Holistic Flow Model of Spiritual Wellness

Melanie Purdy and Peggy Dupey

The Holistic Flow Model of Spiritual Wellness is a conceptualization of spirituai health and well-being thot has implications for clinical practice and research. The model is unique in its placement of the spirit at the center of life and in its fluid vision of the spirit. The authors present the modei after a discussion of spirituolity and the detinitions of "flow" and a brief review of existing wellness models. The model's components are belief in a universal force, making meaning of life, making meaning of death, connectedness, faith, and movement toward compossion. Included in the article are descriptions of spirit, the components of spirifualify. and a sample applicafion of the model.

he curiosity of human nature dictates that individuals wonder about that which they do not know. Interest in one's personal spirit is not a new phenomenon. For centuries, spirituality has been pondered. Ancient theologians, mystics, oracles, shamans, and witch doctors first discussed the concept, and since then, many leaders of organized religion and philosophers have claimed to know the nature of the spirit. Only in the last 20 years has spirituality become equally important in the world of counseliiig, psychology, and medicine (Ingersoll, 1994; Lawrence, 2002; Richards & Bergin, 1997). The question becomes. What is the role of spirit in our work as helping professionals? The meaning of spirit and an individual's approach to and development of spirit is highly personal and varied. Religion, literature, philosophy, psychology, counseling, and science all have perspectives on the nature and purpose of spirituality. The belief that one's personal spirit can be nurtured and developed without conventional religion is gaining acceptance among many counselors and other helping professionals. Those in helping professions try to assist as people attempt to bring happiness into their lives each day. Individuals acquire possessions, begin new relationships, and engage in new activities to try to fill the void that inevitably touches each life at some point, but rarely do people look to spiritual awareness as a means to happiness and health (Hamilton & Jackson, 1998). The Holistic Flow Model of Spiritual Wellness that we present in this article provides a means through which helping professionals can explore spiritual health in both clinical practice and research. We explain how the model enhances holistic wellness by purposefully developing components of an individual's spirit. We describe the components of spirit and how they affect life tasks. When approached with creativity and openness, spirituality and the concept of one's spirit can increase the effectiveness of counseling.
Melanie Purdy, Office for Prospective Students, University of Nevada, Reno; Peggy Dupey, University of Nevada School of Medicine. Correspondence concerning this article should be addressed to Peggy Dupey, University of Nevada Schoal of Medicine, Penniuglon Medical Education Ritildiiig/MS 357, Reno, NV 89557 (e-mail: pdupey@med.unr.edu).

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Models of Wellness
Before exploring the various components of the Holistic Flow Model of Spiritual Wellness, it is important to review traditional models of wellness that focus on life tasks. Concepts of wellness and health now permeate the literature in psychology and counseling. In fact, wellness has become a desirable point at which to begin psychological assessment. In their article introducing the concept of positive psychology, Selign:\an and Csikszcntmihaly (2000) suggested that the social and behavioral sciences can "articulate a vision of the good life" and can "show what actions lead to well-being" (p. 10). Holistic approaches to wellness maintain that "treatment is not just fixing what is broken; it is nurturing what is best" (Seligman & Csikszentmihaly, 2000, p. 9). Many existing models of holistic wellness include spirituality as a component; however, there are no models that identify spiritual wellness as the primary focus that influences all aspects of an individual's life. The life task components of most wellness models include the physical, intellectual, social, spiritual, emotional, and occupational realms (Eberst, 1984; Hawks, 1994; Hettler, 1984; Maples, 1996; Myers, Sweeney, & Witmer, 2000; Sweeney & Witmer, 1991). Despite son:\e variation, cominon definitions for these life tasks include the following; Physical health includes exercise, nutrition, and rest. The goal is a strong body that includes muscular strength, cardiorespiratory wellness, endurance, and flexibility. Intellectual health is the ability to reason, analyze, be creative, and make rational decisions. Social health is the ability to create and maintain loving, genuine relationships. It includes feeling accepted and belonging with larger social groups. Spiritual health has varied meanings in the models but typically includes the concept of spirit as the life-giving force. Emotional health is the ability to identify, manage, and express emotions in an appropriate way and includes the ability to cope with distressful situations and to adjust to change. Occupational or career health includes doing work that is n:\earungful and fulfilling. Several models identify spirit as the central energy source that allows an individual to engage in the activities that are associated with the other components of Ufe (Chandler, Holden, &: Kolander, 1992; Eberst, 1984; Maples, 1996; Myers et al., 2000; Purdy & Dupey, 2000, 2003). As Young, Cashwell, and Woolington (1998) have described spirituality, it is the "core reciprocal component of the overall wellness of the individual rather than as a stand-alone or isolated dimension" (p. 65). Eberst's (1984) Health Cube Model includes the areas listed above. In addition, the components in this model are separate but considered to be intimately related

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and function in a synergistic relationship with one another. Eberst began to define spirituality as a deeper dimension on which the other areas "pivot" or converge, as in one of the axes of his cube, and stated that" it is possible to suggest that the spiritual aspect of health is much more than just one of the six dimensions" (p. 101). Chandler et al. (1992) asserted that the spirit is "the innate capacity to, and tendency to seek to, transcend one's current locus of centricity, which transcendence involves increased knowledge and love" (p. 169). Theirs is a strong, thoughtful model that depicts spirit as a circle from which the other components sprout. In this model, an individual's optimum wellness occurs when the five areas are balanced and "developed potential in both the spiritual and personal realm" (p. 171) is met. The authors asserted that spiritual wellness is a balance between repression of one's spirituality and total immersion in one's spirituality Maples's (1996) Holistic Adult Development Model places spirit at the center and describes three potential configurations. Some individuals possess a flexible and hopeful spirit; some possess a rigid and predictable spirit; and some possess an unpredictable, visionary spirit. Another prominent, well-developed model is Sweeney and Witmer's (1991) Wheel of Wellness, updated in 2000 by Myers et al. The Wheel of Wellness considers wellness a way of life geared to optimal health in which the mind, body, and spirit are integrated and an individual can live fully (Myers et al., 2000; Sweeney & Witmer, 1991). The model integrates five life tasks: spirituality, self-direction, work and leisure, friendship, and love with subtasks that are associated with development of each life task. Spirituality is prominent in this model and is defined as "an awareness of a being or force that transcends the material aspects of life and gives a deep sense of wholeness or connectedness to the universe" (Myers et al., 2000, p. 253). More recently, Myers and Sweeney (2003) introduced the Indivisible Self: An Evidence-Based Model of Wellness. The new n:\odel places the Adlerian concept of the Indivisibility of self at the center, with five second-order factors clustered around the center. These second-order factors are coping, creative, social, essential, and physical (Myers & Sweeney, 2003). In the new model, spirit has been moved from the central position that it occupied in the Wheel of Wellness and now appears as a con:\ponent of the second-order factor called "essential." All of the models discussed in this article focus primarily on the life tasks of intellectual, sociai, physical, emotional, and occupational health, while acknowledging spirituality. However, none of them address how to grow and develop the spirit to make the life task areas richer. The Holistic Flow Model of Spiritual Wellness defines common components of spirit but suggests avenues through which the spirit can be developed to enrich the quality of life. The Holistic Flow Model of Spiritual Wellness (Purdy & Dupey 2000,2003) incorporates the following life tasks associated with holistic wellness: companionship, mind, life's work, emotions, body, beauty, and religion. Although the life tasks of this model share similarities with other models of wellness, the descriptors have been updated to reflect the increasing diversity and multicultural perceptions of human experience.

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Counselors and psychologists are attempting to identify effective ways to assess spirit in order to incorporate it better into clinical and research practices. Other areas of the human experience have been well researched. Entire academic disciplines concentrate solely on how thoughts and behaviors influence the human psyche. Some disciplines of psychology state that how iiidividuals think and behave determines how they react emotionally, whereas other disciplines of psychology maintain that certain emotions occur naturally and are not associated with behavior. To date, however, none of these approaches address the role of spirit. Perhaps Bergin (1988) was accurate when he stated that the spirit is another cog in the holistic structure of people's being. The Holistic Flow Model of Spiritual Wellness considers spirituality the flow of energy that allows individuals to be active in all dimensions of life. In the context of this model, spirituality is defined as the individual hfe energy of each person. The spirit as the energy source from which individuals act, think, feel, exist is complex and varied. There are as many ways to describe spirit, spirituality, personal energy, and "individual flow" as there are raindrops in a thunderstorm. Spirituality is innate and ever present; perpetuates the drive for transcendence; and, when in a healthy state, is adaptable and embraces change. It is open-ended and ever unfolding (Helminiak, 2001). One of the most compelling aspects of the Holistic Flow Model of Spiritual Wellness is the fluidity of the spirit. At times light and moving freely and at others heavy and sluggish, the dynamic nature of the spirit is compatible with Csikszentmihaly's (1999) flow experience (Seligman & Csikszentmihaly, 2000). Csikszentmihaly defined "flow" as "a state of total involvement in an activity that requires complete concentration" (p. 821). The involvement is so intense that it transcends conscious thoughtone Hterally becomes lost in the satisfaction of one's activity. Csikszentmihaly proposed that an individual's happiness is dependent on whether he or she is able to derive flow from his or her activities. Hamilton and Jackson (1998) likened the spirit to fog "that permeates every element, is not separate, but rather emerges into one's consciousness in an almost imperceptible manner" (p. 262). The properties of the spirit presented in the Holistic Flow Model of Spiritual Wellness can be conipared with water. Both spirit and water are alternatively fluid, fresh, deep, shallow, constant, thick, thin, life sustaining, fluctuating, and essential elemetits of life. The nature of the flow of people's spirit into the various aspects of their world (e.g. life's work, beauty and religion, the body, emotions, the mind, and companionship) is variable and fluid. When an individual is in a state of balance and higher functioning, the spirit is like water, moving freely. It is not dammed or overflowing in any area or causing drought in other areas. At other times, the state of an individual's spirit resembles the ice phase of water, as when one feels frozen in a state of discomfort or fear. At times, the spirit becomes similar to a vapor and lacks strength and may manifest itself in an inability to cotacentrate or focus one's thoughts or in chaotic mo ven^ent from one realm to the next. The self may become confused, and life n:\ay seem chaotic, out of controi, or depressing.

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The notion of transcendence, or change in one's perception of self, is reflected in the buoyant nature of spirituality in this model. Transcendence is the foundation of flow. In the Holistic Flow Model of Spiritual Wellness, transcendence represents the natural tendency to reflect and improve one's vision of self. It represents a movement toward change that makes growth possible, despite apprehension about the uiiknown. Spiritual health allows one to accept that change is the only constant in lives, and that with change, there are both positive and negative consequences. Many theorists discuss transcendence in the context of spirituality. In his book The Farther Reaches of Human Nature, Maslow (1971) outlined 35 variations on the meanings of transcendence. Mack (1994) stressed the experience of an individual having a "momentary loss of self-definition" (p. 18). Transcendence is moving out of one's misconception of self into a new, authentic way of being. If an individual does not move outside the old box of thinking, no new frame of reference will be developed, and it will not be possible to integrate the elements of spirituality into a new way of life (Benjamin & Looby, 1998). Larimore, Parker, and Crowther (2002) stated that by intimately integrating a reliance on the transcendent, individuals are able to acknowledge their self-limitations without despair. Conn (1994) stated that self-transcendence is a primary element of personal authenticity. Transcendence is a fundamental drive for individuals to move beyond the self and is vital to the process of making meaning and understanding the "ultimate" (Conn, 1994, p. 178). Human transcendence is similar to the caterpillar's push to pass through the chrysalis to become the moth. As individuals attend to growth and development in specific areas of life, spiritual awareness is crucial. For example, if an individual is feeling out of balance with his or her physical wellness, he or she may assess what exercises to do to feel better physically. As the individual assesses this, he or she may also choose something that promotes one of the spiritual components, such as connectedness (perhaps with others or with nature). Spirituality in the context of the Holistic Flow Model of Spiritual Wellness is the covering that flexes and contracts as aspects of life become unbalanced. Without spiritual awareness and spirituality, an individual's life may be flat or dimensionless.

Components of Holistic Flow Model of Spiritual Wellness

In this model, spirituality is the central force that determines an individual's health and satisfaction within each dimension. Consequently, development and growth in spirit allow an individual to enhance existence in all aspects of life. The multitude of philosophies regarding spirituality is a conceptual cacophony, a kaleidoscope. In reviewing the richness of the literature, some clear, common themes regarding the essential elements of spirit are clear. The common themes derived from other theoretical models and described in the Holistic Flow Model of Spiritual Wellness (Purdy & Dupey, 2000, 2003) include a belief in an organizing force in the universe, connectedness, faith, movement toward compassion, the ability to make meaning of life, and the ability to make meaning of death (see Figure 1; Flkins, Hedstrom, Hughes,

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Model
[Transcendenofe

ComanionshipVI

FIGURE 1 Components of Holistic Flow Model of Spiritual Wellness

Leaf, & Saunders, 1988; Hamilton & Jackson, 1998; Hawks, 1994; Ingersoll, 1994,1998; Stanard, Sandhu, & Painter, 2000; Thoresen & Harris, 2002). An Individual who is healthy in spirit tends to integrate activities into his or her daily life that develop and strengthen the components of spirituality. All components, while intrinsically important, are interrelated and action in one component naturally affects another. For example, an individual may choose to meet with a close friend each week for coffee; discussion of Ufe issues with a friend enhances connectedness and may contribute to a deeper meaning of life.

Belief in an Organizing Force in the Universe

The belief in an organizing force or power in the universe is essential to the concept of spirituality. When an individual is able to feel integrated with this energy, he or she has connected with a dynamic essence and is capable of being one with nature (Helminiak, 2001; Murgatroyd, 2001). Communion or personal relationships with this unknown, unproven, and unobservable force or power are typical of individuals with spiritual health and wellness (Hawks, 1994). It is an

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individual's image or experience with divinity, which may or may not be defined as God, that allows transcendence (Ingersoll, 1998). Belief in an organizing force provides an individual with the capacity to feel interconnected.

Connectedness
"There are no boundaries to our interconnectedness with limitless dimensions and universes. And there are no limits to our continuity of development, bad or good" (Sambhava, 700/1994, p. 26). Connectedness provides transcendence on a physical and emotional level and increases an individual's appreciation of the reality outside oneself. It is essential to think outside tiie self, to feel a part of something greater than oneself to be happy (Maher & Hunt, 1993). Cormectedness can be the feeling or state of beiiig one with others (e.g., in a work environment where all parties are thinking of like mind in a very productive flow), one with nature as when standing on a mountain top with nothing but the trees; or one with a universal force as when one feels transparent and all important and not at all important in the same moment. Oneness with nature and beauty and a sense of connectedness with others are crucial to that spirituality (Hawks, 1994; Ingersoll, 1998; Thoresen & Harris, 2002). According to Murgatroyd (2001), "All lives are interdependent because one's life is sustained by relationships with other people, animals, plants, and a life-sustaining environment" (p. 97). Furthermore, this interconnectedness means that there are no gains without a loss to others or to oneself in another area of one's experience (Murgatroyd, 2001).

Faith
Faith, for individuals who identify as spiritual, means they believe and hope that their worldview is a true depiction of reality (Hawks, 1994). For example, an individual may create a worldview in which people who work hard in a positive, compassionate manner will end up in a situation that is for the best, even if the original goal was not met. Faith allows individuals the motivation to act with purpose. Other researchers identify faith as hopefulness and describe it as believing that suffering is temporary (Ingersoll, 1998; Thoresen & Harris, 2002). Ingersoll (1994, 1998) also discussed mystery or the ability to deal with ambiguity. In a sense, having faith is one way that individuals can make meaning of the unexplainable. The ability to Hve with and make meaning of ambiguity and change through faith is crucial to a healthy spiritual life because, as Murgatroyd (2001) said, life, by its nature, is constantly changing, flowing, and leading to impermanence.

Movement Toward Compassion

In languages that derive from Latin, "compassion" means: we cannot look on coolly as others suffer; or, we sympathize with those who suffer. To have compassion {cofeeliiig) means not only to be able to live with the other's misfortune but also to feel with him any emotionjoy, anxiety, happiness, pain. This kind of compassion . . . therefore signifies the maximal capacity of affective imagination. . . . In the hierarchy of sentiments, it is supreme. (Kundera, 1984, p. 20)

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In external interactions, individuals who are described as spiritual tend to express themselves in compassionate ways (Hawks, 1994). Compassion is behavior in which the individual does not act selfishly. Individuals who are spiritually knowing will understand and act in compassionate ways to create a better world. An individual's abiUty to both receive and grant forgiveness allows movement toward compassion. Forgiveness is a techruque that allows an individual to manage shame, guilt, grief, and depression that are associated with blocking compassionate living (Ingersoll, 1998; West, 2001). "Without an open and loving heart, you can never taste the nectar and pure bliss of Ufe" (Sams & Carson, 1988, p. 213).

Abiliti/ to Make Meaning of Life

"A soul's continuing life-process endlessly goes through the phases of death state, between state, and life state" (Sambhava, 700/1994, p. 33). Making meaning of life allows an individual a sense that his or her life is truly worth living (Ingersoll, 1998). The importance of being able to make meaning of life events is stunningly clarified by Frankl's (1955) logotherapy. The foundations of his philosophy rest on the concept of freedom of the will, the will to making meaning, and the meaning of life (Frankl, 1969). He believed that by having the abiUty to make meaning, people could withstand the worst of conditions and lead happy, healthy, meaningful lives. From the counseling and psychotherapy perspective, Comett (1998) pointed out that people may believe that there is one overall meaning that should be attached to all people's lives and that all people are in this world for the same reasons with the same problems and tasks. He stated that this often leads clients to a severe depressive state because they lack motivation and initiative to engage in a life full of expectations that they cannot meet. He noted that it Is crucial to help people understand tliat a major task is to find meanings unique to their own life, to decide what it means that life is finite, and to take responsibiiity for their lives. This perspective is similar to Frank]'s (1955) belief that individuals must take the responsibility of making life meaningful. Several researchers have proposed that individuals with healthy spirits have a life purpose and are able to create an ultimate n:Teaning, often by being able to face important events such as death and the termination of self (Hawks, 1994; Smith, 1995). One way of assisting in making meaning is to help individuals prioritize what is of value or what is important to them (Comett, 1998). Elkins et al. (1988) described this process as a quest througli which one can see that life is deeply mearungful and that one's own existence has purpose.

Ability to Make Meaning of Death

The cradle rocks above an abyss, and common sense tells us that our existence is but a brief crack of lighl between two eternities of darkness. Nature expects a full-grown man to accept the two black voids, fore and aft, as stolidly as he accepts the extraordinary visions in between. (Nabokov, 1947, pp. 20-21)

Another view of death is that individuals are so afraid of death "not because we know it is nothing, but hecause we know in our bones it cannot automatically bring

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us nothing" (San:ibhava, 700/1994, p. 26). Facing death is one of the most difficult life events, and as one transcends oneself and events in life, with each transition there is a death of something that is familiar and comfortable (Conn, 1994). Kiibler-Ross (1969) stated that death is viewed as a bad, frightening event and that the denial of death plays a great part in people living purposeless, meaningless lives. Kinnier, Tribbensee, Rose, and Vaughan (2001) iiiterviewed individuals who had near-death experiences and found that after confronting their own mortality, there was less fear of death, more appreciation of life, and a deep need to make relationships meaningful. According to the interviewees, it took facing death to emphasize the importance of the spiritual effects of connectedness and meaning in life. Smith (1995) talked of the difficulty and the importance of developing one's own death perspective, of the psychological stress related to this, and how this perspective is typically explored when working with terminally ill individuals. The significant influence of mortality on human development and on the way that an individual conducts his or her life is undeniable. Simply put, making meaning of death seems to enhance an individual's ability to make meaning of life. As individuals develop spiritual awareness and begin to integrate thoughts, actions, and behaviors that promote growth and transcendence, they tend to develop a well-defined worldview. This worldview defines the individual's reality and allows him or her to maintain a positive, optimistic outlook on life and death. He or she is able to act in selfless, giving, altruistic ways; to act with meaning and purpose; to maintain a strong value system that promotes wellness of self and others; and to retain idealism for the betterment of the world (Conn, 1994; Elkins et al., 1988; Hawks, 1994).

Implications Value of Flow Model in Counseling

The value of spirituality in counseliiig is widely discussed and debated among counselors, and many counselors are increasingly integrating the concept into practice and research. The Holistic Flow Model of Spiritual Wellness is an important contribution to the body of literature regarding health and quality of life, because it provides a basis from which helping professionals can assist clients in their spiritual development. This model has potential for both practical application and empirical research and is relevant to virtually al! practices in psychology and counseling because of its inclusive and adaptable nature. The model has been created to reflect the increasing diversity and richness of human experience by accommodating various philosophical and spiritual perspectives. Regardless of whether or not the client has a religious orientation, the treatment of spirituality in the model is inclusive of all philosophies of the meaning of life and development throughout the life span. In addition, there is significant potential for research between and within the components of the model.

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Practical Application of Model

A case study best illustrates the practical application of the model. The case shows that change can occur with appropriate interventions that use three components of the spirit as they are outlined in the Holistic Flow Model of Spiritual Wellness. A college student sought counseling, presenting issues of poor academic performance and lack of motivation. The young woman was depressed about the deaths of her grandmother and a close friend. She was also concerned about her sister who was banished from the family because of cultural differences between her and her parents. In using the Holistic Flow Model of Spiritual Wellness, the counselor and student discussed the condition of her spirit, which the student described as worn down. The counselor clarified that the student's perceived lack of resiliency was contributing to her depression and frustration. The counselor and the client explored three of the six spiritual aspects of the model and discussed interventions associated with the life task components. The spiritual aspects selected were belief in a universal force, connectedness, and the ability to make meaning of death. One intervention selected by the (nonreligious) student that involved the belief in a universal force component was visiting a place in nature that she considered beautiful. She spent time there and journaled her experiences and conversations with this force. During discussion about her activity, the client stated that by focusing on the beauty and the universal force in which she believes she felt less isolated. Another component, connectedness, was explored through the companionship realm. Because in her grief the client had pulled away from her close friends, she established a plan to reconnect witli them for support. She arranged to have lunch with a close friend with whom she liad lost touch. During lunch, she shared some of the trauma of recent life events. This allowed her to increase her sense of belonging and gave her much needed social support. The counselor and client discussed death and the goal of making meaning of the deaths of those close to the client. The client contemplated her belief in what happens to one's spirit and energy after death. The client began to feet less anxious and less distraught with her feelings over the deaths, felt relief at connecting with her friend, and was able to refocus her energy on her studies, thereby improving her grades. This example illustrates the model's capacity to explore spirituality as a tool for balance as an individual works to develop interventions to resolve life's issues.

Conclusion
There are many ways to help clients strengthen and build vitality within these components. For example, meditation, in the Buddhist sense, involves the development of deep and active compassion. Positive thinking can be used to help make meaning of life and enhance faith. Developing values may be used to help individuals understand and develop a meaningful relationship with their concept of the universal force.

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There is also significant potential for empirical application of the model. One of the authors of the model (the first author of this article) is currently engaged in research based on the making-meaning-of-death component of the model. She is investigating whether the introduction of a spiritual intervention to healthy adults can enhance the quality of life. The outcome being measured is happiness as assessed by the Happiness Measures (Fordyce, 1987). The Holistic Flow Model of Spiritual Wellness has promise for enhancing the lives of clients, regardless of the setting, because of its unique treatment of the spirit considering the spirit the dynamic and constantly changing core of human life with definable components. Csikszentmihaly (1999) believed "the job description of psychologists should encompass discovering what promotes happiness, and the calling of psychologists should include bringing this knowledge to public awareness" (p. 824). From clinical practice to ancillary services provided by helping professionals, this model allows counselors and psychologists to help people find balance, meaning, satisfaction, and happiness in their everyday lives.

References
Benjamin, P., Sa Looby, J. (199S). Defining the nature of spirituality in the context of Maslow's and Roger's theories. Counseling ami Values, 42. 92-101. Bergin, A. (1988). Three contributions of a spiritual perspective to couiiseluig, psychotherapy, and behavior change. Counseling and Values, 33, 21-31. Chandler, C. K., Holden, J. M., & Kolander, C. A. (1992). Counseling for spiritual wellness; Theory and practice, journal of Counseling & Development, 71. 168-175. Conn, W. E. (1994). Self-transcendence: Integrating ends and means in value counseling. Counseling and Values, 38, 176-187. Cornett, C. (1998). The soul of psychotherapy. New York: Free Press. Csikszentmihaly, M. (1999). If we are so rich, why aren't we happy? American Psychologist, 54, 821-827. Eberst, R. {1984). Defining health: A multidimensional model, joumai of Social Health, 54, 99-104. Elkins, D. N., Hedstrom, L. ]., Hughes, L. U, Leaf, J. A., & Saunders, C. (1988). Toward a humanistic-phenomenological spirituality: Definition, description and measurement. journal of Humanistic Psychology. 25(4), 5-18. Fordyce, M. W. (1987). A review of research an the happiness measures: A sixty second index of happiness and mental health. Social Indicators Research, 20, 355-381. FrankI, V. E. (1955). The doctor and the soul: From psychotherapy to togotherapi/. New York: Vintage Books. FrankI, V. E. (1969). TIte will to meaning. Cleveland, OH: New American Library. Hamilton, D. M., & Jackson, M. H. (1998). Spiritual development: Paths and processes. journal of Instructional Psychology, 24, 262-271. Hawks, S. (1994). Spiritual heallh: Definition and theory. Wellness Perspectives. 10(4), 3-14. Helminiak, D. A. (2001). Treating spiritual issues in secular psychotherapy. Counseling and Values, 45, 163-190. Hettler, B. (1984). Wellness: Encouraging a lifetime pursuit of excellence. Health Values: Achieving High Level Wellness. 8(4). 13-17. Ingersoll, R. E. (1994). Spirituality, religion, and counseling: Dimensions and relationships. Counseling and Values, 38. 98-112. Ingersoll, R. E. (1998). Refining dimensions of spiritual wellness: A cross-tradilional approach. Counseling and Values, 42. 156-166.

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Kinnier, R. T., Tribbensee, N. E., Rose, C. A., & Vaughan, S. M. (2001). In the final analysis: More wisdom from people who have faced death. Journal of Counseling & Devetopnicitt. 79. 171-177. Kubler-Ross, E. (1969). On death ami dying. New York: Collier Books. Kundera, M. (1984). The unbearable lightness of being. New York: Harper & Row. Larimore, W. L., Parker, M., & Crowther, M. (2002). Should clinicians incorporate positive spirituality into their practices? What does the evidence say? Annals of Behavioral Medicine, 24, 69-73, Lawrence, R. ]. (2002). The witches' brew of spirituality and medicine. Annals of Behavioral Medicine, 24, 74-76. Mack, M. L. (1994). Understandiiij^ spirituality in counseling psychology: Considerations for research, training, and practice- Counseling and Values, 39, 15-32. Maher, M. F., & Hunt, T. K. (1993). Spirituality reconsidered. Counseling and Values. 38, 21-29. Maples, M. (1996, September). Superstar self. Model of adult development presented at a seminar in college student development, Reno, NV. Maslow, A. H. (1971). The farther reaches ofhuman nature. New York: Penguin Books, Murgatroyd, W. (2001). The Buddhist spiritual path: A counselor's reflection on meditation, spirituality, and the nature of life. Counseling and Values, 45, 94-104, Myers, ], E,, & Sweeney, T. J, (2003, March), The indivisible self: An evidence-based, emerging model of wellness. Paper presented at the annual conference of the American Counseling Association, Anaheim, CA, Myers, J. E,, Sweeney, T, ]., & Witmer, J. M, (2000), The Wheel of Wellness counseling for wellness: A holistic model for treatment planning, journal of Counseling & Development, 78. 251-266, Nabokov, V. (1947). Speak, memory. New York: Random House, Purdy, M,, & Dupey, P, (2000, March), Feeling tired? Feeling stressed? Unbalanced? Holistic health and wellness for counselors. Poster session presented at the annual conference of the American Counseling Association, Washington, DC. Purdy, M,, & Dupey, P, (2003, March), Feeling tired? Feeling stressed? Unbalanced? Holistic health and wellnessfor counselors. Paper presented at the annual conference nf the American Counseling Association, Anaheim, CA, Richards, P S,, & Bergin, A. E, (1997), A spiritual strategy for counseling and psychotherapy. Washington, DC: American Psychological Association, Sambhava, P, (1994), The Tibetan book of the dead. (R, A. F. Thurman, Trans,), New York: Quality Paperback Book Club, (Original work published approximately 700) Sams, J,, & Carson, D, (1988J, Medicine cards. Santa Fe, NM: Bear. Seligman, M., & Csikszentmihaty, M, (2000), Positive psychology: An introduction. American Psychologist, 55, 5-14, Smith, E, (1995), Addressing the psychospiritual distress of death as reality: A transpersonal approach. Social Work, 40(3), 1-17, Stanard, R. P., Sandhu, D. S., & Painter, L. C. (2000). Assessment of spirituality in counseling. Journal of Counseling & Development, 78, 204-210, Sweeney, T, J., & Witmer, J, M, (1991). Beyond social interest: Striving toward optimum health and wellness. Individual Psychology. 47, 525-539. Thoresen, C, E,, & Harris, A, H. S, (2002), Spirituality and health: What's the evidence and what's needed? Annals of Behavioral Medicine. 24, 3-13. West, W. (2001), Issues relating to the use of forgiveness in counseling and psychotherapy. British Journal of Guidance & Counselling. 29. 415-423. Young, J., Cashwell, C , & Woolington, V, (1998), The reiationship of spirituality to cognitive and moral development and purpose in life: An exploratory investigation. Counseiing and Values, 43. 63-71.

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