A DISCUSSION OF MENTAL HEALTH THEORIES AND MODELS updated 3/12/07      There are a number of theories or "models" of emotional functioning, personality, and personal counseling. This diversity of theories reflects the growth and trends of knowledge in these areas as well as the complexity of humans; we are high complex biological, social, psychological, and behavioral individuals, and we are constantly building and refining our understanding of human emotions and behavior.      Although the theories and viewpoints discussed below provide different explanations of emotional and behavioral life, they are not mutually exclusive: they are complimentary parts of a large, complex explanation of human behavior, and they are all important ideas that contribute to our understanding and treatment of emotions and behavior. Some of the major viewpoints are: 1. The Psychoanalytic (or Psychodynamic) Viewpoints: This is a family of related theories (and therapy techniques) based on the ideas of Sigmund Freud and his successors. In general, these theories involve a belief that humans have strong unconscious, biologically-based drives, including sexuality and aggression, that unfold during predictable stages of development in a person’s lifetime. The expression, control, and channeling of these drives throughout a person's development are strongly influenced by his/her relationships with parents and with other important individuals in early life, as well as by culture and our genetic nervous system temperment. These factors combine to shape an individual's unique personality and our emotional tendencies.      Individuals may get "stuck" in certain levels of development because they had conflicts at those stages that were not well resolved. For example, a client may stay stuck in feelings of over-dependence on their parents or spouse because they were never able to assert their own independence appropriately in their earlier life.      According to psychoanalytic theory, fears or impulses that are too anxiety-inducing or too shameful for the individual to consciously think about are repressed (that is, are pushed into the unconscious mind), where they are out of conscious awareness but can still cause strong emotional reactions. Emotional problems are often viewed as caused by unconscious (and sometimes conscious) conflicts that are exacerbated by the demands of particular situations. For example, a conflict may develop between an urge (e.g. to scream at someone when we are angry at them) versus fear or guilt about that urge (e.g. screaming at them could lead them to retaliate or could hurt their feelings badly). This conflict between a strong urge and a strong prohibition, especially in the presence of a provocative social situation, may lead to marked anxiety.      Everyone uses certain "defense mechanisms" which help to reduce anxiety about conflictual situations. There are primitive defense mechanisms, like denial, which reduce immediate anxiety but don't really help to solve the underlying situation, and there are also more mature defense mechanisms like problem-solving and sublimation that reduce anxiety in a more productive or socially acceptable manner.       Another major issue in classic Psychoanalytic theory has been the role of "Transference", i.e. the feelings that the client has for the therapist. It is thought that the client "projects" their feelings about important relationships and people from their past (e.g. their parents) onto the therapist, which may allow the therapist to better identify these feelings in the client. In older, traditional Psychoanalysis, the therapist was trained to act like a "blank screen", i.e. suppressing his or her own personality during the session to make it easier for the client to project onto the neutral therapist. However, some critics felt that this technique sometimes resulted in the analyst as appearing cold or uncaring, possibly leading to realistic anger toward the therapist that could be mistaken for transferred anger.      Psychoanalytic therapy can be fascinating in regard to understanding (or hypothesizing about) the complexity, defenses, and conflicts of a person. However the traditional styles of this therapy have often not been very efficient in helping the client feel better or behave more productively in a timely manner. In the last 30 to 40 years, more short-term and efficient schools of psychoanalytic therapy have been developed. In these newer versions of psychoanalysis, the therapist is often more interactive and more empathetic, gives constructive feedback to the client, and points out self-defeating patterns of attitude and behavior, hopefully leading to more rapid insight and emotional growth in the client.       A goal of earlier, traditional Psychoanalysis was for the client to have a corrective emotional experience, whereby their unconscious conflicts were resolved and the emotional stress of those conflicts is released. Another goal of traditional Psychoanalysis is to help a person achieve a better balance between different parts or forces in their psyche, leading to more realistic and satisfying compromise of the competing desires of the person. An early, well-known "dynamic balance" concept in Psychoanalysis is Freud's Three Part model, which discussed the relationship between the conscious, more rational part of the mind (the "Ego") and the less conscious, more emotional parts of the mind (the Id and Super Ego). The "Id" is the impulsive, immediate gratification-seeking part, while the "Super Ego" is moralistic and controlling of impulses. Some psychoanalysts have looked at these 3 parts as the "child-like" part (Id), the "parent-like" part (Super ego), and the "adult-like" part (Ego). Ideally, the rational adult-like Ego should be strong, flexible, and wise, to help create good compromises between the practical demands of the outside world and the emotional demands of the impulsive Id and the parent-like Super Ego. All 3 parts are important, and they all need to be respected and balanced within the individual. If any one or two of them are too strong relative to the other(s), then a dysfunction of emotions and behavior can occur. 2. The Lifespan Development Model: This viewpoint involves the belief that all humans pass through certain biological stages of development (influenced by genetic, cultural, and temperment factors) in regard to physical abilities, emotions, intellect, and relationships, from newborn infant through old age. Each stage of development is accompanied by certain challenges and emotional stresses, because each phase involves learning and practicing new skills, attitudes, self-image factors, and behaviors. Each phase is made possible by the increasing mental and physical maturity and unfolding genetic/biological tendencies as the person grows older. While there are predictable factors in each stage, all humans are also somewhat unique. Therefore, each person will have individual variations in the expression of their stages of development. Although this description may sound similar to Psychoanalytic models, it is more biological-developmental in tone, more research-oriented, and less intensely theoretical. For example, the Lifespan Development Model does not include concepts such as unconscious conflicts, transference, etc., unless they are directly observable. It also does not have highly structured and theoretical therapy techniques; it is more of a way of understanding the common conflicts and issues of people in each age range throughout life. The therapist can then point out the developmental issues or delays that the client is experiencing and hopefully help the client to understand and resolve their issues in a less stressful and more age-appropriate manner. 3. The Cognitive (or Cognitive-Behavioral) Model: This view is based on the concept that it is not just what happens to us that makes us very upset, or angry, or sad, etc. It is also how we interpret what happens to us that influences how extreme our reactions are. For example, two people in the same car accident may react very differently based on the way they view the accident. One person may say: "This is terrible! What bad luck I have! What a rotten, stupid person this other driver must be!" Because this individual is interpreting the incident in a highly negative manner, they will feel more angry or anxious and thus they will probably behave in a more upset manner. Another other individual in the same accident, however, may say to himself: "Well, at least no one got hurt badly, and my car is still able to be driven. This is annoying, but its not the worst thing in the world." Because this person is interpreting the situation in a more moderate manner, he/she will feel less extreme and will probably behave in a less extreme way.      Cognitive-Behavioral Therapy is often used in situations such as depression, anxiety, and anger management, when people interpret trigger situations in a more extreme and over-personalized manner than is really necessary for the situation. The goal of cognitive-behavioral therapy is for the client to: 1) become more aware of their overly negative or extreme attitudes, beliefs, and assumptions; 2) dispute these extreme beliefs and interpretations to themselves on a regular basis; and 3) replace the old rigid or negative beliefs with new, more moderate, optomistic, and flexible beliefs. 4.  The Behavior Therapy Model: This model of human functioning and therapy is based on the principles of James B. Watson and B.F. Skinner and their followers, who conducted research and devised theories starting in the early 20th century. It is a scientific and highly structured model that involves behavioral analysis of a problem situation and then creating a treatment plan that discourages undesirable behaviors and reinforces alternative, positive behaviors. Analyzing and changing the reinforcement (i.e. reward and punishment) of behaviors is a central component of this theory. Behavioral theories have led to the development of Behavior Modification Programs (often called "Behavior Mod") in schools and in Special Education settings, which focus on identifying and quantifying the undesirable behaviors (e.g. of a child) and then create specific steps and time-tables for each stage of learning a new behavior and discouraging inappropriate behaviors. Training, practice, feedback, and reinforcement are important ingredients of Behavior Therapy. 5. The "Integrative Parts" Model: Integrative Parts Therapy is a modern psychotherapy style that has evolved from cognitive, psychodynamic, and humanistic therapies. Insightful writers including Shakespeare, Hippocrates, and Freud have always written about conflicting "parts", tendencies, or motivations in a person's psyche. One might say that the original "parts" theory of the psychiatric age was Freud's three part model of Id, Ego, and Super Ego. This model discussed the conflict and compromise between a biological/impulsive "Id" part vs. a moralistic/inhibitory "Superego" part vs. a rational/adult "Ego" part. In the 1970s, Eric Berne (in Transactional Analysis) discussed the conflict and balance between multiple "Child" parts, "Parent" parts, and "Adult" parts of a person, and the interaction of these parts in social interactions between people. Ego Psychologists, Self Psychologists, and Humanistic authors also wrote about the potential guiding and leadership parts of a person, referred to as the Ego, or Core Self, Inner Self, True Self, etc.      More recently, Parts Therapy has been influenced by the concepts of writers such as Margaret Paul, Ph.D. (e.g. in Inner Bonding), and Richard Schwartz, Ph.D. (e.g. in Introduction to the Internal Family Systems Model". These two writers have discussed the dynamics between a healthy, executive "Core Self" part and the hurt or defensive parts of one’s self. Briefly, Integrative Parts Therapy (IPT) involves the concept of a "Core Self" that is wise and caring and able to be the "leader" or executive part, helping to lead and heal our other (hurt or defensive) parts. The idea of a caring, healthy, and nurturing core self is more positive and more solution-oriented than the older psychoanalytical idea of powerful negative impulses originally discussed by Freud. IPT realistically acknowledges the presence and potential power of those negative parts (e.g. rage, selfishness, shame); it just doesn’t place them as fundamental in our constellation in internal parts. Rather, it sees them as hurt and defensive "wounds" that are oversensitive or are trying to protect us from being more injured by the disappointments and insults of life situations. Because it is empathetic as well as rational, the healthy Core Self is able to understand and calm the different hurt/defensive parts of our feelings, attitudes, and personality.        One of the primary exercises for creating a healing interaction between our Core Self and our hurt or defensive parts is Inner Dialog. This exercise is usually done with our eyes closed, and generally starts with a few minutes of relaxation imagery and relaxed breathing, to put oneself in an introspective and imaginative state. Then the individual imagines a nurturant and inquisitive dialog between the executive Core part and whatever hurt or defensive part that the person wants to address. Over time, this results in a better understanding and acceptance of our hurt or defensive parts, and a greater trust and identification with our healthy Core Self. This eventually leads to the hurt/defensive parts becoming less reactive and less over-sensitive. 6.  The Biochemical and Psychopharmacological Model: This is the model that is most often used by Psychiatrists and other medical Doctors. This viewpoint focuses on the role of the brain functioning and the balance of chemical messengers (called neurotransmitters) in the brain, which influence emotions and behavior. There are many important brain areas, chemicals, and nerve pathways in the nervous system, and their structural and chemical functioning can strongly influence our moods and impulses. Some of the most widely researched neurotransmitter chemicals in our brain are Dopamine, Serotonin, GABA, Norepinephrine, and Acetylcholine. Modern psychiatric medications act by influencing the levels or activities of these neurotransmitters in the brain. Psychiatrists and other medical Doctors often treat depression, anxiety, schizophrenia, and Bipolar disorder with these medications. The use of psychiatric medications is often essential in severe cases of Schizophrenia, Bipolar Disorder, Depression, and Anxiety. In less severe cases, the combination of medications and counseling may be preferable, and in some cases of mild to moderate severity (especially of Depression and Anxiety), counseling alone may be the ideal treatment.        This paper is not meant to be a comprehensive discussion of all of the current models of emotional functioning and therapy. Rather, it is an over-view of several of the primary and most influential models of behavior and emotion. Other viewpoints are the Neuropsychological model, the Evolutionary/Genetic model, the Family Systems model, and the Social/Cultural Influences models. As mentioned at the beginning of this paper, humans are a very complex, multi-dimensional species, and a "Super-Model" including all of the factors mentioned above is probably the most accurate model of complex human behavior and emotion.