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CIDS Final Exam > L2: Personal Recovery > Flashcards

L2: Personal Recovery Flashcards

1
Q

how does the third person perspective (external subject) see mental illness & recovery?

A
  • patiënt has a disorder or is disordered
  • clinician diagnoses the disorder
  • clinician knows and explains the disorder
  • clinician treats the disorder
  • patient needs to follow the treatment
  • clinical recovery: if the treatment is successfull the disorder is cured
  • professional focus
  • one size fits all
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2
Q

how does the first person perspective (internal subject) see mental illness & recovery?

A
  • What is the matter with me?
  • How did I get this way? Am I crazy?
  • What are they telling me? Do they even understand? Can I trust these people?
  • The world seems so different now; so ‘black’, so ‘strange’.
  • Who am I? Where do I belong?
  • What will the future bring?
  • personal recovery: client focus
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3
Q

how does the second persona perspective (the intersubjective dialogue) see mental illness & recovery?

A

between therapist & client
- Attunement of therapist to the ‘first person’ perspective of client
- Empathetic understanding of the mind of the other
- Creative collaboration and co-construction
- Interest in personal narratives and processes of meaning-making.

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4
Q

what are the 4 types of external relationships that play a role in identity and thus in recovery?

A

need to develop the self via others. some crucial relationships in recovery:
- conneciton w higher being or with community (culture, society)
- close relationships (w partner, friends, family, pets etc)
- other mental health service users (experts by experience)
- a specific mental health professional

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5
Q

what are the 4 tasks of recovery (according to chapter 9)?

A
  1. Developing a positive identity
  2. Framing the mental illness
  3. Self-managing the mental illness
  4. Developing socially valued roles
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6
Q

describe the recovery task 1 (developing a positive identity)

A

need to dev positive identity outside of being person w mental illness, involves:
- establishing conditions in which its possible to experience life as a person not an illness (me vs it difference)
- amplifying sense of self
- diminishing identity as person w mental illness
- establishing or re establishing identity-enhancing relationships

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7
Q

what are NIMHE’s meanings of recovery?

A
  1. return to a state of wellness
  2. achievement of a personally acceptable quality of life
  3. process or period of recovering
  4. process of gaining or restoring something
  5. act of obtaining usable resources from apparently unusable sources
  6. recovering an optimum quality of life in disconnected circumstances
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8
Q

describe the recovery task 2 (framing the mental illness)

A

involves
- making sense of the experience so that it can be put in a box (through diagnosis, or formulation or other). this provides constraining frame for the experience which allows agency (stops ppl asking why me? and allows them to start seeing the meaning and a positive future, “yes i have schizophrenia, but at least i can get treatment now)
- acceptance / integration of the mental illness experience into broader identity

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9
Q

describe the recovery task 3 (self managing the mental illness)

A

being responsible for your own well being, including seeking help and support from others when necessary

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10
Q

what are the possible goals of recovery task 3, self managing the mental illness?

A
  1. cure - getting rid of it
  2. adaptation - learning ways of living with it
  3. positive reframing - finding value in it
  4. minimising - downgrading its impact on identity
  5. displacing - getting on with more important things
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11
Q

why are framing the mental illness & self managing it not the first tasks before developing a positive identity?

A

because a person who is focused on personal recovery prioritizes well being over illness. receiving treatment before establishing a positive identity runs the risk of becoming stuck in the mental illness role

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12
Q

describe recovery task 4, developing valued social roles?

A

involves acuiqistion of previous, modified, or new valued social roles.

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13
Q

how does recovery task 4, developing valued social roles, differ from task 1, developing a positive identity?

A

task 4
- is about who i am to other and in the world, rather than who i am to me. focus is more on social identities than personal identities
- is about development of scaffolding that supports the positive identity, by providng rich identity in which no one element is the only element that really matters (have multiple things and identities in your life, youre a painter as well as a friend as well as an employee)

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14
Q

what constitutes a valued social role?

A

comprises 2 parts: personal and social value

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15
Q

why are relationships so important in identity development and thus in personal recovery?

A
  • relationships provide the context in which different possible selves emerge and are reinforced or constrainted
  • relationships provide a means of fostering change through focusing on hoped-for rather than feared-for identiteis
    relationship with self, relationship with the illness, relationship with the world & those in it
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16
Q

What are the 4 key domains of personal recovery?

A
  • Loss of hope, leading to giving up and withdrawal
  • Loss of identity, as it is replaced by an identity as a mental patient
  • Loss of meaning, such as through loss of valued social roles (direct: what has happened?; indirect: what does this mean for me?)
  • Loss of personal responsibility, including agency, choice and personal values: what can i do?
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17
Q

define the hope domain of personal recovery, give the central question, and show its importance in mental illness

A

def: a primarily future-oriented experctation of attaining personally valued goals, relationships or spirituality which lead to meaning and are subjectively considered possible
central question: what will happen to me?
importance in mental illness: mental illnesss and its devaluing consequences can take away hope for a good future

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18
Q

define the identity domain of personal recovery, give the central question, and show its importance in mental illness

A

def: those persistent characteristics which make us unique and by which we are connected to the rest of the world
central question: who am i?
importance in mental illness: mental illness undermines personal & social identity

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19
Q

define the direct meaning domain of personal recovery, give the central question, and show its importance in mental illness

A

def: an understanding which makes adequate personal sense of the “mental illness” experience
central question: what has happened?
importance in mental illness: mental illness is a profound experience which requires a personally satisfactory explanation

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20
Q

define the indirect meaning domain of personal recovery, give the central question, and show its importance in mental illness

A

def: an integration of the direct meaning into personal & social identity
central question: what does it mean for me?
importance in mental illness: mental illness leads to re-evaluation of values and personally meaningful life goals

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21
Q

define the personal responsibility meaning domain of personal recovery, give the central question, and show its importance in mental illness

A

def: a constellation of values, cognitions, emotions and behaviours which lead to full engagement in life
central question: what can i do?
importance in mental illness: the mental illness itself and responses from the person, mental health services and wider society can all undermine the ability to be responsible for one’s own life

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22
Q

what are Andresens’ 5 stages of personal recovery?

A
  1. Moratiorium: characterised by denial, confusion, hopelessness, identity confusion and self-protetive withdrawal
  2. Awareness: first glimmer of hope for a better life, and that recovery is possible. can emergy from within or be triggered by significant other, a role model, or a clinician.
  3. Preparation: the person resolves to start working on recovery (by taking stock of personal resources, values and limitations, by learning about mental illness and available services, becoming involved in groups and connecting w others who are in recovery
  4. Rebuilding: the hard work stage, involving forging a more positive identity, setting and striving towards personally valued goals, reassessing old values, taking responsibility for managing illness and for control of life, and showing tenacitiy by taking risks and suffering setbacks
  5. Growth: (may also be considered the outcome of the previous recovery processes) whether or not symptom free, the person knows how to manage their illness and stay well. associated characteristics are resilience, self confidence and optimism about the future. sense of self is positive, and there is a belief that the experience has made them a better person
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23
Q

what are NIMHE’s 4 stages of personal recovery?

A
  1. Dependent / Unaware
  2. Dependent / Aware
  3. Independent / Aware
  4. Interdependent / Aware
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24
Q

what are The Recovery Advisory’s 6 stages of personal recovery?

A
  1. Anguish - described as botto ming out
  2. Awakening - a turning point
  3. Insight - the beginning of hope
  4. Action plan - finding a way
  5. Determining commitment - to be well
  6. Well being, empowerment, recovery
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25
Q

What are the 2 shortcoming of stage models of personal recovery?

A
  • imposes order on human growth and development which may not fit some ppls experiences. aka limited external validity
  • can easily become seen as model for what should happen, with consequent feeling of failure for ppl who dont seem to be recovering (but each person needs to find their own way forward! its not a list of instructions)
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26
Q

what are the 3 clinical advantages of stage models of personal recovery?

A
  1. contribute to therapeutic optimism
  2. provide a way of making sense of both progress and of lack of progress in non-stigmatising and non-pathologising way
  3. help clinicians to become more sophisticated in providing support matched to the persons stage of recovery
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27
Q

how do psychologists define identity?

A

psych use identity as a term to describe persnoal identity - the thing that makes a person unique. components:
- mental model (or self image) of oneself
- self esteem (a valued personal identity)
- individuation (process of differentiated components becoming a more indivisible whole)
- capacity for self reflection & awarness of self

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28
Q

how do sociologists define idenitty?

A

use the term as meaning social identity - the collection of grou memberships that define the individual. components:
- role behaviour
- discrimination towards outsiders by members of the in group
- identity negotiation in which the person negotiaties w society about the meaning & value of their identity
basically its what joins us. more inner layers of this are those that define our views of who we most deeply are, while outer layer are the range of other identities/social roles that define who we are

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29
Q

how do philosophers define identity?

A

use the term as meaning persistence - the existence of a persisting entity particular to a given person. components
- change
- time
- sameness
identity is that which is preserved from the previous version in time when it was modified

30
Q

what is the overall definiton of identity that combines the philosophical, sociological and psychological defintioins?

A

identity comprises those persistent characteristics which make us unique and by which we are connected to the rest of the world

31
Q

what are the limitations of our overall definition of identity?

A
  • no spritiuality
  • no connection w physical world
    etc
32
Q

what are the 3 components of an identity as someone with a mental illness?

A
  1. i see myself as a person w mental illness (personal identity)
  2. others relate to me, and i relate to others, as a person with mental illness (social identity)
  3. both 1 and 2 are ongoing (permanence)
33
Q

what are some of the dimensions in identity?

A
  • individual (ex: i am an optimist)
  • social (ex: i am a neighbour)
  • cultural (ex: i am european)
  • intepersonal (ex: i am a wife)
  • spiritual (ex: i am a christian)
  • sexal (ex: i am bisexual)
34
Q

what is the RECOVER framework?

A

Reading, researching, and learning from others about mental health
Emotional Growth
Change of circumstances
Others: experiencing social support
Virtues: practicing them
Etcetera
Repeat strategies that work and realise that recovery takes time

35
Q

what are the 5 aims of recovery oriented assessment (intake interview)?

A
  1. Promote and validate the dev of personal meaning
  2. Amplify strengths rather than deficits
  3. Foster personal responsibility rather than passive compliance
  4. Support the dev of a positive identity rather than an illness
    identity
  5. Develop hopefulness rather than hopelessness
36
Q

What are the 4 types of meaning we need?

A
  1. purpose: we need present events that draw meaning from their connection with future events
  2. values: we need values that lend a sense of goodness or positivity to life, that can justify certain courses of actions. we need a reason to do what we do.
  3. efficacy: we need a belief that one can make a difference
  4. self worth: we need reasons fro believing one is a good, worthy person
37
Q

what are the 2 sub-types of the purpose type of meaning?

A
  1. goals: we need an objective outcome, such as job promotion, having a child etc
  2. fulfilments: we need a subjective anticipated state of future fulfilment, like being in love, going to heaven, being happy
38
Q

how can you help the client develop the purpose type of meaning? including the 2 subtypes

A

general: listen for personal meaning & meaning-making approaches in past and current events
goals subtype: identify personal goals, provide goal-setting and goal striving support. faciliate access to mainstream opportunities (employment, education, leisure, social)
fulfilments subtype: encourage optimism and hopefulness. ask future-oriented questions - “where would you like to be in 5 years”, “how can i support you to work towards that dream”

39
Q

how can you help the client develop the values type of meaning?

A
  • support spiritual development by faciliating access to religious, faith, humanist, cultural or political groups
  • avoid undermining the individuals values by imposing personal or porfessional values
40
Q

how can you help the client develop the efficacy type of meaning?

A
  • identify & amplify times of well being, when person showed mastery and coped with unanticipated difficulties
  • plan ahead
  • identify personal & social resources
  • support the dev of crisis plans
41
Q

how can you help the client develop the self worth type of meaning?

A
  • actively enourage the person to take on “giving back” roles (voluntary work, co running a group, writing about their experiences, becoming a peer mentor etc)
  • foster affiliation with high status groups
42
Q

how can you improve stigmatizing views about mental illness?

A

by improving cultural competence (working w ppl without imposing culture based filter of meaning on the interaction)
cultural principles
- therapy is a cross cultural enterprise
- becoming culturally competent is a process not an end point
- need to be aware of personal cultural filters
- group specific info can be used for exploring invidiual experiences
- need to be aware of & challenge stereotypes

43
Q

what is the process of integration of mental illness into personal identity like?

A
  • starts w a quest for direct meaning (making sense of what has been, and is, happening)
    therapist:
  • collects info to offer a clinical perspective & develops treatment goals
  • should be tentative about offering diagnosis (since it shouldnt be seen as “the” the answer)
  • be willing to accept that clinical explanations could not be helpful for every person, they need to find their own way of integrating the illness
44
Q

what are 3 approaches to understand experiences of psychosis?

A
  1. find specific & concrete meanings (listening without filtering through a clinical model to understand context, like did this actually happened in some sense?)
  2. understand metaphoric or thermatic associations (follow the feelings or themes in the psychotic experience)
  3. understand the peurpose & significant of an individuals elaboration of their pyshocsis (focus on maintaining factors rather than etiology)
45
Q

what are the 3 important levels of understanding in psychosis patients?

A
  1. try to understand the meaning of madness - how does it arise? what is the delusion/hallucination?
  2. understand the meaning in madness - either specific or metaphorical - what does it mean?
  3. understand the meaning through madness - existential considerations how does it help the person?
46
Q

what are some common clincial mistakes made in responding to psychotic patients?

A
  • To assume that medication is necessary, when alternative responses exist
  • To define the experience as a mental illness, and consequently to locate the person in a role as a person with a mental illness, despite its stigmatising consequences.
  • to give primacy to voice hearing thus ignoring the social context, other problems, strengths and abilities of the client etc
  • to link voice hearing to schizophrenia instead of using other explanatory frameworks
47
Q

how can a more human recovery process be supported?

A
  • involving ppl w lived experience as workers in mental health services
  • developing new scripts with validating personal meaning (how does the person see their symptoms rather than what the diagnosis says)
  • create opportunities to meet voice hearers (who accept voices as being real, or from outside the normal clinical context, or or some who are further along in their recovery journey)
  • applying social rank theory to the voice hearing relationship (treat it as a full relationship and study it accordingly)
  • asking about strengths and defitics
48
Q

what is coping? how can it help us in personal recovery approach?

A
  • cognitive & behavioural responses intended to reduce either the gap between reality (environmental outcomes) and wants (ideal self image), or the threat associated with the gap (cognitive dissonance)
  • useful way to interpret mental illness symptoms or to improve their coping with the mental illness
49
Q

how does coping arise?

A
  1. appraising the situation (in terms of demands, threats, opportunities etc)
  2. identifying the available resources for managing the situation
  3. estimating the consequences of different responses
50
Q

what are the 4 classes of coping styles?

A
  1. emotional avoidance: emotionally withrdrawn from a too painful reality
  2. re-framing: try to make sense of the situation in a way that fits with current beliefs
  3. active engagement: try to change the world to fit with beliefs
  4. integration: change beliefs, values, and goals to better fit reality
51
Q

what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the emotional avoidance coping mechanism?

A

thoughts: “there’s no problem”
feelings: drained, dead inside, wrung out, heavy, anxious, depressed
behaviours: drug and alcohol over use, social isolation, day dreaming, excessive sleep, giving up
clinical interpretation: disengaged, amotivational, affective, blunting, passivity, lacking insight

52
Q

what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the re-framing coping mechanism?

A

thoughts: i can make sense of whats happened without changing myself
feelings: suspicious, anxious, afraid, alone, uncertain, angry
behaviours: odd behaviour , increased religious activity
clinicial interpretation: paranoid, delusional, reasoning bias, lacking insight

53
Q

what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the active engagement coping mechanism?

A

thoughts: i can change the situation without changing myself
feelings: engaged, angry
behaviours: challenging
clinical interpretation: non compliant, manipulative

54
Q

what are the thoughts, feelings, and behaviours, associated with the integration coping mechanism?

A

thoughts: this is how things are. so now what…?
feelings: acceptance, combined happiness and sadness
behaviours: ventilation of feelings, use of social support

55
Q

what 4 dimensions should clinicial assessment focus on?

A
  1. deficiencies + undermining characteristics of the person
  2. strengths + assets of the person
  3. lacks + destructive factors in the environment
  4. resource + opportunities in the environment
56
Q

why is assessing a person in a way which does not overly focus on negatives difficult?

A
  • its hard work: holding onto complexity is intellectually challenging
  • focus of attention on the individual in the mental health system, not on the full context
  • clinicians usually dont see people when theyre coping so that leads to an illusion that people CANNOT cope
  • clinicians questions often focus on deficits
57
Q

how can you amplify strengths during assessment according to article?

A
58
Q

How can you promote and validate the development of personal meaning according to lecture?

A
  1. Validate (Reflections, summarize using clients own words)
  2. Ask open questions on meaning-making: (What did it mean to you when….? So, how do you make sense of all this? Do you have ideas as to why you feel this way?)
  3. Learn to deal with difficult emotions (Shame, guilt, anxiety, resistance, etc.)
    other things article mentions
    - increase cultural competence (ability to work w ppl without imposing culture based filter of meaning of the interaction like stereotypes or norms)
59
Q

How can you amplify strengths rather than deficits?

A
  1. Open questions in search of strengths (mental health assessment, Values in Action Inventory of Strenghts survey)
  2. Think ‘coping’! Behaviors, thoughts, actions are ways to make sense of the world and deal with it. Ask yourself: “how may this be a way to cope with internal or external obstacles?”
  3. Search with the client for internal and external resources
60
Q

what are the cons of the Mental Health Assessment to amplify strengths rather than deficits?

A
  • its irrelevant for a clinician who sees their job as diagnosis & treating, and irritating for a patient who wants the clinician to tell them what the problem is and how to address it. so role expectations are central.
  • its one sided, since it systematically ignores the negative part of the story so unbalanced picture
61
Q

what are the 2 anti-recovery features of the problem-focus cycle?

A
  1. it focuses on problems, thus reinforcing an illness identity and neglecting the strenghts & independence of the person
  2. the process is inevitably clinician led
62
Q

what are the things assessed in the mental health assessment to amplify strenghts rather than deficits?

A
  • current strengths and resources
  • learning from the past
  • personal goals
  • past coping history
  • inherited resources
  • family environment
  • developmental history
  • valued social roles
  • social supports
  • personal gifts
  • personal recovery
63
Q

name the steps in the Problem Focus Cycle

A

an expert defines and names the problem -> an intervention to address the problem is decided -> implementation of intervention -> assure compliance -> compliance measured -> reassess and redefine -> an expert defines and names the problem

64
Q

how does the recovery-focused system aka appreciative listening cycle refute the problem focus cycle?

A

argues that pateints knows the best solution & patients view is of central interest

65
Q

name the steps of the appreciative listening cycle

A

listening together for passions, interests, dreams - a small (or big) life goal -> discover opportunities -> access resources -> face challenges -> listening together for passions, interests, dreams - a small (or big) life goal

66
Q

How can you foster personal responsibility rather than passive compliance according to lecture?

A
  1. Learn to sit back and shut up
  2. Ask open questions that facilitate agency & personal resourcefulness which can lead to goal setting & step setting
    * What would make a difference in your life? What would it take to get there? Etc.
  3. Give suggestions and ask about them
    * Some people say that their moods improve after exercising. What is your
    experience with that?
67
Q

How can you foster personal responsibility rather than passive compliance according to article?

A
  • you support the individual to take as much personal responsibility as possible so working in a responsibility promoting way
  • promote personal resourcefullness (creativity) as well as responsibility
  • goal setting & step setting
68
Q

How can you support the development of a positive identity rahter than an illness identity according to lecture?

A
  1. Investigate your own biases concerning mental illness.
  2. Be curious about what the mental problems mean to the person.
  3. Do not assume it is the same as for you.
  4. Ask open questions on meaning
69
Q

How can you support the development of a positive identity rahter than an illness identity according to article?

A
  • Some individuals report being a completely different person due to illness. Changes can be identity redefinition (redefining existing elements of identity) and identity growth (developing new elements) of both direct meaning of mental illness and indirect meaning for the person
  • Draw from non-mental health approaches to amplify identity
  • Use of timeline
  • Increase involvement when client is well
  • Assess indirect meaning t have a chance to process and make sense of what mental illness means for them as a person
70
Q

How can you develop hopefulness rather than hopelessness according to lecture?

A
  1. Trust us: there is good reason for hope
  2. Learn to be present
  3. Learn to understand, validate, summarize, etc.
  4. Don’t give ‘cheap’ hope
71
Q

How can you develop hope according to article?

A
  • Values (value person as unique human being and trust in authenticity of what person says)
  • Attitudes (believe in person’s potential and strength, accept who they are, view set backs and recovery as part of recovery)
  • Behaviours (listen non-judgementally, tolerate uncertainty and express a genuine concern for person’s wellbeing and use humour appropriately)

CIDS Final Exam (5 decks)

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