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Counseling for Wellness

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 93
C H A P T E R

Counseling for Wellness

Laura R. Shannonhouse, Jane E. Myers, and Thomas J. Sweeney

The profession of counseling has served clients for more treated with counseling services . . . all people
than 100 years (King, 2012), and professional counsel- can benefit from counseling, fully functioning
ors provide client-centered services that foster wellness people who experience everyday stress in their
for all persons (Chi Sigma Iota, n.d.), without restric- lives and those who are seriously mentally ill
tions based on demographic factors (e.g., age, gender); can benefit from a counseling philosophy that
cultural differences (e.g., rural vs. urban); individual offers hope for a better tomorrow. (Myers,
uniqueness (e.g., disability, size); or lifestyle choices 1992, p. 138)
(e.g., religious affiliation). After a brief overview of the
interconnectedness of wellness and development, two Diagnosis and the treatment of pathology, essen-
wellness models grounded in counseling theory are tial to the medical model, have become less central
described, along with the basic steps for developing as professional counselors focus more on develop-
wellness plans and evaluating client outcomes. These mental growth for positive change. For more than
steps are explicated through two case studies demon- a quarter century, professional counseling has dem-
strating wellness-centered counseling approaches from onstrated that developmental interventions can be
both an individual and group context. used to treat pathology, and are in many cases more
impactful than the medical model (Ivey & Goncalves,
1988; Ivey, Ivey, Myers, & Sweeney, 2005). As cli-
ents address problem issues and facilitate change
DEVELOPMENT AND WELLNESS in long-standing behaviors, they begin to move
toward more optimal or “well” functioning, which
The roots of professional counseling are embedded in a can have a powerful impact on their remaining life
bedrock of development. Some of the earliest foci of the span. Consequently, the practice of developmental
profession are around career issues and working with counseling and a wellness philosophy can be seen
children (Gladding, 2012; Sweeney, 2012), and some as, “if not synonymous, at least closely intertwined”
of the earliest definitions of guidance are developmen- (Myers, 1992, p. 136).
tal in nature (e.g., Farwell & Peters, 1957). Concerned Professional counseling has therefore embraced
with positive human growth, development is viewed as an identity around developmental, preventative,
central to counseling (Ivey & Rigazio-DiGilio, 1991; and wellness-centered approaches. It is important to
King, 2012; Myers, Sweeney, & Witmer, 2000). The clearly define wellness as a construct and know how
wellness paradigm, in contrast to the medical, “ill- to apply these techniques and approaches in counsel-
ness-oriented” model of client care, shifts the focus to ing practice.
facilitating optimal growth and development in clients.
Remediation of many disorders may be reconceptual-
ized as helping clients overcome developmental chal- WELLNESS DEFINITION AND MODELS
lenges through positive lifestyle choices; growth itself
can become the target of counseling. Or, as stated by
Remley (1991) and emphasized by Myers (1992): Wellness “requires conscious choices to engage in
healthful behaviors” and results in “helping you live
We do not believe that people must first be your life more fully in all areas” (Myers & Sweeney,
diagnosed with an illness before they can be 2006, p. 3). This approach is holistic and “involves

tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
 618 n The Professional Counselor’s Desk Reference

the integration of mind, body, and spirit” (Myers & the holistic nature of wellness and working with cli-
Sweeney, 2006, p. 3). Two wellness models, namely ents on specific aspects of their wellness.
(a) the Wheel of Wellness (WoW; Myers et al., 2000) While the WoW does encapsulate the wellness liter-
and (b) the Indivisible Self Model (IS-Wel; Myers & ature and has been used to positive effect with clients,
Sweeney, 2005a), offer a framework for structuring structural equation modeling of data gathered using
interventions to enhance the well-being of persons the Wellness Evaluation of Lifestyle (WEL; Myers,
struggling from a variety of issues (Myers & Sweeney, Sweeney, & Witmer, 1998) failed to support the pro-
2005a, 2008). posed wheel model. The self-report WEL data did con-
firm that the 17 WoW components were independent
The WoW wellness factors, but the relationships among them in
the WoW were not supported, and neither did spiritu-
Using Adler’s Individual Psychology as a founda- ality emerge as a higher order factor (Hattie, Myers, &
tion and incorporating the findings from empiri- Sweeney, 2004). Results of these analyses precipi-
cal studies on health, longevity, and quality of life tated to a revision of the WoW into a more empiri-
across disciplines, the WoW is a theoretical model cally robust model, the IS-Wel.
that integrates 17 specific areas into a holistic con-
ceptualization of wellness (Myers et al., 2000). Five The Indivisible Self-Model of Wellness
life tasks are central to healthy human functioning:
(a) work, (b) friendship, (c) love, (d) self, and (e) spiri- The IS-Wel (Myers & Sweeney, 2005b) grew out of
tuality, with the latter hypothesized to be the most that research and illustrates Alfred Adler’s concept
important aspect of wellness, incorporating both reli- of holism, for the self cannot be divided. Supported
gious beliefs and more individualized aspects of mean- through structural modeling, the IS-Wel wellness
ing and purpose making (Myers & Sweeney, 2005b). components are highly interrelated and grouped into
As spirituality is core to many racial and ethnic groups five second-order factors. Changes in any one area of
across the world, Myers and Sweeney (2005b, 2008) wellness cause changes to other areas, which may be
noted that the WoW model has broad applicabil- for better (through positive lifestyle choices) or for
ity. Furthermore, through its simple visual depiction worse (through maladaptive behavior). This integra-
(Figure 93.1), this model is useful for teaching about tion of wellness components is shown in the model

al iness/Industry
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FIGURE 93.1 The Wheel of Wellness. ba y
ts
l en
© J. M. Witmer, T. J. Sweeney, and Ev
J. E. Myers (1996). Reprinted with
permission.

tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
 93. COUNSELING FOR WELLNESS n 619

Le
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is u
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Positive Hu
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ti

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FIGURE 93.2 The Indivisible Self: An evidence-based
model of wellness.
© T. J. Sweeney and J. E. Myers (2003, 2004).

(Figure 93.2) through dashed lines between the self studies, see Myers & Sweeney, 2008). Working from
and the second-order factors. this established research base, counselors can apply
Seventeen third-order factors are nested within the these wellness models as an evidence-based practice.
second-order factors, and include those wellness com-
ponents originally presented in WoW. These include:
(a) the creative self (thinking, emotions, control, PROMOTING WELLNESS IN
work, positive humor), defined as the sum of one’s COUNSELING PRACTICE
intrapersonal and interpersonal characteristics, which
distinguishes oneself from others; (b) the coping self
(leisure, stress management, self-worth, and realistic As with most counseling approaches, wellness coun-
beliefs), which includes the skills and resources that seling can be applied to work with individuals,
buffer one from stressors and enhances quality of life; groups, families, or communities. Within any of these
(c) the social self (friendship and love), which reflects interventions, a common four-step paradigm is usu-
experiences with and satisfaction from quality mutual ally applied. As described by Myers and Sweeney
relationships with others; (d) the essential self (spiri- (2005b), wellness counseling involves: (a) introduc-
tuality, gender identity, cultural identity, self-care), tion of the wellness model, (b) assessment, (c) devel-
which involves meaning-making processes that result opment and implementation of a personal wellness
from experiences one has in relation to self, others, plan, and (d) evaluation and follow-up. Within all
and life; and (e) physical self (exercise and nutri- four steps, clients are empowered to make lifestyle
tion), which includes health-promoting behaviors choices, whereby each choice leads toward greater
in the service of overall bodily well-being (Myers & wellness and more positive lifestyle choices. The
Sweeney, 2004, 2008). application of these four steps in practice is further
The IS-Wel and the revised WEL instrument, the elaborated subsequently.
Five-Factor Wellness Inventory (5F-Wel; Myers &
Sweeney, 2005a), have been used with varied popu- Introduction of the Model
lations across numerous studies. Myers and Sweeney
(2008) summarized this research, which showed that Clients become more committed to wellness when
wellness was a critical factor in relation to career and the concept is personalized; thus, wellness coun-
job satisfaction, relational success, self-esteem/worth seling often begins with helping clients explore the
and mattering, and cultural identity development. personal meaning of wellness and their self-assessed
Additionally, outcome studies showed the effectiveness wellness strengths and challenges to being more well.
of wellness approaches to improving stress manage- The visual depiction of a wellness model can facilitate
ment and college success (for an exhaustive list of these this process, allowing clients to see the components

tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
 620 n The Professional Counselor’s Desk Reference
of their wellness while discussing definitions of the
factors and the interrelationships among the compo-
nents in their own life. Encouraging clients to provide
examples to support the definitions and any modifi-
cations needed to personalize the definitions of the
factors is most beneficial.
Along with self-definition, self-direction is also
central to wellness counseling; personal decision
making and choices are key concepts. Clients should
explore how their lifestyle choices and decisions, in
small and more significant ways, contribute to (or
detract from) wellness. Presenting wellness in each
area as a continuum from low to high may also be
helpful. Although negative lifestyle choices move one
toward lower wellness, positive lifestyle choices cre-
ate movement toward higher wellness, and can be
affirmed throughout the counseling process.
Assessment
While discussing wellness components, self-assess-
ment is needed to personalize the meaning of each
factor for clients. This can be accomplished formally,
with a measure such as the 5F-Wel, or informally dur-
ing the counseling session. Given the large number
of factors, we encourage clients to select one or two
areas that are most present and important to them as
focus for the development of their wellness plan. By
focusing on too many factors, the potential for posi-
tive change declines significantly.
Developing and Implementing
a Wellness Plan
There are many possible choices for enhancing well-
ness, and after a thoughtful selection of which area(s)
to focus on, clients should be encouraged to develop
resources and goals for change. Helping them learn
to evaluate their own resources and goals is critical to
successful outcomes. During this process, it is impor-
tant for the counselor to assist by linking any present-
ing issues and problems with wellness components,
so that barriers to achieving goals can be identified
and discussed.
Evaluation and Follow-Up
As is true of any behaviorally oriented plan for
change, wellness counseling is a process that includes
continual evaluation of progress, examination of
choices, discussion of barriers, and assessment of
commitment. Though punishment and negative con-
sequences are sometimes suggested by clients, that
discussion may be served more by helping clients
learn to focus on strengths rather than limitations.
Over time, as clients grow and change, their goals will
tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
similarly evolve. Using a psychoeducational model to
teach wellness components allows clients to see how
change in one area contributes to changes in others,
and helps them review the components of holistic
wellness. Helping empower clients in this process can
lead to self-perpetuating growth, where choices lead
to positive lifestyle changes that enable more positive
choices.
CASE STUDIES
The following case studies were chosen to demon-
strate the application of wellness counseling in both
an individual and group context. Emphasis is placed
on the areas of wellness that may have been compro-
mised and particular wellness issues that could arise
during the counseling process. For both cases, the
authors provide details or insight from their experi-
ences with similar cases and in facilitating the well-
ness-centered group. The reader is charged with using
these examples as strategies for case conceptualiza-
tion from a wellness-oriented framework, to promote
personal growth and development and optimize cli-
ent outcomes.
Case Study 1: Alicia
Alicia is a 40-year-old, high functioning, second-grade
teacher. She enjoys daily exercise, good nutrition, and
overall reports meaningful relationships and connec-
tions in her family of origin as well as current family
system. At work, Alicia’s students traditionally excel,
scoring several standard deviations above the mean
in her grade level; she has been identified as a “mas-
ter teacher.” Alicia has reported high job satisfaction
until recently as her students’ “emotional and behav-
ioral needs have become increasingly more challeng-
ing.” Resources such as art, computer lab, physical
education, and music have been cut due to budget
deficits and to provide funding for new administra-
tive staff hired to implement and evaluate school
reforms. Children with special needs who would oth-
erwise attend English as a second language classes are
mainstreamed. Unfortunately, teachers do not have
the specialized training to adequately respond, nor
do they have teacher aids to provide support or help
enter the data required for the new reforms.
Alicia reports that the routine testing of students
is “overwhelming,” and “many report having tummy
aches due to stress.” She said, “There are always new
ways of giving feedback to students, different ways to
evaluate, assess, and collect data.” She reported that
members of the evaluation team are routinely observ-
ing her in her classroom: “They keep coming in and

check, check and check to make sure we are doing
it according to the standard, it’s like the Gestapo.”
Alicia reported, “I have been teaching for 18 years,
however I cannot say anything about any of the
changes,” “I do not have any power over my class-
room,” and “they have taken all the fun out of teach-
ing.” Alicia was recently asked to serve as a mentor
to a new teacher who is struggling with controlling
the behavior in her classroom. Alicia now co-teaches
with this teacher, “While providing mentorship is
meaningful, it is an added stress as I’m responsible for
her development too, and our class size has doubled.”
Furthermore, Alicia reports feeling “powerless,”
“undervalued,” and “worried about the future.” She
reported these feelings have disrupted her sleep as
well as anger at herself for snapping at her husband
and son. Discouraged and disheartened she stated, “I
am myself as a mom or as a teacher . . . I remember
when I could tailor assignments to the learning level
of the individual student—we had a great grade level,
great team, we shared resources, we loved teaching
and we were good at it.”
When presented with the wellness model, Alicia
may identify a lack of control at work and unsatisfac-
tion with her work (creative self) as problem issues.
She has acknowledged that these issues are impact-
ing her life outside of work through disrupted sleep
and personal relationships, and so her focus may
naturally gravitate toward exploring–improving her
ability to deal with the changing demands of her job
(coping self). Although such a goal seems appropriate,
it would also be wise to integrate into her wellness
plan, the wellness strengths she brings, including her
habits of healthy exercise and good nutrition (physi-
cal self), and the meaningful relationships she has
with her support network of colleagues (social self).
Alicia traditionally has had effective strategies at cop-
ing with work stress and as a professional counselor
you can help her see the interconnectedness of these
components to her overall wellness. In the moment,
Alicia currently recognizes how deficits in one area
of wellness can easily spill over to others (e.g., how
she has started having diminished interactions with
her family), and the IS-Wel model can help her see
that the reverse is true and that she can continue to
make lifestyle choices that lead toward greater well-
ness and more resiliency. As wellness counseling with
Alicia progresses through strengths-based counsel-
ing and work on self-care and coping strategies, the
changing nature of her chosen profession (what does
it mean to be a teacher in today’s schools?) may lead
to existential issues and require a deeper explora-
tion of her essential self. However, her wellness plan
evolves through the four-step model, and the result-
ing impacts across her wellness domains will be with
her for the rest of her life span.
tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
93. COUNSELING FOR WELLNESS n 621
In addition to her personal wellness, school coun-
selors can also consider the wellness of the system.
Alicia feels powerless in her current job and, in fact,
may not be empowered in the educational system.
Unfortunately, this experience is far too common
in education, as reflected in the high burnout rate
among teachers (National Commission on Teaching
and America’s Future, 2003). Feeling powerless,
without a voice, and trapped in one’s current work
environment can lead to anxiety, depression, and
lessened effectiveness in one’s professional roles.
Professional counselors may choose to implement
an Employee Assistance Program where teachers can
dialogue about their struggles and connect with an
internal advocate who can help create needed change.
Perhaps, this advocate can work with and on behalf of
teachers, bringing their concerns to both the admin-
istration and the county. In addition to the myriad of
school reform models, there are some policies being
implemented in which teachers will be paid according
to their child’s progress and not on the services pro-
vided. This policy places stress on the system; school
counselors must be able to think systemically about
the types of concerns within them, and how they are
impacting positively or negatively the wellness of all
stakeholders.
Counselors can offer personal counseling, group
counseling, and psychoeducational services from a
wellness perspective. Although Alicia may be reluc-
tant to seek counseling, she may willingly partici-
pate in a psychoeducational group designed to help
teachers cope with system changes and budget and
resource cuts, as well as changing generations of stu-
dents and parents. No doubt she would quickly find
that other teachers share her concerns and challenges.
Through positive reframing, perhaps she and her col-
leagues could reconnect with some of the joys of
teaching and the reasons they were drawn to this pro-
fession. Further, this has the potential to positively
impact many teachers who share Alicia’s experience.
The importance of social support in relation to well-
ness cannot be overstated.
Case Study 2: The Group Experience
In addition to using wellness as an approach to indi-
vidual counseling, it can be implemented in group
contexts, serving as the organizing principle by which
to structure a group experience. In particular, the
application of wellness is beneficial when working in
a setting that incorporates multiple facets of the group
members’ identity as the holistic nature of wellness
recognizes the importance of all aspects of a person
and capitalizes on the interconnectedness of them to
the whole. Recently, the qualitative and quantitative
outcomes of implementing a wellness-oriented group
 622 n The Professional Counselor’s Desk Reference
with cancer survivors were published (Shannonhouse
et al., 2014), which speak in depth about the ben-
efits of using wellness counseling in a group context
and may serve as a model for structuring other group
experiences for specific client needs or populations.
The basic structure of that group counseling experi-
ence is discussed subsequently with a brief note to
how it specifically impacted the wellness of group
members.
The Finding Your New Normal (FYNN) group
met for 2 hours weekly for 8 weeks and was designed
around the theoretical WoW model to improve holis-
tic wellness in breast cancer survivors that were in
remission. Wellness was an appropriate underlying
structure for this group as the focus of FYNN was
on helping participants build a new comprehensive
identity after having undergone an experience that
dramatically impacted all aspects of their life. An
interdisciplinary team including a chaplain, nurse, and
mental health counselor used their combined expertise
to address topics such as spirituality, medical manage-
ment, and emotional health, along with other facets
of wellness. After introducing roughly two dozen
group members to the WoW, group sessions began
with some form of physical activity (e.g., yoga, Pilates,
water aerobics, etc.), followed by a psychoeducational
presentation (on a specific component of wellness),
and then concluded with a group discussion.
Changes in group members’ wellness were quan-
tified using the 5F-Wel-A (Adult Form; Myers &
Sweeney, 2008) and captured qualitatively through
structured interviews. 5F-Wel results showed signifi-
cant positive increases in total wellness and three of
the five IS-Wel second-order wellness factors: coping,
essential, and physical self. Interview data corrobo-
rated those results as themes emerged through con-
sensual qualitative research (CQR; Hill et al., 2005)
that corresponded with third-order wellness factors
that comprise the three significantly impacted well-
ness domains (e.g., spirituality, gender identity, nutri-
tional and exercise habits, etc.). Particularly, group
members appreciated an emphasis on coping strate-
gies and getting “more tools in their belt.” The cen-
trality of spirituality to wellness was also observed
with this group as those participants who mentioned
appreciating that aspect of the group’s structure dis-
played increases in total wellness, while the converse
was also observed. Additionally, having a variety
of activities to serve as models for physical wellness
proved beneficial as it accommodated the diverse
proclivities of the participants; however, more homo-
geneous groups may benefit from focusing more spe-
cifically on certain wellness behaviors.
Of all the findings from the example of the well-
ness-oriented FYNN group, the one that is most
salient toward incorporating wellness into group
tebnicki, M. A. P. L. C. (2015). <i>The professional counselor's desk reference, second edition</i>. Retrieved from http://ebookcentral.proquest.com
counseling is the impact of shared experiences on
group members. Having access to all of the combined
experiences and narratives of how their peers were
navigating the myriad aspects of wellness was a pro-
found source of strength for participants. Although
this benefit of a group format is not unique to wellness
groups or to cancer survivors, the narratives analyzed
from the FYNN group point to how group members
appreciated hearing the example of others on mul-
tiple aspects of wellness (e.g., how they were adapting
to new priorities and emotions, coping, and making
meaning, etc.). As seen in this example, holistic well-
ness may be a positive addition to group counseling,
as the shared experience and social support provided
in this context work synergistically at enhancing the
wellness of group members’ social and coping selves.
CONCLUSION
This chapter focused primarily on one of the core
qualities of the professional counselor: a commitment
to wellness. Interrelated with development, personal
growth, and prevention, wellness informs the way
counselor assess client needs, develop and implement
wellness plans, and evaluate client outcomes. Two
wellness models were described, along with strategies
for integrating wellness counseling into counseling
practice through case studies. Additional information
may be found at http://wellness-research.org/well-
ness/docs/wellness.htm.
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