Recovery Model in MFT
Steven W. Place
Northcentral University

Recovery Model in MFT
The Recovery Model Introduction
If the famous quote by Heraclitus, “The only thing that is constant is change,” is true, then one must wonder how the mental health field resisted change for so long. In light of the modern age, characterized by scientific methodologies, the mental health field advanced rapidly. Amazingly, the human condition could be put to test, understood and categorized. Sadly, anything falling outside the “norm” became “abnormal.” Once a person was identified as “abnormal,” they were the lucky recipients of a label they carried with them for life, or until they “recovered.” Mental health labels carry with them a certain stigma that communicates to the person they are different, perhaps less of a person and that “normal” may never be a reality with their “illness.” Recovery would be based on becoming symptom-free, or at the very least, a significant reduction in symptoms (Gehart, 2012).
The mental health field has experienced tremendous growth in terms of understanding the plethora of conditions people experience, as well as in treatment of those conditions. However, one thing remained unchanged until recently. The idea behind recovery shifted from coercive treatment to person-centered change (Onken, et al, 2007). Gehart states is this way, “instead of using the medical paradigm of disease, the recovery paradigm approached mental “illness” using a social model of disability that emphasizes psychosocial functioning over medical symptomatology” (2012). The focus of recovery shifted from the illness to the person. The recovery model gave way to the idea that change can happen and that the person should be at the center of the decision-making process to “reach their highest possible level of functioning, while developing new meanings for their lives” (Reisner, 2005). The U.S. Department of Health and Human Services (2004) identifies mental health recovery as a journey where the individual can live a meaningful life of their choosing as they work through the process of change to reach their full potential.
Development of the Recovery Model The recovery model is, inherently, a shift in thinking that produces an atmosphere of change by allowing clients (now referred to as consumers) to choose the programs and providers they feel will help them along their journey (Reisner, 2005). According to Gehart, the recovery model has its origins as early as the 1930s rooted in consumer self-help, but was not embraced until some near 60 years later (2014). As the recovery model garnered worldwide attention, it was quickly adopted as policy within the United States and other first world countries. The reason for the popularity of this model (more a paradigm, than a model) was via research done by the World Health Organization. In this study, 52% of patients diagnosed with a severe mental illness reported a social recovery and 28% reported full recovery (Gehart, 2014). With these results, it was inevitable that recovery moved toward a person-centered, strengths-based outlook, instead of one that focused solely on the “illness” and the symptoms.
Concepts of the Recovery Model
There are 10 fundamental components of recovery according to the U.S. Department of Health and Human Services (2004). As outlined in Gehart’s text, they are self-direction, individualized and person-centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope (2014). Onken, et al, categorized the elements to include those that are person-centered, re-authoring, exchange-centered, and community-centered, expanding on each from common recovery models (2007). The concepts presented will take this categorical approach with a brief description of each.
Person-Centered.
The person-centered elements of the recovery model centers around hope, sense of agency, self-determination, meaning and purpose and awareness and potentiality (Onken, 2007). Ultimately, this gives the therapist an opportunity to help clients understand that there is hope and if they are able to internalize that hope, they can then take responsibility for their recovery and direct the steps toward finding a fulfilling and meaningful life. Gehart states it this way, “the therapist help persons diagnosed with a severe mental illness not simply to believe that things can get better but also to impart the will to take responsibility for their recovery and develop the unshakable faith that they are capable of making it happen” (2012).
Re-Authoring.
The recovery model requires the consumer to understand their challenges are not their identity. This is the crux of re-authoring one’s narrative so they understand that what they are experiencing is but one facet of their life. As Onken puts it, they are “a whole person who is facing challenges” (2007). Re-authoring focuses on strengths around coping, healing, wellness, and thriving so that a person begins taking their challenges and turning them into opportunities for growth. Coping allows the person to begin the healing process, which promotes wellness so that the person can exceed where they were prior to recovery (Onken, 2007).
Exchange-Centered.
As a person begins to see their situation in a different light, they can then begin functioning within the larger scope of community. If a person is to have a meaningful role in society, the issues surrounding social functioning, power and choice among meaningful options must be addressed (Gehart, 2012). Social functioning provides an avenue to connect the person with peers that can provide support and encouragement and even allowing them to mentor others experiencing the challenges they are or have faced. Onken says, “the role of “patient” accompanying the diagnosis of mental illness is not a primary life role” (2007). A person must be empowered to claim their life, their personhood and reject labels along with the stigma of being labeled with a mental illness. Also, in order to experience substantial freedom, a person must be able to have options that meet their basic needs and move them toward recovery (Onken, 2007).
Community-Centered.
Full recovery cannot be actualized until a person can be integrated into the larger society (Onken, 2007). Community supports are required to make this happen, in the form of social connections and relationships built on love, patience and trust. This is also done through social circumstances and opportunities, which goes back to the idea that a person’s basic needs be met to allow the person to thrive in community. The final step in recovery is integration which basically helps the individual learn to function in society around others (Onken, 2007).
Postmodernism, Social Constructionism and the Recovery Model
Although the recovery model has underpinnings from the early 20th century, it is to no surprise that it wasn’t fully articulated and embraced until society moved into the postmodern era. Postmodern thought has significantly influenced the recovery model and challenges therapists in the following assumptions:
1. A person’s experience of “mental illness,” including his or her sense of autonomy and personal identity, is informed by broader societal discourses, which must be questioned and reexamined in the process of recovery (Kirkpatrick, 2008; Roberts, 2000).
2. “Recovery” involves developing identity narratives in which persons diagnosed with a mental illness feel a sense of agency, hope and possibility that enables them to create a life that is personally meaningful and fulfilling (Kirkpatrick, 2008; Roberts, 2000).
3. One of the primary tasks of the therapist is to identify strengths and resources and promote a hopeful vision of their future (Davidson et al., 2009).
4. Social justice and stigma are key issues in recovery, and therapists are responsible for doing their part to promote positive community and social change (Davidson et al., 2009).
The recovery model is greatly influenced by both postmodern thought and social constructionism and requires providing an opportunity to help the person redefine their self so they can experience a meaningful and fulfilling life.
The Recovery Model and MFT
Marriage and family therapy has a long history that closely aligns with much of the ideas presented in the recovery model. The recovery model places a heavy emphasis on strength-based approaches and less focus on pathology. Both of these are inherent in marriage and family therapy and provide an opportunity for the MFT therapist to utilize the strengths within the field. Gehart points out that family therapy proponents outlined many of the ideas encompassing the recovery model today, such as “decreasing hospitalizations, exploring alternatives to psychoanalysis, using multidisciplinary teams, increasing outcomes research, and adopting a more sociological approach” (2012). The importance of implementing the recovery model within the practice of marriage and family therapy may seem daunting, but when understood from the assumptions of marriage and family therapy and systems thinking, it may not be as difficult as previously thought. An opportunity such as this, can bring an awareness to the field of marriage and family therapy and the fact that it has long been supporting the ideology surrounding the recovery model and the benefits it contains for consumers. As Gehart says, “in many ways the principles of recovery return MFTs to their roots, a nonpathologizing, down-to-earth, and hopeful approach to working with families with a member diagnosed with severe mental illness (2012).
The Recovery Model and Me
This is section contains personal reflection from a first-person perspective and highlights the implications of the recovery model for me as an effective MFT. As I researched the recovery model, I found it to be, as stated previously, a shift in thinking. It will be a welcome, yet challenging approach to realize change in individuals. In all of the reading from the provided articles to the ones I found on my own, I highlighted this as one of the most significant statements in how I view myself as a case manager, and into marriage and family therapy… “The therapist has the challenging role of seeing hope when few others do and to inspire not only the consumer but often the network of professionals, family, and friends who have witnessed serious ongoing problems” (Gehart, 2012). She continues on to say these are, perhaps the most difficult, most dependent on the personal development of the therapist, and the least teachable elements of recovery. I say that this, in essence, is what an MFT is born to do and then coming alongside the consumer during the journey to realize true and lasting change as they head toward a meaningful and fulfilling life.
References
Davidson, L., Harding, C., & Spaniol, L. (2005). Recovery from severe mental illness: Research evidence and implications for practice, Vol. 1. Boston: Center for Psychiatric Rehabilitation, Boston University.
Gehart, D. R. (2012). The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness. Journal Of Marital And Family Therapy, 38(3), 429-442. doi:10.1111/j.1752-0606.2011.00230.x
Gehart, D. R. (2012). The Mental Health Recovery Movement and Family Therapy, Part II: A Collaborative, Appreciative Approach for Supporting Mental Health Recovery. Journal Of Marital And Family Therapy, 38(3), 443-457.
Gehart, D. R. (2014). Mastering competencies in family therapy: A practical approach to theory and clinical case documentation. Belmont, CA: Brooks/Cole Pub.
Kirkpatrick, H. (2008). A narrative framework for understanding experiences of people with severe mental illnesses. Archive of Psychiatric Nursing, 22(2), 61-68. Doi: 10.1016.j.apnu.2007.12.002
Onken, S. J., Craign, C., Ridgway, P., Ralph, R. O., & Cook, J. A. (2007). An analysis of the definitions and elements of recovery: A review of the literature. Psychiatric Rehabilitation Journal, 31, 9-22.
Reisner, A. D. (2005). The common factors, empirically validated treatments, and recovery models of therapeutic change. Psychological Record, 55(3), 377-399.
Roberts, G. (2000). Narrative and severe mental illness: What place do stories have in an evidence-based world? Advances in Psychiatric Treatment, 6, 432-441.