In order to understand and effectively use neurofeedback, it is helpful to consider how the brain manages its own brain states, and how this process is disregulated in different individuals. Neurofeedback will be seen first as an exercise in self-regulation of state and second as a process for accessing deep states for resolution of learned fears and habits. An evolving clinical model will be discussed that helps guide neurofeedback assessment and training in order to optimize training benefits for each client. Understanding the specific effects of reward and inhibit frequencies allows the adjustment of training protocol within and between sessions according to the client’s response to training. General and specific effects of training different cortical sites also guide protocol development to address each individual’s specific symptoms. The clinical model allows us to think about neurofeedback as a process of improving function by increasing self-regulation of brain states. This applies both to symptom reduction and also to peak performance applications. Tools for assessing and tracking performance will be discussed. Expected outcomes will be considered in terms of rate of progress, and short-term and long-term gains with varying clinical complexity.