personal recovery lec 2 Flashcards
what are the two meanings of the word recovery?
- Clinical recovery: the observable, professionally determined outcomes
- Personal recovery: self-reported and focuses on leading a meaningful life despite symptoms
according to the paper, which one should mental health services prioritize?
personal recovery
Clinical recovery four key features?
- It is an outcome or a state, generally dichotomous
- It is observable – in clinical parlance, it is objective, not subjective
- It is rated by the expert clinician, not the patient
- The definition of recovery is invariant across individuals.
what did Long-Term Follow-Up Studies on schizophrenia show? (3)
- challenge outdated assumptions that schizophrenia is inevitably chronic and deteriorating, with many individuals improving significantly
- highlighted the importance of social, psychological, and environmental factors in shaping recovery trajectories
- reinforces the argument that mental health services should prioritize personal recovery over purely clinical recovery, as it may not reflect the lived experience of individuals
4 key elements of personal recovery?
- hope
- identity
- meaning
- personal responsibility
origins of personal recovery?
emerged from the lived experiences of individuals with mental illness who choose to write about their experiences
descriptions of personal recovery? 5
- Recovery is seen as a journey rather than an end goal
- personal recovery is an individual process -> it’s about growth and active coping
- Recovery is not the same as cure
- Recovery requires hope and means reclaiming a positive sense of self
- Recovery is nonlinear—relapses do not mean failure
advantages personal recovery? (3)
- High Ecological Validity
- Removes Harmful Evaluations (since it is self-defined and individualized)
- Supports Autonomy and Self-Determination
challenges of personal recovery?
- Difficult to Measure
- Not Easily Operationalized
- Contradicts Traditional Clinical Models
Are Clinical and Personal Recovery Incompatible?
- Not all authors identify two meanings of recovery (Ruth Ralph and Patrick
Corrigan three definitions of recovery: spontaneous, treatment-assisted, and hopeful perspective) - Mental health professionals tend to prioritize clinical recovery, while consumers focus on personal recovery
clinical recovery and hope? 3
- Hope is essential for recovery, as it fosters motivation and resilience
- Mental health services often fail to nurture hope, instead reinforcing low expectations
- Some professionals unintentionally harm recovery by discouraging aspirations like employment or independent living
Clinical Recovery and Meaning?
- Finding meaning in one’s experience is central to recovery
- People with mental illness develop personal explanations for their experiences, including:
- life history
- medical
- spiritual
- social narratives
- Mental health services should support individuals in constructing their own meaning rather than imposing a singular explanation
Clinical Recovery and Symptoms?
- Clinical recovery prioritizes symptom elimination, whereas personal recovery may involve living well despite symptoms
- Medication is not always effective, and strict adherence to symptom reduction can lead to coercion
- Some individuals find meaning or personal growth in their symptoms
Five justifications for the prioritization of personal recovery over clinical recovery in mental health services?
- Epistemological – Personal recovery values lived experience
- Ethical – Professionals should not dictate recovery goals
- Effectiveness – Medications do not always lead to full recovery
- Empowerment – Services have historically disempowered individuals
- Policy-based – Recovery-oriented approaches align with national policies
what are the 5 aims of recovery oriented assessment (intake interview)?
- Promote and validate the development of personal meaning
- Amplify strengths rather than deficits
- Foster personal responsibility rather than passive compliance
- Support the development of a positive identity rather than an illness identity
- Develop hopefulness rather than hopelessness
What are the 4 types of meaning we need?
- purpose: we need present events that draw meaning from their connection with future events
- 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
- efficacy: we need a belief that one can make a difference
- self worth: we need reasons fro believing one is a good, worthy person
what are the 2 sub-types of the purpose type of meaning?
- goals: we need an objective outcome, such as job promotion, having a child etc
- fulfilments: we need a subjective anticipated state of future fulfilment, like being in love, going to heaven, being happy
how can you help the client develop the purpose type of meaning? including the 2 subtypes
- 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”
how can you help the client develop the values type of meaning?
- 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
how can you help the client develop the efficacy type of meaning?
- 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
how can you help the client develop the self worth type of meaning?
- 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
how can you improve stigmatizing views about mental illness?
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
what is the process of integration of mental illness into personal identity like?
- starts w a quest for direct meaning (making sense of what has been, and is, happening)
the therapist:
1. collects info to offer a clinical perspective & develops treatment goals
2. should be tentative about offering diagnosis (since it shouldnt be seen as “the” the answer)
3. 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
what are 3 approaches to understand experiences of psychosis?
- find specific & concrete meanings (listening without filtering through a clinical model to understand context, like did this actually happened in some sense?)
- understand metaphoric or thermatic associations (follow the feelings or themes in the psychotic experience)
- understand the peurpose & significant of an individuals elaboration of their pyshocsis (focus on maintaining factors rather than etiology)
what are the 3 important levels of understanding in psychosis patients?
- try to understand the meaning of madness - how does it arise? what is the delusion/hallucination?
- understand the meaning in madness - either specific or metaphorical - what does it mean?
- understand the meaning through madness - existential considerations how does it help the person?
what are some common clincial mistakes made in responding to psychotic patients?
- 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
how can a more human recovery process be supported?
- 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
what is coping? how can it help us in personal recovery approach?
- 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
how does coping arise? (3)
- appraising the situation (in terms of demands, threats, opportunities etc)
- identifying the available resources for managing the situation
- estimating the consequences of different responses
what are the 4 classes of coping styles?
- emotional avoidance: emotionally withrdrawn from a too painful reality
- re-framing: try to make sense of the situation in a way that fits with current beliefs
- active engagement: try to change the world to fit with beliefs
- integration: change beliefs, values, and goals to better fit reality
what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the emotional avoidance coping mechanism?
- 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
what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the re-framing coping mechanism?
- 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
what are the thoughts, feelings, behaviours, and clinical interpretation(s) associated with the active engagement coping mechanism?
- thoughts: i can change the situation without changing myself
- feelings: engaged, angry
- behaviours: challenging
- clinical interpretation: non compliant, manipulative
what are the thoughts, feelings, and behaviours, associated with the integration coping mechanism?
- thoughts: this is how things are. so now what…?
- feelings: acceptance, combined happiness and sadness
- behaviours: ventilation of feelings, use of social support
what 4 dimensions should clinicial assessment focus on?
- deficiencies + undermining characteristics of the person
- strengths + assets of the person
- lacks + destructive factors in the environment
- resource + opportunities in the environment
why is assessing a person in a way which does not overly focus on negatives difficult?
- 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
How can you promote and validate the development of personal meaning according to lecture?
- Validate (Reflections, summarize using clients own words)
- 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?)
- Learn to deal with difficult emotions (Shame, guilt, anxiety, resistance, etc.)
other things article mentions
How can you amplify strengths rather than deficits?
- Open questions in search of strengths (mental health assessment, Values in Action Inventory of Strenghts survey)
- 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?”
- Search with the client for internal and external resources
what are the cons of the Mental Health Assessment to amplify strengths rather than deficits?
- 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
name the steps in the Problem Focus Cycle 6
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
what are the 2 anti-recovery features of the problem-focus cycle?
- it focuses on problems, thus reinforcing an illness identity and neglecting the strenghts & independence of the person
- the process is inevitably clinician led
what are the things assessed in the mental health assessment to amplify strenghts rather than deficits?
- 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
name the steps of the appreciative listening cycle 4
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
how does the recovery-focused system aka appreciative listening cycle refute the problem focus cycle?
argues that pateints knows the best solution & patients view is of central interest
How can you foster personal responsibility rather than passive compliance according to lecture?
- Learn to sit back and shut up
- 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.)
- Give suggestions and ask about them (Some people say that their moods improve after exercising. What is your experience with that?)
How can you foster personal responsibility rather than passive compliance according to article?
- 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
How can you support the development of a positive identity rahter than an illness identity according to lecture?
- Investigate your own biases concerning mental illness
- Be curious about what the mental problems mean to the person
- Do not assume it is the same as for you.
Ask open questions on meaning
How can you support the development of a positive identity rahter than an illness identity according to article?
- 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
How can you develop hopefulness rather than hopelessness according to lecture?
- Trust us: there is good reason for hope
- Learn to be present
- Learn to understand, validate, summarize, etc.
- Don’t give ‘cheap’ hope
How can you develop hope according to article?
- 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)
