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Mental Wellness and How to Help Your Clients Find It
By Megrette Hammond, Med
Social Work Today
Vol. 6 No. 1 P. 40

Focusing on what is well in your clients can help them move beyond being overwhelmed by symptoms and embrace strengths-based living.

In a conference of 350 mental health workers (Vanguard In Action: Mindsight Conference, October 21, 2005), Daniel Siegel, MD, asked, “How many of you can define mental wellness?” The dimly lit room had less than 30 hands raised. Siegel continued, “I have asked this question to more than 55,000 mental health workers and, in general, only 5% have ever considered the question.” Siegel, a Harvard-trained psychiatrist and author of The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are, asks professionals to consider the concept of mental wellness as more than the absence of disease.

Defining mental illness is the difficult task that the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has taken on. The word diagnosis is defined as the identification of the nature of an illness or other problem by examination of the symptoms. This method of determining illness has some inherent problems, the most obvious being the listing of symptoms does not identify the cause of the illness.

The ability to identify the presence of specific behaviors is a skill that helps the clinician successfully bill for services but may be less therapeutic for a client trying to achieve mental wellness. Why? Think of the current method of symptom-focused treatment as similar to a map. It can tell individuals where they are but does little to offer directions. Additionally, when clients do not have a clear sense of where they want to go, therapy can be reduced to a sightseeing trip of personal difficulty. The clinician’s ability to describe the components of mental wellness may be helpful during a session. Exploring this concept can offer some mental “places of interest” for the client to consider visiting, providing the direction and motivational force necessary during the change process.

Strengths-Based Treatment
Ron Sterling, MD, a general and geriatric psychiatrist in Seattle, agrees that relying on the conventional method for making a diagnosis has significant limitations. “People are trained to focus on problems. It is the thing that brings them into treatment. Unfortunately, this does not help the individual understand why the problem developed. The pathology view is a bit too simplistic.” Focusing solely on pathology can severely limit a clinician’s options. It creates a narrow view of the individual—seeing clients as labels instead of as people with something to contribute to society.

Molly Kellogg, RD, LCSW, a nutrition therapist and psychotherapist in private practice in Philadelphia, explains, “A critical part of the assessment is to see what is well in the client. This benefits both client and therapist. Any time we focus our attention on the problem and not the person, the session will be less productive.”

Problems lack the dynamic nature inherent in all people. They are fixed, solid, and unmovable. When the attention is directed on the problem, it is easy, as Kellogg explains, “to leave out the resources—the skills and abilities—that the person has.” Kellogg adds that in every counseling session it is helpful for the practitioner to “…recognize that there are some areas that the patient is doing okay in. Sometimes this takes effort—to see the ‘well’ part of the person—but it is a critical part of the treatment.” When individuals focus their attention on a problem, it is easy to forget about the resources and skills. Kellogg’s voice dips low, infused with an excited energy as she offers the following: “I love ‘how’ questions. They tend to be expansive. They scan what is [present] in the brain.” Kellogg explains that “how” questions are process-oriented. “When a clinician focuses on the problem, it is easier to ask ‘what.’” Unfortunately, these sorts of questions are narrow in focus. For example, asking the client, “How is it that you were able to get out of bed this morning?” is more expansive than “What did you do to get out of bed this morning?” The inclusion of broad, process-oriented questions fosters a sense of perspective, helping an individual distinguish between real deficits and small life annoyances. Over time, this skill helps a person become more resilient and avoid being overwhelmed by naturally-arising day-to-day difficulties.

Stress and Mental Illness
Sterling says, “Stress is the bug-a-boo that surrounds most mental illness. Stress hurts the hippocampus.” The hippocampus is the cognitive mapper, creating links in the brain, which integrate factual and autobiographical memory. He explains that people live in a stressful society. That is difficult to escape. “People become habituated to stress. They are completely unaware of how much stress they are actually experiencing. So, a big part of mental wellness is learning how to feel less stress.” Simply becoming aware of how much stress a person is dealing with, whether from a physical illness, lack of sleep, or some other source, is helpful in promoting mental wellness. Helping clients identify the different ways stress can physically manifest is also a useful technique.

Leah J. Dickstein, MD, notes that a client may say, “I feel it in my heart” or “It got me in my gut” (Dickstein, 2002). She urges providers to explain that there are physiological ways the body handles stress. Educating patients on how the mind and body are connected can result in a more rapid identification of harmful stress.

Charlotte Wilkins, LCSW, a psychotherapist in West Hartford, CT, who is trained extensively in mindfulness meditation and stress reduction through the Mindfulness Based Stress Reduction (MBSR) program at the University of Massachusetts, agrees. “Health includes mind, body, and spirit. Most of us live in our heads, especially those suffering from depression, and there’s little or no connection with our bodies. There is so much wisdom in our bodies. You can’t really separate mental wellness from the physical and spiritual sense of wellness.” Wilkins explains that “helping the client access the physical sensation that may accompany worry or stress is helpful. With practice, clients can come to rely on the body to give them insight into what they are feeling.”

This insight can help clients make connections to other areas that affect health, including eating, activity, and sleep. When individuals are mentally well, they are less likely to engage in thoughts or behaviors that damage the body. Wilkins explains that focusing on basic techniques, such as awareness of breathing and observing it without expectation or judgment, can help individuals become aware of what they are currently experiencing. This awareness is an important connection for most clients. It can be the first time a person has experienced the sense of mind-body integration—an aspect of mental wellness.

Understanding the Nature of Complexity
The human mind and its functions are far from simple. Exploring the mathematical theory of complexity may be helpful in deepening the understanding of mental well-being. Though the word complexity is synonymous with difficulty, the two terms should not be used interchangeably. Complexity theory was created to describe the behaviors of integrated systems, such as cloud formations or weather patterns. Siegel uses this theory to explain another dynamic system: human behavior. He writes, “Complexity theory suggests that the most stable, flexible, and adaptive flow of states occurs when the self-organizing process of a system moves it toward complexity” (Siegel, & Hartzell, 2003).

Siegel demonstrated this theory by asking individuals from the audience of the Mindsight Conference to sing a single note. The resulting sound is rigid and boring, offering little for the listener to enjoy. He then had individuals sing any desired song, creating an unpleasant discourse. Finally, he demonstrates how complexity, the path between rigidity and chaos, can lead to harmony by having these 10 voices sing the same song. The results were vitalizing and rich, which Siegel explains is what complexity theory predicts. “There is a natural movement towards complexity; a natural push of the mind towards a stable, adaptive, and flexible path.” He continues to explain that “a stressed system is one that tends to move away from complexity, toward either extreme: rigidity on one side or chaos on the other.”

Sterling echoes the feelings of many clinicians when he asks, “How ill do you have to be to be mentally ill?” Wilkins adds, “It is uncomfortable for me to assign someone a diagnosis. People aren’t finite. People aren’t just one thing,” which is sometimes what can happen when clients come to internalize a diagnosis. They no longer celebrate their complexity but attempt to define life experiences in more rigid terms. Wilkins continues, “It’s simplistic to think in terms of either mental wellness or mental illness especially since we counsel our clients that good or bad, all-or-nothing thinking isn’t healthy.” This tendency can also disable a person’s healthy coping mechanisms. Clients are often facing situations that have no clear answer. Deeply, clients may realize this, but because it fails to fit into their black-and-white thinking, they reject the idea.

Wilkins explains, “There are basically two energies in the world. We are either pushing against what we don’t want, or we are moving toward what we want more of in our lives.” Those things we are pushing against can be people or things we dislike or fear, and that energy is more reactionary and habitual in nature. When we focus our energy on moving toward what we like, such as peace, happiness, and health, we will be engaging feelings of comfort, kindness, and compassion—all of which are healing. Mental distress happens when a person is trying to do both at the same time. For example, clients may try to comfort themselves with food, but experience the desire to push away because they feel shame and disgust. When these kinds of situations happen, the client is likely to feel stuck, trapped, and fall into rigid thinking. “Clients feel overwhelmed and unsure where to start. Unfortunately, they engage in the same thoughts over and over, which lead to the same answers,” says Wilkins.

Big C and Little c
Sterling believes our baseline mental wellness is determined mostly by our biology. Understanding a client’s history is an important step of any therapy session. However obvious, this basic initial intake can build more than just rapport. He explains that this “…shifts the focus to include a curious exploration of the individual.” Building on this idea, Wilkins offers the following: “People tend to have two views. I like to call the first view critical—the ‘big C’—that’s the critic that sits on your shoulder and shouts negative comments in your ear about you and everything else. The second is the ‘little c’ which stands for curious, which, for most of us, hardly has a voice at all. I work with clients to help them recognize if they are viewing a current situation with critical or curious eyes.”

Wilkins shares a fun counseling scenario. “I ask if they’ve heard of the I.T.I. theory—which stands for ‘Isn’t that interesting?’” She explains that having the clients reframe situations to include a growing interest in how their choices affect their life helps them open up during counseling sessions instead of closing down.

Sterling has identified five areas of focus to promote mental wellness: self-appreciation, resilience, affiliation, negotiation, and exercise (physical and mental).

The first is the ability to appreciate oneself. Sterling notes that this is different than self-esteem, which can take on a narcissistic quality. Self-appreciation is more than recognizing and liking personal qualities; it also includes acknowledging a person’s current stressors and vulnerabilities. Reflecting on the ability of the client to engage in self-appreciation can be a helpful step on the path to mental wellness.

A person’s ability to recover quickly is also a skill that can contribute to mental wellness. Sterling says, “The qualities that allow for resilience are optimism, a sense of perspective [seeing the big picture], believing that there is a positive meaning to life, and the ability to laugh at some of the tricks that life plays on us.”

Friendships and supportive relationships are often what an individual will rely on during periods of emotional stress. Sterling describes a person’s affiliation as an individual’s ability to make connections with other people. Paired with the ability to negotiate these relationships, healthy friendships can assist a person to admit they do not have all the answers and allow themselves to learn from others.

Exercising both the body and brain is the final way to promote mental wellness. According to Sterling, “Research has consistently shown that physical exercise protects against depression.” This reinforces the mind/body connection. But mental exercise is also helpful in promoting mental wellness. This can be done by engaging in leisure activities and cultivating a curiosity in the world around us.

When asked to describe mental wellness, Wilkins offers the following definition: “Mental wellness is a deep sense of self, which is strong and flexible. When individuals are mentally well, they are relying on their own wisdom, not rejecting or ignoring it.”

Unfortunately, there are few general mental wellness resources. The term mental wellness is undefined and is a catch-all phrase. However, mental wellness is more than the absence of disease or a list of stress management techniques. Exploring what mental wellness means to your clients can offer direction and opportunity for exploration during a session beyond a specific problem. Over time, clients may be more able to develop a sense of balance and acceptance for the events in their lives. Wilkins says, “When we can welcome all that is in our lives, without judgment, we allow equanimity into our lives.” This becomes the doorway to inner peace.

— Megrette Hammond, MEd, is a New Hampshire-based freelance writer.

References
Dickstein, L. J., (2002). Primary Prevention and Practical Techniques to Encourage Mental Wellness. Primary Care, 29(1):199-210, ix.

Siegel, D., (1999). The Developing Mind. New York: The Guilford Press.

Siegel, D. J., & Hartzell, M., (2003). Parenting from the Inside Out. New York: Jeremy P. Tarcher-Penguin.

“The Guest House” by Jelaludin Rumi
This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.