This theory believes that humans have five basic needs: power, love (and belonging), freedom, fun, and survival, and it focuses on what its founder William Glasser called the psychiatry's three R's: Realism, Responsibility, and Right-and-Wrong. It emphasizes making decisions and taking action and control of one's life. Reality therapy assists the individual in making an evaluation of his/or her own behavior. The focus is on doing what is under the individual's control, and action is at the core of this treatment modality, pressing to create the client's desired "quality world".

Some of the techniques used in reality therapy include:

1. Metaphors: when a client speaks in metaphors, the therapist may choose to respond to the metaphor rather than the apparent content.

2. Confrontation: because setting specific plans is a key element in this theory, when a client does not follow through on something, confrontation is unavoidable. The therapist cannot accept excuses, but he/or she works to be positive and may attempt to engage humor to address the issue. A question the therapist might ask is, "What impact will not taking steps have on you?"

3. Paradox: cautioning the client to not follow through or encouraging the opposite behavior may be indicated to lower resistance. If a client does not elect to follow through on a goal or intervention, the therapist might say, "It seems we may have rushed that plan. You are not ready for that, but it is still a forward step because we know other issues need to be addressed first."

4. Humor: humor is spontaneous, idiosyncratic, and only occurs in the here-and-now, so it is a natural fit for reality therapy. Therapists can engage friendly involvement with the client by laughing at themselves, modeling clients to do the same.

5. Plans of action: this technique involves assisting the client in making a specific, attainable, beneficial, time-limited plan of action. The client must be clear on what he/or she wants and what he/or she is taking responsibility for before success can be attained.