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New Endeavors, Risk Taking, and Personal Growth in the Recovery Process: Findings From the STARS Study

Mr. Young and Dr. Green are affiliated with the Center for Health Research, Science Programs Department, Kaiser Permanente Northwest (KPNW), Portland, Oregon. Dr. Estroff is with the Department of Social Medicine, University of North Carolina, Chapel Hill. Send correspondence to Dr. Green at KPNW, 3800 N. Interstate Ave., Portland OR 97227-1110 (e-mail: carla.a.green{at}kpchr.org).

OBJECTIVE: This study examined consumers' perspectives on the role of personal growth-related risk taking in the recovery process and on clinicians' roles in patients' decisions to take on new activities and opportunities. Clinical approaches cited by patients as most helpful in making significant changes were also identified. METHODS: A total of 177 members of a nonprofit health plan (93 women and 85 men), ranging in age from 16 to 84 years, participated in a mixed-methods exploratory study of recovery among individuals with serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis). Participants completed four in-depth semistructured interviews over 24 months; interviews were transcribed verbatim and coded for content by study staff. Data were analyzed using a modified grounded theory approach. RESULTS: The most helpful discussions about new endeavors occurred in the context of healthy, collaborative, mutually trusting clinician-patient relationships. Advice was accepted when clinicians listened well, knew patients' capabilities and interests, and pushed gently at a pace that was comfortable for patients. Knowledge gained by clinicians in the context of good relationships with patients provided a firm grounding for approaching the delicate balance of providing helpful levels of support and encouragement without pushing consumers so hard that it caused difficulties. CONCLUSIONS: Enduring, strong, collaborative relationships provide a healthy framework for discussions between patients and clinicians about taking on new activities, roles, or responsibilities and increase the likelihood that new activities and opportunities will be planned and carried out in ways that promote, rather than endanger, recovery.

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