Article

New Endeavors, Risk Taking, and Personal Growth in the Recovery Process: Findings From the STARS Study

Center for Health Research, Science Programs Department, Kaiser Permanente Northwest (KPNW), Portland, Oregon, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 01/2009; 59(12):1430-6. DOI: 10.1176/appi.ps.59.12.1430
Source: PubMed

ABSTRACT

This study examined consumers' perspectives on the role of personal growth-related risk taking in the recovery process and on clinicians' roles in patients' decisions to take on new activities and opportunities. Clinical approaches cited by patients as most helpful in making significant changes were also identified.
A total of 177 members of a nonprofit health plan (93 women and 85 men), ranging in age from 16 to 84 years, participated in a mixed-methods exploratory study of recovery among individuals with serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis). Participants completed four in-depth semistructured interviews over 24 months; interviews were transcribed verbatim and coded for content by study staff. Data were analyzed using a modified grounded theory approach.
The most helpful discussions about new endeavors occurred in the context of healthy, collaborative, mutually trusting clinician-patient relationships. Advice was accepted when clinicians listened well, knew patients' capabilities and interests, and pushed gently at a pace that was comfortable for patients. Knowledge gained by clinicians in the context of good relationships with patients provided a firm grounding for approaching the delicate balance of providing helpful levels of support and encouragement without pushing consumers so hard that it caused difficulties.
Enduring, strong, collaborative relationships provide a healthy framework for discussions between patients and clinicians about taking on new activities, roles, or responsibilities and increase the likelihood that new activities and opportunities will be planned and carried out in ways that promote, rather than endanger, recovery.

Download full-text

Full-text

Available from: Sue E Estroff, Jan 08, 2016
    • "In interview studies where users are asked about their recovery from severe mental illness, the relationship with the professionals in charge of their care emerges as an important, and even decisive, factor, either as having helped users or obstructed them in their recovery (Borg and Kristiansen, 2004; Green et al., 2008; Schön et al., 2009; Sullivan, 1994; Tooth et al., 2003; Topor et al., 2006, 2009; Young et al., 2008). This finding applies to custodial as well as outpatient care (Johansson and Eklund, 2003; Schröder et al., 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users’ experiences of helping relationships with professionals. Data and methods: This was a grounded theory analysis of 71 qualitative interviews to explore users’ experience of helping relationships and their components, in psychiatric care in Sweden. Discussion: Within the three main categories – interpersonal continuity, emotional climate and social interaction – two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines. Conclusions: The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified. Keywords alliance, helping relationships, psychiatry, severe mental illness, user’s perspective
    No preview · Article · Jan 2012 · International Journal of Social Psychiatry
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disengagement from services by people with serious mental illnesses continues to be a major challenge for the mental health system. Assertive community treatment combined with Housing First services is an intervention targeted toward consumers whom the system has failed to engage. The processes involved in engaging and maintaining consumers in mental health services play an important role but remain an understudied aspect of the intervention. This study examined the social interaction between consumers and case managers from the perspective of consumers. Seventy service contacts between unique consumer-case manager dyads were sampled. Consumers with co-occurring serious mental illness and substance use disorders completed interviews after each service contact. They provided information on sociodemographic characteristics, service contact characteristics, consumer-provider relationship, utilization of coercive strategies, perceived coercion, and service contact evaluation. Multivariate regression analyses examined the association of consumer-provider relationship and perceived coercion with service contact evaluation. Consumer-provider relationship was negatively associated with perceived coercion (effect size=.08). Perceived coercion was negatively associated with service contact evaluation (effect size=.34). Perceived coercion was positively associated with time in the program (effect size=.17) and negatively associated with length of the service contact (effect size=.14). Effect sizes ranging from .08 to .34 are typically considered small to medium. Findings demonstrate that for consumers, a positive response to service contacts indicated that they did not feel coerced. With consumers whose connection to services is tenuous, an immediate positive response to service contacts may be vital to maintain engagement. Research is needed to identify supportive case manager strategies that facilitate relationship building.
    Preview · Article · Mar 2009 · Psychiatric services (Washington, D.C.)
  • [Show abstract] [Hide abstract]
    ABSTRACT: The recovery model refers to subjective experiences of optimism, empowerment and interpersonal support, and to a focus on collaborative treatment approaches, finding productive roles for user/consumers, peer support and reducing stigma. The model is influencing service development around the world. This review will assess whether optimism about outcome from serious mental illness and other tenets of the recovery model are borne out by recent research. Remission of symptoms has been precisely defined, but the definition of 'recovery' is a more diffuse concept that includes such factors as being productive and functioning independently. Recent research and a large, earlier body of data suggest that optimism about outcome from schizophrenia is justified. A substantial proportion of people with the illness will recover completely and many more will regain good social functioning. Outcome is better for people in the developing world. Mortality for people with schizophrenia is increasing but is lower in the developing world. Working appears to help people recover from schizophrenia, and recent advances in vocational rehabilitation have been shown to be effective in countries with differing economies and labor markets. A growing body of research supports the concept that empowerment is an important component of the recovery process. Key tenets of the recovery model - optimism about recovery from schizophrenia, the importance of access to employment and the value of empowerment of user/consumers in the recovery process - are supported by the scientific research. Attempts to reduce the internalized stigma of mental illness should enhance the recovery process.
    No preview · Article · Jun 2009 · Current opinion in psychiatry
Show more