Recovery Alliance Theory, Essay Example

First person that contributed greatly to the psychiatric and mental health nursing was Hildergard Peplau in 1950’s (Norman, Ryrie, 2004). Since then a lot of changes have taken place, but there are still very few researches in this area about development of new mental health nursing models. Mostly, these changes have occurred ‘in the treatment of service users include a move away from a psychoanalytic interpretation of an individual’s experiences to a greater emphasis on the ‘here and now’ with many interventions involving the use of cognitive and behavioral approaches, such as brief solution-focused therapy and cognitive behavior therapy’ (Shanley, Jubb-Shanley, 2007). The predominating medical model was doubted due to its tendency to recognize as pathology any unusual form of behavioral phenomena. So Eamon Shanley and Maureen Jubb-Shanley formulated a new theory – recovery alliance theory. Its formulation has been influenced by authors’ investigations of mental health problems in Australia and Ireland, where significant changes in the liberalization of legislation, decentralization of decision making and adoption of the recovery-orientated approach in mental health care occurred.

Attempts to provide a more client-centered service led to emergence of the new approach in the Australia, Ireland, United Kingdom, New Zealand and Canada. So these changes were reflected in legislation and needed clearly defined theories for mental nursing. Social changes also took place in these countries. The recovery alliance theory was made up to take into account cultural differences and different characters of people; this problem was actual in Ireland and Australia but it also can be applied to America where there are lots different cultures.

Another reason why the recovery alliance theory was designed because of uncertainty and role ambiguity among mental health nurses when they become aware of a new approach. Nursing academics feel unsure about whether nurses should retain their administrative role or should change it to more humanistic and versatile. Even practicing mental health nurses face some difficulties when asked about their role in recovery. ‘Some see the main aspects of their work involving caring, counseling, advocacy, alleviation of distress and ‘being there’ for patients, while others talk more of maintaining control, monitoring and administration of medications’ (Shanley, Jubb-Shanley, 2007). According to a study conducted by E. Shanley & M. Jubb-Shanley (unpublished) concerning perception of mental health nurses of their role, no clear idea was present, being reduced to single eclectic role. So recovery alliance theory was the very thing they needed because it included a comprehensive and easily applicable system of mental health nursing practice. The main idea of this system was that both nurses and service users (patients, clients) should be involved in the process of the decision making.

The authors of the recovery alliance theory claim that the recovery alliance theory is the first comprehensive formulation that led to a creation of the system of mental health nursing, and this new system (Partnership in Coping, PinC) is applicable across all areas where mental health nurses work. It enables all participants who are interested in recovery, either nurses, or service users, to participate directly in the recovery process.

What is the recovery alliance theory, what are its critical attributes that can asses nursing practice?

Identify definitions and critical attributes of the concepts from the middle range theory that you will want to assess for practice improvement. Identify the relational statements that compose the theory.

The recovery alliance theory is defined as a middle-range explanatory nursing theory; it relates straight to mental health nursing practice. Its scope in practice can be easily derived from its applicability across people of various socio-economic groups, ages or cultures, across wide range of mental health concerns and across different contexts. (Shanley, Jubb-Shanley, 2009) The name of the theory reflects recovery-oriented approach and underlies the key element in the theory related to the working alliance of the client and mental health nurse.

The main concepts of theory are coping, working alliance and self-responsibility and control. Authors also specify six constructs of the theory that I find crucial for my future work and thus I will discuss some of them in my paper.

There are six concepts that are claimed to underpin the theory of recovery alliance. All of them are indivisible parts of the theory and relate closely to my future mental health nurse practice. First principle is humanistic philosophy, and its main idea is that people that share common humanity can help each other and that their self perception and self-efficacy can be influenced by a respectful approach. Mental health concerns are perceived not as an abnormality, but as a common part of life. Role of mental health nurse is seen as helping service users in applying their own developed and usual strategies to cope with their concerns. Unlike medical approach, recovery alliance theory denies mental nurse diagnose theory and tends to use individual’s ‘understanding of their mental health concerns as a starting point’ (Shanley, Jubb-Shanley, 2007). It changes the roles of nurse and client, integrating them into each other.

Concept of common humanity underlies importance of the human understanding in nursing practice. Some parallels can be found in lives of nurse and client and it can help to get into the service user’s world perception.

Recovery concept implies that realizing a possibility to recover is a key element in the recovery process. Concentrating on things that go well but not wrong can help service user to recover and increase his self-efficacy. And partnership relation can help to achieve it. Partnership is seen as a process in which both the nurse and the service user join forces in a working alliance in problem solving to achieve common goals. Strong points of client are used to cope with his mental concerns, and it is a central point of strength focus concept. And empowerment concept means that client is the first source of his diagnosis and his own understanding is the basic in the decision making. Mental health nurses according to this theory must accept that clients have an ability to use their inner strengths for their recovery.

Working alliance employed in the theory is not a part of the therapy; it is a means of achieving application of therapeutic approaches, for example, PinC therapy. It may include everyday speeches that are used for demonstrating common humanity and openness, different contexts and times that are used to deepen the nurse’s understanding of client’s environment, self-disclosure, etc.

Coping is understood as person’s attempts to deal with difficult life circumstances. It implies modifying person’s own ideas of problem solving so as to achieve the result desired.

Self-responsibility/control concept deems it logical that the service user is responsible for his well-being. All things that client does must be perceived as those that influence his well-being. It is not like in medical theory that the person is seen as one reflecting the results of someone’s activity or medical intrusion.

The main idea of the recovery alliance theory that can be derived is that patient is allowed to evaluate his own diagnosis with the help of mental health nurse. The potential for recovery is found in the service user’s own life and habits, and he is approached as a person able to cope with problems being provided with some help. Person’s potential for recovery and development is improved by mental health nursing processes which help individuals to cope with potential or actual disruptions in their mental health. Positive sides of person’s environment are used to overcome negative ones.

This theory can be incorporated into my Nurse Practitioner practice.

In order to use it, one should be aware of its methods and main approaches. The working alliance that leads to understanding and mutual help consists of bond, goals and tasks.

Bond is the main focus of the first of the 8 guided steps in PinC. The bond, or therapeutic relationship, involves the creation of empathy, positive regard and genuineness. These conditions help created a positive relationship between the partners (mental health worker and the client) such as mutual trust, acceptance, confidence and feelings of a common purpose (Shanley, Jubb-Shanley, 2008)

Also an agreement between the partners should be established about what goals they do want to achieve. In recovery alliance theory, and its partnership in coping system, deem that it is the customer who sets the goals and the nurse just helps him or her with it. Finally, are understood as collaboration on the action to be taken. ‘Within PinC, the bond, tasks and goals are integrated in a systematic way in the partnership designed to give clients the major responsibility in undertaking tasks towards achieving theirs goals’ (Shanley, Jubb-Shanley, 2008)

Authors of the theory emphasized that mental health nurses’ role was to follow eight steps of PinC system: establishment of core conditions (bond); identification of experiential threats; identification of concerns; prioritization of concerns; identification of existing coping strategies; setting of goals; application of coping strategies; evaluation of outcome. Mental health nurses can also collaborate with other doctors, reporting drug and method outcomes.

The whole theory is easily understandable but its parts must be explained. For example, how to make your service user more open, ready to collaborate? How to act so as to encourage him or her and enhance his self-efficacy? A PinC system directs health care professionals through the whole process, clarifying every point and giving rise to proper understanding of the roles and tasks. For me as a Nurse Practitioner it will be really important to be aware of PinC system that is part of recovery alliance theory. As Shanley and Jubb-Shanley claim, first step includes empathy and ability to cooperate. In stages which include identification of experiential threats and identification of concerns, clients are empowered through the application of recovery principles. Prioritization of concerns and identification of existing coping strategies emphasize the strengths focus and the fact that service users use ‘their own coping strategies to achieve their goals in accepting self-responsibility and control of their well-being’ (2008).

The recovery alliance theory is rather non-intrusive as it uses client’s methods, strategies, allows conversational decision-making. In my practice it can be used to define the problem as clearly as possible basing my diagnosis not only on medical readings and objective facts, but also on service users’ perception of the problem, subjective feelings and observations.

The theory implies change of attitude of the service users to their disorders or mental health concerns. Through the conversations and dialogues people can evaluate the decision, and such decisions will be highly appreciated as people tend to value their own thoughts.

My basic clinical practice will consist of seeing patients on an outpatient basis in a family practice setting based on evidence-based practice. The evidence-based practice implies use of some methods of gaining information from customers.

I am going to introduce recovery alliance theory in my practice. First of all, information needed is not to be derived from service user on a basis of some questions. According to PinC, I am not going to interview my clients, but rather talk to them emphatically and giving them an ability to exchange information with myself. This way is very tolerant to person’s strategies and considers his own understanding of his role in the recovery. Self-responsibility that is vital part of the theory will also help people to understand that there is nobody more powerful that themselves when it comes to recovery. For example, ability to ask questions freely will lead to increase of self-responsibility and consciousness.

Implementing PinC system I will get a holistic impression of the service user’s problem and realize whether he or she needs an intervention or assistance. After getting an impression of what coping strategies are present I will advice in a conversational manner a way of solving the problem. It can be either support, or pharmacological or other intervention. Outpatient basis will not allow different contexts, but employing other methods will help me to guide the client through his recovery process and take notes about how he or she is going.

Interactions of the health professional and service user are represented on the Fig. 1 (Shanley, Jubb-Shanley, 2007)

Works Cited

Norman I., Ryrie I. (2004). The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. Maidenhead, England: Open University Press. 79-80

Shanley E. & Jubb-Shanley M. (2007) Journal of Psychiatric and Mental Health Nursing 14, 734–743

Shanley E. & Jubb-Shanley M. (2008) Users’ Manual: Partnership in Coping System of Recovery. Retrieved April 10, 2009 from http://pinc-recovery.com/PinC_Users_Manual.pdf

Shanley E. & Jubb-Shanley M. (2009) Partnership in Coping: A System of Recovery. Retrieved April 10, 2009 from http://www.pinc-recovery.com/recovery-alliance-training-2/