Although reality therapy has been effective in reducing symptoms of depression in adults, there is little research to support the use of reality therapy with deaf adults. This article demonstrates the use of reality therapy in reducing symptoms of depression in a deaf adult. Cultural competence is an important factor in the psychological treatment of individuals. It is important for clinicians to identify the cultural components that can play a part in the client’s identity and treatment. The objective of this study is to highlight the importance of cultural competence and the use of reality therapy to help in meeting therapeutic goals.