Psychological Recovery E-Book

Retta Andresen

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 396

Veröffentlichungsjahr: 2011

Beschreibung

This book offers a succinct model of recovery from serious mental illness, synthesizing stories of lived experience to provide a framework for clinical work and research in the field of recovery.
• Places the process of recovery within the context of normal human growth and development
• Compares and contrasts concepts of recovery from mental illness with the literature on grief, loss and trauma
• Situates recovery within the growing field of positive psychology – focusing on the active, hopeful process
• Describes a consumer-oriented, stage-based model of psychological recovery which is unique in its focus on intrapersonal processes

Leseprobe

Contents

Cover

Title Page

Copyright

Dedication

About the authors

Foreword by Jon Strang

Preface

Acknowledgements

Part I: Recovery in Historical Context

Chapter 1: Introduction: Recovery from schizophrenia

Overview

Early Conceptualizations of Schizophrenia

Diagnostic Systems and Prognostic Pessimism

Empirical Evidence for Recovery

The Persistence of a Pessimistic Prognosis

The Real Possibility of Recovery

The Emergence of the ‘Recovery’ Movement

What Do We Mean by ‘Recovery’?

Conclusion

Summary

Chapter 2: Conceptualizing recovery: A consumer-oriented approach

Overview

Developing a Consumer-oriented Model of Recovery

The Search for Common Ground

Meanings of Recovery in the Literature

Consumer Descriptions – Psychological Recovery

Diverse Opinions on Some Aspects of Recovery

Four Component Processes of Recovery

A Definition of Psychological Recovery

Steps Along the Journey of Recovery

Five Stages of Psychological Recovery

Conclusion

Summary

Appendix 2.A: Summary of the Consumer Literature Reviewed

Appendix 2.B: Summary of Qualitative Studies Reviewed

Part II: Elaboration of the Model: From Hopelessness to Flourishing

Chapter 3: Moratorium: The first stage of psychological recovery

Overview

Negative Symptoms or Psychological Sequelae?

Hope in the Moratorium Stage: Hopelessness

Responsibility in the Moratorium Stage: Powerlessness

Identity in the Moratorium Stage: Loss of Sense of Self

Meaning in the Moratorium Stage: Loss of Purpose in Life

Conclusion

Summary

Chapter 4: Awareness: The second stage of psychological recovery

Overview

Hope in the Awareness Stage: The Dawn of Hope

Responsibility in the Awareness Stage: The Need to Take Control

Identity in the Awareness Stage: I Am Not the Illness

Meaning in the Awareness Stage: Need for a Purpose in Life

Conclusion

Summary

Chapter 5: Preparation: The third stage of psychological recovery

Overview

Hope in the Preparation Stage: Mobilizing Resources

Responsibility in the Preparation Stage: Taking Autonomous Steps

Identity in the Preparation Stage: Taking an Internal Inventory

Meaning in the Preparation Stage: Reassessing Goals

Conclusion

Summary

Chapter 6: Rebuilding: The fourth stage of psychological recovery

Overview

Hard Work and Hopefulness

Hope in the Rebuilding Stage: Active Pursuit of Personal Goals

Responsibility in the Rebuilding Stage: Taking Control

Identity in the Rebuilding Stage: Self-redefinition

Meaning in the Rebuilding Stage: Valued Goals

Risk-taking, Perseverance and Resilience

Conclusion

Summary

Chapter 7: Growth: The fifth stage of psychological recovery

Overview

Hope in the Growth Stage: Optimism About the Future

Responsibility in the Growth Stage: In Control of Life and Wellbeing

Identity in the Growth Stage: An Authentic Self

Meaning in the Growth Stage: Living a Meaningful Life

Resilience, Personal Growth and Wisdom

Conclusion

Retrospective Overview

Summary

Chapter 8: Common questions regarding the stage model of psychological recovery

Overview

Ten Questions That Have Been Raised About the Model

Conclusion

Summary

Part III: Measuring Recovery

Chapter 9: Recovery-oriented outcome measurement

Overview

Why the Need for Measures of Recovery?

Approaches to Operationalizing Recovery in Research

Assessing Outcomes in Routine Clinical Practice

Outcome Measurement from the Consumer Perspective

Measuring Consumer-Defined Recovery

Measures Based on the Stage Model of Psychological Recovery

Concluding Comment

Summary

Part IV: Towards a Positive Future

Chapter 10: Psychological recovery and positive psychology

Overview

A Scientific Approach to Recovery

Hope

Meaning and Purpose

Responsibility

Identity

Resilience

Strengths

Values

Autonomous Goals

Growth

Wellbeing

Living with Illness and Flourishing

Summary

Chapter 11: Reflections and future directions

From Wellness to Wellbeing

Applications of the Model

Recovery Measures in Clinical Work, Evaluation and Research

Current and Future Research Directions

A Word About Words

Afterword

References

Index

This edition first published 2011

© 2011 John Wiley & Sons, Ltd

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The right of Retta Andresen, Lindsay G. Oades and Peter Caputi to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

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Library of Congress Cataloging-in-Publication Data

Andresen, Retta.

Psychological recovery : beyond mental illness / Retta Andresen, Lindsay G. Oades, Peter Caputi.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-71143-9 (hardback : alk. paper) – ISBN 978-0-470-71142-2 (pbk. : alk. paper)

1. Mentally ill–Rehabilitation. 2. Psychotherapy. I. Oades, Lindsay G. II. Caputi, Peter. III. Title.

[DNLM: 1. Mental Disorders–rehabilitation. 2. Mental Disorders–psychology. 3. Models, Psychological. 4. Outcome Assessment (Health Care) 5. Recovery of Function. WM 400]

RC439.5A53 2011

616.89′14–dc22

2011006418

Dedication

This book is dedicated to all those people who have experienced mental illness and have generously shared their stories in print or taken part in research in order to further the understanding of mental illness and recovery.

About the Authors

Retta Andresen

Dr Retta Andresen is a Research Fellow at the University of Wollongong, Australia. Her research interests were inspired by personal accounts of the experience of schizophrenia, which led to the development of the stage model of psychological recovery. She is committed to the use of the recovery model in mental health services. To that end, she has developed outcome measures to reflect the consumer recovery experience that have received international attention. Retta is a strong believer in positive psychological approaches in mental health, and worked to develop Flourish, a self-development programme of recovery. She is currently working on a project which trains mental health practitioners in the use of a recovery model that focuses on the identification of core values as the basis for a meaningful life.

Lindsay Oades

Dr Lindsay Oades is a Clinical and Health Psychologist and Director of the Australian Institute of Business Wellbeing, Sydney Business School, University of Wollongong, Australia. Lindsay works to combine principles of mental health recovery with positive psychology and positive organizational scholarship in order to develop approaches to recovery oriented services, including measurement of psychological recovery, the development of the Collaborative Recovery Model (CRM) and the Flourish self-development programme. During his career Lindsay has worked as a practitioner, manager, researcher, trainer and coach in the service of mental health. Lindsay currently chairs the Serious Mental Disorders Panel at the Illawarra Health and Medical Research Institute, and is on the Board of Directors of Neami, a major Australian mental health non-government organization.

Peter Caputi

Associate Professor Caputi's expertise is in the area of measurement, with particular interest in outcome measurement. His innovative work on measuring recovery from serious mental illness, in collaboration with Drs Retta Andresen and Lindsay Oades, has received national and international recognition. Peter is an active reviewer for The Journal of Psychology: Interdisciplinary and Applied, Journal of Constructivist Psychology, Personal Construct Theory and Practice, Personality and Individual Differences, Australian Journal of Psychology, Clinical Schizophrenia & Related Psychoses. He is also a consulting editor for the Journal of Constructivist Psychology and The Journal of Psychology: Interdisciplinary and Applied. Since 2000, he has published over 100 peer-reviewed conference papers, journal articles, and book chapters and is currently teaching several statistics based subjects at the University of Wollongong.

Foreword

This book is written in the context of the consumer movement dating back to the 1960s. Alongside that movement, an evolving recovery movement specifically emphasised the empowerment of consumers to get on with their lives and to achieve the goals they choose to pursue and that they value. Some observers of history say that themes and principles of the recovery movement are more than 160 years old but have come to the fore only relatively recently.

My credentials are that I have experienced three mental illnesses since 1984 – paranoid schizophrenia, anxiety attacks and major depression – and have been involved with a modern day mental health service since 1988. I have lived in group homes, being case managed and encouraged to work on my recovery journey since then. My last hospital admission was in 1990. I have developed my role with the mental health service, initially as a Consumer Representative (both unpaid and paid), then as Coordinator of Consumer Initiatives, as a Community Development Officer and now as a Consumer Advocate working in hospital and community settings. I became aware of and exposed to recovery philosophy in the late 1990s.

Consumer workers can be great role models, and I had a good positive group of people around me who encouraged me in the early days after diagnosis. None of them told me I could not recover (unlike the experience of some of my friends). This gave me immense hope. But, like many people, after my diagnosis I reassessed my life and lowered my expectations of and for myself – in a very big way. My identity had taken a huge beating, and only after a long struggle (recovery is hard work) did I rebuild it. The core of this is a very strong world view based on our place in the universe and caring for our planet and all living things on it (live in harmony with the universe).

My job – I have the best job in the world – is now a big part of my identity and gives me a huge sense of meaning; but it is my interest and active participation in philosophy, science, astronomy, scrabble, my housing community and my local mental health fellowship that give me the greatest meaning. I have accepted that I have a mental illness and am moving on with my life and working on my recovery journey. I give back to my local community by doing a range of voluntary community development activities, and this is one way in which I have taken responsibility for my life. Working on my spiritual development (not to be confused with religious beliefs) by taking an interest in everything around me, and respecting and appreciating it, I try to be the best human being I can be in a rapidly changing technological world.

I first met and worked with Lindsay Oades on the Consumer Evaluation of Mental Health Services Project between 1999 and 2004. I soon learnt that Lindsay has immense understanding of and sensitivity to consumer needs, and his accuracy and meticulous attention to detail make him stand out against other researchers. I have also participated in the Collaborative Recovery Model Training with Lindsay. I met and worked with Retta Andresen on ‘Flourish – A Recovery-Based Self Development Program’ in the late 2000s. Retta demonstrated great patience and tolerance for participants and facilitators, and showed significant insight into and understanding of those living with mental illness.

In my profession, as a consumer worker and as a mental health professional, we talk about treating each other (human being to human being) with respect and dignity as a foundation to working in a modern mental health setting. We expect all mental health professionals to treat their clients with this in mind. In working with the authors I have seen that they show the utmost care and consideration to their work colleagues and the people with whom they interact, and this is reflected in their understanding of recovery philosophy and the human condition.

The book opens with an examination and historical record of recovery from schizophrenia, showing that recovery from any mental illness is not only possible but highly likely. As schizophrenia has been seen as the most disabling and stigmatised mental illness, if recovery from schizophrenia is possible, recovery from other mental illnesses is perhaps even more attainable. The notion that recovery requires ‘returning to a former state’ (or a period in your life) is well examined as a myth and misunderstanding of recovery philosophy, and it is very important to see this highlighted here. The outstanding feature of the book is that the model of psychological recovery is based on thematic analysis of many ‘real’ personal recovery stories; and from these also emerged the major themes: finding and maintaining hope; taking responsibility for life and wellbeing; rebuilding a positive identity, and finding meaning and purpose in life. The stages of recovery - Moratorium, Awareness, Preparation, Rebuilding and Growth – are examined in detail with a separate chapter for each, and this forms the bulk of the text. The ideas therein are supported by many meticulously researched references.

I know the authors believe in life-long learning and have left no stone unturned to adapt, update and find new ways of incorporating new developments, initiatives and insights in philosophy, psychology and spirituality into their work. Chapter 8 explains how the ideas being developed in positive psychology are relevant to, and complement, recovery philosophy. These ideas can be especially useful in helping someone to get back on track and live the life that they want and value. Psychological recovery is clearly not just absence of symptoms, or about preventing symptoms, but something much bigger, a human growth process, promoting strengths and increasing wellbeing. This is explained clearly and developed in this chapter and I hope interested persons take note, for this is a major step forward in thinking about these issues.

The content of this book will be helpful to students of psychology and mental health, mental health staff, service providers, consumers and carers who want to further understand the recovery process as examined herein, how it relates to their life and how we can all better support persons living with mental health issues. I believe that this text will be a landmark in the development, understanding and uptake of personal psychological recovery in our communities.

On a wealthy planet like Earth, I think we are all entitled to, and deserve, a happy and rewarding life that encourages us to reach our growth potential; a life that we appreciate and respect. This book shows that this is possible, and an increased understanding of recovery philosophy, as demonstrated in the stage model of psychological recovery, may facilitate this for all human beings.

Jon R. Strang Consumer Advocate December, 2010

Preface

The moving stories that people with a mental illness have published were the inspiration for this work, and we are deeply indebted to all those people who have shared their experiences with others in order to enhance our understanding. We have written this book to share a model of psychological recovery from mental illness which was derived from many personal accounts. There is a large and growing scholarly literature on recovery, most of which is in broad agreement about the elements of recovery and the many influences on the course of mental illness and its impact on the individual. Our model focuses on the intrapersonal psychological aspects, and does not include external factors such as employment, housing or other social factors. Although these are all extremely important to recovery, they are not the focus of the model. The simplicity of the model brings structure to a very complex field, and has proven to be a useful heuristic in clinical work, education and research. The book elaborates on the model, which was originally published in a journal article (Andresen et al., 2003), and presents our ongoing work, in the hope of furthering understanding of recovery and contributing towards the scientific endeavour of advancing recovery-oriented practice. Although aimed primarily at mental health professionals and students, we hope a wider audience will find the book interesting and informative, particularly people with a mental illness and their loved ones, who may find hope within these pages.

Throughout the book, we have used the term ‘consumer’ – synonymous with ‘service user’ or ‘user’ in the UK – to describe a person who has experienced mental illness. We acknowledge that not all people with a mental illness use mental health services, and are therefore not consumers in this context. We are also aware of, and deeply respect, the preference for other terminology, including ‘survivor’ and ‘ex-patient’. However, even these terms do not apply to all. Since there is broad consensus on the term ‘consumer’ in the literature, and the book is aimed primarily at professionals, we have adopted this word for simplicity's sake.

In Part I we look at the concept of recovery. Schizophrenia may be considered an exemplar of mental illness, having historically had the worst prognosis. Due to the severity of the illness, there is a large body of literature on the course and outcome of schizophrenia, which provided us with the empirical evidence for recovery. Chapter 1 sets the scene for the book with a historical background of the concept of schizophrenia. It covers how recovery from schizophrenia came to be considered impossible, how this notion was disproved by empirical research, and the reasons for its persistence. The chapter also introduces the consumer recovery movement, and the difference between clinical definitions of recovery and the consumer definition. In Chapter 2 we describe our exploration of what consumers say about recovery, and the psychological processes that they describe. Because this research used earlier consumer accounts, these were less likely to have been influenced by the then burgeoning recovery literature and thus imbued with the language of recovery. This enhances the authenticity of the consumers' voices. These stories led us to a definition of psychological recovery. We also reviewed qualitative studies, and found that a number of researchers had described similar phases of recovery, although they identified varying numbers of phases or stages. From the experiential accounts and qualitative studies, we gleaned the elements of the stage model of psychological recovery, consisting of four psychological processes that develop across five stages.

Part II elaborates on the model, stage by stage. Chapters 3 to 7 each examine the four processes of recovery within one of the five stages. The discussion is structured around quotes from the consumer stories, and for this we have included some more recent consumer literature. We draw parallels between aspects of recovery and concepts in the broader psychology literature, culminating with the Growth stage, in which we expand on the themes of resilience and wisdom. Chapter 8 addresses some issues and criticisms relating to the model, such as the assertion that recovery is a highly individual and non-linear process, and therefore cannot be ‘modelled’. In order to apply the recovery model to the advancement of research and the enhancement of mental health services, it is necessary to develop measures of recovery, and in Part III we describe our empirical work. Chapter 9 covers our work on developing and testing three approaches to recovery measurement based on the model. These measures have received international attention. The chapter underlines the complexity of this task and the need for more empirical research into the process of recovery and its measurement.

Part IV presents the implications of the model and directions for future research. The recovery literature has clear parallels with that of the positive psychology movement, and these are highlighted in Chapter 10. We explore ways in which the tenets of positive psychology can combine with the recovery literature in developing programmes for promoting recovery. Examples of such programmes, which have been developed with colleagues at the University of Wollongong, are described.

In conclusion, Chapter 11 serves to reflect on our findings, describe some current applications of the model and measures and propose directions for future research. We hope this book will be an inspiration for service providers, researchers, people with a mental illness and their families.

Retta Andresen Lindsay G. Oades Peter CaputiUniversity of WollongongNovember, 2010

Acknowledgements

The authors wish to thank all the people who have contributed to the publication of this book. Most importantly, we wish to thank the people living with a mental illness who published stories of their experiences and recovery. These have provided the foundations of our research, and enriched the text of the book. We also thank the mental health practitioners who participated in collecting data for our research, and their clients who consented to the use of their data for publication.

We would also like to thank our families. Retta especially thanks her husband John, children Mandy, Tony, Paul and Kat, Dave and Jess, parents Martin and Janet, and her brothers and sisters for their love, encouragement and support. Lindsay would like to thank his wife Alison and two sons Bodhi and Jai. Peter wishes to thank Elayne, James and Jack for their support and encouragement. We also wish to thank editor Karen Shield for her assistance, publisher Andy Peart and the team at John Wiley & Sons for their work in bringing this book to publication.

Part I

Recovery in Historical Context

Chapter 1

Introduction: Recovery from Schizophrenia

Overview

In this chapter, schizophrenia serves as an exemplar of a most serious form of mental illness, which historically has been difficult to understand, classify or treat. As such, it has been widely researched over many years, generating a large body of empirical research into recovery. Much of the consumer-oriented qualitative research into recovery, however, includes other mental illnesses Therefore, we have utilized the empirical research into schizophrenia to provide ‘hard evidence’ for recovery from mental illness before expanding our work to incorporate the consumer-oriented literature.

Here we put into historical perspective how the idea that there was no hope of recovery from schizophrenia became entrenched within the mental health profession. First we present an historical overview of concepts of schizophrenia, and how these influenced diagnostic systems and prognosis. Next, we present findings from longitudinal and cross-cultural research that show that recovery, in the medical sense – that is, freedom from signs and symptoms of mental illness – occurs more frequently than once believed, and discuss why the rate of recovery went unrecognized for most of the twentieth century.