CLINICAL HANDBOOK OF SCHIZOPHRENIA

55. Recovery 573cian must become competent in eliciting, encouraging, and supporting the client’s interests,assets, talents, energies, and efforts. Midwives catalyze the mother’s own naturalprocesses and her efforts to facilitate the baby being born (as opposed to “delivered”).Conductors bring out the unique contributions of their musicians to create a whole that isgreater than the sum of its parts. Recovery-oriented clinicians likewise focus on identifyingand maximizing the person’s own interests and abilities in laying the foundation forthe work of recovery.A recovery-oriented clinician identifies and builds upon each person’s strengths andareas of health and competence to help him or her achieve a sense of mastery over his orher condition, while regaining a meaningful, constructive sense of membership in thecommunity. Furthermore, when engaging in evaluation and treatment, recovery-orientedclinicians place as much, or possibly even more, emphasis on clients’ personal narrativesand quality of life as on their symptoms and diagnosis. In other words, in addition to attemptingto reduce and/or contain the symptoms and impairments associated with the illness,practitioners focus on ways to promote their clients’ functioning and help them reclaima meaningful and gratifying life in the presence of enduring disability. As we sawwith Celeste’s second clinician in the case presented earlier, the key components of thisprocess involve active and disciplined listening, and the cultivation of a trusting relationship,which then provides the basis for enhancing the client’s access to various opportunitiesto pursue his or her own interests and gifts. Finally, recovery-oriented practitionersalso stand together with their clients in the forefront of the struggle for a society more accommodatingof those individual differences that make each of us unique.KEY POINTS• There are many different meanings of recovery related to serious mental illnesses such asschizophrenia.• Recovery is variously used to refer to a cure, the absence of symptoms, the resumption ofnormal functioning and more recently, the assumption of fundamental rights and responsibilities,as well as the promotion of the kinds of institutional change that guarantee theserights and responsibilities will be respected by society.• The most confusing, but also perhaps the most important, meaning of recovery, which is addressedin a number of recent Federal policy documents, is that being in recovery does notrequire being cured, diminution of symptoms, or restoration of previous level of functioning.• This notion of being in recovery is grounded in a civil rights movement that seeks to restoreto people with schizophrenia their fundamental rights and responsibilities as citizens, includingmost centrally the rights to self-determination and full inclusion in community life.• Mental health services, education, and training oriented to this sense of recovery emphasizesidentifying and building on people’s strengths, and areas of health and competence tosupport their management of the condition, while they regain a meaningful and constructivesense of membership in the community.REFERENCES AND RECOMMENDED READINGSAnthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health servicesystem in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23.Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia.New York: New York University Press.Davidson, L., Harding, C. M., & Spaniol, L. (2005). Recovery from severe mental illnesses: Researchevidence and implications for practice. Boston: Center for Psychiatric Rehabilitation of BostonUniversity.