Today’s mental health treatment has an eclectic ap-
proach, meaning one that incorporates concepts and
strategies from a variety of sources. This chapter pre-
sents an overview of major psychosocial theories, high-
lights the ideas and concepts in current practice, and
explains the various psychosocial treatment modali-
ties. The psychosocial theories have produced many
models currently used in individual and group therapy
and various treatment settings. The medical model of
treatment is based on the neurobiologic theories dis-
cussed in Chapter 2.
PSYCHOSOCIAL THEORIES
Many theories attempt to explain human behavior,
health, and mental illness. Each theory suggests how
normal development occurs based on the theorist’s
beliefs, assumptions, and view of the world. These
theories suggest strategies that the clinician can use
to work with clients. Many of the theories discussed
in this chapter were not based on empirical or re-
search evidence; rather, they evolved from individual
experiences and might more appropriately be called
conceptual models or frameworks.
Psychoanalytic Theories
SIGMUND FREUD:
THE FATHER OF PSYCHOANALYSIS
Sigmund Freud (1856–1939; Fig. 3-1) developed
psychoanalytic theory in the late 19th and early 20th
centuries in Vienna, where he spent most of his life.
Several other noted psychoanalysts and theorists
have contributed to this body of knowledge, but Freud
is its undisputed founder. Many clinicians and theo-
rists did not agree with much of Freud’s psycho-
analytic theory and later developed their own theo-
ries and styles of treatment.
Psychoanalytic theory supports the notion that
all human behavior is caused and can be explained
(deterministic theory). Freud believed that repressed
(driven from conscious awareness) sexual impulses
and desires motivated much human behavior. He de-
veloped his initial ideas and explanations of human
behavior from his experiences with a few clients, all
of them women who displayed unusual behaviors
such as disturbances of sight and speech, inability
to eat, and paralysis of limbs. These symptoms had
no physiologic basis, so Freud considered them to
be the “hysterical” or neurotic behavior of women.
After several years of working with these women,
Freud concluded that many of their problems re-
sulted from childhood trauma or failure to complete
tasks of psychosexual development. These women re-
pressed their unmet needs and sexual feelings as well
as traumatic events. The “hysterical” or neurotic be-
haviors resulted from these unresolved conflicts.Personality Components: Id, Ego, and Superego.
Freud conceptualized personality structure as having
three components: id, ego, and superego. The idis the
part of one’s nature that reflects basic or innate de-
sires such as pleasure-seeking behavior, aggression,
and sexual impulses. The id seeks instant gratifica-
tion; causes impulsive, unthinking behavior; and has
no regard for rules or social convention. The super-
egois the part of a person’s nature that reflects moral
and ethical concepts, values, and parental and social
expectations; therefore, it is in direct opposition to the
id. The third component, the ego,is the balancing or
mediating force between the id and the superego. The
ego represents mature and adaptive behavior that al-
lows a person to function successfully in the world.
Freud believed that anxiety resulted from the ego’s
attempts to balance the impulsive instincts of the id
with the stringent rules of the superego. The accom-
panying drawing demonstrates the relationship of
these personality structures.Behavior Motivated by Subconscious Thoughts and
Feelings.Freud believed that the human personal-
ity functions at three levels of awareness: conscious,
preconscious, and unconscious (Gabbard, 2000). Con-
sciousrefers to the perceptions, thoughts, and emo-
tions that exist in the person’s awareness such as
being aware of happy feelings or thinking about a
loved one. Preconsciousthoughts and emotions are3 PSYCHOSOCIALTHEORIES ANDTHERAPY 49
Figure 3-1.Sigmund Freud: the father of psychoanalysis.