Slade (2020) Chapter 9: The Personal Recovery
Framework
The Personal Recovery Framework (PRF) is underpinned by a contructivist epistemology (changing
and negotiated nature of experience).
Thus not prescriptive about what recovery is, since this is not generalizable.
Aims:
o Identify how clinical models can help, and hinder, recovery;
o Focus attention on the person rather than the illness, and on the person in their
social context rather than decontextualising the individual.
Empirical foundations
Four negative impacts following from being diagnosed with a mental illness (Spaniol et al.):
1. Loss of a sense of self – replaced by identity as mental patient;
2. Loss of power, including agency, choice, and personal values;
3. Loss of meaning (e.g. through loss of valued social roles);
4. Loss of hope – leading to giving up and withdrawal.
Four processes in personal recovery (Ralph):
1. Internal factors (e.g. awakening, insight, determination);
2. Self-managed care, inluding coping with difficulties;
3. External factors, especially connection with others who express hope for the person;
4. Empowerment, combining internal strength and interconnectedness with others.
HEART (Lapsley et al):
Hope;
Esteem (self-esteem);
Agency;
Relationship;
Transitions in identity (e.g. personal identity, cultural identity, lesbian/gay identity, leaving
behind illness identities).
Four themes in accounts of recovery (Andresen et al.):
1. Hope as a frequent self-reported component of recovery;
2. Self-identity, including current and future self-image;
3. Meaning in life, including life purpose and goals;
4. Responsibility: ability to take personal responsibility for one’s own recovery.
Four key domains of personal recovery (based on abovementioned research):
1. Hope: a primarily future-oriented expectation of attaining personally valued goals,
relationships or spirituality which lead to meaning and are subjectively considered possible;
a. “What will happen to me?”
2. Identity: those persistent characteristics which make us unique and by which we are
connected to the rest of the world;
a. “Who am I?”
3. Meaning: direct and indirect meaning;
, a. Direct meaning = an understanding which makes adequate personal sense of the
‘mental illness’ experience;
i. “What has happened?”
b. Indirect meaning = an integration of the direct meaning into personal and social
identity.
i. “What does this mean for me?”
4. Personal responsibility: a constellation of values, cognitions, emotions, and behaviours which
lead to full engagement in life.
a. “What can I do?”
b. Not a passive recipient, but an active attitude towards improvement.
Five stages of personal recovery (Andresen et al.):
1. Moratorium: denial, confusion, hopelessness, identity confusion, and self-protective
withdrawal;
2. Awareness: glimmer of hope for better life and possibility of recovery;
a. Can be triggered within or by a significant other, role model, or clinician.
b. Involves a developing awareness of a possible self other than that of mental patient.
3. Preparation: resolve to start working on recovery, e.g. by taking stock of personal resources,
values and limitations, by learning about mental illness and available services, becoming
involved in groups and connecting with others who are in recovery;
4. Rebuilding: hard work stage, involving forging a more positive identity, setting and striving
towards personally valued goals, reassessing old values, taking responsibility for managing
illness and for control of life, and showing tenacity by taking risks and suffering setbacks;
5. Growth: person can manage their illness and stay well. Positive sense of self, and belief that
the experience has made them a better person.
a. Can be considered the outcome of the previous recovery processes;
b. Can be symptom-free or not;
c. Associated characteristics are resilience, self-confidence, and optimism about the
future.
NIMHE four-stage model of recovery:
1. Dependent/Unaware;
, 2. Dependent/Aware;
3. Independent/Aware;
4. Interdependent/Aware.
Recovery Advisory Group Recovery Model six-stage non-linear model of recovery:
1. Anguish – bottoming out;
2. Awakening – turning point;
3. Insight – beginning of hope;
4. Action plan – finding a way;
5. Determined commitment – to be well;
6. Well-being, empowerment, recovery.
Two shortcomings of stage models:
1. Imposes an order on human growth and development;
a. Might not fit everyone’s experience – limited external validity;
b. Spiral might be better metaphor than linear stages.
2. Can be seen as model for what should happen.
a. Can result in feelings of failure for those who do not recover like in the model;
b. Model should be seen as map rather than route (a map does not show the best way
through it).
Three clinical advantages of stage models:
1. Contribute to therapeutic optimism: established pathways to recovery becoming visible
combats the clinician’s illusion that no-one recovers (as clinicians only see people when in
crisis);
2. Provide a way of making sense both of progress and of lack of discernible progress in a non-
stigmatising and non-pathologising way;
3. Help clinicians become more sophisticated in providing supprt matched to the person’s stage
of recovery.
a. Different sorts of action/help needed at different stages of recovery.
Ultimate goal of personal recovery is healing: reclaiming or regaining or restoring or discovering
oneself and one’s world.
Identity
Identity has a psychological, sociological, and philosophical definition:
Identity (psychological) = personal identity – the things that make a person unique.
o The different, idiosyncratic, interesting, damaged, impassioned part of us.
o Components: mental model of oneself (self-image), self-esteem, individuation,
capacity for self-reflection and awareness of self.
Identity (sociological) = social identity – the collection of group memberships that define the
individual.
o Components: role-behaviour, discrimination towards outsiders by members of the in-
group, identity negotiation in which the person negotiates with society about the
meaning and value of their identity.
o Contextual richness.
Identity (philosophical) = persistence – the existence of a persisting entity particular to a
given person.
, o Components: change, time, and sameness.
o Identity is that which is preserved from the previous point in time when it was
modified, or it is the recognisable individual characteristics by which a person is
known.
Identity (combined definition) = those persistent characteristics which make us unique and by
which we are connected to the rest of the world.
o Personal and social identity will often overlap.
Three component elements of an identity as someone with a mental illness:
1. Personal identity: I see myself as a person with mental illness;
2. Social identity: others relate to me, and I relate to others, as a person with mental illness;
3. Permanence: both personal and social identity are ongoing.
Recovery begins when you find somewhere to connect to – people who believe in you and your
recovery.
The four tasks of recovery
Task 1: Developing a positive identity.
Involves establishing the conditions in which it is possible to experience life as a person, not
an illness.
o Me-it difference: finding the self outside of the mental illness – finding the me who
has the it.
Moving from either-or stance to both-and stance: “I am a person in my own right and I have a
mental illness.”
o Two elements:
Amplifying sense of self;
Diminishing the identity as a person with mental illness.
o Spotlight metaphor: not denying that the mental illness exists, but moving the focus
(spotlight) to other aspects of the self.
Developed by establishing or re-establishing identity-enhancing relationships.
o E.g. relationship with aspects of the self (personal identity) or with things outside the
person (social identity).
Task 2: Framing the ‘mental illness’.
Developing a personally satisfactory meaning to frame the experience which professionals
would understand as mental illness.
o Framed as part of the person but not the whole person.
o Meaning must provide a contraining frame for the experience, and can serve as a
springboard to a better future.
o Unframed mental illness expereince diminishes agency (“I can’t do that because
[something illness related].”)
Move from ‘Why me?’ to ‘Yes, but’.
o E.g. “Yes, I have a mental illness, but at least I can now get treatment.” Or “Yes, I will
always be a schizophrenic, but at least now I understand what is happening to me.”
Acceptance or integration of the mental illness experience into broader identity (indirect
meaning).
