Well-Being Counselling

​Mainstream psychology spent the last century studying what goes wrong with us and how to treat it. That task, which arose out of a medical and psychiatric desire to help, is of course highly important. But what about the other, larger part of life - what about the things that go right? What about the study of those and how we can increase them? As an existential therapist (a counsellor with a background also in philosophy) this is a fundamental principle of my work. Alongside helping people cope with adversity, the biggest question for me is, how can I help people create their good life? How do I help people increase their well-being? In this reflection I will discuss some contemporary models of well-being which inform both research and therapeutic practice. As you read, I invite you to consider the various factors which lead to well-being, in terms of their presence or absence in your life.

​There are two main ways of researching well-being in the contexts of psychotherapy, psychology, and social science. One is the lens of objective, statistical analysis; for example the health, income, education, life expectancy and so on of a population. The other is qualitative, focused on the subjective dimensions of people's experience of happiness and so on. Both forms of research are of course highly important. Governments and activists pay most attention to objective measures and how systems can better facilitate them. But as a therapist helping individuals, it is the subjective side which matters most in my work. Subjective problems of well-being are what bring most people into therapy, and they are the things over which we have the most responsibility and power.
 
Subjective ways of understanding well-being tend to divide into two or three categories depending on the tradition. The ancient Greek tradition focuses on two categories, and this dichotomy has continued down the centuries in Western thought. On this model, well-being is understood as either hedonistic - focused on feelings such as satisfaction and pleasure - or eudaimonic - focused on fulfillment and purpose. To illustrate this distinction, imagine the difference between having a great time at a party (hedonic) versus meaningful work (eudaimonic). This distinction was captured by the philosopher John Stuart Mill when said that “it is better to be Socrates dissatisfied, than a pig satisfied.”
 
Mill’s sentiment reflects how most people think, even if our actions contradict that. But we don’t have to make an either/or choice between the hedonic and eudaimonic. The ancient Greeks idea was that integrate and balance the two. This seems to be a much wiser approach. The tendency to condemn hedonic well-being is a modern, puritanical attitude, reflecting centuries of religious contempt for the body. As I say, the fundamental issue here is integration and balance. We need a holistic understanding of well-being which takes account of human nature as body, mind, and spirit; which accepts our nature as conscious, meaning-seeking animals. We go wrong when we reduce ourselves to one aspect of our being, as does the sensualist or glutton, or the religious or moral fanatic.   
 
Therapists, theorists, and researchers have developed increasingly powerful models of well-being which take account of our whole being. For example Carol Ryff developed a model which includes self-acceptance, positive relations with others, autonomy, environmental mastery (e.g. work and money), purpose in life, and personal growth. Martin Seligman - probably the greatest figure in this field - set out the PERMA theory, an acronym meaning Positive emotions, Engagement (with absorbing activities), Relationships, Meaning (purpose in life), and Achievement (a sense of accomplishment). These models are highly empirical in orientation, a result of research, and a framework for doing more of the same. Coming instead from therapeutic experience and philosophical reflection, the existential therapist Emmy van Deurzen developed a complementary model focused on how we are with different dimensions of life. For example, how do you in particular exist with, and in, the physical world (in your body, with nature); and in your relations with and to others; and in your relationship with yourself and your inward life; and how you are with the transcendental dimensions of life (the philosophical or spiritual or religious).
 
We can see from just those few models above that well-being is multi-dimensional, that many factors are important. We are a unity of parts, and each different part affects the other. For example a problem at the physical level such as chronic physical can have significant impacts on us at the social, personal, and transcendental level - consider a person who comes to be isolated, hating their body, and feeling bitter toward the world, as a result of their torment.

Furthermore, overinvestment or underinvestment in any factor or dimension of well-being can lead to problems. For example overinvestment in what Ryff calls environmental mastery (and Seligman achievement, and van Deurzen the physical dimension), such as by obsessively pursuing financial security to the neglect of other factors, can lead to a life of damaged relationships, poor health, emotional atrophy, and cynicism or arrogance. On the other hand to neglect money in favour of, say, philosophy, can lead to states like anxiety, depression, or resentment, and to physical states of insecurity or dependence, and so on.
 
It should be clear from all of this that recognising the various dimensions and factors of well-being can help us take stock of our lives, to understand the ways in which we are not realising our potential for flourishing, the ways in which we are unhappy and struggling. Such models are vital for a therapist like myself. For example, as an existential therapist I have seen depressed clients who picked me out because they felt that their core problem was a lack of meaning and purpose, Most depression is, after all, an experience of emptiness or despair. Their instinct was to spend some time with me in applied philosophical reflection in order to answer their questions. Once those questions were intellectually resolved, they could move forward, so they figured. And you know, some of them were right. But there have been plenty of others for whom those questions were only the surface expression of a deeper problem. To take van Deurzen’s four dimensions, some people were depressed because of their relations with others. For example when we lose somebody through death or separation, we need to grieve. But if we suppress the grief too much then it can transform from a feeling of focused specifically on the absence of a particular other, to a general feeling of emptiness in life. That is, specified grief, when suppressed or processed badly, can transform into unspecified depression. For such people, philosophical reflection on questions of meaning will not ne enough. Instead, the person needs help to deal with their fear and pain in a better way than through suppression, and then to do the work of grieving. This is how such depression lifts.

Continuing this example but moving to the personal dimension, for some other such clients the core problem is self-esteem and, in fact, hatred of self. Such feelings are very common, in fact the psychoanalyst Jacques Lacan famously quipped that “the Christian injunction to love thy neighbour as thyself must be ironic…because people hate themselves!” When people are blind to their self-hate, which is usually how it is, they naturally become depressed. The become depressed because they are constantly, subliminally shaming or guilting themselves. (The somewhat unconscious aspect of this is what explains so many inexplicable suicides in the context of otherwise tolerable misfortunes. If you lose one of the things that was holding you together, and so fall into a gaping hole of worthlessness and self-hate, then suicide is the logical answer. They're not being irrational or cowardly, rather they're responding to an overwhelming feeling that others cannot see in them.) Such people also become depressed because they unconsciously invite others to use or mistreat them, and then feel angst and despair over the cruelty of other people which, because it is their pattern, seems to be "how things are."

Again, moving to the physical dimension, some people come to a point where their material life is no longer working well - they are not holding down a job, or not finding meaningful work, or not keeping up with expenses, or not taking the steps they know they need to take, or their environment is traumatising, or it is too angry and ugly and that is a bad match with their unconscious problems, et cetera. In all the above cases, understanding which of the four dimensions of well-being are involved and how, means people can receive more than a band-aid. By recognising the real causal factors they can be helped to heal and create change.
 
This discussion wouldn't be complete if we used the factors of well-being simply to explore how problems happen or are healed. After all, we are talking about creating positive flourishing in people's lives. This is more than going from minus five to zero, it is about going from zero to plus five. So, how do therapists like myself help people grow and improve their well-being? To take another general example, using again van Deurzen's model, I have seen many people whose sources of happiness and fulfillment were mostly located at the physical and social levels - running businesses, succeeding in the arts, engaging with fitness and strength, being very active and present in the natural world. Before coming to me, they had suffered a disease or injury which radically compromised their ability to access those sources of well-being. Life was emptied out for them. I help such people in two ways. First, by turning their attention to the other dimensions, in this case the third and fourth: their relationship with themselves and their inner world, as well as the philosophical or spiritual or religious possibilities in their lives. And second, by helping them reconsider how they engage with the physical and social. Through misfortune, life has called on these people to expand their way of existing, but at first they don’t know how to do that. I help them recognise this fact first of - often doing grief and adjustment work to wisely, strongly accept reality, and then do the work on making life good and meaningful again, in new and deeper ways. This is not a solution to their problems - life now contains more suffering than it did - but it is an expansion of self, including into greater compassion for themselves, deeper relationships with themselves, others, and life, and a more profound sense of gratitude and strength and purpose and joy. Nothing can replace climbing a mountain. But likewise nothing can replace the new gifts these people cultivate in their lives. 
 
Let’s conclude here. Well-being is about “well” “being” - a good being, a good existence, a good life. Existential Therapy cares about this because it is the art of living well. Every aspect of well-being is important and interconnected. Of course any life will inevitably emphasis some factors, and de-emphasise or neglect others - as somebody once said, we all go lopsided to the grave. But you can solve many problems, and enrich and deepen your life, through taking stock of your life in the light of these various factors and making choices and taking action to expand in the ways you want and need. By focusing on well-being we do not deny our suffering, in fact we care for it in a better way. But we are focusing also on what might be, on creating a life that is as joyful and meaningful as possible.