Wellness: The Goal of Therapy?

While reading the wonderful change therapy blog today, I stumbled upon the UN definition of wellness. I quote: “Wellness is not only the absence of illness but also the sense of total physical and mental well-being.”

This makes me wonder. It is clearly an attempt to make wellness a positive rather than negative concept, more than just the absence of illness. But for a start how can we define the absence of illness when our bodies looked at under a microscope would reveal themselves to be a constant battlefield? By our subjective feeling that we are not ill? We can spend years feeling well, not knowing that in fact we have a particular condition, cancer for example. But more interesting to me is the implication that those who are physically ill cannot have a sense of total well-being. This seems to fly in the face of the experience of many chronically ill people, who find a sense of peace, and does not account either for people suffering from severe psychotic delusions or conditions such as Alzheimer’s, who may feel perfectly fine. There has to be more to being well than feeling well.

It leads me to wonder what we mean when we use the concept of working towards wellness in therapy, as we usually do, despite the change in terminology from patients to clients. Clients often arrive feeling there is something wrong with them, according to the medical model, and wanting to feel better. Carl Rogers wrote (1959) of the ‘fully functioning person’ as a person who has received the therapeutic conditions of empathy, unconditional acceptance, and realness in relationship to a sufficient degree. It could be read that this person has been healed from a condition of incongruence, in which the full, direct experience of her/his organism was not directly accessible to the sense of ’self’ the person had built up, and is now well, their actual experience matching their sense of self.

The ‘fully functioning person’ is characterised by their possessing ‘no conditions of worth’ and ‘unconditional positive regard’ for the self, by accurate awareness of their own experience, by openness and fluidity of response (Rogers (1959). This concept has been understood as a goal by many person centred counsellors, and fiercely debated as such. Is such an ideal at all possible? Is it desirable or even ethical to have such ideals in an imperfect world in which not everyone is free to react fluidly to situations? And how is it in accord with respect for the autonomy of the client to enter a helping relationship with a model of the final result somewhere in mind?

I think that the concept of the fully functioning person is best taken, as Rogers may well have meant it, as a set of characteristics that tend to emerge as a successful counselling relationship develops, and they do indeed hold a clue to wellness. Whatever conditions we live under, or within, whether mental or physical, if we are aware of our experience, with its specific and unique texture and quality, and do not habitually judge either it or ourselves for ‘having it’, we are likely to experience a kind of inner freedom and contentment. Which sounds like an attainable and good enough definition of wellness to me.

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