Most psychology students are still trained in the medical model, say members of APA's Recovery Advisory Committee. They learn to identify a patient's pathology and treat that pathology.
But psychology students should also learn how to help people recover the skills they need to function well in society once the acute problem is resolved, committee members say.
"If I break my leg, I not only want it to heal but want to walk again and do all the activities I did before my leg was broken," says committee member Arthur C. Evans Jr., PhD, commissioner of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services. "It's no different with mental illness. People want more than just to not have symptoms; they want to regain their lives to whatever extent they can."
Now Evans, other Recovery Advisory Committee members and members of APA's Committee on Assessment and Training in Recovery are helping to ensure that future psychologists learn how to help their patients recover from serious mental illness and regain their lives. The team has released a 15-module curriculum for doctoral, internship and postdoctoral psychology programs that teaches students how to provide recovery-oriented behavioral health care.
"You need specialized training to work effectively with this population," says Mary A. Jansen, PhD, a Recovery Advisory Committee member and director of Bayview Behavioral Consulting Inc., in Vancouver. "Together, the modules form a solid foundation of the basic training psychologists need."
Known as Reframing Psychology for the Emerging Healthcare Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders, the curriculum is part of a broader effort called the Recovery to Practice initiative.
Funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), the initiative aims to promote recovery-oriented principles and practices among mental health professionals in all disciplines. The initiative has two goals: to create an online library of recovery resources and to support APA and four other mental health organizations in developing training materials.
Funded by a subcontract from SAMHSA, APA's Recovery to Practice initiative is contributing materials to the Recovery Resources Library. The new curriculum fulfills the second objective.
The curriculum's modules include one that introduces recovery-based psychological practice and another that offers a historical overview of the recovery movement and how health-care reform emphasizes recovery.
Another module outlines recovery's empirical underpinnings. Research documenting that people can recover from serious mental illness began in the mid-1970s, the module points out. In the mid-1990s, psychologist Courtenay Harding, PhD, published a landmark compendium of studies from around the world, which showed similar rates of recovery in several countries. Harding identified studies showing that between 46 and 84 percent of people with schizophrenia had recovered or significantly improved, for example.
Other modules teach practical skills, such as how to conduct a clinical assessment that focuses on strengths and a person's functional capabilities and how to work with other professionals and patients to develop recovery-oriented treatment plans.
Three modules focus on interventions. One lays out the guiding principles of recovery-oriented interventions. Another describes evidence-based practices, while a third describes promising or emerging practices and supportive services.
Other modules cover the role of partnership and engagement in the recovery process, peer-delivered services, special issues and interventions in forensic settings, health disparities, systems transformation and inclusion of people with mental health disorders in the community.
Each module consists of lecture notes, which include learning objectives, terminology and other items; PowerPoint slides; a suggested learning activity, such as role playing how to integrate a peer support worker into a practice or coming together in small groups to define recovery; a suggested assessment; and citations and resources, including links to videos of people in recovery describing their experiences.
APA's Recovery to Practice initiative designed the curriculum for flexibility so that training programs can integrate the approximately 1.5-hour-long modules into existing courses or use the introductory module along with specific groupings, such as the clinically oriented or systems-oriented modules, to create a special mini-course. However, the project team believes that training in all the modules is necessary for psychology students to fully understand the concepts and be ready to use them in practice, Jansen says.
That's one reason the Recovery to Practice team isn't just posting the curriculum on its website for anyone to use, adds Andrew Austin-Dailey, who directs the Recovery to Practice initiative at APA. To get the free curriculum, training directors or others must request it from Recovery to Practice or call APA.
"We want to maintain quality control and make sure that people getting the modules understand what's expected of them," Austin-Dailey says.
For example, the project team expects faculty to present the curriculum alongside someone who has recovered from a serious mental illness. (The team can help faculty find co-facilitators, if necessary.)
Recovery Advisory Committee member Peter Ashenden says that people in recovery offer a unique perspective on the curriculum's content.
"Unless you've been diagnosed with a particular illness, you don't have as clear an understanding as those individuals who have gone through that experience," says Ashenden, the former chief executive officer of the Depression and Bipolar Support Alliance.
Ashenden is also living proof of how important a recovery orientation is. "The system told me I wouldn't be able to complete college or hold a full-time job, and I've done both," says Ashenden, who is recovering from clinical depression. "Those are the kinds of limitations we tend to put on people and why it's so important that we work with our emerging students so they stop doing that and instead build on people's strengths and help them identify and achieve their goals."
This feature prompted the most enthusiasm in pilot testing of the curriculum by about 200 trainees in 14 doctoral, internship and postdoctoral programs, Austin-Dailey says.
"Trainees were very positive about the fact that they could interact with people who have experienced serious mental illness as opposed to just hearing about recovery or maybe never hearing about it at all," he says. "Very few people, for instance, understand that people with schizophrenia can and do recover."
The curriculum's release is just the first step. APA's two recovery committees are also reaching out to psychology training councils, peer support organizations, consumer organizations and other groups to get the word out about the curriculum and promote its use. The committees are also working to ensure that the upcoming revision of APA's accreditation guidelines and principles reflect a recovery orientation.
"The idea that people actually do recover from serious mental illness is foreign to many psychologists," says Jansen. "It really is a paradigm shift — one that psychologists must make in order to compete in an evolving health-care landscape that emphasizes primary care, interdisciplinary practice and accountability."
Rebecca A. Clay is a journalist in Washington, D.C.
