ABSTRACT
The concept of recovery in long-term conditions is both paradoxical and contested; paradoxical in that long-term conditions are those from which people are not expected to recover. Yet there are plenty of ways in which people with long-term conditions can and do recover. People can recover from exacerbations and complications of the condition; from the psychological impact of the diagnosis; from associated mental health problems such as depression or anxiety; from associated physical health problems such as overweight and obesity; and from chronic pain syndrome. Lifestyle changes can reverse some of the pathological changes in coronary heart disease (CHD), and exercise programmes can stop people experiencing angina – even if the underlying disease remains untouched. People with long-term conditions can recover their sense of meaning, purpose and self-worth when these are affected by their condition. And finally, of course, some people can and do recover from the condition itself. The concept of recovery is also contested in that within mental health discourse the concept of recovery has multiple meanings – being a journey people experience, a process, a movement, an approach, a philosophy, a set of values and a paradigm (Turner 2002). In a recent review of the British literature Bonney and Stickley (2008) identified six main, somewhat interweaving themes to do with recovery and mental health: identity; the service provision agenda; the social domain; power and control; hope and optimism; and risk and responsibility. A range of recovery models are in existence (May et al. 1999; Heather 2002; NICE 2002; Repper and Perkins 2003; Fisher 2005) and many organisations are implementing a recovery approach. In mental healthcare, a key policy document has been the National Institute for Mental Health in England (NIMHE) (2005) NIMHE Guiding Statement on Recovery which seeks to place emphasis on recovery being related to the person achieving a life of optimum personal value rather than a focus on the reduction of medical symptoms of mental distress (see Chapter 15). For an excellent discussion of how the recovery approach can and should be used to inform policy and service redesign, see A New Vision for Mental Health (Future Vision Coalition 2008). Earlier chapters have identified the range and extent of long-term conditions. Consideration has been given to assessing people with such conditions and assisting them with appropriate symptom control. In this chapter the focus will be on ways in which holistic care can be structured and enhanced by using specific therapeutic approaches. Specifically, this chapter will provide an overview of some key
psychological and therapeutic strategies. The main focus will be on brief interventions, motivational interviewing, problem-solving, cognitive behavioural therapy and applied positive psychology.
