In November, I'll begin a blog series called "The Working Life." Dr. Paul Ballas, an expert here, quoted statistics that indicate up to 75 percent of people diagnosed with SZ want to obtain work. In next week's first blog entry, I'll talk about the results of a longitudinal study of peers who are employed. Today I'll tackle the kinds of competencies that are prerequisites for living successfully with the SZ and finding work or achieving other goals.
In 1999-nearly 10 years ago-Zlatka Russinova, a lead researcher at Boston University where the study later took place, identified "Providers' Hope-Inspiring Competence as a Factor Optimizing Psychiatric Rehabilitation" in her article of that title in the Journal of Rehabilitation. She examined the role of hope in the process of recovery of people who have psychiatric disabilities.
According to Russinova, "Practitioners' ability to inspire and maintain hope in clients with psychiatric disabilities is viewed as playing a central role in providing the motivational resources necessary for the recovery process to occur." The notion of recovery has been the vital core of the peer self-help movement since the 1990s.
For too long, it was thought that those of us living with serious and persistent mental illnesses were unable to recover, and this dim view was held by too many psychiatrists whose despair about treatment outcomes reinforced their clients' sense of hopelessness. The strengths perspective and the empowerment perspective have begun to edge out the deficit model which for decades was the treatment norm.
Thus, "The focus of service delivery changes from treating the disorder to treating the whole person, as the development of the person's strengths allows him to overcome the limitations of illness and to recovery." It truly is a tango if you will-a choreographed relationship between the professional, such as a psychiatrist or therapist, and the patient.
Peers and practitioners increasingly acknowledge the importance of hope as a prime catalyst in the recovery process. What is hope, exactly? Quite simply, it's the overall perception that goals can be met.
My humble take on hope is that it's the driving force that compels you to see tomorrow as a better day; it's an optimistic outlook that anyone can adopt regardless of his or her circumstances. Hope has nothing to do with how hard your struggle is; you can be hopeful even in the most dire straits. In this regard, hope almost isn't rational.
However you define hope, one thing is clear: it requires you have a person you can trust even when you don't believe in yourself. When you have someone in your corner, you're able to internalize his confidence in you and see recovery as possible. After receiving the diagnosis of schizophrenia, I had two people cheering me on: Aldo, a therapist I saw once a week, and Dr. Cruz, a psychiatrist who was more of a friend than a professional, and always felt I could eventually return to work. It would've been harder to believe I could recover if I didn't have these allies early on.
Unfortunately, untold numbers of peers' initial contact with mental health professionals leave them feeling hopeless and they despair of ever getting better. Deegan, an advocate, calls this "spirit-breaking" and it is one of the reasons too many of us adopt learned helplessness as a coping mechanism. Not being able to care for ourselves or envision a way out of our problems is a barrier to recovery.
In here, I often urge everyone to research at least three psychiatrists or therapists, see each one for a trial session, and only then choose "the one"-just like you're considering a marriage. You're going to be with this person "in sickness and in health," and "for better or worse," and you want someone who's not going to throw in the towel when the going gets tough.
Russinova identified these dimensions of practitioners' hope-inspiring competence:
• Beliefs about the potential for recovery [better future outcomes] from a disabling mental illness.
• Capacity to tolerate uncertainty regarding future outcomes from a disabling mental illness.
• Motivation of the practitioner for promoting better outcomes for people with a disabling mental illness, and
• Hope-inspiring resourcefulness of the provider.
She further identified three types of mental health practitioners' hope-inspiring strategies: strategies utilizing or mobilizing respectively interpersonal resources, internal resources, and external resources. These, in turn, generate hope and promote recovery.
Interpersonal resources strategies include: believing in the person's potential and strength, valuing the person as a unique human being, accepting the person for who he/she is, listening non-judgmentally to the person's experiences, and tolerating the uncertainty about the future developments in the person's life.
Internal resources strategies include: helping the person to set and reach concrete goals, helping the person to recall previous achievements and positive experiences, using techniques for changing the person's negative perceptions of events and self, helping the person to accept limitations, and supporting the person's spiritual beliefs.
External resources strategies include: helping the person to connect to successful role models [i.e., persons at a more advanced stage of recovery], being available when the person is in crisis, helping the person to manage the illness through medication, and supporting peers to obtain and maintain employment.
In closing, I'd like to say that I believe each one of us has what we need, right inside us, to succeed. A good professional can bring this out, and challenge us to use these skills in our everyday life as well as in our long-term recovery habits. My not-so-humble hope is that mental health professionals read what I've written and take it to heart. I also hope it gives you the courage to demand more of your psychiatrist, and actively observe and assess whether he or she is meeting your needs.
Published On: October 30, 2008