163 General discussion Another limitation of the longitudinal study is the relatively high drop-out at follow-up. In the research in chapter 7 it would also have been informative to study the collaboration within the same triad. Implications for clinical practice The findings of the research in this thesis support the idea that recovery transcends illness in two ways: 1. Personal recovery seems to occur largely independent of clinical remission of symptoms, especially of psychotic symptoms and 2. Personal recovery is associated with resilience and social functioning, factors that are universally human and suit us all. Point 1 means for clinical practice that a pure focus on symptom reduction is not the necessary or only road to personal recovery. Like Slade states: clinical recovery is one approach to support personal recovery, but hope, meaning, empowerment, autonomy and self-determination are superior goals. He argues that personal recovery is not about symptoms, but about the relationship with symptoms, i.e. ownership of illness (13). When treating symptoms, it is important, also in patients with a psychotic disorder, that there is enough attention to affective, i.e. depression and anxiety, symptoms, because they show a stronger association with personal recovery than positive and negative symptoms. Furthermore, the awareness that psychotic experiences can have meaning and are not always negative, can help in deciding whether to target treatment on reducing these symptoms (further) or not (55). Measures, such as the Subjective Perception of Positive Symptoms–Revised (SUPPOSY–R) can be of help (56). How can mental health professionals support personal recovery (57)? Some argue that recovery supportive care is not about specific interventions, but about a helpful attitude of health care professionals. Slade and Hayward describe an “optimistic and hope-inducing view about the ability of people to find meaning in their experiences – to generate a story or narrative about themselves which leads to a future beyond (though possibly including) mental illness. (…) At its simplest, this will mean clinicians basing decisions less on professionally-defined goals and more on listening to and acting on the service user’s wishes (58).” Barriers in the meaning-making of experiences of patients with psychosis were found to be mostly situated within mental healthcare and stigma-related (59). The concept of ‘presence’ has also been mentioned to be important for recovery, which refers to “the quality of attentiveness, listening, understanding, as well as being open to the needs, wishes, requests, reasoning and frame of reference of the care receiver that one is trying to help (60, 61).” 8
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