09 Nov PSYCHOLOGICAL HEALTH: THE PATH FROM SURVIVING TO THRIVING – PART III
Chrysalis Well-Being Model
We’re going to try something new on longer blog posts, which is to provide a very quick summary to start, and you can decide if you’d like to read further for more depth and context.
Quick Hitter: The Chrysalis model views psychological health as a multidimensional profile of capacities, many of which are interrelated, founded in research and clinical work from many psychological disciplines. The therapy process can provide an atmosphere to develop or cultivate these capacities. We also affirm each person’s ability to determine what they believe, feel, and choose to pursue as part of a psychologically healthy life rather than having well-being objectively defined for them.
Back to the question we asked in our first blog: What is well-being? Well, as you can see, there really isn’t a single, agreed-upon definition. At Chrysalis, we think of well-being in some important ways:
A Dimensional Well-Being Profile
There isn’t a single trait or variable that captures well-being—there are many elements with dimensions for each. This is like many things we measure as psychologists. People might talk about your IQ, but you and I can have the same Full Scale IQ score and have very different profiles of strengths and vulnerabilities, such as those related to verbal comprehension versus perceptual reasoning. Well-being is similar. You might have a strength in emotional awareness and regulation but struggle with intimacy in your relationships, or vice versa.
Breadth, Depth, Integration
Unlike some models that value a single emotion, state, or side of a continuum, we believe strongly that well-being is having a breadth and range of capacities. As an example, this means that it’s not about having a single emotional state all the time but rather access to the full range of your various emotional states and not being restricted to one or another.
From another area of study, let’s think about this in relation to your biological fear response. We hear quite a bit about the “toxic” effects of chronic stress response. This is very true. What is also true is that without your stress response … you would die. There are several conditions (e.g., Addison’s disease, Shy -Drager Syndrome) in which the body doesn’t produce adequate hormones to create the typical stress response. The lack of a stress response is deadly. If you’re an animal on the savannah, you’d better be able to experience fear, or you won’t live very long. So, while chronic activation of any state is problematic, so is the inability to experience a normal range of states. It’s also the depth at which one can access different states. Basically, we can experience a restriction in our ability to feel or experience something fully, or we might experience it in characteristically underregulated and overwhelming ways.
Having a capacity does not mean you must use it. For example, having the capacity to experience intimacy does not mean that you are compelled to be close to someone that you might choose not to trust. This is related to a concept of agency that we’ll cover shortly.
Finally, psychological health embodies an ability to more fully integrate our various capacities. This could mean feeling complex emotional states like sadness and gratitude simultaneously, or experiencing cognitive states like having a connection to what you are experiencing in the moment while keeping context of a broader range of time and place. This could also be the ability to be aware of and integrate multiple kinds of experiences (such as emotional and cognitive) that might not feel like they’re aligned.
Dynamic Balance
We might think that there is a single state of well-being, but it might actually be more helpful for us to think about a process of well-being. What I mean by this is that well-being might look and feel different at different times, depending on a range of factors. The fancy scientific term for what I’m referring to is allostasis. It’s a swanky way of saying that one’s sense of well-being is a dynamic process where the demands of life and the resources to meet those demands are in constant flux. For example, well-being might look one way when you’re in a celebratory moment in life like graduation, your wedding, or getting the long-sought-after job. It might look different in a moment of loss, like a death of a loved one, losing that job, or a physical injury or illness. These different moments in life promote different types of responses that are more or less adaptive. For a physiological analogy, your blood pressure, glucose level, heart rate, and respiratory rate are different depending on whether you are sleeping or awake, passive or active. You wouldn’t want to set an ideal static value for any of those physical process because of these different states. This might seem obvious when reading it here but often we aspire to a single state, such as happiness or peace, despite the circumstances.
Your well-being is influenced by a balance of internal and external demands and resources. Consider this scenario: You have the flu, and your neighbor’s dog is keeping you up at night. How might your sense of well-being be different if you are alone, versus having the full support of a family, a partner, or your community? So, the key is that we are flexible and adaptive in our process so that we can accommodate a whole range of states and experiences in life while demands and resources are always shifting. This is essentially what we call resilience (a topic for another blog).
Key Domains
I imagine one could come up with an endless list of possible psychological variables related to well-being, but at Chrysalis we tend to focus most specifically on the following listed below. They come from cognitive and affective neuroscience, developmental and parent-infant research, and a long lineage of psychodynamic theorists and clinicians. They are presented as separate and yet they tend to be interrelated, creating either a mutual virtuous or vicious cycle of experience. They are influenced by a host of (interrelated) factors such as genetics, early critical physical and emotional periods of development, life experiences, and so on. The therapy process allows for someone to further cultivate or develop these capacities where they might be lacking or stuck.
I want to acknowledge a particular debt of gratitude to Nancy McWilliams for her integrative and creative work, and its influence on our own model (McWilliams 2021; Personal Communication).
Identity
Our sense of ourselves is fundamental in psychological health. We might take some of these aspects for granted or not think about them, but when we are struggling they can often seem much more apparent as either the source of the difficulty or how it’s impacted by our difficulties. The ability to have an identity that feels consistent and yet flexible over time is crucial to psychological stability. When this identity has not developed sufficiently or has been temporarily waylaid, we can feel as though we don’t recognize ourselves at times, that we’re very different people in different contexts, or that we too rapidly shift from one experience to another. On the other hand, we can feel very restricted in our ability to have range in our self-experience, and others might even describe us as annoyingly consistent or boring. So, one aspect of psychological health is having a stable yet flexible sense of ourselves that endures over time.
Another aspect of psychological health is a broadly positive sense of self, or what we might call self-esteem. This is based on a realistic awareness of our strengths and where our vulnerabilities and sensitivities are. To achieve stable and positive self-esteem, we must balance being so overly critical that we feel bad or lacking against an unrealistic overvaluation. Overvaluing leaves us vulnerable to a sudden and destabilizing collapse.
At Chrysalis we think quite a bit about what is referred to as agency. Agency is a belief or experience that one has an impact on their world or that they are an active agent of change. In many cases, people struggling with depression and anxiety (as well as most other psychological disorders) have difficulty with realistic agency. Often there is a sense that one cannot impact significant change, and despair or vague, directionless anxiety sets in. Others may take on unrealistic levels of responsibility that leave them feeling chronically at fault or anxious about the need to control events well beyond what is feasible. At Chrysalis, we think about this not just as something in someone’s life outside of therapy, but also how that person can come to feel like they have more agency in their own therapy process.
Relationship Functioning
I began with self but in reality, we are always a self in relation to others. Our very sense of self emerges in the context of our earliest relationships. Our ways and patterns of relating to others directly impacts our well-being. The concepts I mentioned of stability, flexibility, and a feeling of consistency over time is also a product of relationships that support this experience. Research on how we attach to our caregivers and later peers and romantic/sexual partners consistently demonstrates how important feelings of safety and reliability are for a variety of well-being outcomes and how the absence is related to impairments. This is referred to as secure attachment. Interestingly, this does not mean that these kinds of relationships are without conflict or strain but rather that there is sufficient awareness of one another that when breakdowns inevitably happen, there is a “repair” of the disruption. Over time this builds increasing confidence in an ability to trust and depend on one another that is the hallmark of true safety. When we can truly trust another, then we can move into states of intimacy, be it emotional or physical, that allow for closeness. Other forms of attachment leave us feeling unable to trust or allow closeness, or fear being left and unable to allow distance or a feeling of autonomy. Another way to talk about this is the ability to love. Love is a complicated word with different forms and meanings, but here we mean the experience of providing and receiving care and devotion.
Resilience
The concept of resilience has received increasing focus in recent decades, in part because of a heightened awareness of the potential for trauma. The concept is also a good example of the interrelatedness of these various components because while we could think of it as one aspect of well-being, you could easily make the case that it’s actually the outcome of healthy functioning in all these other areas. What resilience is not is being unaffected by challenge and difficulty. Rather, it is the ability to rebound from the initial impact to our system. This is where the concept of allostasis is so helpful. It only makes sense that we would be affected by some difficulty, such as an illness or death, but then we need to be able to recover. Resilience is undergirded by so many functions that it has been quite difficult for anyone to predict who is going to be resilient with an equation of related variables. We often develop characteristic ways that we consciously and unconsciously manage distress. For example, the way we talk to ourselves can be encouraging or discouraging, support our agency or lead to feelings of passivity and despondence, or provide hope or lead to despair. Similarly, our choices about behaviors such as appropriate physical activity and sleep can promote resilience, while problematic substance use or eating could lead to decreased resilience and increased distress.
There are a variety of defenses we use, sometimes unknowingly, to manage distress. The more we can use forms of defenses that don’t require significant distortions in our reality and experience, the more resilient we tend to be. It won’t be surprising at this point to hear me say again that it’s also about flexibility. Having only a few ways of dealing with things quickly becomes overly restrictive. If I must go for a run to deal with distress, then I have a problem when I’ve injured my ankle. (In turn, this also may be why I injured it in the first place, from having to overexercise.) Now I have to risk furthering the injury if I feel unable to cope another way.
Insight
I’m going to lump some complex concepts into the broad category of insight or psychological mindedness here. These different concepts go by names like meta-cognition, theory of mind, reflective function, and a personal favorite … mentalization. What they share in common is an awareness of minds. This might sound obvious but in non-healthy psychological states we see profound deficits or losses of this capacity. Some would make the case that the whole project of psychotherapy is really about developing this capacity. Even for those who are quite insightful about themselves and others, momentary losses of this ability lead to real difficulty. The aspects of our brain functioning that support this capacity are much less accessible under intense emotional distress. One form of insight is about attaining knowledge about yourself and others over time. Another is a process of gaining more immediate awareness of one’s own mind and attempting to understand the mind of another. At Chrysalis we prioritize the development of the capacity to be aware of minds above just attaining intellectual knowledge about oneself.
Emotional Experience
It’s a challenge to succinctly cover the complexity of emotional experience in a brief section, which is why I plan to write a series of blogs on the topic itself, but I’ll do my best here. As humans we typically come to experience ourselves disproportionally in relation to our thoughts. By this I mean that we tend to identify with our thoughts as if they were the essence of who we are. What is easily forgotten or purposefully rejected is that we were first and foremost an emotional being, before we had mature thinking capacities. Our emotional lives often operate more quietly behind the scenes in the background, until moments when they seem to erupt into the foreground.
There are several aspects to emotional health that we pay attention to. The first is have a capacity to experience the full range of emotions. If we find that we are unable to experience certain emotions our experience in life will be constricted. Secondly, we need an ability to tolerate emotional experience. If we cannot sufficiently tolerate emotions, then we either have to find ways of disconnecting from ourselves or the world to avoid them, or we need to immediately discharge them, which leads to problematic forms of impulsivity. Behavioral reactivity and impulsivity are often about being unable to tolerate an upsetting emotional state and a need to discharge it. It’s not only the capability of tolerating unpleasant emotions that we need but also the ability to allow and enjoy the positive emotional states in our lives. Thirdly, our ability to tolerate our emotional experiences is related to our ability to modulate them—a fancy way of saying impact their intensity in one direction or another. One way we do this is by developing language to capture these experiences and make them more accessible and useful personally and in relationships. This brings us to the fourth aspect, which is the capacity for emotional expression. Our emotions provide us with individual grounding and direction, but they are also very relational. If we feel able to be aware of and express our emotions in our relationships, it increases the likelihood that we feel agency, experience security of attachment, and get our needs met or meet the needs of others.
Vitality
The experience of vitality can be hard to define, but it is sort of our life blood, drive, or energy. It’s common to hear people speak about the neurochemical dopamine and its relationship to pleasure. This is often mistakenly referred to as the reinforcement or reward system. While we do experience release of dopamine around the attainment of something we desire, it’s actually released in the pursuit of what we desire. The late Jaak Panksepp (2012), the founder of affective neuroscience, listed this as one of the seven primary emotional mammalian experiences, which he referred to as the SEEKING system. This affective state is the foundation in many other affective experiences as well. Substances such as cocaine and amphetamines are notorious for this effect. They bring about feelings of intense, goal-directed activity and energy. Manic and depressive states represent the psychological ends of the continuum. People often enter the therapy process struggling with having lost or possibly never having experienced sufficient vitality in their lives. Psychological health involves a sense of vitality and aliveness.
Play and Creativity
I am including another affective state that we at Chrysalis believe is crucial to psychological health but doesn’t receive enough “play” (sorry, I had to). Panksepp lists PLAY as one of the seven fundamental affective states we experience. Stuart Brown (2010) is also well known for his work in this area and makes the point that no one needs to teach us to be able to play—it is part of the human and mammalian experience. Play is not a behavior per se but a state of mind that is both creative and expansive. It allows us to approach challenging experiences and to not be overwhelmed by them. One example would be the early forms of rough and tumble play that allow us to work at the edge of too much. Inevitably, someone plays just a little too rough, and the other participant lets them know. From this comes empathy and an awareness of one’s abilities.
Brown and others, like Donald Winnicott (1970), detail the damaging effects of trauma on the ability to play in life. Continuing the theme of interrelatedness of these concepts, play and exploration are byproducts of environments safe enough to allow for it. States that require a focus on survival don’t allow for play; therefore, secure attachments are central. In fact, the way that attachment is measured with children involves assessing how they use their caregiver to manage distress in order to return to play and exploration. Play also leads to emotional tolerance, modulation, and expression. Playfulness is part of a capacity for humor that we know is a more mature defense mentioned earlier and is related to resilience. The capacity to imagine the mind of another person and hold in mind various perspectives simultaneously, a sign of mentalization, requires some creativity and imagination and flows from relationships in which we can playfully explore our minds and the minds of others. Many people would also consider play and creativity to be inherently part of vitality as well. In other words, the capacity for play is kind of a big deal!
Values and Virtues
Lastly, there has been an increasing focus on virtue and values in recent years as being part of the “good life.” This interest and emphasis can be found in the fields of positive psychology, social psychology, and clinical theories such as Acceptance and Commitment Therapy. Dacher Keltner and his group at the Greater Good Science Center list gratitude, awe, happiness, compassion, altruism, diversity, empathy, forgiveness, mindfulness, and social connection as central virtues related to well-being. Nancy McWilliams lists acceptance, forgiveness, and gratitude as virtues that are found in a psychoanalytic sensibility to psychological health. A sense of morality, or individual values, provide a framework for living and moving through the world that are important. Finally, the pursuit of meaning and purpose in life provide a sense of well-being at a larger scale. This most closely resembles the form of well-being called Eudemonic in Part II of this blog series.
The ability to have meaningful “work” in one’s life is central to this experience. Work does not require a big paycheck but an activity that one finds value and purpose in. This could be someone building a company, caring for and raising children, volunteering for an organization, or engaging in a craft such as art or sport. Accomplishing this is often related to what is measured as satisfaction with life in the research literature.
Summary
So, after all this exploration it can really be summed up with the statement that well-being is both complicated and contextual. There are many different facets, each with their own dimensions, that contribute to a broad concept of psychological health. We also believe that part of the agency we hope to engender with those we work with is the agency to explore and make their own determinations about which facets of well-being they will prioritize working toward, rather than having someone impose their ideas of what is best for any one person.
References:
Brown, S. (2010) Play. New York: Penguin Group.
McWilliams, N. (2021) Psychoanalytic Supervision. New York: Guilford Press.
Panksepp, J. & Biven, L. (2012) Archaeology of Mind. New York: Norton.
Winnicott, D. W. (1970). Playing and Reality. New York: Basic Books.