146 Chapter 7 are involved, question if these are the right persons and to facilitate development of a shared (if not converging) understanding of the problem by the parties involved. Since recovery is a process of change, we suggest regularly revisiting these matters in long-term care. Promoting collaboration for recovery in clinical practice How to promote relational and process oriented care in clinical practice? We point to two lines of work. Both are ways to organize a service rather than a set intervention. Firstly, our results on collaboration for recovery align to open dialogue principles, including its social network approach, psychological continuity and process oriented practice (49, 51). A large open dialogue trial currently underway in the United Kingdom and implementations in Italy may clarify its feasibility and effectiveness for first episode psychosis, and strengthen the case to investigate such approaches for long-term mental health care (52, 53). Secondly, care models that set standards for organization of care, team structure and housing facilities such as the Dutch “Active Recovery Triad” model, may work as a scaffold to promote process oriented and relational work (54). Strengths, limitations and future research Strengths of this study are that we used a well defined methodology, importantly emphasizing rich data and analysis through participatory process. This was vital to balance the voices of all parties involved in the triad throughout our research. The sampling of our study was limited by its confinedness to one institution, and the willingness of participants to share their story. Since recruitment of persons with severe mental illness was via professionals, we likely excluded the most aversive views on professional involvement, although aversion to professional help was still represented in our research. A further limitation of this study is that it presented an analysis of the views of the three parties involved, but did not focus on convergences and differences in views between actors within a single triad on their collaborative process. We also did not witness actual interaction between actors within the same triad. Our study included “snapshot” views of persons with SMI, family and professionals, but did not map what actually happens during a long term collaboration that advances recovery (a series of “snapshots”, or a “movie”). We suggest longitudinal, within-triad research, possibly including ethnographic approaches and/or realist evaluation, to address these matters, and ultimately shed light on what works for whom under what circumstances (33, 55-57). We finally note that in that research, it will be important to conceptualize families as polyphonic networks including multiple family members, which may have differential perspectives and roles towards a person with severe mental illness.
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