Models of Wellness in Counseling: Integrating Health and Well-Being

Wellness pertains both the dynamic process of optimizing and integrating the physical, mental, and spiritual aspects and the outcome of the process. According to Bill Hettler (1984), wellness is 'an active process through which people become aware of, and make choices toward a more successful existence.' Myers, Sweeney, and Witmer (2000) further describe wellness as a way of life that focuses on optimizing health and wellbeing while integrating the body, mind, and spirit to allow an individual to live life more fully within the human and natural community.

Wellness finds its roots back to over 2,000 years ago during the teachings of Aesculapius’ (the ancient Greek God of healing) two daughters, Panacea and Hygeia. Panacea believed that the way to promote healing was by treating an existing illness while Hygeia believed that the best way to prevent illness is by teaching positive ways. Statistics show the predominance of the first approach, where more than half of the deaths in the United States are caused by lifestyle factors that can be adjusted by making conscious choices.

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All the approaches to counseling focus on the importance of individual decision making, and this makes counseling a natural partner in the pursuit for wellness.

The counseling profession has its foundation on the values that seek to facilitate positive functioning, prevention, and optimum development. For this reason, the Governing Council of the American Counseling Association made a proposal in 1989 to identify counseling as an advocate for wellness and optimum health for individuals.

This digest describes the key models that originate in counseling, makes assessments of these models, and provides the results of these assessments.

It also offers suggestions of how the wellness information can be applied in counseling.

The Wheel of Wellness

The Wheel of Wellness by Sweeney and Witmer (1991) and Witmer and Sweeney (1992) was the first model of wellness that is based on counseling. It is a theoretical model emerging from the reviews of various cross-disciplinary studies where authors seek to correlate longevity, health, and quality of life. The organizing principle based on this model is provided by Adlerian Individual Psychology.

In this model, spirituality forms the center of the wheel, and its components are a sense of meaning in life and spiritual or religious beliefs and practices (Myers et al., 2000). The wheel is surrounded by 12 spokes that focus on self-direction and they direct all the activities of an individual. The spokes include a sense of worth; a sense of control; realistic beliefs; emotional responsiveness and management; intellectual stimulation, problem-solving, and creativity; a sense of humor; exercise; nutrition; self-care; stress management; gender identity; and cultural identity. The authors suggest that all of these components are interactive, where a change in one area results in changes in the other areas.

The authors developed the Wellness Evaluation of Lifestyle Inventory (WEL) based on the Wheel of Wellness, to assess the components in the model. This instrument has resulted in the development of a large database of wellness behavior that helps analyze the structure of wellness.

An Evidence-Based Model of Wellness

This model came up after Hattie, Myers, and Sweeney (2004) made an analysis of the database of the adults who had completed WEL inventory. The Wheel model had issues that made it difficult to define the factor structure developed through structural equation modeling. Myers and Sweeney (2005) came up with the Indivisible Self (IS-Wel), to help explain the factor structure and this proved the Adlerian theory to be the organizing principle providing a coherent explanation of the structural model, again.

Alder emphasized the unity and indivisibility of the self, claiming that we are more than our parts and we are indivisible. This holism is what formed the basis of Alder’s new model, where self is at the very center of wellness and is represented graphically as being indivisible. There are five-second order factors of the self: Creative, Coping, Social, Essential, and Physical and 17 third order factors that have different interrelationships than initially hypothesized.

The IS-Wel model uses the Five Factor Wellness Inventory to measure its components (5F-Wel; Myers & Sweeney, 2005). There are several versions of the same including, elementary school students (5F-Wel-E), middle school students (5F-Wel-T), adults (5F-Wel-A), among several other cultural adaptations in various languages. Like the WEL, the 5F-Wel is extensively used in counseling research.

Wellness Counseling Research

The 5F-Wel and the WEL have been used extensively as outcome measures or dependent variables, and to study wellness in various aspects. Other areas of application include program evaluation and pre-post-test measures for counseling interventions.

Myers and Sweeney (2005) summarized the various studies conducted using the Wheel and IS-Wel models in various categories to make it easier to understand this application. Several studies of wellness acknowledge the usefulness of the 5F-Wel in cultural studies. These studies examine the wellness scores based on such factors as ethnic identity and acculturation of adolescent from different ethnic groups, college juniors and seniors, adult gay males, and mid-life lesbians. The wellness scales in these cases provide the differential measures of population and subpopulation characteristics.

There are several studies of psychological correlates of wellness that use the WEL and 5F-Wel. Wellness has a positive link to such constructs as short-term state and long-term trait aspects of psychological well-being, healthy love styles, job satisfaction, and mattering, and negative links to constructs like objectified body consciousness perceived stress, and psychological disturbance.

Several translations of the 5F-Wel have been made to facilitate studies of cross-cultural differences in wellness and complete adaptations have been tested in Japan, Korea, Turkey, and Israel. Additional adaptations are in progress in Turkey, Lithuania, China, and Korea focusing on elementary school children, adolescents, and adults. The studies show major challenges regarding cross-cultural equivalence of wellness concepts. For instance, it is difficult to explain cultural identity in monocultural societies. Also, some concepts have been differently explained in other cultures.

Wellness Counseling Applications

The Wheel of Wellness and the Indivisible Self Model form the basis for individual and group counseling interventions where the WEL and 5FWel may be used to establish a baseline. Myers et al. (2000) and Myers and Sweeney (2005) provide a four-phase model for assessing and integrating wellness interventions into counseling sessions:

• Introduction of the wellness model.
• Formal and/or informal assessment based on the model.
• Interventions to enhance wellness in selected areas of the model based on the needs of the client.
• Evaluation, follow-up, and continuation of steps two through four.

Wellness counseling emphasizes strengths, personal choices, and the importance of daily decision making to achieve the goal of an increasingly healthy lifestyle.