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October 6, 2011 Volume 2, Issue 37
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Twelve Steps Toward Recovery-Oriented Clinical Practice
by Andy Bernstein, Ph.D., CPRP
Before describing how the recovery paradigm manifests in my practice as a clinician, I would like to say a few words about how I came to this place. Although it was not a typical psychologist's career path, my professional journey has taught me lessons on recovery that can and should be learned in other ways.

In 1984, I came to New Jersey with all but my dissertation complete for a Ph.D. in Clinical and Community Psychology from George Peabody College for Teachers. Peabody was an environment that embraced a "transactional–ecological" approach to science and practice. It posited a critical unity, or connection, between the knower and the known (à la John Dewey, the educator), and assumed a priori that all phenomena to be observed or impacted occur in contexts—environments—that must be acknowledged and understood.

The implications of this epistemology are far reaching with regard to culture, language, and inquiry, and imbue in students a certain sense of humility when approaching a question to ask or person to help. The latter affects clinical practice, in that one must absolutely recognize what clients bring to the table, as well as what we bring as providers, especially in terms of our own values and biases. Fortunately, I found this formal educational experience was consistent with a systems orientation I acquired before my doctoral studies. It focused my attention on the client–therapist relationship, much as all good clinical training should, but perhaps a notch or two more.

My first job after graduate school was as a community psychologist with the New Jersey Self-Help Clearinghouse, an organization that helps people find and form support groups. The position clarified the difference between two distinct paradigms of helping: professional help, delivered by trained experts, and mutual help, facilitated by peers who have lived experience coping with problems. The distinction is critical, and the fact that I often find myself bridging these two worlds is not surprising or tedious.

The job led me to the mental health consumer/survivor/ex-patient movement, which at the time in New Jersey was starting its own journey, beginning at a few local peer advocacy and support groups, moving to State-funded drop-in and self-help centers, and eventually progressing to whole consumer-operated wellness and recovery programs and the peer–provider workforce.

I was accepted into this community despite my "professional" status—years of outpatient therapy doth not a consumer make—and offered an extraordinary opportunity to participate in its growth and development, contributing what I knew about mutual help, group process, community structures, and social influence, as well as emotion, cognition, and mental health and illness. Conversely, the movement contributed enormously to my informal education, opening my eyes to what I'd now call recovery phenomena. Even then, it was changing the way I thought about mental health and help itself.

I came to know many people with serious and persistent mental illnesses who were staying out of the hospital and accomplishing wonderful things in their communities. I saw how meaningful engagement in activities and interaction with people of one's choice had the profound effect of enabling and empowering individuals to push back against symptoms, histories, and life challenges most clinicians believe are incapacitating. Often (but not always) with the help of medication, people with long histories of impairment, addiction, and disability are able to overcome these conditions and inspiringly turn their problems into the building blocks of others' solutions. Most of my provider peers do not get to know people with serious and persistent mental illnesses in this light, and I fear the absence of such exposure colors their expectations and dims their views about how recovery is truly real and possible.

Out of this personal and professional life experience, my clinical and consulting practice grew. I saw families, adults, and adolescents dealing with less dramatic life disturbances, but many who were trying to cope with chronic physical health issues, especially HIV/AIDS.

In the HIV community, I saw how peer support and a focus on wellness were critical elements in people's success for achieving better health outcomes, and how powerful it was to acknowledge the limitations of my own experiences and become the listener—having them teach me what their lives were like, before attempting to collaborate in therapeutic endeavors. This was particularly evident with members of ethnic and sexual minority groups who had been stigmatized and marginalized much of their lives, and certainly not treated well by the medical establishment.

Twelve ideas and ways of practicing that have grown from my understanding of recovery are listed below and described in detail on a separate page. Some of them will be recognizable as simply good clinical practice; others might place me on the periphery of the known clinical universe. It is therefore with some awareness of risk and vulnerability that I proceed.
  1. The dignity of risk
  2. The power of hope
  3. The centrality of the relationship
  4. The value of collaboration
  5. The right to autonomy and choice
  6. An awareness of power dynamics
  7. Framing therapy implicitly as a psychoeducational experience
  8. Demystifying diagnosis
  9. Acknowledging strengths and underscoring positives
  10. Sharing some of one's self
  11. Sharing some of one's professional thinking
  12. Asking for feedback
Although I recognize most clinicians have very different career and life paths, I believe it is realistic and important to include some exposure to people who have serious and persistent mental illnesses (but not patients) in graduate training and related practicum and internship experiences. Graduate students need to see these people in mutual help and peer-support activities where their talents, abilities, courage, and wellness are plainly visible, and where they can help dispel some of the myths surrounding mental illness that perniciously persist in the mental health community. I think students should build experience in settings where recovery and wellness are core parts of an agency's foundation, and where at least some staff work in positions as recovery support specialists or the like. This is the only way we can change the future of the formal "helping professions" and infuse a better appreciation of recovery into the next generation.

Andy Bernstein is an independent psychologist licensed in New Jersey and Arizona.

Wellness Tips from Peers
From the September 2011 Depression and Bipolar Support Alliance e-Update
The Facing Us Clubhouse is an online "home" for health and wellness, where consumers who have discovered small ways to make big differences in their recovery can share wellness tips. Visit the Clubhouse to be inspired by your peers... and to pass on some of your own tips for recovery.

Listening to Music
"I try to find time in the morning to listen to music. It calms me for the day. It puts a routine in place, and helps me get started. I have no favorite song; it's just what I'm in the mood for that day."

Why Should I Feel Sorry for Myself?
"I was in a DBSA meeting and people were talking about how it wasn't your fault you had this disease; you shouldn't be guilty, etc. It occurred to me: being bipolar is the best thing that's happened to me. Sure it's been extremely difficult at times, but I have an interesting life story and I was forced to really re-examine my life because of it. Now I only do what I love and think is important."

15 Minutes
"Tell yourself: I can do ANYTHING for 15 minutes. If anxiety hits me at the office and I don't know how to cope with a mountain of work—just pick one task and do it for 15 minutes. If the house is a wreck, pick one area and clean for 15 minutes. THEN STOP. Step back. Look at what you did. It may not be finished, but you did something! Be proud! You just kicked anxiety's butt for 15 minutes. Can you do another 15 minutes? Maybe? If not, it's okay. Be proud that you made progress!"

A Note About FacingUs.org:
When you visit the Facing Us Clubhouse, you'll notice that several "rooms" require you to log in or create an account. These rooms allow you to develop personal journals, books, and wellness plans that are uniquely yours. Logging in is a way to access your personalized wellness tools—like pulling your file from a filing cabinet.

To use the Wellness Tracker, visit the Facing Us Clubhouse. Joining is easy and free.

DBSA e-Update is a monthly newsletter produced by the Depression and Bipolar Support Alliance that highlights news articles, upcoming programs, services, and ways you can become involved. Click here to join DBSA's mailing list.

Online Plan Finder Offers Unbiased Information for Medicare Beneficiaries
People with Medicare can begin reviewing plan benefits and cost information on October 1, 2011, in advance of the new, earlier annual enrollment period. The Centers for Medicare & Medicaid Services (CMS) will launch access to their popular Web-based Medicare Plan Finder, which allows beneficiaries and their families, trusted representatives, and senior program advocates to look at available local drug and health plan options for the 2012 benefit year. The Plan Finder was the most popular tool on Medicare's site in 2010, accumulating more than 280 million page views.

"With open enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year," said CMS Administrator Donald M. Berwick, M.D. "The information that's available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs."

The annual enrollment period begins earlier this year (October 15) and runs through December 7. People with Medicare will have 7 weeks to review Medicare Advantage and Prescription Drug plan options and choose the plan that best meets their needs. The earlier open enrollment period also ensures that Medicare will have enough time to process plan choices, so coverage begins without interruption on January 1, 2012.

As beneficiaries review available plan options, they will note more value in the Medicare Advantage (Part C) and Prescription Drug (Part D) benefits. All beneficiaries will have access to Medicare-covered preventive services at no cost sharing, including an Annual Wellness Visit. Thanks to the Affordable Care Act, those affected by the Part D coverage gap, or donut hole, will continue to receive 50 percent discounts on covered brand name drugs. On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011; plans expect enrollment to increase by 10 percent. Average premiums for Part D Prescription Drug plans will also decrease to $30 in 2012, about 76 cents less than the average 2011 premium. The premium amount is based on bids submitted by Part D plans for the 2012 plan year. Benefits in 2012 are consistent with those offered in 2011.

People can use the Plan Finder at www.Medicare.gov by entering their zip code to determine which Medicare Advantage and Prescription Drug plans are available. Also available online is Medicare's Formulary Finder, which allows beneficiaries to enter their prescribed medication and zip code for a display of locally offered plans covering their drugs.

Due to provisions in the Affordable Care Act, Medicare will begin to financially reward Medicare Advantage plans that achieve high quality ratings. Part D plans will also continue to receive quality ratings. Beginning October 12, 2011, the Medicare Plan Finder will include each plan's quality star rating. For the first time this year, the Plan Finder will display a gold star designating top rated five-star plans. Users will continue to see warnings for plans that are consistently poor performers. "We encourage all Medicare beneficiaries enrolled in private plans to know their plan's overall star rating and to consider enrolling in plans with high ratings," said Jonathan Blum, CMS Deputy Administrator and Director of the Center for Medicare. When comparing plans, beneficiaries should review the plan's quality in addition to costs, coverage, and other benefits.

More information is available at www.healthcare.gov, a new Web-based portal managed by the U.S. Department of Health and Human Services.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-
oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other
recovery resources, please contact Stephanie Bernstein, MSW, at 877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
877.584.8535, or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.