Spinal cord injury resulting in permanent paralysis and loss of sensation may appear to many individuals as one of the most devastating experiences imaginable. Emptying one’s bladder with a catheter, using a wheelchair, having difficulty entering one’s home and public buildings, being unable to participate in enjoyed activities, and disrupted sexual expression may seem to the outsider a life not worth living. Yet the experience of most persons who live with spinal cord injury (SCI) is quite different. Advances in acute care and rehabilitation practices have reduced morbidity and mortality dramatically over the past 10 years (Brown, 1992; DeVivo, Stover, & Black, 1992). People who sustain SCI do live independent and fulfilling lives. The process by which they deal with disability-related limitations and attain a meaningful quality of life is the focus of this chapter.