Quality of Life

Quality of life (QOL) is a concept that has been considered vital to counseling and psychotherapy services since the profession began. Clients seek counseling services to improve their QOL, and so QOL is of critical importance to both process and outcome in therapy. Although more than 20,000 articles referencing QOL appeared in the psychological literature between 1980 and 1994, a consensus definition of QOL remains elusive. The concept is often assumed to be self-explanatory, but it is used in varying ways by different authors and professions.

The World Health Organization first defined QOL as multifaceted, consisting of total well-being in social, physical, and mental functioning. Medical definitions of QOL, derived from this early work, emphasize the capability for a full and active life by patients with physical illness; in other words, the individuals’ ability to live fully without restrictions on their everyday activities.

Recent works in psychology have added additional key observations. First, since quality denotes excellence, quality of life at its most basic reflects the degree to which an individual experiences excellence in the major domains of his or her life. Second, QOL involves more than physical comfort and the absence of pathology. QOL represents a degree of excellence in which an individual’s personal experience and functioning are excellent in social, psychological, cognitive, and physical ways. Positive psychology distinguishes between the “pleasant” (enjoyable) life and the “meaningful” (engaged) life, and it suggests that the highest degree of QOL is gained from a life fully engaged in sustaining meaningful activities. This latter reasoning dates to Aristotle’s definition of happiness (often paraphrased by John F. Kennedy) as “full use of one’s faculties along lines of excellence.”

QOL exists on a continuum that ranges from the lowest to the highest degrees of subjective experience and excellence in life. QOL can be reliably measured via self-report; hundreds of scales have been developed to measure aspects of QOL. Each measure typically selects specific dimensions of QOL that involve emotional, physical, or cognitive functioning. Subjective estimates of QOL may also be made related to a specific client group or “referral reason” (e.g., QOL in pediatric, medical, or oncological care). Qualitative assessment procedures (most often in the form of an interview) also have been developed.

Multiple subdisciplines of psychology, counseling, and medicine use the construct of QOL in three common ways: (1) as a construct denoting overall well-being, (2) as a factor for assessing a person’s satisfaction with his or her life situation (even during serious or chronic illness), and (3) as an outcome variable for evaluating the effectiveness of counseling and therapy efforts to improve a person’s life. Quantifying and refining the concept of QOL will further enhance practitioners’ ability to evaluate therapeutic interventions, and, by focusing clients’ attention on what is right with their lives, these efforts may be therapeutic in and of themselves.

References:

  1. Gladis, M. M., Gosch, E. A., Dishuk, N. M., & Crits-Christoph, P. (1999). Quality of life: Expanding the scope of clinical significance. Journal of Consulting and Clinical Psychology, 67, 320-331.
  2. Keyes, C. L. M., & Magyar-Moe, J. L. (2003). The measurement and utility of adult subjective well-being. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures (pp. 411-425).
  3. Washington, DC: American Psychological Association. Koot, H. M., & Wallander, J. L. (2001). Quality of life in children and adolescents: Concepts, methods, and findings. London: Brunner-Routledge.

See also: