When Amazon Prime Day arrived in mid-October, media from NBC News to Health.com reported on the “wellness offers” – from sneakers and wristband fitness trackers to yoga pants and weighted blankets – that one was looking for Not to be missed is the online giant's annual sales rate.
The term wellness is often thrown around in the popular lexicon (some would say a little too often). No wonder the aura of wellbeing is touted so often to grab consumer attention. Who doesn't want to be healthy?
In the area of consulting, wellness naturally encompasses much more than just yoga pants and running shoes. But what exactly does wellness mean? When counselors say they are practicing through a lens of wellbeing, what makes that different from other therapy settings? How does wellness advice help clients in particular?
Define wellness
The ACA Encyclopedia of Counseling describes wellness as "a state of positive wellbeing … in which body, mind and spirit are integrated".
While wellness is often used as a catchphrase in modern culture, it is nothing new. The ancient Greeks, including the philosopher Aristotle, wrote about the importance of a prevention-based approach to health.
As Jane Myers, perhaps the person most associated with wellness in the counseling profession, wrote in the wellness entry of the encyclopedia: “The main qualities defined by the ancient Greeks are the hallmarks of wellness to this day . In order to live long and live well, people need to take care of their physical, cognitive, emotional, and spiritual selves. "
As Myers went on to describe, wellness counseling involves a strengths-based approach. Because each area of wellbeing affects the other, counselors can evaluate a client to find an area of wellbeing they are strong in and use that as a tool to promote other areas of wellbeing in the client's life.
Myers and her husband Thomas J. Sweeney are known for their development of the indivisible self, an evidence-based wellness model.
A helpful approach to wellness uses a client's existing strengths, values and resources, says Michael Desposito, a licensed professional advisor (LPC) who uses a variety of wellness models to work with clients in his canton, including Myers and Sweeney & # 39; s. Ohio, private practice. What wellness counseling is not, he points out, is adding things to a client's regimen that may ultimately detract from their wellness. The mere recommendation of physical activity or other wellness activities for the benefit of well-being – "additive subtractions" as Desposito calls them – is neither wellness advice nor helpful, he claims. Adding something that isn't already part of a customer's daily life may not be waiting for them, he notes. Additionally, advisors need to keep in mind that some clients may not be able to afford gym membership, massage, or other services that are often offered under the spa umbrella.
Furthermore, viewing wellness as an either / or concept – like attending or skipping yoga classes – is a disservice to customers, Desposito says. Wellness is not something to add or subtract, but rather to honor the customer and improve how it works in the now, he explains.
A wellness framework works best "when you can bring in the client's unique strengths and resources," says Desposito, a member of the American Counseling Association. “You know each other best. Let them show you. "
Beyond the diagnosis
Wellness counseling is a framework that clinicians use alongside and in addition to their preferred theoretical orientation. Wellness counseling takes a holistic view of customers at their roots and focuses not only on a person's mental and physical health, but also on their spirituality, social connections, work life, home environment and numerous other factors that depend on the wellness used -Model may vary slightly.
In essence, wellness counseling goes beyond the diagnosis or concern of the client. However, as Desposito points out, professional counselors often follow the medical model dictated by the diagnosis in order to function as practitioners – and in particular to be reimbursed by insurance companies.
"Over time, this culture floods the way we [counselors] view people," he says. "It can reduce people to a symptom rather than a whole person."
Wellness is an integral part of the person, says Desposito, who co-presented the “Including Wellness in Treatment Planning” session at the ACA Conference & Expo 2019 in New Orleans. He often tells his clients, "Ultimately, just because I decrease a symptom doesn't improve your health."
Desposito offers a few examples to further illustrate a wellness framework. Perhaps a college-aged client may be struggling with social anxiety and uncomfortable presenting or speaking in class. A practitioner with no wellness focus can equip the client with adaptive coping tools or challenge the client to push themselves between counseling sessions and talk to three coworkers or classmates. Instead, as a wellness practitioner, Desposito would find ways to harness a strength that is already present in the client's life. For example, if the client enjoys playing video games, Desposito can "assign" social exposure issues outside of sessions where video games are played online and chatting with other players.
Similarly, if a client created to-do lists at home and at work, Desposito would use them in the session to have the client create lists of therapeutic goals. Checking items off their list would give the customer a sense of achievement and build growth momentum, he says.
“Just reducing the fear [or other presenting concerns] helps you feel better, but does it help the client holistically? … Just because you reduce your symptoms does not improve the client's life [necessarily] and it makes it open to return to old patterns if life does not get better, ”explains Desposito, who is active in the association for humanistic counseling and is 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 twenties who was taking a semester off college. After moving home, he found himself separated from his friends and social supporters. The client's family did not endorse his transgender identity, so he spent much of his time alone in his bedroom playing the Animal Crossing video game. (Note: The identification information has been changed to maintain confidentiality.)
Desposito began seeing the client after he was hospitalized for suicidal intent and multiple suicide attempts. His main subjects were self-harm, gender dysphoria, thoughts of suicide, and major depression. In their joint work, Desposito listened to the client's existing strengths and pulled them out. This led to the customer reviving his love for drawing and painting. In the course of their work, the client Desposito showed some of his drawings in a meeting and they discussed them together. "The wellness model helped him see what he was getting out of life versus everything that went wrong," says Desposito.
Due to the coronavirus pandemic, all of Desposito's sessions with this client were virtual, and an important turning point occurred in real time during a video session. The customer opened a drawer in his bedroom to look for something and came across a box cutter. His fear increased when he realized he had overlooked this one device when he was stripping his bedroom of all his self-harming tools.
Desposito helped the client to process the feelings he was experiencing, and the client stated: the box cutter had been in his drawer the whole time and he had forgotten it because he never felt the need to had use it.
Desposito says it was an incredible feeling to hear the customer while he was still in the session on his phone, walking down the hall, handing the box cutter to his father and saying, "I don't need this more. "
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"That was the first important turning point for this customer," says Desposito. “What this client [instead of cutting] was using were other skills that had been taught to him [in counseling]. He realized that he no longer felt trapped in his bedroom. … He opened the drawer and boomed, "Oh my God!" He saw the knife and found that he had done a lot of other things and didn't need them. "
Use strengths
Cristal Clark, LPC, consultant and private practice founder in Fort Worth, Texas, describes her approach to wellness as working with clients to "fix the why, not the what."
Wellness, says Clark, is “Peace – but not satisfaction. It is joyful and thrives in the circumstances you find yourself in. "
The focus of the harnessing customer strength approach can be to reconnect them with interests they once enjoyed, such as hobbies they had before they had children or other life changes Experience, explains Clark, an ACA member and an ophthalmologist, desensitization and movement reprocessing.
Ann Church, a licensed clinical mental health consultant and co-founder of a wellness-focused therapy practice in Charlotte, North Carolina, notes that harnessing client strengths can also help clients identify things who are already part of their lives have not yet been recognized as a strength. For example, counselors may need to encourage clients to reach out to a friend in their church or spiritual community, or to reconnect with former classmates through an alumni group. Counselors can also ask, "Who is your favorite person in your family?" Most clients have an answer to that question, Church says, and counselors may then suggest that they call that family member to reconnect and find support.
In order to focus on the clients' strengths, a strong therapeutic bond must also be forged to find out what their strengths really are, says Clark. "What appears to be someone's strengths at first could [just] really be something they are good at," she notes.
Clark once worked with a client who was doing her PhD and had a successful job at a local university. The client was very logical, calculated, and organized – a type eight in the Enneagram – but she was also very sad and grappling with suicidal thoughts.
Clark's counseling work with this client focused on the regulation of emotions, dealing with their fear triggers and the use of their spirituality. When they entered into a therapeutic alliance, Clark began to understand – and in turn, helped the client understand – that the client's organizational skills were not really their forte.
"She had to have things exactly the way she wanted to deal with her fear," remembers Clark. “Your organization was a skill to keep fears at bay. Her real strengths were listening and helping her students identify goals and make plans to get there. When she is in this help mode and gives control to other people, she can find peace. "
During the admission, the client had shown strong thoughts of suicide. Six months later, she tearfully entered a session with Clark and exclaimed, "This is the first time in 30 years that I have not felt suicidal." Those feelings had ebbed because the client learned to regulate her emotions and her self-esteem had increased, says Clark.
The client's story included abuse and neglect, and she had "spent her entire life proving she was worth it," says Clark. "Now she believes that she is worth it. This is the paradigm shift from an external to an internal trust."
The client has completed a second master's degree and has got used to walking every day.
"To be able to use the strengths of a customer [in counseling] you have to develop a relationship with them, to hear their story and to hear what their strengths really are," says Clark. “We looked at her overall picture of wellness to find out what she wanted [to improve about her life]. The root of this was that she wanted to stop feeling these painful feelings and didn't want to die [by suicide]. "
Advising a customer without considering all facets of their wellbeing is like buying a car that is based on color rather than fuel economy and other factors, says Clark. "It's not just the person in your office. It's their job, their family [and] the whole system. If you don't ask the questions to get to know the whole person, if you don't look at outside factors and offer concrete opportunities to achieve what they need and want … [counseling] will not break the cycle. "
The whole picture
Research continues to confirm what wellness practitioners have long recognized: "Physical health, spirituality, social support, mental and emotional health, and all of these systems are interconnected and mutually influencing," says Church.
"If we are only talking about a client's feelings or, for example, about fear … it is really important to understand where the root of this fear lies, but what factors also help you to deal with it?" [Ask clients,] “What are your social supports? How much caffeine do you drink How is your sleep “We know that everything has an impact on how you feel. … If you don't take all of that in, you are missing a key factor that will help people feel good, ”says Church.
Hailey Shaughnessy, a licensed Florida mental health advisor, sees the benefits of holistic focus in her work as a therapist in the cardiology department of Sarasota Memorial Hospital. The hospital uses Dr. Dean Ornish is used to treat heart disease and not only enrolls patients in medical treatments, but also in a multidisciplinary program that includes exercise classes, nutritional counseling, and therapy sessions aimed at relieving stress, regulating emotions, and promoting mental health.
Shaughnessy, who also has a private counseling practice in Sarasota, says many of the heart patients she sees in hospital for therapy are concerned with issues of emotion management (particularly those related to anger) and stress. Patients are also screened for anxiety, depression, and other mental illnesses. Before treatment, Shaughnessy said, patients often go unaware that emotions have a direct impact on their physical health, particularly the heart.
In sessions with cardiac patients, Shaughnessy sometimes reads passages from Deb Shapiro's book Your Body Speaks Your Mind: Deciphering the Emotional, Psychological, and Spiritual Messages That Underlie the Disease. In response, Shaughnessy often sees these patients nod or hear them say, "That's me."
According to Shaughnessy, patients often see tremendous improvements, not only in terms of their physical health, but also in terms of their general quality of life and in less time than if they did not receive multidisciplinary treatment.
“The brain is not separate from the body. Your emotions affect your brain and, in turn, your body, ”says Shaughnessy, an ACA member whose first career was as a personal trainer and fitness trainer. “[Wellness] is something I believe in deeply and practice myself. I know how much better I feel when I work out. I know how much more confident I have when I'm [physically] strong, ”she says.
Shaughnessy grew up in a family where girls were not encouraged to exercise. When she started training in college, she noticed a corresponding surge in mood. "I've seen for myself how these different things have affected me personally and I really believe that if you can help me, you can help others," she says.
Asking the right questions
Many of the consultants interviewed for this article not only rely on the strengths of the customer, but also combine a wellness focus with a thorough revenue process. This requires targeted questions to be asked to understand and monitor all areas of a client's wellbeing, from whether they have a family doctor and regularly bring vitamins to their social support, home environment, and family of origin.
Jen Monika McCurdy is an LPC working in a wellness setting in her private St. Louis practice specializing in maternal mental health. Your admission form contains full sections with detailed questions about clients' medical health and medical history (including any prescribed or non-prescribed medication they are taking), exercise habits, and other areas of wellbeing. In the sleep section, she asks clients how easily they fall asleep, whether they are dreaming, and whether they feel refreshed when they wake up. McCurdy primarily advises female clients, so she also asks specific questions about their menstrual cycle and how it affects their mood and functioning.
All of this information helps her treat clients holistically, going beyond their diagnoses or presenting problems, says McCurdy. When working with peripartum clients, the wellness framework is a natural fit, she explains, as social support, sleep patterns, prenatal vitamins, water intake, diet, exercise, and other wellness indicators for nursing mothers, clients undergoing fertility treatment, and those essential are battling postpartum stress.
"With a wellness approach, you don't just work with fear [or another presenting issue] but with the whole person," says McCurdy, a member of ACA. "It empowers them that their illness does not define them and empowers them to tell their story."
Church also uses a thorough questionnaire with customers, noting that open-ended questions help customers tell their story. Not only does she ask about a client's sleep, but she also asks them to walk them through their evening and bedtime routines. Do they log into Facebook or have a glass of wine after putting the kids to bed? How much caffeine do they normally consume and what time of the day?
From there the Church will move on to psychoeducational care for clients, talking about what a normal sleep cycle looks like (and confirming that it is normal to be awake at night), how alcohol affects metabolism, and How Both alcohol and the blue light emitted by electronic devices can disrupt sleep.
"If I were to speak to a beginning practitioner [about wellness] I would say, 'Mind, body, spirit – it's really important to get these things into recordings and sessions,'" says Church , an ACA member. "Because we humans can teach all skills and coping mechanisms and all kinds of models, but if we don't help them to use [and draw from] other aspects of their lives, we're really seeing them through a narrow, narrow lens." We see it as a diagnosis rather than a whole person. "
Several of the consultants interviewed for this article found that a wellness perspective also includes working closely with other professionals in referring or co-treating clients. This can include a range of practitioners, from chiropractors and doctors to massage therapists, acupuncturists, and physical trainers. Shaughnessy often works with a nutritionist who can advise her clients in private practice about their diet and map their gut microbiome, as well as with a specialist who conducts sleep studies. As a maternal mental health specialist, McCurdy has made connections with infertility clinics and gynecologists in her area.
"It is very helpful to think of a customer as a team," says McCurdy. "I can't be your sleep specialist, but I can talk [in counseling] about the importance of sleep. But if you have a potential sleep problem, I have to let you support [from a specialist]. It is my worth and my duty to give you this support." to let. "
For McCurdy, one of the most important parts of the wellness framework is that counselors are ready to practice what they preach. This includes everything from self-compassion to maintaining social relationships to meditation exercises and consistent physical exercise
Counselors must also show empathy about how difficult it can be to talk about and monitor aspects of one's lifestyle that are very personal. "If you want to preach wellness to someone, you have to believe that it is important and share that value with them," says McCurdy. "When you have a wellness perspective, always think about how things will work systemically – how an intervention in life [a client’s] will work in your family, in your community. We have to keep this truth to ourselves too … we must acknowledge that when you are mentally troubled it is not easy to go for a run, not drink beer, and eat healthily, honor the concept of where the customer is, and hope for him [that they can get there]. "
Desposito recognizes the importance of asking questions about nutrition and other areas of wellbeing, but cautions that asking too many questions can cause customers to become discouraged. He uses wellness models, including the eight dimensions of well-being (social, environmental, physical, emotional, spiritual, professional, intellectual, and financial) referenced in the Drug Abuse and Mental Health Agency wellness initiative to assess which Areas of a client's wellbeing are severely affected and may need special attention.
Wellness goes far beyond exercise and other physical indicators, says Desposito, who recently co-authored an article in the Journal of LGBT Issues in Counseling on promoting identity well-being in LGBTQ + youth. "If I only look at physical factors, I am only making a compilation of my client," he says. "We cannot say," This is the best answer. "We have to evaluate what the client values. We have to help the client find their values and adjust [our counseling] to their values, but temper that with a multicultural lens. Yes, it's great to take vitamins, but what is if you can't afford it? "
"A wellness framework doesn't say, 'This is wrong,'" continues Desposito. "It says," What can we do to use this [aspect of a client’s life] to help? "
Counselors must also remember the parameters of their role and not make medical or other recommendations that are outside their field of activity.
On questions about psychoeducation
For the Church, an important first step for clients is often to normalize the feelings they experience and to explain their biological connections. For example, she says, a client who exercises excessively may not realize that the nervous system interprets this physical stress in the same way as the stress a person experiences at work or during a divorce.
“Normalize these feelings and don't pathologize them. Explain [to the client]"This is your body that motivates you to change," says Church. “Then explore the changes they can make. Maybe a support network or whatever it takes for that person to create it. "
Wellness counselors examine not only what brought a client into therapy, but also the relationship that problem has with the client's spiritual life, emotional health, and other areas of wellbeing, Church points out. "We are very keen to bring those aspects into the session, to raise customers' awareness of the issues that may affect why we are here, and then to follow suit."
Church once worked with an adult client seeking advice after a long-term relationship had broken up. He experienced intense feelings of shame, vulnerability, fear and sadness. He's also faced a loss of identity and struggles to figure out who he was outside of the relationship, she says. All of this led to frequent fits of crying.
As a wellness advisor, Church helped the client understand the biological and physical relationships with the emotions he was feeling and how they can be used to induce healing. Part of it, Church says, was offering psychoeducation about how the nervous system and our fight or flight response work, and how that left him nervous and “emotionally everywhere”.
The client also had trouble sleeping and turned to alcohol to cope with it. In meetings, Church explained that lack of sleep inhibits the body's ability to deal with stress and discussed how alcohol further exacerbates this cycle. She also worked with the client's doctor when a psychotropic drug was prescribed to help the client.
In counseling, Church and the client worked to identify and manage his anxiety triggers and to find connections that extend beyond his ex-partner. The relationship had represented his entire immediate social circle, and they worked to rebuild it based on bonds he already had through work, family, and old friends.
This also included the client being able to ride a bike again, an activity he had once enjoyed but which he had largely stopped during a relationship. Getting back on his bike not only lifted the customer's spirits and eased their stress, but also helped them find an identity outside of their relationship with their ex-partner. It also led him to find a social connection when he started riding a local bike group. 
Over time, the client managed to make decisions based on a thoughtful response rather than an emotional response, says Church. "Dies ist eine Person, die [previously] nicht viel darüber erzählte, wie er sich fühlte. Jetzt kann er mit großen Gefühlen umgehen und wird nicht überfordert “, sagt sie. "Er ist in der Lage, seine körperlichen und emotionalen Empfindungen und Gedanken auf hilfreiche Weise einzubeziehen und einige seiner körperlichen Wellness-Dinge wie Fahrradfahren und die Mäßigung seines Alkoholkonsums zu nutzen, um all dies zusammenzubringen." Außerdem hat es ihn wirklich geöffnet [to see]was für ihn ein bedeutungsvolles Leben ist. “
Für McCurdy beinhaltet die Psychoedukation mit Kunden oft die Kraft des Journaling. Sie bittet Kunden, ihre Ess-, Bewegungs- und anderen alltäglichen Indikatoren in einem Tagebuch zusammen mit ihren Emotionen und ihrem mentalen Zustand zu erfassen. Dies hilft Kunden, die Punkte zu verbinden, sagt sie. Zum Beispiel könnten Kunden bemerken, dass sich ihre Stimmung am Tag nach dem Trinken von Alkohol verschlechterte.
Shaughnessy empfiehlt ihren Kunden auch das Journaling sowie die Verfolgung von Schlaf, Bewegung, Nahrungsaufnahme und Vitaminaufnahme sowie Stimmungen. Berater fragen in der Regel bei Kunden nach, wie sie auf Psychopharmaka reagieren, die sie möglicherweise einnehmen. In ähnlicher Weise, so Shaughnessy, sollten Berater die ganzheitlichen Aspekte der täglichen Routine ihrer Kunden prüfen.
McCurdy führt ihre Tagebücher und sagt ihren Kunden: "Alle Ihre Gedanken sind wichtig – die hoffnungsvollen und die beängstigenden." In Sitzungen bittet sie Kunden, über etwas zu sprechen, das gut läuft, "auch wenn es das Kleinste ist".
Sie fordert Kunden außerdem auf, Listen von Dingen zu erstellen, für die sie in ihren Zeitschriften dankbar sind. Dies alles mit dem Ziel, Kunden zu stärken und sich auf ihre Stärken zu konzentrieren, insbesondere wenn Umstände wie Fehlgeburten oder Unfruchtbarkeit ihnen das Gefühl geben, dass so viel außerhalb ihrer Kontrolle liegt. McCurdys Arbeit mit peripartalen Klienten beinhaltet oft die Regulierung ihres Selbstgesprächs und die Ausstattung mit positiven Affirmationen wie "Ich werde das überleben" oder "Ich kann das durchstehen". Für Klienten, die sich einer Unfruchtbarkeitsbehandlung unterziehen, arbeitet sie daran, mit ihnen im Voraus zu planen, damit sie ein Toolkit mit Bewältigungsmechanismen – insbesondere sozialer Unterstützung – für die beiden angstauslösenden Wochen zwischen dem Zeitpunkt der Fruchtbarkeitsbehandlung und dem Zeitpunkt eines Schwangerschaftstests erhalten
Mit allen Kunden in der Sitzung sagt McCurdy: "Ich höre zu, was für sie funktioniert, und arbeite daran. Ich frage Kunden oft: „Was läuft heute gut für Sie? Was freut dich? Was ist gut gelaufen und wovon können wir mehr tun? “… Und [I] feiern auch ihre Siege. Ich sage Kunden, dass ich stolz auf sie bin, voller Ehrfurcht vor ihnen. Die Tatsache, dass Sie Ihre Haare hochlegen, Ihre Schuhe anziehen und nach draußen gehen konnten, ist ein Gewinn. Nur zum Briefkasten zu gehen, ist ein Gewinn. Ehre den Mut, den sie dafür brauchten. “
Mehr als Massagen
Das Wort Wellness ist genau die Definition von Beratung, die von ACA verwendet wird und vor mehr als einem Jahrzehnt im Zeitraum 20/20 entwickelt wurde: Eine Vision für die Zukunft der Beratungsinitiative: „Beratung ist eine berufliche Beziehung, die verschiedene Personen und Familien befähigt und Gruppen, um psychische Gesundheits-, Wellness-, Bildungs- und Karriereziele zu erreichen. “
Wellness wird manchmal in vereinfachenden Begriffen gesehen, aber in Wirklichkeit hängt es mit dem Ruf des Berufs nach sozialer Gerechtigkeit zusammen, sagt Desposito, "weil Sie [clients] dort treffen, wo sie sich befinden und ihre Erfahrung honorieren."
“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.”
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Action steps for more information:
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Contact the counselors quoted in this article:
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Related reading
Book titles recommended by the counselors quoted in this article:
Your Body Speaks Your Mind: Decoding the Emotional, Psychological, and Spiritual Messages That Underlie Illness by Deb Shapiro
Spark: The Revolutionary New Science of Exercise and the Brain by John J. Ratey
Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker
Intuitive Eating by Evelyn Tribole and Elyse Resch
The Body Keeps the Score by Bessell Van der Kolk
Start Where You Are: A guide to compassionate living by Pema Chodron
Exercise-Based Interventions for Mental Illness: Physical Activity as Part of Clinical Treatment by Brendon Stubbs and Simon Rosenbaum
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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at [email protected].
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
