Q: What is personality?

A: Personality is the way we think, feel, and act in the three key spheres of life: self, intimacy, and achievement. 

Q: What is the self sphere?

A: Self is the way we think and feel about and act toward ourselves. 

Q: What is the intimacy sphere?

A: Intimacy is how close we are to our partners in our most important, close, one-on-one relationship, such as that with a spouse or significant other. For children, parents represent an important relationship that is critical to their growth and development.

Q: What is the achievement sphere?

A: Achievement involves our activities that are productive and creative, those that make us feel connected to the world at large-studies, work, career, sport, hobbies, and so forth. Achievement gives us a sense of satisfaction and a sense of meaning in our lives.

Q: Should I try to build my sense of self, intimacy, and achievement simultaneously? This seems like a rather tall order. My work schedule requires long hours. During vacations, I try to make up my time away from home to my family. Occasionally, I find time for myself, but it's rare.

A: Short-term tradeoffs among aspirations for self, intimacy, and achievement are not only natural, but often necessary to maintain and balance internal health and success. Although such short-term flexibility is essential to well-being, a consistent denial of human aspirations over long periods of time can result in great vulnerability to stress, imbalance, and even insanity. Conversely, a steady attention to each of the three spheres over one's life span can result in an increased ability to live life fully, with resilience to overcome inevitable setbacks and maintain psychological health.

Q: I have heard of the work of Carl Rogers on personality and have admired it considerably. How is your approach similar or different?

A: Like the humanist Carl Rogers, the positive mental health Lifetrack model was inspired, developed, and tested in daily clinical practice with demanding patients. It evolved from the need to help demanding patients with hectic lives improve their overall psychological adjustment. Patients inspired the model of positive mental health, put it to the test, and challenged it daily. Much like Rogers approach, Lifetrack therapy recognizes that the relationship with the therapist is an essential means to engage someone in change. Lifetrack, however, goes beyond this recognition to state that a close interdependent relationship, such as that with a partner, is even more critical to fundamental change and long-term well-being. Hence, rather than make the therapist the object of the close relationship in therapy, the Lifetrack approach helps the patient to become significantly closer to a person who can stay in his or her life long after therapy has ended.

Q: I know of Maslow's hierarchy of needs. Are the three spheres an explanation of psychological needs? What is the difference between your work and that of Maslow?

A: Maslow's hierarchy of human needs does not allow for tradeoffs. It mixes physical and psychological needs. According to Lifetrack, the need for self, intimacy, and achievement can be creatively met in myriad ways. In the short run, tradeoffs among these psychological needs are a sign of flexibility and health. The ability to make tradeoffs, however, does not imply that these needs are merely desires, not critical elements of a healthy life. Over time, consistent frustration in any one of these needs can result in distress and breakdown. 

Another important difference from Maslow is that the model of positive mental health provides a means to understand the same individual at different points in the life cycle, whether in dire distress or optimal health. This differs with Maslow's studies of self-actualization, which focus on historical figures such as Lincoln, Jefferson, Thoreau, Einstein, and others as ideal candidates. Although Maslow contributed much to the field by balancing the darker side of the human psyche with an understanding of love, well-being, and exuberance, some say he fell short of integrating the two halves; the positive and the negative. In this sense, the positive mental health approach represents a middle ground, integrating the mind (or personality) both in distress and in well-being.

Q: Are you a psychoanalyst? How does your approach differ from psychoanalysis?

A: The positive mental health approach differs significantly from psychoanalytic theory in that its focus is not on the diseased mind, but on the healthy mind. Successful therapy is defined not in the absence of disease or neurosis, but in the presence of health.

Although my training in psychiatry taught me how to reduce or contain symptoms diagnosed as diseases or mental disorders, it has not helped me understand health to the same degree. When I realized that "successful psychological adjustment" was not necessarily much better understood or practiced by traditional mental health experts than by ordinary people who have never heard of sophisticated psychological theories, I stopped being a passive observer of patients divulging problem after problem. Instead, speaking more than 80 percent of the time in dynamic therapy sessions, I challenged what I was taught and sought new insights; I put each idea to a daily test. I spent most sessions analyzing, interpreting, explaining, and finally persuading patients as to how they must think, feel, and act for them to break out of the confines of their existing personalities. The process includes application of visual models of Lifetrack concepts, as well as daily graphic tracking of patients' subjective self-rating. 

I quickly found that people kick, scream, and yell all the way to well-being! It is only through persuasion, humor, perseverance, and a concerted effort that some individuals, according to their own self-rating and account, achieve and surpass a previous best level of adjustment. This active approach to therapy differs both in substance and style to the classical psychoanalytic approach, which focuses on neurosis and bringing the unconscious to the fore through the method of free association.

Careful listening to patients' difficult pasts is effectively finished during the first hour of the first session; during the second hour, the patients are presented with the therapists' analysis of their problem. I lay out the goal, method, and process of therapy; the expected course of therapy; and the required time and cost of therapy, which typically lasts from 3 to 6 months.

Q: I have heard of preventive mental health, but not of positive mental health. Why the new term?

A: Positive mental health is different from preventive mental health, which entails attending to risk factors, in that it does not suggest that all disorders are preventable or curable by early intervention. Rather, a positive mental health approach uses crisis as an opportunity for fundamental change. The objective is not to directly decrease the symptoms of disease, but to actively increase the positive factors in an individual's life beyond a previous best level of adjustment. When this is achieved, symptoms often disappear, and a new pattern of coping emerges.

Q: What do you think of the Oedipus complex and other Freudian concepts?

A: Although the Lifetrack positive mental health approach eschews the Oedipus complex and the emphasis on sexuality found in psychoanalysis (intimacy is only one of the three spheres, not the only sphere in mental health), it does recognize the existence of the conscious, preconscious, and unconscious. The central goal of therapy, however, is not to bring the unconscious to the conscious, but to change the way an individual thinks, feels, and acts about areas in his or her life that can contribute to positive health. 

This is not a passive process. Nowhere is it assumed that understanding conflicts in oneself can free the individual and create health. Naturally, understanding the self is part of the process, but the individual must go farther. Rather than dwelling on a difficult past, the emphasis in Lifetrack is on helping the individual accept the past and to think, feel, and act in ways that can improve the ability to fulfill core human psychological needs in the present.

Q: What is the difference between your therapeutic approach and that of behaviorists who emphasize personality change by focusing on changing actions?

A: Unlike Skinner, Watson, and other behaviorists who emphasize behavioral elements that bring about desired change, the Lifetrack approach puts equal weight on cognition, emotion, and action. Individuals, when rating themselves on the Lifetrack scale, are encouraged to consciously improve how they think, feel, and act about critical areas in their lives that contribute to psychological health, often overcoming their emotional resistance. 

Q: How is your approach different from Henry A. Murray's large list of more than 20 motives or needs?

A: Because the three-sphere model seeks to determine the essence of, rather than great detail about, human personality, it is more succinct than Murray's 1938 lengthy list of more than 20 motives or needs. The three spheres are helpful to patients and lay people precisely because they remain conceptually broad enough to encompass all critical psychological events, yet simple enough to be remembered. At the same time, the tripod model has been further broken down into three dimensions or nine elements for each sphere (see Definitions of Terms). This allows the three spheres to be better understood by individuals who wish to improve in each sphere and provides a conceptual means to cluster essential elements of each sphere to show how individual elements and spheres overlap and interact.

Q: What are the similarities between Lifetrack theory and organismic or systems theory that views personality as an open system of interacting parts?

A: Unlike strands of organismic theory, which assumes a constant equilibrium among parts, the parts of personality in the Lifetrack model influence and are influenced by the environment. A sense of self is not created in a vacuum. There is no assumption that human beings are good and are perverted by the environment. A balanced personality organization is not the natural state of the organism, nor is disorganization always a sign of pathology. Crisis and disorganization can be painful but are sometimes necessary to help the individual challenge and change the way he or she thinks, feels, and acts in key areas of life. In this sense disequilibrium, however painful, can become an opportunity.

Q: What do you think of medications such as Prozac or of the Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications?

A: Although pharmacological research has given the medical field increasingly effective and safer medications such as Prozac, the disease model has failed to prove that specific chemical changes in the brain are the sole cause or the cure for all mental illnesses. 

Experts in psychopharmacological therapy admit that only 8 to 15% of the depressed population actually receives treatment, and only 30% of those who received pharmacological therapy under proper professional supervision actually achieve remission. It is also reported that some 30 to 60% of the general population receiving care from general physicians receives antidepressants such as Prozac. If these two statistics are accurate, it means that a great majority of the general population should or may receive antidepressants, and only 30% of them could expect remission, leaving 70% to continue to take ineffective, and potentially dangerous, medications at great expense under inadequate pharmacological supervision or follow-up. 

The DSM is a classification for diseases and disorders that is helpful for describing patients' symptom presentations, for the disbursement of medication, and for insurance claim and reimbursement purposes. Today, this science based on the disease concept is outliving its usefulness-not because it is wrong, but because it is too narrow a worldview. Mental maladjustments and suffering by so many is indeed a serious problem deserving great sympathy and care comparable to all other physical illnesses. However, the disease concept has its limitations and inhibits advance in our understanding of the problem we face and constrains our effort to provide potentially more effective ways of helping the suffering population. Most of all, the disease concept does not attempt to do what all natural sciences must: 
effectively explain, predict, and measure experiences. 

Natural science has already gone through such a change in paradigm over the last century, having been liberated from the Newtonian worldview that had dominated science for 350 years. Relativity, quantum mechanics, and Bell's theorem have provided the world with a far more inclusive and useful paradigm that made possible rapid advancement of science. Psychiatric science must undergo a similar transition after 150 years of domination by the "disease model." 

The Lifetrack model is one such attempt. Naturally, all models are to be continuously challenged, tested, and replaced by more useful models. In case of psychiatric problem, the most, if not the only, qualified observer must do such testing, and that is the patient who is suffering.