Language matters, Enhancing Recovery, Humble Pie
savvy
Earlier this month, Janelle Wesloh, Executive Director of Recovery Management at Hazelden Betty Ford Foundation asked me about the samples of recovery language which I have included in SKILLS this month. They do sound like things I have talked and written about before:
We couldn’t find the source except that it appeared to originate with Washington State Department of Social and Health Services published August 2, 2010. Zephyr Forest, Administrative Assistant for the Division of Behavioral Health and Recovery (zephyr.forest@dshs.wa.gov) was kind enough to try to track down the source, but he couldn’t trace its origins either. In the meantime though, he forwarded some equally stimulating resources some of which I am sharing in SAVVY this month.
TIP 1
Compare and contrast a pathology-oriented, deficit-based view of mental health versus a recovery, strength-based system of mental health services.
The following comparison was adapted from Ridgway, P. (2004). Research Findings: Key factors and elements of a recovery-enhancing mental health system. Document prepared for “Recovery in Action: Identifying Factors and Trends of Trans-formational Systems” meeting sponsored by CONTAC and NCSTAC. Indianapolis, Indiana.
Ridgway offers a comparison of the pre-recovery mental health system and a recovery enhancing mental health system.
| Pre-Recovery Mental Health System | Recovery Enhancing System |
| 1. Message is: “you’ll never recover” – illness is a lifelong condition. | 1. Message is: “recovery is likely” you can and will attain both symptom relief and social recovery. |
| 2. Minimal attention to basic needs. | 2. Attention to basic needs, including housing, human and civil rights, income, healthcare, transportation. |
| 3. Focus is on person as patient, client, service recipient. | 3. Focus is on success in social roles: parent, worker, tenant. Activities to reclaim and support a variety of social roles are emphasized. |
| 4. Treatment plan and goals are primarily set by staff with minimal input by individual or family. Plans often generic and focus on illness/medical necessity of treatment. | 4. Personalized recovery plan is mandated based on person’s individual goals and dreams. Plan is broad and ranging across many domains. Often includes services and resources that are not directly affiliated or controlled by mental health service system. |
| 5. People lack access to the most effective or research validated services. | 5. There is ready access to research validated practices and ongoing innovation and research on promising approaches. |
| 6. Peer support is discouraged, lacking, or underfunded. | 6. Peer support is actively encouraged, readily available, adequately funded and supported. |
| 7. Coercion and involuntary treatment are common. Staff act “in locus parentae”, over use of guardianships, representative payee and conservatorships. | 7. Coercion and involuntary treatment are avoided. People are treated as adults. Temporary substitute decision makers used only when necessary. Advanced directives and other means are used to ensure people have say even in crisis. |
| 8. Crisis services emphasize coercion and involuntary treatment, often use seclusion and restraint which can be (re)traumatizing. | 8. Crisis alternatives such as warm lines and respite are available. Staff has been trained to avoid seclusion and restraint and is skilled in alternative approaches. |
TIP 2
Note how language matters. Consider these alternatives which promote recovery.
In the same module of the Washington State Certified Peer Counselor Training Manual
(MODULE 3: CORE PRINCIPLES OF RECOVERY & RESILIENCE), that referenced Ridgway’s work, there was a succinct list on page 37 emphasizing that language matters.
“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
- 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
“The words on the left are positive and have a sense of power to them. They engender hope and possibility. The words on the right are negative. Words can go a long way in facilitating someone’s recovery and combating stigma within and outside of the mental health system.” (page 37).
Harris and Felman provided their list of how “language that is commonly used within the mental health system can often be improved. The following are examples of simple, practical ways to reframe the conversation in recovery-oriented ways.”
Rather than these words: Use words that promote recovery:
1. Refused 1. Declined / Repeatedly said no
2. Resisted 2. Chose not to / Disagreed with the suggestion
3. Client believes that… 3. Client stated that…
4. Delusional 4. Experiencing delusional thoughts
5. Paranoid 5. Experiencing paranoid symptoms
6. Decompensate 6. Experiencing an increase in symptoms
7. Manipulative 7. Seeking alternative methods of meeting needs
8. Noncompliant 8. Not in agreement with the treatment plan
Difficulty following treatment recommendations
9. Unmotivated 9. Bored /Has not begun
10. Suffering from… 10. Has a history of…
11. Low functioning 11. Has difficulty with…
References:
1. Washington State Certified Peer Counselor Training Manual (Revised July 2009). “Language Matters” in MODULE 3: CORE PRINCIPLES OF RECOVERY AND RESILIENCE, pp. 37-41. Washington State’s Division of Behavioral Health & Recovery. Prepared by the Washington Institute for Mental Health Research & Training.
2. Harris, Jamie & Felman, Kristyn (2012): “A Guide to the Use of Recovery-Oriented Language In Service Planning, Documentation, and Correspondence” Mental Health America Allegheny County, 100 Sheridan Square, 2nd Floor Pittsburgh, PA 15206 Phone: 1-877-391-3820 www.mhaac.net
skills
It takes some practice and skill to avoid falling into the same old pathology-oriented and blaming language we get so used to doing. So here is the recovery language grid to helps re-frame and sharpen your skills. If you are aware of the source, please let me know at davidmeelee@gmail.com.
TIP 1
Build your skills to move away from blaming or labeling language to respectful empowering terminology.
“The following are some of the terms we have traditionally used to describe people and/or their behaviors. These terms place judgment and blame on the individual and generalize their actions. It is much more helpful to describe the specific situation that a person is facing than to use generic and punitive clinical terms.”
| Worn Out Language | Language that Promotes Acceptance, Respect & Uniqueness | Comments |
| Max is mentally ill Max is schizophrenic Max is a bipolar Max is… | Max has a mental illness. Max has schizophrenia. Max has been diagnosed with bipolar disorder. Max is a person with… | Avoid equating the person’s identity with a diagnosis. Max is a person first and foremost, and he also happens to have bipolar disorder. Very often there is no need to mention a diagnosis at all. It is sometimes helpful to use the phrase “a person diagnosed with”, because it shifts the responsibility for the diagnosis to the person making it, leaving the individual the freedom to accept or not. |
| Alex is an addict | Alex is addicted to alcohol. Alex is in recovery from drug addiction. | Put the person first. Avoid defining the person by their struggles. |
| Rebecca is brain injured/damaged | Rebecca has a brain injury. | Put the person first. Avoid defining the person by their struggles. |
| Jane is disabled/handicapped | Jane is a person with a disability. | Put the person first. Avoid defining the person by their struggles. |
| Mark is normal/healthy | Mark is someone without a disability. | Referring to people without disabilities as normal or healthy infers that people with disabilities are not normal and not healthy. |
| Sarah is decompensating | Sarah is having a rough time. Sarah is experiencing… | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Avoid sensationalizing a setback into something huge. |
| Mathew is manipulative | Mathew is trying really hard to get his needs met. Mathew may need to work on more effective ways of getting his needs met. | Take the blame out of the statement. Recognize that the person is trying to get a need met the best way they know how. |
| Kyle is non-compliant | Kyle is choosing not to… Kyle would rather… Kyle is looking for other options | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Does Kyle agree with your plan? |
| Megan is very compliant | Megan is excited about the plan we’ve developed. Megan is working hard towards the goals she has set. | Being compliant means that someone is doing what they were asked or told to do. The goal of recovery-oriented services is to help the person define what they want to do and work towards it together. Someone being compliant does not mean that they are on the road to recovery, only that they are following directions. |
| Mary is resistant to treatment | Mary chooses not to… Mary prefers not to… Mary is unsure about… | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Remove the blame from the statement. |
| Allie is high functioning | Allie is really good at… | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. |
| Jesse is low functioning | Jesse has a tough time taking care of himself. Jesse has a tough time learning new things. Jesse is still early in his recovery journey. | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Avoid defining the entire person negatively based on the fact that he struggles in some areas. |
| Michael is dangerous | Michael tends to become violent when he is upset. Michael sometimes strikes out at people when he is hearing voices. | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Remove the judgment from the statement. Avoid defining the person by the behavior. |
| Harry is mentally ill chemically abusing (MICA) | Harry is a person with co-occurring mental health and substance use/abuse problems. | Put the person first. Avoid defining the person by their struggles. |
| Sam is unmotivated | Sam doesn’t seem inspired to go back to work. Sam is not in an environment that inspires him. Sam is working on finding his motivation. Sam has not yet found anything that sparks his motivation. | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Avoid defining the person by the behavior. Remove the blame from the statement. |
| Andy is manic | Andy has a lot of energy right now. Andy hasn’t slept in three days. | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. Avoid defining the person by the behavior. |
| Kate is paranoid | Kate is experiencing a lot of fear. Kate is worried that her neighbors want to hurt her. | Describe what it looks like uniquely to that individual. That information is more useful than a generalization. |
| Hailey is a cutter | Hailey expresses her emotional pain through self-harm. Hailey hurts herself when she is upset. | Avoid defining the person by the behavior. Recognize the reason behind the behavior. |
| Jordan has a chronic/persistent mental illness | Jordan has been working towards recovery for a long time. Jordan has experienced depression for many years. | Avoid conveying a prognosis. It is difficult to accurately predict an individual’s prognosis and it only impedes their progress to define them as someone who will not recover (or will not be in recovery for a very long time). There is no need to address prognosis in describing a group of people or an individual. |
| Tom is very difficult | Tom and I aren’t quite on the same page. It is challenging for me to work with Tom. | Avoid making a judgment, which may be based on your dissatisfaction with the fact the person has not met your expectations (which may be different from what he wants for himself). |
| Manipulative Grandiose In denial Passive aggressive Self- defeating Oppositional | These are often people’s ineffective attempts to reclaim some shred of power while being treated in a system that often tries to control them. The person is trying to get their needs met, or has a perception different from the staff, or has an opinion of self not shared by others. And these efforts are not effectively bringing them to the result they want. | These are labels for strategies and perceptions we all have about ourselves, although possibly more subtle and effective. We all present information to achieve a desired result to some degree (manipulation). Or have an inflated opinion of ourselves, or are unable to see or agree with something presented to us by another. |
soul
Earlier this month I had to eat humble pie twice – all in the same shopping expedition- in the space of one hour. I consider myself a reasonably patient person……but not so fast. Because when it’s getting late and the shops will close soon and I haven’t finished my must-do errands, suddenly some old wisdom rears its ugly head:
“Patience is a virtue
Possess it if you can
Seldom found in women
Never in a man.”
Well it wasn’t found in this man, this writer, this month anyway.
I had just finished buying some printer cartridges at Office Depot before they closed. I wanted to get to next store before they closed too. Stuck behind a driver at a red light, I started fuming and judging his knowledge of the road rules. He just sat there and didn’t seem to know that you can, sir, turn right on red in the USA. Let’s get on with it; there’s no traffic coming; it is quite safe for you to turn on a red light and then I can get going on my errands. He still just sat there, apparently not getting my psychic message to get moving beamed from my car to his.
The light turns green. Finally, I’m thinking, he’ll turn now so I can rush to the next store. But he has already made me waste at least 45 seconds tolerating his stubbornness and refusal to turn right on red. So inconsiderate and ignorant of basic driving rules.
Oops! He didn’t turn right, because he was going straight ahead and had never even indicated he was going to turn right. That was all in my head, assuming that just because I was turning right, he must be going that direction too. Sheepishly, I ate some humble pie, noting how easy it is to see the world just through my eyes and perspective.
Not 10 minutes later…. I find my self stuck again behind an inconsiderate driver. This time, not stuck at a red light, but crawling along at 15 miles per hour in a 30 mph zone. Don’t they know where the accelerator is? I’m rushing to get to the next store before it closes. Do they really need to choose this time to drive slowly and smell the roses? I’m tempted to move closer and tailgate them to send a not-so-subtle message to “hurry up, will you!”
Oops again! Just as I start to speed up towards them, they turn right into the next street. They were not smelling the roses. Ironically they were turning right when I was focused on going straight ahead. That is why they were going slowly, preparing to turn.
There was the second slice of humble pie all in less than an hour. I had done it again – seeing the world just through my eyes and perspective. Now, who was the inconsiderate driver?