Module 3: The Recovery Paradigm
Ch 3: What is Recovery?
(Slade, 2009)
What is the difference between clinical recovery and personal recovery according to Slade (2009)?
Clinical Recovery Personal Recovery
Refers to recovery in the sense of cure Refers to individuals self-reporting as being
It is an outcome or a state, generally dichotomous recovered – even when they experience ongoing
It is observable in clinical parlance, it is objective symptoms
It is rated by the expert clinician, not the patient Recovery is an individual process
The definition of recovery is invariant across Recovery is seen as a journey into life – not an
individuals outcome to be arrived at
The intention with this definition is that it is Recovery is about seeing people beyond their
operationalizable – suitable for use in empirical problems (e.g., abilities, possibilities, interests,
research dreams) – and not about cure
Recovering the social roles and relationships that
give value and meaning
Early individual accounts of recovery provide
ecologically valid pointers to what recovery looks
and feels like from the inside
This understanding of recovery emphasizes the
centrality of hope, identity, meaning and personal
responsibility
This understanding of recovery reflects its
individually defined and experienced nature
Recovery is a deeply personal, unique process of
changing one’s attitudes, values, feelings, goals,
skills and/or roles
It is a way of living a satisfying, hopeful, and
, contributing life within the limitations caused by
illness
Recovery involves the development of new meaning
and purpose in one’s life as one grows beyond the
effects of mental illness
It is the establishment of a fulfilling, meaningful
life and a positive sense of identity founded on
hopefulness and self-determinations
Recovery involves living as well as possible
Personal recovery makes the operationalization of
the concept and empirical investigation problematic
Recovery can be identified using the domains
empowerment, hope and optimism, knowledge,
and life satisfaction
Where do they overlap?
Clinical recovery and personal recovery are two overlapping, but different, understandings –
subsequently, three definitions of recovery have been proposed:
1. Spontaneous Recovery – i.e., recovery is a naturally occurring phenomenon – some
people who meet the diagnostic criteria for a serious mental illness are able to
overcome their disabilities and fully enjoy a life in which their life goals are
accomplished – without any treatment
2. Clinical Recovery – i.e., as with other medical illnesses, people can recover from
mental illness with proper treatment – others who do not enjoy spontaneous recovery
from mental illness are able to achieve a similar state of goal attainment and life
satisfaction as a result of participating in variety of services
3. Personal Recovery – i.e., recovery reintroduces the idea of hope in understanding
serious mental illness – it means that even though one is diagnosed with serious psych
disorder, his/her life need not be limited by institutions
Personal recovery encompasses all three types of recovery listed above
, 1. Spontaneous recovery occurs for some people – when one’s biological,
psychological, social and spiritual self-righting skills and supports combine to manage
the mental illness
2. Personal recovery occurs for some people – via receiving evidence-based treatments
(clinical recovery) – so treatment is an important element of MHS
- This is where personal recovery and clinical recovery overlap
3. Crucially – personal recovery is underpinned for all people by hope, meaning,
identity, and personal responsibility
Although these concepts overlap – a primary focus on clinical recovery is incompatible with
a primary focus on personal recovery
- The current focus on clinical recovery can hinder personal recovery in the
domains (1) hope, (2) meaning, and (3) symptoms
Approaches and Core Arguments
RECOVERY-FOCUSED SERVICE – RECOVERY APPROACH
Summary Description A recovery-focused service – is an approach, a way of thinking, a set of attitudes
and values put into practice by skilled MH practitioners
Recovery involves a journey – from disengagement to engagement – from
surviving to living and growing
Awareness of the journey starts in adversity – such as mental illness – the journey
is not about the adversity
The journey has many routes – and each person’s journey is unique – it involves
finding the courage to hope for a good future and to relate to yourself and others in
beneficial ways
Setbacks are inevitable – but the challenge is universal
Aspects Identified by Recovery is a continuing journey – not an end-product or result
Perkins and Repper Recovery is about growth
A recovery vision is not limited to a particular theory about the nature and causes
of mental health problems
Recovery is not the same as cure
, Recovery can, and does, occur without professional intervention
Everyone’s recovery journey is different and deeply personal – there are no rules of
recovery and no formula for success
Recovery is about taking back control over one’s own life
Recovery is not a linear process
Recovery is not specific to people with mental health problems
Aspects Identified by Recovery is a journey from alienation to a sense of meaning and purpose
Ralph Recovery is moving from withdrawal to engagement and active participation in
life
Recovery is active coping rather than passive adjustment
Recovery is breaking through denial and achieving understanding and
acceptance
Recovery is reawakening of hope after despair
Recovery means no longer viewing oneself as primarily a person with a psychiatric
disorder and reclaiming a positive sense of self
Recovery is not accomplished alone – the journey involves support and partnership
Recovery is a complex and nonlinear journey
CLINICAL RECOVERY PITFALLS
Clinical Recovery and Hope is central to personal recovery as it leads to action based on approach rather
Hope than avoidance motivation – having positive goals rather than trying to avoid
negative outcomes
Hope is a problem in MHS – they should work in ways to foster hope and
optimism
Professionals rarely communicate possibility of good future and clients may
develop the belief that they will never recover – self-fulfilling nature of belief
Spirit breaking – i.e., when interactions with MH professionals engender feelings
of being disrespected, discouraged, and hopeless
Hopelessness takes away the motivation to become well – a focus on clinical
recovery with its emphasis on engendering realistic (low) expectation – can
destroy hope
,
Clinical Recovery and Finding meaning involves making sense of experience and generating a story
Meaning which fits for the person
Meaning gives a narrative of how they come to be where they are in life – such a
discovery that we do not need to be a slave to our genes is a facilitator of hope
Imposing a single explanatory model on the ways of developing meaning – can be
damaging
Individuals need to be supported in finding meaning via a stance of offering
understanding rather than imposing an explanation
If a service is focused on clinical recovery – lack of insight is always to be avoided
as it is a symptom of illness – and symptoms are by definition undesirable
In a service focused on personal recovery – it is important that the person finds
their own meaning which can make sense of their experience and provide hope for
the future
Clinical Recovery and For clinical recovery – symptom abatement is necessary
Symptoms For personal recovery – there is no universal stance about symptoms
Viewing symptom reduction as the primary goal of MHS – (1) leads to an
escalating cycle of increasing compulsion and (2) a view of symptoms as always
undesirable – ignores the potential benefits
Personal recovery is almost always about the relationship with the symptoms
EXPLANATORY MODELS OF DEVELOPING MEANING
Life History E.g., a difficult childhood
Medical Often expressed with ambivalence – such as a view of medication as a necessary
evil
With recovery as present when medication has ceased to be an issue
Ch 3: What is Recovery?
(Slade, 2009)
What is the difference between clinical recovery and personal recovery according to Slade (2009)?
Clinical Recovery Personal Recovery
Refers to recovery in the sense of cure Refers to individuals self-reporting as being
It is an outcome or a state, generally dichotomous recovered – even when they experience ongoing
It is observable in clinical parlance, it is objective symptoms
It is rated by the expert clinician, not the patient Recovery is an individual process
The definition of recovery is invariant across Recovery is seen as a journey into life – not an
individuals outcome to be arrived at
The intention with this definition is that it is Recovery is about seeing people beyond their
operationalizable – suitable for use in empirical problems (e.g., abilities, possibilities, interests,
research dreams) – and not about cure
Recovering the social roles and relationships that
give value and meaning
Early individual accounts of recovery provide
ecologically valid pointers to what recovery looks
and feels like from the inside
This understanding of recovery emphasizes the
centrality of hope, identity, meaning and personal
responsibility
This understanding of recovery reflects its
individually defined and experienced nature
Recovery is a deeply personal, unique process of
changing one’s attitudes, values, feelings, goals,
skills and/or roles
It is a way of living a satisfying, hopeful, and
, contributing life within the limitations caused by
illness
Recovery involves the development of new meaning
and purpose in one’s life as one grows beyond the
effects of mental illness
It is the establishment of a fulfilling, meaningful
life and a positive sense of identity founded on
hopefulness and self-determinations
Recovery involves living as well as possible
Personal recovery makes the operationalization of
the concept and empirical investigation problematic
Recovery can be identified using the domains
empowerment, hope and optimism, knowledge,
and life satisfaction
Where do they overlap?
Clinical recovery and personal recovery are two overlapping, but different, understandings –
subsequently, three definitions of recovery have been proposed:
1. Spontaneous Recovery – i.e., recovery is a naturally occurring phenomenon – some
people who meet the diagnostic criteria for a serious mental illness are able to
overcome their disabilities and fully enjoy a life in which their life goals are
accomplished – without any treatment
2. Clinical Recovery – i.e., as with other medical illnesses, people can recover from
mental illness with proper treatment – others who do not enjoy spontaneous recovery
from mental illness are able to achieve a similar state of goal attainment and life
satisfaction as a result of participating in variety of services
3. Personal Recovery – i.e., recovery reintroduces the idea of hope in understanding
serious mental illness – it means that even though one is diagnosed with serious psych
disorder, his/her life need not be limited by institutions
Personal recovery encompasses all three types of recovery listed above
, 1. Spontaneous recovery occurs for some people – when one’s biological,
psychological, social and spiritual self-righting skills and supports combine to manage
the mental illness
2. Personal recovery occurs for some people – via receiving evidence-based treatments
(clinical recovery) – so treatment is an important element of MHS
- This is where personal recovery and clinical recovery overlap
3. Crucially – personal recovery is underpinned for all people by hope, meaning,
identity, and personal responsibility
Although these concepts overlap – a primary focus on clinical recovery is incompatible with
a primary focus on personal recovery
- The current focus on clinical recovery can hinder personal recovery in the
domains (1) hope, (2) meaning, and (3) symptoms
Approaches and Core Arguments
RECOVERY-FOCUSED SERVICE – RECOVERY APPROACH
Summary Description A recovery-focused service – is an approach, a way of thinking, a set of attitudes
and values put into practice by skilled MH practitioners
Recovery involves a journey – from disengagement to engagement – from
surviving to living and growing
Awareness of the journey starts in adversity – such as mental illness – the journey
is not about the adversity
The journey has many routes – and each person’s journey is unique – it involves
finding the courage to hope for a good future and to relate to yourself and others in
beneficial ways
Setbacks are inevitable – but the challenge is universal
Aspects Identified by Recovery is a continuing journey – not an end-product or result
Perkins and Repper Recovery is about growth
A recovery vision is not limited to a particular theory about the nature and causes
of mental health problems
Recovery is not the same as cure
, Recovery can, and does, occur without professional intervention
Everyone’s recovery journey is different and deeply personal – there are no rules of
recovery and no formula for success
Recovery is about taking back control over one’s own life
Recovery is not a linear process
Recovery is not specific to people with mental health problems
Aspects Identified by Recovery is a journey from alienation to a sense of meaning and purpose
Ralph Recovery is moving from withdrawal to engagement and active participation in
life
Recovery is active coping rather than passive adjustment
Recovery is breaking through denial and achieving understanding and
acceptance
Recovery is reawakening of hope after despair
Recovery means no longer viewing oneself as primarily a person with a psychiatric
disorder and reclaiming a positive sense of self
Recovery is not accomplished alone – the journey involves support and partnership
Recovery is a complex and nonlinear journey
CLINICAL RECOVERY PITFALLS
Clinical Recovery and Hope is central to personal recovery as it leads to action based on approach rather
Hope than avoidance motivation – having positive goals rather than trying to avoid
negative outcomes
Hope is a problem in MHS – they should work in ways to foster hope and
optimism
Professionals rarely communicate possibility of good future and clients may
develop the belief that they will never recover – self-fulfilling nature of belief
Spirit breaking – i.e., when interactions with MH professionals engender feelings
of being disrespected, discouraged, and hopeless
Hopelessness takes away the motivation to become well – a focus on clinical
recovery with its emphasis on engendering realistic (low) expectation – can
destroy hope
,
Clinical Recovery and Finding meaning involves making sense of experience and generating a story
Meaning which fits for the person
Meaning gives a narrative of how they come to be where they are in life – such a
discovery that we do not need to be a slave to our genes is a facilitator of hope
Imposing a single explanatory model on the ways of developing meaning – can be
damaging
Individuals need to be supported in finding meaning via a stance of offering
understanding rather than imposing an explanation
If a service is focused on clinical recovery – lack of insight is always to be avoided
as it is a symptom of illness – and symptoms are by definition undesirable
In a service focused on personal recovery – it is important that the person finds
their own meaning which can make sense of their experience and provide hope for
the future
Clinical Recovery and For clinical recovery – symptom abatement is necessary
Symptoms For personal recovery – there is no universal stance about symptoms
Viewing symptom reduction as the primary goal of MHS – (1) leads to an
escalating cycle of increasing compulsion and (2) a view of symptoms as always
undesirable – ignores the potential benefits
Personal recovery is almost always about the relationship with the symptoms
EXPLANATORY MODELS OF DEVELOPING MEANING
Life History E.g., a difficult childhood
Medical Often expressed with ambivalence – such as a view of medication as a necessary
evil
With recovery as present when medication has ceased to be an issue
