What is the Recovery Alliance Theory (RAT)?

• a way of understanding what mental health work is about and a way of organising its practice. Although developed with mental health nursing in mind, the theoretical underpinning is equally applicable to the practice of others (social workers, care workers and family members etc) dealing with mental health concerns.

• it offers a humanistic and empowering basis for organising practice

How does it work?

• designed to be directly relevant to the day-to-day work of mental health workers through the translation of the concepts into the PinC system of recovery.

Why was it developed?

• to realise the potential of people using mental health services in helping themselves through a partnership with mental health workers.

• to make the most of the mutual strengths of both clients and mental health workers in sharing a common goal.

Summary of Recovery Alliance Theory (RAT)

Its name reflects the synergy between the philosophy of the recovery oriented approach (Anthony 1993) and the use of the therapeutic alliance (Bordin 1994) in the interactions of the mental health worker with clients. The theory is considered applicable to the whole of mental health practice across a range of mental health client groups in a variety of contexts and dealing with a wide range of concerns experienced by mental health clients.

Composition of the Recovery Alliance Theory

 The 6 outer constructs underpin the theory

• Humanistic philosophy
• Common humanity
• Recovery
• Partnership Relation
• Strengths focus
• Empowerment

And from which the 3 main concepts are derived.

• Coping
• Working Alliance
• Self responsibility and control

Constructs of the Recovery Alliance Theory

Humanistic Philosophy

The characteristics of the philosophy underpinning the RAT, derived from humanistic philosophy, are:

• Individuals are social animals and share a common humanity.
• Individuals have the potential for growth through awareness of and interaction with self and others.
• The individual’s growth is enhanced by a respectful approach in validating the person’s ability to deal competently with his/her own life experiences.
• Individuals have the ability to make choices and to exercise control in decisions affecting their lives.
• Individuals can not be categorised into discrete entities such as a diagnostic label in that each person is composed of many different facets of which not one stands alone.

Common Humanity

Common humanity involves a partnership of mental health workers and the client in sharing a basic understanding of what it is to be human, that is, taking another’s perspective and identifying with him or her similar life experiences and applying the sentiments expressed in the adage ‘do unto others as you would have them do unto you’. It is not a one-way process. It is applicable to both client and mental health worker.

Recovery

The RAT values the importance of the participation of clients in their own recovery and de-emphasises the curative medical based nature of services provided.

Partnership relation

Partnership is seen as a process in which both worker and client join forces in a working alliance in problem solving to achieve common goals.

Strengths focus

A strengths focus concentrates on the person’s ability rather than their disability particularly their repertoire of coping strategies.

Empowerment

Within the RAT the client is empowered by the acceptance of the worker that his or her own understanding of their mental health concerns is the starting point and by their active participation in the decision making process effecting their recovery.

Concepts of the Recovery Alliance Theory

Three concepts, namely Working Alliance, Coping and Self Responsibility/Control describe the translation of the RAT to the dynamics of practice. Other concepts, namely person, mental health, mental health worker and environment, make more explicit the transition of the theory to mental health practice.

Working Alliance

The working alliance is a partnership within which the person using the mental health service and the mental health worker collaborate in working towards their mutually agreed goals within a positive relationship.

Coping

The application of the RAT helps clients tap into the strategies they had developed to cope with their particular mental health concerns.

Self responsibility/control

The following factors promote the person’s sense of responsibility and control over their own wellbeing:

• the acknowledgement that they have the prime responsibility for their own well being.
• the use of their own language in describing and dealing with their concerns

Person, mental health mental health worker and environment

The concepts of person, mental health concerns, mental health worker and environment are seen as more immediately relevant to mental health practice within the RAT.

Person

The person has the potential for growth and development towards realising a valued sense of self and of purpose.

Mental Health

The concept of mental health that is relevant to mental health workers is the psychological state and processes which promotes people’s abilities to cope with events in their lives. These states and processes include resilience, optimism and self-efficacy. Conversely, mental health concerns are disruptions in this psychological state or processes which periodically result in adversely affecting the person’s ability to cope with events in their life.

Mental Health Worker

The main role of mental health workers is helping the person to deal with their difficulties in coping with events in their lives. Mental health workers promote health by encouraging clients to use their existing coping strategies or to help develop new coping strategies.

Environment

The environment is the social, physical, economic and cultural context in which the person lives. Aspects of the environment can have a positive and a negative influence on the person’s mental health. In turn, the person can use environmental resources to cope effectively with situations, events and influences that have the potential to cause or actually disrupt his/her psychological state or processes.

Within the PinC system of recovery the person is encouraged to use main stream environmental resources (furthest removed from helping agencies including mental health services).

Conclusion

The RAT is a mid-range theory from which a system of mental health intervention (Partnership in Coping) was developed to be applicable across all areas where mental health workers work. For specific details of the theoretical concepts and constructs of the Recovery Alliance Theory go to the Recovery Alliance Theory paper.