Understanding the Recovery-Based Model
I sat waiting in a cold, empty room. This was only my second time holding an orientation group for individuals interested in our program. As the social work intern, I was tasked every other Thursday morning with explaining our recovery-based program to clients who were referred to our empowerment program by a licensed provider and diagnosed as having a serious mental illness. I had very little experience with the recovery-based model and was somewhat relieved when the clock read 8:38 and no one showed up.
Fate had its way that day. Mr. Smith rushed in around 8:40, looking frazzled and confused. He was 10 minutes late and I was the only person sitting at the table. As I started orientation, I apologized for the room being so empty. More people were supposed to show up, but for reasons beyond my knowledge, they didn't. I didn't realize it then, but Mr. Smith would shape my perception of the recovery-based model and my future as a social worker.
Mr. Smith explained to me during orientation that he wanted to pursue a degree in fashion design, but he would not be a traditional college student. He was a 49-year-old black male struggling with income and complex family conflicts. His eyes were shameful when I questioned what prevented him from doing this already. He reported that he had started but quit classes quite suddenly more than eight months ago. He was unable to finish a required English 101 course due to what he referred to as "test anxiety."
Mr. Smith was motivated; I could see it in his eyes. He was ready to tackle these anxieties but was unsure of his capabilities, largely because of shame. I didn't know what type of shame or what his past experiences entailed, but the shame was with us like the proverbial elephant in the room. As orientation concluded, I encouraged him to join our program. We were the right program for him; we could help him pursue his dreams of fashion design.
Shortly after orientation, Mr. Smith and I were matched as partners. We were to be equals, working together to pursue his dreams through a strategy referred to as the Community Integration and Recovery Plan. He would be the lead partner, the leader and expert on himself; I would be the staff partner, a supporter and resource guide. This is how the recovery-based model operates. It is designed for clients to have primary control over decisions about their care. This is in contrast with most traditional models of service, in which consumers are instructed on what to do, or simply have services done for them with minimal, if any, consultation for their opinions. The recovery model is guided by self-determination theory, which posits that human beings thrive and grow, achieve goals, and feel greater well-being under conditions that support the fulfillment of basic human needs such as autonomy, competence, and relatedness to others. The problem was that Mr. Smith had been in therapeutic treatments for PTSD and schizoaffective disorder for many years, without any autonomy or control of what his goal plan would look like.
Shortly after completing the goal plan, we encountered complications. Mr. Smith was ready to jump into classes right away; the other providers working with Mr. Smith, who weren't familiar with the recovery-based model, felt that this would be a mistake. I encouraged Mr. Smith to pursue his dreams no matter what others believed of him or his capabilities. How could he, though? For so many years, he dutifully followed their advice. He listened to what he was told to do, and at that moment, he was being told he would not be able to handle the stress of college. It would be too much for him and might trigger his posttraumatic stress. He might fail and be worse off financially than he was last year when this happened.
Mr. Smith felt hopeless. How could he pursue his dreams without his supports? His diagnoses of PTSD and schizoaffective disorder would get in the way once again. I explained to him, as I would to any person struggling with the stigma of mental health diagnoses, that these disorders were only a list of symptoms. Diagnoses do not, and never should, define who we are or what we are capable of. I told Mr. Smith that we may never shed the voices consistent with schizoaffective disorder and we cannot change his past or the traumatic events that happened to him while he served our country in the military, but we could quiet them long enough to pursue his dreams. These identities, or symptoms, were not the priority anymore; his hopes and dreams of being a fashion designer were. To be a fashion designer, he had to finish his English 101 course—that was our new priority.
One day Mr. Smith called me on the phone and anxiously rushed to say, "I think I'm going to drop my courses. I can't handle it anymore." I wanted so badly to tell him no. I wanted to tell him that quitting would be a very big mistake, but instead I insisted he take a deep breath. I asked Mr. Smith why and then helped him weigh the pros and cons. Naturally, I wanted to spend more time on the pros, but that's not my role. My role, as defined by the recovery-based model, is to support whatever decision he makes, whether it be quitting or pushing through the stress and anxiety. I concluded by stating that we could further explore his anxieties during our next session together.
We unfolded during our next appointment that Mr. Smith's "test anxiety" was actually a freeze response during a fight, flight, or freeze situation. Many individuals have heard of the fight-or-flight response, but freeze often gets overlooked. Mr. Smith would freeze when stressed. When he finally moved, or got "unstuck," it was too late. His papers would be past due. The time was up. He hadn't acted quickly enough. This was a response he learned from trauma he incurred in the military. We tackled these freeze moments, one by one, with mindfulness and positive thought replacement. He had to learn to stay in the present moment to tackle his negative thoughts; he had to keep moving when he wanted to freeze.
Mr. Smith would be the first to tell you that enduring English 101 was not glamorous, in contrast with the thought of having a degree in fashion design. There were many sleepless nights, thoughts of failure, and the horrors of having his dreams be another traumatic memory of the past. He learned much about himself in the process, however. He was capable of achieving his dream, despite racial injustices, his age, his socioeconomic status, or his past education. He was also capable of making his own decisions regarding his life; he could be autonomous and competent.
— Rikkelle Showalter, MSW'16, is a winner of the Virginia P. Robinson publication prize for the University of Pennsylvania School of Social Policy & Practice.