1. Resourcefulness for Recovery: Model, Measurement, and Implications
Marek J. Celinski and Lyle Allen III

2. Rehabilitation Assessment and Intervention Process Model
Premorbid Personality,
Life Roles,
and Experiences
Physical/Psychological
Trauma/Disease
Symptoms/Impairments
Psychosocial and
Environmental Stressors
Client Schemas and
Perceived Barriers
Coping Status,
Post-morbid Roles
Activity Level
Emotional Adjustment
Subjective Recovery Strategy
Intervention Planning
Copyright © 1990, 2000
J. Douglas Salmon, Jr., Ph..D.
& Marek J. Celinshi, Ph. D.
Rehabilitation Outcome

3. Operationalizing the model…

4. Subjective Recovery Strategy(RRI)
Rehabilitation Assessment and Intervention Process Model: Relating Concepts and Assessment Instruments
Assessment Tools Legend
RCL: The Rehabilitation Checklist
PPCLES: The Pre/Post Condition Life Event Survey
R-ADLS: The Rehabilitation Activities of Daily Living Survey
R-SOPAC: The Rehabilitation Survey of Problems and Coping
RNHSI: The Rehabilitation Neuropsychological and Health Status Inventory
ITS: The Impact of Trauma Scale
RRI: Resourcefulness & Recovery Inventory
Premorbid Personality (RNSHI)
Roles (RCL)
and Experiences (PPCLES)
Physical/Psychological
Trauma/Disease (ITS)
Symptoms (RCL, R-SOPAC, RNHSI)
Psychosocial and
Environmental Stressors
(PPCLES)
Client Schemas and
Perceived Barriers (RCL, RNHSI)
Coping Status (R-SOPAC )
Roles (RCL)
Activity Level (R-ADLS,
RNSHI)
Emotional Adjustment
(RNHSI, R-SOPAC)
Subjective Recovery Strategy(RRI)
Intervention Planning
Copyright © 1990, 2000
J. Douglas Salmon, Jr., Ph..D.
& Marek J. Celinshi, Ph. D.
Rehabilitation Outcome

5. We begin with presenting the Resourcefulness for Recovery Inventory, which is both a diagnostic and therapeutically oriented scale. Various models will be subsequently presented as the theoretical underpinnings for the scale.
Even though they may appear “too philosophical,” they will have their representation in the clinical data and in statistical analysis presented by Lyle Allen III.
The major point that we try to advance is that the rehabilitation and recovery processes are better understood with references to choices, autonomy, and freedom, rather than to a deterministic model based on “contingencies.”

11. The primary assumption is that it is possible to develop a theoretical model for a ubiquitous way of coping with loss and illness.
Clinical practice and everyday experience indicate that there are two opposite tendencies which are utilized in coping with any novel situation which somehow impacts on us:
One is to preserve continuity and stability. However, if this remains the primary focus of the everyday life, it leads to a sense of boredom and a sense of unfulfillment that may result in depression; in case of illness or some undesirable physical or emotional condition, a tendency to maintain status quo leads to chronicity.
The other coping strategy involves engagement in the process of change but the risk is that if the change becomes uncontrollable, it leads to chaos experienced as confusion and anxiety.
In everyday life and in the process of therapy, we have to acknowledge both tendencies and decide how much our clients wish to be inspired by either approach. An interplay of both enables for progress with respect to whatever condition.

12. Psychological intervention becomes possible when the “status quo” is not viewed as the acceptable option and the person comes to a conclusion that one’s own effort is not sufficient to produce the desired outcome. This becomes a motivation to seek professional help.
Psychotherapy is about triggering and continuing with manageable changes until a desirable mental state, potentially leading to optimal mindset for handling a particular life problem is achieved.

13. Therapeutic change becomes possible thanks to our professional beliefs that people, through their perceptions and attitudes, are co-creators of reality by attributing to it an objective value, coherence with other aspects of life, importance, and permanence that in the end make such a reality appear attractive to us.  
By establishing priorities worthy of effort to live for, people become motivated to be energized and take specific actions. In essence, we create meaning of life for ourselves and a direction to pursue our goals. If reality was co-created, it could also be changed and this is both our opportunity and a continuous responsibility.
While this offers a prospect for a positive therapeutic outcome, such changes require certain effort and skills. Buddhists already knew this 2,500 years ago.
Therapeutically, in order to reduce suffering and improve coping with life problems, we need to question and “loosen” those attributions causing our strong bonds and involvements if they are no longer functioning well.

14. Ego and Non-Ego Interactions
In our dealing with reality, we utilize resources which could be attributed to the ego and to non-ego resources.

15. In order to create psychodynamics of change we propose a space- and time-based model of the self-orientations enabling the self to position itself in the optimal way vis-à-vis important issues in life.

16. In the spatial dimension model of the self, the primary orientation is with respect to how the self relates to the group of people who are regarded as a representation of one’s own life situation, as an incentive for change and an example of how to achieve this.
Please note in the graphic model which will follow, that there is a natural tendency to remain in the group with which we identify ourselves. Any attempt to cross boundaries of this group can potentially trigger anxiety.
This occurs when we lower our level of functioning and fall into beneath-optimal levels expected for the group or if we attempt to create our own psychodynamics assuming more freedom (such as on the sovereign level) than we actually have (for example, marrying outside one’s cultural or religious group in opposition to family wishes).

18. In order to create further psychodynamics, a vertical sense of freedom (which is in relation to the group of people we select for comparisons with ourselves) needs to be supplemented by the self-oriented sequential dynamics called transformation.
Please note that there are two major points in the transformation model which will follow. In order to promote any change, a person needs, as the first step, to disengage from the previous ways of dealing with the problem at hand and engage in the dynamics leading to engagement in the new way. Basically, this is a further extension of Eric Fromm’s model of “freedom from and freedom to” which for the purpose of this presentation is called “Detachment / Reattachment” model.

19. Detachment
Reattachment

21. There is a practical question: How can these concepts be integrated in the clinical practice? This requires addressing three major issues with which we are dealing clinically:
Assessment of where the person is, when we first meet her, with respect to major, clinically-important variables.
Therapist’s future projection of what should be the client’s most optimal state of mind for dealing with particular life problems if therapy is to be successful.
The Therapeutic Path, referring to how a person will be able to achieve such a desirable state of mind.

22. The model which we will present as the next slide represents the narrative of recovery which summarizes all the stages of therapeutic process.
Please notice in the model that the transformation starts with utilizing RRI variables that lead to achieving “freedom from”; “detachment” is the primary “mechanism.”
Subsequent stages leading to “reattachment” are also addressed by various RRI subscales. Underlying concepts represent a mental state at a given time and stage of recovery, and the primary motive allowing for achieving a higher stage in the recovery.

23. Freedom From Freedom Through Freedom In Freedom For Freedom To
To Achieve detachment from dysfunctional self
Reduce a sense of entitlement
Overcoming a negative bias
Challenging fatalistic views
Looking for support
Positive relation with health care professionals
Communication and Social Support
Find comfort ‘in spite’
Achieve emotional stabilization
Positive values
Intentionality
Self Responsibility
Focus on the future and personal growth
Reattachment
Exercising the new self
Positive bias
Formulation of recovery schema
Controllability
Manageability
Commitment to implementation
Commitment to good causes
Projection of control
Ability to care for self and others
Active and creative search for solutions
Utilizing internal and external incentives
Making specific plans
Integration and control
Minimizing losses
Stress Management
Perceived choice
Ability to do things differently
Shift to positive cognitions
Generating positive emotions
Sense of humour
References to RRI variables
Detachment from former ways requires:
Appraisal
Emotional and Cognitive Absorption
Acceptance
Broadening Awareness
Healthful Attention
“I need to take care of myself in spite of everything”
*Stages are connected by the will to continue living
*Stages are linked by a sense of purpose and projection of efficacy and control

24. Let me explain more specifically the consecutive stages of recovery.
Our therapeutic work starts with an assumption and understanding that trauma, loss or illness suppress our ability to use our resources which allow us to be engaged in a self-directed and purposeful effort.
Psychotherapy is about uncovering and expanding on a client’s resourcefulness which would allow for transcending the stereotypic, spontaneous and typical reactions which proved to be less than optimal for dealing with particular life situations and thus “dysfunctional”. The primary goal is to facilitate “detachment” from the former self which would allow for creative use of client’s life experiences, knowledge and skills. Ultimately, a free, deliberate “reattachment” has to be achieved leading to optimal adaptive functioning, at least as good as the group with which the client is advised to compare.

25. At the first stage, it is particularly difficult for the client to undo the bonds which keep a person in a “dysfunctional” state of mind; undoing these bonds is a painful process as we meet resistance to give up on something which was cherished (i.e. pre-traumatic life) because it was an expression the self, and was regarded as the desirable and the familiar way of life.
We created a sense of entitlement to possess all these things, and to enjoy the lifestyle and to follow up on the images of ourselves to which we attributed a sense of importance and permanence. We also assume that we have control over how life proceeds; when the reality does not correspond to these images, a sense of personal failure develops which creates fear, anger and confusion about how to deal with the issues which slipped out of our control. We have a tendency to blame others, the system or ourselves. We view others as abandoning us or not being helpful in the way in which we would like to.

26. If we do not succeed in restoration of the former way of life, this even further contributes to the distress and a sense of helplessness. However, giving up on the former self and on one’s own “rights”, triggers fear that even a further disintegration will occur.
Detachment from these dysfunctional preoccupations is expected to be achieved through utilizing RRI variables such as acceptance, broadening awareness, healthful attention by taking care of herself in spite of the circumstances and by focusing on the present: “one step at a time.”

27. To reach the next step, it is required that the client has a wish to continue living in the circumstances that were created against a person’s will.
At this stage, the objective is to find some comfort and a degree of emotional stabilization in spite of the unfavourable circumstances. For this purpose, we utilize possibilities associated with “freedom through” which refers to communication, social support and resources of health care professionals.
Through this process, the clients learn how to use stress management techniques including relaxation, mindfulness, and desensitization, and develop positive cognitions and emotions, such as hope, confidence, love, peace, calmness, and sense of humour, etc, which should allow clients to develop some control over their symptoms, and a feeling of comfort.

28. Actively search for creative solutions to the problems.
While being confident of one’s own ability to deal with symptoms at a manageable level, there is a possibility of entering a further stage in recovery associated with “freedom for”; at this stage:
There is a need to recognize one’s own autonomy and freedom to transform into a new self.
Actively search for creative solutions to the problems.
Utilize whatever internal or external incentives for maintaining effort at searching for solutions.
This stage is motivated by a desire to grow personally and to achieve some degree of mastery over one’s own mind which ultimately may lead to better control of internal / external circumstances. In the RRI, this is addressed by positive values, intentionality and sense of self-responsibility to create the new projections and bonds with reality that would represent values (objectives), sense of importance, priorities, permanency, hope and ways of control with a focus on the future.

29. In the final stage, a client should develop a recovery schema, recognize one’s own “calling in life”, acquire a sense of controllability / manageability, be committed to implementation of the recovery plan, and have a sense of efficacy about it.
In essence, a person becomes hopeful and committed to good causes in life and through such a process “reinvents one’s self”. What has been achieved represents the “new self” based on positive bias related to efficacy associated with skills, and self confidence in handling life situations. At this stage, specific plans, sense of integration and control are developed and the previous losses have been minimized. The final stage represents “freedom to” according to Fromm’s conceptualization and “reattachment” through commitments.

30. Credits Acknowledgements
Antonovsky, A., Bandura, A., Beck, A., Dalai Lama, Freud, S., Lazarus, R. S., Sartre, J. P., Seligman, M. E. P., Rotter, J. B., Positive Psychology and Dialectic Psychology
Acknowledgements
Mark Antoniazzi, Lyle Allen III, Lynda Mainwaring, Andrei Kozlowski, Judith Pilowsky, Jennifer Celinski, Tara Eriksen, Yuri Yatsenko, and many others.