How do we know when clients, or we ourselves as counselors, are realizing wellness? When presenting symptoms subside? When returning to expected functionality? When no longer feeling consumed by pain or desire? Is alleviation of human suffering the same as mental health? Or is it merely a starting point for wellness development?
As Frances (2013) described, wellness is essentially optimal homeostatic functioning. Feeling is essentially indications of how far from this optimal zone. As we drift from ideal center we feel a need to respond eventually. But as we stretch further from ideal equilibrium we feel an increasing urgency for course correction. As Frances noted, when one of our many homeostatic levels drops too low or rises to high, we experience dis-ease. And ultimately death.
It occurs to me that any time one of these homeostatic levels climbs too high we experience this as pain—feeling the need to remove a threat to equilibrium. When dropping low we experience this as desire—feeling the need to draw in what’s needed to restore equilibrium. Could these be what Freud regarded as the primal drives of aggression and sex?
Drive theory with its emphasis on unconscious forces illuminates those unconscious drives resulting in frequent error, but tends to leave in the dark the larger volume of unconscious energies resulting in wellness. When discussing the unconscious, I visualize it as a bank of generalizations upon which we depend to conduct our lives. They permit is to automatically respond as needed to restore homeostatic equilibrium, most of the time. A few overgeneralizations upon which we misbehave can give the realm of generalizing such a bad name. Which is itself generalizing. Despite the psychoanalytic emphasis on pathology, the depths of the unconscious—of these acted upon generalizations—actually serve the humanistic interest of growth potential.
Ego psychology starts to illuminate the psychosocial feature of life. To restore internal equilibrium requires external resources often beyond one’s own control. The traditional focus on ego deficits easily neglects how the evolution of human wellness relied upon tight knit social connections. Those consistently enjoying a supportive sociocultural environment may not be cognizant of how much their own wellness depends upon that familiar support environment being there, especially when asserting their autonomy. Those without such supports lack the means to develop their ego strengths, and no amount of self-changing will change the fact of needing those missing supports. It can be easy for therapists to take for granted if reliable social supports is all they have known. Humanism at least empowers the client to express this often socially invisible psychosocial dimension.
Object relations brings the psychosocial feature to the fore. Although I tend to appreciate this better from a Bowlby attachment theory perspective. Instead of the object relations approach which easily erases sociocultural factors (Ivey et al., 2005, p. 282), attachment theory casts self as both independent and interdependent. Or as Gilligan et al. (1988) proposed as a distinct objective self complemented by a connected self.
Self psychology is primarily a theory of psychological deficit (Hansen, 2000). If the humanist approach empowered clients to explore the etiology of such deficits from a broader family systems or feminist perspective, then this psychosocial dimension can more easily come into focus. There may be a kind of “psychosocial privilege” for those with ready access to resources for both their social and their ego needs in relative parity. When a problem crops up then it is easy to presume the problem is psychological—when in fact what is missing is something external that the internal requires for restoring equilibrium. A routinized adjustment to this “social deficit” reality is then readily blamed on the less privileged client. Such unfounded stigma, it seems, is what keeps many from seeking help from a “psychotherapist.”
Frances, A. (2013). Saving normal: An insider's revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. New York NY: HarperCollins Publishers. Chapter One: What’s normal and what’s not?
Gilligan, C., Ward, J., & Taylor, J. (1988). Mapping the moral domain. Cambridge, MA: Harvard University Press.
Hansen, J. (2000). Psychoanalysis and humanism: A review and critical examination of integrationist efforts with some proposed resolutions. Journal of Counseling & Development. 78, 21-28.
Ivey, A., Ivey, M., Myers, J., & Sweeney, T. (2005). Developmental counseling and therapy: Promoting wellness over the lifespan. Boston, MA: Houghton Mifflin Company.