Reality Therapy / Choice Theory
Reality Therapy / Choice Theory is a cognitive-behavioral approach developed by William Glasser in 1965. It holds that all behavior — misery included — is chosen in an attempt to meet five basic needs, so clients evaluate whether their current total behavior (acting, thinking, feeling, physiology) is working, then plan more effective choices. Evidence is limited: few RCTs, mostly institutional outcome data from schools and corrections, and one meta-analysis (Kim, 2008). It is used in short-term individual and group work for substance use, adolescent behavioral problems and depression. Its anti-diagnostic stance — Glasser rejected the DSM, and later psychiatric medication and the category of mental illness itself — is the main reason to hold it carefully.
Related condition topics
These links support exploration. They do not establish that Reality Therapy / Choice Theory is effective or recommended for each condition.
How Reality Therapy / Choice Theory works
Clients evaluate whether their current total behavior (acting, thinking, feeling, physiology) is effectively meeting their basic needs, then plan and commit to more responsible choices
Ontology
All behavior is chosen to meet five basic needs; suffering results from ineffective behavioral choices, not mental illness or unconscious forces
Therapeutic Voice
"Is what you're doing right now getting you closer to what you want?"
View of the Person
A choosing being whose every behavior, misery included, is a best current attempt to meet a need. Glasser turned the nouns into verbs for exactly this reason: a person is not depressed but depressing, and what is being done can be done otherwise.
Epistemology
Evidence
Assessment not yet completed
An overall effectiveness assessment has not been completed. This describes the state of our review, not whether the approach works.
Recorded material under review
The existing notes below are retained separately from assessment records. These recorded claims await source checking, including study design, recommendations and numerical estimates.
Not in major guidelines
Limited RCTs; more institutional outcome data (schools, corrections)
Kim (2008) meta-analysis
Widely used in school counseling, corrections, and addiction settings. Anti-psychiatric stance (rejected DSM diagnoses). Simple framework with broad accessibility. Choice Theory replaced Control Theory in 1996.
Training and certification
Open to counselors, educators, managers. William Glasser Institute/Glasser Institute for Choice Theory multi-stage certification. Requires Basic Intensive Training Week, practicum period, and Certification Week.
William Glasser Institute: Certified Reality Therapist (CRT). Basic Intensive Training Week → 18-month practicum with supervision → Certification Week + examination.
Basic Week (~30 hrs) + 18 months supervised practicum + Certification Week (~30 hrs)
$2K–5K for full certification path
Clinical cautions and blind spots
Assessment and precautions
Active psychosis, severe depression where emphasis on choice feels blaming, dissociative disorders where the concept of a unified choosing self is clinically inappropriate, clients in genuinely constrained circumstances where choice framework feels invalidating
Blind spots
Oversimplifies psychopathology by rejecting diagnosis, and Glasser's later position went further, rejecting psychiatric medication and the category of mental illness itself; limited applicability to severe mental illness, trauma, and neurobiological conditions; responsibility framing can blame victims; very limited controlled research
Philosophical roots
Pragmatism (what works matters); Glasser rejected psychoanalytic and medical models; existentialism (responsibility, choice); Powers (perceptual control theory); anti-psychiatry (Szasz)
Compared with other approaches
Test Yourself
What are Glasser's five basic needs?
Show answer
Survival, love/belonging, power/achievement, freedom, and fun: all behavior is an attempt to satisfy these needs.