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Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 2 Practitioner Guidelines for Handout #1:
Recovery Strategies
Introduction
This module sets a positive and optimistic tone that is continued throughout
the Illness Management and Recovery Program. It conveys confidence that people
who experience psychiatric symptoms can move forward in their lives. It introduces
the concept of “recovery” and encourages people to develop their
own definitions of recovery and to develop personal strategies for taking steps
towards recovery. In this module, practitioners help people to establish personally
meaningful goals which will be followed up throughout the program.
Goals
- Instill hope that the person can accomplish important personal
goals.
- Help the person identify and put into practice some strategies
that will help him or her make progress towards recovery.
- Help the person identify goals that are important to him
or her.
- Help the person develop a specific plan for achieving one
or two personal goals.
Number and Pacing of Sessions
“Recovery Strategies” can usually be covered in two to four sessions.
Within each session, most people find that covering one or two topics and completing
a questionnaire is a comfortable amount.
Structure of Sessions
- Informal socializing and identification of any major problems.
- Review the previous session.
- Discuss the homework from the previous session. Praise
all efforts and problem-solve obstacles to completing homework.
- Set goals or follow-up on goals.
- Set the agenda for the current session.
- Teach new material (or review material from the previous
session if necessary).
- Summarize progress made in the current session.
- Agree on homework to be completed before the next session.
Strategies to be used in each session
Motivational strategies
Motivational strategies in this module focus on helping the person identify
the benefits of moving towards recovery and on helping the person develop the
confidence that he or she can achieve recovery goals.
- Some people immediately embrace the concept of recovery.
Others are more hesitant and need to be encouraged that pursuing recovery
is worth the effort. Help the person identify some of the personal benefits
of engaging in recovery. Help the person evaluate the advantages and disadvantages
of keeping things the way they are, and the advantages and disadvantages of
changing.
- To increase the person’s confidence about pursuing
recovery goals, encourage him or her to talk about past accomplishments. Keep
in mind that these accomplishments need not be major events, such as awards
or promotions, but can be smaller achievements, such as doing household tasks,
being a good parent, graduating high school, having knowledge about certain
subjects, managing money well, and taking care of one’s health.
- Some people may need help in “re-framing” past
challenges in order to see that the strategies they used to cope with these
difficulties reflect personal strength.
- Acknowledge past problems or disappointments, and express
empathy, but help the person focus on the future and what he or she might
accomplish.
- Help the person to identify goals that are personally meaningful
and worth striving for. These goals can be short-term or long-term, rudimentary
or ambitious.
- Help the person break down goals into manageable steps
that can be accomplished and which will give the person a sense of progress.
Let people know that you will help them make progress towards their goals
throughout the program.
Educational strategies
Educational strategies for this module focus on helping the person learn about
recovery and become familiar with strategies that may help him or her make progress
towards recovery goals.
- Review the contents of the handout, summarizing the main
points or taking turns reading paragraphs. Encourage discussion of the material
in order to help the person identify what’s important to him or her.
- Pause at the end of each topic (or more frequently depending
on the person) to check for understanding and to learn more about the person’s
point of view. There are questions provided for this purpose at the end of
almost every topic in the handout. You can ask other questions such as:
- “What did you think of that section?” “What
would you say is the main point of the section we just read?”
- “Was there anything in this section you disagree
with?”
- “Was this similar to your own experience?”
- “Do you have any comments about what we just read?”
- “What did you think of the examples? Which examples
had the most meaning to you?”
- “Can you think of an example from your own experience
about what we just read?”
- Allow plenty of time for interaction. Make the communication
a two-way street. You are both learning something from each other about the
topic. It is important not to ask questions too quickly, which the person
may experience as an “interrogation.”
- Pause to allow the person to complete the checklists and
questionnaires and allow time for discussing them. Some people need no help
in completing them. Others may appreciate assistance, such as reading words,
spelling, or writing some of their answers.
- Break down the content into manageable “pieces.”
It is important not to cover more than the individual can absorb and to present
information in small “chunks” at a comfortable pace.
Cognitive-behavioral strategies
Cognitive-behavioral strategies focus on helping people learn how to use the
information in this module to think more positively about themselves and to
actively pursue personal recovery goals.
- Using the checklist “Strategies for Recovery,”
help the person identify a strategy that will help him or her in recovery.
- After the strategy is identified, help the person decide
how he or she might use that strategy, and if possible, help the person practice
the strategy in the session. Modeling (demonstrating) strategies and engaging
the person in role-plays (behavioral rehearsal) to practice strategies is
very helpful. For example, if a person wanted to improve his or her social
support network, you could set up a role play where the person could practice
what he or she might say in a phone call inviting a friend to do something
together. You could offer to pretend to be the friend who is receiving the
call.
- Using the “Satisfaction with Areas of My Life”
checklist, help the person identify a goal in an area that he or she is not
satisfied with.
- Using the “Step-by-Step Problem-Solving and Goal
Achievement“ sheet, you can help the person develop a plan for achieving
one or two of their goals.
- Help the person practice one or more of the steps of the
plan they developed on their “Step-by-Step Problem-Solving and Goal
Achievement” sheet.” For example, if a person identified the goal
of pursuing a part-time job, one of the steps of the plan might be to contact
the Office of Vocational Rehabilitation or the Supported Employment specialist.
You could help him or her do a role-play of an interview about their job interests
(e.g., answering common interview questions and describing the kinds of jobs
he or she might be interested in).
- Help the person identify and practice a strategy for overcoming
obstacles to achieving his or her goal. For example, if the person identified
that he or she would like to go to the local peer support center, you could
do a role-play on how to start a conversation with someone there.
Homework
- At the end of each session of this module, help the person
identify something he or she can do before the next session to review or follow
p on the information or skills that were just covered. Sometimes the homework
will involve furthering their knowledge or understanding, such as reviewing
a section of the handout or completing a questionnaire. Sometimes the homework
will involve practicing or using a strategy they developed.
- When homework involves practicing a strategy, it is very
helpful for the person to make a specific plan for how that will be accomplished.
The more the practical the plan, the better. For example, if the person identified
that he or she would like to practice the strategy of exercising regularly,
help make a plan about what type of exercise, how many minutes, what days
of the week, what time of day, and how to overcome anticipated obstacles.
This plan could be written down on a Step-by-step problem-solving and goal
achievement sheet (see the blank copy of this sheet in the “Recovery
Strategies” handout).
- Help the person do some troubleshooting regarding what obstacles
might interfere with completing the homework. This gives the person some options
and helps him or her avoid becoming distressed.
- When possible, encourage homework that involves family members
and other supportive people. For example, if the person is working on the
goal of exercising more regularly, the homework might be to invite a family
member or another supportive person to go for a walk once a week.
Follow up on each homework assignment by asking how it went. Praise the person
for his or her efforts and accomplishments on the homework. Explore the following
questions: What was the person able to do? What was the person not able to
do? What might the person do differently in the future to follow through
with homework?
- If the person does not do the homework, you can help identify
obstacles that he or she may have encountered, and help problem-solve ways
that these obstacles can be overcome. For example, if the homework assignment
was to attend a support group meeting and the person did not have transportation,
you could help identify a bus or subway that the person could take to the
meeting.
- If the person did not complete the homework because the
assignment was unrealistic, you can help him or her to modify the assignment
to be more achievable. For example, if the homework is to attend a support
group meeting, but the person is very apprehensive about being with people
he doesn’t know, a better assignment might be to start by calling up
the contact person for the support group and asking a few questions.
The following examples of homework may be helpful:
- The person might formulate his or her own definition of
recovery and write it down before the next meeting.
- After the person has completed the “Strategies for
Recovery” checklist, he or she might pick one strategy to try. For example,
if he or she is interested in creative expression, homework might include
sketching in a notebook every other day.
- A person might ask a family member or other supportive
person to participate in a recovery strategy. For example, if the person would
like to play chess again as a leisure activity, he or she could ask a sibling
to play chess at least once during the week.
- If the person is still in the process of completing the
step-by-step problem-solving and goal achievement sheet during the session,
he or she might complete one of the planning steps before the next session.
For example, for Step 3, he or she could list the advantages and disadvantages
for at least one of the options identified in Step 2.
- If the person has completed the step-by-step problem-solving
and goal achievement sheet, he or she might begin to carry out at least one
of the steps in the plan. For example, if the goal is to join a support group,
the plan might include the step of contacting the local peer support organization
to find out about the schedule of their groups.
- The person might review the section in the handout containing
examples of people in recovery, and underline the parts that he or she found
especially relevant. Or the person might discuss the recovery examples with
a family member or other supportive person.
- The person could complete the chart at the end of the module
(“What reminders, guidelines or suggestions to yourself will help you
most in pursuing your recovery goals?”)
Tips for common problems
People may be reluctant to talk about recovery.
Some people have been told, “You’ll never get better,” or
“You’ll have to give up your goals,” “You should never
have children,” or “You can’t work.” These messages
are discouraging, and often result in people developing very low expectations
for themselves. The notion that recovery is possible may not be consistent with
the person’s self-concept of feeling like “a failure.” The
practitioner may need to help the person challenge this view.
Explore what the person has heard from others and what he or she believes
about recovery. Suggest alternative ways of looking at the future. If a person
says, “When I first had symptoms they told me to give up on school,”
you could say, “I’m sorry someone told you that. They may have meant
well, but it is not true that people should give up their goals. People with
mental illness have skills and abilities they can use to accomplish personal
goals in their lives.”
If the person dwells on past setbacks and disappointments, gently re-direct
him or her to think about the future. Express empathy, but do not remain focused
on the past. For example, if a person frequently talks about how he or she lost
several jobs after becoming ill, you could say, “That must have been very
difficult for you. Although you’ve had some setbacks, it doesn’t
have to be like that in the future. Let’s talk about what might work better
this time.”
People may find it difficult to identify goals.
Before talking about goals, it may be helpful to know more about what the
person’s life is like. The person may have provided substantial information
when they completed the Knowledge and Skills Inventory, at the beginning of
the program. You can also ask questions such as the following:
- Where do you live? Do you like the place you’re living?
- With whom do you spend time? Is there anyone you would like to spend more
time with?
- What is a typical day like for you? Is there anything you would rather
be doing?
It can also be helpful to discuss what the person’s goals were before
he or she became ill, asking questions such as:
- When you were younger, what did you imagine yourself doing when you grew
up?
- What types of things did you used to enjoy doing?
- Did you want to go further in school?
- What were your dreams and hopes for your life?
Depending on the person’s answers, you might be able to talk about what
the person would like to pursue. For example, if someone says he or she wanted
to be a veterinarian, you could ask if they are still interested in animals,
and explore whether they might be interested in a part-time job at a veterinary
clinic or an
animal shelter.
People may identify very ambitious goals.
If people identify very ambitious goals, it is important not to discourage
their hopes. Instead, it is preferable to help them break down goals into a
series of smaller steps and to work towards those steps, using a “shaping”
approach. For example, if a person with a very limited budget says he would
like to go on a 6-week vacation to the Riviera, you might explore the options
of more local trips to a relaxing place, such as a local beach, a lake or even
a pleasant park. Or you might begin to explore with the person how he or she
could begin saving money towards the goal of taking a vacation.
Review Questions
At the end of the module, it is helpful to assess how well the person understands
the main points. You can use the following types of questions (open-ended questions
or multiple choice).
Open-ended questions
- What does the word “recovery” mean to you?
- What helps you feel confident or optimistic about the future?
- What are some goals you would like to achieve?
- What advice would you give to someone with a mental illness
who is discouraged about recovery?
Multiple choice and true/false questions
- When people have a mental illness they cannot accomplish
important goals in their lives. True or False
- One strategy for moving forward in recovery is:
- Focusing on past mistakes
- Giving up all leisure and recreation activities
- Developing a support system
- One helpful strategy for achieving goals is:
- Make a step-by-step plan
- Leave it to chance
- Tackle everything at once
- If someone wanted to get involved in a hobby that
they used to enjoy, what would be good advice?
- Don’t do it
- Try it out, starting with small activities
- Throw yourself into it full force
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