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COUNSELING FOR WELLNESS
AND PREVENTION

Counseling for Wellness and Prevention brings Preventive Counseling, one of preven-
tion’s founding texts, firmly into the twenty-first century. Counseling for Wellness and
Prevention thoroughly updates and significantly expands on discussions of practical
applications and emerging best practices. Counselors and counseling psychologists
will find evidence-based, contemporary guidance to help them engage in needed
efforts to help clients and the general population enhance their overall wellness
and ward off future dysfunction. Author Robert Conyne demonstrates the ways in
which the traditional model of one-to-one therapy can be expanded to embrace
wellness and prevention as well as strategies for putting into practice a broad range
of environmental and system change strategies, such as advocacy and community
organization.The book is well suited for adoption in counselor-education courses
and includes explicit connections to CACREP accreditation standards. It’s also an
excellent choice for programs in psychology, where the APA-approved prevention
guidelines for psychologists are now available, and in social work, where preven-
tion and community change have long been hallmarks.
Robert K. Conyne, PhD, is Professor Emeritus of the University of Cincinnati
counseling program. He is a licensed psychologist, a licensed professional clinical
counselor, and a fellow of several divisions of the American Psychological Associa-
tion and of the American Counseling Association’s Association for Specialists in
Group Work.
This page intentionally left blank
COUNSELING FOR
WELLNESS AND
PREVENTION
Helping People Become
Empowered in Systems
and Settings

Third Edition

Robert K. Conyne
Third edition published 2015
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2015 Robert K. Conyne
The right of Robert K. Conyne to be identified as author of this work has
been asserted by him in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without
intent to infringe.
First edition published as Primary Preventive Counseling by Accelerated
Development 1987
Second edition published as Preventive Counseling by Brunner-Routledge 2004
Library of Congress Cataloging-in-Publication Data
Conyne, Robert K., author.
[Preventive counseling]
Counseling for wellness and prevention : helping people become
empowered in settings and systems / by Robert K. Conyne. — 3rd ed.
   p. ; cm.
Preceded by Preventive counseling : helping people to become empowered
in systems and settings / Robert K. Conyne. 2nd ed. 2004.
Includes bibliographical references and index.
I. Title.
[DNLM: 1. Counseling—methods. 2. Mental Health. 3. Mental
Disorders—prevention & control. WM 55]
RA790
158'.3—dc23
2014045902
ISBN: 978-0-415-74313-6 (hbk)
ISBN: 978-0-415-74314-3 (pbk)
ISBN: 978-1-315-81384-4 (ebk)
Typeset in Bembo
by Apex CoVantage, LLC
The second edition of this book appeared 17 years following the first. Both edi-
tions were dedicated to my children, Suzanne and Zack. This third edition comes
yet another decade later, reflecting the slowly maturing growth in the field. Now
that my children are grown, I dedicate this book revision to all children everywhere
and to all those others who may find themselves living in positions of vulnerability
for which wellness and prevention initiatives are needed. And to the memory of my
beloved and faithful dog companion, Lucy, who sat by my side as I wrote this (and
other) books and who finally had to say goodbye—during the copyediting stage of
this book—after 14.5 years:You helped keep me well over all these years. I miss you
deeply, my Buddy, as does our whole family.
This page intentionally left blank
CONTENTS

List of figures and tables xiii

Prefacexv
Acknowledgementsxvii

SECTION I
Foundations of Wellness and Prevention 1

1 Wellness and Prevention in Mental Health 3

Introduction 3
Lifestyle Diseases and Lifestyle-Induced Disorders
Can Be Prevented 4
Being Well: Personal Actions 5
Being Well: Environmental Actions 6
Wellness and Prevention: General Goals and
Intervention Strategies 6
Personal, Relational, and Collective Levels
of Wellness Intervention 7
Wellness at All Levels 8
Prevention: Before the Fact 9
How Prevention and Wellness Interrelate 12
Behavioral Health Versus Mental Health 13
Return on Investment for Wellness and Prevention Programs 14
Issues for Reflection and Discussion 15
References 15
viii Contents

2 Everyday Wellness and Prevention: A Foundation

of Positive Practices for People, Settings, and Systems 18
Introduction 18
Everyday Practice of Wellness and Prevention
Is Possible and Important 19
What Is “Everyday Wellness and Prevention”? 19
The Emergence of Wellness and Prevention
in Everyday Life 20
Person-Centered and System-Centered:Two Avenues
for Daily Practice 21
Person-Centered Avenues 21
Settings- and System-Centered Avenues 22
Person-Centered Everyday Wellness and Prevention
Practice Areas 22
Be Positive 22
Cultivate Resilience 23
Assess Your Positive Psychology Strengths
to Assist in Leading the “Good Life” 23
Practice Wellness 25
Become Involved in the Wellness Domains 28
Develop and Use Life Skills 35
Carefully Consider Complementary and Alternative
Medicine Health Care Approaches 36
Settings- and System-Centered Everyday Wellness
and Prevention Practice Areas 38
Thirteen System-Centered Strategies for Everyday
Wellness and Prevention 39
Role of the Counselor in Everyday Wellness and Prevention 41
Issues for Reflection and Discussion 42
References 42

3 Wellness and Prevention Strategies

in Mental Health 48
Introduction 48
Public Health and the Medical Model in Relation
to Wellness and Prevention 48
Public Health Model: Direct Support for Wellness
and Prevention in Mental Health 49
Medical Model: Indirect Support for Wellness
and Prevention in Mental Health 49
The Counseling Profession in Relation to the Two Models 52
 Contents ix

History of Counseling and Counselor Education 52

Seven General Strategies of Wellness and Prevention 55
Wellness and Prevention Strategy 1: Education,
Both Direct and Indirect 56
Wellness and Prevention Strategy 2: Social Competency
Facilitation—Connecting With Resources 61
Wellness and Prevention Strategy 3: Natural
Caregiving—Connecting With Helpful People 62
Wellness and Prevention Strategy 4: Community
Organizing and Systems Intervention 65
Wellness and Prevention Strategy 5: Environmental
Redesign—Altering Physical or
Organizational Environment 70
Wellness and Prevention Strategy 6: Assist
Developmental Transitions—Anticipating Predictable
Needs and Challenges 72
Wellness and Prevention Strategy 7: Encourage
Everyday Wellness and Prevention—Positive
Practices for People, Settings, and Systems 73
Issues for Reflection and Discussion 74
References 74

4 Counseling for Wellness and Prevention 80

Introduction 80
General Behavioral Change Frameworks Supporting
Wellness and Prevention 80
Individual- and Intrapersonal-Level Focus 81
Interpersonal-Level Focus 84
Community-Level Focus 85
Perspectives Supporting Wellness and Prevention 86
Ecological Perspective 86
Positive Psychology Perspective 90
Social Justice Perspective 91
Models Emphasizing Counseling and Aspects
of Wellness and Prevention in Counseling 93
Change Models Emphasizing Counseling in General 94
Change Models Emphasizing Wellness in Counseling 95
Change Models Emphasizing Prevention in Counseling 97
Change Models Emphasizing Wellness and Prevention 98
Competencies in Wellness and Prevention Counseling 105
Seven Competencies:The “Big Ones” 105
x Contents

Issues for Reflection and Discussion 108

References 109

SECTION II
Wellness and Prevention Applications 115

Wellness and Prevention Approaches, Programs, and Initiatives 115

Program Selection Criteria Used in This Book 116
Online Resource Directories Containing Effective
Wellness and Prevention Programs 117
Fit of Online Registries Within Planning of Wellness
and Prevention Projects 118
References 119

5 Personal Wellness: Individual Counseling

and Group Work 120
Introduction 120
Wellness and Prevention Through Individual Counseling 120
A General Process for Wellness and Prevention Approaches
in Individual Counseling 122
Step 1: Form Beginnings of a Sustainable
Helping Relationship 122
Step 2: Conduct a Wellness and Prevention Assessment 122
Step 3: Develop a Personalized Wellness and Prevention
Counseling Plan, Including Pertinent Strategies 124
Step 4: Apply the Plan 133
Step 5: Evaluate Process and Outcomes 133
Wellness and Prevention Through Group Work 133
Group Work Foundations 133
Supporting Research 134
Wellness and Prevention Groups: Psychoeducation Format 136
A Detailed Plan for a Wellness and Prevention Group 138
Example of a Stand-Alone and of an Embedded
Wellness and Prevention Group 140
Issues for Reflection and Discussion 142
References 142

6 Relational Wellness: Family and School Programs 146

The Family Setting 146
Functional Family Therapy 148
FAST Track Prevention Project 151
 Contents xi

Triple P: Positive Parenting Program 154

Conclusion: Family Programs 156
The School Setting 157
Life Skills Training 160
Seattle Social Development Project 163
Olweus Bullying Prevention Program 169
Conclusion: School Programs 171
School Counselors Are Needed for Wellness and Prevention
Counseling in the Schools 172
Issues for Reflection and Discussion 173
School 173
Family 173
References 174

7 Relational Wellness and Prevention: Community

and Workplace Programs 179
The Community Setting 179
Big Brothers/Big Sisters of America 181
Communities Mobilizing for Change on Alcohol 185
Families and Schools Together: Protecting Hearts and Minds 189
Conclusion: Community Programs 191
The Workplace Setting 191
The Healthy Workplace Program 195
Coping With Work and Family Stress Project
(Formerly Known as the Yale Work and Family
Stress Project) 199
The JOBS Project for the Unemployed 202
Conclusion:Workplace Programs 205
Issues for Reflection and Discussion 207
References 208

8 Wellness and Prevention Initiatives With

Collectives: Systems 212
Systems Strongly Influence Our Lives 212
One Example: Incarceration Tied to Policy 213
Some Public Policy and Legislative Gains 214
The World Health Organization’s Comprehensive
Mental Health Action Plan: An Initiative for the World 217
National Prevention Strategy: Moving From a System
of Sick Care to One of Wellness and Prevention 219
Gun Violence Prediction, Prevention, and Policy:
Addressing an Urgent Societal Problem 222
xii Contents

The Importance of Public Policy and Legislative

Awareness for Counselors 225
A Successful Initiative: Preventing Cigarette Smoking 225
An Initiative Yet Unfulfilled: Suicide Prevention 228
Public Policy and Legislation Systems-Level Resources
of Professional Associations 228
APA Web Site Resources: Public Education
and Outreach 229
American Counseling Association Web Site Resource 229
Additional Systems-Level Involvement
and Change Approaches 231
Final Thoughts on Counseling for Wellness and Prevention 233
Issues for Reflection and Discussion 234
References 234

Index237
FIGURES AND TABLES

Figure 4.1Behavior change wheel. 86

Figure 4.2Person in context. 88
Figure 4.3A broad perspective of health determinants. 89
Figure 4.4Counseling for wellness and prevention model. 100
Figure 5.1Individual counseling session. 121
Figure 5.2Meeting of support group. 134
Figure 6.1Enjoying family time outdoors. 147
Figure 6.2Classroom. 158
Figure 7.1Urban park. 180
Figure 7.2Two carpenters working on wood. 192
Figure 8.1National Prevention Strategy: America’s plan
for better health and wellness. 221
Table 8.1 Illustrative Public Policy and Prevention
Initiatives: Programs and Outcomes 226
This page intentionally left blank
PREFACE

It was necessary in this third edition to produce a nearly complete rewrite of the
second edition of Preventive Counseling to accommodate exploding knowledge
over the last decade in the areas of heath care, wellness, ecology, social justice, and
prevention as they relate to counseling and the helping professions. So this new
version of the book also sports a new main title that accurately embraces all of this
new material: Counseling for Wellness and Prevention.
This new edition incorporates an ecological orientation toward mental health
care in which full attention is given to both human and environmental strengths
and weaknesses. It is supported by extensive sets of chapter references that draw
from theory and evidence bases, classics in the wellness and prevention field,
applications from across the disciplines that contribute to wellness and preven-
tion, and information that literally is ripped from today’s headlines. Underscoring
the importance of social justice in wellness and prevention counseling, the book’s
contents ask practitioners to consider both the immediate and broader contexts
of their clients’ lives. As such, this model of counseling avoids being restricted to
a deficit-driven medical interpretation of psychological health by emphasizing a
holistic, wellness perspective.
As the book’s subtitle, Helping People Become Empowered in Systems and Settings,
suggests, the intent is to show how counselors and other professional helpers can
work with others to make substantial positive differences with clients and in the
world. Its contents demonstrate not only how the traditional model of one-to-
one therapy and small group work can be expanded to embrace wellness and
prevention but also how a broad range of environmental and system change strat-
egies, such as advocacy and community organization, can be included centrally
within the helping repertoire. The new counseling for wellness and prevention
xvi Preface

model comprehensively incorporates the necessary elements and is intended to be

of practical and heuristic value for practitioners, theorists, and academics.
The four chapters of section I address the foundations of wellness and preven-
tion counseling. Concepts drawn from public health and the medical model and
the evolution of wellness and prevention in health care are considered in chap-
ter 1. How wellness and prevention can be expressed through daily life (“Every-
day Wellness and Prevention”) is the subject of chapter 2. Seven broad wellness
and prevention strategies are explored in chapter 3, with the following chapter
examining how counselors and other mental health professionals can apply these
strategies in their work.The new counseling for wellness and prevention model is
presented, along with other models, to provide direction.
Detailed information is presented in section II about specific evidence-based
wellness and preventive programming in family, school, community, and work
settings and in systems associated with public policy and legislation. (Note to
Instructors: When assigning readings, you may find splitting chapter 6 (families,
schools) and chapter 7 (communities, the workplace) to be helpful.) The intro-
duction to section II contains valuable information about how the programs were
selected and presents sets of resources that readers will find helpful in their own
research.
I have tried throughout these pages to provide a needed road map for chal-
lenging the status quo and substantially altering the training and practice of coun-
seling. See the book’s ending, especially for suggestions about how to positively
alter counseling training programs to more fully embrace wellness and prevention.
For practitioners, students, and professors interested in the expanded role of
counseling for wellness and prevention in education, health care, and throughout
the helping process, my hope is that this book will provide valuable guidance.
ACKNOWLEDGEMENTS

To Anna Moore, senior editor of Routledge Mental Health for the United States
and North America, for supporting and guiding this third book revision; to
George Zimmar, publisher of Routledge Mental Health for the United States
and North America, for sponsoring the second edition; and to Joe Hollis (in
memoriam), the founder of Accelerated Development, for taking a risk on the
first version way back in 1987, when prevention and wellness were mere blips on
a somewhat distant horizon.
To Seattle University and its College of Education, for all the support and
kindness. The university was my home away from home as I revised this edition
while serving as its Boeing-William M. Allen Endowed Chair and Distinguished
Professor during 2013–2014.
To the Boeing Corporation, for providing the endowment that supported my
invited position at Seattle University.
To Dr. William O’Connell at Seattle University, who shepherded my appoint-
ment and then my stay for the year at the university, and to my other terrific
colleagues at Seattle.
To Perry Firth, my graduate assistant at Seattle University. Her resourcefulness,
good cheer, and creative ideas contributed markedly to this revision.
To all at Illinois State University and the University of Cincinnati who sup-
ported my work in prevention over many decades.
To Richard H. Price and the community psychology program at the Univer-
sity of Michigan, from whom I learned much about prevention during my visit-
ing scholar year in 1979–1980.
xviii Acknowledgements

To my colleagues and friends in the Prevention Section of the Society of

Counseling Psychology of the American Psychological Association, whose insight
and dogged determination about prevention serve as a model for us all.
And last, but definitely not least, to my wife, Lynn, who supported this venture
all along the way.
SECTION I

Foundations of Wellness
and Prevention

We all want to live healthy lives in nourishing environments. A noticeable shift

is occurring in counseling and general mental health practice to align with this
impulse. This evolving direction is termed wellness and prevention, and it is the
subject of this book.
The contents of chapters 1–4 in this first section lay down the foundations
supporting a wellness and prevention approach to counseling and mental health
practice. Chapter 1 traces the emergence of wellness and prevention and elabo-
rates these terms’ definitions.
The thesis of chapter 2 is that persons can proactively pursue wellness and
prevention in their own lives through participating in counseling or other men-
tal health services and by acting on their environments to produce needed
health-oriented improvements. This is not an argument against counseling by any
means but rather an affirmation of the responsible actions individuals can launch in
their own lives and in society to attain a healthier existence, while also benefiting
others. I term this personal initiative everyday wellness and prevention. It refers to the
positive practices we can all use to improve our health status and our capacity to
function satisfactorily and, indeed, happily in the settings and systems of our lives.
Chapter 3 explores major wellness and prevention strategies for promoting
wellness and prevention. Seven significant strategies are identified and elaborated.
Chapter 4 asks a big question: How can counselors and other helpers use wellness
and prevention strategies to promote healthiness in people, settings, and systems?
To answer this question, a number of behavior change approaches are reviewed,
followed by an examination of several counseling models that are especially sensi-
tive to wellness and prevention, including the new counseling for wellness and
prevention model, which includes interrelationships among prevention, wellness,
ecology, and social justice. The chapter, and section I, conclude with attention to
the wellness and prevention competencies that training programs need to address.
This page intentionally left blank
1
WELLNESS AND PREVENTION
IN MENTAL HEALTH

Live in rooms full of light

Avoid heavy food
Be moderate in the drinking of wine
Take massage, baths, exercise, and gymnastics
Fight insomnia with gentle rocking or the sound of running water
Change surroundings and take long journeys
Strictly avoid frightening ideas
Indulge in cheerful conversation and amusements
Listen to music.
Aulus Cornelius Celsus (25 BCE)

Health starts in our homes, schools, workplaces, neighborhoods, and communities

Healthy People.gov (2014)

Introduction
I begin this revised edition by relaying a message I hear from so many counseling
and mental health professionals and professors. It goes something like this:

It’s more than time that counselors and other mental health profession-
als take the steps necessary to elevate wellness and prevention to occupy a
prominent place in mental health delivery that effectively complements the
important role of treatment.
4 Foundations of Wellness and Prevention

This first chapter begins that discussion by introducing some important initial
contextual information accompanying wellness and prevention in mental health.
This information is expanded in subsequent chapters within section I. Then,
­section II of the book focuses on how counselors and other mental health profes-
sionals can apply wellness and prevention concepts in what I term counseling for
wellness and prevention. Let’s begin by considering issues surrounding the important
place of lifestyle in wellness and prevention.

Lifestyle Diseases and Lifestyle-Induced Disorders

Can Be Prevented
Noncommunicable conditions account for nearly two-thirds of deaths world-
wide.Therefore, the emergence of chronic diseases as the main challenge to global
health is unquestioned. In the United States, chronic diseases are the main causes
of poor health, disability, and death and account for most health care expenditures
(Bauer, Briss, Goodman, & Bowman, 2014).
As mentioned earlier, the very good news for counselors and their clients is that
lifestyle diseases and chronic disorders, sometimes referred to as lifestyle-induced
disorders, are preventable. In fact, up to 80% of illness is accountable by lifestyle
choices (Ford et al., 2009). Lifestyle-induced disorders are those that are substan-
tially impacted by how we live our lives and by the ongoing daily choices we
make. A particular concern, and opportunity, for counselors and other mental
health professionals in the United States adopting a wellness and prevention per-
spective is that unmanaged stress strongly adds to lifestyle-induced dysfunctions;
this lifestyle variable is an area where counselors can make a substantial positive
contribution.
Disorders attributable to lifestyle evolve through exposure, often intentional,
to risk or certain health-compromising factors. It might be surprising to realize
that heart disease, cancer, stroke, and diabetes are not the causes of illness and death,
as may be commonly understood. Rather, they are the effects of people making
unhealthy life choices day after day, year after year (McGinnis & Foege, as cited in
Katz, 2013); of toxic environmental conditions; or of genetic causes. Examples of
unhealthy choices and influences that may be subject to personal control include
cigarette smoking, excessive use of alcohol or other drugs, lack of physical exer-
cise, poor nutrition and dietary habits, low social support, ineffective thought
processes, and responses to continual and/or accumulative stress. Encouraging
and supporting individuals’ positive lifestyle choices is a central tenet of wellness,
where people learn how to take increased personal responsibility for their life
trajectories.
Notice the long list of lifestyle-induced diseases in the following box. All of
them can be positively affected through wellness and prevention interventions.
 Wellness and Prevention in Mental Health 5

Lifestyle-Induced Disorders
Heart disease
Hypertension
Stroke
Type 2 diabetes
Some cancers (e.g., colon cancer)
Obesity
Diseases strongly associated with smoking, excessive alcohol consumption,
and drug use
Emotional disorders not attributable to organic causes
(adapted from Matthews, 2011)

Being Well: Personal Actions

There is much that individuals themselves can do to get and stay well, how-
ever, and that counselors can promote with their clients and through program-
matic offerings. Daily life choices, or everyday wellness and prevention practices
(see chapter 2), are critically important. For example, people can choose not to
smoke cigarettes or, if they do smoke, to participate in a smoking cessation pro-
gram to become smoke free.They can choose to move more and to become more
active, appropriate to their life situation and with doctor preapproval, leaving a
sedentary lifestyle behind.
Katz (2013), in his book Disease Proof, amassed research to support a basic pre-
scription for individual healthiness: Do not smoke, eat well, be active, and maintain a
healthy weight. (Mental health professionals also recognize the critically important
contribution of managing stress.) As Katz put it, “we are all making life-or-death
decisions every day in terms of what we choose to put into our bodies and how
we choose to use them” (p. 8). At the same time, these risk factors can be counter-
acted by conscious exposure to protective factors and behaviors such as Katz’s: not
(or never having started) smoking, eating nutritiously, and engaging in a regular
pattern of physical exercise that is appropriate to life stage and age.
Walsh (2011) has crystallized how what he terms therapeutic life changes (TLCs)
can promote wellness. TLCs are evidence-based lifestyle actions that individuals
can take to improve their mental health and that counselors and other helpers
can use in working with clients for that purpose. He maintains that TLCs can be
as effective as psychotherapy or pharmacotherapy, offering unique and signifi-
cant therapeutic advantages. Ivey (2012) has cogently illustrated how TLCs can
promote new neural connections in the brain, suggesting that counseling and
6 Foundations of Wellness and Prevention

medicine connect. I discuss TLCs more extensively in chapter 2 as they relate to

everyday wellness and prevention.
Positive alternative choices exist, therefore, to be made in the various wellness
domains of life, and once made and maintained, they can contribute substantially to
improving the quality of life. New research from the Centers for Disease Control
and Prevention shows that life expectancy in the United States reached an all-time
high of 78.8 years in 2012, but this marker varies by ZIP code, with those living in
more affluent areas living longer, on average, than those living in poor areas.
Lifestyle choices also can contribute significantly to these results, according to
observations solicited from Dr. Suzanne Steinbaum, a preventive cardiologist: “The
most common causes of death are due to how you choose to live. If we can get how we
eat and how we exercise under control, we can prevent many major causes of death.
We can stop being a treatment-oriented country, and become a prevention-oriented
country and extend life tremendously” (Healthfinder.gov, 2014).

Being Well: Environmental Actions

However, it’s important to remember that becoming healthy is not solely a matter
of individual choice. “Because people’s lives are a complex kaleidoscope of expe-
riences that influence what they believe and do, focusing merely on individual
experiences leaves individuals trying to understand their lives out of context”
(Prilleltensky, Dokecki, Frieden, & Wang, 2007, p. 32).
In fact, people live in context and are subject to multiple interactive forces con-
stantly, some of which might support a healthy lifestyle, such as the availability of
walking paths nearby, others of which might detract from a healthy lifestyle, such
as high unemployment coupled with the lack of good jobs. Recall the second
quotation at the chapter’s beginning: “Health starts in our homes, schools, work-
places, neighborhoods, and communities” (Healthy People.gov, 2014). People can
take steps to directly influence and improve many aspects of their environment.
As well, when counselors consider helping people and systems to become and
stay healthy, an individual model of change, while important, makes only partial
sense. An ecological model, concerned with people-in-systems, is more reflective
of reality because humans experience their lives in relation to other people and to
a variety of settings and systems. Counselors, then, need to help people learn how
to use their knowledge, awareness, and skills to function effectively interpersonally
and in the range of other environments in their lives.There are many implications
emerging from this perspective, including, for example, that wellness and preven-
tion goals apply both to people and to environments.

Wellness and Prevention: General Goals

and Intervention Strategies
Wellness and prevention are interconnected goals for health care, for personal liv-
ing, and for settings and systems.They also are accompanied by sets of intervention
 Wellness and Prevention in Mental Health 7

strategies that mental health professionals use to help clients and client systems
reach desired goals. Both wellness and prevention are aimed at producing the
“good life and the good society.” Wellness refers to a health status of abundance,
where persons or settings are not only free from dysfunction but also are max-
imizing healthy functioning across all important domains. Prevention refers to
living life in such a way as to avoid significant problems and disorders and to
intentionally improve the major settings of life: family, work, school, neighbor-
hood, and community.
In terms of intervention strategies, counselors and other professional helpers
can assist clients to engage in specific activities and behaviors that can elevate
wellness in their lives and to modify their environments to become more empow-
ering. Doing so has been endorsed in a number of ways, including through an
official resolution, The Counseling Profession as Advocates for Optimum Health and
Wellness, adopted by the Governing Council of the American Counseling Asso-
ciation (then known as the American Association for Counseling and Develop-
ment) on July 13, 1989 (Myers & Sweeney, 2008).
Numerous ways are available for counselors to assist in promoting wellness.
For instance, they can teach clients, train other professionals, and consult with
agencies about the importance of lifestyle choices and how environments can
support positive choices. Two major sets of empowerment strategies are available:
(a) helping people to learn before the fact how to implement wellness strategies
in their lives and (b) collaborating with others to facilitate system changes aimed
at supporting wellness initiatives.

Personal, Relational, and Collective Levels of Wellness Intervention

As Prilleltensky and colleagues (2007) argued, wellness and quality of life are
attainable when three primary sets of needs are met and mutually influence each
other in an ecological system: (a) personal, (b) relational, and (c) collective. The
personal and relational are very familiar to counselors. We counsel individuals,
groups, and families all the time; those approaches have been, and remain, our
bread and butter. From this viewpoint, the goal is to help individual clients to acti-
vate self-esteem and mastery through counseling and to promote support, caring,
and positive relationships at the group and family levels. Less familiar to counsel-
ors is focusing on the collective level, where the approach is to influence positive
change in settings and systems that may negatively affect people, using community
organization and system intervention (COSI) strategies. It is important to empha-
size that these three nodes, personal, relational, and collective, are not exclusive. In
fact, they overlap and are interconnected, as is the case in any ecological system.
Give special attention to the collective node. This one is situated at the civic
properties of life, on social justice, and on social systemic dynamics. Its prov-
ince is spreading opportunities for all, creating equity and access to services and
opportunities, and diminishing or eradicating assaults on the human spirit such as
­oppression, racism, sexism, and ageism.
8 Foundations of Wellness and Prevention

Addressing the collective level is no doubt considerably less familiar right now
for counselors and other helpers, and probably less comfortable to effect. Con-
sultation, advocacy, and social justice strategies are attuned to facilitating needed
social system change in such dimensions as culture, policies, procedures, and
legislation.
Wellness and prevention efforts need to be informed by—and often to include
directly—social justice. George Albee, a central figure in the development of
mental health prevention, strongly asserted that prevention involved social justice,
where the settings and systems of life—collective entities—are proactively altered
to produce just and equitable environments that support the health and well-
ness of all citizens. Closing the have–have not gap represents one such area to be
addressed from the social justice perspective. Indeed, wellness and prevention are
goals for human and societal functioning—both—and they interrelate.
Let’s take a closer look at both wellness and prevention.

Wellness at All Levels

Wellness is dynamic, comprehensive, and holistic, and its essence can be under-
stood as the integration of the mind, body, and spirit. At the nub of the issue for
understanding wellness is that health is far more than the mere absence of diag-
nosable illness or noxious environments, as important as those conditions are. After
all, no one wants to be coping with diabetes, or depression, or urinary inconti-
nency, or academic failure, or to be subjected to community environments that are
oppressive, unjust, and sick—the list, unfortunately, seems endless.Yet healthiness,
or wellness, involves the absence of personal illness or environmental dysfunction
and also the presence of functioning at or near the potential for well-being across
all domains.
Moreover, wellness is not languishing, not being free from a disorder or from
inequity, not “just getting by,” or not being “just enough.” Rather, wellness refers
to optimal functioning within and across personal, relational, and collective levels.
Another way of stating it is that wellness represents the ultimate state of well-being
and health that is capable of being achieved by individuals, groups and families,
organizations, and communities (for additional definitions, see Myers & Sweeney,
2005, 2008; Prilleltensky et al., 2007). Keyes and Lopez (2002), in fact, discussed
the concept of flourishing, a state of experiencing high levels of well-being in the
emotional, social, and psychological domains.
So, there can be healthy individuals, healthy groups, healthy organizations,
healthy communities, and so on. By being “healthy,” it is much more likely that
life will be satisfying, enjoyable, productive, and fair and equitable, and that a host
of major life dysfunctions will be avoided or prevented.
Sometimes people comingle prevention and wellness. While the concepts
are highly related, each stakes its own turf. As O’Connell, Boat, and Warner
(2009) put it, prevention emphasizes the avoidance of risk factors at systemic
 Wellness and Prevention in Mental Health 9

levels (individual, group, family, organization, community), whereas health pro-

motion/wellness promotes supportive family, school, and community environ-
ments and seeks to develop in people protective factors—resources that enhance
well-being and provide competencies to avoid deleterious behaviors and emo-
tions. Thus, a wellness and prevention counseling model (see chapter 4) needs
to take into account proactively (before problem onset) the goal of reducing
risk and increasing protective factors within and across personal, relational, and
collective levels.
When considering wellness, most attention and research have been concen-
trated on the individual level: actions that a person can take to enhance her or his
wellness or individual counseling addressing wellness issues. Note that the sub-
sequent discussion follows that approach. Later, the discussion of prevention will
emphasize the collective perspective, with a focus on social system change issues.

Prevention: Before the Fact

When I introduce the concept of prevention to those who are unfamiliar with
it, I often draw from the classic fable referred to variously as the “river story,” the
“upstream/downstream” story, or some other similar descriptor. Its origins are
attributed to various sources, most commonly to Julian Rappaport, the com-
munity psychologist, or to Saul Alinsky, the community organizer. Its specific
contents also vary, but the essence of the message remains similar. In any case, its
contents set the stage nicely for introducing prevention to an audience.

A Classic Prevention Fable

Imagine a warm, sunny afternoon. You are in a local park, lounging indo-
lently on a blanket, with a bottle of wine and a good book on the grassy
banks of a river below a swimming area. Suddenly you hear thrashing sounds
and a cry for help from the river. Startled, you look over to see a person
struggling unsuccessfully as the water sweeps him away. You courageously
dive in, rescue him, and then return to the serious business of soaking up
the sun. There is to be no respite for you, however, for you find yourself
repeating this performance with several other drowning people throughout
the afternoon. As you are ministering to the final victim, an observer asks
a question that is startlingly powerful in its logic and simplicity: “Would it
not ultimately be much easier and less dangerous to go to the swimming
area and teach those people, collectively, how to swim than to rescue each
individually?”
(Conyne, 2004)
10 Foundations of Wellness and Prevention

Can we any longer afford the luxury of gearing our helping services around
the model of “rescue each individually”? Of always swimming upstream, in a
sense, against the prevailing current of treatment after the fact? Wouldn’t it be
more effective to take the advice of the observer in the previous anecdote and
begin to teach people collectively the wellness competencies they will need in the
future (in this case, floating and swimming) so that they can successfully cope with
the demands of life later (again, in this case, so they can successfully handle a rough
current)? Additionally, although the astute observer did not mention this, would it
not have been useful for a railing to have been erected around the swimming area
to keep the nonswimmers away from the danger of falling in and drowning? That
is, as a general rule, can we begin designing environmental improvements to protect
and enhance human functioning?
Teaching wellness competencies and accomplishing prevention through the
design of environmental improvements, both conducted before the onset of
problem formation, represent important ways to promote wellness and prevent
dysfunction.
Social justice. I mentioned earlier how Albee (1986) called on mental health
personnel engaged in prevention to help produce a “just society.” His vision of such
a society meant that oppression, such as exertion of privilege, sexism, racism, con-
sumerism, ageism, patriarchy, and homophobia, must be eliminated. Counteracting
oppression would allow settings and systems to develop more humanely, with posi-
tive effects on people. Social justice is a chief antidote to oppression, and it is a cen-
tral tenet of prevention justice (Hage & Kenny, 2009; Kenny, Horne, Orpinas, &
Reese, 2009; Ratts, 2009; Shriberg, Song, Miranda, & Radliff, 2013;Vera & Kenny,
2013;Vera & Speight, 2007). Its presence within wellness and prevention initiatives
needs to be increased; it is important for social systems to be well, too. As Conyne,
Horne, and Raczynski (2013) put it: “Prevention of disease is not contained in the
doctor’s office, but it starts in our communities and at home” (p. 51). It is the same
for wellness, which is not limited to the efforts of individuals to remain healthy or
to maintain a state of optimum health; rather, the wellness of a person is dependent
on participating in a proficient health care system, through proactive individual
efforts, and—importantly, but frequently not addressed—through environments in
addition to health care that themselves are healthy.
Incidence reduction: A classic prevention approach. Albee (1982, 1985)
adapted a public health approach known as incidence reduction to prevention in
mental health. He emphasized that prevention is realized when the occurrence of
new cases of a disease or disorder, or the rate of development of such new cases, is
stopped, a kind of “No mas!” Some have proposed that such an understanding of
prevention—prior to the onset of a mental, emotional, or behavioral disorder—is
true prevention (O’Connell et al., 2009). “Before-the-fact” interventions and pro-
grams, then, are an outgrowth of incidence reduction as a goal. Incidence reduc-
tion typifies a view of what I would term “classic” prevention.
See the incidence reduction formula in the following box.
Another random document with
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