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Psychiatric Rehabilitation is a philosophy as well as specific strategies that has been formed over the past 30 years about how treatment should be provided to those individuals who suffer from a mental illness. During the 1970 's, due in large part to pioneers like Fountain House and Fair-weather Lodge, a shift began in the paradigm that had till then defined the "treatment" of mental illnesses. A growing consciousness emerged that, in addition to medications, skill building and social support enhancement could significantly improve the quality of life for mentally ill individuals. This new, rehabilitative paradigm reflected a consumer-oriented, community-based, recovery-focused, outcomes-grounded approach to delivering mental health care.
Rehabilitation professionals have long suspected that a patients motivation plays an important role in determining the outcome of therapy, despite the lack of a clear definition of the phenomenon. In the last 20 years, a new sociopolitical paradigm has emerged based upon the view that disability is a product of the interaction between individuals and their surroundings. Influenced by the understandings that have grown out of the civil rights movements of other minority groups, many disability rights advocates and some researchers believe that the inaccessibility faced by those with disabilities is based on deeply rooted cultural attitudes and embodied in an inaccessible physical environment (Oday & Killeen, 2002). Whereas traditional rehabilitation and programs based on the medical model focus on changing the individual, these new rights-based approaches concentrate upon changing society. Attention has shifted away from the medical or rehabilitation definitions of disability as physical impairment or vocational restriction to a new definition of disability as a product of the interaction between the individual and the environment (Oday & Killeen, 2002). From this perspective, the principal problems of disability stem from a disabling environment rather than from personal defects or deficiencies.
Many people with disabilities are now redefining themselves as members of a minority group in need of civil rights protection, accessible environments, and workplace accommodations This paradigm includes the recognition that society is enhanced by the presence of people with disabilities because they enable society to be more creative, diverse, and accepting of individual differences (Oday & Killeen, 2002). Speaking about the Positive Psychology constructs and issues I have to say that its goal is to shift the conventional focus of psychology from a fixation with repairing what is wrong in life to working on building and retaining positive qualities that make life more fulfilling, such as hope, wisdom, creativity, courage, spirituality, etc. etc. (Seligman & Csikszentmihalyi, 2000). One aspect of positive psychology that is linked to the success of the rehabilitation of disabled persons is motivation. As Ryan and Deci put it, motivation has been a central and perennial issue in the field of psychology, for it is at the core of biological, cognitive, and social regulation (2000).
To say that motivation plays a critical role in physical performance or therapeutic outcome is to state the obvious. An individual's motivation has a strong impact on physical performance and on the outcome of physical therapy given to the individual (Lewthwaite 1990). There are numerous aspects of motivation. Motivational processes can be internal or external and affect an individual's feelings, thoughts, and behaviors. The processes are a result of the meaning that the individual derives from situations.
Meaning or perception of a situation arises from personal factors such as goals and perceptions of competency and other traits, and social influences such as supportive or hostile influences, novelty of equipment, and sociocultural values related to age, gender, health, and illness behavior (Lewthwaite 1990). The key factors involved in personal motivation are goal orientations or aims of personal involvement, self-perceptions of capabilities, and perceptual-affective experiences in physical activity (sensory and emotional experiences essential to physical activity). Goal orientations are context-specific concerns or aims of personal involvement that, in part, create the framework or meaning through which people act and react to events in their environment (Lewthwaite 1990). In other words, choices to become and remain involved in physical activity are guided, in part, by individuals goals and perceptions that goals can be or have been satisfied in this context.
Self-perception, which is the belief in ones own personal capabilities to perform or cope in a given situation, is another key cognitive variable of motivation that determines ones willingness to invest effort and persistence (Lewthwaite 1990). This self-confidence was termed self-efficacy by psychologist Albert Bandura and was used as the central theme in his Self-Efficacy Theory. Within his theory, Bandura suggests that many programs aimed to change behaviors, in effect, focus intervention and education efforts largely on the influence of the expectations of the outcome (e. g. , by attempting to convince clients that the treatment will promote better physical or mental health). Although establishing trust in the effectiveness of treatment can be critical, attention must also be directed to the individuals beliefs in their personal capabilities in order to be able to adopt and maintain the desired actions (Lewthwaite, 1990). As discussed previously, sensory and emotional experiences can form goal attainments or means to goal attainment in physical activity.
Therefore, perceptions and affective responses central to the framework of physical activity can serve as effective motivational factors in exercise involvement and athletic participation. Perceptual and affective variables that may promote or hinder physical activity involvement include perceived exertion and the extent to which physical activity is associated with negative affect, such as feelings of aversion or anxiety, and with positive affect, such as feelings of enjoyment, exhilaration, or satisfaction and mastery (Lewthwaite, 1990). Studies have shown that the motivational significance of perceptual and affective responses to physical activity levels demonstrate the long-held hedonic principle of motivation which asserts that people are attracted to activities that bring them pleasure and avoid those activities that are associated with displeasure or pain. One conclusion arising from prior research is that while social and physical parameters of sport or exercise can be arranged to affect the motivation of patients, variation among patients' personalities will cause different responses to exercise environments. As knowledge of these factors improves, physical therapists can benefit by taking advantage of motivational factors when implementing a therapeutic program (Lewthwaite, 1990).
Stress plays a crucial role in persons mental illness and psychotic disorder. Stress rehabilitation can be considered a part of the Psychiatric Rehabilitation The concept or stress is possibly one of the most misunderstood matters in human life. It is commonly recognized as a negative condition accompanied by nerves and aggravation. In actuality, stress is an inner, physical reaction of the body that mobilizes energy needed to overcome problems and difficulties.
Stress can strengthen defenses, stimulate greater productivity, and sharpen resolution to overcome difficulty. A certain amount of controlled stress is, in fact, considered a key to performing well in many situations. By keeping anxiety in check consciously, stress can be a very useful tool (Biscup, 1990). The ultimate goal of rehabilitation is to maximize independence through mastery of physical, linguistic, cognitive, and psychosocial skill.
Rehabilitation (i. e. physical therapy and other therapeutic activities) is an outlet for which physically disabled persons can cope with stresses of being handicapped. Professional medical, therapeutic, psychological, educational, vocational, and social expertise should be tapped through the development and completion of a managed therapeutic plan, but the ultimate indicator of a successful outcome can be found only within the individual (Biscup, 1990).
The old saying that says "You can lead a horse to water, but you can't make it drink" encompasses this message. All the expertise available can be delivered to the client, but unless it is absorbed in a cooperative manner, it will remain just that detached expertise. To be beneficial, persons with mental and other disabilities need to be accepting of treatment. An observation regarding coping with the destructive effects of illness and disability is that medical technology has advanced to a point that physical life can be preserved in spite of tremendous trauma. However, the inherent meaning of the word "living" cannot be achieved through the process of rehabilitation without cooperation of the client with the various providers of service. Although no human being should be forced to handle the havoc caused by a disabling condition, life does not always mold neatly to human desires (Biscup, 1990).
When faced with a tragedy like severe illness, a position of determination to endure can help a person conquer the survival, struggle, and success cycle. Determination can enable a person or family to cope with complex situations that seem impossible to deal with at first glance (Biscup, 1990). The aim of psychiatric rehabilitation, restore an individual to his / her former functioning and environmental status, or alternatively, to maintain or maximize remaining function (Teague, Cipriano & McGhee, 1990) continues to be at the heart of all care provided to people with mental disabilities. A new emphasis in rehabilitation therapy has focused on 'independent living' and developed as a specialty since 1980 (Teague et. al, 1990). In an effort to maximize a patient's rehabilitation through stress management, this approach stresses consumer sovereignty, self-reliance, and the political and economic rights of the disabled.
The Independent Living Movement has been effective in the process of translating independent living theory into reality by promoting appropriate support services, accessible environments, and pertinent information and skills (Teague et. al, 1990). Rehabilitation professionals commonly believe that motivation of patients has an important role in determining outcome. A study conducted by Maclean, Pound, Wolfe and Rudd (2000) reported that a range of factors affected stroke patients beliefs about rehabilitation.
Those factors included: information from professionals about rehabilitation, comparisons with other stroke patients, the desire to leave the hospital, overprotection from family members or stroke unit nurses, mixed messages, and a lack of information and support from professionals on the stroke unit. Maclean et. al. found that although all patients thought rehabilitation was important for recovery, only those characterized as having high motivation were likely to view rehabilitation as the most important means of recovery and to accord themselves an active role in rehabilitation. These patients were also more likely to understand rehabilitation and in particular to understand the specialist role of the nursing staff. Information from professionals about rehabilitation, favorable comparisons with other stroke patients, and the desire to leave hospital had a positive effect on motivation.
Conversely, overprotection from family members and professionals, lack of information or the receipt of "mixed messages" from professionals, and unfavorable comparisons with other patients had a negative effect. The researchers concluded that there are some differences in beliefs between stroke patients identified as having low or high motivation for rehabilitation. These beliefs seem to be influenced by the environment in which the patient is rehabilitated. Professionals and carets should be made aware of the ways in which their behavior can positively and negatively affect motivation. Therapists and other health care providers can play a critical role in patients's elf-efficacy levels. These individuals manage the immediate social environment and design interventions that implicitly or explicitly operate as sources of efficacy information.
Well-managed programs from a self-efficacy perspective might influence self-efficacy by creating a series of performance accomplishments, using vicarious experience when appropriate (e. g. , having patients demonstrate exercises to other patients), utilizing credible verbal persuasion (e. g. , "I've seen patients with similar problems come through this program very successfully. "), and offering beneficial labeling of physiological sensations when reasonable (e. g. , "If you feel a little pressure in your joint when you do this exercise, that's a good sign. ") (Lewthwaite, 1990)...
Maclean et. al. (2000) stated that if motivation is linked to understanding rehabilitation (especially understanding the role expected of the patient by rehabilitation professionals), and if this understanding is related to the possession of information about rehabilitation, then motivation might be increased through the provision of more extensive and more efficiently communicated information. Provision of information to patients could conceivably diminish the negative effects of overprotection, unfavorable comparisons with other patients, and the encouragement of a role at odds with the one prescribed by rehabilitation. In addition, information about setting goals and involving the patient in the process of setting these goals have previously been proposed as positive determinants of motivation (Maclean et. al). In general, Maclean et.
al. suggest clinical awareness of the ways in which factors beyond the patient's control can affect motivation might reduce the temptation to place sole responsibility for being motivated on to the individual patient. Several studies have suggested that the personality trait model of motivation prevalent in much of clinical literature, which does place this sort of responsibility on patients, can negatively affect engagement with rehabilitation (2000). Concluding all these I have to say that motivation plays one the leading role in persons psychiatric rehabilitation. Rehabilitation professionals have long held that patient motivation affects outcome, but, of course, more researches are needed in order to determine the nature of motivation. On the whole many other researches are needed that might help ands give necessary information about how to maintain motivation among rehabilitation patients.
References Oday, Michel & Killeen, John (2002). Concepts of Disability. Boston: Pearson Custom Publishing. Seligman, Ryan & Csikszentmihalyi, Deci. (2000) Positive Psychology. Gaithersburg, MD: Aspen Publishers, Inc. Lewthwaite, Bruce (1990) Motivation As a Key to Rehabilitation.
New Haven: Yale University Press. Biscup, James (1990) Stress Rehabilitation. New York: Harcourt Brace & Company Teague, Cipriano & McGhee, (1990) Psychiatric Rehabilitation. Bristol, G.
B. : John Wright and Sons Ltd. Teague et. al, (1990. ) Independent Living. New York: Graphic Society.
Maclean, Pound, Wolfe and Rudd (2000) Study: What Makes Rehabilitation Work the Best. Philadelphia, PA: Davis Company
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Research essay sample on Negatively Affect Physical Activity
