Recovery Alliance Theory

     Throughout the history of mental health the dominant model used to guide patient care has been the medical model (Shanley & Jubb-Shanley, 2007). In recent years there have been alternative models proposed for providing nursing care in mental health. One model outlined by Shanley & Jubb-Shanley (2007) is the Recovery Alliance Theory. Application of this theory requires a paradigm shift away from the traditional medical model towards a strengths based humanistic approach. The theory resonates with my personal views of what constitutes good mental health nursing because it places emphasis on (1) humanistic philosophy, (2) recovery, (3) partnership relation, (4) strength focus, (5) empowerment and (6) common humanity. These constructs underlie the theory. From these emerge three main concepts that translate the theory into mental health nursing practice, (1) coping, (2) working alliance and (3) self responsibility.

     I agree with Shanley & Jubb-Shanley (2007) that, “the scope of the recovery alliance theory in practice is comprehensive in its applicability across people, across mental health concerns and across different situations,” (pp.736) including inpatient and community settings because it focuses on the human aspects and internal strengths of the client while also creating a trusting relationship between the nurse and client. This theory helps to focus care on maintaining and improving quality of life to optimize positive patient outcomes while also promoting personal growth on the part of the nurse (Shanley & Jubb-Shanley, 2007).  I believe that this framework can be applied outside of mental health settings because the concepts can be utilized to look beyond an illness or disease to develop strategies to foster the overall health and wellness of the client.

     In my practice I have seen instances of clients being labeled and stigmatized by their mental health diagnosis which often creates depersonalization and distrust of clients, making establishment of rapport difficult. As Shanley & Jubb-Shanley (2007) emphasize, by shifting focus away from viewing the patient as simply a diagnosis nurses may avoid client conflict as there is no predetermined category assigned. I have also experienced instances where the application of the traditional medical model creates a power differential between health care professional and client, placing the nurse in the position of expert while the client is deemed unknowing and unable to manage their own care. In contrast, the Recovery Alliance Theory advocates that the client is the expert on their mental health, experiencing a mental health concern use their own understanding and knowledge base as a starting point (Shanley & Jubb-Shanley, 2007).

     This approach allows a normalization of mental health concerns, incorporating them as part of one’s life and development, rather than an illness or disease. I believe in my own practice use of this approach will help build relationships with clients because it allows the nurse to think about their own experiences that mirror the client’s. I agree with this approach because it gives the client responsibility and control of their recovery plan, working with the nurse rather than having their decisions made by nurses. The nurses role is to help the client develop strength and problem-solving ability while identify resources that help them grow toward their psychological goals and cope with their mental health challenges (Shanley & Shanley, 2007).

     The medical model is the prevalent model used in medicine which guides both doctor and nursing practice. Shanley & Jubb-Shanley (2007) discussed how this model tends to pathologize any psychological and behavioural characteristics that lie outside societal norms, emphasizing implementing cures rather than viewing each client as a whole that requires guidance for recovery. I believe that the underlying constructs of the Recovery Alliance Theory, and the practice focused concepts for it’s implementation allow for the greatest success of positive outcomes for clients across all practice settings. This theory resonates with me, lending itself well for application in my own practice because of the emphasis on a strength based, recovery oriented, humanistic approach, working with the client rather than giving treatment to the client.

References

Shanley, E., & Jubb-Shanley, M. (2007). The recovery alliance theory of mental health nursing.   

     Journal of Psychiatric and Mental Health Nursing, 14,(8), 734-743.