for basic human needs,

choice, and responsibility. I realized that my depression was my own choice. I had

chosen not to balance all the aspects of needs. I had chosen to replace my real needs

with other things. I had also chosen not to take responsibility to satisfy my own needs.

I believe that it is crucial to use a more rational perspective to understand my own

situation. More importantly, the conceptual framework of Reality Therapy is much

more compatible to my personal philosophy of life: (i) life has a purpose as it is

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created by a purposeful God and (ii) every human being is given free will and is

therefore responsible for his or her own choices, including the satisfaction of basic

needs. Since then, I practice Reality Therapy in my everyday life. And I feel myself

taking effective control of my life.

Expand inner experience to Total behaviour

Second, professional development. It is no doubt that the Satir Model has

provided an epistemological framework for a therapist to conceptualize inner

experience of a person (for example, the metaphor of personal iceberg). Yet its over-

emphasis on awareness and autonomy of an individual has failed to facilitate the

client to take action in response to his needs in a positive manner. As a result, the

client maintains a self-sufficient condition or lives in a self-fulfilling reality without

undergoing a radical change. The concept of total bebaviour in Reality Therapy is to

transform every aspect of human experience into behavioral terms. That is to say, it

seeks to include feeling, thinking, acting, and physiology into behaviour. More

importantly, cognition, affection, and behaviour are all regarded as vehicles of change

in Reality Therapy. For this reason, the client has no excuse for changing his

behaviour. It is because he has to be responsible for his total behaviour. Because of

this, every piece of behaviour the client elicits is a matter of choice. The client owns

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his own freewill. Therefore, he is a free person. A free person is one with optimal

level of self-worth.

From process to structure

Another major area of concern is the mechanism leading to the outcome of

therapy. Although the Satir Model is so process-oriented that it follows closely the

pacing of the client, there is always a time when the client becomes too emotional or

overwhelmed to achieve the counseling goals. In this way, the effectiveness of therapy

will be discounted. The therapeutic process of Reality Therapy, however, includes a

four-step guidance (WDEP) enhancing the problem-solving capacity of the client and

leading to a responsible consequence. Therefore, Reality Therapy has provided a

structural process for the counselor and the client to meet the mutually agreed

expectations.

From universal yearnings to five basic human needs

Besides, both models acknowledge internal drives motivate people. Despite the

fact that the Satir Model successfully demonstrates the human desire for universal

yearnings, understanding client’s yearnings is very much confined to the personal

experience of the counselor. If the counselor is too young or lacking extensive life

experience, he may not be able to understand what is driving his client to act in a

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certain manner. Yet Reality Therapy has successfully included all universal yearnings

into five basic human needs. According to Glasser, all people are born with these five

genetic needs that are fixed at birth. Although Glasser identified the five basic human

needs according to his clinical observation, this concrete idea has already enabled

people to change their behaviour effectively.

Advocate for marriage enrichment

Finally, as I compared the two models in marriage counseling, I realized a big

difference in the orientation to preservation of marriage. With its meta-goal on raising

a person’s self-esteem, the Satir Model seeks to preserve the self at the expense of

marriage and family. Reality Therapy, however, asserts the eternality of marriage by

developing an internal control psychology and enabling the couple to make

commitment to a problem-solving relationship. For this reason, Reality Therapy

contributes to family and societal stability.

Limitations of Reality Therapy

What have been brought out so far suggests that Reality Therapy offered a more

constructive and positive approach to changing behaviour. It is rational, behavioral,

and structural. It deals with basic human needs. It is also normative to conventional

marital values. Despite the strengths described above, Reality Therapy also has a

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number of shortcomings. First, Reality Therapy is built on the assumption that a

person should satisfy five basic human needs. Although these five needs are socially

desirable, are they necessary or sufficient conditions for people to function? Are there

other essential needs not included? For example, the spiritual needs. Second, Reality

Therapy does not give emphasis to the person’s family of origin as a determinant of

present behaviour. As in the case of H in this study, exposing him to the impact of his

parents’ relationship on the influence of power in the family may certainly help him

gain more insight of the present situation, and thus facilitate effective therapeutic

change. Third, although the emphasis is on relationship enhancement in the present

stage of Reality Therapy, Glasser did not give detailed protocol for skills-training.

Practitioners should either develop their own skills or borrow the techniques from

other behavioral models. Fourth, despite the fact that total behaviour includes all

human experience, it is dubious that all emotions can be seen as behaviours. Can

emotions be reduced to behaviours? Is there an ontological difference between the

two? As a practitioner, I should be honest to confess that Reality Therapy is a

behavioral therapy. It is not emotion-focused though it regards feeling as a behaviour.

Finally, it is inadequate to attribute all the problems to the failure of satisfying the five

basic human needs. There is an old Chinese saying, “when the heaven is calling a

person for a great mission, it will testify him and make his body and soul suffer.” In

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some circumstances, handling problems is for the sake of gaining resilience.

Essential conditions of effective therapeutic relationship

I believe that an effective therapeutic relationship depends on at least two factors.

The first one is a trustful and constructive supervisor-supervisee relationship. From

the practicum experience, my supervisor has demonstrated to me what is meant to be

genuine, accepting and empathetic. When I shared my past struggle to him in the first

two sessions, he was able to attend to my feelings and to see me as a unique person

who needs affirmation of my strength. This personal experience enables me to

understand some aspects of myself which had previously been repressed. It also

strengthens me to cope with the problems of life more adequately. After all, I have

transferred this learning to my counseling experience. I began to realize that an

affirming supervisor-supervisee relationship is essential to developing effective

therapeutic alliance.

The next condition is genuine feedback from clients. No matter it comes from

self-report or the Empathy Scale, asking for feedbacks from clients has strengthened

my sensitivity to others’ feelings. During the therapeutic interview, I always liked to

ask my client to tell me how the experience of counseling is like for him in the end of

the session. I saw this action as a collaboration between the client and the counselor. It

has made a successful working alliance between the two.

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Integration between clinical practice and research study

The project-based project seeks to incorporate research elements into clinical

practice. When I stated my research questions in this report, I have focused on what

Tsang (2000) described as practice-oriented questions. For example, the cognitive and

behavioral changes that occur in the clients, the counseling experience like for them,

and the perceived role of social worker in marriage counselling all have significant

meanings for clinical practice. Therefore, I am using these questions to guide my

practice and, in return, my counseling experience to answer these questions. Another

advantage of such an integration is that I was able to fully understand my clients

through multiple sources of information. Because of this, I could examine how these

sources relate to one another.

Context of counseling

Much of what Caritas IFSC – Aberdeen does is designed to tackle the multi-

faceted needs of families in the community. When attention is given to the tangible

needs of clients, useful resources and accurate information must often be provided. To

be proactive, user-friendly, and responsive may involve equipping the counselor with

a comprehensive system of welfare knowledge.

Sitting in a quiet place in the office is not an easy thing. As Caritas IFSC –

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Aberdeen is near the traffic, it would sometimes be difficult for counselors and clients

to talk a while without a break. Because of this, the effect of tape-recording is much

disturbed. When tapes are reviewed, some information is missing. Hence, the

environment of the office also plays a significant role in conducting supervision and

research.

According to the core principles of IFSC, all service provisions should meet four

criteria, namely accessibility, early identification of needs, integration, and

partnership. Being a counselor in IFSC also implies his readiness for service, his

critical mind for assessment of needs, his availability for people, and a heart for

shared responsibility.

5.1.3 Limitations

Several limitations of the study were identified. First, as there is a limitation to

the time frame for data collection, understanding of the topic is confined to the

characteristics of the three cases conveniently selected in Caritas IFSC - Aberdeen.

Second, the study does not intend to generalize the results to other IFSCs or family

service settings. Therefore, it does not imply a general pattern of treatment effect in

similar context, though it certainly contributes to the construction of knowledge.

Third, although the Empathy Scale has been claimed to provide significant

information to successful treatment, the tool which is translated into Chinese has not

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been validated. Hence, the results can only serve as a reference to the narrative

findings. Fourth, the failure to use an outsider’s perspective or an observational

method in this study limits the results to the subjective reality of the participants. For

this reason, the behavioral change of clients only relies on self-report measures. For

example, the process of decision-making and conflict resolution should be best

examined through observation. When it is impossible to put the participants in a

laboratory setting, the presence of the investigator in the marital interaction has

become obtrusive. Because of this, the investigator has difficulties of collecting the

data for communication modes and problem-solving skills from an outsider’s

perspective. Finally, the practice research approach has been criticized for lacking of a

secure external position of a researcher. As the practitioner is playing the role of a

researcher at the same time, he needs to be very conscious of the risk of abusing the

therapeutic relationship in order to collect purposeful data.

5.2 Social Work implications

This section seeks to make connections between what have been highlighted in

this study and the profession of social work. Three value-laden issues are discussed.

They also call for more attention in future study.

Choice and responsibility

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What have been brought out so far suggests that the premise of choice and

responsibility is not applied to Reality Therapy, it is also a core principle for worker-

client relationship. When we say client has the right to self-determination, we refer to

his choice of making decision for himself. Nevertheless, his choice is always subject to

social responsibility. For example, when WC said that he would kill himself if he was

disregarded by the Social Security officer, he was making his choice but he also needed

the social worker to warn him about the calling of police. In order to protect clients and

others from harm, such a duty to warn should be introduced as early as possible, usually

in the first session. However, not many social workers have such a practice.

Besides, the premise of choice and responsibility is also related to the authority

of social worker in such a way that standards of marital quality are to be enforced. This

is especially true in the case of AC, when she has been neglected by her husband for

over two years. The social worker should be able to share the knowledge about the

power issue in marital relationship and the skills of effective coping. This is significant

true in the case of suspected spouse abuse. Social workers therefore should be very

sensitive in handling cases involving marital power.

Accountability

Regarding such an ethical issue in the worker-client relationship, there is an urge

for the collaboration between client and worker in clinical practice. Despite the fact that

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social workers are accountable to the agency they work for, they are also called for a

transparent agenda in the therapeutic relationship. As in the cases cited in this study, the

social worker has introduced the concept of choice theory used in counseling and

explained thoroughly how he was going to facilitate changes in every session. Such an

open dialogue may strengthen the therapeutic alliance, hence leading to effective

treatment. Because of this, it also makes evidence-based practice possible since the

clients may be able to tell what counseling is and how counseling is helpful to them in

therapeutic language.

Role of social work profession

Much have been realized about the role of social worker as case manager and

resource person in the IFSC. Yet for the discipline of social work to develop on its own

stand, three more distinguished roles should be considered in the IFSC.

The counselor role serves the function of a skilled helper in clinical practice. It

can be seen as a primary role of the profession. As various clinical practices in terms of

practice models and methodologies emerged, the researcher role begins to play a

significant part in the construction of knowledge. It can therefore be regarded as a

secondary role of the profession. Last but not the least, for knowledge to be

disseminated, skills to be acquired, and more importantly, values to be imparted, the

educator role becomes the best mediator between the two roles.

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5.3 Chapter Summary

This last chapter discusses the findings as regard to the research questions,

presents the investigator-practitioner experience, and highlights the implications of the

study for social work.

APPENDIX I: Caritas IFSC – Aberdeen

(Please refer to hard copy. 2 pages)

85

86

APPENDIX II: Approval letter from Head of Family Service

(Please refer to hard copy)

87

APPENDIX III: Consent form

(Please refer to hard copy)

88

APPENDIX IV: General message stating the purpose of the interview

I am XXX, a social worker and pursuing a master degree in counseling in the

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University of Hong Kong. I am conducting a research aiming to enhance my

counseling skills and understand what your experience is like in receiving counseling.

It is hoped that the information so gathered will help others who will receive

counseling service in the future. Do you mind if I work with you for this purpose?

APPENDIX V: IFSC Standardized measurements- USS (OS2) and TPR (OS5)

(Please refer to hard copy)

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APPENDIX VI: Empathy Scale (ES)

(Please refer to hard copy)

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APPENDIX VII: Semi-Structured Interview Guide

1. The counseling experience

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Meaning of counseling

Role of social worker

Nature of therapeutic alliance

Time of therapeutic alliance

Therapeutic process

Therapeutic outcome

Areas for improvement

2. The relationship between counseling and the perception of internal locus of control.

The participants were asked, in their own experience of the counseling process in

IFSC, what they considered as the cognitive changes that helped them resolve marital

problem.

3. The relationship between counseling and the ownership of personal responsibility.

The participants were asked, in their own experience of the counseling process in

IFSC, what they considered as the behavioral changes that helped them resolve

marital problem.

4. The marriage experience

First discovery of marital problem

Reasons and experience of marital problem at three points of time:

Initial encounter

Ongoing marital problem

Prior to receiving counseling

Attempts to resolving marital problem

Reasons for relapse

APPENDIX VIII: Case profiles

The case of AC

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AC, now 46, was brought up in a Chiu Chow family. She was the

sixth of nine children. Her parents sold vegetables in the market.

She describes her relationship with them was very close and sweet.

She remembers her mother has committed suicide when she was

10. The family demonstrated little affection. Yet in many ways she

was the centre of attention. She also describes herself as active,

patient and indecisive. One incident took place when she was in P4.

She carried heavy goods from Causeway Bay to Wanchai without

any cursing.

In her social relationships AC felt socially isolated from her peers

because she worked hard for the family business. She had her first

date arranged by an aunt working in the same market. At the age of

30 she married the first person she had dated.

Since she was married in 1989, her husband had developed a

superior role in the family and expected her to be submissive. She

had then become silent and served as a housewife. There were little

verbal expressions of affection and self-disclosure of intimate

personal facts between the couple. The marital relationship became

worse when her husband had been laid off for the accusation of

making fraud document in a non-government organization in 2002.

Since then her husband refused to go to work and she started to

find a job to support the family. Despite the fact that her husband

was trained as a social worker, his communication style was

reported to be indirect, confused and double-bind. The couple began

to quarrel a lot. By that time, AC has received regular medical

treatments for respiratory illness. In December 2003, she had

internal bleeding in lung and was hospitalized for half a month.

She describes her in-law relationships relationship was cold and

distant.

Significant incidents leading to help-seeking behaviour:

Owing to the financial turmoil in 1997, AC’s husband became

indebted to heavy loans. The family lost their privately owned flat

and moved to a rented one. Since then he refused to go to work and

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did not allow AC to apply for financial assistance despite the family

income lessened.

As the family has less income, they owed the landlord rental for

several months. Nevertheless, her husband refused to move to

somewhere with lower rent and to seek any help. The couple was

also granted bankruptcy some years ago. As there has been much

disagreement in the marital relationship that led to unbearable

financial burden of the family, AC sought help from Caritas IFSC and

was referred to Social Security Field Unit for Comprehensive Social

Security Assistance in October 2004. It was then granted to her in

December 2004.

When the family has moved to another rented flat in December

2004, her husband insisted to stay with his children and began to

sleep on the floor in the sitting room. Despite their final agreement

on divorce, the couple quarreled sometimes and disturbed their

children and their neighbours occasionally.

The case of WC and L

WC, now 37, was grown up in a rural area in mainland China. His

father came to Hong Kong before he arrived in 1994. He has

finished lower secondary education in China and has worked as a

technician apprentice for many years. He describes himself as shy

and introvert. He did not have any close friends in Hong Kong. WC

has been working as a self-employer in a tobacco stall in Sheung

Wan since 1995. He works very hard for more than 12 hours every

day. He is the successor of his deceased father, who was the

original owner of the business. He earns about HK$5,000 a month

and has been paying the monthly rent of the stall at the same

amount for several years.

He met his present wife L in China and was married in 1990. Since

he was married, WC had developed a superior role in the family and

expected his wife to be submissive and helpful to him. After he was

married for 3 years, he became disappointed with his wife as she

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did not meet his expectation of a helpful partner in his business. L

describes herself as easy-going and extrovert while WC saw her as

controlling and ignorant. Although there were laughters in the

family, little verbal expressions of affection and self-disclosure of

intimate personal facts between the couple were shown.

The marital relationship became worse when WC went out for

several hours in the midnight of the day before Lunar New Year in

2004 without informing L. Since then, L always became suspicious

of WC’s behaviour. She would ask every detail of WC’s schedule and

complain him of staying too long in China whenever he went back

for trading.

WC is the sole breadwinner of a family of six members, including

wife, four dependent children and himself. The family is living in

Wah Fu Estate. He is also expecting his mother, who is now residing

in mainland China, to stay with them in the near future. L maintains

a satisfactory in-law relationship with WC’s mother.

In the parent-child relationships, both WC and L demonstrate a good

model for their children. Their children would share their feelings to

them when they are available.

Significant incidents leading to help-seeking behaviour:

WC was informed by his landlord about a 74% increase of rental and

deposit. Despite frequent negotiations, WC failed to maintain the

previous amount. Nevertheless, he has decided to continue the

business under heavy financial burden. Because of this, WC refused

to share his worry to L and he started to seek assistance from the

District Councillors’ Office. He was then referred to Caritas IFSC for

help.

The case of H and YL

Client H, 61, and his wife YL, 58, grew up in the Southern District.

After finishing secondary education, H started to work as a foreman

in a telecommunication company. In 30 years, he was promoted to a

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supervisory post. He was retired and worked as a taxi-driver 10

years ago. YL has long been working as a domestic helper for the

expatriates before giving birth. Their mothers were working

together as manual worker. Through his aunt, H and YL knew each

other. They usually met 2-3 times a week. H had suspended the

relationship for a short period when YL once brought her girlfriend

with them during dating. They were married in 1968 after they had

dated for 5 years.

H describes himself as hostile, impatient, and altruistic. One incident

took place when H was tutoring his children at elementary level.

When his children asked him to repeat the instruction, H elicited his

temper. Another incident happened when H felt a lot of stress in his

work without telling his wife. When his children had misbehaved at

home, he blamed his wife for not standing on his side, but rather

criticizing him. The marital relationship had then turned into a cold

war for 40 days.

In his social relationships H felt socially active with peers because

he enjoyed playing mahjong with them. However, he turned into a

quiet person after he was retired.

Since he was married, H had developed a superior role in the family

and expected his wife to be submissive and helpful to him. He

describes his wife as naïve, stubborn, and suppressive. There were

little verbal expressions of affection and self-disclosure of intimate

personal facts between the couple. The marital relationship became

worse when his son had returned home after finishing his studies

aboard 10 years ago. Since then his wife had moved out twice and

the couple began to quarrel a lot.

In the parent-child relationships, H isolated himself from his children

as he did not think that they showed any respect to him. When his

son had returned home after finishing his studies aboard, H

complained his son of not showing any sense of gratitude to him for

paying all the expenses. Besides, H criticized his children of not

supporting the parents financially after they had become

independent.

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However, YL thought that H was too rigid, hostile, and lacking

understanding. She believed that her children were unable to

support their parents financially because they even could not

support themselves.

In the in-law relationships, H describes his relationship with them

was more than satisfactory.

Significant incidents leading to help-seeking behaviour:

H was informed by a legal officer about the divorce proceedings

regarding the request of YL. When H knew that he might save the

marriage through mediation and counseling, he called Caritas IFSC

for help.

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