What is Recovery Coaching?

Introduction

Recovery coaching is a form of strengths-based support for people with addictions or in recovery from alcohol, other drugs, co-dependency, or other addictive behaviours. They work with people who have active addictions, as well as those already in recovery. Recovery coaches are helpful for making decisions about what to do with one’s life and the part addiction or recovery plays in it. They help clients find ways to stop addiction (abstinence), or reduce harm associated with addictive behaviours. These coaches can help a client find resources for harm reduction, detox, treatment, family support and education, local or online support groups; or help a client create a change plan to recover on their own.

Recovery coaches do not offer primary treatment for addiction, do not diagnose, and are not associated with any particular method or means of recovery. They support any positive change, helping persons coming home from treatment to avoid relapse, build community support for recovery, or work on life goals not related to addiction such as relationships, work, or education. Recovery coaching is action-oriented with an emphasis on improving present life and reaching future goals.

Recovery coaching is unlike most therapy because coaches do not address the past, do not work to heal trauma, and put little emphasis on feelings. Recovery coaches are unlike licensed addiction counsellors in that they are non-clinical and do not diagnose or treat addiction or any mental health issues.

Refer to Recovery Model.

Relationship to Life Coaching

Similar to life and business coaching, recovery coaching uses a partnership model wherein the client is considered to be the expert on his or her life, the one who decides what is worth doing, and the coach provides expertise in supporting successful change. Recovery coaching focuses on achieving goals important to the client, not just recovery-related goals. The coach asks questions and offers reflections to help the client reach clarity and decide what steps to take. Recovery coaching emphasizes honouring values and making principle-based decisions, creating a clear plan of action, and using current strengths to reach future goals. The coach provides accountability to help the client stay on track.

Other Similar Terms

The moniker “recovery coach” is used for a variety of specific addiction support roles. The main distinction is between the professional or highly compensated recovery coach and the volunteer or agency-employed peer recovery support specialist. Recovery support roles include the following:

Sober Escort

A sober escort, or travel escort, is a paid sober travel companion or travel escort that accompanies a client to an event, to treatment, or to court, to ensure the client maintains sobriety. Transportation can be a significant challenge to a newly abstinent person. Whether the client is interested in maintaining an ongoing recovery or just needs to stay abstinent for a period of time, getting from point A to point B can be difficult. This version of a recovery coach may be required to transport a person in recovery across town, across the state, or across the county.

Sober Companion

A sober companion or sober coach works full-time with the client: full work days, nights, weekends or extended periods where the coach is by the client’s side 24 hours a day. This long-term option can begin with treatment discharge and may develop into a coaching relationship that continues for several weeks, months or longer.

When returning home from treatment, the client trades a secure, drug-free environment for a situation where they know there are problems. The sober companion may provide the symbolic and functional safety of the treatment centre. This coach will introduce the client to 12-step meetings, guide them past former triggers for their addiction, and support them in developing a recovery plan. The sober companion helps the client make lifestyle changes in order to experience a better quality of life in the first crucial days after discharge from a treatment centre. Sometimes a recovery coach is necessary to keep a client sober in order to regain custody of a child.

Recovery Support Specialist

A recovery support specialist (RSS) or a peer recovery support specialist (PRSS) is a non-clinical person who meets with clients in a recovery community organisation or goes off-site to visit a client. They may volunteer for these coaching services, or be employed by a recovery community organisation for a low wage. The recovery support specialist ensures there is a contract for engagement, called a personal recovery plan. This is a key component of the recovery management model, which all RSSs follow. These specialists are sometimes also called “recovery coaches”. William L. White, researcher and original author of the recovery management model, uses the term “recovery support specialist”. This is referenced in the paper titled “Recovery Oriented System of Care (ROSC) Substance Use Disorder (SUD) Glossary of Terms”, compiled by the Bureau of Substance Abuse and Addiction Services (BSAAS). Another term for a peer recovery support specialist is “peer mentor“.

Family Recovery Coach

The family plays an important role for a person in recovery but is often neglected by traditional models of recovery. Specially trained family recovery coaches strive to create a calm, objective, non-judgmental environment for the family of a recovering addict. They are knowledgeable in specific models that help the family cope with the changes that they have gone through living with an active addict or living with a recovering addict. Regardless of an addict’s choices, working with a family recovery coach may help a spouse, partner, or loved ones avoid the mental obsession that plagues many families affected by addiction and learn to lead sane and productive lives.

Phone or Virtual Recovery Coach

A phone or virtual recovery coaching relationship may be established to continue beyond the face-to-face meeting of a client and a recovery coach. Today, many treatment centres are embracing virtual recovery coaching, and linking phone or virtual recovery coaches with clients prior to leaving treatment, as a way to continue the connection to the treatment centre, as well as meeting the guidelines of an aftercare programme. Online virtual coaching programmes also exist, either fee-based or for free, that will help anyone apply the methods of recovery (e.g. developing a recovery plan and building recovery capital), whether the client has completed a stay at a treatment centre or has relapsed many months after treatment.

Legal Support Specialist

Lawyers dealing with criminal drug cases or drug courts sometimes request a type of recovery coaching to ensure a client (perhaps under house arrest, enrolled in a drug court outpatient programme or pending trial) stays sober as per the law’s mandate. Recovery coaches with the required certification and legal knowledge are contracted for this purpose. Certified Peer Recovery Support Specialists, Licensed clinical social workers or certified alcohol and drug counsellors with training in assessments can perform these tasks. The court will request them to perform a client assessment and work with the client on a continuing basis and re-assess after a period of time. The coach will then draft a letter to the court and offer suggested placement in a residential alcohol/drug treatment centre, an outpatient treatment programme, or a sober living facility. A legal support specialist can also appear in court with the client and provide transportation to or from the courthouse.

In the Emergency Departments of Hospitals

The AnchorED programme, developed in 2014 with a group of Rhode Island hospitals and the Anchor Community Recovery Centre in Providence RI, was launched in an attempt to reduce the instance of accidental opioid overdose by connecting overdose patients with Certified Recovery Coaches in the emergency departments of regional hospitals. The AnchorED programme is now a benchmark in this field and is used nationwide. This programme is meant to connect people experiencing an overdose, or revived from an overdose in the ED in the hospital emergency departments with peer-to-peer recovery support. Specially trained ED Peer Recovery Specialists are on call to all Emergency Departments 24/7 and called in when individuals are transported to a hospital emergency department having survived an opiate overdose. The hours immediately after an overdose are medically risky, but they also present a unique opportunity. The AnchorED trained recovery coaches will make sure that patients and their families know that substance use disorder is a medical condition and that recovery is possible. Recovery Coaches engage with those who have survived an opiate overdose, listen and be present to answer questions patients may have about recovery supports or treatment options. These coaches also provide recovery and treatment information to family members. These same coaches offer post-discharge recovery contact and support to the revived patients for a period of weeks.

Brief History

Alida Schuyler, a coach credentialed by the International Coach Federation (ICF), who was in recovery from addiction, wrote the first recovery coach certification training programme specifically aimed at training students to coach people with addictions. She also created the first special interest group for recovery coaches, and she co-founded the non-profit Recovery Coaches International with Andrew Susskind.

William L. White used the term “recovery coach” in his 2006 paper “Sponsor, Recovery Coach, Addiction Counselor”, but later adopted the term “peer recovery support specialist” to emphasize a community-based peer model of addiction support.

White’s Recovery Management model, adapted from the Minnesota Model, includes recovery coaching (peer recovery support specialist) and was developed in 2006. Many recovery coaches use different recovery approaches adapted from the Minnesota Model. Schuyler developed a professional model of life coaching for addiction recovery by blending the Minnesota Model and Harm Reduction model with the core competencies of the ICF.

Through the research of White, David Loveland, Ernest Kurtz, and Mark Saunders, and the efforts funded through Faces and Voices of Recovery, the Fayette Companies, Great Lakes Addiction Technology Transfer Centre, the Chestnut Health Systems and many other universities, research on recovery coaching is progressing rapidly. The theory has been developed that recovery coaching reduces relapse by providing ongoing support developing healthy problem-solving skills and self efficacy (reaching worthwhile goals), as well as connecting with the local recovery community for additional support. In other words, recovery coaching helps the client develop the cognitive skills necessary for considering options and consequences, making clear choices, planning, and taking actions toward a healthier life and recovery goals.

Recovery coaching is currently offered by some notable 12-step treatment centres as well as several private “academies” and “institutes” with certifications that are usually country and/or state specific. Be sure to check local laws for compliance.

Addiction Recovery Support Groups

Recovery coaches encourage (but most do not require) participation in groups such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, or non 12-step groups such as LifeRing Secular Recovery, SMART Recovery, Moderation Management, and Women for Sobriety. They also work with individuals who dislike groups to help them find their own path to recovery.

Niches within Recovery Coaching

Recovery coaches may work with any type of addict. There are also niches within recovery coaching such as those who work exclusively with families of recovering individuals, or a financial coach who works on rebuilding an overspender’s credit rating. Many peer recovery support specialists work with individuals who have left the prison system and are attempting to rebuild their lives. Some recovery coaches specialise in emotional and financial recovery after divorce.

A few recovery coaches specialise in merging the characteristics of recovery coaching within a life coaching framework. This concept takes into account the often overlooked reality that those in early recovery tend to have unique difficulties in applying the realities of day-to-day living within their new sober lifestyle. Such unique coaching styles are able to span far beyond the recovery component and properly introduce outside influencers, such as family relationships, employment, schooling, and relationships.

For those requiring a higher level of care, such as medical detoxification for heroin or opiate withdrawal, or 24/7 sober companion and oversight services, there exist recovery coaching firms which specialise in providing what could often be described as an alternative to inpatient or outpatient treatment. Companies like The Addictions Coach and others which have nationwide credentials are able to essentially bring the addiction treatment component to the client, no matter where he or she may be located.

What Recovery Coaches Do

Recovery coaches support the client in achieving and maintaining a solid foundation in recovery, and building upon recovery to achieve other life goals that make recovery worthwhile. David Loveland and Michael Boyle wrote a lengthy manual on recovery coaching and how to guide an individual through creating their recovery plan. William White, preeminent scholar on addictions, worked closely with the Philadelphia community-based recovery centre PRO-ACT to prepare a document outlining the “Ethical Guidelines for the Delivery of Peer-Based Recovery Support Services”. These documents provide a discussion of what a recovery coach does. Also included in these guidelines are the definition of coaching roles as they relate to others in the realm of personal conduct and conduct in service relationships with the community service provider or treatment team. White’s document presents a simple statement of core competencies.

Book: Finding Your Best Self

Book Title:

Finding Your Best Self: Recovery from Addiction, Trauma, or Both.

Author(s): Lisa M. Najavits (PhD).

Year: 2019.

Edition: Second (2nd).

Publisher: Guildford Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Addiction and trauma are two of the most common and difficult issues that people face. In this motivating book, leading expert Lisa Najavits explains the link between addiction and trauma and presents science-based self-help strategies that you can use no matter where you are in your recovery. Every chapter features inspiring words from people who have “been there,” plus carefully designed reflection questions, exercises, and other practical tools. Learn how you can:

  • Build coping skills so that the future is better than the past.
  • Keep yourself safe and find support.
  • Set your own goals and make a plan to achieve them at your own pace.
  • Choose compassion over self-blame and shame.
  • Move toward your best self – the person you want to be.

If you are a family member or friend seeking to support a loved one – or a helping professional – this book is also for you. Now in a convenient large-size format, the revised edition features added materials for professional and peer counsellors. First edition title: Recovery from Trauma, Addiction, or Both.

Mental health professionals, see also the author’s Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, which presents an evidence-based treatment approach developed specifically for PTSD and substance abuse.

What is the Recovery Model?

Introduction

The recovery model, recovery approach or psychological recovery is an approach to mental disorder or substance dependence that emphasizes and supports a person’s potential for recovery. Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects sane-insane dichotomy.

William Anthony, then Director of the Boston Centre for Psychiatric Rehabilitation, developed a quaint cornerstone definition of mental health recovery in 1993.

“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 even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”

The use of the concept in mental health emerged as deinstitutionalisation resulted in more individuals living in the community. It gained impetus as a social movement due to a perceived failure by services or wider society to adequately support social inclusion, and to studies demonstrating that many people do recover. A recovery approach has now been explicitly adopted as the guiding principle of the mental health or substance dependency policies of a number of countries and states.

In many cases practical steps are being taken to base services on a recovery model, although a range of obstacles, concerns and criticisms have been raised both by service providers and by recipients of services. A number of standardised measures have been developed to assess aspects of recovery, although there is some variation between professionalised models and those originating in the psychiatric survivors movement.

Refer to Recovery Coaching.

Brief History

In general medicine and psychiatry, recovery has long been used to refer to the end of a particular experience or episode of illness. The broader concept of “recovery” as a general philosophy and model was first popularized in regard to recovery from substance abuse/drug addiction, for example within twelve-step programs.

Application of recovery models to psychiatric disorders is comparatively recent. The concept of recovery can be traced back as far as 1840, when John Perceval, son of one of Britain’s prime ministers, wrote of his personal recovery from the psychosis that he experienced from 1830 until 1832, a recovery that he obtained despite the “treatment” he received from the “lunatic” doctors who attended him. But by consensus the main impetus for the development came from within the consumer/survivor/ex-patient movement, a grassroots self-help and advocacy initiative, particularly within the United States during the late 1980s and early 1990s. The professional literature, starting with the psychiatric rehabilitation movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the “First World”. Similar approaches developed around the same time, without necessarily using the term recovery, in Italy, the Netherlands and the UK.

Developments were fuelled by a number of long-term outcome studies of people with “major mental illnesses” in populations from virtually every continent, including landmark cross-national studies by the World Health Organization from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery, with exact statistics varying by region and the criteria used. The cumulative impact of personal stories or testimony of recovery has also been a powerful force behind the development of recovery approaches and policies. A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.

Increasingly, recovery became both a subject of mental health services research and a term emblematic of many of the goals of the Consumer/Survivor/Ex-Patient Movement. The concept of recovery was often defined and applied differently by consumers/survivors and professionals. Specific policy and clinical strategies were developed to implement recovery principles although key questions remained.

Elements of Recovery

It has been emphasized that each individual’s journey to recovery is a deeply personal process, as well as being related to an individual’s community and society. A number of features or signs of recovery have been proposed as often core elements and comprehensively they have been categorised under the concept of CHIME.

CHIME is an abbreviation of:

  • Connectedness;
  • Hope and optimism;
  • Identity;
  • Meaning & purpose; and
  • Empowerment.

Connectedness and Supportive Relationships

A common aspect of recovery is said to be the presence of others who believe in the person’s potential to recover and who stand by them. According to Relational Cultural Theory as developed by Jean Baker Miller, recovery requires mutuality and empathy in relationships. The theory states this requires relationships that embody respect, authenticity, and emotional availability. Supportive relationships can also be made safer through predictability and avoiding shaming and violence. While mental health professionals can offer a particular limited kind of relationship and help foster hope, relationships with friends, family and the community are said to often be of wider and longer-term importance. Case managers can play the role of connecting recovering persons to services that the recovering person may have limited access to, such as food stamps and medical care. Others who have experienced similar difficulties and are on a journey of recovery can also play a role in establishing community and combating a recovering person’s feelings of isolation. In practice, this can be accomplished through one-on-one interviews with other recovering persons, engaging in communal story circles, or peer-led support groups. Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing and potentially retraumatising, and that reciprocal relationships and mutual support networks can be of more value to self-esteem and recovery.

Hope

Finding and nurturing hope has been described as a key to recovery. It is said to include not just optimism but a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks. Hope may start at a certain turning point, or emerge gradually as a small and fragile feeling, and may fluctuate with despair. It is said to involve trusting, and risking disappointment, failure and further hurt.

Identity

Recovery of a durable sense of self (if it had been lost or taken away) has been proposed as an important element. A research review suggested that people sometimes achieve this by “positive withdrawal” – regulating social involvement and negotiating public space in order to only move towards others in a way that feels safe yet meaningful; and nurturing personal psychological space that allows room for developing understanding and a broad sense of self, interests, spirituality, etc. It was suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance, mutuality, and a sense of social belonging; and is often challenging in the face of the typical barrage of overt and covert negative messages that come from the broader social context. Being able to move on can mean having to cope with feelings of loss, which may include despair and anger. When an individual is ready for change, a process of grieving is initiated. It may require accepting past suffering and lost opportunities or lost time.

Formation of Healthy Coping Strategies and Meaningful Internal Schema

The development of personal coping strategies (including self-management or self-help) is said to be an important element. This can involve making use of medication or psychotherapy if the patient is fully informed and listened to, including about adverse effects and about which methods fit with the consumer’s life and their journey of recovery. Developing coping and problem solving skills to manage individual traits and problem issues (which may or may not be seen as symptoms of mental disorder) may require a person becoming their own expert, in order to identify key stress points and possible crisis points, and to understand and develop personal ways of responding and coping. Developing a sense of meaning and overall purpose is said to be important for sustaining the recovery process. This may involve recovering or developing a social or work role. It may also involve renewing, finding or developing a guiding philosophy, religion, politics or culture. From a postmodern perspective, this can be seen as developing a narrative.

Empowerment and Building a Secure Base

Building a positive culture of healing is essential in the recovery approach. Since recovering is a long process, a strong supportive network can be helpful. Appropriate housing, a sufficient income, freedom from violence, and adequate access to health care have also been proposed as important tools to empowering someone and increasing her/his self-sufficiency. Empowerment and self-determination are said to be important to recovery for reducing the social and psychological effects of stress and trauma. Women’s Empowerment Theory suggests that recovery from mental illness, substance abuse, and trauma requires helping survivors understand their rights so they can increase their capacity to make autonomous choices. This can mean develop the confidence for independent assertive decision making and help-seeking which translates into proper medication and active self care practices. Achieving social inclusion and overcoming challenging social stigma and prejudice about mental distress/disorder/difference is also an important part of empowerment. Advocates of Women’s Empowerment Theory argue it is important to recognise that a recovering person’s view of self is perpetuated by stereotypes and combating those narratives. Empowerment according to this logic requires reframing a survivor’s view of self and the world. In practice, empowerment and building a secure base require mutually supportive relationships between survivors and service providers, identifying a survivor’s existing strengths, and an awareness of the survivor’s trauma and cultural context.

Concepts of Recovery

Varied Definitions

What constitutes ‘recovery’, or a recovery model, is a matter of ongoing debate both in theory and in practice. In general, professionalised clinical models tend to focus on improvement in particular symptoms and functions, and on the role of treatments, while consumer/survivor models tend to put more emphasis on peer support, empowerment and real-world personal experience. “Recovery from”, the medical approach, is defined by a dwindling of symptoms, whereas “recovery in”, the peer approach, may still involve symptoms, but the person feels they are gaining more control over their life. Similarly, recovery may be viewed in terms of a social model of disability rather than a medical model of disability, and there may be differences in the acceptance of diagnostic “labels” and treatments.

A review of research suggested that writers on recovery are rarely explicit about which of the various concepts they are employing. The reviewers classified the approaches they found in to broadly “rehabilitation” perspectives, which they defined as being focused on life and meaning within the context of enduring disability, and “clinical” perspectives which focused on observable remission of symptoms and restoration of functioning. From a psychiatric rehabilitation perspective, a number of additional qualities of the recovery process have been suggested, including that it: can occur without professional intervention, but requires people who believe in and stand by the person in recovery; does not depend on believing certain theories about the cause of conditions; can be said to occur even if symptoms later re-occur, but does change the frequency and duration of symptoms; requires recovery from the consequences of a psychiatric condition as well as the condition itself; is not linear but does tend to take place as a series of small steps; does not mean the person was never really psychiatrically disabled; focuses on wellness not illness, and on consumer choice.

A consensus statement on mental health recovery from US agencies, that involved some consumer input, defined recovery as a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Ten fundamental components were elucidated, all assuming that the person continues to be a “consumer” or to have a “mental disability”. Conferences have been held on the importance of the “elusive” concept from the perspectives of consumers and psychiatrists.

One approach to recovery known as the Tidal Model focuses on the continuous process of change inherent in all people, conveying the meaning of experiences through water metaphors. Crisis is seen as involving opportunity; creativity is valued; and different domains are explored such as sense of security, personal narrative and relationships. Initially developed by mental health nurses along with service users, Tidal is a particular model that has been specifically researched. Based on a discrete set of values (the Ten Commitments), it emphasizes the importance of each person’s own voice, resourcefulness and wisdom. Since 1999, projects based on the Tidal Model have been established in several countries.

For many, recovery has a political as well as personal implication – where to recover is to: find meaning; challenge prejudice (including diagnostic “labels” in some cases); perhaps to be a “bad” non-compliant patient and refuse to accept the indoctrination of the system; to reclaim a chosen life and place within society; and to validate the self. Recovery can thus be viewed as one manifestation of empowerment. Such an empowerment model may emphasize that conditions are not necessarily permanent; that other people have recovered who can be role models and share experiences; and that “symptoms” can be understood as expressions of distress related to emotions and other people. One such model from the US National Empowerment Centre proposes a number of principles of how people recover and seeks to identify the characteristics of people in recovery.

In general, recovery may be seen as more of a philosophy or attitude than a specific model, requiring fundamentally that “we regain personal power and a valued place in our communities. Sometimes we need services to support us to get there”.

Recovery from Substance Dependence

Particular kinds of recovery models have been adopted in drug rehabilitation services. While interventions in this area have tended to focus on harm reduction, particularly through substitute prescribing (or alternatively requiring total abstinence) recovery approaches have emphasised the need to simultaneously address the whole of people’s lives, and to encourage aspirations while promoting equal access and opportunities within society. From the perspective of services the work may include helping people with “developing the skills to prevent relapse into further illegal drug taking, rebuilding broken relationships or forging new ones, actively engaging in meaningful activities and taking steps to build a home and provide for themselves and their families. Milestones could be as simple as gaining weight, re-establishing relationships with friends, or building self-esteem. What is key is that recovery is sustained.”. Key to the philosophy of the recovery movement is the aim for an equal relationship between “Experts by Profession” and “Experts by Experience”.

Trauma-Informed Recovery

Trauma-Informed care is a philosophy for recovery that combines the conditions and needs of people recovering from mental illness and/or substance abuse into one framework. This framework combines all of the elements of the Recovery Approach and adds an awareness of trauma. Advocates of trauma-informed care argue the principles and strategies should be applied to individuals experiencing mental illness, substance dependence, and trauma as these three often occur simultaneously or as result of each other. The paradigms surrounding trauma-informed care began to shift in 1998 and 1999. In 1998, the Centre for Mental Health Services, the Centre for Substance Abuse Treatment, and the Centre for Substance Abuse Prevention collaborated to fund 14 sites to develop integrated services in order to address the interrelated effects of violence, mental health, and substance abuse. In 1999, the National Association of State Mental Health Programme Directors passed a resolution recognising the impact of violence and trauma and developed a toolkit of resources for the implementation of trauma services in state mental health agencies. Trauma-informed care has been supported in academia as well. Scholars claim that neglecting the role of trauma in a person’s story can interfere with recovery in the form of misdiagnosis, inaccurate treatment, or re-traumatisation. Some principles of trauma-informed care include validating survivor experiences and resiliency, aiming to increase a survivor’s control over her/his/their recovery, creating atmospheres for recovery that embody consistency and confidentiality, minimising the possibilities of triggering past trauma, and integrating survivors/recovering persons in service evaluation. In practice, trauma-informed care has shown to be most effective when every participant in a service providing context to be committed to following these principles. In addition, these principles can apply to all steps of the recovery process within a service providing context, including outreach and engagement, screening, advocacy, crisis intervention, and resource coordination. The overall goal in trauma-informed care is facilitating healing and empowerment using strengths-based empowerment practices and a comprehensive array of services that integrate co-occurring disorders and the multitude of needs a recovering person might have, such as drug treatment, housing, relationship building, and parenting support.

These approaches are in contrast to traditional care systems. Advocates of trauma-informed care critique traditional service delivery systems, such as standard hospitals, for failing to understand the role of trauma in a patients life. Traditional service delivery systems are also critiqued for isolating the conditions of a recovering person and not addressing conditions such as substance abuse and mental illness simultaneously as part of one source. Specific practices in traditional service delivery systems, such as unnecessary procedures, undressing for examinations, involuntary hospitalisations, crowded emergency rooms, and limited time for providers to meet with patients, have all been critiqued as insensitive to persons recovering from trauma and consequential mental illness or substance abuse. Limited resources and time in the United States healthcare system can make the implementation of trauma-informed care difficult.

There are other challenges to trauma-informed care besides limits in the United States healthcare system that can make trauma-informed care ineffective for treating persons recovering from mental illness or substance dependence. Advocates of trauma-informed care argue implementation requires a strong commitment from leadership in an agency to train staff members to be trauma-aware, but this training can be costly and time-consuming. “Trauma-informed care” and “trauma” also have contested definitions and can be hard to measure in a real world service setting. Another barrier to trauma-informed care is the necessity of screening for histories of trauma. While agencies need to screen for histories of trauma in order to give the best care, there can be feelings of shame and fear of being invalidated that can prevent a recovering person from disclosing their personal experiences.

Concerns

Some concerns have been raised about a recovery approach in theory and in practice. These include suggestions that it: is an old concept; only happens to very few people; represents an irresponsible fad; happens only as a result of active treatment; implies a cure; can only be implemented with new resources; adds to the burden of already stretched providers; is neither reimbursable nor evidence based; devalues the role of professional intervention; and increases providers’ exposure to risk and liability.

Other criticisms focused on practical implementation by service providers include that: the recovery model can be manipulated by officials to serve various political and financial interests including withdrawing services and pushing people out before they’re ready; that it is becoming a new orthodoxy or bandwagon that neglects the empowerment aspects and structural problems of societies and primarily represents a middle class experience; that it hides the continued dominance of a medical model; and that it potentially increases social exclusion and marginalises those who do not fit into a recovery narrative.

There have been specific tensions between recovery models and “evidence-based practice” models in the transformation of US mental health services based on the recommendations of the New Freedom Commission on Mental Health. The Commission’s emphasis on recovery has been interpreted by some critics as saying that everyone can fully recover through sheer will power and therefore as giving false hope and implicitly blaming those who may be unable to recover. However, the critics have themselves been charged with undermining consumer rights and failing to recognise that the model is intended to support a person in their personal journey rather than expecting a given outcome, and that it relates to social and political support and empowerment as well as the individual.

Various stages of resistance to recovery approaches have been identified amongst staff in traditional services, starting with “Our people are much sicker than yours. They will not be able to recover” and ending in “Our doctors will never agree to this”. However, ways to harness the energy of this perceived resistance and use it to move forward have been proposed. In addition, staff training materials have been developed by various organisations, for example by the National Empowerment Centre.

Some positives and negatives of recovery models were highlighted in a study of a community mental health service for people diagnosed with schizophrenia. It was concluded that while the approach may be a useful corrective to the usual style of case management – at least when genuinely chosen and shaped by each unique individual on the ground – serious social, institutional and personal difficulties made it essential that there be sufficient ongoing effective support with stress management and coping in daily life. Cultural biases and uncertainties were also noted in the ‘North American’ model of recovery in practice, reflecting views about the sorts of contributions and lifestyles that should be considered valuable or acceptable.

Assessment

A number of standardised questionnaires and assessments have been developed to try to assess aspects of an individual’s recovery journey. These include the:

  • Milestones of Recovery (MOR) Scale;
  • Recovery Enhancing Environment (REE) measure;
  • Recovery Measurement Tool (RMT);
  • Recovery Oriented System Indicators (ROSI) Measure;
  • Stages of Recovery Instrument (STORI); and
  • Numerous related instruments.

The data-collection systems and terminology used by services and funders are said to be typically incompatible with recovery frameworks, so methods of adapting them have been developed. It has also been argued that the Diagnostic and Statistical Manual of Mental Disorders – in reference to the then DSM-IV – (and to some extent any system of categorical classification of mental disorders) uses definitions and terminology that are inconsistent with a recovery model, leading to suggestions that the next version, the DSM-V, requires: greater sensitivity to cultural issues and gender; to recognise the need for others to change as well as just those singled out for a diagnosis of disorder; and to adopt a dimensional approach to assessment that better captures individuality and does not erroneously imply excess psychopathology or chronicity.

National Policies and Implementation

United States and Canada

The New Freedom Commission on Mental Health has proposed to transform the mental health system in the US by shifting the paradigm of care from traditional medical psychiatric treatment toward the concept of recovery, and the American Psychiatric Association has endorsed a recovery model from a psychiatric services perspective.

The US Department of Health and Human Services reports developing national and state initiatives to empower consumers and support recovery, with specific committees planning to launch nationwide pro-recovery, anti-stigma education campaigns; develop and synthesize recovery policies; train consumers in carrying out evaluations of mental health systems; and help further the development of peer-run services. Mental Health service directors and planners are providing guidance to help state services implement recovery approaches.

Some US states, such as California (see the California Mental Health Services Act), Wisconsin and Ohio, already report redesigning their mental health systems to stress recovery model values like hope, healing, empowerment, social connectedness, human rights, and recovery-oriented services.

At least some parts of the Canadian Mental Health Association, such as the Ontario region, have adopted recovery as a guiding principle for reforming and developing the mental health system.

New Zealand and Australia

Since 1998, all mental health services in New Zealand have been required by government policy to use a recovery approach and mental health professionals are expected to demonstrate competence in the recovery model. Australia’s National Mental Health Plan 2003-2008 stated that services should adopt a recovery orientation although there is variation between Australian states and territories in the level of knowledge, commitment and implementation.

UK and Ireland

In 2005, the National Institute for Mental Health in England (NIMHE) endorsed a recovery model as a possible guiding principle of mental health service provision and public education. The National Health Service (NHS) is implementing a recovery approach in at least some regions, and has developed a new professional role of Support Time and Recovery Worker. Centre for Mental Health issued a 2008 policy paper proposing that the recovery approach is an idea “whose time has come” and, in partnership with the NHS Confederation Mental Health Network, and support and funding from the Department of Health, manages the Implementing Recovery through Organisational Change (ImROC) nationwide project that aims to put recovery at the heart of mental health services in the UK. The Scottish Executive has included the promotion and support of recovery as one of its four key mental health aims and funded a Scottish Recovery Network (SRN) to facilitate this. A 2006 review of nursing in Scotland recommended a recovery approach as the model for mental health nursing care and intervention. The Mental Health Commission of Ireland reports that its guiding documents place the service user at the core and emphasize an individual’s personal journey towards recovery.

Complementary Medicine & Integrative Health Approaches to Trauma Therapy & Recovery

Research Paper Title

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

Abstract

The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years.

According to the National Centre for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing.

Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020).

For the purpose of this special issue, the researchers use the NCCIH’s definition of CIH as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients’ preference is possibly due to providers’ lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017).

Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients’ nondisclosure of the use of these therapies. Patients’ fear of disclosure due to perceived scepticism or disapproval from their provider was frequently attributed as a cause of patients’ nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012).

The arrival of patient-centred care models is beginning to shift the ways we understand the patient’s role in treatment engagement. Patient-centred approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019).

The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient’s cultural beliefs, or what Kleinman called the “explanatory belief model” (Kleinman, 1978)- for example, by “aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice” (APA, 2019, p. 24).

Reference

Mattar, S. & Frewenm P.A. (2020) Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery. Psychological Trauma. 12(8):821-824. doi: 10.1037/tra0000994.

Creativity & its Role in the Treatment & Recovery of those with Mental Disorders

Research Paper Title

Creativity, mental disorders and their treatment: recovery-oriented psychopharmacotherapy.

Background

This paper discusses interrelations between creativity, mental disorders and their treatment.

The psychology of creativity is very important for successful psychopharmacotherapy, but our knowledge about creativity is still insufficient.

Even that which is known is not within the armamentarium of most practicing psychiatrists.

  • In the first part of this article creativity and possible associations between creativity, mental health, and well-being are described.
  • The second part deals with the intriguing relationship between creativity and mental disorders.
  • The third part emphasizes the role of creativity in the treatment of mental disorders.

This paper ends by underlining the importance of a creativity-enhancing oriented, and personal recovery-focused psychopharmacotherapy in helping psychiatric patients achieve fulfilled and purposeful lives.

Reference

Jakovljevic, M. (2020) Creativity, mental disorders and their treatment: recovery-oriented psychopharmacotherapy. Psychiatria Danubina. 25(3), pp.311-315.

Book: Recovery of People with Mental Illness

Book Title:

Recovery of People with Mental Illness: Philosophical and Related Perspectives.

Author(s): Abraham Rudnick.

Year: 2012.

Edition: First (1st).

Publisher: Oxford University Press.

Type(s): Paperback and EPUB.

Synopsis:

It is only in the past 20 years that the concept of ‘recovery’ from mental health has been more widely considered and researched.

Before then, it was generally considered that ‘stability’ was the best that anyone suffering from a mental disorder could hope for. But now it is recognised that, throughout their mental illness, many patients develop new beliefs, feelings, values, attitudes, and ways of dealing with their disorder. The notion of recovery from mental illness is thus rapidly being accepted and is inserting more hope into mainstream psychiatry and other parts of the mental health care system around the world.

Yet, in spite of conceptual and other challenges that this notion raises, including a variety of interpretations, there is scarcely any systematic philosophical discussion of it. This book is unique in addressing philosophical issues – including conceptual challenges and opportunities – raised by the notion of recovery of people with mental illness. Such recovery – particularly in relation to serious mental illness such as schizophrenia – is often not about cure and can mean different things to different people.

For example, it can mean symptom alleviation, ability to work, or the striving toward mental well-being (with or without symptoms).

The book addresses these different meanings and their philosophical grounds, bringing to the fore perspectives of people with mental illness and their families as well as perspectives of philosophers, mental health care providers and researchers, among others.

The important new work will contribute to further research, reflective practice and policy making in relation to the recovery of people with mental illness.It is essential reading for philosophers of health, psychiatrists, and other mental care providers, as well as policy makers.

Book: Integrated Group Therapy for Bipolar Disorder and Substance Abuse

Book Title:

Integrated Group Therapy for Bipolar Disorder and Substance Abuse.

Author(s): Roger D. Weiss and Hilary S. Connery.

Year: 2011.

Edition: First (1st).

Publisher: Guildford Press.

Type(s): Paperback and Kindle.

Synopsis:

Packed with practical clinical tools, this book presents an empirically supported treatment expressly designed for clients with both bipolar disorder and substance use disorders. Integrated group therapy teaches essential recovery behaviours and relapse prevention skills that apply to both illnesses.

The volume provides a complete session-by-session overview of the approach, including clear guidelines for setting up and running groups, implementing the cognitive-behavioral treatment techniques, and troubleshooting frequently encountered problems.

In a large-size format for easy reference and photocopying, the book features more than 30 reproducible handouts, forms, and bulletin board materials.

Book: Molecular Neurobiology of Addiction Recovery

Book Title:

Molecular Neurobiology of Addiction Recovery: The 12 Steps Program and Fellowship (SpringerBriefs in Neuroscience).

Author(s): Kenneth Blum, John Femino, Scott Teitelbaum, John Giordano, Marlene Oscar-Berman, and Mark Gold.

Year: 2013.

Edition: First (1st).

Publisher: Springer.

Type(s): Paperback and Kindle.

Synopsis:

Since Alcoholics Anonymous was founded in 1935, its 12 step programme of spiritual and character development has helped individuals overcome addiction.

This book takes a systematic look at the molecular neurobiology associated with each of the 12 steps.

Recovery-focused Services

Learning directly from people’s experience of recovery can offer new and different approaches to the way mental health services are offered.

This is sometimes referred to as developing ‘recovery-focused’ or ‘recovery-orientated’ services.

There are many initiatives in the United Kingdom (UK), and around the world, which are designed to ensure that services are developed incorporating the principles of recovery.

UK initiatives include work to introduce recovery indicators and to promote self-management tools, such as Wellness Recovery Action Planning and the introduction of new training for the mental health workforce.

The Scottish Recovery Network

The Scottish Recovery Network (SRN) has been working since 2004 to:

  • Raise awareness of recovery;
  • Develop a better understanding of the factors which help and hinder recovery; and
  • Build capacity for recovery by sharing information and supporting efforts to promote recovery.

A major part of the initial work of the SRN involved a large-scale narrative research project. As part of this project, 64 people from Scotland, who described themselves as in recovery, or having recovered from a long-term mental health problem, were interviewed.

Key findings from that research include:

  • The importance of having a positive identity focused on wellness, strengths, and recovery.
  • The need to be involved in activities which provide meaning and purpose, and to pace and control that involvement. Such activities included volunteering, paid employment, and creativity.
  • The importance of relationships based on hope, belief, and trust.
  • The need for easy access to services and treatments that are focused on recovery.

Many people described the importance of believing in the possibility of recovery. They described how taking a more optimistic approach to their illness created hope, a feeling of self-worth, and confidence. It helped them create a new identity as a person who was in recovery.

It is rare for anyone to return to the way they were before a major life event. Our experiences change us, and it is often true that people who have experienced serious and distressing life events say that in the longer term they have grown and developed through them. This is part of the recovery message. People who have had a diagnosis of serious mental health problems often report that embarking on the journey of recovery and finding ways to live fulfilling lives has enabled them to grow. Another similarly strong theme was focused around being in control and making choices.

Learning about recovery helps a mental health first-aider recognise the importance of relating to a person who is in distress or unwell as more than just an immediate crisis to be dealt with. We can help the process of recovery by speaking to the person with respect rather than talking down to them, and also to speak with hope and reassurance.

Learning about recovery can also help protect us from becoming unwell. Understanding what helps us recover is a good basis for helping our own and others’ mental health.