Advances in Qualitative Methods Conference Banff, May 2-5, 2003 Participatory Approach To Qualitative Research In Community Mental Health The Drive to Move Forward: Negotiating Self and External Circumstances in Recovery Joanna Ochocka, Geoffrey Nelson, & Rich Janzen

Overview of Presentation Background Recovery Framework - Drive to Move Forward - Spiral of Positive and Negative Changes - Context of Recovery - Negotiation between Self and External Circumstances © Centre for Research and Education in Human Services Overview of Presentation

Purpose of the Longitudinal Study of Consumer/Survivor Initiatives To examine the activities and impacts of Consumer Survivors Initiatives on new members (individual level) and the communities within which they exist. (systems level) © Centre for Research and Education in Human Services

Purpose of the Paper To clarify the concept of recovery through a grounded theory analysis © Centre for Research and Education in Human Services

Methodology: Individual Qualitative © Centre for Research and Education in Human Services Baseline, 9, 18 month follow-up interviews 26 qualitative interviews (11 active and 15 non-active CSI members) Semi-structured interviews - asked about changes in past 9 months, factors facilitating and inhibiting changes, typical day in the life, CSI experiences for active participants Interviews transcribed and analyzed using grounded theory approach

The Drive to Move Forward © Centre for Research and Education in Human Services l l l l l Self External Circumstances Positive Changes Negative Changes l l l l NegotiationDrive Forward

The Drive to Move Forward © Centre for Research and Education in Human Services Motivation for life Desire to improve lives and prepare for the future Sense of hope and optimism, determination, faith in higher power, sometimes awakening I would definitely say that it’s been much worse and it's been much better. It wasn't going first, I think it has started just moving forward, towards getting better and better. Within the 9 months it was progressing, progressing to healthier and not really going backwards. I think I was going in the right direction.

Positive and Negative Changes Life can be thought of as a series of happenings, a constant struggle between positive times of personal growth and negative times of setback (spiral of the life struggle) Life isn’t easy itself so you can’t expect it to be smooth running the whole time. Recovery is non-linear process with positive and negative aspects of life intermingling in unpredictable way © Centre for Research and Education in Human Services

Positive and Negative Changes Positive life changes included improved relationships in people’s lives, increased community involvement, more self-confidence and assertiveness, more control over one’s mental health treatment, more independence, and more self-care. Negative life changes included a deterioration in general health, increased loneliness, increased relationship difficulties, increased financial difficulties, and work-related negative changes © Centre for Research and Education in Human Services

Context: Self and External Circumstances People live in the context of two main realities: the reality of self and the reality of external circumstances Dialectic process of negotiation between internal mental health struggles and external circumstances © Centre for Research and Education in Human Services

Context: Self and External Circumstances I started thinking that maybe I could start back to work. There are still so many things—I would like to go back. What happens if I wake up that morning and I can’t go out of the house. That fear. I think that I have to get over those phobias, but how do I get over those phobias when I don’t even know what the hell they are? The individual as active agent of change © Centre for Research and Education in Human Services

Accommodation-Oriented Negotiation Strategies Acceptance of limits and capacities Knowing own illness Being realistic in setting goals Balancing various aspects of life © Centre for Research and Education in Human Services

Accommodation-Oriented Negotiation Strategies “I have had my daily difficulties and I have to remain aware that they are there because if I don’t I could stumble and fall and that could cause a trail into downward spiral into depression which I don’t want to happen. I do have to be careful and take steps to ensure that I don’t take on too great a task. For instance let’s say an example would be if I took on a full time, everyday college course. That would be too much and over burdening myself and with my memory and concentration it wouldn’t work and then I’d be discouraged because I couldn’t do that. Taking one night a week night course is not over burdening myself yet, it is taking a step forward. In general that is the way things are right now”. © Centre for Research and Education in Human Services

Action-Oriented Negotiation Strategies Positive thinking Taking control Seeking support © Centre for Research and Education in Human Services

Action-Oriented Negotiation Strategies I have had independently meet new people. I had a support system with family and friends in London. In Hamilton I have been forced to find a support system. For the first three years this was very difficult. I guess it would be hard in any new city. But, by volunteering, participating on churches and getting in contact with various professionals and MHRC [a self-help organization] has assisted me in building a network. © Centre for Research and Education in Human Services

Take Home Messages The drive to move forward is a foundation/ starting point for recovery. Many people who experience serious mental illness have had this motivation diminished. The spiral of life struggle capture both forward movements and setbacks Context of recovery is ecological (personal, social and political) © Centre for Research and Education in Human Services

Take Home Messages Recovery is about negotiation of relationships with ourselves, with others, with social structures and with a higher power Two negotiation strategies: accommodation- acceptance and action-resistance For some participants recovery is a spiritual journey © Centre for Research and Education in Human Services

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