LETS PEER COUNSELING TRAINING TWO
HOW DIAGNOSIS AFFECTS SELF-IMAGE.
SELF-IMAGE A FEW YEARS AGO, THE MENTAL HEALTH EMPOWERMENT PROJECT IN NEW YORK LED 30 EMPOWERMENT WORKSHOPS AROUND THE STATE. ABOUT 600 CONSUMERS PARTICIPATED. ONE OF THE QUESTIONS THEY ANSWERED WAS, "WHAT'S DISEMPOWERING ABOUT BEING DIAGNOSED WITH A MENTAL ILLNESS?” IN OTHER WORDS, HOW DOES GETTING DIAGNOSED WITH A MENTAL ILLNESS IMPACT SELF-IMAGE? THE PARTICIPANTS CAME UP WITH SIX MAJOR REASONS, PARAPHRASED HERE, FROM THE CONSUMERS' POINT OF VIEW:
SELF-IMAGE •
Stigma: The public often views us as violent and incompetent people. This negative stigma can do terrible damage to our self-image, the way we see ourselves.
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Self-Doubt: We often have strong feelings of confusion, shame, guilt, humiliation and fear of the unknown that come with our diagnosis. All of these feelings affect our self-image.
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Symptoms and Medication Side Effects: We feel less whole as a person when the focus of our treatment is more on medication than on coping or managing symptoms.
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Sense of Loss and Isolation: Living with a mental illness, we often feel separated from our family, friends, career, financial stability, etc.
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System Creates Dependence: Often, the mental health care system views us as unable to care for ourselves and tells us what to do and not do. This creates a sense of dependence on the system in many of us and lowers our self-image.
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Being Seen as Your Illness: We're often not seen as people, but instead as the illness we live with. And then, the "illness" becomes the lens we see ourselves through.
REFLECTING •
What are some negative ways that society relates to people living with a mental illness?
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What are some of the negative side effects of medication?
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How does that affect a person's self-image?
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How does the traditional mental health system sometimes relate in a negative way to people living with a mental illness?
How do these symptoms and side effects affect a person's self-image?
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How does that affect a person's self-image?
What helps you the most to create and maintain a positive self-image, in spite of so many negative messages around you?
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What are some of the symptoms we associate with "mental illness?"
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How can a peer specialist help someone whose selfimage is damaged by these negative messages?
WHAT IS A
RECOVERY STORY?
SELF-IMAGE •
A personal account of moving on with his/ her life after being diagnosed
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A powerful tool for a peer specialist to use with others
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A story about finding, or re-finding, meaning in one's life
ILLNESS STORIES FOCUS ON WEAKNESSES AND TREATMENTS; RECOVERY STORIES FOCUS ON STRENGTHS AND A MEANINGFUL LIFE.
RECOVERY STORY •
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A person's story of recovery is one of the strongest tools he or she has to help others heal. Effectively using your own personal story can open the door to a successful partnership with a peer. It can help eliminate the self stigma that gets in the way of recovery from mental illness. And it can be a powerful symbol-a true example-that recovery is possible. It is critical, though, to use the story appropriately. Different occasions with our peers call for different parts of our story. Peer specialists don’t want to become self-centered, and only talk about their own struggles and personal path. Peer specialists want to use their story in ways that truly help.
REFLECT: •
Spend a few moments thinking about your own recovery story. Try to summarize it in a few paragraphs, keeping a written/printed copy. At the end of this module--after you've learned more about recovery stories--you'll have the chance to write another version and compare it to this one.
SO,
WHAT’S YOUR STORY?
RECOVERY STORY SHARING ABOUT OURSELVES. SOMETIMES, WHEN WE DO PEER SPECIALIST TRAININGS, WE'LL START THE LEARNING WITH SOME SIMPLE INTRODUCTIONS. WE'LL ASK THE 30 OR SO PEOPLE IN THE ROOM TO SHARE THEIR FIRST NAME AND SOMETHING IMPORTANT ABOUT THEMSELVES THAT WE SHOULD KNOW.
What do you think many of these people share? Keep in mind that most of our peer specialist candidates are people who have lived with a serious mental illness for much of their lives. They've often been highly medicated, hospitalized, and in significant distress. They’ve seen the darkest of dark days, and still fight everyday to experience wellness. So, what do you think that one thing is that they choose to share with the group?
MORE THAN AN ILLNESS? So often, they share their diagnosis, medication regimen, diagnosis of family members or some other thing that they see as a deficiency in their lives. Often when we've been diagnosed with a serious mental illness, we can only see what's wrong with our current situation.
KNOW THE DIFFERENCE. Seeing the difference between an illness story and a recovery story is at the heart of being a good peer specialist. Knowing when and how to use your personal story to help another peer is the mark of a great peer specialist.
KNOW THE DIFFERENCE
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Because the peer specialist's story is so important to what they do, it's very important that peer specialists understand the difference between a recovery story and an illness story. Many peers are very practiced at telling their illness story … telling their symptoms … telling about the bad things that have happened to them … and we honor the fact that there are very many difficulties with an illness story. But the peer specialist is focusing on a recovery story. That doesn't mean they don't talk about the bad times, but the focus of the recovery story is really to talk about what they've done to move on-the actions they have taken, the steps they have put into place-so that they can move forward in their lives and overcome the disabling power of their illness.
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Many consumers are quick to point out that, occasionally, there is an appropriate time to tell your illness story as opposed to your recovery story. We can all relate to those times in our lives when we've just wanted to hear that others have been where we have been.
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Sometimes telling the hard truth about your life experiences can be helpful. But, peer specialists never leave out the fact that they are working, or have worked, to experience recovery on the other side of the illness.
Early in my diagnosis of bipolar illness, the illness really took over my life, and I shared my illness story. I wanted people to know my diagnosis. I talked a lot about my medications. I bought into negative ideas like "the stress may keep me from working again," and I really became someone that was so focused on my illness and not the possibility of recovery. Today, I share my recovery story. My recovery story is about my strengths. It's about my life. It's about authoring two books. It's about writing for a newspaper. It's about walking in the woods with my dogs ‌ with my wife. I have a meaningful and purposeful life. Those are elements of my recovery story. - Larry Fricks
KNOW THE DIFFERENCE
RECOVERY
ILLNESS
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Story about overcoming challenges
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Story about challenges
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Focus on choices & responsibility
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Focus on symptoms & treatments
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Emphasis on strengths & opportunities
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Emphasis on deficiencies & problems
STAGE 1
IMPACT OF ILLNESS This stage is the time between when symptoms first begin and when a person is diagnosed. People can go through intense emotional suffering from the symptoms of the illness and also from being diagnosed with a mental illness. These experiences are often overwhelming. And they change the way they see themselves. The danger is that people will start to see themselves in terms of their mental illness. By re-defining their identity , they automatically limit their belief about what they can and will be able to do. They begin to see themselves as the illness. They see themselves as unable to do most of the things they would like to, and they give up their hopes, dreams and expectations.
USING YOUR RECOVERY STORY In Stage 1, peers often simply need to know that they're not alone, that others have gone through what they're going through right now. As a peer specialist, you might talk about the pain and challenges you encountered when the illness and/or diagnosis first impacted your life. But you also want to be sure to talk about the fact that a psychiatric diagnosis does not define who you are as a person. While you've experienced despair and loss, in time, and with good choices, the impact of the illness passed.
STAGE 2
LIFE IS LIMITED During this stage, people resign themselves to a life without the possibility of anything ever changing. They believe their lives are limited, because of the diagnosis, in ways that aren't necessarily true. And they get "stuck" in the mental health system for years. They might not believe they can work, continue their education, live on their own or do other things that would bring a sense of meaning and purpose to their lives. They often resign themselves to a limited life of "being on benefits and going to program." The danger is that these individuals will refuse to acknowledge that there's anything they can do that will make a difference in their life.
USING YOUR RECOVERY STORY It’s often during this stage that a full recovery story can be the most effective. Sharing where you've been-and how you emerged from feeling like "life was limited"-can be one of the most powerful techniques you can use as a peer specialist. So often, mental health professionals, who haven't had the lived experience, are at a loss as to how to help someone move beyond this stage. But peer specialists can share practical, real and authentic stories with their peers that show them what life can be like beyond that "limited" stage.
STAGE 3
CHANGE IS POSSIBLE When people accept a life without the possibility of change, they see their lives with a mental illness as limited. They believe there's nothing they can do about it, and they may have been stuck in the mental health system for years. But in this Change is Possible stage, something happens that causes them to see that life can be more than they thought it could be. When people see they need to take some risks and move out of their "comfort zone," they might begin to doubt whether they can actually do this.
USING YOUR RECOVERY STORY Some people find this surprising but many peers appreciate hearing stories about failure in this stage. Talking about how you've tried something outside of your comfort zone, been uncomfortable or even unsuccessful doing it--and then tried again anyway-an be really empowering to some people. Others just need to know that there have been times in your life when you've reached outside your comfort zone and everything has turned out OK and you were able to move on with your life. Those anecdotes are important parts of your
STAGE 4
COMMITMENT TO CHANGE This is the stage when people decide to take a risk and move out of their comfort zone. Often, this involves taking small steps that don't necessarily "move you toward a goal" but do break the pattern of doing nothing. The danger is that people won't know all of the supports they'll need to be successful and they'll move too quickly. Then, if they don't succeed, the danger is that they'll retreat back into their comfort zone in the mental health system.
USING YOUR RECOVERY STORY This stage is an excellent time to tell the parts of your recovery story that have to do with how you asked for help, even if it was hard to do. If the danger in this stage is that people won't know all of the supports they'll need to be successful, it can be incredibly powerful for a peer specialist to talk about the support structure they've built around themselves and the important role each of their supporters plays.
STAGE 5
ACTIONS FOR CHANGE In this stage, people decide to make a major change in their life. This often involves finding relationships and activities outside the mental health system. As they move away from the system, they must take more and more responsibility for their own decisions. The danger is that they'll begin to doubt whether they can make decisions and function on their own. If they feel like they can't function without the mental health system's support, they could fall back into a limited life inside the system.
USING YOUR RECOVERY STORY In this stage, your recovery story can be helpful if told from the point of view of all the celebrations you've had on your journey. Re-telling your successful, triumphant recovery story can "prove" that all the risks and responsibilities that the peer is taking on are the right decision. Your story can assure a fellow consumer that all the hard work is worth it.
SHARING YOUR ILLNESS STORY.
ILLNESS STORY •
“I haven't found that it's particularly helpful to describe the pit of despair or the agitation of mania without also sharing the fact that one can recover from those places.”
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The value of including and not excluding the illness part is again that one isn't presenting some sort of canned “and they lived happily ever after” scenario but they are allowing other people to see that one is human and fallible and broken just like they are.
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It important not to go around just telling war stories or just commiserating - that the illness part, of course, can be included as long as there is a recovery perspective too.
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“I have to be careful to stay in reality. Especially with the passing of time, there is a temptation to elaborate because we think our stories may be boring, may not be colorful enough, or may just not be interesting. I think that it's very important for us to resist that temptation when we're telling the story and stick to what really happened because otherwise we really do an injustice to the people that we are speaking to.
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I think it's really important to stay honest. We don't have to entertain. We don't have to titillate. We don't have to have people say “Wow!” We don't need to be admired or revered. The point is to assist the other person in their recovery. And person after person has discovered that honestly sharing what worked to get us unstuck or to get us moving - that is what makes the difference.”
CHANGING YOUR STORY
“I don't think that I change the facts but I may choose not to lay out all the details. If a person is in crisis and has a short attention span, I may only have a minute of their attention and so I need to put in that minute what is most appropriate for them. We always have to meet people where they are. If a persons understanding is confused and they are agitated, maybe a sentence is all they can really digest. That sentence may not be about deciding to become the leader of a support group at that point. That's not where they are. We always have to meet people where they are. One just adjusts to the situation. A person may have just lost a loved one. That is not the time to go into a detailed story of my hospitalization. That may just be the time to share with them what it was like when I lost a loved one.”
“There are times when our experience won't match another person's experience. Actually, it was times like that made me realize how important training is. Because as basic as our lived experience is, every individuals lived experience is different. There are many, many people whose experience I won't have lived. So what's the point of sharing my story, I asked myself, with someone whose story is so different? It really doesn't matter what the specific circumstances are. What matters is an approach. If a person is at, for example, a stage where they are committed to changing; committed to retaking control of their life, that's not the time for me to share about when I was in crisis and when I was hospitalized. That's the time to share when I was committed myself; to making a change and what helped me there.”
CHANGING YOUR STORY
“So it's like having a little library of your own experiences. Because my life is a series of volumes, or a mini-series, and you choose which one you want to use. Our own life is the best tool, but we use the right tool for the moment. Rarely have I found myself sharing the entire story with one person, rarely, because I'm always looking for where they are and what may best mirror that. I think it's very important to keep in mind why we tell our story. We're not telling our story to vent. We're not telling our story because it's helping us. We're telling our story with the purpose and objective to demonstrate something to that person that will hopefully assist them in their own recovery. And so, keeping that purpose first and foremost will keep us from the pitfalls of embellishing or being shy or being afraid or talking too much or not talking enough. I think many times we get so caught up in our own story.”
“One of the little vignettes I'd like to share - there were many times early on in my work as a peer that there were some things in my story that if I brought them up I would cry. The strength of it was still so overwhelming to me personally that I couldn't share it without becoming very emotional. That, I find in general, was unhelpful to people. I wasn't done healing yet. Now, there are some circumstances where that might be helpful, but in general if I got so caught up in the telling of my story that I was focused on myself instead of the other person, that's a problem. I find that if I am able to tell the story and keep my focus on the other person's wellbeing, on the other person's recovery, and listen to them as they react to my story, then it's useful. If I get caught up in the telling, then I'm paying too much attention to myself. That's dangerous. Then we've missed a cue.”
WITH CAUTION •
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For some peer specialists, it can be traumatizing to re-hash some of the more challenging times in their recovery journey.
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Many people would suggest that there might be some dangers or pitfalls involved with telling your own recovery story to others in an effort to support their recovery.
Furthermore, it's important to keep in mind that many of our peers who are recovering from mental illness have experienced some sort of abuse or trauma in their lives. Hearing your story of similar experiences might retraumatize them.
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The first thing that comes to mind is a cultural consideration. Having a person talk to you about some of the most vulnerable periods in your life can be overwhelming, and even inappropriate, for people of certain cultures.
There are other parts of our stories that can trigger symptoms of our illnesses in ourselves or others. Talking about hyper-sexuality, suicide attempts or experiences that come along with drug use can be particularly triggering for some people. (Create guidelines with your mentee)
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Still, with all this in mind, a peer specialist's recovery storywhen told authentically and with pure intentions-is one of the most powerful tools you, as a peer specialist, can have.
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Tell your story with care.
The telling of your personal story is a tool, is a skill that is used for the purpose of enhancing someone else's recovery, assisting someone else in their recovery. There are times when asking questions is a more appropriate tool. There are times when silence is a more appropriate tool. Telling our story can be very powerful when we keep in mind that it is a means to an end and not an end in itself.
Some cultures simply don't promote that type of selfdisclosure. Other language or cultural challenges might also arise when you're sharing these sensitive stories, so it's important, as a peer specialist, to use your story with care.
RECOVERY STORY
USE THE QUESTIONS TO BUILD YOUR OWN RECOVERY STORY. FOR SOME PEOPLE WHO HAVE DONE THIS EXERCISE IN THE PAST, WORKING ON THESE QUESTIONS TRIGGERED SOME ANXIETY, FEAR AND SADNESS.
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Please be mindful of your own triggers while you work through these questions. Be careful to avoid anything that might be traumatic. But also remember that the more authentic you can be, the more powerful your story will be.
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What were some of the early indications that you were beginning to have difficulties?
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Briefly describe yourself and your situation when you were at your worst.
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What helped you move from where you were to where you are now? What did you do? What did others do?
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What have you had to overcome to get where you are today?
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What have you learned about yourself and what we call recovery? What are some of the strengths you’ve developed?
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What are some of the things that you do to keep yourself on the right path?
RECOVERY STORY We know that the essential elements of a good recovery story are honesty, good intentions, a focus on what has helped and using it in a way that's appropriate to your peer's needs. We know that everyone has a powerful story to share, and all of us who have experienced mental health challenges can find a strong common bond on our journey to recovery. Recovery stories build trust. They break down walls. They help eliminate stigma. They empower others, and they give our peers opportunities to learn from our life lessons. And, they prove that recovery is possible. But if we use them inappropriately, recovery stories can do harm and get in the way of healing. It's important to respect the power of a peer's story-and use it in helpful ways.
ARE YOU TELLING A DIFFERENT STORY NOW? Has your focus shifted from an illness story to a recovery story?
VALUE OF PEERS.
MYTHS/FEARS
COMMON FEARS EXPRESSED BY PROVIDERS •
What if the peer specialist gets sick again and can't handle the pressure of this job? After all, they might have experienced very acute phases of a serious mental illness that they have to manage daily.
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What about confidentiality? Can they be trusted if they access medical records? Will they tell their other peers about the clients they're working with?
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What will these peer specialists do? How's the work they're doing different from the work our therapists, case managers and social workers are doing?
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Are they reliable? Are we going to have to make special arrangements for these new employees because of their mental health issues? Will they show up?
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What about liability issues? Aren't we setting our agency up for potential malpractice liability or some other problems because of their past history of mental illness?
SUPPORTING OURSELVES
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As mental health systems shift to focus on strengthbased recovery, rather than illness or disability, many of the current concerns that supervisors have will iron out naturally. For example … fear of relapse. In a recovery-focused environment, relapse is considered part of recovery rather than something to fear.
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A peer specialist should know their early warning signs, their triggers. They need to model owning your own recovery, being aware of the things that keep you well. And in doing that, you start to shift the system, and relapse just becomes something that's less fearful. It becomes a part of recovery.
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As part of recovery, a consumer is trained to use selfdirected prevention tools like the Wellness Recovery Action Plan (WRAP) that helps them to be aware of their early warning signs and triggers. That awareness-coupled with a personal action plan to stay well and identified supports to connect with as neededhas proven successful in many states to minimize relapse and keep people out of hospitals.
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All Peer Counselors are required to complete their own Crisis Plans, Safety Plans, and Wellness Plans.
SUPPORTING RECOVERY
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As consumers of mental health services, many people on LETS’ team have unfortunately encountered mental health care facilities that did not support or encourage recovery. These facilities had atmospheres, or environments, that subtly sent negative messages to the clients receiving services there.
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Now, most of the time, this was entirely unintentional, but the messages were being received nonetheless. Those who've used mental health care services in the past can teach us a lot and offer an interesting perspective about their program's environment-and what they'd do to change it if they could.
WE'VE ASKED PEOPLE IN RECOVERY FROM MENTAL ILLNESS ABOUT WHAT THEY'VE SEEN IN MENTAL HEALTH CARE PROGRAMS THAT DIDN'T REALLY PROMOTE THE SPIRIT OF RECOVERY. THEIR RESPONSES WERE SO INTERESTING. WE BELIEVE THAT MOST PROGRAMS DON'T MEAN TO SEND THESE MESSAGES-OR EVEN KNOW THEY'RE SENDING THE MESSAGES-BUT CONSUMERS DEFINITELY RECEIVE THEM.
HURTS RECOVERY •
* "Progress reports show no changes."
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* "Goals are to stay out of the hospital and take my meds on time."
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* "Staff tells consumers what to do."
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* "Staff telling another staff that a certain consumer will never change."
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* "Clients are not on the advisory council."
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* "Cookie cutter treatment plans."
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* "Shamed into compliance."
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* "Separate bathrooms for patients."
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* "Staff does the treatment plan; client signs it.”
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* "Staff leading all groups."
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* "Clients do not know their goals.”
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* "Clients watch TV and smoke cigarettes all day long."
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* "Inappropriate comments by staff about consumers (which they don't think we can hear)."
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* "Focus is on problems, not solutions."
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* "Lack of physical contact."
Obviously, these messages aren't in every program environment. But when we've talked with newly hired peer specialists and peer specialists in training, they tell us these are real situations they've encountered. Environments that send these subtle messages about the lack of potential in consumers make it very challenging for peer specialists-who are trained to promote and support true recovery-to do their work effectively.
HELPS RECOVERY •
* "Bring in program graduates to tell their success stories."
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* "Paint the place more inviting, comforting, healing colors."
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* "Celebrate consumer and staff victories."
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* "Train consumers to write their own progress notes."
* "Ensure that everyone has input into program development and evaluation."
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* "Educate staff and consumers on the philosophy of recovery."
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* "Always ask, 'How does that support his/her recovery?'"
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* "Set up an ongoing goals support group."
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* "Offer training in stress reduction and stress management."
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* "Teach consumers problem-solving skills."
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* "Surround everyone with written messages of hope and recovery on the walls."
CAN YOU NOTE ANY OF THESE IN YOUR OWN LIFE, TREATMENT, OR RECOVERY?
SERVICES IN THE PUBLIC MH CARE SYSTEM.
SERVICES
OUTPATIENT •
Brief Intervention Treatment
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Individual Treatment Services
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Crisis Services
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Intake Evaluation
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Day Support
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Medication Management
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Family Treatment
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Medication Monitoring
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Free Standing Evaluation and Treatment
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Mental Health Services Provided in Residential Settings
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Group Treatment Services
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High Intensity Treatment
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Stabilization services
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Therapeutic psychoeducation
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Peer Support
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Psychological Assessment
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Rehabilitation Case Management
CRISIS •
Hotlines, 27/4 care, face-toface evaluations
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Stabilize a person in crisis
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Prevent condition from worsening
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Immediate treatment
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Voluntary/involuntary hospitalization
MEDICAL MODEL •
Dominant approach to illness in Western medicine
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Find medical treatments for diagnosed diseases and treat the human body as a very complex machine
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Drives research and theory and physical and mental problems on a basis of cause/cure The recovery movement grew out of the desire of people with disabilities to obtain a better quality of life when it was clear that the medical model was often focused on simply maintaining or coping.
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A medical approach has its place and is not necessarily inconsistent with a recovery approach
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Early pioneers in the consumer movement had a vision that they could do more than just survive, maintain, or cope.
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They had a dream of equality, of a place at the table in work places and finding their own powerful voice. They recognized that they had strengths and abilities.
LANGUAGE MATTERS •
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When we talk about mental illness, the words we choose are very important. Respectful language can promote recovery and reduce stigma. A poor choice of words can have the opposite effect. Consider the following word choices: person instead of patient or client; challenge instead of failure, opportunity instead of crisis, life experience instead of history of illness, strengths instead of weaknesses, recovery path instead of cure, acceptance instead of blame
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The bolded words are positive and have a sense of power to them; they engender hope and possibility. The words on the right are negative and do not demote a sense of personal identity.
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Words can go a long way in facilitating someone’s recovery and combating stigma within and outside of the mental health system.
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Use terms like service/resource coordination rather than case management. People are not cases, and should not be managed.
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Peer Counselors promote a partnership, which means that terms such as compliance (a metaphor of force), are to be avoided, since compliance suggests mindless conformity.
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Other words seem loaded with judgment—consider the implications of words like refuse and resistant.
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Terms like involvement, adherence, partnership, and cooperation are less passive, and more suggestive of someone taking active responsibility for his or her own recovery.
FIRST-PERSON LANGUAGE
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“Words have power. They have the power to teach, the power to wound, the power to shape the way people think, feel, and act toward others.” -Otto Wahl
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Person first language refers to the practice of putting the person first when writing or talking about a person with a disability. Using person first language emphasizes the person rather than his or her symptoms or diagnosis.
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For example, it is preferable to say “the person with mental illness,” rather than “the mentally ill man” or “the schizophrenic.” We do not want to lose sight of the person just because a psychiatric label has been attached to them.
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Referring to a person simply by his or her diagnosis is on some level dehumanizing, even if this is not what the speaker or writer intends.
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It is the hope of many in the consumer movement that print and online documents will use person-first language, which refers to people in a way that focuses attention on their humanity, rather than on the existence of a disability, illness, condition, or characteristic.
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Person: Use person alone when the person’s role (e.g., psychiatrist) or diagnosis is irrelevant. For example: The sentence “People succeed at work when they have adequate skills and supports.” is true whether we are talking about someone who is returning to work after receiving supported employment services or about someone who has landed a first professional job following graduate school.
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Someone with a history of depression, not suffering from depression. Suffering is a self-descriptive concept, to be used only by the person who is experiencing the suffering.
PSYCHIATRIC DISABILITY
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In general, the term psychiatric disability is preferred to both the phrase mental illness, and the use of specific diagnoses.
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This term will be used in the manual but we do not prescribe any particular term.
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People have the right to refer to themselves as they choose, for example, a person might not believe that his/her psychiatric condition is disabling, and might prefer a term other than disability.
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Some other acceptable terms are: person living with a psychiatric disability/psychiatric illness
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While effective communication with the medical community might, at times, make medical terminology useful, peer counselors are urged to avoid the most medically oriented terms, and to assist the medical community in transitioning from a system that “does to” into a system that “does with.” In other words, we want to encourage partnerships between the people who use services and the people who provide them.
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When necessary, specific diagnoses are preferred to more global terms, and are to be used in a personfirst format, as in using the term “a person living with schizophrenia.”
LANGUAGE GUIDELINES
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Psychiatric disability implies something a person has (not is), while emphasizing ability, and is comparable to physical disability.
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The term “mental illness” implies a medical perspective, with an emphasis on diagnosis and symptoms, and is comparable to a physical illness.
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Mental health implies wellness and successful cognitive and interpersonal behaviors, and is comparable to physical health, in the sense that someone can be basically healthy while still experiencing occasional periods of illness or symptoms.
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Terms like serious, significant, severe, and persistent provide an image of a long-term (potentially life-long) difficulty, and are better than chronic, which implies hopelessness. Even for the most severe and longterm psychiatric disorders, however, we must all believe in the possibility of recovery.
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A description of specific strengths and weaknesses in relation to a desired goal is preferable to an overly general and pejorative term such as “low functioning.”
HOPE.
“The capacity for hope is the most significant fact of life. It provides human beings with a sense of destination and the energy to get started.� - Norman Cousins
WHAT IS HOPE?
HERE ARE SOME ADDITIONAL WAYS OF THINKING ABOUT HOPE: And why is hope so important for individuals dealing with a diagnosis of mental illness?
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Hope is the belief that a positive outcome lies ahead.
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It is a way of thinking, feeling, and acting that can help ease overwhelming doubts and fears, and help one move through difficult situations.
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Hope is being honest with yourself about your situation in life while still looking forward to possible positive outcomes in your future.
There is no other area of healthcare where people come for help with overwhelming amounts of hopelessness, fear, shame, and guilt.
WHAT IS HOPE? THERE ARE COMMON EXPERIENCES THAT OFTEN ACCOMPANY RECEIVING A DIAGNOSIS OF A MENTAL ILLNESS, THESE INCLUDE: •
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The above quote came out of the Well-Being Project —which was a landmark effort by the California Department of Mental Health in 1989 to identify factors which promoted and hindered the well-being of individuals with mental illness. What they found is that people were just as harmed by the internalization of stigma and the feelings of helplessness and hopelessness as they were by their own symptoms of mental illness.
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Experiencing major losses
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Becoming socially disconnected
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Losing economic status
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Experiencing stigma from society
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Becoming demoralized by “the system”
MAKING HOPE
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ON THE SURFACE, THIS LIST SOUNDS PRETTY HOPELESS, FORTUNATELY IT’S NOT THE WHOLE PICTURE.
More often than not, when individuals are asked, “What helped you to begin your recovery journey?” they reply “There was this one person…this one person who I came in contact with who didn’t treat me like an incapable sick person—who looked beyond my symptoms and realized that I had many strengths and skills and abilities. This person helped me re-discover my true self and helped me begin to put the pieces of my life back together. This person held the hope for me when I believed there was no reason to go on.”
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Hope, then is the turning point or the moment when one’s desire is accompanied by the belief in the fulfillment of something better, perhaps when one takes that first step and dares to dream again…
WRITE DOWN WHEN YOU FIRST ENCOUNTERED HOPE. WHAT INSPIRED YOU TO THINK YOU HAD OPTIONS?
LEARNED OPTIMISM •
Martin Seligman is known for his research on “learned helplessness,” which describes what can occur when animals or human beings learn that their behavior has no effect on the environment.
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We often say and hear others say “it’s just my nature” to be pessimistic. Some of us may believe that pessimism is a family trait and that family characteristics are set in cement. They are not!
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In 1998, after being elected the President of the American Psychological Association, he decided to change the focus of his research and instead began looking at “learned optimism” and “positive psychology,” intent on focusing on those things that lead to mental wellness. This represented a huge shift.
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The health of every human body is greatly influenced by the state of its mind. This means that people with an optimistic outlook are less likely to be ill, both mentally and physically. Once people are ill, the course of their illness can be strongly influenced by the way they think about it.
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Personal empowerment requires that individuals overcome all the pessimistic expectations that are associated with receiving a diagnosis.
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Moving away from language that is self-stigmatizing is a huge step peer counselors can take in empowering individuals to believe in themselves, to have the ability to determine their destiny, and to look optimistically about their future.
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Peer counselors should begin to teach the skills of optimistic thinking, to help move peers from a place of learned helplessness to learned optimism. If the peer counselor by nature has difficulty with optimism he or she may be encouraged to know that optimism is a skill that can be learned.
EMPOWERMENT.
HISTORY •
Modern use of the term originated during the Civil Rights Movement, which sought political empowerment for its followers. It was then taken up by the Women’s Movement and then finally adopted by the Disabilities and Mental Health Consumer Movements as they migrated out of political arenas.
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What all of these groups had in common was a need for a word that made individuals feel that they were or were about to become more in control of their destinies.
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Empowerment is central to recovery and resilience. Peers are empowered when they participate in their own services and are involved in self-help with a mind-set of consumer rights. Peer participation in their own services, self-help, and embracing consumer rights are key strategies for promoting empowerment.
IN PRACTICAL TERMS, FOR THE PEER COUNSELOR, THIS MEANS: •
Focusing on the strengths of an individual and/or family
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Supporting active participation in the helping process by the individual and/or family
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Approaching the use of resources in a way that relies on the entire community rather than relying solely on formal services
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Reconnecting and strengthening informal and social networks and support systems.
ELEMENTS DECISION MAKING POWER People must be encouraged and allowed to practice making decisions. Everyone learns through trial and error. Without the opportunity to make important decisions about one’s life, people can remain stuck in long-term dependent relationships.
ACCESS TO INFORMATION AND RESOURCES When people have access to resources and information, they have the tools they need to act with more autonomy. Peer counselors promote psycho-education and encourage problem-solving techniques. Aids such as medication logs and mood charts may help individuals who will then go on to manage their needs more independently, increasing their level of empowerment. Peer Counselors can also support the use of Advance Directives. Advance Directives are legally binding documents that empower people to make their treatment preferences known prior to going into crisis. There are Advance Directives for both physical and mental health, we encourage the use of both.
LEARNING TO THINK CRITICALLY; SEEING THINGS DIFFERENTLY The empowerment process includes a reclaiming of one’s sense of competence and recognition of the often-hidden power relationships inherent in the treatment environment. As peers become empowered, they may want a more collaborative relationship with their treatment providers than they previously had.
ELEMENTS LEARNING ABOUT AND EXPRESSING ANGER
Individuals should learn to safely express their anger. People need to understand how anger can be used constructively and to recognize its limits. For some, the expression of anger has been restricted in part due to fear and an overestimation of its destructive power. Anger can be destructive—however it can also be a legitimate expression that is handled both safely and constructively.
NOT FEELING ALONE - FEELING PART OF A GROUP It is important to recognize that empowerment does not occur to the individual alone, but has to do with experiencing a sense of connectedness with other people.
EFFECTING CHANGE IN ONE’S LIFE AND COMMUNITY Empowerment is more than a feeling or a sense—these feelings are a precursor to action. Making change in one’s life increases feelings of mastery and control—which in turn leads to further and more effective change.
CHANGING OTHERS’ PERCEPTIONS OF OUR COMPETENCY AND CAPACITY TO ACT Sometimes people set low expectations for an individual due to a psychiatric disability, however when people take control of their lives and demonstrate competency these false expectations are disproved. As individuals earn the respect of others, their self confidence increases and this helps them to act with increasing empowerment—which further changes the perceptions of others.
REFLECTING
DISCUSS YOUR PERSONAL EXPERIENCES WITH EMPOWERMENT. WHICH ELEMENTS DID YOU RELATE WITH? CHOOSE A PART OF YOUR RECOVERY STORY THAT RELATES TO ONE OF THE ELEMENTS TO SHARE WITH YOUR GROUP.
PERSONAL
RESPONSIBILITY
TAKING CARE
1. 2. 3. As we reveal more of ourselves to the peers we work with, we are role modeling recovery and resiliency. It is important that we continue to work on our own wellness and encourage the same for peers. One of the ways we model recovery and resilience is to take personal responsibility for our best health.
“You are the expert on yourself. You know what you need and want. It is up to you to take personal responsibility for your own wellness and your own life. Sometimes this means taking back control that you have lost in the past. Those of us who take back this control and accept this responsibility achieve the highest levels of wellness, happiness, and life satisfaction.�
Personal responsibility also means that individuals have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Individuals must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness. The role of the peer counselor is to support individuals in doing so.
WRAP:
A TOOL YOU SHOULD KNOW.
WRAP PLAN
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Part of being responsible for ourselves and our wellness may include developing a plan to ensure that our needs are being met. There are different tools available for doing this, one example is the WRAP or the Wellness Recovery Action Plan (WRAP) by Mary Ellen Copeland.
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“The beauty of WRAP is the fact it is completely individualized to what each of us needs for our recovery. For some peers, WRAP training provided the first opportunity to really think about our lives and not feel victimized by illnesses we felt we had no control over.
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WRAP lays out an organized way of creating a selfhelp recovery plan for how you can meet your needs on a day to day basis and in times of crisis. This can be useful to you in your own recovery which you can model to peers. It is also a significant tool that you can learn to teach to peers.
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We learned that we could have some control and that we could learn to identify what we were like when we were doing well, what we were like when we weren’t. By labeling our experiences we could dig further and find those key individual elements that were present in our good times.”
“We found we had the power with a little training to incorporate positive, health imparting things into our lives. This moved us to self-empowerment and the ability to take control of our mental health. We became more confident and began to believe we had it in us to recover and we had a path marked for ourselves to get there. The tools gave us a sense of hope that we could identify triggers or flags if our mental health was deteriorating and by recognizing the triggers we could put limits on them.�
RECOVERY PROCESS.
RECOVERY PROCESS
SIGNS OF RECOVERY: •
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As we said earlier, mental health recovery is a journey. If we take this idea further, we can look at it as a pathway, recognizing that each individual has their own unique path. Each person is in a different place on the recovery pathway. People move at their own pace.
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Hope, self-awareness, positive language
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Positive language
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Having positive self-regard instead of stigma against mental illness
The recovery approach views setbacks in recovery as part of the human process and as opportunities for learning rather than regarding a relapse as a permanent and stigmatizing event.
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Connection with peers, friends, and family
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Connections in the community
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Helping others
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Self-advocacy
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Involvement in one’s spirituality or spiritual tradition
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Having a support network
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Having a crisis plan/WRAP plan
The word relapse is laden with negative emotions and judgment from the past. Because this model recognizes that growth can occur from setbacks in recovery, the pathway does not necessary look like a straightforward arrow.
BARRIERS TO RECOVERY •
Stigma
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Blame
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Discrimination
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Getting stuck in anger
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Misinformation
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Negative self-talk
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Lack of services, programs, and/or resources
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Poverty and lack of resources
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Lack of individual care plans
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Homelessness
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Lack of certified peer counselors for positive role models in the system
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Domestic violence
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Dependence on an abusive partner or family member
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If any of these are current issues in a peer’s life, their WRAP plan and/or their Individual Service Plan may have strategies to counteract these barriers.
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Choose three of the above barriers and, with a partner from the class, develop strategies that you, as the peer counselor, could use to overcome them.
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Lack of options to allow for individual choice in the care plan
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Poor self-care
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Isolation due to fear or rejection
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Substance abuse/misuse of medications
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Finding the right medication