Galia S. Moran

Benefits and Mechanisms of Recovery Among Peer Providers With Psychiatric Illnesses

Providing peer support to individuals with psychiatric disabilities has emerged as a promising modality of mental health services. These services are delivered by individuals who experience mental illnesses themselves. The purpose of this study was to explore how working as a peer provider can enhance personal recovery. The study was conducted with 31 peer providers employed in a variety of mental health agencies. Data were collected through face-to-face semistructured interviews and analyzed using a grounded theory approach. Qualitative analysis revealed a wide range of recovery benefits for the peer providers. The benefits span across five wellness domains: foundational, emotional, spiritual, social, and occupational. In addition, analysis revealed five role-related and five work-environment-related mechanisms of beneficial impact. The role of sharing one’s personal story is highlighted as contributing to positively reauthoring one’s self-narrative. Implications for peer training, job development, and workplace supports are discussed.

Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Peer providers are increasingly employed in mental health services. We explored challenges experienced by 31 peer providers in diverse settings and roles using in-depth interviews, as part of a larger study focusing on their recovery (Moran et al. in Qual Health Res, 2012). A grounded theory approach revealed three challenge domains: work environment, occupational path, and personal mental health. Challenges in the work environment differed between conventional mental health settings and consumer-run agencies. Occupational domain challenges included lack of clear job descriptions, lack of skills for using one’s life story and lived experience, lack of helping skills, and negative aspects of carrying a peer provider label. Personal mental health challenges included overwork and symptom recurrence. Implications for all domains are discussed, with focus on training and skill development.

Motivations of persons with psychiatric disabilities to work in mental health peer services: a qualitative study using self-determination theory.

Introduction Individuals with psychiatric disabilities have low rates of employment and occupational rehabilitation success. Mental health peer services are a new occupational modality that opened a promising occupational path: persons with serious mental illnesses employed to provide support to others with psychiatric conditions. However challenges to successful peer work exist. Work motivation is central to understanding and supporting peer workers, yet little is known about sources of motivation to work as mental health peer providers. The aim of this study was to identify what drives individuals to mental health peer work using self determination theory (SDT). Methods Motivations of 31 mental health peer workers were explored as part of a larger study. A theory driven approach was employed to emerging qualitative data using SDT concepts: external motivation and internally regulated motivations derived from basic needs (autonomy, competence, relatedness). Results External motivations included generic occupational goals and getting away from negative work experiences. Internal motivations corresponded with SDT basic needs: autonomy met-needs was reflected in having freedom to disclose and finding that work accords with personal values; competence met-needs was reflected in using personal experience as a resource to help others; and relatedness met-needs were reflected in having opportunity to connect intimately and reciprocate with consumers. Conclusion This study identified external and internal motivations of persons with psychiatric disabilities to work as peer providers—a novel occupation in mental health. Employing personal experience and enabling peer contact emerge as major motivational tenets of mental health peer work. According to SDT instrumental occupational goals are considered more external than satisfaction of basic psychological needs. The study demonstrates the applicability of SDT in the design of autonomy supported environments to promote work engagement and sustenance of mental health peer providers.

Walking on the Sunny Side: What Positive Psychology Can Contribute to Psychiatric Rehabilitation Concepts and Practice

TOPIC This article suggests a positive psychology framework to strengthen and broaden psychiatric rehabilitation and recovery thought and practice. PURPOSE We inform about positive psychology concepts and measures that can be used to further knowledge, enhance practice, and guide research. SOURCES USED Foundational concepts are drawn from the published literature. Specific positive psychology concepts and measures are highlighted: complete mental health, well being, flourishing, positive emotions, flow, self-determination, posttraumatic growth, and resilience. CONCLUSION AND IMPLICATIONS FOR PRACTICE Employing a positive psychology framework can advance research on recovery phenomena and be used to assess rehabilitation outcomes. In addition we advocate positive psychology interventions in education and training of service providers that will enhance a positive focus and the culture of recovery.

The relational reframe and parents’ problem constructions in attachment-based family therapy

Abstract The authors studied the impact of relational reframes on parents’ problem constructions and the reciprocal impact of parents’ problem constructions on therapists’ use of the relational reframe in five early sessions of attachment-based family therapy for depressed adolescents. Across all five sessions, relational reframes led parents to construct problems in interpersonal terms in at least two of their six subsequent speech turns. There was partial support for the hypothesis that reframes led to shifts in parents’ constructions, from intrapersonal to interpersonal. In good, but not poor alliance sessions, parents’ interpersonal problem constructions led therapists to use relational reframes. Future research should examine not only how interpersonal problem constructions are generated but their quality as well.

Generating nonnegative attitudes among parents of depressed adolescents: The power of empathy, concern, and positive regard

Abstract Parental negativity is associated with the onset and maintenance of adolescent depression. Reducing parental negativity is a primary focus of family-based treatments for this clinical population. This study examined the association between therapist relationship-facilitating and attachment-oriented interventions and the valence (i.e., positivity–negativity) of parents’ attitudes toward their depressed adolescent in a sample of 13 sessions of attachment-based family therapy. Lag sequential analyses revealed that in good alliance sessions relationship-facilitating interventions, such as empathy and positive regard for the parent, were associated with parents’ nonnegative attitudes toward their adolescent in the five speech turns subsequent to the intervention. Attachment-oriented interventions, such as relational reframes, addressing core relational themes, and highlighting vulnerable emotions, were also intermittently associated with nonnegative parental attitudes in good alliance sessions. No such effects were evident for the comparison interventions. This study represents a first step in the process of testing specific strategies for reducing parental negativity in family therapy.

Psychiatrists’ Challenges in Considering Disclosure of Schizophrenia Diagnosis in Israel

Doctors’ clear disclosure of diagnoses to patients is fundamental to patient autonomy and patient-centered approaches in health care. Although diagnosis disclosure is common in general health, it is less so in psychiatry. The aim of this study was to explore psychiatrists’ experiences of schizophrenia diagnosis disclosure to patients and/or family members. We conducted in-depth interviews with 14 psychiatrists from hospital and community settings in Israel and used a phenomenological framework to analyze the interviews. Overall, psychiatrists experienced disclosure as problematic, unproductive, and harmful. We identified 10 themes of psychiatrist experiences and concerns conceptualized under three domains: (a) characteristics of schizophrenia, (b) the doctor–patient/family relationship, and (c) psychiatrists’ difficulties with the disclosure task. We discuss the results suggesting a multilayered model of medical, relational, social, and personal disclosure challenges. We suggest that a constructive schizophrenia diagnosis disclosure needs to take into account psychiatrist- and patient-related factors and specify possible directions.

Understanding Universal Elements in Mental Health Recovery A Cross-Examination of Peer Providers and a Non-Clinical Sample

In our study, we examined underlying human elements embedded in mental health recovery, by exploring shared positive change among peer providers with serious mental illnesses in recovery and a normative sample in spiritual growth following adversity. We conducted secondary analysis based on two independent qualitative study samples consisting of 31 American peer providers and 27 Israeli adults. We identified three shared and two distinct enablers of positive change: peer groups, significant mentor, self-transcendent experiences. Distinct enablers were having meaningful task/role (clinical sample) and deliberate choice to commit to change in face of uncertainty (non-clinical sample). Enablers facilitated positive processes of meaning making and enhancement of agency. Enablers provided opportunities to which the person responded and made use of—thus, enacting a positive reinforcement of change processes. The findings highlight the value of examining mental health recovery in a broad holistic perspective and have implications for practice.

A Qualitative Study Examining Experiences and Dilemmas in Concealment and Disclosure of People Living With Serious Mental Illness

People with mental illnesses face the dilemma of whether to disclose or conceal their diagnosis, but this dilemma was scarcely researched. To gain in-depth understanding of this dilemma, we interviewed 29 individuals with mental illnesses: 16 with major depression/bipolar disorders and 13 with schizophrenia. Using a phenomenological design, we analyzed individuals’ experiences, decision-making processes, and views of gains and costs regarding concealment and disclosure of mental illness. We found that participants employed both positive and negative disclosure/concealment practices. Positive practices included enhancing personal recovery, community integration, and/or supporting others. Negative practices occurred in forced, uncontrolled situations. We also identified various influencing factors, including familial norms of sharing, accumulated experiences with disclosure, and ascribed meaning to diagnosis. Based on these findings, we deepen the understanding about decision-making processes and the consequences of disclosing or concealing mental illness. We discuss how these finding can help consumers explore potential benefits and disadvantages of mental illness disclosure/concealment occurrences.

Adaptation and Psychometric Assessment of the Hebrew Version of the Recovery Promoting Relationships Scale (RPRS)

Recovery is supported by relationships that are characterized by human centeredness, empowerment and a hopeful approach. The Recovery Promoting Relationships Scale (RPRS; Russinova, Rogers, & Ellison, 2006) assesses consumer-provider relationships from the consumer perspective. Here we present the adaptation and psychometric assessment of a Hebrew version of the RPRS. The RPRS was translated to Hebrew (RPRS-Heb) using multiple strategies to assure conceptual soundness. Then 216 mental health consumers were administered the RPRS-Heb as part of a larger project initiative implementing illness management and recovery intervention (IMR) in community settings. Psychometric testing included assessment of the factor structure, reliability, and validity using the Hope Scale, the Working Alliance Inventory, and the Recovery Assessment Scale. The RPRS-Heb factor structure replicated the two factor structures found in the original scale with minor exceptions. Reliability estimates were good: Cronbachs alpha for the total scale was 0.94. An estimate of 0.93 for the Recovery-Promoting Strategies factor, and 0.86 for the Core Relationship. Concurrent validity was confirmed using the Working Alliance Scale (rp = .51, p < .001) and the Hope Scale (rp = .43, p < .001). Criterion validity was examined using the Recovery Assessment Scale (rp = .355, p < .05). The study yielded a 23-item RPRS-Heb version with a psychometrically sound factor structure, satisfactory reliability, and concurrent validity tested against the Hope, Alliance, and Recovery Assessment scales. Outcomes are discussed in the context of the original scale properties and a similar Dutch initiative. The RPRS-Heb can serve as a valuable tool for studying recovery promoting relationships with Hebrew speaking population.