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In the fall of 1999, I was contacted by NAMI and asked if Id be willing to author a consumer course on the topic of recovery. I said yes immediately and without hesitation. Yes was my hasty answer, because I believed strongly that such a thing needed to be written and that it urgently needed to exist.
A few moments after I put down the phone, I realized that I had just agreed to develop a course for which there was little precedent, on behalf of a major and reputable national organization, on a topic with just about a decade of documented history and barely emerging research; that I had only some notions of what it should be like when it was finished, and no idea of how to make it so.
My commitment to recovery was based on years of observing others struggle with mental illness, first as a case manager and emergency services worker in the public mental health system, and later, in aggregate, as an information services manager for the same workplace. It was also based on years of leading mutual support groups, once I became diagnosed with my own serious disorder. And, finally, it was based on the path I had traveled with grave disability and convalescence when my condition worsened in the early 1990s.
My notions about what the curriculum should look like were based on an experience Id had - many years previously - as a returning adult college student in a non-traditional learning program. For my senior project, which was a graduation requirement, I looked at the structural underpinnings of that program itself. I learned a bit about adult development and the kinds of environments and situations that are conducive to learning for adults. In a very short time, I found that body of knowledge was already at work in the NAMI Family-to-Family Education Program, and so there was immediate and accessible common ground from which a new and related NAMI educational program could be built.
Literally several hundred pages reached the proverbial cutting room floor, but what survived the 13 month process of getting to the pilot draft stage were certain core ideas that comprise the basis for a successful recovery course:
The course must take the person where they are at and bring them to their own next stop in the path to recovery - not my next stop or your next stop.
What do we know about this? We know that recovery is a unique experience for each individual. We know that it is unpredictable. We know that it involves a magic or mystery moment that changes everything; what we dont know is how to make that moment come about. We know that moment involves another person having hope for the individual who needs to change. We know that there may be an experience of bottom that prepares the way for the hope message to be received.
The course must encourage the telling of the story.
For some, this will be the first opportunity presented to tell their own story in their own words, from their own perspective. Telling the story allows a person to hear their own life, also allows for a process of being listened into voice. It promotes reframing of overwhelming experience into something more manageable and understandable. Telling allows for normalizing of the experience by others, and the shedding of shame that comes from telling the secrets.
The course must promote an atmosphere of trust where it is impossible to get it wrong.
This requires that facilitators and members of the group be willing to go with the person wherever they are going. It requires a suspension of judgement. It requires a high tolerance (at least) and appreciation (at best) for an individuals uniqueness. For some participants, this will be the first experience of uncritical acceptance of their truths and experiences; for some this may mitigate against the good patient role they have assumed due to lack of options, low self-esteem, and years of being ground down by their differentness. It is essential to foster a spirit of you are the expert on your own life among participants.
The course must create an absolutely neutral political environment.
There must be no factions: the lions must lie down with the lambs on this one. Accomplished speakers with strong and well-developed points of view must not interfere, do-for, or contradict others who are in the process of developing voice. Quiet ones must not be bullied into speaking before they have something to say. Family members may not be trashed or made other, nor may the survivor movement. We are going to assume, in this course, that it is ignorance and not malevolence that has us polarized, and we are going to seek to understand rather than mistrust others motives for saying and doing what they do and say.
In addition to a kind of built in, structural coherence that promotes growth, there are five essential messages, that build on one another, contained within the weeks of the curriculum. They are:
I am not alone
I have a voice
I have choices
I am free to decide
I am free to live well
These essential messages capture the position of awareness in the lived experience of recovery for most individuals, and provide the foundation for the work of transforming experience among course participants. A combination of structured exercises and lectures focus on helping participants to identify and resolve some common conflicts in the recovery process, such as:
Transforming isolation into belonging.
Transforming silence into voice.
Transforming passivity into choice.
Transforming indifference into decision.
Transforming endurance into zest.
What can not be accomplished in the nine week period of class meetings is available to all participants in a binder of class materials and memories of experiences that they take along with them when the course ends. As part of the course, participants create a written relapse prevention plan and devise an advance directive for mental health care decision making. It is a very full nine weeks, with each week building on the next.
NAMIs Peer-to-Peer Recovery Course is a unique, experiential learning program for any person with a serious mental illness, led by persons who live day to day with serious mental illness, and it is only in its infancy. A cautiously implemented and carefully evaluated pilot phase will conclude in the spring of 2001, bringing with its close a host of ideas for refinement and improvement of this potentially very powerful consumer program. It is a huge undertaking - and a concurrently huge privilege and responsibility - to roll out a course of this kind, touching, as it does, peoples lives in the most intimate of ways.
In the words of a member of the original trainee mentor - or teachers of the course - group:
I feel as though a great burden has been lifted; a burden I wasnt aware was there.
With wonderful feedback like that, it is simply a matter of time before this infant program is ready for a broader distribution. And as it is with all growing things, the importance of giving the program the time it needs to mature can not be overemphasized.
Kathryn Cohan-Haerry
January 2001
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