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Your ideas about recovery and what helps

oneday

oneday

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I’ve got a bit of work coming up – as a user researcher – helping facilitate groups looking at people’s experiences and ideas about recovery (however you want to define it), and how much, how far, mental health services help people’s recovery.

What do people here think? (if you want to see some of my ideas re. my own ‘recovery’ check out my ‘Introduce yourself’ and ‘Journal’). It would be great to hear people’s ideas (and with due respect that what works for one person doesn’t work for someone else).

Look forward to hearing any ideas – however short or long.

oneday
 
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Apotheosis

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Hi OneDay

This is a massive, often complex, & often highly individual subject.

I have found that acceptance has been a key to things. In trying to accept myself, my past, & also being accepted by others. To have my experiences acknowledged, & to be able to chat about them openly; has been highly therapeutic. I have also found that finding information on these subjects has been very useful.

Looking at things from 'alternative' & 'spiritual' perspectives has also been critical for me. A connection with nature is a big part of this for me.

Where I have been at recently; & over the past couple of years; is in trying my best to let go of things. Looking at ways to relax & release things. To 'take things easy' as much as possible. Sometimes it can be as simple as having a hot bath; & lighting some candles & josticks. Playing some classical or relaxing music; or just sitting quietly. Meditation has helped as well.

I have found alternative therapies to be of a lot of benefit; & I have tried many of them. Reiki I have found to be of most benefit; & I have trained in it as well.

Diaphragmatic breathing has been good too; slowing my breathing down, & focusing on breath.

Something which has been critical is in having my own space; a flat to live in; & in finding some kind of routine - good sleep, good food & regular meals, & some exercise. All these things need working on however.

12 step recovery has been a great help; & abstinence from alcohol & drugs.

Human contact & friendships is important for me. Maintaining bonds with family & friends.

I took part in a recent recovery narratives project. Some of the conclusions were very interesting. I'll post some here below.

http://www.mentalhealthshop.org/pro...tting_back_into_th.html?shortcut=intotheworld

(The brief summary on the above link is very interesting [At the bottom of the page], Full Article in Link on Right)

Recovery mediators

Three recovery mediators highlight ways in which contextual and personal factors work together, and the importance of the actual situation for and resources available to the person. The recovery mediators describe the dilemmas and challenges of daily living that meet the person in recovery.

They are:
a. Acceptance
b. Locus of power and control
c. Dependence, independence, and
interdependence

a. Acceptance:

It is crucial that the person feels accepted by others and finds a way to accept themselves and their condition in order to progress
towards recovery.

b. Locus of power and control:

Mental illness often leaves the person feeling deprived of any sense of having control over their own lives. Recovery involves (re)gaining this, often by starting small through developing self-management techniques.

c. Dependence, independence, and interdependence:

Often people with mental illness feel dependent on others and on treatments. Finding a balance between regaining independence and recognising interdependency is essential to recovery. Recovery is neither something done to the person nor something that can be achieved by the person in isolation. It is about how the person relates to their environment and the role and opportunities that the environment allows for the person. Recovery happens in the space in-between person and context: personal relationships, physical space and other economic, social and cultural factors.
 
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oneday

oneday

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Thanks for this Apo, :)

And how much - if at all - or who/what/where among them did mental health services help (if you want to say)?
 
oneday

oneday

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Help with all the above things, that is?
 
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Apotheosis

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And how much - if at all - or who/what/where among them did mental health services help (if you want to say)?
Again I think that it's complex & has many perspectives. I can't know for sure how I would have been, or how things would have turned out if I had been treated differently. I can't know for sure if I had been given comprehensive & proper psychological help, social support & other guidance & genuine therapeutic assistance from MH services - if I would now be dependant on a med; or have suffered with 20 years of severe MH difficulties. Some days I look at it all & think that I have been severely damaged by MH services; & sometimes I see it as being less clear.

People know my views on here & how much general opposition I have to orthodox psychiatry & it's practises.

On balance & looking more at the positives. Maybe at times certain meds have helped?

I have met some good people within the system; the odd psychiatrist, many nurses that were a help & support; & especially other mad people. The most therapeutic help has mainly come from other people that have been through the system & experienced MH difficulties; In my on-line & day to day life.

I was in hospital 4 times. The first admittance was horrific; the second time wasn't so great either. The third time I started chatting & opening up a bit with people; but was very highly over medicated as a consequence of that; so I learned to be very careful in what I said to staff. The last time I was hospitalised I have to say that an aspect of it I quite enjoyed. The last admittance was some refuge & respite from my life at the time.

In the 20 years since I was first in hospital; I do realise that things have changed & progressed slightly. That progress does seem painfully slow. But granted that things are altering for the better, overall I think.

There is also the element & aspect that it is what I have gone through & experienced that has made me who I am today; & the results of certain 'treatments' & actions by MH services may well be; intended or not; the reason that I have the life that I have today. On the level of growing through adversity & suffering; then maybe certain aspects of things has lead to growth.
 
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Apotheosis

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The main bone of contention that I have has been the lack of proper psychological support & social help from MH services.

After each discharge & hospitalisation I was fully discharged back into the community. But maybe an aspect of that was good thing too? given the state of services & MH treatment.

The past 5 years I have been under the 'care' of the local LMHT. Support is limited. But overall I have to say that I have found the staff amicable & accommodating. My gripe is the same; the psychological (pscyho/spiritual) help & social support just isn't there. I have minimal contact with services.

I did have 12 sessions with an NHS psychologist last year - but that took close to 20 years to get, & I have been refused any more psychological help. The psychologist I saw was very good; but the sessions were no way long enough or adequate; & there was the usual refusal to 'go there' with the content of discussing the experiences of 'psychosis'.

Before this contact with services I was 6 years without any contact with them, & went through 3 of the worst psychotic episodes that I have ever had. It was wrong to have just been left; but personal, social & other issues played a part in it all; as well as a crap GP.
 
emski

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Ooh this is something that I've often thought about but never really broken down. It's so individual and experiential and for me personally, extremely multifaceted.

For me too, the biggest aid in my recovery has been acceptance. Acceptance of a diagnosis and the implications of that, acceptance of times when I have not been well, and acceptance that when I have recovered just how far I have come. I have also had to learn to accept my own limitations. Letting some things go has also had a massive influence, like accepting that after 18 months on and off work that this position had been marred by me not being well, and team dynamics had changed, and it was incredibly hard to accept but I knew I could not go back to this. Therefore change has been a big factor - reassuring myself that I could and should do other things. I'm training to be a nurse now.

My family and friends have given me the most support and this has aided in recovery. I can hand on heart say that my current medication made a huge difference in comparison with previous drug regimes.

I am one of the lucky ones, in that at the time I was at my worst I had access to medical insurance and was able to have treatment privately, including psychological therapies. That said, I have since had good care in the form of mental health practitioners within the NHS. I never saw the NHS consultant psychiatrist, and considering my last hospital admission was roughly a year ago, I was discharged from CMHT/Crisis team after a period of 7 months! This is unfortunately happening to an awful lot of people with diagnoses of severe and enduring mental health problems the minute they get to recovery.

Other things that have helped in my recovery is trying not to drink alcohol, sleep hygiene, taking time to relax, exercise, eating healthily, being responsible with my meds, blood tests and check ups and trying to pace myself and keep orgainsed. I also take part in a self-help group. Spending time with friends and family has kept me social and grounded.

There will be many more things that have had a positive impact on my mental wellbeing and recovery but I think this have been the main ones
 
oneday

oneday

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Thanks, emski, Apotheosis for posting. It's good to think about these things and 'compare notes' so to speak - especially to see where or how our ideas overlap, not just where we might differ.

Good luck. Onwards. Oh, Apo' - you say about 12 steps recovery - have a look at my journal, I started talking about that there...
 
oneday

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Also, Apo I'm going to order a hatd copy of that Rethink recovery report, so thanks for putting me on to that.
 
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Apotheosis

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Also, Apo I'm going to order a hatd copy of that Rethink recovery report, so thanks for putting me on to that.
I hope that you get something from it. Some of the Quotes are mine in the report. You may be able to spot them.
 
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starfish

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apotheosis

thanks for this, i couldnt read all of it because i lack concentration, but thanks anyway. i like the bit about acceptance.(y)
 
emski

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in my opinion it was most fundamental to my recovery
 
oneday

oneday

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Recovery

I wanted to revive this thread by posting a summary of some things that I believe have been most important in my own 'recovery' journey from a major mental breakdown in my early adulthood, and some things that have helped, and continue to help, to keep me sane! (You can find more of my story in the 'Introduce yourself' section, headed 'introducing....' by oneday.)

And thanks to everyone else who has posted here too - more ideas and discussion welcome....

Recovery

Recovery from the crisis stage:

1. A safe, supportive environment – Perhaps somewhere to go to get away from your present situation, preferably, for me, this would be a non-medical crisis house.

2. Not having any kind of ‘treatment’ forced on you – In my case this was about not having psychiatric drugs forced on me.

3. Someone to talk to – When you’re ready. Acceptance and understanding.

4. Space for creativity, self-expression; including creative therapies – For me, art therapy was important, but there’s also dance movement therapy, music therapy, drama therapy, creative writing and poetry.

5. Allowing your madness the space and time to “burn itself out” – Just that, giving things time to calm down within a safe environment.

6. Someone to stand up to the professionals (advocacy) – Having someone properly ‘on your side’, providing information, particularly about your rights, and advocating for you if you’re finding it difficult to speak up for yourself.

7. Space for relaxation – I didn’t include this in my original story but there were yoga sessions offered at the hospital I was in. I have also since worked in hospitals where relaxation sessions were provided for inpatients, facilitated by occupational therapists or by/in the psychology department.

8. Exercise – Using, or ‘getting into’, your body, using your energy physically. Of course some things suggested above already come into this category: dance movement therapy, yoga. I know a psychiatric hospital that has a gym – I don’t know how common this is these days. I ‘ran away’ from the hospital I was in several times because I just needed to walk (and walk and walk…).


Continuing to recover, and keeping well – after the crisis stage:

1. Love, acceptance and support – We all need this to make our way in the world. I was lucky enough to have a partner through this time who stuck by me, loved, accepted and supported me along the way.

2. Talking therapies – There are many kinds of counselling and psychotherapy available out there. You might access these via your doctor/the NHS, but there also many independent agencies offering counselling or therapies to which you can self-refer, often these are charities that offer low-cost and even free options.

3. Learning relaxation techniques – This can sometimes be offered by statutory services (NHS and/or social services), but there are lots of options available out there in our communities: perhaps, for instance, through yoga, meditation, T’ai Chi, or a martial arts class.

4. Friendship – People you can feel close to and can talk to, more love, acceptance and support (both giving and receiving, of course); being part of a supportive social network.

5. Alternative therapies – Again, there are many kinds of alternative and complementary therapies out there. You may find some services available via the NHS, but there are also many independent centres and practitioners offering therapies to which you can self-refer, and some will offer low-cost and free options. These often offer ways of looking after yourself, mind and body, and can be reassuring and relaxing.

6. Reading – Many people find self-help books helpful, and other books about mental health, psychology, psychotherapy, etc, as well autobiography and literature, and writings by mental health system survivors, for instance… And, of course, these days there is much to read available via the internet. Inspire and educate yourself.

7. Looking after yourself – For instance, through exercise, eating healthily, getting enough sleep, and so on…

8. Training, education, work – ‘Meaningful occupation’, as they say: something that engages you meaningfully in your community, doing something that you can commit yourself to. I’m a great believer in finding your ‘path with a heart’, and following it. You can start with voluntary work, lots of places need some help, or try studying something that interests you in an adult education class.

In my own case, through a local employment training project, I began by helping out with a weekly art group at a local mental health centre (I love/d art), and from there began studying counselling at a local adult education college; and I later studied psychotherapy, eventually qualifying in a psychotherapy discipline, through which, eventually, I began working in the mental health field.
 
keepsafe

keepsafe

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Thats inspiring oneday, but yes I will have to give myself time to heal and get better.

I hope to do some volutary work when I am more mentally stable.
 
oneday

oneday

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I was interested to find this list of recovery (from psychosis) resources by US social worker/therapist Ron Unger. Its focus is on CBT resources (often for professionals), but goes beyond this. His blog is interesting too: http://www.recoveryfromschizophrenia.org/blog/[/B], discussing psychosis and psychosocial alternatives to medications.

Cognitive Therapy for Psychosis: Ron Unger LCSW


Some Resources:

Cognitive Therapy of Schizophrenia (Guides to Individualized Evidence-Based Treatment) by David G. Kingdon and Douglas Turkington. 2005 The Guilford Press. "Drawing on the authors' decades of influential work in the field, this highly practical volume presents an evidence-based cognitive therapy approach for clients with schizophrenia (and psychotic symptoms that may be associated with other diagnosis). Described in thorough, step-by-step detail are effective techniques for working with delusional beliefs, voices, visions, thought disorders, and negative symptoms; integrating cognitive therapy with other forms of treatment; reducing the risk of relapse; and helping clients stay motivated and engaged."

Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention by Andrew Gumley, Matthias Schwannauer "Staying Well After Psychosis is extremely readable, based on solid research evidence and packed full of clinical insights and strategies that will satisfy any clinician seeking innovative approaches to the promotion of recovery from psychosis." — Anthony P. Morrison, Professor of Clinical Psychology, University of Manchester, UK. Topics include: Taking a developmental perspective on help seeking and affect regulation; Supporting self-reorganization and adaptation after acute psychosis; Understanding and treating traumatic reactions to psychosis; Working with humiliation, entrapment, loss; fear of recurrence; working with cognitive interpersonal schemata.

Cognitive Therapy for Psychosis: A Formulation-Based Approach by Anthony Morrison, Julia Renton, Hazel Dunn, Steve Williams and Richard Bentall. A very systematic book, tying together research, theory, and practical interventions emphasizing the use of formulations. Includes useful suggestions about how to structure therapy sessions, and even ways to get clients to do homework!

Person-Based Cognitive Therapy for Distressing Psychosis by Paul Chadwick. Key features include; the integration of the author’s work on Mindfulness (a simple meditation technique for people with psychosis); inclusion of the two-chair method; plus a chapter on group therapy.

Madness Explained: Pyschosis and human nature by Richard Bentall 2004 Penguin Books, London England. Bentall is a research psychologist who pulls together a great deal of evidence to shatter the medical model myths about madness and to "demonstrate that the apparently mysterious, incomprehensible symptoms of the mentally ill are actually extensions of what many of us experience every day." (quote from Aaron Beck's intro.)

PRAXIS CBT Starting in late 2009 or early 2010, http://www.praxiscbtonline.co.uk/ is reported as planning to offer an e-learning training program in CBT for psychosis – including video showing therapy sessins. “PRAXIS CBT offers the complete package of training including: the online programme; supervisory support; access to tutors; advice on organisational preparation to ensure the learner is supported to use their newly acquired skills in the workplace; university accreditation; opportunities for CBT career progression.”

Cognitive Therapy for Delusions, Voices and Paranoia by Paul Chadwick, Max Birchwood, & Peter Trower. 1996. This is a good source for ideas about both theory and practice of cognitive therapy with psychotic symptoms.

Making Sense of Voices: A guide for mental health professionals working with voice-hearers by Prof Marius Romme & Sandra Escher 2000 Mind Publications. Romme looks at voices "from outside the illness model" and has been a pioneer listening to what voice-hearers have to say, while encouraging networking and peer support among them. He advocates acceptance of voices along with constructive coping.

Models of Madness: Psychological, social and biological approaches to schizophrenia edited by John Read, Loren Mosher, Richard Bentall. Brunner-Routledge, 2004. critiques the ‘medical model’ of madness; examines the dominance of the ‘illness’ approach to understanding madness from historical and economic perspectives; documents the role of drug companies; outlines the alternative to drug based solutions; identifies the urgency and possibility of prevention of madness.

Intervoice - http://www.intervoiceonline.org/ is the website of an “international community for voice hearing.” A mailing list for voice hearers and their supporters is at http://health.groups.yahoo.com/group/voicesupporters/: there is also a mailing list just for people who hear voices themselves at http://health.groups.yahoo.com/group/voice-hearers/

“Prejudice and schizophrenia: a review of the `mental illness is an illness like any other' approach“ by Read, J.; Haslam, N.; Sayce, L.; Davies, E. Source: Acta Psychiatrica Scandinavica, Volume 114, Number 5, November 2006 , pp. 303-318. Looks at research finding that acceptance of medical model type beliefs by the public and by mental health workers is associated with an increase in perceptions of dangerousness and unpredictability and desire for social distance. Suggests alternative approaches to stigma reduction.

Soteria - The most detailed controlled comparison of psychosocial/mostly non-medical treatment with standard medically oriented treatment ever performed was probably the experiment called “Soteria.” (The clients treated with the experimental psychosocial model did better on average, but the mental health field has ignored this outcome.) For information about this check out http://www.moshersoteria.com/ or order Soteria: Through Madness to Deliverance by Loren R. Mosher, Voyce Hendrix, and Deborah C. Fort.

“Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies,” by Jaakko Seikkula1, Jukka Aaltonen, Birgittu Alakare, Kauko Haarakangas, Jyrki Kera¨Nen, & Klaus Lehtinen, Psychotherapy Research, March 2006; 16(2): 214/228. This study of the Open Dialogue approach in Finland that used as little neuroleptics as possible found that in a group of 42 patients, 82% did not have psychotic symptoms at the end of five years, 86% had returned to their studies or jobs, and only 14% were on disability allowance. Only 29% had ever been exposed to a neuroleptic medication at all during the five years, and only 17% were on neuroleptics at the end of five years. Other studies of this program are also posted at [B]http://psychrights.org/index.htm[/B] (click "scientific research by topic" and then "effective non-drug treatments.") The psychrights site also has a whole collection of other articles on alternatives.

The Massachusetts General Hospital Department of Psychiatry has a couple videos on the web. One shows small excerpts of cognitive therapy for psychotic symptoms, which appears designed to introduce clients to cognitive therapy. http://www2.massgeneral.org/allpsych/schizophrenia/scz_care_treatment-cog-beh.html
It isn't great, but does convey some of the basics. Then there is an excerpt from a lecture about cognitive therapy for psychotic symptoms: http://www2.massgeneral.org/allpsych/schizophrenia/psy20041106/cather/start.htm

A Casebook of Cognitive Therapy for Psychosis edited by Anthony P. Morrison, 2002. Leading clinicians and researchers present their individual approaches to understanding and offering assistance with the difficulties faced by specific people.

The Case Study Guide to Cognitive Behaviour Therapy of Psychosis, edited by David Kingdon & Douglas Turkington, is written by practitioners from differing clinical backgrounds and at different stages in their use of CBT. It provides vibrant and colourful descriptions of patient and therapist problems and the use of various techniques with them. Part 2, Training, Supervision, and Implementation, consists of four chapters dealing with such things as "Training for CBT in Psychosis" and "Clinical Supervision."

Ron Unger - http://www.recoveryfromschizophrenia.org/blog/ is my blog, where I paste in information I come across, thoughts, theories, whatever. Subjects might include the nature of psychosis, why alternatives to relying on medications are needed, and specific psychosocial alternatives like cognitive therapy.

"A Casebook of Cognitive Behaviour Therapy for Command Hallucinations: A Social Rank Theory Approach" by Byrne, S., Birchwood, M., Trower, P., & Meaden, A. This book is based on a research study that was successful overall in reducing problems from command hallucinations. Lots of case studies, with clear steps outlined.

For an approach to people who are just starting to experience psychotic symptoms, using cognitive therapy but no medications, also based on a successful research study, check out "Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach". The mental health field has not much attended to the idea of prevention, but the potential savings to society, in preventing suffering, disability, and treatment cost, indicates that much more attention should be given to programs like this!
 
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