Wellness and Wellness Counseling Notes

Wellness and Wellness Counseling: History, Status, and Future

Abstract

Wellness and wellness counseling, despite professional and empirical support, are largely absent from counselor preparation standards and ethical codes.
The authors summarize the current state of these concepts and provide suggestions to enhance documents and utilize wellness competencies to advance counseling research and practices.

Keywords

Competencies
Counselor identity
Ethics
Wellness

Wellness as a Foundational Concept

Wellness is a foundational concept within the counseling profession, a defining characteristic of counseling practice, and an outcome sought with clients.
Defined in the initiative, 20/20 A Vision for the Future of Counseling, counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals (Kaplan et al., 2014).
Wellness has roots extending deeply into the profession’s founding (Myers, 1992; Witmer, 2013), refined with Adlerian concepts (Sweeney, 2019), and extended with multicultural social justice principles (Conyne, 2015; Prilleltensky, 2011).
The American Association of State Counseling Boards (AASCB, 2018) recognizes counseling as a central change agent for mental health and wellness.
Chi Sigma Iota (CSI) affirmed that wellness counseling is a defining characteristic of professional counselors’ identity and adopted a leadership position for promoting professional counselor identity with wellness counseling.
The Counselor Wellness Competencies (CSI, 2020) hold promise for integrating wellness among counselors with wellness counseling practices.
Wellness counseling practices remain largely absent and underdeveloped in profession standards and training.
The 2014 ACA Code of Ethics minimally addresses wellness, often using the term well-being, which commonly denotes life satisfaction (Cooke et al., 2016) rather than the holistic, mind-body-spirit conceptualization of self suggested by the term wellness.
The 2016 Council for Accreditation of Counseling and Related Educational Program (CACREP) Standards uses “wellness” as the preferred term, but it is scantly found.
Wellness counseling research is underdeveloped yet holds great promise as a signature practice for the profession.
Wellness research has largely focused on wellness outcomes and correlates (Shannonhouse et al., 2020; Sweeney, 2019), but less so on wellness counseling practices (Myers & Sweeney, 2008) and related ecological contextual factors (Reese & Myers, 2012; Sweeney, 2019).
Emerging wellness counseling intervention studies show good initial evidence to support its application in the field (Myers & Sweeney, 2008; Ohrt et al., 2019).
Wellness has as its desired outcome living long and living well.
Decartes (1596–1650) is credited as the source of a philosophy of explaining human functioning based on scientific reasoning (Myers & Sweeney, 2005a).
Western medicine has functioned under the assumption that one treated the body or the mind, but organizations like WHO and SAMHSA embrace a holistic approach to health and healing.
The counseling profession’s developmental, holistic, and life span approach to helping is more relevant today than at any time in recent history.

Wellness as an Essential Counseling Principle

Wellness is defined as a way of life oriented toward optimal health and well-being, in which body, mind, and spirit are integrated by the individual to live life more fully within the human and natural community (Myers et al., 2000, p. 252).
It is both an outcome and a process, attending to the holistic health one may achieve, as well as the means by which one reaches these ends (Sweeney, 2019).
Adler has been attributed for founding wellness practices within the context of mental healthcare (Sweeney, 2019).
His theory, Individual Psychology, challenged the concept individuals are segregated and composed of competing parts, as posited by Freud (Sweeney, 2019).
Individual psychology posits the concept that humans—mind, body, and spirit—are “indivisible.”
Positive psychology possesses elements of the wellness perspective (Witmer, 2013), but it does not necessarily suggest a holistic conceptualization of the individual or their overall wellness (Sweeney, 2019).
Positive psychology has been criticized for its lack of attention to multicultural issues and other contextual factors (Ivey et al., 2012).
The counseling profession has always attended to a holistic understanding of the individual (Myers, 1992; Witmer, 2013).
The American Association for Counseling and Development codified this commitment to wellness for all society’s individuals through its 1989 resolution: The Counseling Profession as Advocates for Optimum Health and Wellness (Myers, 1992).
Wellness has emerged as an essential pillar of the practice of counseling (Kaplan, et al., 2014).
Wellness and empower were the most commonly used terms across all first-round definitions, and thus essential to the final version (Kaplan et al., 2014).

Wellness Counseling in Practice

One of the most comprehensive and empirically validated models is the Indivisible Self (Granello & Witmer, 2013; Ivey, et al., 2012; Myers & Sweeney, 2008; Roscoe, 2009).
Its precursor, the Wheel of Wellness, is a theoretical model also based in Adler’s psychology (Sweeney, 2019).
Understanding the key elements and assumptions of this model will enable professional counselors and counselor educators to distinguish how it is used to assess overall wellness and engage in wellness counseling practices.
Sweeney (2019) documented the evolution of wellness counseling models, beginning in the early 1990s as he and Witmer examined the literature on correlates of quality of life, health, and longevity.
Influenced by Adlerian theory, they developed an early model that would be revised in collaboration with Jane E. Myers, resulting in the Wheel of Wellness (Myers et al., 2000).
In this model, wellness was conceptualized around 5 life tasks and 12 subtasks.
At the center of the wheel is spirituality, the central most task of this model, with self-direction and its 12 subtasks extending outward toward the remaining three life tasks: love, friendship, and work and leisure.
The 12 subtasks include sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self-care, stress management, gender identity, and cultural identity (Myers et al., 2000).
To assess wellness with this model, Myers et al. (2000) developed the Wellness Evaluation of Lifestyle (WEL).
Over a decade of data collection led to the development of a large empirical database that was analyzed using structural equation modeling (Hattie et al., 2004); however, the Wheel of Wellness Model could not be used to explain the resulting analyses.
The outcome of exploratory and confirmatory factor analyses resulted in a clearly defined structural model, still based in Adlerian theory, now evidence-based, and called the Indivisible Self (IS-Wel; Myers & Sweeney, 2008).
This model and its Adult form of the Five Factor Wellness Inventory 5F-Wel have been translated into more than a dozen languages.
The Indivisible Self (Myers & Sweeney, 2008) reflects a single holistic factor (Wellness) to which five second-order factors contribute including: The Essential Self, Creative Self, Social Self, Physical Self, and Coping Self.
All 17 factors from the original Wheel of Wellness (Myers et al., 2000) were supported as third-order factors in the new model; however, the conceptualization of spirituality at the center was not supported nor were the third-order factors with each other as originally conceived (Myers & Sweeney, 2008).
The Indivisible Self demonstrated the multiple and interrelated dimensions of wellness.
Myers and Sweeney (2004) revised their understanding of contextual life forces that shape the individual, incorporating and modifying some of the ecological concepts originally purported by Bronfenbrenner (1999).
These variables include local (microsystem), institutional (macrosystem), global (retained from the original model), and chronometrical factors.
As these elements were not included in the 5F-Wel or its earlier versions, they are supported conceptually in the literature, but to date there is little empirical understanding of how these factors fit with the overall wellness model (Reese & Myers, 2012).
Perspectives such as EcoWellness (Reese, 2016) and Ecological Counseling (Cook, 2012) both expand upon Myers’s and Sweeney’s work and offer opportunities to conceptualize the impact of these ecosystemic factors and to research novel approaches that impact overall wellness.
Wellness counselors understand the dynamic and interrelated nature of this holistic model, building on client strengths and their choices to maximize overall wellness (Myers & Sweeney, 2004, Ohrt et al., 2018).
Myers and Sweeney (2005b) and Sweeney and Myers (2005) each describe wellness counseling as a process of assisting clients with changes in habits and behaviors throughout two major phases: (1) assessment and treatment planning, followed by (2) the delivery of wellness counseling interventions.
In Myers and Sweeney’s (2005b) model focusing on assessment and treatment planning, there are six steps including: (1) assessing overall wellness and a targeted area for change; (2) assessing the readiness for change in that specific area using the transtheoretical model (Prochaska et al., 1992); (3) collecting baseline information on the thoughts, feelings, and behaviors associated with this targeted area; (4) taking additional assessments to draw on strengths and resources for change; (5) researching this targeted area for change, positive outcomes that may result, and strategies to change; and (6) the final development, implementation, and evaluation of the change plan, allowing for revisions as needed.
Sweeney and Myers (2005) subsequently widened their perspective on the wellness counseling approach, suggesting four steps in delivering wellness counseling interventions including (1) introducing clients to the wellness model; (2) conducting formal and informal assessments of dimensions of wellness and their satisfaction with those levels of wellness; (3) selection of one or two areas of change and appropriate interventions as well as identification of internal and external resources to facilitate and support these changes; and (4) evaluation of behavioral change through ongoing tracking.
A distinguishing characteristic of wellness counseling is the cross-dimensional strengths facilitation, where clients are encouraged to not only identify their strengths, but also to use the “assets” of other wellness areas to improve the one(s) primarily targeted for change (Fullen, 2016; Granello, 2013; Myers & Sweeney, 2004; Ohrt et al., 2018; Sweeney & Myers, 2005).
It is also future-oriented in that practitioners help clients conceptualize wellness goals and may engage in solution-oriented visioning practices (Sweeney & Myers, 2005).
The Indivisible Self provides an empirically supported conceptualization of the multidimensional aspects of one’s overall wellness.
Wellness counseling practices offer a structured approach to comprehensive assessment and strengths-based treatment that facilitates change across these dimensions of the whole self.
Since the development of the Indivisible Self, subsequent wellness models have been proposed in the counseling profession (e.g., Granello & Witmer, 2013; Ohrt et al., 2018); however, to date these models are yet to be empirically validated.

Wellness and Wellness Counseling Research

Following the development of the WEL and subsequent editions up through the 5F-Wel, there has been substantial research about many of the wellness factors and their relationship to overall wellness in many populations.
Shannonhouse et al. (2020) screened over 100 reported studies using the 5F-Wel to conduct a psychometric synthesis of its properties for both practice and research.
The 5F-Wel is a common and structurally sound instrument used to assess wellness.
Myers and Sweeney (2008) reviewed the literature on wellness counseling, with a specific emphasis on the Indivisible Self model.
These and subsequent wellness counseling studies have included culturally diverse samples such as Appalachians (Mynatt et al., 2014), Native Americans (Garrett et al., 2009), Korean Americans (Chang & Myers, 2003), African Americans (Spurgeon, 2009; Spurgeon & Myers, 2010), Caribbean Americans (Mitchell, 2001), Turkish students (Oguz-Duran & Tezer, 2009), Korean counselors (Jang et al., 2012), as well as gay men (Dew et al., 2005), and lesbian and bisexual women (Degges-White & Myers, 2006a).
With versions for adolescents and adults, the 5F-Wel has included samples of youth (Watson & Lemon, 2011), college students (Foster et al., 2016), those in middle adulthood (Degges-White & Myers, 2006b), and older adults (Fullen et al., 2018).
Myers and Sweeney (2008) identified many correlates of wellness as measured by the WEL and 5F-Wel.
These early studies and subsequent research have shown the positive correlation between wellness and self-esteem (Myers et al., 2011), ethnic identity (Rayle & Myers, 2004), mattering (Connolly & Myers, 2003), religiosity and spirituality (Gill et al., 2010), job satisfaction (Connolly & Myers, 2003), appearance control beliefs (Sinclair & Myers, 2004), pet ownership (Chandler et al., 2015), and healthy love styles (Shurts & Myers, 2008).
Wellness is negatively correlated with stress (Gibson & Myers, 2006; Myers & Degges-White, 2007) and anxiety (Foster et al., 2016).
Clark et al. (2020) found that Physical Self wellness was associated with decreased odds of relapse days during substance use disorder treatment, and Creative Self wellness, difficulties in emotion regulation, and reappraisal were associated with increased odds of relapse days of substance abusers.
In comparison to the correlates of wellness, there are fewer wellness counseling outcome studies, and even fewer using experimental designs (Clarke et al., 2016; Myers & Sweeney, 2008).
Observational studies have shown that overall and targeted wellness domains improve among university students in orientation courses and cocurricular experiences using wellness counseling practices (Choate & Smith, 2003; Wolf et al., 2014).
Similarly, elementary aged students improved overall wellness and a majority of second-order factors after completing a school-based classroom guidance unit (Villalba & Myers, 2008).
Individual interventions with a child diagnosed with Autism also show promising results (Hartwig et al., 2008).
Two known experimental design studies have provided additional insights into the results of wellness counseling procedures.
Tanigoshi et al. (2008) found that police officers completing a five-session individual wellness counseling intervention significantly improved their wellness in comparison to a no-treatment control group.
Kwon (2015) also used a randomized control design to examine the effects of a Wheel of Wellness counseling intervention group with elderly participants (n = 93) in a Korean senior center.
There is strong evidence concerning the positive relationship between wellness and many client beliefs and behaviors of interest to counselors.
Wellness counseling interventions are effective, yet there remains a need for additional outcome research to demonstrate efficacy across populations and to better understand which elements of the intervention are most effective.
Future studies also need to include details about wellness counseling interventions, particularly the extent to which strengths among wellness subfactors are used to bolster other subfactors.
A wellness perspective among counselors is well supported, particularly as practitioners understand the interrelated dimensions of the Indivisible Self, and wellness counseling interventions have growing evidence of their efficacy and promise to be a signature practice of the profession.

Including Wellness Counseling in Ethical Codes, Preparation Standards, and Competencies

There are only minimal references to client wellness and wellness counseling in the ACA Code of Ethics and CACREP Standards, adding to the nascent wellness counseling competencies to guide professional practice.

2014 ACA Code of Ethics

In the 2014 ACA Code of Ethics, the term wellness is only noted in the Preamble, where the definition of counseling is stated, but nowhere specifically within the Codes.
Another related, but not equal term, well-being, is used seven times in the Code, more commonly as an overall good, but not necessarily a holistic multidimensional wellness perspective on the individual.
The phrase wellness counseling is also absent from the Code.
Using the term wellness is preferred as it is uniquely emphasized by counselors (Cooke et al., 2016), historically defined by optimal functioning (Dunn, 1959; Myers et al., 2000), and commonly agreed upon as holistic, multidimensional, and integrated (Cooke et al., 2016; Palombi, 1992; Roscoe, 2009).
The absence of wellness counseling as a phrase used to denote specific wellness practices is problematic as well, as there are specific ethical issues to highlight within these practices.
Given the holistic nature of wellness counseling, there is a need to understand the interrelated nature of physical, mental, and spiritual health; complementary and alternative medicines (CAMs); spiritual wellness; and referral sources for primary care (Granello, 2013).
Wellness counseling requires knowing how all aspects of one’s life affects an individual’s wellness, when to refer to another professional, and importantly, when to refrain from providing advice that falls outside one’s scope of practice.
The Code’s sections on Professional Competence (C.2.) and Relationships with Colleagues, Employers, and Employees (D.1.) could each benefit by including language specific to wellness and wellness counseling that would better guide counselor ethical decision-making.
Granello and Witmer (2013) recognize the need for responsible integration, whereby counselors are able to evaluate the services to which they refer their clients. In particular, they should ask whether they are empirically supported through verifiable research and consistent with ethical guidelines (Granello & Witmer, 2013).
Granello (2013) suggests that wellness counselors proceed with “cautious openness” (p. 68) as clients explore their options.

Professional educational standards

Similar to the ACA Code of Ethics, there are opportunities to strengthen accreditation standards for the counseling profession related to wellness and wellness counseling practices.
In the 2016 CACREP Standards, the term wellness is used only three times as follows: once in the eight common core areas (Section 2, F.) for entry-level counseling programs, once in the Addiction Counseling specialty area (Section 5. A.), and once in the Marriage, Couple and Family Counseling specialty area (Section 5. F.)
Wellness is not defined in the Glossary to Accompany the 2016 CACREP Standards.
“Wellness counseling” is absent entirely.
In the first case, wellness appears in the core area of Human Growth and Development (Section 2,.F.3.i.) as entry-level counselors understand “ethical and culturally relevant strategies for promoting resilience and optimum development and wellness across the lifespan”.
The term holistic is also largely absent from the Standards, with the exception of one Clinical Rehabilitation Specialty standard as students must learn the “effects of the onset, progression, and expected duration of disability on clients’ holistic functioning (i.e., physical, spiritual, sexual, vocational, social, relational, and recreational)” (Section 5. D. 2. m.).
In Addictions Counseling, entry-level graduates are to have learned the “role of wellness and spirituality in the addictions recovery process” (Section 5, A. 2. f.).
In the Marriage, Couple, and Family Counseling specialty standards, entry-level graduates are to have demonstrated practices that “[foster] family wellness” (Section 5. F. 3. b.).
It would be useful for the Standards to clearly define wellness and family wellness in the Glossary, consistent with the counseling literature.
The explicit use of the term wellness in the standards may reify how it is both a correlate of mental health and a desired outcome in one’s holistic care.
This also includes self-care strategies (Section 2. F. 1. l.), where career sustaining behaviors such as physical activity, quiet leisure activities, time with friends, spirituality, and mindfulness contribute to counselor wellness (Lawson & Myers, 2011), including lower levels of compassion fatigue and burnout (Thompson et al., 2014).
There are many elements of wellness counseling implicitly included such as interprofessional relationships with other healthcare providers (Section 2.F.1.b., Section 5.C.3.d.) as well as understanding the role of medications (Section 5.C.2.h., Section 5.D.2.l.) and biological and neurological functioning (Section 5.C.2.g., Section 5.D.2.i.).
Noticeably absent are standards that emphasize knowledge in holistic care practices and professionals utilizing CAM, spirituality, nutrition, and exercise outside of medical practices.
The Standards may be greatly improved through the specific inclusion of research supported wellness and wellness counseling theories and models, denoting the importance of the multiple dimensions of wellness and specific practices using them to achieve desired outcomes.

Wellness counseling competencies

It is important that the counseling profession establishes wellness counseling competencies so that practitioners and supervisors understand how to effectively serve clients, while engaging in their own wellness practices.
Such competencies will also be foundational guides for counselor educators to teach students to be competent in this signature practice.
Wellness counseling competencies may supplement and extend the CACREP Core areas of professional identity.
One early attempt to create wellness counseling competencies was by Barden et al. (2015), who focused on integrated care practices, borrowing heavily from the American Psychological Association Division 38’s (Health Psychology) clinical health psychology competencies (France et al., 2008) and adding knowledge of CAM (Granello, 2013).
A subcommittee from the Wellness Counseling Practice and Research Committee developed the CSI Counselor Wellness Competencies (CSI, 2020; Gibson et al., 2021), which were adopted by the Executive Council on November 6, 2020.
They proposed nine essential wellness competencies across a continuum of counselor-centered, professional-centered, and client-centered applied behaviors.
Individual competencies include: (1) Self-Care; (2) Personal Relationships; (3) Boundaries; (4) Stress, Burnout, and Impairment; (5) Professional Support Practices (including supervision); (6) Wellness Promotion; (7) Wellness Research; (8) Wellness Assessment; and (9) Wellness-Based Goal-Setting and Plans.

Implications for Counselor Education

Counselor educators and supervisors can play a key role in promoting wellness and wellness practices in training programs and the field.
Witmer and Granello (2005) suggested counselor education programs consider incorporating wellness training by one of three models, course specific, curriculum infusion, or holistically, that is, extending beyond the curriculum into the philosophy of the program, across cocurricular activities, and adopted personally in the lifestyles of students and faculty alike.
There are ample opportunities to infuse wellness and wellness counseling concepts into specific courses.
The CSI Counselor Wellness Competencies (CSI, 2020) may serve as a broad framework to understand how domains of wellness are interrelated, and while each may be emphasized in different courses, they are not separate from one another.
Introduction and ethics coursework may emphasize wellness as foundational to counselor identity and essential self-advocacy practices to prevent burnout and impairment (Dang & Sangganjanavanich, 2015), concerns likely exacerbated during the COVID-19 pandemic.
Assessment courses may utilize the 5F-Wel (Myers & Sweeney, 2005c), to explore their own wellness while learning how to conduct, interpret, and plan interventions with a well-researched instrument consistent with counseling principles and practices.
Group, techniques, and relationship counseling courses may train students in cross-dimensional strengths facilitation practices (Orht et al., 2019).
Practicum, internship, and supervisor training courses may utilize wellness supervision models such as the Wellness Model of Supervision (Lenz & Smith, 2010).
Multicultural and theories counseling may explore the relationships between wellness models (e.g., Indivisible Self) and multicultural and social justice counseling practices (Blount & Acquaye, 2018; Ivey et al., 2012; Prilleltensky, 2012).
As faculty consider adopting wellness holistically, it may also be useful to explore the role of cocurricular wellness activities as well as advocacy opportunities for students, faculty, and community members.
Wolf et al. (2014) demonstrated the role of CSI chapters in facilitating wellness activities.
Storlie et al. (2016) analyzed chapter activities, finding many were engaging in wellness and social justice concerns.
As counselor education faculty consider program-wide events such as fall cookouts or holiday events, they may consider adopting a wellness theme, inviting faculty and students to bring food that connects across at least two wellness dimensions (hint—it does not have to include nutrition!).
Dang and Sangganjanavanich (2015) proposed ecosystemic, interpersonal strategies to advocate for wellness in the counseling profession and the larger community.
Individuals may advocate for specific wellness policies within one’s agency, school, program, university, or community group.
Dang and Sangganjanavanich also suggest intra- and interprofessional advocacy to promote wellness, attending to “professional standards, social policies, and legislation” (p. 9).

Conclusion

There are many opportunities for counselors and counselor educators to further codify and expand upon wellness and wellness counseling as defining elements of the profession.
The counseling literature is filled with research and scholarship on the Indivisible Self, the correlates of wellness, and wellness counseling, all of which suggests the need to highlight these concepts and practices more fully in future editions of the ACA Code of Ethics and CACREP Standards.
There remains a need for the broad adoption of wellness counseling competencies among professional organizations and in counselor preparation programs.
Through these enhancements, counselors have the opportunity to encourage optimal health and wellness for all people including themselves, strengthen professional identity, and further establish an even more significant role for professional counselors among helping professions.