Dr Manju Antil (Counselling Psychologist and Psychotherapist)

Mental health and well-being are integral components of overall health, influencing individuals' abilities to cope with life's challenges, realize their potential, and contribute to society. Stress, in its various forms, significantly impacts mental health, potentially leading to a range of psychological and physiological disorders. This paper delves into the definitions and concepts of mental health and well-being, examines the types and effects of stress, and explores theoretical models and diagnostic frameworks, including the DSM-5 and ICD-11. By incorporating global data, historical developments, and case studies, the paper aims to provide a comprehensive understanding of these interconnected domains.

1. Introduction

The concepts of mental health and well-being have evolved significantly over time, reflecting changes in societal values, scientific understanding, and cultural contexts. Historically, mental health was often viewed narrowly, focusing primarily on the absence of mental illness. However, contemporary perspectives recognize mental health as a dynamic state encompassing emotional, psychological, and social well-being. Similarly, well-being extends beyond mere happiness, encompassing a holistic sense of fulfillment and purpose.

Stress, a ubiquitous aspect of human experience, plays a pivotal role in influencing mental health. While acute stress can serve adaptive functions, chronic stress is associated with numerous adverse outcomes, including anxiety, depression, and cardiovascular diseases. Understanding the interplay between stress and mental health necessitates an exploration of various theoretical models, diagnostic classifications, and empirical data.

2. Defining Mental Health and Well-being

2.1 Mental Health

The World Health Organization (WHO) defines mental health as "a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community" . This definition emphasizes that mental health is more than the absence of mental disorders; it is a fundamental component of overall health and well-being.

2.2 Well-being

Well-being, often used interchangeably with mental health, encompasses a broader spectrum of experiences. It includes subjective well-being (individuals' perceptions of their lives), psychological well-being (personal growth, autonomy, purpose), and social well-being (relationships, community engagement). The integration of these dimensions reflects a comprehensive approach to understanding human flourishing.

3. Historical Evolution of Mental Health Concepts

The understanding of mental health has undergone significant transformations throughout history. In ancient civilizations, mental illnesses were often attributed to supernatural forces or moral failings. The Hippocratic tradition introduced a more naturalistic approach, suggesting that mental disorders resulted from imbalances in bodily humors.

The 19th and early 20th centuries saw the emergence of asylums and the medicalization of mental illness. Pioneers like Sigmund Freud introduced psychoanalytic theories, emphasizing unconscious processes and early life experiences. The mid-20th century marked a shift towards community-based care and the development of psychotropic medications.

In recent decades, there has been a growing emphasis on positive psychology, resilience, and the social determinants of mental health. This holistic perspective recognizes the interplay of biological, psychological, and social factors in shaping mental health outcomes.

4. Theoretical Frameworks in Mental Health

Various theoretical models have been proposed to explain the development and maintenance of mental health and illness:

• Biopsychosocial Model: This integrative model posits that biological (genetics, neurochemistry), psychological (cognition, emotions), and social (relationships, culture) factors interact to influence mental health.

• Cognitive-Behavioral Theory: Emphasizes the role of maladaptive thought patterns and behaviors in the development of mental disorders. Cognitive-behavioral therapy (CBT) is a widely used intervention based on this model.

• Psychodynamic Theory: Originating from Freudian psychoanalysis, this theory focuses on unconscious conflicts and early developmental experiences as determinants of mental health.

• Humanistic-Existential Models: Highlight individual agency, self-actualization, and the search for meaning as central to mental well-being.

• Social Determinants Framework: Recognizes that socioeconomic status, education, employment, and social support significantly impact mental health outcomes.

5. Diagnostic Classifications: DSM-5 and ICD-11

Standardized diagnostic systems are essential for identifying and treating mental disorders:

• Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): Published by the American Psychiatric Association, the DSM-5 provides criteria for diagnosing mental disorders based on symptomatology and duration. It categorizes disorders into various classes, such as mood disorders, anxiety disorders, and psychotic disorders.

• International Classification of Diseases, Eleventh Revision (ICD-11): Developed by the WHO, the ICD-11 offers a global standard for diagnosing health conditions, including mental and behavioral disorders. It emphasizes a dimensional approach, considering the severity and impact of symptoms.

Both systems aim to facilitate accurate diagnosis, treatment planning, and research, though they differ in structure and emphasis.

6. Understanding Stress: Definitions and Types

Stress is defined as the body's response to perceived threats or challenges, triggering physiological and psychological reactions. It can be categorized into:

• Acute Stress: Short-term stress arising from immediate threats or pressures. While it can enhance performance, excessive acute stress may lead to anxiety and irritability.

• Episodic Acute Stress: Frequent episodes of acute stress, often experienced by individuals with high-pressure lifestyles.

• Chronic Stress: Prolonged exposure to stressors, such as ongoing work pressure or relationship problems. Chronic stress is linked to numerous health issues, including depression and cardiovascular diseases.

• Eustress: Positive stress that can motivate individuals and enhance performance, such as preparing for a competition.

• Distress: Negative stress that impairs functioning and well-being.

7. Physiological and Psychological Impact of Stress

Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to the release of cortisol and adrenaline. While these hormones prepare the body for immediate action, prolonged activation can have detrimental effects:

• Physical Health: Chronic stress is associated with hypertension, weakened immune function, and increased risk of chronic diseases.

• Mental Health: Persistent stress can contribute to the development of anxiety disorders, depression, and cognitive impairments.

• Behavioral Effects: Stress may lead to maladaptive behaviors, such as substance abuse, overeating, or social withdrawal.

8. Global Trends and Data on Mental Health

Mental health disorders are a leading cause of disability worldwide. According to the WHO:

• Approximately 1 in 8 people globally live with a mental disorder.

• Depression is the leading cause of disability, affecting over 280 million people.

• Suicide accounts for over 700,000 deaths annually, with young people being particularly vulnerable.

The COVID-19 pandemic has exacerbated mental health challenges, highlighting the need for robust mental health systems and support services.

9. Case Studies: Stress and Mental Health in Context

Case Study 1: Workplace Stress

High job demands, low control, and lack of support contribute to occupational stress. For instance, a study conducted among employees of the United Workers Union (UWU) in Australia revealed that 75% of respondents exhibited signs of psychological distress, with 33% experiencing severe distress. Nearly 65% reported burnout, and only 22% perceived their workplace as mentally healthy, significantly below the national benchmark of 60% .

Case Study 2: Financial Stress

Economic instability can lead to significant psychological distress. A recent study by News Corp's Growth Distillery in partnership with Medibank found that financial concerns are the leading cause of mental distress for Australians, with 48% of respondents citing money as their top stressor. Over 60% frequently feel financially behind or guilty about spending, impacting their mental wellbeing .

Case Study 3: Youth and Social Media

Among Generation Z, excessive use of social media platforms has been linked to increased anxiety and depression. A case in point is that of Oliver (Ollie) Hughes, a 14-year-old from Brisbane, who developed anorexia nervosa influenced by harmful online content on TikTok and was subjected to cyberbullying. Tragically, Ollie took his own life, prompting his mother, Mia Bannister, to launch "Ollie's Echo: Pathways to Prevention," aiming to educate communities about eating disorders and the destructive influence of social media .

10. Interventions and Strategies for Enhancing Mental Health

Effective approaches to promoting mental health and managing stress include:

• Psychological Therapies: CBT, mindfulness-based stress reduction (MBSR), and other evidence-based therapies can alleviate symptoms and enhance coping skills.

• Pharmacological Treatments: Medications, such as antidepressants and anxiolytics, may be prescribed for certain conditions.

• Lifestyle Modifications: Regular physical activity, balanced nutrition, adequate sleep, and social engagement are crucial for mental well-being.

• Policy and Advocacy: Implementing mental health policies, reducing stigma, and increasing access to care are essential for systemic change.

11. Conclusion

Mental health and well-being are multifaceted constructs influenced by a complex interplay of biological, psychological, and social factors. Stress, in its various forms, significantly impacts mental health, necessitating comprehensive strategies for prevention and intervention. By integrating theoretical models, diagnostic frameworks, and empirical data, we can develop a nuanced understanding of these domains and implement effective measures to promote mental well-being across populations.

References

• World Health Organization. (2022). Mental health. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

• World Health Organization. (2019). International Classification of Diseases 11th Revision (ICD-11).

• Selye, H. (1956). The Stress of Life. McGraw-Hill.

• Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer.

• Mind. (n.d.). About stress. https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/about-stress/

• News Corp Australia. (2025). 'Contagious': Grim phenomenon grips Aus. https://www.news.com.au/lifestyle/health/mental-health/something-has-to-give-warning-australia-cant-ignore-any-longer/news-story/c

This paper offers a comprehensive doctoral-level examination of the counselling process, providing a theoretical, empirical, and practical understanding of its components. Emphasizing contemporary models, multicultural perspectives, ethical frameworks, and real-life applications, the document explores each stage of the counselling process through scholarly literature and case studies. The analysis is situated within the broader discourse of psychotherapy, mental health, and behavioural interventions, providing a scaffold for Ph.D. scholars and professionals in psychology.

1. Introduction
Counselling is a structured, professional interaction aimed at assisting individuals in overcoming psychological, emotional, interpersonal, or behavioural difficulties. The process is collaborative and grounded in theories of human behaviour, development, and change (Corey, 2017). Counselling transcends mere advice-giving and delves into the dynamics of empathy, active listening, therapeutic alliance, and client empowerment (Rogers, 1957; Hill, 2009). As a multi-stage and multi-theoretical process, it requires rigorous academic analysis, especially in doctoral training where the integration of clinical skills with theoretical insight is essential.

2. Definition of Counselling
The British Association for Counselling and Psychotherapy (BACP, 2018) defines counselling as "a talking therapy that involves a trained therapist listening to you and helping you find ways to deal with emotional issues." The American Counseling Association (ACA, 2014) articulates counselling as a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

From a scholarly viewpoint, counselling is a psychosocial intervention grounded in communication theory, psychological models, and behavioural science. It incorporates evidence-based practices, cultural sensitivity, and ethical considerations (McLeod, 2019).

3. Historical Evolution and Theoretical Grounding
The counselling profession emerged in the early 20th century through vocational guidance (Parsons, 1909) and later evolved with the humanistic, psychodynamic, cognitive-behavioural, and integrative paradigms (Capuzzi & Stauffer, 2016). Carl Rogers’ person-centred approach revolutionized the field by emphasizing unconditional positive regard, empathy, and congruence as the foundation for therapeutic change (Rogers, 1957).

Contemporary theories—such as Cognitive Behavioural Therapy (Beck, 1976), Solution-Focused Therapy (de Shazer & Dolan, 2007), and Multicultural Counselling Theory (Sue & Sue, 2012)—offer structured approaches for addressing complex client needs. These theories inform the counselling process at every stage, from assessment to intervention.

4. Stages of the Counselling Process

4.1 Stage 1: Establishing the Therapeutic Alliance
The therapeutic alliance is a key predictor of counselling outcomes (Horvath & Bedi, 2002). This stage involves building trust, setting boundaries, clarifying roles, and establishing confidentiality. Effective rapport-building enhances client engagement and reduces resistance (Gelso & Samstag, 2008).

Case Study: A 28-year-old woman presenting with social anxiety was initially resistant. However, the therapist’s use of reflective listening and validation of her experiences fostered trust, enabling deeper exploration of her fears over subsequent sessions.

4.2 Stage 2: Assessment and Goal Setting
This stage involves identifying client concerns through interviews, psychometric assessments, and observational methods. The therapist collaborates with the client to set SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound).

Example: Beck Depression Inventory (BDI) and the GAD-7 scale are used to evaluate depression and anxiety severity (Beck et al., 1961; Spitzer et al., 2006).

4.3 Stage 3: Intervention and Exploration
Intervention is tailored according to the client’s needs and theoretical orientation. Techniques range from cognitive restructuring and exposure (CBT), to narrative therapy, mindfulness, and psychodynamic interpretation.

Clinical Vignette: In a case of post-traumatic stress, trauma-focused CBT was employed over 12 sessions, including imaginal exposure, cognitive processing, and grounding techniques.

4.4 Stage 4: Evaluation and Termination
Termination is not simply the end but a phase where progress is reviewed, relapse prevention strategies are discussed, and future plans are made. This stage is emotionally charged and requires sensitivity.

Client Reflection: “I came in broken, and I leave feeling like I have tools to rebuild.”

5. Ethical and Cultural Considerations
Counselling must adhere to ethical guidelines regarding informed consent, confidentiality, competence, and dual relationships (ACA, 2014). Cultural competence is essential for addressing power dynamics, stereotypes, and systemic oppression (Arredondo et al., 1996).

Case Example: A therapist working with an LGBTQ+ client from a conservative background integrated intersectionality theory to validate the client’s experiences and challenge internalized homophobia without imposing personal values.

6. Models of the Counselling Process

6.1 Egan’s Skilled Helper Model
This model involves three stages: Exploration, Understanding, and Action. It provides a framework for developing client self-efficacy and problem-solving skills (Egan, 2014).

6.2 Prochaska and DiClemente’s Transtheoretical Model (TTM)
Used particularly in addiction counselling, TTM emphasizes readiness for change across stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance (Prochaska & Norcross, 2018).

7. Technology and the Counselling Process
Digital counselling and teletherapy are gaining prominence. While they increase accessibility, they also present challenges related to data security, therapeutic presence, and digital empathy (Richards & Viganó, 2013).

Example: A client undergoing therapy via video conferencing reported greater flexibility and continuity, especially during the COVID-19 lockdowns, but also shared concerns about emotional disconnection.

8. Conclusion
The counselling process is a dynamic, multi-dimensional journey shaped by theoretical orientation, client characteristics, and contextual variables. It demands high levels of professional integrity, cultural sensitivity, and clinical competence. For doctoral scholars, mastering the intricacies of the counselling process is not only an academic pursuit but a foundation for ethical, effective psychological practice.

References

• American Counseling Association. (2014). ACA Code of Ethics.

• Arredondo, P., Toporek, R., Brown, S., Jones, J., Locke, D., Sanchez, J., & Stadler, H. (1996). Operationalization of the multicultural counseling competencies.

• Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Penguin.

• Capuzzi, D., & Stauffer, M. D. (2016). Counseling and psychotherapy: Theories and interventions. American Counseling Association.

• Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning.

• de Shazer, S., & Dolan, Y. (2007). More than miracles: The state of the art of solution-focused brief therapy. Routledge.

• Egan, G. (2014). The skilled helper: A problem-management and opportunity-development approach to helping. Cengage Learning.

• Gelso, C. J., & Samstag, L. W. (2008). The therapeutic relationship. In Norcross, J. C. (Ed.), Psychotherapy relationships that work. Oxford University Press.

• Hill, C. E. (2009). Helping skills: Facilitating exploration, insight, and action (3rd ed.). APA.

• Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work. Oxford University Press.

• McLeod, J. (2019). An introduction to counselling (6th ed.). McGraw-Hill Education.

• Parsons, F. (1909). Choosing a vocation. Houghton Mifflin.

• Prochaska, J. O., & Norcross, J. C. (2018). Systems of psychotherapy: A transtheoretical analysis (9th ed.). Oxford University Press.

• Richards, D., & Viganó, N. (2013). Online counseling: A narrative and critical review of the literature. Journal of Clinical Psychology, 69(9), 994–1011.

• Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.

• Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

• Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice (6th ed.). Wiley.