Skip to main content

Advertisement

Log in

Community Mental Health Care Providers’ Understanding of Recovery Principles and Accounts of Directiveness with Consumers

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

The present qualitative study examined community mental health providers’ accounts of their therapeutic interactions with adults with serious mental illness in a recovery-oriented model of care. Ten long-time mental health care providers discussed their understanding of recovery principles, their use of directive practices, and factors that shape their work with consumers. Content analysis of mental health providers’ accounts suggest that providers had no difficulty articulating basic principles of recovery-oriented care. Providers reported engaging in directive practices with consumers and described using traditional clinical factors such as level of functioning, degree of psychiatric symptoms, safety concerns, and legal status to assess consumers’ ability for autonomous decision making. Providers generally did not express tension between their views of mental health recovery and their beliefs about utilizing directive approaches with consumers. Implications of present findings for research and practice are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Alverson, H.S., Drake, R.E., Carpenter-Song, E.A., Chu, E., Ritsema, M. & Smith, B. (2007). Ethnocultural variations in mental illness discourse: Some implications for building therapeutic alliances. Psychiatric Services, 58, 1541–1546. doi:10.1176/appi.ps.58.12.1541

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  3. Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: Towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586–594. doi:10.1046/j.1440-1614.2003.01234.x

    Article  PubMed  Google Scholar 

  4. Andresen, R, Caputi, P & Oades, L (2010). Do clinical outcome measures assess consumer-defined recovery? Psychiatry Research, 177, 309–317. doi:10.1016/j.psychres.2010.02.013

    Article  PubMed  Google Scholar 

  5. Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990’s. Psychosocial Rehabilitation Journal, 16, 12–23.

    Google Scholar 

  6. Beutler, L.E., Rocco, F., Moleiro, C. M., & Talebi, H. (2001). Resistance. Psychotherapy, 38, 431–436.

    Article  Google Scholar 

  7. Bischoff, M.M., & Tracey, J. J. (1995). Client resistance as predicted by therapist behavior: A study of sequential dependence. Counseling Psychology, 42, 487–495. doi:10.1037/0022-0167.42.4.487

    Article  Google Scholar 

  8. Borkman, T.J. (1998). Is recovery planning any different from treatment planning? Journal of Substance Abuse Treatment, 15, 37–42.

    Article  CAS  PubMed  Google Scholar 

  9. Casterlé, B., Gastmans, C., Bryon, E., & Denier, Y. (2012). QUAGOL: A guide for qualitative data analysis. International Journal of Nursing Studies, 49, 360–371. doi:10.1016/j.ijnurstu.2011.09.012

    Article  Google Scholar 

  10. Cook, J.A., & Jonikas, J.A. (2002). Self-determination among mental health consumers/survivors: Using lessons from the past to guide the future. Journal of Disability Policy Studies, 13, 87–95.

    Article  Google Scholar 

  11. Corrigan, P.W., Angell, B., Davidson, L., Marcus, S.C., Salzer, M.S., Kottsieper, P., Larson, J.E., Mahoney, C.A., O’Connell, M.J., & Stanhope, V. (2012). From adherence to self-determination: Evolution of a treatment paradigm for people with serious mental illness. Psychiatric Services, 63, 169–173. doi:10.1176/appi.ps.201100065

    Article  PubMed  Google Scholar 

  12. Davis, S. (2002). Autonomy versus coercion: Reconciling competing perspectives in community mental health. Community Mental Health Journal, 38, 239–259. doi:10.1023/A:1015267707856

    Article  PubMed  Google Scholar 

  13. Deegan, P.E. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19, 91–97.

    Article  Google Scholar 

  14. Drake, R.E., & Deegan, P.E. (2008). Are assertive community treatment and recovery compatible? Commentary on ACT and Recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 44, 75–77. doi:10.1007/s10597-007-9120-9

    Article  PubMed  Google Scholar 

  15. Farkas, M., Gagne, C., Anthony, W.A., & Chamberlin, J. (2005). Implementing recovery-oriented evidence-based programs: identifying the critical dimensions. Community Mental Health Journal, 41, 141–158. doi:10.1007/s10597-005-2649-6

    Article  PubMed  Google Scholar 

  16. Green, C.A., Polen, M.R., Janoff, S.L., Castleton, D.K., Wisdom, J.P., Vuckovic, N., Perrin, N.A., Paulson, R.I., & Oken, S.L. (2008). Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness STARS study results. Psychiatric Rehabilitation Journal, 32, 9–22. doi:10.2975/32.1.2008.9.22

    Article  PubMed  PubMed Central  Google Scholar 

  17. Healy, T.C. (2008). Levels of directiveness: A contextual analysis. Social Work in Health Care, 40, 71–91. doi:10.1300/J010v40n01_05

    Article  Google Scholar 

  18. Karno, M.P., & Longabaugh, R. (2005). Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment. Journal of Consulting and Clinical Psychology, 73, 262–267. doi:10.1037/0022-006X.70.5.1161

    Article  PubMed  Google Scholar 

  19. Lysaker, P.H., & Buck, K.D. (2008). Is recovery from schizophrenia possible? An overview of concepts, evidence, and clinical implications. Clinical Focus, 15, 60–65.

    Google Scholar 

  20. McCann, T.V., & Clark, E. (2004). Advancing self-determination with young adults who have schizophrenia. Journal of Psychiatric and Mental Health Nursing, 11, 12–20. doi:10.1111/j.1365-2850.2004.00645.x

    Article  CAS  PubMed  Google Scholar 

  21. Miles, M. & Huberman, A. (1994). Qualitative data analysis: An expanded sourcebook, 2nd Edition. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  22. Monahan, J., Redlich, A.D., Swanson, J., Robbins, P.C., Appelbaum, P.S., Petrila, J., Steadman, H.J., Swartz, M.S., Angell, B., & McNiel, D.E. (2005). Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services, 56, 37–44. doi:10.1176/appi.ps.56.1.37

    Article  PubMed  Google Scholar 

  23. Muir-Cochrane, E., Gerace, A., Mosel, K., O’Kane, D., & Barkway, P. (2011). Managing risk: Clinical decision-making in mental health services. Issues in Mental Health Nursing, 32, 726–734.

    Article  PubMed  Google Scholar 

  24. Ning L. (2010). Buidling a ‘user driven’ mental health system. Advances in Mental Health, 9, 112–115.

    Article  Google Scholar 

  25. Oades, L., Deane, F., Crowe, T., Lambert, G.W., Kavanagh, D., & Lloyd, C. (2005). Collaborative recovery: An integrative model for working with individuals who experience chronic and recurring mental illness. Australian Psychiatry, 13, 279–284.

    Google Scholar 

  26. O’Connell, M., Tondor, J., Croog, G., Evans, A., & Davidson, L. (2005). From rhetoric to routine: Assessing perceptions of recovery-oriented practices in a state mental health and addictions system. Psychiatric Rehabilitation Journal, 28, 378–386. doi:10.2975/28.2005.378.386

    Article  PubMed  Google Scholar 

  27. Osborn, L.A., & Stein, C.H. (2016). Mental Health Care Providers’ Views of Their Work with Consumers and Their Reports of Recovery-Orientation, Job Satisfaction, and Personal Growth. Community Mental Health Journal, 52, 757–766. doi:10.1007/s10597-015-9927-8

  28. Peebles, S. A., Mabe, P. A., Davidson, L., Fricks, L., Buckley, P. F., & Fenley, G. (2007). Recovery and systems transformation for Schizophrenia. Psychiatric Clinics of North America, 30, 567–583. doi:10.1016/j.psc.2007.04.009

    Article  PubMed  Google Scholar 

  29. Randal, P., Stewart, M.W., Proverbs, D., Lampshire, D., Symes, J., & Hamer, H. (2009). “The Re-covery Model” - An integrative developmental stress-vulnerability-strengths approach to mental health. Psychosis, 1, 122–133. doi:10.1080/17522430902948167

    Article  Google Scholar 

  30. Rodgers, M.L., Norell, D.M., Roll, J.M., & Dyck, D.G. (2007). An overview of mental health recovery. Primary Psychiatry, 14, 76–85.

    Google Scholar 

  31. SAMHSA: Recovery and Recovery Support (2015, October 5) Retrieved from http://www.samhsa.gov/recovery

  32. Sawyer, A. (2008). Risk and new exclusions in community mental health practice. Australian Social Work, 61, 327–341.

    Article  Google Scholar 

  33. Sheehan, K.A., & Burns, T. (2011). Perceived coercion and the therapeutic relationship: A neglected association? Psychiatric Services, 62, 471–476. doi:10.1176/appi.ps.62.5.471

    Article  PubMed  Google Scholar 

  34. Seale, C., Chaplin, R., Lelliott, P., & Quirk, A. (2006). Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences. Social Science & Medicine, 62, 2861–2873. doi:10.1016/j.socscimed.2005.11.002

    Article  Google Scholar 

  35. Sowers, W. (2005). Transforming systems of care: The American Association of Community Psychiatrists Guidelines for recovery oriented services. Community Mental Health Journal, 41, 757–774. doi:10.1007/s10597-005-6433-4

    Article  PubMed  Google Scholar 

  36. Stein, C.H., & Mankowski, E.S. (2004). Asking, witnessing, interpreting, knowing: Conducting qualitative research in community psychology. American Journal of Community Psychology, 33, 21–35.

    Article  PubMed  Google Scholar 

  37. Swanson, J.W., Swartz, M.S., Elbogen, E.B., Van Dorn, R.A., Wagner, R. Moser, L.A., Wilder, C., & Gilbert, A.R. (2008). Psychiatric advance directives and reduction of coercive crises interventions. Journal of Mental Health, 17, 255–267.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29, 311–314.

    Article  PubMed  Google Scholar 

  39. Wancheck, T. (2012). Reducing mental health civil commitments through longer temporary detention Periods. Developments in Mental Health Law, 30, 1–15.

    Google Scholar 

  40. Wason, P.C. (1968). Reasoning about a rule. Quarterly Journal of Experimental Psychology, 20, 273–281.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lawrence A. Osborn.

Ethics declarations

Conflict of Interest

Dr. Osborn declares that he has no conflict of interest.

Dr. Stein declares that she has no conflict of interest.

Research Involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Osborn, L.A., Stein, C.H. Community Mental Health Care Providers’ Understanding of Recovery Principles and Accounts of Directiveness with Consumers. Psychiatr Q 88, 755–767 (2017). https://doi.org/10.1007/s11126-017-9495-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-017-9495-x

Keywords

Navigation