To date, recovery has mostly been a long-term, hit-or-miss process. Yet there is no reason to believe that we cannot foster and nurture it, speeding people towards more and longer periods of well-being and satisfaction. The question is, how
? Researchers, practitioners, and consumers are beginning to identify many of the important elements of the recovery process (American Psychiatric Association, 1994b
; Davidson & Strauss, 1995
; Deegan, 1988
; Fisher, 1994
; Harrison et al., 2001
; Lehman & Steinwachs, 1998
; Liberman et al., 2002
; Onken et al., 2003
). But how and, perhaps more importantly, when
, do we address these elements, and how do we intervene to increase positive and reduce negative cascades of events?
Answers to these questions must now become one of the critical tasks for those working to understand and foster recovery. If we conceive of recovery as a developmental process, the focus of treatment and research changes from that of solely identifying interventions and techniques that promote recovery generally (e.g., evidence-based practices) to how to collaborate with mental health care consumers so that they can direct their own care, and how to appropriately time approaches to collaboration, interventions, and services. In these ways, we can target our energies to produce the utmost benefit for the greatest number of people, while fostering, within individuals, the capacity to take advantage of all the possibilities for promoting recovery that come their way.
Toward this end, much can be gained by drawing on the work of other traditions. For example, motivational interviewing (Miller & Rollnick, 1991
) is, at its core, a method for fostering hope and optimism for behavior change and, correspondingly, agency and control. Work from the field of health promotion can provide frameworks for understanding where an individual is situated with respect to readiness for a particular change, as well as suggestions for how to facilitate increased readiness and, finally, the change itself (Prochaska et al., 1994
). Developmental psychology and life-course studies can help us to identify normal developmental tasks that may have been delayed or disrupted by the onset of mental illness or its acute flare-ups, and suggest appropriate remediation, necessary prerequisites, and timing for specific interventions. Cognitive behavioral therapy techniques may be helpful in fostering optimism (Peterson, 2000
), and should also have applicability in promoting agency.
I cannot emphasize enough, however, the importance of involving consumers in assessments of their own lives, treatment process, and recovery, and to do so from the beginning, in global terms, with regard to specific domains, and to the greatest extent possible. Some argue that evidenced-based, technical approaches to treatment are most appropriate and effective for individuals severely affected by their mental health problems, and that person-directed approaches are more appropriate as individuals progress toward recovery (Frese et al., 2001
). Such transitional approaches, besides not having been evaluated for effectiveness, appear to conflict with the need to develop agency and control very early in the recovery process. More importantly, consumers may desire an entirely different process. It is time to address these questions empirically, learn what consumers of mental health care prefer and find most helpful, and find common ground among all stakeholders.
Finally, I do not believe that it is possible to foster recovery with a paternalistic attitude or approach. To the extent that clinicians want to be a part of the recovery process, they should be involved as caring, hopeful, collaborators and team members, rather than as (even benevolent) dictators of that process. One of our research participants described his much-loved psychiatrist as “like a brother to me.” A brotherly relationship is characterized by closeness, caring, common experience, and equality—we can learn a great deal from this simple statement.