12 Chapter 1 outcomes, like clinical scales. Many patients find the definition of recovery as an outcome to be unsatisfactory, because it suggests an evaluative component (25). Rudnick suggests, from a philosophical framework, to characterize recovery as “a process of adaptive or compensatory self-organization of the person as a whole and in relation to the environment (24).” The process of being ‘in recovery’ can be continuous, but can also be defined with stages. Several personal recovery measures have been developed (26). Some try to capture the process by identifying the stages of recovery, such as the Stages of Recovery Instrument (STORI) (27). Others define recovery as an outcome, for example the widely used Recovery Assessment Scale (RAS) (28, 29). The Individual Recovery Outcomes Counter (I.ROC) can be used to start a discussion with a patient about recovery and what is needed to support this process. The resulting spidergram visually shows individual areas of strength, and areas that are a priority to work on. As such, the I.ROC does not measure an outcome, but focuses on the individual evaluation of the patient (30). The relationship between clinical and personal recovery Traditionally, the primary goal of treatment of mental disorders is reduction/ remission of symptoms leading to clinical recovery (31). But if clinical and personal recovery do not overlap, are we helping the patient enough by focusing on symptom reduction? Does clinical improvement of specific symptom domains support personal recovery? Or do we need to extend our treatment strategies beyond clinical goals to promote personal recovery (32)? Earlier studies on the relationship between clinical and personal recovery were usually done in patients with schizophrenia spectrum disorders. They show substantial variation in direction and magnitude of the association (33-36). Evidence suggests that symptoms of psychosis, i.e. positive and negative symptoms, show a smaller association with personal recovery than affective symptoms (37, 38). It is important to know which symptom domains particularly influence personal recovery and vice versa, because this could also inform professionals about priorities in their treatment-focus. Anyway, the association between clinical and personal recovery varies. If both types of recovery are placed in a figure with clinical recovery on the x-axis and personal recovery on the y-axis, a model is established with four ‘profiles of recovery’ (see figure 1): A: personal recovery, but no clinical recovery B: clinical recovery and personal recovery C: no clinical recovery and no personal recovery D: clinical recovery, but no personal recovery
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