Reality Therapy

Reality therapy encourages clients to face their challenges head-on and proactively change their behavior. The process is based on the understanding that individuals are responsible for their behavior and may struggle to realize how much they focus on thoughts rather than actions. 

Therapist-client relationship

A key aspect of reality therapy is the relationship between the therapist and the client. In reality therapy, therapists create a safe, non-judgmental space for clients to express their feelings and thoughts. This supportive relationship may enable clients to become comfortable exploring their current behaviors and the resulting consequences of those behaviors to develop new patterns.

Reality therapy operates on the premise that all humans have basic needs for belonging, power, enjoyment, and freedom. The therapist assists the client in identifying their unmet needs and finding constructive and socially acceptable ways to satisfy them. Often, the aim is to empower individuals to make healthier choices and become more mindful of the cause-and-effect patterns in their lives.

Reality therapy is a forward-focused, problem-solving approach that encourages individuals to constructively confront and accept their current situation. The therapy underscores the importance of fulfilling essential needs like belonging, power, freedom, and fun.

Reality therapy sessions

This modality utilizes three techniques: self-evaluation, action planning, and reframing. The therapeutic process begins with self-evaluation, where clients are encouraged to take an introspective look at their thoughts, feelings, and behaviors. This process of self-discovery promotes personal accountability and self-awareness, which are often two components of successful reality therapy.

In the action planning phase, therapists collaborate with clients to formulate a concrete, achievable plan of action to facilitate desired behavioral change. In this stage, clients are asked to set realistic goals within their control and focus on the present and future rather than dwelling on past mistakes. This action plan is often adapted and improved over time as progress is made. 

The final phase of reality therapy involves reframing. In this phase, therapists may help individuals identify negative thought patterns and replace them with more positive and adaptive perspectives. Reframing may help individuals view challenges as opportunities for growth and understand the importance of acting when necessary. This shift in perspective is thought to enhance coping abilities and overall emotional well-being.

Reality therapy may benefit a wide range of individuals experiencing various life challenges. It may be particularly effective for those seeking to improve their problem-solving skills and take more control over the reality of their lives. For example, individuals experiencing substance use challenges, marital and relationship conflict, stress, anxiety, and depression may benefit.  

Reality therapy may also be a powerful tool for those experiencing behavioral challenges, as it encourages mindfulness and active consideration of the consequences of specific behavior patterns. However, the effectiveness of reality therapy may vary from person to person.

Reality therapy is often used as one part of a more comprehensive plan for mental health treatment. This form of therapy is not designed for any specific mental health condition. Still, it may be a helpful resource for certain individuals struggling to realize the connection between choices and emotions. 

People who might benefit from this approach could include those living with the following:  

• Relationship conflicts with friends, family, or a spouse
• Addiction
• Mental health conditions like personality disorders and anxiety disorders
• Excess rumination 
• Difficulty problem solving 
• Depressive symptoms like hopelessness, lack of energy, and repetitive thought patterns

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Reality therapy emphasizes the benefits of decision-making to fulfill one's innate needs and attain personal goals. The primary objective is often to help individuals better understand their own behaviors, evaluate the effectiveness of these behaviors in meeting their goals, and make deliberate choices to change repetitive destructive behaviors.

Reality therapy objectives

Reality therapy and cognitive-behavioral therapy (CBT)³ share common therapeutic goals. Both methods help individuals identify, understand, and adjust maladaptive behaviors or thought patterns often underlying their experiences. They also emphasize the importance of the present moment rather than dwelling on past experiences. These modalities focus on addressing current struggles and developing practical steps toward constructive behavioral change. Additionally, reality therapy and CBT advocate for self-efficacy and personal responsibility, empowering individuals to take control of their well-being. 

Main objectives of this modality

One of the main goals of reality therapy is fostering personal responsibility. Clients are encouraged to comprehend that they are in control of their actions to develop a sense of empowerment. This modality underscores the idea that individuals have innate needs that must be met to achieve self-actualization. According to choice theory and reality therapy, these needs include:

• Safety and basic survival 
• Belonging
• Choice and power
• Freedom
• Fun and enjoyment

Another goal of reality therapy is to strengthen interpersonal relationships. Reality therapists often recognize the profound influence of relationships on overall well-being. For this reason, the modality can equip individuals with the skills to form and maintain healthy relationships, emphasizing the value of fulfilling one’s innate need for connection, love, and belonging.

According to research, reality therapy is effective in the treatment of a wide range of mental health disorders, from depression and anxiety to post-traumatic stress disorder (PTSD).⁴ Studies show that clients may ensure a more functional future by focusing on what is presently happening and how to problem-solve. 

This method encourages individuals to confront conflicts and challenges head-on and understand that they control their actions and reactions. A noteworthy study supports these findings, indicating a significant decrease in depression symptoms in individuals with major depressive disorder after participating in reality therapy. 

Reality therapy has also shown potential effectiveness in reducing recidivism rates in incarcerated populations. This form of therapy has been utilized in correctional facilities to help individuals take responsibility for their actions and make constructive plans for their future. 

In one study, researchers examined the ability of reality therapy to improve behavioral patterns in juvenile offenders. Their findings suggest that reality therapy may be an effective method for improving these individuals' self-concept while enabling more mindful control of their actions and behavioral patterns. 

Therapist