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Article Excerpt
Although the concept of wellness is central to the flourishing current positive psychology movement (Seligman & Csikszentmihalyi, 2000; Seligman, Steen, Park, & Peterson, 2005), it has a long history in counseling. Myers (1991, 1992) viewed wellness as the central paradigm for counseling and development. Furthermore, several theories or models of wellness (Adams, Bezner, & Steinhardt, 1997; Greenberg, 1985; Hettler, 1980; Lafferty, 1979; Renger et al., 2000) and wellness instruments (e.g., Optimal Living Profile, Renger et al., 2000; Perceived Wellness Survey, Adams et al., 1997) have been developed. Despite significant attention to wellness in the literature, there is surprisingly little consensus on the definition of the construct.
Although several authors have proposed definitions (Ardell, 1977; Clark, 1996; Dunn, 1977; Edlin, 1988; Greenberg, 1985; Jensen & Allen, 1994; Lafferty, 1979), the models contain different dimensions of wellness (focuses and number of dimensions), and an integrated definition has not been created. Clarifying the definition of wellness is difficult because of the subjective nature of the construct (Kelly, 2000) and because of the inherent value judgment about what wellness is and what it is not, and the implication that one can be either well or not well (Sarason, 2000).
There is some alignment, however, on the nature of wellness. Most authors generally agree that wellness is a multidimensional, synergistic construct (Adams et al., 1997; Ardell, 1977; Dunn, 1977; Hettler, 1980) that is represented on a continuum, not as an end state (Clark, 1996; Dunn, 1977; Lafferty, 1979; Lotion, 2000; Sarason, 2000; Sechrist, 1979; Teague, 1987). Most definitions also include the assumption that wellness is not just the absence of illness (Ardell, 1977; Edlin, 1988; Lafferty, 1979; Teague, 1987). Although there is some consensus on the nature of wellness, further progress needs to be made to better elucidate a comprehensive definition.
Considering the increased interest and emphasis on wellness in counseling, it is first necessary to review the literature to come to an agreement on the definition, conceptualization, and preferred means of assessing wellness. Increased conceptual clarity will facilitate the creation of better measures of wellness. Current wellness assessment instruments can only be as good as the conceptual frameworks upon which they are based. New wellness assessments need to reflect a comprehensive conceptualization of the construct. In this article, I review wellness theory, definitions, and assessment measures and synthesize the research into an integrated, comprehensive definition of wellness that can be the foundation of new wellness assessment measures.
* Wellness
Attempts to define wellness often begin with references to the World Health Organization's (1967) definition of wellness being not just the absence of illness but a state of complete physical, mental, and social well-being. Many conceptualizations of wellness include the central tenet that wellness is not just the absence of disease (Adams et al., 1997; Dunn, 1977; Edlin, 1988). Dunn, for example, emphasized wellness as a positive state, one that is beyond simply nonsickness. He defined high-level wellness as "an integrated method of functioning, which is oriented toward maximizing the potential of which the individual is capable. It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning" (Dunn, 1977, p. 4).
Beyond the absence of illness, wellness conceptualizations focus on areas of health or strength. Egbert (1980) outlined the focal areas of wellness as being an integrated personality with a clear sense of identity, a reality oriented perspective, and a clear meaning and purpose in life. Furthermore, he described wellness as including the recognition of a unifying force in one's life, the ability to cope creatively and to be inspired by hope, and the capability of creative, open relationships. Similarly, Travis and Ryan (1988) conceptualized wellness as comprising self-responsibility and love. In their meta-analysis of qualitative research on wellness, Jensen and Allen (1994) defined wellness as the subjective experience of health. They described the wellness-illness relationship as dialectical, where health, wellness, and illness are the same. For example, both wellness and illness are needed to define the other; without illness there would be no concept of wellness. Witmer and Sweeney (1992) and later Myers, Sweeney, and Witmer (2000) described a holistic model of wellness that comprises five life tasks: spirituality, self-regulation, work, friendship, and love. Those authors described the Wheel of Wellness (WOW) as having 12 spokes, or subtasks: 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). Myers, Luecht, and Sweeney (2004) described the evolution of the WoW model into the 5F-Wel, which comprises five factors (creative, coping, social, essential, and physical) and the subsequent revision of the 5F-Wel that includes the factors cognitive-emotional wellness, relational wellness, physical wellness, and spiritual wellness.
In work similar to the creation of the WoW, other researchers have explored and defined the various elements, or interrelated areas, that comprise wellness (Adams et al., 1997; Greenberg, 1985; Hettler, 1980; Lafferty, 1979; Renger et al., 2000). A comparison of these models is presented in Table 1. Depken (1994) indicated that most college health textbooks describe wellness as comprising physical, intellectual, social, emotional, and spiritual dimensions. Both Lafferty and Greenberg described wellness with the five factors used by Depken; Greenberg, however, referred to mental wellness instead of intellectual wellness. Lafferty and Greenberg both defined wellness as the integration of the five dimensions and high-level wellness as the balance among the dimensions.
Other wellness models included the factors described by Depken (1994), Lafferty (1979), and Greenberg (1985) but incorporated additional dimensions (Adams et al., 1997; Hettler, 1980; Renger et al., 2000). Hettler's (1980) wellness model comprised six dimensions: social, spiritual, physical, intellectual, emotional, and occupational. Hettler agreed with Dunn's (1977) conceptualization of wellness and stressed the process of becoming aware of wellness and actively making choices toward optimal living. Similar to the other models, Hettler's model conceptualized wellness as the integration and balance of the six dimensions.
Adams et al. (1997) conceptualized wellness similarly to Hettler (1980). However, Adams et al. did not include occupational wellness. Instead they included the additional dimension of psychological wellness, reflecting the general perception of positive outcomes in response to life's circumstances. Adams et al. labeled the six dimensions of wellness as social, spiritual, physical, intellectual, emotional, and psychological and conceptualized wellness from a systems perspective. Subsystems (i.e., dimensions) have their own elements and are integrated into a larger whole. The authors described wellness as salutogenic, or health focused, and emphasized the importance of including multiple factors such as cultural, social, and environmental influences.
Renger et al. (2000) described another six-domain wellness conceptualization similar to those of Adams et al. (1997) and Hettler (1980). Renger et al. defined wellness as consisting of emotional, spiritual, physical, social, intellectual, and environmental domains. In defining each of the domains, Renger et al. stressed the importance of knowledge, attitude, perception, behavior, and skill in each of the wellness areas. Similar to Hettler, Renger et al. included the five core dimensions described by many authors (Depken, 1994) and added the sixth dimension of environmental wellness to recognize the important impact of one's surroundings. Similar to other authors, Renger et el. defined wellness as the integration and balance of the dimensions, resulting in the optimal state of being that an individual is able to achieve in relation to his or her life circumstances.
Consistency in describing the nature of wellness is seen in most of the models and definitions. First, most authors incorporated the idea that wellness is not just absence of illness as first outlined by the World Health Organization's definition of wellness (Ardell, 1977; Edlin, 1988; Lafferty, 1979; Teague, 1987). Second, wellness is described in terms of various factors that interact in a complex, integrated, and synergistic fashion (Adams et al., 1997; Ardell, 1977; Duma, 1977; Hettler, 1980). In other words, the dynamic interaction of the dimensions causes the sum of the dimensions to be greater than the whole. Each dimension is integral to the whole and no one dimension operates independently (Adams et el., 1997; Alster, 1989; Clark, 1996; Crose, Nicholas, Gobble, & Frank, 1992; Dunn, 1977; Edlin, 1988). Therefore, the wellness approach is holistic within the person and with the environment. Third, most authors outlined the necessity of balance or dynamic equilibrium among dimensions. Fourth, several models define wellness as the movement toward higher levels of wellness or optimal functioning (Ardell, 1977; Clark, 1996; Dunn, 1977; Greenberg, 1985; Hettler, 1980) and that wellness is, therefore, partially dependent on self-responsibility (Dunn, 1977; Krivoski & Piccolo, 1980; Leafgren, 1990) and one's motivation (Ardell, 1977; Clark, 1996; Dunn, 1977; Hettler, 1980). Finally, wellness is viewed as being a continuum, not...
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