In response to requests on how health care providers can persuade more of their patients to regularly attend weekly Recovery meetings, the following referral techniques have been compiled Professionals and Recovery members were canvassed to determine which referral techniques were the most effective. We hove you find the information helpful Please contact us if you use other approaches.

As a non-profit community service organization, Recovery, Inc. is designed to work in conjunction with professional help and medication to reinforce the therapists' objectives. As an adjunct to therapy, weekly self-help meetings can provide understanding, support, hope, reassurance, encouragement and practical coping techniques between appointments. Members learn how to identify and change the negative thoughts, beliefs, reactions and behaviors that lead to emotional pain and disturbing psychosomatic complaints. The benefits of group attendance can continue even after therapy is completed

Primary Care Physicians Can Feel Safe Referring:

• people with no obvious emotional disorder who are coping badly with their day to day problems.
• those with emotional disorders who initially refuse specialist care. Attending the group helps many overcome the sense of shame associated with a mental disorder, so professional care becomes more acceptable to them.
• patients who are being referred to a mental health professional but must wait a considerable length of time before their first appointment.
• patients waiting for their medications to take affect.
• recovering alcoholics with emotional symptoms.

Professionals encourage attendance at Recovery meetings by saying:

"It [Recovery meeting] is like going to a class to learn. You will gain knowledge to take the fear away and learn how to control the fear. If you do use Recovery, it's something you can do yourself rather than having to depend on another person. It will make you more independent and more in control of your symptoms.

"You don't have to get the language right during the learning process. Focus on the process and realize you won’t learn the language overnight." Michael Fusillo, MD

"Go to three meetings before your first/next appointment with me.

Observe the leader and report back to me how the leader functioned before Recovery. How do they feel and function now? Are they well?" George Deering, MD.

"Try it! Recovery shows people how to regain control over their lives." Donel Warde, MD.

"If you go, it (Recovery) won't be like therapy, it will be like going to school or a study group."

(In general, if a patient comes to see me who has obvious problems with anticipatory anxiety or in some way has a type of thinking which tends to cause symptoms to be magnified, or to recur frequently..., I tell them about Dr. Low and Recovery.) George L. Warren,,M.D.

Other Successful Strategies

"I occasionally have Recovery members call an outpatient on the phone to introduce themselves. They share their experiences and present information on Recovery." Michael Fusillo, MD.

"I sometimes scheduled a dual appointment for a new patient and a patient who attended Recovery meetings.

I wrote a prescription for buying the Recovery, Inc. book, "Mental Health Through Will Training", (MHTWT) with instructions to bring it to the next session so patient and doctor could go over it together." George Deering, MD

Other Successful Strategies that were shared:

• Many practices distribute lists of local Recovery meeting places to their clients.
• Write the Recovery contact phone number on discharge papers.
• One professional loans copies of MHTWT to patients and assigns pertinent reading assignments.
• One psychiatrist in the northeast reported attending Recovery meetings to become familiar with Recovery's self-help techniques. He was then able to reinforce those techniques with his patients during counseling sessions.
• Some therapists offer to let the client use their office telephone to call the local Recovery contact person.
• Several respondents have a therapist or staff member accompany some patients to their first Recovery meeting. During the next private session, they discuss objections, fears, projections, rationalizations and questions which the patient had while attending their initial meeting.

• After I started going to the mental health clinic, the psychiatric social worker that I was seeing told me that he would only work with me if I went to Recovery.
• I was hesitant when I told my psychiatrist that I wanted to start going to Recovery meetings and he said: "Remember, you can always come back to me."
• My social worker and neurologist both said, "Recovery will help you get close to good mental health each time you go to a meeting."
• It was comforting to hear that people in Recovery would understand what I was going through and could relate to how I felt because they had experienced similar conditions.
• When I expressed being afraid to sit with a group of strangers, I was told to think of attending meetings as going out for coffee with friends.
• I was relieved to find that Recovery would help with my shyness.
• If I became discouraged at my slow but steady progress, my therapist said, "Keep going to Recovery meetings." (He knew when to help me and when to let me help myself.)
• My counselor recognized my potential when I couldn't. She remarked: "If you work at The Method you have the potential of being a positive influence in the organization." ('This instilled a challenge and curiosity in me.)
• I was more than a little apprehensive! I heard, "Go to Recovery!", more than once. (He kept repeating this message until I finally started to attend the weekly meetings.)
• If you continue practicing Recovery techniques, you will gain insight into what is contributing to your symptoms.

"So many patients might benefit from Recovery: All types of anxiety disorders, depression, psycho-physical disorders, and stress of psychological symptoms. Those suffering from manic depression and schizophrenia can benefit after some medical treatment." Mark Hansen, MD.

"To a clinician, Recovery's constituency is surprising. The organization offers something of value for nearly everyone." Earl. N. Solon, MD.

When to Refer

"The majority of patients with fears, anxiety or physical symptoms with a psychological cause, can be referred as soon as the problem is identified. People with chemical dependence or substance abuse should be referred only after addiction has been controlled." Mark R. Hansen, MD.

When Can Improvements be Expected?

"As soon as the first Recovery term or concept is understood and practiced. I recommend attending no less than five meetings, before judging its suitability." George Deering, MD.

Recovery, Inc. Program Benefits for:

Health Care Providers Through:

• Fewer panic calls
• Patient self-reliance
• Shortened treatment time
• Cost effectiveness
• Greater patient compliance

• Hope
• Understanding
• Support and acceptance
• Encouragement
• Specific coping techniques

"Recovery makes my job easier because the patients don't cling to me. They learn to rely on themselves, not medication, family or the doctor." George Warren, MD.

"The patients were disciplined, so there was little quibbling and arguing in the physician's office, which means that the "resistance" to my explanations and directions was reduced to a minimum." George Deering, MD.

"I see my patients in Recovery doing much better clinically than those with comparable problems not in a Recovery group.

With it (Recovery), treatment is not only strengthened, but shortened and accelerated." Earl N. Solon, MD.

"These (Recovery) patients help me with their management and in essence become part of the therapy team. Their response to treatment is greater, they report feeling better, they have fewer hospitalizations, less need for medication, and they learn to differentiate between true medical ailments and psychosomatic complaints." Jorge Lindenbaum, MD.

"Patients referred to Recovery develop greater confidence in the integrity of their therapist. They take their medication and follow guidance more routinely. Their response to therapeutic efforts is more favorable all around and hence, more satisfying and rewarding to me." Joseph C. Janis, MD.

Helpful Features of Recovery

"Recovery creates contacts that existed in the old time small village. It offers acceptance, support and understanding.

It provides another chance for individuals to learn social skills and learn to live more fully." George Deering, MD.

"The emotional climate of a group is an effective instrument for combating the feeling of isolation and withdrawal of the patients. Mass suggestion and mass identification help to extrovert a patient's emotions and draw him out of his shell." Stanley Dean, MD

DR. LOW, FOUNDER OF RECOVERY, INC., SAYS:

"Since Recovery places the emphasis on the self-help action of the patients, it must ignore investigations and explorations which are not within the province of inexperienced lay persons."

WHAT OTHERS SAY:

"Recovery intentionally avoids making therapeutic distinctions based on diagnoses in its groups, and instead focuses on helping members learn to cope with the restlessness, tenseness, preoccupation, terrifying sensations, threatening impulses, obsessing thoughts and dressed feelings that are actually common across many diagnostic groups." Peter Murray, M. D

The Role of Recovery, Inc. As An Adjunct to Internal Medicine

Dr. Jorge Lindenbaum is a board certified internist specializing in hypertension and geriatrics in Pittsburgh, Pennsylvania. He is a graduate of Buenos Aires University school of Medicine, and finished his fellowship in clinical pharmacology and hypertension at the University of Pittsburgh. He is the president of Medical Staff at Mercy Providence Hospital in Pittsburgh.

Dr. Donel Warde is the past president of Allegheny General Hospital Medical Staff in Pittsburgh. He is a graduate of the University of Dublin and Trinity College Medical School. He is a board-certified internist and cardiologist practicing in Pittsburgh, Pennsylvania.

QUESTION: As a practicing internist/cardiologist, how has Recovery helped with patient management?

ANSWER;

DR. LINDENBAUM: Recovery has been a tremendous help because it enhances my own treatment regime by teaching the patient important self-management skills in coping with their illness. Recovery is also a no-cost, supplemental support group to which I can refer patients. This is a prime consideration in an era of managed care, cost containment, for the patient already burdened with medical bills.

DR. WARDE: In patients with conditions such as mitral valve prolapse (M.V.P.) or benign rhythm disturbances, Recovery has been a great help in getting such patients to come to grips with their medical condition. Recovery enables patients to achieve great insight into their condition and the confidence that they too can overcome their fears.

QUESTION: After a complete physical examination has ruled out organic disease, what common symptoms may indicate an underlying nervous condition?

ANSWER:

DR. WARDE: The presence of undue anxiety in the absence of a known medical/cardiac condition is a major indicator. The presence of agoraphobia or excessive claustrophobia can be indicative of a "nervous condition." Obsessive/compulsive or ritualistic behavior can also be present in many of these patients.

DR. LINDENBAUM: The garden variety of anxious, panic, depressive symptoms are always present in these patients and most often do not correlate with any particular medical pathology.

QUESTION: Can Recovery help you handle a patient who feels insulted or "angry" when told his physical problems are really nervous in origin?

ANSWER:

LINDENBAUM: Yes, without a doubt. I stress to my patients that the symptoms they are experiencing are indeed very real, but not at all life threatening. By attending a Recovery group, the patient will find others with exactly the same problems, who are improving by using The Recovery Method.

DR. WARDE: Absolutely! Frequently patients, such as M.V.P. patients, have not had a sympathetic hearing given to their complaints. A comprehensive history and physical exam, with appropriate diagnostic studies, will help to reassure patients that their complaints have been taken seriously and Recovery can help greatly in giving them insight into their condition.

QUESTION: Do you feel Recovery is helpful for the patient who is depressed and/or anxious due to a true medical condition?

ANSWER:

DR. WARDE: Yes, when the medical condition is reasonably stable. Recovery helps patients to cope with their physical limitations as well as the anxiety that accompanies illness.

DR. LINDENBAUM: Recovery can help many patients with underlying medical conditions. The obvious benefit is that as the symptoms of anxiety and depression decrease, successful medical management increases.

QUESTION: How do you convince your patients of the long term benefits they can gain with the Recovery program when most are looking for the "quick fix" or the 11 perfect pill" to solve their problems?

ANSWER:

DR. WARDE: I tell them to "try it." Recovery shows them how to regain control over their lives and reduce their need for anxiety lowering medication.

DR. LINDENBAUM: It's imperative to have a good rapport with your patients in order for them to believe and trust your judgment. It may take extra time on my part, but once my patients realize the consequences of not treating nervous symptoms, most are willing to at least give Recovery a trial. Once basic Recovery techniques are learned, the patient has simple, effective tools, which complement the physician's treatment.

QUESTION: What improvements have you seen in your patients who regularly attend Recovery meetings?

ANSWER:

DR. LINDENBAUM: These patients help me with their management and in essence become part of the therapy team. Their response to treatment is greater, they report feeling better, they have fewer hospitalizations, less need for medication, and they learn to differentiate between true medical ailments and psychosomatic complaints.

DR. WARDE: Patient compliance (with their medical regimen) improves significantly as patients develop a better understanding of themselves.

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