[di meliora]

the act or fact of changing or being changed

Those who suffer from mental disorders frequently are told they must change to get better. That begs the question of changing what to what else? Once we know what has to be changed, how do we go about making the change? How much of an impediment will our illness be in the process of change?

Frequently too is being told by the sufferer they want to be normal, or like they were before the current malaise. That begs the question about what is considered normal? Who decides if one is normal? After all, we are all unique genetically and environmentally.

I have asked several if they could describe what they were like before and what differences have occurred. The responses often were generalizations -- I was happier; I could hold a job; my relationships were better; etc. I would ask if they liked their job -- many did not. How about relationships? Not so good a track record there either. The conversations reminded me of talk about the good old days many fondly recalled, but in many ways were not that good.

Another facet of change many have difficulty with is envisioning what they would like their lives to become. I would ask if they had to choose between more money or a better family life, most had never entertained the question. Successful change requires something definitive to shoot for.

Dr. Grohol tells us: Change is Hard, But Not Impossible He iterates:

• Humans are complex.
• Change is difficult, even under ideal circumstances.
• No one model is going to work for everyone.
• Methods should adapt to meet the individual and personalized needs of the person.

He concludes:

Change is hard. But it’s not impossible. With the right tools, the right motivation, and often with someone helping you out directly, one-on-one, you can change something you want to change. It just takes patience, time, and a lot of effort on your part.

Theoretically, the professionals will help us with the tools and with the process. We must provide the right motivation. A treatment plan is an important key to change.

After the evaluation, and the discussion of treatment options, the next therapy session or two will be devoted to the creation of a written treatment plan. It can take up to thirty (30) days to fully develop a complete plan depending on the complexity of the issues you face. In fact, over time, the plan will flex and grow as you do so expect changes after thirty days as well. A treatment plan is a living document—it will need to be referred to, checked in with, updated, and amended by you and your therapist, together.

“A treatment plan is a written plan created by a therapist and patient that is used as a guide to how therapy should ideally proceed in order to address clinical and any other relevant life issues. It is central to effective therapy.”*

Written treatment plans are maps or guides to therapy. They should contain realistic and measurable goals and objectives and list time frames in which to check in and see if reasonable progress towards achieving the goals and objectives has been made. http://blogs.psychcentral.com/therap...al-ingredient/

Setting goals:

One of the most frustrating challenges for individuals in recovery from mental illness and substance abuse is setting goals. But without goals, there is no sense of progress or forward direction. And hope is required in order to have the ability to envision goals in the first place. Given that goals are vitally important to every person in recovery, how can those with mental illness and substance abuse get help – or help themselves – to understand both the importance of setting goals and become better able to set them on their own? http://www.elementsbehavioralhealth....bstance-abuse/

It is all about choices:

• Making the individual aware they have choices. – Again, this gets back to the issue of hope or the lack of it. If there’s no hope, there can be no thought of setting goals. Why bother? But when individuals are given the opportunity to see that they do have choices that they can make, this gives them some measure of autonomy. They choose what they will do, which direction to take – given responsible and appropriate choices. It is important to note that the individual needs to become aware that they have choices, and then be able to recognize the choices. What those choices are is not that important at this stage. It’s enough that they recognize they have choices and that there are numerous choices available to them.

• Encouraging the individual to make choices. – Just recognizing choice isn’t enough. The individual needs encouragement to get and keep them motivated enough to make choices. Once again, the choices the individual makes are not as important as the act of making the choices.

• Supporting the individual’s choices. – Support, in this instance, involves assisting the individual in creating an action plan to achieve the goal or choice they’ve decided upon. It doesn’t mean doing the work for them, but facilitating the process of their being able to do the step-by-step work of deciding on a goal, figuring out what it will take in order to achieve the goal, and building a network of support to help them continue in their goal setting, pursuit, and achievement. This circle of support helps bring about a sense of social connectedness and belonging. It also facilitates empowerment – the belief that the individual has choices, wants to make choices, and takes actions that result in a more satisfying life. The more they learn and do, the more their array of choices – and, thus, their horizon – expands.

In the end, goal setting is important as individuals recover from mental illness and substance abuse, but it has to go hand-in-hand with a gradual building-block process of restoring or building hope; developing a therapeutic alliance; identifying interests, desires, or aspirations; dealing with the fear of taking risks; getting help with neuro-cognitive or skill impairments; expanding access to participation in pleasurable activities; and becoming aware of, receiving encouragement, and support in making appropriate choices.

Not every individual in recovery from mental illness and substance abuse will have the same trajectory of growth. Some will be able to achieve significant success toward identifying, setting, and working to achieve goals. Others will have a more modest rate of improvement. But any improvement is a good sign – particularly for those whom society may have written off or cast aside. Everyone deserves to have the opportunity to live a healthy and productive life – to the extent that they are able and willing and given the availability of counseling and support services that can help them succeed.

Having a good working relationship with your treatment team is crucial too. The controversy over the viability of the revisions to the Diagnostic and Statistical Manual of Mental Disorders makes having the right people treating you all the more important. See: Why Psychiatry Needs to Scrap the DSM System: An Immodest Proposal

The World Health Organization:

Mental health is an integral and essential component of health. The WHO constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important consequence of this definition is that mental health is described as more than the absence of mental disorders or disabilities.

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. http://www.who.int/mediacentre/factsheets/fs220/en/

So, how does one go about reaching the state of well-being? Should being "normal" become a goal? The Mayo Clinic:

Understanding what's considered normal mental health can be tricky. See how feelings, thoughts and behaviors determine mental health and how to recognize if you or a loved one needs help.

***

What's the difference between mental health and mental illness? Sometimes the answer seems clear. For instance, a person who hears voices in his or her head could have schizophrenia. A person who goes on a frenzied shopping spree or starts an ambitious project — such as remodeling the bathroom — without any plans might be having a manic episode caused by bipolar disorder.

In some cases, however, the distinction between mental health and mental illness isn't so obvious. If you're afraid of giving a speech in public, does it mean you have a mental health condition or a run-of-the-mill case of nerves? If you feel sad and discouraged, do you have the blues, or is it full-fledged depression?

Appears to me "normal" may be what is left over after the DSM's abnormals are ruled out. Is there a better way? Your treatment team may decide to listen to you to try to understand how the discomfort you now present came to be. Once the team is more familiar with you, the treatment plan should be viable, with the understanding changes will be made when appropriate.

My road to more functionality began with a list of values. http://www.selfcounseling.com/help/p...nalvalues.html I asked myself, "How would I liked to be remembered by people who are important to me."

Then, I looked at the dimensions of wellness. I really appreciate the Definition of Wellness site: http://www.definitionofwellness.com/ The Resources tab has a plethora of useful forms and other information.

More recently, I have been visiting the Essential Zen Habits of 2012 site. 7 Little Habits That Can Change Your Life, and How to Form Them has been a good read for me. http://zenhabits.net/7-little-habits...-to-form-them/

HelpGuides' Bring Your Life Into Balance Toolkit is another wonderful resource. http://www.helpguide.org/toolkit/emotional_health.htm

You might begin the process of change by writing down ten things you feel are important for you to change. Also remember:

“Without goals, and plans to reach them, you are like a ship that has set sail with no destination.” - Fitzhugh Dodson
“First you write down your goal; your second job is to break down your goal into a series of steps, beginning with steps which are absurdly easy.” - Fitzhugh Dodson

Good luck!