Have you ever met with a counselor or therapist and thought, “This is not a good fit?” It might have had something to do with the theories they use to inform their practice.
Counselors and therapists worldwide receive training about the theoretical underpinnings of mental health. They learn how to use those theories to support their work with clients. These professionals use diagnostic tools based on old and new theories of well-being.
What are these theories, and who created them? That is what you will learn as you continue reading.
What are Mental Health Theories?
In the sciences, a theory is more than a simple guess. It is a “coherent group of propositions formulated to explain a group of facts or phenomena in the natural world and repeatedly confirmed through experiment or observation” (Dictionary.com, n.d.).
One could create theories about almost anything, but it is rigorous testing that distinguishes simple theories from scientific ones. Not all theories will survive this type of testing. In fact, the acceptance or rejection of parts of theories is not unusual.
Theories developed 50-100 years ago fall into six broad categories. They still influence us today. You might recognize them as:
- Analytical/developmental (Freud, Jung, Erickson, Kohlberg)
- Behavioral (Watson, Skinner, Pavlov)
- Cognitive (Tolman, Piaget, Chomsky)
- Social (Bandura, Lewin, Festinger)
- Humanistic (Rogers and Maslow)
- Personality (Erickson’s psychosocial development theory)
From these, many contemporary theories followed. Some are specific to a domain like development. Others make use of neuroimaging to explain why we do the things we do.
Mental health theories strive to explain human development behaviorally, psychologically, and socially. For many years, researchers focused on alleviating pain or suffering. The approach centered on what was wrong with a person and how to fix it. There was no assumption that a person could strengthen their well-being.
A Look at the Models and Methods
Mental health and well-being experts draw from other areas to inform their perspective. They also review a person’s mental health within context. An act could be psychopathological in one cultural context but not in another.
The main areas from which counselors, psychologists, and psychiatrists gain understanding about mental health are (Dasgupta, 2013):
- Spiritual – This approach explains who we are in the world and how we are to act. It also tells us what we can expect after death based on our actions. The spiritual perspective discusses good and evil as they relate to suffering.
- Moral character – This perspective posits that there are certain virtues a person needs to learn. Doing so allows the individual to live a better life free from mental illness.
- Statistical – Based on mathematics, this seeks to define what is ‘normal’ or ‘average’ for populations. Anyone falling outside of the norm is abnormal.
- Disease/medical/biological (genetics, neuroimaging, neurobiology) – This approach explains mental health as it relates to changes in the brain. The well-known case of Phineas Gage is an example. A rod went through his left frontal lobe. This affected his personality and behavior. Before the accident, people enjoyed his company and thought he was reliable. After, they described him as ill-tempered, foul, and unreliable.
- Psychological (psychodynamic, behavioral, cognitive-behavioral, existential/humanistic) – Mental health develops along an expected path. People try to adjust to their environment to survive within it. Problems arise when a person learns maladaptive strategies as a response to new situations.
- Social – Biology, psychology, and society all affect a person’s mental health. The influence of societal norms is important to the adaptive or maladaptive behavior of the individual.
- Psychosocial (Social learning model) – Researchers in this area study the relationship between a person’s thoughts (psychological) and their social behavior. This includes the meaning a person gives to their psychological processes. According to Bandura, people learn through observation and modeling of other people’s behavior (McLeod, 2016).
- Biopsychosocial – The interplay of biological, psychological, and social factors explains mental illness. This depends on the person and their environment.
The diagnosis and treatment of mental illness vary, but many therapists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This tool provides clear definitions of and criteria for more than 265 disorders. Diagnosis usually includes a physical exam, including lab tests, and a psychological evaluation (Mayo Clinic, n.d.).
There are approximately 20 classes of mental illness covering everything from neurodevelopmental to paraphilic disorders.
Some treatment methods are medications, psychotherapy, brain-stimulation, hospital and residential treatment programs, and substance misuse treatment.
There are three ways to experience therapeutic intervention. Sometimes therapists use a combination of these. Each environment stresses confidentiality and creating a safe space for people to share.
- Individual counseling – This is a one-one session with a trained counselor. Depending on the type of therapy used, these sessions can continue for months or years.
- Group Counseling – People with similar challenges work together with a trained counselor. The goals are to talk about issues, share knowledge, and solutions.
- Family therapy – This method involves helping a family improve their communication. Through the guidance of a licensed therapist, they learn conflict resolution techniques. Not every family member necessarily participates, and it is often short term.
Mental Health Counseling Theories
There are five schools of thought that attempt to explain mental health. Many therapists and counselors operate from one or two of these.
Theories guide the services and interactions therapists have with their clients. This is important to know because it can affect how well you and your therapist “click.”
The five schools of thought are:
- Behaviorism – Behavior is a result of life experiences, not the unconscious mind. We learn through our experiences with our environment. This approach is all about conditioning. It is present-focused.
- Biological – This is a medical model of treating mental disorders. The idea is that something physical is the cause of the mental illness. Symptoms are “outward signs of the inner physical disorder” (McLeod, 2018).
- Psychodynamic – Like behaviorism, psychodynamic therapists view behavior as a result of experiences. One of the differences, though is that their focus is on past experiences. They assert that unconscious forces drive people’s behavior. The client and therapist revisit explored ground to achieve more understanding. This therapeutic process can take many years.
- Cognitive – The emphasis of this theory is on thinking, not doing. A feedback loop exists between the person’s assumptions and attitudes, their resulting perceptions, and the conclusions drawn from them (Grace, n.d.). These therapists work to assist a person to change their thoughts. Doing this leads to a change in feeling and behavior.
- Humanistic – Three different therapies can help people achieve their highest potential. Client-centered therapy, developed by Carl Rogers, allows the client to investigate who they are at their core. The therapist creates an environment of empathy, acceptance, and genuineness. This encourages the client in their self-exploration. Gestalt Therapy, created by Frederick Perls, is present-focused and involves role-playing. Existential therapy is about ownership of one’s life, including all its mishaps. The responsibility of one’s life is one’s own.
It is easy to understand how a therapist influenced by one of these theories might interact with a client. Positive psychology practitioners, for example, primarily follow humanistic theories. One would expect this therapist to be empathetic and stress ownership and responsibility. The sessions would include a healthy dose of self-exploration, especially related to developing strengths.
A List of Popular Mental Health Theories
Every theory of mental health comes from one of the above five areas or a combination of them. Here is a brief overview of theories derived from those broader categories.
Network theory explains that “mental disorders arise from direct interactions between symptoms” (Borsboom, 2017). The biological, psychological, and societal influences facilitate the connection between Psychopathological symptoms.
Cognitive-behavioral Therapy (CBT) focuses on assisting the person in changing destructive thoughts and behaviors. It is a type of psychotherapy that helps a client to quickly identify and manage problems. The approach is goal-oriented and often involves homework. The homework helps to reinforce the in-person sessions. It is the “gold standard in the psychotherapy field” (David, Cristea, & Hofmann, 2018).
Operant conditioning still is a popular approach. Whether used by therapists or physical trainers, it involves identifying the cue-routine-reward pattern. The goal is to change the person’s behavior by changing the routine and sometimes the reward. It is often used in the treatment of OCD through exposure therapy.
Exposure therapy allows the person to engage with the source of their anxiety in a safe space. The goal is to slowly, and incrementally, increase the person’s exposure to their fear. There are several variations of exposure therapy (APA, n.d.).
It is useful in the treatment of:
- Panic Disorder
- Social Anxiety Disorder
- Obsessive-Compulsive Disorder
- Post-traumatic Stress Disorder
- Generalized Anxiety Disorder
Classical conditioning also remains a popular treatment for phobias through the use of systematic desensitization. This is a variant of exposure therapy (Grace College, 2016).
Popular Mental Health Theories on Well-Being
The Self-determination Theory of motivation (SDT), and more specifically, the Basic Psychological Needs Theory (BPNT) posit that autonomy, competence, and relatedness are the primary supports for well-being and optimal functioning (SDT, n.d.) If anyone of these is faulty, then the person’s well-being decreases. Intrinsic motivation increases through the satisfaction of having these needs met (read more about intrinsic coaching here).
The Broaden and Build Theory of Positive Emotions (Fredrickson, 1998, 2000) changed the discussion around emotions. Many of the psychological theories and research before this dealt with negative affect. These are emotions like anger, fear, sadness, guilt, and shame (Stringer, 2013).
Fredrickson argued that negative emotions create a sort of tunnel vision. Positive affect widens one’s perspective. Positive emotions like awe, joy, and gratitude expand one’s experience within the environment. The theory doesn’t advocate ignoring negative emotions. Instead, it discusses the ramifications of continuing to ignore positive ones.
The focus of the PERMA Theory of well-being (Seligman, 2011) is helping people to thrive. It promotes building skills that allow one to flourish (Positive Psychology Center, n.d.). Many contemporary theories attempt to help a person reduce suffering. PERMA theory of well-being states that well-being consists of five elements:
- Positive emotion – These emotions increase our hedonic happiness.
- Engagement – This is the flow that Mihaly Csikszentmihalyi discusses. Being engrossed in one’s pursuit is the reward.
- Relationships – Support is critical to our survival and emotional well-being.
- Meaning – Serving or working in a capacity that contributes to something larger than ourselves gives us a sense of purpose and meaning.
- Achievement – We enjoy pursuing accomplishments for the sake of doing so.
Each of these contributes in varying degrees to a person’s ability to flourish. Positive psychology therapists and coaches often use this as a backdrop for their sessions.
A Take-Home Message
There are several mental health theories, but they all come from one of five schools of thought. They are behaviorism, biological, psychodynamic, cognitive, and humanistic.
In recent years, there has been a move toward studying how people flourish. This is positive psychology. Unlike previous years, this field of research explores what humans already do well. Doing this type of research helps others to increase their opportunities to thrive.
If you seek the help of a therapist or counselor, it is important to know the basis for their approach. You do not want to see a behavioral psychologist to flesh out how you can find meaning in your life. They are better suited for helping you change, develop, or extinguish a habit.
The continued study of mental health, including the more positive aspects, is critical to each person’s well-being.