Rejecting the concept of mental illness, reality therapists do not bill using the DSM-5 because they do not believe in the pathology model. As might be inferred from the name reality therapy, this approach encourages the client to face reality without excuses or explanations.

In reality therapy, individuals are seen as possessing two psychological needs:

1. The need to love and to be loved

2. The need to feel worthwhile to themselves and to others

Developed by William Glasser, reality therapy proceeds on the theory that the brain functions as a system to control behavior by fulfilling needs created by the environment. When an individual is unable to control or effectively act on such environmentally based needs, problems result. Reality therapy seeks to help clients choose actions that satisfy basic needs of survival, reproduction, power, freedom, and fun. With this model, behavior is an integration of a person's feelings, thoughts, and actions. Relating personal needs to behaviors of others, action comes from within and is dependent upon the needs it means to satisfy.