What is Mental Health?
What does it mean to be well? How is mental health defined?
Every counseling approach has an implicit model of health or well-being. Most of them share a common set of assumptions about health, but use different terms, jargon, and concepts to explain it. Counselors should be able to provide a clear model of health so that you know what a successful treatment outcome might look like from the first session.
Here are 10 vital signs of mental health (inspired by Nancy McWilliams’ work, which summarizes the positive outcomes of depth-oriented psychotherapy).
Inner safety and an ability to form mature connections with other people. You should feel comfortable and safe with your counselor throughout your work with them - this measure of health is both an outcome and requirement of good counseling. There should be a measure of trust, warmth, and a sense of being understood at the beginning of counseling, but also the freedom to work toward trust at greater depth during your time in sessions. Practically, you may experience this as me checking in on how we’re relating to one another and how you’re feeling about our relationship, which builds a form of trust and mature connection over time.
Viewing yourself and others with a sense of holistic continuity. McWilliams puts it this way, “A key part of mental wellness is the capacity to see the self and others as complex and generally consistent individuals, with both good and bad aspects, who are not subject to abrupt and catastrophic transformation”. We all struggle with this at some level in our lives. When people offend or hurt us (in a real or imagined way), it’s tempting to view them as “all bad”. On the other hand, when people are meeting our expectations or needs, we may view them as “all good”. Truthfully, we contain multitudes. Counseling can help you sort through the ways you sort people (and yourself) into these split categories, which improves your resilience and inner strength.
A sense of agency and autonomy in life. This is quite important, and there’s a paradox embedded in this vital sign. You’ve come to a counselor for help and support, yet one outcome of good counseling is that you find your own way to validate your experience, chart a new course in life, and make decisions for your well-being. Jungian Analyst James Hollis writes, “…virtually all of us lack a deep sense of permission to lead our own lives. We learned very early that the world exacted conditions that, if not met, could result in punishment or abandonment”. Counseling allows you to step back so you can find your own tools and take full responsibility for your life and future.
Realistic and reliable self-esteem. Realistic self-esteem is the ability to view yourself as someone who is “good-enough” without needing to overcompensate through perfectionistic achievements or inflating your accomplishments. A reliable sense of self can hold together during the inevitable ups and downs of life without feeling overly crushed or grandiose. Counseling helps you hold together and accept all these parts of yourself in a trusting, nonjudgmental relationship with another person, which you will internalize over time.
Having resilience and flexibility in the way you regulate emotions. The old term for this vital sign is “ego strength”. Over the course of counseling, you will experience intense emotions (inside and outside the room) which you’ll learn to regulate (a term for noticing, experiencing, labelling, and moving through). All of us have defenses to ward off intense emotions we’d rather not feel - and our defenses are useful and important. But not all defenses are created equal. In counseling, you’ll learn more flexible ways to engage with emotions, which will help life feel more rich and engaging.
An ability to engage in higher reflective functioning. The best way to understand reflective functioning (also called ‘mentalization’) is to think about the classic defensive maneuver of projection. When we fail to own our internal state, we can project it onto other people. Others become a canvas for our own unresolved material. The ability to step back, withdraw our projection, and see the other as a separate human being with their own thoughts, feelings, and wishes requires reflective functioning. This is why a good counselor is going to constantly inquire about your sensations, imaginations, feelings, and thoughts - so you can own and understand them.
Comfort with solitude and community. To be alone is a developmental achievement. It means we can find comfort and solace within our own inner world without losing a sense of reference for who we are in relation to others (it means we have a rich and stimulating inner world). Dwelling richly in community with others is another component of mental well-being. In some ways, it’s the acid test for all the preceding measures of health, requiring us to acknowledge the other, find ways to address our needs in relationships, and sort through our differences (without splitting others into all good/all bad categories).
A sense of feeling alive to your own experience. This measure of well-being is something that’s hard to understand until you really feel it. Counseling is meant to get you in touch with your own experience at depth, which helps create a sense of zest and aliveness in the way you approach living. It’s like watching a television in black and white without knowing what color is and then experiencing color.
Acceptance, forgiveness, and gratitude. Accepting what cannot be changed and what must be mourned is a key part of living life with connection and honesty. The world is inherently uncertain, which requires all of us to navigate grief and loss throughout our lives. Counseling helps you turn toward these losses and transition, mourn them (a never-fully achieved process), and move toward what is possible in life with a realistic sense of hope.
The ability to love, work, and play. Freud reportedly wrote that the goal of treatment is the ability to love and to work, with the added component of enjoyment. At the end of the day, counseling is meant to fall away and provide you with an experience that helps you more fully engage in life, work, and relationships. All of the preceding vital signs of health support this one. My aim as a counselor is to help you accompany you in a process that supports your ability to love others, engage in meaningful contribution to your community, and live your life with a sense of vitality and curiosity.
If you enjoyed this overview, you can listen and hear more from Nancy McWilliams in this video.
References
Hollis, J. (2006). Finding meaning in the second half of life. Gotham Books.
McWilliams, N. (2021). Psychoanalytic Supervision. Guilford Publications.