How Reality Therapy Works

Potential benefits of reality therapy

Verywell / Laura Porter

Reality therapy is an approach to psychotherapy that views all behaviors as choices, which means that it doesn't consider mental health conditions.

It is based on a concept called choice theory, which says that humans only have five basic needs, all of which are genetically driven and can't be changed. Because of this, reality therapy is a bit controversial in the therapy world since it rejects the diagnosis of mental health conditions.

William Glasser developed reality therapy in 1962, but he didn't describe choice theory until 34 years later, in 1996. He described it as an update on an existing concept called control theory because he thought that name sounded more positive.

Choice theory says that people can take control of their lives by taking more responsibility for their actions. It believes that most unhappiness results from poor relationships—either because those relationships are nonexistent or generally unsatisfying—and that people's negative actions and choices result from dealing with the void left by these poor relationships. It also says that people choose to have negative emotions, which leads to people making negative decisions.

Glasser believes that the solution to a happier existence is fairly simple: people making better choices will lead to better relationships and overall happiness. The choice theory dictates that people, at their core, are trying to satisfy five basic needs.

Five Basic Needs of Choice Theory

  1. Survival: This covers the standard needs of food and shelter, including psychological needs, such as feeling safe and secure.
  2. Love and belonging: This focuses on relationships with everyone, including friends and family, co-workers, teachers, and even pets.
  3. Power: This doesn't mean that everyone seeks to achieve some domineering presence but rather says that people want to make some difference that allows them to leave behind a legacy.
  4. Freedom: This need says that people need to feel as though they have autonomy in their daily lives and their creative lives.
  5. Fun: More than just a good outing, this says that people need to experience pleasure, humor, relaxation, and learning that they find interesting and satisfying.

Techniques of Reality Therapy

During reality therapy, therapists will often work with their patients to understand these four concepts laid out by choice theory.

Relationship Habits

This is particularly important for couples who are interested in reality therapy. It proposes that every interaction can practice the seven connecting or the seven disconnecting relationship habits. Connecting relationship habits include supporting, encouraging, and listening, while disconnecting habits include criticizing, blaming, and complaining.

Quality vs. Perceived World

According to Glasser, everyone has a quality world in their minds, where they store away their goals and visions for their lives. For your mind to consider something a part of the quality world, it only has to meet at least one basic need.

The perceived world, on the other hand, is much more subjective. Basically, Glasser explains that the perceived world is based on all of your life experiences, as well as your background. From there, each experience or person that you encounter is filed away based on things that have happened to you in the past.

Comparing Place

Comparing place is the act of mentally comparing what you want (your quality world) with what you have (your perceived world). Glasser believes that the closer the two are, the better a person feels.

External vs. Internal Control Psychology

Glasser believes that every choice is purposeful and that people make their best attempt with the information at their disposal. That said, in reality therapy, Glasser encourages people to look at these choices objectively so that they can determine whether they're actually bringing them closer to their goals.

What Reality Therapy Can Help With

Since reality therapy hinges on the beliefs of choice theory, the practice techniques focus largely on the five basic needs that humans aim to fulfill in their lives. While Glasser believes that humans are genetically driven to attain all five needs, he says that some people might need more of one than the other.

While many therapists use concepts from reality therapy in their practices, some of the tenets of reality therapy have proven most helpful in school settings.

In an article for The Education Digest, William Glasser explained that more mindful student-teacher interactions and relationships could change the outcome of a child's ability to learn. This, he explains, is because children need to feel respected, and teachers need to make efforts to understand students' individual roadblocks.

Couples therapy is another setting where aspects of reality therapy and choice theory have proven particularly helpful. It asks couples to think about what they are directly responsible for and build on the good.


Since reality therapy emphasizes accountability, it's proven to be particularly helpful for adults struggling with addiction. Not only does it help them recognize the negative impacts that it has had on their lives in the past, but it has also been shown to increase feelings of hope. This is because it also helps them feel more in control.

Reality therapy has also proven to be quite beneficial in school settings. Not only does it emphasize self-control, but it also shows kids that they can control the consequences that result from their behaviors and their school work.

Effectiveness of Reality Therapy

Reality therapy has proven to be super effective in groups since it emphasizes accountability. This concept is often easier to grasp when taught alongside others who are also participating. That said, it teaches people to hold themselves personally accountable as well.

It's worth noting, however, that it has been studied significantly less in practice during individual therapy sessions. That said, in addition to improved performance with students, it has also proven beneficial with teachers. This is partially because interacting with groups of people going through similar experiences helps people, in general, feel less alone and more supported.

Another group that has experienced positive effects as a result of reality therapy is people with schizophrenia. Patients engaged in sessions of group reality therapy experienced boosted self-esteem, a higher feeling of being in control, and had an easier time coping with stress.

All of the groups share a positive boost in self-esteem because reality therapy emphasizes that individuals can practice and get better at self-control. This helps people feel as though they can control their life choices and even help others do the same.

Things to Consider

While many of these concepts are widely accepted, there are some pitfalls to consider if you're looking for a personal therapist specializing solely in reality therapy. The most major, of course, is that it does not take mental health conditions into account.

This is particularly important if you're looking for a therapist for yourself or you and a partner. However, the overarching concepts can still be useful in school or educational settings.

How to Get Started With Reality Therapy

If you are searching for a counselor or an educator certified in choice theory and reality therapy, the Glasser Institute offers a directory. If you're looking for a reality therapist that understands the concepts, consider setting up an initial call with a new therapist to ask about their methods and if they integrate reality therapy into their sessions.

If you're seeking a couples therapist specializing in reality therapy, you can expect some initial questions that Glasser himself laid out. They focus on determining why you and your significant other went into therapy in the first place, to see if the couple is truly seeking help because they want to make their relationship work or because they just want to say they've tried.

Other questions prompted couples to explain what they think is wrong with the relationship, what they think is good in the relationship, and what they will do in the next week that they believe will help. The point of these questions is to help the couple focus on what they can control, and throughout the sessions, they will be asked to continue adding in things that they can change.

8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Glasser W. “Choice theory” and student successThe Education Digest. 1997;63(3):16-21.

  2. Bradley E. Choice Theory and Reality Therapy: An OverviewInternational Journal of Choice Theory and Reality Therapy. 2014;34(1):6.

  3. Duba, Dr. Jill D.; Graham, Mary Amanda; Britzman, Mark; and Minatrea, Neresa. (2009). Introducing the “Basic Needs Genogram” in Reality Therapy-based Marriage and Family Counseling. International Journal of Reality Therapy, 28 (2), 3-9.

  4. Jahromi MK, Mosallanejad L. The Impact of Reality Therapy on Metacognition, Stress and Hope in AddictsGlobal Journal of Health Science. 2014;6:281–287.

  5. Mason DrCP, Duba DrJD. Using Reality Therapy in Schools: Its Potential Impact on the Effectiveness of the ASCA National ModelInternational Journal of Reality Therapy. 2009;29(2):5-12.

  6. Nematzadeha A, Sheikhy Sary H. Effectiveness of Group Reality Therapy in Increasing the Teachers’ Happiness☆Procedia - Social and Behavioral Sciences. 2014;116:907-912.

  7. Kim J. Effectiveness of Reality Therapy Program for Schizophrenic PatientsJournal of Korean Academy of Nursing. 2017;35(8):28 March 2017.

  8. Lynn Fitzgerald A. Reality Therapy for Marital and Family Systems Counseling. Counseling and Wellness: A Professional Counseling Journal . 2011;2:93.

Additional Reading

By Brittany Loggins
Brittany is a health and lifestyle writer and former staffer at TODAY on NBC and CBS News. She's also contributed to dozens of magazines.