Conceptualization Of Recovery Research Articles

Relational recovery: beyond individualism in the recovery approach

ABSTRACTObjective: While the recovery approach in mental health currently enjoys immense support, it is not without its critics. The most persistent criticisms focus on the individualism underpinning many conceptualisations of recovery. In this paper, we outline the shortcomings of individualistic approaches to recovery, and explore the alternative notion of relational recovery.Method: We begin this article by reviewing recent research and theory that critiques individualistic approaches to recovery. We then draw together disparate bodies of research that view recovery as an inherently social process.Results: Our reading of the literature suggests that although many models of recovery recognise relationships or connectedness as a component of the recovery process, an overemphasis on the ‘inner’, subjective experiences of people with a lived experience of mental ill-health largely obscures the interpersonal contexts of recovery. Interpersonal relationships can more accurately be seen as suffusing all aspects of recovery, including experiences such as hope, identity and empowerment.Discussion: We conclude by arguing that the way forward for mental health systems lies in developing, promoting and implementing approaches that properly acknowledge the irreducibly relational nature of recovery.

Relationships over time of subjective and objective elements of recovery in persons with schizophreni

Recovery from schizophrenia involves both subjective elements such as self-appraised wellness and objective elements such as symptom remission. Less is known about how they interact. To explore this issue, this study examined the relationship over the course of 1 year of four assessments of symptoms with four assessments of self-reports of subjective aspects of recovery. Participants were 101 outpatients with schizophrenia. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) while subjective recovery was assessed with the Recovery Assessment Scale (RAS). Separate Pearson׳s or Spearman׳s rank׳s correlation coefficients, calculated at all four measurement points, revealed the total symptom score was linked with lower levels of overall self-recovery at all four measurement points. The PANSS emotional discomfort subscale was linked with self-reported recovery at all four measurement points. RAS subscales linked to PANSS total symptoms at every time point were Personal confidence and hope, Goal and success orientation, and No domination by symptoms. Results are consistent with conceptualizations of recovery as a complex process and suggest that while there may be identifiably different domains, changes in subjective and objective domains may influence one another.

Applying the CHIME recovery framework in two culturally diverse Australian communities: Qualitative results.

CHIME (connectedness, hope and optimism about the future, identity, meaning in life and empowerment) is a framework for conceptualising personal recovery from mental illness. To date, there has been limited research on its cross-cultural applicability. To apply CHIME to two culturally diverse groups' conceptualisation of recovery from depression. Qualitative interviews with 30 Anglo-Australians and 28 Indian-Australians living with depression in Melbourne, Australia. Data were thematically analysed. Both groups valued connectedness but experienced stigma and struggled to broker family support. Identity, hope and optimism for the future were associated with positive thinking, being 'cured' and discontinuing treatment. Spirituality gave Indian participants meaning in life; Anglos derived meaning from the illness experience itself. Feeling empowered, for both groups, was related to improved socio-economic status and being 'settled' (e.g. having gainful employment, a home and family). CHIME was applicable in both groups, but culture mediated how cross-cutting issues (e.g. stigma) and sub-components of CHIME were operationalised. Recovery was also influenced by participant's socio-economic context. Research, policy and practice implications are discussed.

Recovery from problem gambling as a couples’ project

This paper presents a perspective on recovery from problem gambling – as a couples’ project. While an extensive literature shows how problem gambling can harm the relationships of problem gamblers, and research shows how a partners’ responses can enhance or exacerbate efforts to recover from problem gambling, missing from the literature is a conceptualization of recovery as a «couples’ project». We situate an important aspect of recovery as potentially occurring within the conversations and interactions of couples. Recovery, as a couple’s project, involves intended and shared efforts to relate in ways beyond unintended patterns and habits that accompanied and enabled problem gambling. These conversations and interactions are in turn described in ways relevant to therapeutic conversations and interventions.

Psychometric properties of the Recovery Assessment Scale in a sample with substance use disorder

Background: Conceptualisations of recovery from substance use disorder (SUD) and mental illness overlap significantly, and the rate of comorbidity of these problems is high. This study investigated the psychometric properties of the Recovery Assessment Scale (RAS), a measure originally developed for individuals with mental illness. Method: A sample of 1094 people with SUD attending residential treatment services provided by the Australian Salvation Army completed the RAS and other outcome measures at admission. Results: Confirmatory factor analysis (CFA) indicated a poor fit of the data to the five factor solution previously identified in mental illness samples. Exploratory factor analysis, however, produced three of the five factors included in the CFA, and two factors which arranged constructs in a slightly different manner from previous factor analytic studies in samples with mental illness. Correlations of these factors with other symptom distress and recovery measures indicated satisfactory convergent and divergent validity. Conclusions: The study provides modest support for the use of the RAS in groups with SUD.

Social recovery and the move beyond deficit models of depression: A feminist analysis of mid-life women's self-care practices

In Australia, like other advanced liberal democracies, the adoption of a recovery orientation was hailed as a major leap forward in mental health policy and service provision. We argue that this shift in thinking about the meaning of recovery requires further analysis of the gendered dimension of self-identity and relationships with the social world. In this article we focus on how mid-life women constructed meaning about recovery through their everyday practices of self-care within the gendered context of depression. Findings from our qualitative research with 31 mid-life women identified how the recovery process was complicated by relapses into depression, with many women critically questioning the limitations of biomedical treatment options for a more relational understanding of recovery. Participant stories revealed important tacit knowledge about recovery that emphasised the process of realising and recognising capacities and self-knowledge. We identify two central themes through which women's tacit knowledge of this changing relation to self in recovery is made explicit: the disciplined self of normalised recovery, redefining recovery and depression. The findings point to the need to reconsider how both recovery discourses and gendered expectations can complicate women's experiences of moving through depression. We argue for a different conceptualisation of recovery as a social practice through which women realise opportunities to embody different 'beings and doings'. A gendered understanding of what women themselves identify is important to their well-being, can contribute to more effective recovery oriented policies based on capability rather than deficit.

Recovery in Severe Mental Illnesses: A Literature Review of Recovery Measures

Recovery is an increasingly important construct in mental health services for adults with serious mental illnesses. It is defined as an active process of integrating mental health care with daily existence, creating a purposeful life regardless of diagnosis. Social work principles align with central values of recovery. Social workers who provide services to consumers may find it helpful to use a standardized recovery instrument in practice. The authors conducted a literature review to identify recovery instruments and assess the characteristics of those instruments, examining specifically the definitions of recovery, the nature of consumer involvement in instrument development, and the psychometric properties of recovery instruments. Multiple databases (CINHAL, JSTOR, PubMed, PsycARTICLES, PsycINFO, Social Sciences Citation Index, Social Services Abstracts, and Social Work Abstracts) were searched, as well as the gray literature. Seventeen articles discussing 12 recovery instruments were identified, with widely different conceptualizations of recovery, types of consumer involvement, and psychometric properties. Social workers should consider the purposes for which they wish to use a recovery instrument and, when appropriate, discuss recovery conceptualizations and goals with consumers. They should then select an instrument that best matches these goals. On the basis of this review, several instruments may be helpful to social workers in providing services to consumers.

Adolescents with Anorexia Nervosa Have Their Say: A Review of Qualitative Studies on Treatment and Recovery from Anorexia Nervosa

Anorexia nervosa often begins in adolescence, and there is a growing body of quantitative literature looking at the efficacy of treatment for adolescents. However, qualitative research has a valuable contribution to make to the understanding of treatment and recovery. This paper aims to review qualitative studies on the experience of treatment and recovery for adolescents with anorexia nervosa. Key themes from the 11 studies identified the role of family, peers and professionals, family therapy, the inpatient setting, emphasis on physical versus psychological and conceptualisation of recovery. Future studies would benefit from relating their findings to adolescent theory and considering reflexivity. Implications for clinical practice are also discussed.

Subjective judgements of perceived recovery from psychosis

BackgroundRecent conceptualisations of recovery from psychosis have recognised the importance of psychosocial aspects as well as the presence or absence of symptoms. Qualitative research and personal accounts of recovery highlight its subjective and idiosyncratic nature. This study aims to explore subjective judgements of recovery from the perspective of service users, and examine the agreement and consistency in such judgements across different measures of recovery. It also aims to investigate the relationships between subjective judgements of recovery and psychosocial factors.MethodsA total of 122 participants with experience of psychosis completed three self-report measures of recovery judgements, as well as measures of psychological functioning (including self-esteem, optimism, anxiety and depression) and socio-demographic measures.ResultsJudgements about recovery from psychosis across the three measures, while showing a trend, also show within-person variability. Recovery judgements were significantly correlated with each other and with all psychological variables, but were not associated with socio-demographic variables except for age. Regression analyses showed that recovery judgements were predicted by mood, optimism and self-esteem.ConclusionsSubjective judgements of recovery were seen to be idiosyncratic, with people appearing to have different thresholds for perceived recovery. The conclusions of the existing qualitative research and first-person accounts appear generalisable to larger samples.

Measures of the recovery orientation of mental health services: systematic review

The review aimed to (1) identify measures that assess the recovery orientation of services; (2) discuss how these measures have conceptualised recovery, and (3) characterise their psychometric properties. A systematic review was undertaken using seven sources. The conceptualisation of recovery within each measure was investigated by rating items against a conceptual framework of recovery comprising five recovery processes: connectedness; hope and optimism; identity; meaning and purpose; and empowerment. Psychometric properties of measures were evaluated using quality criteria. Thirteen recovery orientation measures were identified, of which six met eligibility criteria. No measure was a good fit with the conceptual framework. No measure had undergone extensive psychometric testing and none had data on test-retest reliability or sensitivity to change. Many measures have been developed to assess the recovery orientation of services. Comparisons between the measures were hampered by the different conceptualisations of recovery used and by the lack of uniformity on the level of organisation at which services were assessed. This situation makes it a challenge for services and researchers to make an informed choice on which measure to use. Further work is needed to produce measures with a transparent conceptual underpinning and demonstrated psychometric properties.

Factors involved in recovery from schizophrenia: A qualitative study of Thai mental health nurses

Recovery-oriented services increasingly are being called for around the world. These services do not just consider recovery from mental illness as symptom remission, but as individuals' ability to redefine their self and to "live well", even with enduring symptoms. However, little is known about the views of Thai nurses regarding the conceptualization of recovery. This article presents the findings of a qualitative study that explored the perspectives of 24 Thai nurses regarding schizophrenia and recovery. Semistructured interviews were conducted with nurses who were providing care for persons who were living with schizophrenia in both hospital and community settings. A thematic analysis identified the personal and environmental factors that were related to recovery. Illness acceptance, hope, and adherence to treatment were viewed as the facilitators of recovery, while a low level of self-responsibility and illness-related factors were barriers. Environmental factors, such as the presence of a supportive environment and accessibility to mental health services, were described as facilitators, while stigma towards mental health illness and fragmented health services were barriers. The implications of these results in promoting recovery-oriented mental health services in Thailand are discussed.

Conceptualisation of recovery from psychosis: a service-user perspective

Aims and methodThere has been much uncertainty about the concept of recovery in psychosis. The aim of this paper is to conceptualise recovery, through service users' descriptions of their recovery stories. A qualitative approach (interpretive phenomenological analysis) was used to guide interviews and analysis of data.ResultsEight service users were interviewed about their recovery from psychosis. Data analysis revealed four superordinate themes: ‘impacts on mental health’, ‘self-change and adaptation’, ‘social redefinition’ and ‘individualised coping mechanisms’.Clinical implicationsData indicates that multiple dimensions of recovery are all important to individuals when considering their subjective experiences of recovery from psychosis. Recovery can only be conceptualised by the person making the recovery journey and treatment outcome measures must reflect this individuality.

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness

Background: Conceptualizations of recovery involve more than just symptom amelioration and include the development of hope, meaning and self-identity. Goal attainment increases wellbeing within non-clinical samples and mental health consumers report its facilitative value for psychological recovery. There is a lack of empirical data regarding the impact of goal progress/attainment on mental health outcome for consumers with enduring mental illness.Aims: (i) To examine whether baseline measures of symptoms, functioning and recovery are associated with greater goal progress, and (ii) to examine the impact of goal attainment on improvements in mental health outcome.Method: Seventy-one consumers with enduring mental illness who were receiving case-management support from mental health services in eastern Australia participated in the study. Level of attainment for case-management goals was examined against mental health outcome measures for the corresponding goal-setting period.Results: Path modelling indicated that goal attainment mediated the relationship between baseline (pre-goal setting) levels of symptom distress and progress on recovery constructs; hope, self-confidence, sense of purpose and positive identity.Conclusions: When symptoms are perceived as less distressing consumers are better able to progress toward their case-management goals, which in turn promotes aspects of psychological recovery.

What does recovery mean for me? Perspectives of Canadian mental health consumers.

The objective of this study was to explore the meaning of recovery from the perspectives of consumers receiving mental health services in Canada. Sixty semi-structured interviews were conducted with 54 mental health consumers in Montreal, Québec City and Waterloo-Guelph, Ontario. Two contrasting meanings of recovery emerged. The first definition strongly attached recovery to illness while the second definition linked recovery to self-determination and taking responsibility for life. The prominence of biomedical definitions of recovery suggests the need to find common ground between these two perspectives, if conceptualizations of recovery are to include the views of consumers who routinely experience the mental health system.

Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives

The People Awakening (PA) study explored an Alaska Native (AN) understanding of the recovery process from alcohol abuse and consequent sobriety. PA utilized a cross-sectional, qualitative research design and community-based participatory research methods. The study included a state-wide convenience sample of 57 participants representing all five major AN groups: Aleut/Alutiiq, Athabascan, Inupiaq, Yup'ik/Cup'ik and Tlingit/Haida/Tsimshian. Participants were nominated and self-identified as being alcohol-abstinent at least five years following a period of problem drinking. Open-ended and semistructured interviews gathered extensive personal life histories. A team of university and community co-researchers analyzed narratives using grounded theory and consensual data analysis techniques. A heuristic model of AN recovery derived from our participants' experiences describes recovery as a development process understood through five interrelated sequences: (i) the person entered into a reflective process of continually thinking over the consequences of his/her alcohol abuse; (ii) that led to periods of experimenting with sobriety, typically, but not always, followed by repeated cycling through return to drinking, thinking it over, and experimenting with sobriety; culminating in (iii) a turning point, marked by the final decision to become sober. Subsequently, participants engaged in (iv) Stage 1 sobriety, active coping with craving and urges to drink followed for some participants, but not all, by (v) Stage 2 sobriety, moving beyond coping to what one participant characterized as 'living life as it was meant to be lived. The PA heuristic model points to important cultural elements in AN conceptualizations of recovery.

Recovery and the Good Life: How Psychiatric Survivors Are Revisioning the Healing Process

The recovery literature in clinical psychology often focuses on abstract outcome measures of mental health and wellness that in turn serve to shape the process and goals of psychotherapy. However, there is often an experiential disconnect between these conceptualizations of recovery and the lived experience of psychological suffering and healing. In the current article, the authors present alternative views of what recovery or, more accurately, what living a good life means for a group of people who identify themselves as psychiatric survivors. Like the feminist paradigm, the psychiatric survivor movement does not separate the personal and political, and thus this counterculture facilitates the telling of alternative narratives of recovery that more closely represent people's lived experiences. The authors discuss how these alternative discourses of the movement conceptualize the good life in terms of creating countercultural communities, engaging in political activism, and working for social justice and human rights in the mental health system.

Connectedness and Citizenship: Redefining Social Integration

Connectedness and Citizenship: Redefining Social Integration

Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery

Background: There is an increasing global commitment to recovery as the expectation for people with mental illness. There remains, however, little consensus on what recovery means in relation to mental illness.Aims: To contribute to current efforts to tease apart the various aspects of recovery appearing in the psychiatric literature by describing two conceptualizations of recovery from and recovery in mental illness.Method: Review of empirical literature on recovery and use of the term in clinical and rehabilitative practice.Results: Two potentially complementary meanings of recovery were identified. The first meaning of recovery from mental illness derives from over 30 years of longitudinal clinical research, which has shown that improvement is just as common, if not more so, than progressive deterioration. The second meaning of recovery in derives from the Mental Health Consumer/Survivor Movement, and refers instead to a person's rights to self-determination and inclusion in community life despite continuing to suffer from mental illness.Conclusions: The implications for practice of each of these concepts of recovery, as well as for that group of individuals for which neither concepts may apply, are discussed.Declaration of interest: None.