Reality Therapy: How It Works & Who It’s Right For

What Is Reality Therapy?

Reality therapy is a therapeutic approach rooted in choice theory, which is the idea that a person’s circumstances are a result of their choices.⁴ In reality therapy, clients are taught that they can control their actions, thoughts, and even how they feel through the choices they make.³ The goal is to help people make more responsible, effective, and healthy choices that improve their lives and reduce their suffering.^1,3

Reality Therapy & Choice Theory

Reality therapy is a therapeutic approach rooted in the idea that people choose their thoughts, feelings, actions, and reactions.^3,4 Reality therapists work based on the principle that when these choices are irresponsible or ineffective, they cause psychological distress.^1,3,4 Dr. William Glasser, the developer of reality therapy, considered all choices an attempt to meet certain basic human needs.³

According to choice theory and reality therapy, these five needs drive all human behavior:^1,2,6

1. Survival and safety: including the need to survive, basic needs like food and shelter met, and the need to feel safe and secure
2. Love and belonging: the need to have close, healthy, strong relationships with others and to feel loved, accepted, and connected
3. Power and achievement: the need to feel in control of ourselves and our lives, as well as the need to grow, progress, and achieve things in order to feel fulfilled
4. Freedom and independence: free will and the ability to make choices, be independent, and feel a sense of autonomy
5. Fun and enjoyment: the need to spend time doing things that bring a sense of pleasure, enjoyment, and personal satisfaction

How Is Reality Therapy Different Than Other Types of Therapy?

Unlike trauma-informed approaches, reality therapy does not focus on the influence of childhood trauma, attachment issues, or other root causes of a person’s problems. Instead, reality therapy focuses on current problems and issues.^1,3,5 Similar to solution-focused therapy, reality therapy is usually short-term and focused on problem solving.

Reality therapy is also more behavioral than other therapies, including cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), which are focused on thought patterns and emotions/coping skills respectively. Similar to motivational Interviewing, most reality therapy techniques are aimed at helping people make behavioral changes.^1,2,3

Reality Therapy Techniques

The techniques used in reality therapy are relatively simple and easy to understand. Most of them aim to help people evaluate their current choices in order to identify which ones are causing problems. Once they identify choices that need to change, the focus of reality based therapy is on helping clients make and implement a plan for lasting transformation^1,2,3

Five reality therapy techniques are:

1. Self-Evaluation

Self evaluation is used early on in therapy to help clients identify their problem, a goal, and a plan to reach this goal.^1,2 Counselors who use reality therapy often refer to the WDEP system to help with self-evaluation.^2,3

WDEP stands for:

• Wants: help clients identify what they want and need in therapy and their lives; often refers back to the five basic needs to identify unmet needs and wants
• Doing: work with clients to identify what they’re actively doing to meet their needs, achieve their goals, and get the things they said they want in life
• Evaluating: support an evaluation of current choices and actions to see whether each is helping the client get what they want or hinder/harm them in some way
• Plan: collaborate with the client to develop a plan of actionable changes they can make that will help them get what they want without causing more problems

2. Action Planning

An action plan is another reality therapy technique that involves helping clients make a plan to overcome their problems and achieve their goals. This often requires the therapist to steer and direct the sessions to stay focused on actionable changes the client can make.^1,3

Techniques reality based therapists may use include:^2,3,4

• Focus of control: encourage clients to stay focused on problems they have the power to change or improve vs. ones beyond their control
• SMART goals: help clients develop goals that are specific, measurable, attainable, relevant, and time-bound (SMART)
• Responsibility: hold clients accountable for the changes they outline in their plan by assigning homework, following up, and encouraging clients to not make excuses
• Revision: once plans are created, they may be continuously revised, updated or changed to reflect changes in a client’s priorities, goals, or behavior

3. Reframing

Cognitive reframing is a skill that is usually attributed to CBT, but it’s also used in reality based therapy.^1,2,4 This technique helps people change the way they think about something.

Reality therapists may use reframing to help clients do the following:^2,3,5

• Switch their focus away from the problem and towards the solution
• Stay present-focused and avoid discussing the past or future
• Interrupt unhelpful comparisons between a person’s expectations and their reality
• Encourage people to take responsibility for their actions vs. using denial, minimization, or excuses

4. Behavioral Rehearsal

Behavioral rehearsal is essentially any role-playing activity a therapist might ask clients to do in sessions.^1,5 These role-plays may be used in couples therapy or group therapy to help two or more people practice healthier methods of communication or conflict resolution. In individual reality therapy sessions, they may be used to help clients practice using specific skills or responding in different ways to certain situations.^1,2,3

5. Relationship Habits

Relationships are central to the way that people meet their basic need for love and belonging, and reality therapists believe disconnection is one of the main causes of psychological distress.¹ Reality therapists believe there are some unhealthy relationship habits that lead to disconnection, including things like blame, criticism, complaining, and nagging.⁴

Reality therapists working with couples, families, or individuals with relationship issues often help their clients identify and change these bad habits. The goal is to replace them with seven “connecting” relationship habits.

Seven connecting habits are:⁴

1. Supporting
2. Encouraging
3. Listening
4. Accepting
5. Trusting
6. Respecting
7. Negotiating differences

When Is Reality Therapy Used?

Unlike some therapy approaches, reality based therapy does not market itself as a treatment for any particular mental health condition or psychological problem.  It is sometimes part of a more comprehensive therapeutic plan, and isn’t necessarily used alone. It is often criticized for being anti-establishment and denying the validity of diagnosing and treating mental illness.^5,7

Despite this, reality therapy is sometimes used to help people struggling with:^1,3,5

• Mental health issues like mood disorders or anxiety disorders
• Behavioral problems in children, teens, or adults
• Substance use disorders or behavioral addictions
• Relationship conflicts with friends, family, or partners
• Existential anxiety or people looking for meaning or fulfillment
• Problem solving for specific issues at work, in life, or in relationships

Is Reality Therapy Effective?

There hasn’t been a lot of research on reality therapy, which makes it hard to determine whether it’s effective or not.⁵ It isn’t considered an evidence-based practice, but there are some studies showing that it may help people struggling with addiction or chronic health issues.^8,9

One study found group reality therapy helped socially anxious teens improve their symptoms and relationships.¹⁰ Another study found that eight 90-minute sessions helped couples seeking counseling reduce infidelity and negative feelings towards each other.¹¹

Critiques & Limitations of Reality Therapy

Reality therapy has been criticized because it doesn’t take mental illness or personality disorders into account as a contributing factor; instead, it suggests that emotional distress is a result of unmet psychological needs. For this reason, most therapists who use this approach don’t diagnose people with psychiatric disorders or prescribe medications.⁷

It could be argued that choice theory, a central tenet of reality therapy, blames and stigmatizes people with mental illnesses by suggesting their symptoms are a result of their poor or irresponsible choices. This could be offensive to people with a diagnosed mental illness who may feel like the therapist is telling them their problems are imagined or self-created.⁷

Other elements of reality therapy that have been criticized include:

• Reality therapy focuses on the present and does not investigate root causes, including childhood trauma, attachment issues, or underlying insecurities or core beliefs⁵
• Reality based therapy does not focus on unconscious or subconscious thoughts or feelings that may drive behaviors; instead, it believes that all behavior is an intentional attempt to meet one of the five basic needs⁵
• Reality therapy may be influenced by the counselor’s biases or personal beliefs about “right vs. wrong” choices or behaviors⁵
• Reality therapy rejects the notion that any person or external circumstances beyond a person’s control can be a source of unhappiness⁷

What to Expect in Reality Therapy

Reality therapy can be provided in sessions for couples, families, groups, or individuals.⁴ People who seek counseling from a reality based therapist can expect for their sessions to be focused on finding solutions to current problems. Therapists who use this approach will work with clients to develop and stay accountable to a plan of action involving specific change.^3,4

Because reality therapy doesn’t endorse diagnoses, it’s unlikely that mental health symptoms or conditions will be the focus of treatment. A reality based therapist will probably not endorse or recommend the use of medications to treat anxiety, depression, or other mental health issues.^1,3,5,7 People who seek this treatment can expect therapy to be behaviorally focused and short-term with a lot of emphasis on personal choice and responsibility.³

How to Find Reality Therapist

Reality therapy isn’t commonly used, but there are some therapists who use this approach and others who may incorporate reality therapy techniques into their counseling style. If you’re interested in finding a therapist who uses this approach, a good place to begin your search is online. Using a free therapist directory, narrow down your options by location, insurance type, specialty, and counseling approach.

Who Is Able to Offer Reality Based Therapy?

Reality therapy is often offered by licensed counselors or therapists; however, anyone can be trained or certified in this approach, including teachers, mentors, or coaches.⁴ Some counselors who use reality therapy have had training in this approach. Others may have chosen to go through the certification process with the Glasser Institute for Choice Theory.⁴

Key Questions to Ask When Considering Reality Therapy

When you’re in the process of finding a therapist, it’s always important to find the right therapist for you. This means looking for someone who is experienced in the issue or problem you need help with, as well as a counselor with a style or approach that you think will work for you. The best way to choose a therapist is to request a consultation, which many counselors offer for free.

Here are questions to consider asking a therapist when considering reality therapy:

• What kind of training have you received in reality therapy?
• How would you use this approach to help me with my issue?
• What is the cost or fee for sessions and do you accept insurance?
• How many sessions are needed for someone with my issue?
• What are your views on medications?

Final Thoughts On Reality Therapy

Reality therapy is an approach that focuses on individual choices, personal responsibility, and actionable solutions. This approach is founded on choice theory, which endorses the idea that personal problems (including mental health issues) are the result of personal choices.^1,3

People looking for short-term, solution-focused therapy may be interested in reality therapy. Those interested in a more traditional approach to treating a diagnosed mental health condition may want to explore other styles of psychotherapy.