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January 01, 2007

Have you ever noticed how most conversations begin between behavioral health professionals and people receiving services? From our experience, the conversation usually begins by identifying the presenting problem and goes downhill from there, becoming more and more immersed in layers of the problem. By the time the conversation is over, both the person and the professional are exhausted, sometimes overwhelmed, and have little energy left to find a creative solution. If you think about it, people don't come to our programs to wallow in their problems. They come for help in finding solutions. Yet we seem to spend most of our time talking about the problems.

If you want to blame someone for this situation, there are always the regulators, licensors, and payers. They want to be sure that the person has a problem that fits into one of their designated categories, so that required paperwork begins guiding a “problem-oriented” conversation right off the bat.

Problem-oriented approaches to conducting assessments and therapies are common in behavioral health settings, but for the most part these approaches were established before the concept of recovery was recognized as a reality, especially for people with serious mental illness.

Now that we know about recovery, most of what we practiced before needs to change, including this negative approach that drains the spirit out of all of us. Deficit-based conversation neither inspires the person to recover nor inspires the professional to concentrate on creative alternatives or solutions.

The Recovery Conversation

There is another way, one that builds inspiration and energy to address problems in a meaningful way. We call it the Recovery Conversation. It's based on the Recovery Coaching protocol that Dr. Ashcraft developed a few years ago and that is taught as a three-unit class in the Recovery Education Center at META Services.

Lisa St. George, MSW, CPRP, a peer manager at META, was the first to put her finger on this issue. She saw that people receiving services were acculturated to a problem-oriented therapeutic approach with low expectations and without requiring personal accountability. She began experimenting with ways of focusing on personal responsibility and self-determination. Dr. Ashcraft revisited this concept while developing the Recovery Coaching protocol that ultimately became the basis of the Recovery Conversation. The Recovery Conversation focuses on strengths and the potential for self-determination instead of acceptance of limitations that perpetuate feelings of helplessness and hopelessness.

While the Recovery Conversation draws on some established best-practice approaches to interviewing, coaching, and counseling, it's unique because the sequencing focuses on building self-esteem and self-determination before identifying barriers or problems. The Recovery Conversation's steps occur more or less in this order:

  • The Recovery Conversation begins by focusing on the person instead of the problem. This develops a relational foundation that supports the person in identifying and solving the problems interfering with his/her level of motivation, goals, etc.

  • A concentrated focus is on empowering the person so he/she can develop the momentum necessary to address the problem successfully by identifying workable solutions.

  • Each session includes a dynamic planning phase where the person takes the lead to identify the next steps and a sense of overall direction.

  • Risks and outcomes are held in mutual partnership between the person and the coach, with the person taking the lead to put the plan into action.

  • The presenting problems always are framed in the context of the person's strengths and action plan.

  • Special attention is given to building resilience.

  • Each session is concluded with a mutual assessment of the process and progress, with both the coach and the person's participation. This step allows for feedback that helps the person and the coach improve their participation.

One Organization's Experience

The charming little town of Wenatchee, Washington, has a fierce community spirit reflected in its behavioral health program. The director of the regional mental health network, Jim Colvin, recently took a strong leadership position focused on moving his system toward recovery practices. Jim was looking for ways to move beyond talking about recovery principles to actually implementing recovery practices.

Jim arranged for key leaders in the regional system to learn the Recovery Coaching protocol and to develop a plan to implement it throughout their programs. They knew better than to just send out a memo requiring the change if they really wanted it to work. They decided to actually use the Recovery Conversation themselves in their relationships with their staff, knowing that this would be the most effective way for it to be passed down to the relationship between staff and people receiving services. The plan included the following steps:

  • Leaders used the Recovery Conversation when talking to staff, empowering them to come up with solutions, partnering with them in risky situations, supporting their plans to find solutions, building resilience as an antidote for burnout, and giving and asking for feedback on performance.

  • Leaders worked in mutual partnership with staff to develop a roll-out plan for using the Recovery Conversation organization-wide.

  • Leaders joined staff in learning and practicing Recovery Coaching principles through group meetings that included role-playing, using the Recovery Conversation to solidify the actual delivery of the practice.

  • Leaders were willing to learn, make mistakes, and admit that they don't have all the answers. Leaders learned and discovered the Recovery Conversation right along with staff.

So, as you can see, the Recovery Conversation can be used beyond the person/coach relationship. It can be used throughout a recovery-oriented organization to empower staff to better serve people.

We recently checked in with the folks in Wenatchee to see how it was going, and Jim says that “there is a new spirit of excitement in the network. The commitment to recovery principles is growing by the day and is already transforming our system.”

We hope you will give the Recovery Conversation a try and let us know how it goes. We think you will be delighted with the results.

Lori Ashcraft, PhD, directs the Recovery Education Center at META Services, Inc., in Phoenix. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University. Lisa St. George, MSW, CPRP, is a Peer Manager at META Services.
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