Oil and Water or Oil and Vinegar? Evidence-Based Medicine Meets Recovery

Department of Psychiatry, Program for Recovery and Community Health, Yale University School of Medicine, Erector Square 6 West, Suite #1C, 319 Peck Street, New Haven, CT 06513, USA.
Community Mental Health Journal (Impact Factor: 1.03). 09/2009; 45(5):323-32. DOI: 10.1007/s10597-009-9228-1
Source: PubMed


With the increasing prominence of the notions of "recovery" and "recovery-oriented practice," practitioners, program managers, and system leaders are increasingly asking about the relationship between "evidence-based practices" and recovery. After reviewing the concepts of recovery from mental illness, being in recovery with a mental illness, recovery-oriented care, and evidence-based medicine, the authors argue for a complementary relationship between recovery and evidence-based practices. This relationship is neither simple nor straightforward, but results in a whole that is greater than the sum of its parts through which each element benefits from the influence of the other.

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Available from: Thomas J Dinzeo, Jun 03, 2015
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    • "As a recovery-oriented practice, music therapy has received little attention in research and theory thus far, although the interest seems to be growing. The increasing prominence of the notion of recovery and recovery-oriented practices has called forth a request for more research in this field (Davidson, Drake, Schmutte, Dinzeo, & Andres-Hyman, 2009). This study has identified music therapy as a practice that is highly aligned with the perspective of recovery. "
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    ABSTRACT: An understanding of recovery as a personal and social process has emerged within mental health systems, and is increasingly shaping international mental health policy and practice. In this critical and user-oriented perspective, recovery is understood as a way of living a meaningful, hopeful and contributory life, despite the limitations caused by illness, with the primary job of mental health professionals being to support these processes of change. The recovery perspective has to a small degree been explored in relation to music therapy, and implications for practice have only been vaguely described. The primary aim of this study was to explore the user perspective of people diagnosed with psychosis in order to understand how music and music therapy can contribute to the processes of recovery. A qualitative case study methodology was chosen as a framework, and a hermeneutical-phenomenological approach was utilized in order to understand participants’ experiences of music therapy. In addition, a qualitative meta-synthesis of previous studies containing first-person accounts was conducted. The findings in this thesis are presented in three articles. The first article presents the meta-synthesis, and discusses the results in relation to the theory of mental health recovery. Through a systematic literature review, 14 studies containing first-hand accounts of participants’ experiences with music therapy were identified. From the synthesis, a taxonomy of four areas of users’ experiences was identified: (1) Having a good time, (2) Being together, (3) Feeling, and (4) Being someone. Music therapy’s possible role in supporting the recovery processes of the person, and as part of recovery-oriented mental health services, were discussed. The second article is a multiple case study based on participatory observation and qualitative interviews of nine inpatients diagnosed and hospitalized at a psychiatric intensive care unit. The data were analysed using IPA (interpretative phenomenological analysis), and resulted in the development of a taxonomy of four super-ordinate themes: (1) Freedom, (2) Contact, (3) Well-being, and (4) Symptom relief. Mental health recovery, positive mental health and agency were proposed to constitute an appropriate framework for music therapy in mental health care. The third article is a single case study of a young man’s experiences of music therapy and the progressing processes of recovery. This was achieved by means of a qualitative case study that featured a description of the music therapeutic process based on participatory observation, alongside first-hand accounts of the participant’s subjective experiences gathered from interviews. The data were analysed using interpretative phenomenological analysis (IPA), and the presentation has a narrative form. The discussion highlights music therapy’s possibilities to afford agency and empowerment, promote a positive identity, develop positive relationships and expand social networks. The findings of the three articles are discussed in relation to established theory research and practice. Primary findings include that: music therapy was primarily experienced in relation to aspects of positive mental health and well-being and only occasionally in terms of symptom remission, music therapy supported the processes of recovery by affording a therapeutic and social arena that promoted participants’ agency and music therapy supported processes of recovery across multiple contexts in the participants’ lives.
    Full-text · Thesis · Nov 2014
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    • "Emphasis on evidence-based practice and research An empirical approach to training and practice was taken. Characteristics of the learners Indoctrinated in traditional illness views of mental health care Adopted Davidson's " recovery from " and " recovery in " model of care (Davidson et al., 2009). Contrasted and compared models of care. "
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    ABSTRACT: The advocacy of recovery-oriented practices in mental health care with its emphasis on freedom and choice in care has been gaining considerable traction in recent years. In response to the growing recognition and promotion of recovery-oriented services, several training initiatives have been developed to bring about mental health care system transformation. These initiatives, however, have been primarily focused on broad organizational and procedural changes as well as hospital and clinic staff development. Relatively neglected have been initiatives to educate physicians and doctorally trained psychologists in the concepts and practices of recovery-oriented care. This article describes a case study of the efforts of Project GREAT (Georgia Recovery-Based Educational Approach to Treatment) that has aspired to transform the education and practice of an academic department of psychiatry into a recovery-oriented one with the focus on shaping the recovery knowledge, attitudes, and practices of psychiatry and psychology faculty and trainees. Core issues in the transformation effort were identified and led to the implementation of the following change interventions: (a) administrative leadership and support, (b) consumer mediated interventions, (c) educational presentations/materials, (d) interactive small groups/program champions, (e) reminders/prompts/practice tools, (f) newsletters/pamphlets, and (g) educational outreach visits. It is proposed that this transformation experience provided valuable lessons that are generally applicable to other academic programs for psychiatrists and psychologists attempting to adopt recovery-oriented training and care.
    Full-text · Article · Aug 2014 · Professional Psychology Research and Practice
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    • "For professionals, it is important to keep in mind that being recovery-oriented means to not only pay attention to the level of symptoms but also to the individual's life as a whole (Borg and Davidson, 2008). Recovery means to improve well-being/ mental health, where professionals can support the client to find his or her own strategies to achieve balance in life and to develop strategies to manage the symptoms that might occur occasionally (Deegan, 2005, 2007; Davidson et al., 2009; Slade, 2010). It is important to support the client to develop valued social roles such as being a parent, a student, or an employee (Anthony, 1993). "
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    ABSTRACT: Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs' work; it was the only tool' they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client's needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client's recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
    Full-text · Article · Sep 2013 · International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation
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