By: Bethany Bray, Senior Writer and Social Media Coordinator at Counseling Today
Retrieved from Counseling Today: Wellness: Getting beyond the buzzword
When Amazon’s Prime Day arrived in mid-October, media outlets from NBC News to Health.com reported on the “wellness deals” — on everything from sneakers and wristband fitness trackers to yoga pants and weighted blankets — not to be missed during the online behemoth’s annual spate of sales.
The term wellness is frequently tossed around (some would say a little too frequently) in the popular lexicon. But it’s no wonder that the aura of wellness is so often touted to attract consumer attention. After all, who doesn’t want to be well?
Of course, in the realm of counseling, wellness encompasses way more than yoga pants and running shoes. But what does wellness mean exactly? When counselors say they are practicing through a lens of wellness, what sets that apart from any other therapy framework? Most importantly, how does wellness counseling help clients?
The ACA Encyclopedia of Counseling refers to wellness as “a state of positive well-being … in which body, mind and spirit are integrated.”
While often used as a buzzword in modern culture, wellness is nothing new. The ancient Greeks, including the philosopher Aristotle, wrote of the importance of a prevention-focused approach to health.
As Jane Myers, perhaps the individual most associated with wellness in the counseling profession, wrote in the Encyclopedia’s wellness entry, “The main qualities defined by the ancient Greeks remain the hallmarks of wellness today. To live long and live well, individuals need to attend to their physical, cognitive, emotional and spiritual selves.”
As Myers went on to describe, wellness counseling incorporates a strengths-based approach. Because each area of wellness affects the others, counselors can assess a client to find one area of wellness in which they are strong and use that as a tool to boost other realms of wellness in the client’s life.
Myers and her husband, Thomas J. Sweeney, are known for their development of the Indivisible Self, an evidence-based model of wellness.
A helpful approach to wellness leverages a client’s existing strengths, values and resources, says Michael Desposito, a licensed professional counselor (LPC) who pulls from several wellness models, including Myers and Sweeney’s, in his work with clients at his Canton, Ohio, private practice. What wellness counseling is not, he stresses, is adding things to a client’s regimen that could ultimately subtract from their wellness. Simply recommending physical activity or other wellness-focused activities for wellness’ sake — “additive subtractions,” as Desposito calls them — is not wellness counseling, nor is it helpful, he asserts. Adding something that isn’t already part of a client’s daily life may not be maintainable for them, he notes. In addition, counselors must remember that some clients might not be able to afford gym memberships, massages or other services frequently promoted under the wellness umbrella.
Additionally, viewing wellness as an either-or concept — such as either going to or skipping yoga class — does a disservice to clients, Desposito says. Wellness is not something to be added or subtracted, but rather honoring the client and improving their functioning in the now, he explains.
A wellness framework works best “when you can bring in the client’s own unique strengths and resources that they have,” says Desposito, a member of the American Counseling Association. “They know themselves the best. Have them show you that.”
Wellness counseling is a framework that clinicians use alongside and in addition to their preferred theoretical orientation. At its root, wellness counseling views clients holistically, focusing not only on an individual’s mental and physical health but also on their spirituality, social connections, work life, home environment and numerous other factors that vary slightly depending on the wellness model used.
In essence, wellness counseling looks beyond just the client’s diagnosis or presenting concern. However, as Desposito points out, to function as practitioners — and, particularly, to be reimbursed by insurance companies — professional counselors often follow the medical model, which is driven by diagnosis.
“Over time, that culture starts to inundate how we [counselors] look at people,” he says. “It can cut people down to a symptom instead of a whole person.”
Wellness is integral to the person, says Desposito, who co-presented the session “Factoring Wellness Into Treatment Planning” at ACA’s 2019 Conference & Expo in New Orleans. He often tells his clients: “At the end of the day, just because I decrease a symptom, it doesn’t increase your health.”
Desposito offers some examples to further illustrate a wellness framework. Perhaps a college-age client struggles with social anxiety and is uncomfortable presenting or speaking in class. A practitioner without a wellness focus might equip the client with adaptive coping tools or challenge the client to push themselves and speak to three peers or classmates in between counseling sessions. As a wellness-focused practitioner, Desposito would instead find ways to leverage a strength that is already present in the client’s life. For instance, if the client enjoyed playing video games, Desposito might “assign” social exposure challenges outside of sessions that involved playing video games online and chatting with other players.
Similarly, if a client was drawn to making to-do lists at home and work, Desposito would leverage that in session to have the client make lists of therapeutic goals. Checking items off their list would provide the client a sense of achievement and build momentum toward growth, he says.
“Simply decreasing anxiety [or other presenting concerns] will help them feel better, but is it holistically helping the client? … Just because you reduce their symptoms doesn’t [necessarily] make the client’s life any better, and it makes them open to going back into old patterns if life doesn’t get any better,” explains Desposito, who is active in the Association for Humanistic Counseling and is a past president of the Ohio branch of the Association for Spiritual, Ethical and Religious Values in Counseling.
Desposito recently worked with a transgender client in his 20s who was taking a semester off from college. After moving home, he found himself apart from his friends and social supports. The client’s family did not support his transgender identity, so he spent much of his time alone in his bedroom playing the video game Animal Crossing. (Note: Identifying details have been changed to preserve confidentiality.)
Desposito began seeing the client after he had been hospitalized for suicidal intent and multiple suicide attempts. His presenting issues were self-injury, gender dysphoria, suicidal ideation and major depression. In their work together, Desposito listened for and pulled out the client’s existing strengths. This led to the client rekindling his love for drawing and painting. As their work progressed, the client would show Desposito some of his drawings in session, and they would discuss them together. “The wellness model helped him look at what he was getting out of life versus everything that was going wrong,” Desposito says.
Due to the coronavirus pandemic, all of Desposito’s sessions with this client occurred virtually, and a major turning point happened in real time during a video session. The client opened a drawer in his bedroom to look for something and came across a box cutter. His anxiety spiked as he realized he had overlooked this one implement when ridding his bedroom of all of his self-injury tools.
Desposito helped the client process the feelings he was experiencing, and the client came to a realization: The box cutter had been in his drawer the entire time, and he had forgotten about it because he never felt the need to use it.
Desposito says it was an incredible feeling to hear the client, while still in session on his phone, walk down the hallway, give the box cutter to his father and state, “I don’t need this anymore.”
“That was a first major turning point for this client,” Desposito says. “What was being utilized by this client [instead of cutting] was other skills he had been taught [in counseling]. He recognized that he didn’t feel trapped in his bedroom anymore. … He opened the drawer and, boom, ‘Oh, my gosh!’ he saw the knife and realized that he had been doing a host of other things and didn’t need it.”
Cristal Clark, an LPC, counselor supervisor and founder of a private practice in Fort Worth, Texas, describes her approach to wellness as working with clients to “fix the why, not the what.”
Wellness, Clark says, is “peace — but not contentment. It’s being joyful and thriving in the circumstances where you are.”
The approach’s focus on leveraging client strengths can include reconnecting them to interests they once enjoyed, such as hobbies they previously engaged in before having children or encountering other life changes, explains Clark, an ACA member and a practitioner of eye movement desensitization and reprocessing.
Ann Church, a licensed clinical mental health counselor and co-founder of a wellness-focused therapy practice in Charlotte, North Carolina, notes that leveraging client strengths can also involve helping clients identify things that are already part of their life that they haven’t previously recognized as a strength. For instance, counselors may need to encourage clients to reach out to a friend in their church or spiritual community or reconnect with former classmates through an alumni group. Counselors can also ask, “Who is your favorite person in your family?” Most clients have a ready answer to that question, Church says, and counselors can follow up by suggesting that they call this family member to reconnect and find support.
A focus on client strengths also requires forging a strong therapeutic bond to discover what their strengths truly are, Clark says. “What appears to be someone’s strengths at the outset really could [just] be something that they’re good at,” she notes.
Clark once worked with a female client who had a doctorate and a successful job at a local university. The client was very logical, calculated and organized — a type eight on the Enneagram — but she was also very sad and wrestled with suicidal ideation.
Clark’s counseling work with this client focused on emotion regulation, managing her anxiety triggers and drawing on her spirituality. As they formed a therapeutic bond, Clark began to understand — and, in turn, helped the client understand — that the client’s organization skills weren’t actually her strength.
“She had to have things exactly the way she wanted to manage her fear,” Clark recalls. “Her organization was a coping skill to keep anxiety at bay. Her true strengths were listening and helping her students identify goals and creating plans to get there. When she is in that helping mode and giving control to other people, she is able to find peace.”
At intake, the client had exhibited strong suicidal ideation. Six months later, she came into a session with Clark in tears and exclaimed, “This is the first time in 30 years I haven’t felt suicidal.” Those feelings had ebbed because the client had learned to regulate her emotions and, in turn, her self-esteem had grown stronger, Clark says.
The client’s history included abuse and neglect, and she had “spent her whole life proving that she’s worthy,” Clark says. “Now, she believes that she’s worthy. That’s the shift in the paradigm, from an external to an internal confidence.”
The client has gone on to complete a second master’s degree and has adopted a habit of walking every day.
“To be able to use a client’s strengths [in counseling], you have to build a rapport with them to hear their story and hear what their strengths truly are,” Clark says. “We looked at her overall picture of wellness to find what she wanted [to improve about her life]. The root of it was that she wanted to stop feeling these painful feelings and didn’t want to die [by suicide].”
Counseling a client without considering all of the facets of their wellness is like buying a car based on color instead of its gas mileage and other factors, Clark says. “It’s not just the person in your office; it’s their job, their family [and] entire system. If you don’t ask the questions to get to know the whole person, if you don’t look at outside factors and provide tangible opportunities to reach what they need and want … it [counseling] won’t break the cycle.”
The whole picture
Research continues to confirm what wellness practitioners have long acknowledged: “Physical health, spirituality, social supports, mental and emotional health, and all of these systems are interrelated and they impact one another,” Church says.
“If we’re talking just about a client’s feelings or, for example, anxiety … it’s really important to understand what the root of that anxiety is, but also what are the contributing factors around that that can help them manage that? [Ask clients,] ‘What are your social supports? How much caffeine are you drinking? What is your sleep like?’ We know that all has an impact on how you feel. … If you [the counselor] are not taking all of that in, you’re missing a key factor in helping people feel well,” Church says.
Hailey Shaughnessy, a licensed mental health counselor in Florida, sees the benefits of a holistic focus all the time in her work as a therapist in the cardiology unit at Sarasota Memorial Hospital. The hospital uses Dr. Dean Ornish’s program for treating heart disease, enrolling patients not only in medical treatments but also in a multidisciplinary regimen that includes exercise instruction, nutrition counseling, and therapy sessions focused on reducing stress, regulating emotions and boosting mental health.
Shaughnessy, who also has a private counseling practice in Sarasota, says many of the cardiac patients she sees for therapy at the hospital are dealing with emotion management issues (especially around anger) and stress. Patients are also screened for anxiety, depression and other mental health conditions. Prior to treatment, Shaughnessy says, patients often don’t realize that emotions have a direct impact on their physical health, most notably on the heart.
In sessions with cardiac patients, Shaughnessy sometimes reads sections of Deb Shapiro’s book Your Body Speaks Your Mind: Decoding the Emotional, Psychological, and Spiritual Messages That Underlie Illness. In response, Shaughnessy often sees these patients nodding or hears them say, “That is me.”
Patients often see vast improvements, not only in their physical health but in their overall life quality as well, and in a shorter time than if they didn’t receive multidisciplinary treatment, according to Shaughnessy.
“The brain is not separate from the body. Your emotions affect your brain and then, in turn, your body,” says Shaughnessy, an ACA member whose first career was as a personal trainer and fitness instructor. “[Wellness] is something that I deeply believe in, and I practice it myself. I know how much better I feel when I work out. I know how much more confidence I have when I’m [physically] strong,” she says.
Shaughnessy grew up in a family in which girls weren’t encouraged to play sports. When she began exercising in college, she noticed a corresponding boost in her mood. “I’ve seen myself how these different things affected me personally, and I truly believe if they can help me, they can help others,” she says.
Asking the right questions
In addition to drawing upon client strengths, many of the counselors interviewed for this article associate a wellness focus with a thorough intake process. That involves asking targeted questions to understand and monitor all domains of a client’s wellness, from whether they have a primary care physician and take vitamins regularly to their social supports, home environment and family of origin.
Jen Monika McCurdy is an LPC who works within a wellness framework at her St. Louis private practice that specializes in maternal mental health. Her intake form includes entire sections with detailed questions asking about clients’ medical health and histories (including any prescribed or nonprescribed medicines they are taking), exercise habits and other areas of wellness. In the section about sleep, she asks clients how easily they fall asleep, whether they dream and if they feel refreshed when they wake up. McCurdy mostly counsels female clients, so she also asks targeted questions about their menstrual cycle and how it affects their mood and functioning.
All of this information helps her treat clients holistically, beyond their diagnoses or presenting issues, McCurdy says. When working with peripartum clients, the wellness framework is a natural fit, she explains, because social supports, sleep patterns, prenatal vitamins, water intake, nutrition, exercise and other wellness indicators are all integral for breastfeeding mothers, clients undergoing fertility treatments and those struggling with postpartum stress.
“With a wellness approach, you’re not just working with anxiety [or another presenting issue], but the whole person,” says McCurdy, a member of ACA. “It’s empowering them that their illness does not define them, empowering them to tell their story.”
Church also uses a thorough intake questionnaire with clients and notes that open-ended questions help clients tell their story. Beyond simply asking about a client’s sleep, she’ll ask them to walk her through their evening and bedtime routines. Do they log on to Facebook or have a glass of wine after putting the kids to bed? How much caffeine do they normally consume, and at what time of day?
From there, Church will transition to providing psychoeducation to clients, talking about what a normal sleep cycle looks like (and confirming that it’s normal to have periods of wakefulness in the night), alcohol’s effect on metabolism, and how both alcohol and the blue light emitted from electronic devices can disrupt sleep.
“If I were talking to a beginning practitioner [about wellness], I would say, ‘Mind, body, spirit — bringing those things into intake and sessions is really important,’” says Church, an ACA member. “Because we can teach all the skills and coping mechanisms and all sorts of models to people, but if we’re not helping them use [and draw from] other aspects of their life, we’re really seeing them through a narrow, narrow lens. We’re seeing them as a diagnosis rather than as a whole human being.”
Several of the counselors interviewed for this article noted that a wellness perspective also involves working closely with other helping professionals to refer or co-treat clients. This can include a range of practitioners, from chiropractors and medical doctors to massage therapists, acupuncturists and physical trainers. Shaughnessy often works with a nutritionist who can advise her private practice clients about their diet and map their gut microbiome, as well as a specialist who conducts sleep studies. McCurdy, as a maternal mental health specialist, has forged connections with infertility clinics and OB-GYN practitioners in her area.
“It’s so helpful to look at a client as a team,” McCurdy says. “I can’t be their sleep specialist, but I can talk [in counseling] about the importance of sleep. But if they have a potential sleep issue, then I’ve got to get them support [from a specialist]. It’s my value and my duty to get them that support.”
For McCurdy, one of the most important parts of the wellness framework is for counselors to be willing to practice what they preach, encompassing everything from self-compassion and working to maintain social relationships to having a meditation practice and getting consistent physical exercise.
Counselors also need to show empathy regarding how difficult it can be to talk about, and monitor, aspects of one’s lifestyle that are very personal. “If you’re going to preach wellness to someone, you have to believe it’s important and share that value with them,” McCurdy says. “When you have a wellness perspective, you’re always thinking of how things are going to work systemically — how an intervention will work in [a client’s] life, their family, their community. We have to hold that truth to ourselves as well … acknowledging that it’s not easy to go for a run, not drink beer, and eat healthy when you’re mentally struggling. Honor the concept of where the client is, where they want to be, and hold hope for them [that they can get there].”
Desposito acknowledges the importance of asking questions about diet and other domains of wellness, but he warns that too many questions can cause clients to become discouraged. He uses wellness models, including the eight dimensions of wellness (social, environmental, physical, emotional, spiritual, occupational, intellectual and financial) referenced in the Substance Abuse and Mental Health Services Administration wellness initiative, to assess which areas of a client’s wellness are strong and which may need extra attention.
Wellness goes far beyond exercise and other physical indicators, says Desposito, who recently co-authored an article on promoting identity wellness in LGBTQ+ adolescents in the Journal of LGBT Issues in Counseling. “If I am only looking at physical factors, I am only making a composite of my client,” he says. “We can’t say, ‘This is the best answer.’ We have to value what the client values. We have to help the client find their values and adapt [our counseling] to their values, but temper that with a multicultural lens. Yes, it’s great to take vitamins, but what if you can’t afford them?”
“A wellness framework doesn’t say, ‘That’s wrong,’” Desposito continues. “It says, ‘What can we do to use that [aspect of a client’s life] to help?’”
Counselors must also remember the parameters of their role and refrain from making medical or other recommendations that are outside their scope of practice.
From questions to psychoeducation
For Church, a powerful first step with clients is often normalizing the feelings they are experiencing and explaining their biological connections. For example, she says, a client who overexercises may not realize that the nervous system interprets that physical stress the same way it does the stress a person experiences at work or when going through a divorce.
“Normalize those feelings and don’t pathologize them. Explain [to the client], ‘This is your body motivating you to make a change,’” Church says. “Then, explore the changes they can make. Maybe it’s creating a support network, or whatever it takes for that person.”
Wellness counselors look not only at what brought a client into therapy but also at the connection that issue has to the client’s spiritual life, emotional health and other domains of wellness, Church emphasizes. “We are very intentional about bringing those aspects into the session, raising awareness with clients around those issues that may or may not be impacting why we’re here, and then following their lead.”
Church once worked with an adult client who sought counseling after the breakup of a long-term relationship. He was experiencing intense feelings of shame, vulnerability, anxiety and grief. He was also confronting a loss of identity, having trouble “figuring out who he was” outside of the relationship, she says. All of this resulted in frequent bouts of weepiness.
As a wellness counselor, Church helped the client understand the biological and physical connections to the emotions he was feeling and how they could be harnessed to move him toward healing. Part of this, Church says, was offering psychoeducation about how the nervous system and our fight-or-flight response work, and how that was leaving him on edge and “emotionally all over the place.”
The client was also having trouble sleeping and was turning to alcohol to cope. In sessions, Church explained that a lack of sleep inhibits the body’s ability to deal with stress and discussed how alcohol further exacerbates that cycle. She also worked with the client’s physician when a psychiatric medication was prescribed to help the client.
In counseling, Church and the client worked on identifying and managing his anxiety triggers and finding connections beyond his ex-partner. The relationship had represented his entire immediate social circle, so they worked on rebuilding that based on ties he already had through work, family and old friends.
This also included the client getting back into bike riding, an activity he had once enjoyed but had largely stopped engaging in while in a relationship. Getting back on his bike not only lifted the client’s mood and alleviated his stress but also helped him forge an identity outside of his relationship with his ex-partner. It also led him to find social connection when he started riding with a local biking group.
Over time, the client progressed to being able to make decisions based on a thoughtful response instead of emotional reactions, Church says. “This is a person who [previously] didn’t share a lot about how he felt. Now he’s able to manage big feelings and not get overwhelmed,” she says. “He’s able to start incorporating his physical and emotional sensations and thoughts in a way that is helpful and utilize some of his physical wellness things, such as bike riding and moderating his alcohol intake, to bring that all together. Also, it has really opened him up [to see] what is a meaningful life for him.”
For McCurdy, psychoeducation with clients often involves the power of journaling. She asks clients to track their eating, exercise and other day-to-day indicators in a journal, along with their emotions and mental state. This helps clients connect the dots, she says. For example, clients might notice that their mood worsened the day after they drank alcohol.
Shaughnessy also recommends journaling to her clients, along with tracking their sleep, exercise, food and vitamin intake, and moods. Counselors typically check in with clients about how they are reacting to any psychiatric medications they may be taking. Similarly, Shaughnessy says, counselors should check in about the holistic aspects of their clients’ daily routines.
In keeping their journals, McCurdy tells her clients, “All of your thoughts matter — the hopeful ones and the scary ones.” In sessions, she asks clients to talk about something that’s going well, “even if it’s the tiniest of things.”
She also prompts clients to make lists of things for which they’re grateful in their journals. This is all with an eye toward empowering clients and focusing on their strengths, especially when circumstances such as a miscarriage or infertility make them feel like so much is out of their control. McCurdy’s work with peripartum clients often includes regulating their self-talk and equipping them with positive affirmations, such as “I will survive this” or “I can get through this.” For clients going through infertility treatments, she works to plan ahead with them so they will have a toolkit of coping mechanisms — especially social supports — for the two anxiety-provoking weeks between when the fertility treatment occurs and when it’s time to take a pregnancy test.
With all clients in session, McCurdy says, “I listen to what’s working for them and hone in on that. I often ask clients, ‘What is going well for you today? What is your happy? What went well, and what can we do more of?’ … And [I] celebrate their wins too. I tell clients that I’m proud of them, in awe of them. The fact that you were able to put your hair up, put on your shoes and get outside is a win. Just walking to the mailbox is a win. Honor the courage that it took for them to do that.”
More than massages
The word wellness is in the very definition of counseling used by ACA and developed more than a decade ago during the 20/20: A Vision for the Future of Counseling initiative: “Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.”
Wellness is sometimes viewed in simplistic terms, but in reality, it is tied to the profession’s call to social justice, Desposito says, “because you’re meeting [clients] where they’re at and honoring their experience.”
“Wellness can be very abstract, [but] that holistic piece, how the whole person is working together, social justice is paired with that,” he says. “Wellness is often assumed to be self-care or taking a vacation. Wellness is often viewed as this thing that you do on the side. … Wellness can’t just be, ‘Oh, just go get a massage.’ You [the counselor] have to honor the multicultural aspects of a client and discover how you can find wellness [for them] right here in this moment.”