Professional Documents
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Rehabilitation Teaching and Research Unit, University of Otago, Wellington, 2School of Psychology,
Victoria University of Wellington, Wellington, New Zealand, and 3Health and Rehabilitation Research Centre,
AUT University, Auckland, New Zealand
Abstract
Aims of the paper. The aim of this paper was to introduce the Good Lives Model, originally developed for offender
rehabilitation, to the clinical rehabilitation community. We argue that this model has considerable promise, both as a
thinking tool and as an integrative framework emphasizing the centrality of the person in clinical and community
rehabilitation for complex and chronic health conditions.
Key findings and implications. The essential features of a good rehabilitation theory are first outlined. These are the general
principles and assumptions that underpin a theory, the aetiological assumptions and the intervention implications. The Good
Lives Model for clinical rehabilitation is then described in terms of these three components of a good rehabilitation theory.
Conclusions and recommendations. The Good Lives Model has considerable promise as a tool for integrating many diverse
aspects of current best practice in rehabilitation while maintaining the individual client as the central focus. At the same time
it is provisional and further theoretical development and empirical support is required.
Keywords: Good Lives Model, rehabilitation theory, primary goods, client-centred rehabilitation
Introduction
The aim of this paper was to introduce the Good
Lives Model, originally developed for offender
rehabilitation, to the clinical rehabilitation community [1]. In a recent paper we argued that theory
development in rehabilitation has lagged behind the
development of an empirical foundation for contemporary rehabilitation [2]. That paper argued that
it is not sufficient to prove what works in
rehabilitation we also need to discover how it
works. An analogy can be drawn to the discovery of a
new medication that is found to be effective for a
particular disease. At first it is sufficient to just know
that this medicine is effective in treating the illness.
However, research quickly turns to understanding
the exact biochemical mechanism and physiological
pathway by which this new drug acts. Understanding
how the new drug works allows for the development
Correspondence: Dr Richard J. Siegert, Department of Pallative Care, Policy and Rehabilitation, School of Medicine at Guys, Kings College and St Thomas
Hospitals, Kings College London, Weston Education Centre, 3rd Floor, Cutcombe Road, Denmark Hill, London SE5 9RJ. E-mail: richard.siegert@kcl.ac.uk
ISSN 0963-8288 print/ISSN 1464-5165 online 2007 Informa UK Ltd.
DOI: 10.1080/09638280701618794
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assumptions about their core features. As rehabilitation is a fundamentally human enterprise, one in
which humans help other humans or themselves, the
essential metaphysical concern has to do with human
nature in general. At first glance such philosophical
concerns might appear rather abstract or esoteric
when considered in relation to the practice of
rehabilitation. However, even a casual reading of
the World Health Organizations International Classification of Functioning, Disability and Health
demonstrates certain implicit assumptions about
human nature [8]. For example, the emphasis on
social participation and the inclusion of chapters on
topics such as domestic life, interpersonal interactions, relationships and civic life, all reflect basic
assumptions about what it means to be human and
what is valued in human lives (see Leplege et al. [9]
in this issue).
Another metaphysical assumption is our belief
about the capacity for individuals to change, to grow,
to adapt and even to thrive in oppressive circumstances. Can people learn new and more adaptive
ways of coping after trauma or in the face of chronic
illness? Or is this ability to adapt and develop as a
person in trying circumstances fixed by genes, social
history or personality? As we have noted elsewhere,
even the concept of motivation is a controversial
one in rehabilitation literature [2,3,10]. An important related issue concerns our basic assumptions
about the process of rehabilitation. Is it primarily a
largely technical process (see MacLeod and McPherson [11] in this issue) whereby expert clinicians treat
a passive or dutiful patient or is some notion of
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explanations. Clearly, further theoretical development and empirical research is required here to
develop this aspect of the GLM as it is applied to
clinical rehabilitation.
Intervention implications
There are a number of implications for assessment
and intervention in rehabilitation that arise from a
GLM perspective. However, given the novel and
rather tentative status of this approach for clinical
rehabilitation, we will limit these to just a few.
Perhaps the most obvious implication of the GLM
for clinical and community rehabilitation is that each
client should have their own individual GLP and that
this plan should form the overarching, integrative
framework for that persons rehabilitation (i.e.,
replace what might be considered the concept of a
traditional rehabilitation plan). One of the distinguishing features of a GLP when compared with a
more traditional rehabilitation plan would be in the
inclusion of primary goods and the focus on specific
means to achieve these. While some authors have
described the inclusion of long-term goals in the
development of a rehabilitation plan [21,42 44],
these long-term goals have tended to focus on
issues relating to secondary goods (e.g., to return
home, to walk again, to return to work) rather
than on primary goods. More compatible with a GLP
would be the approach to rehabilitation planning that
have included some consideration of a patients life
goals as primary goods when selecting the more
intervention-focused short-term goals of treatment
[45,46].
It is assumed in the GLM of rehabilitation that
motivation is a crucial factor in successful rehabilitation outcomes and that motivation is directly related
to the acquisition of primary goods. Put simply it is
through determining which primary goods are most
highly valued by a patient or client that health
professionals can learn what motivates that person.
In other words, the individuals particular strengths,
interests, values (i.e., weightings of goods), social
and personal circumstances and home environment
should be taken into account when constructing a
rehabilitation plan. Again, this concept relates to the
work that has occurred around the application of life
goals in rehabilitation. Nair [46] has argued that a
patients motivation to participate in a rehabilitation
programme may depend in part on the degree to
which the rehabilitation goals align with their own
life goals. Further to this however and while GLM
interventions may still be implemented in a systematic and structured way, therapeutic tasks within ward
or outpatient programmes should be shaped to suit
the person in question based on their own life plan.
For example, while an individual in a programme for
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seems to lack adequate balance and range of
priorities? For instance, we referred earlier to
some TBI patients, who try so hard to return
to full-time employment that the resultant
exhaustion, headaches and irritability jeopardize their family life, their work life or even
self-care [41].
Are some human goods pursued through
inappropriate means? That is, has the individual chosen strategies for achieving goods,
which have turned out to be counter-productive? An example of this might be a situation
where an individual with a severe disability
becomes reliant upon alcohol or drugs as a
means of achieving the goods of inner peace
and happiness.
Is there conflict among the goods articulated?
For instance, does the individual prioritize
goals that cannot co-exist easily? An example
of this might be a situation where a person
with severe cognitive or psychiatric problems
wants to be fully autonomous in their life, but
also wants to be physically healthy and meaningfully productive, when their impairments
limit their ability achieve this independently.
Emmons has clearly described the stress that
results from a lifestyle that is inconsistent with
ones most valued goods [28].
Does the person have the capacity or capabilities to enact their life plan and achieve their
stated life goals? Is the plan realistic in light of
their abilities, likely opportunities, deep preferences, and values? Is intervention required
in order to retrain capabilities or alter their
environment in such as way as to enable that
person to progress in their life plan?
References
1. Ward T, Gannon T. Rehabilitation, etiology and selfregulation: The Good Lives Model of sexual offender
treatment. Aggress Violent Behav 2006;11:77 94.
2. Siegert RJ, McPherson KM, Dean SG. Theory development
and a science of rehabilitation. Disabil Rehabil 2005;27(24):
1493 1501.
3. Siegert RJ, Taylor WJ. Theoretical aspects of goal-setting and
motivation in rehabilitation. Disabil Rehabil 2004;26(1):1 8.
4. Levack WMM, Dean SG, Siegert RJ, McPherson KM.
Purposes for goal planning in rehabilitation: The need for a
critical distinction. Disabil Rehabil 2006;28(120):741 749.
5. Levack WMM, Taylor K, Siegert RJ, Dean SG, Weatherall
M, McPherson KM. Is goal planning in rehabilitation
effective? A systematic review. Clin Rehabil 2006;20:1 17.
6. Ward T, Stewart C. Criminogenic needs and human needs: A
theoretical model. Psychol Crime Law 2003;9:125 144.
7. Kukla A. Methods of theoretical psychology. Cambridge,
Massachusetts: MIT Press; 2001.
8. World Health Organisation. International Classification of
Functioning, Disability and Health: ICF. Geneva: World
Health Organisation; 2001.
9. Leplege A, Gzil F, Cammeli M, Lefeve C, Pachoud B, Ville I.
Person-centredness: Conceptual and historical perspectives.
Disabil Rehabil 2007;29(20 21):1555 1565.
10. Maclean N, Pound P. A critical review of the concept of
patient motivation in the literature on physical rehabilitation.
Soc Sci Med 2000;50:495 506.
11. MacLeod R, McPherson KM. Care and compassion: Part of
person-centred rehabilitation, inappropriate response or a
forgotten art? Disabil Rehabil 2007;29(20 21):1589 1595.
12. Cott CA, Wiles R, Devitt R. Continuity, transition and
participation: Preparing clients for life in the community poststroke. Disabil Rehabil 2007;29(20 21):1566 1574.
13. Barnartt S, Schriner K, Scotch R. Advocacy and political
action. In: Albrecht GL, Seelman KD, Bury M, editors.
Handbook of disability studies. California: Sage Publications
Ltd; 2001. pp 430 449.
14. Williams G. Theorising disability. In: Albrecht GL,
Seelman KD, Bury M, editors. Handbook of disability
studies. California: Sage Publications Ltd; 2001. pp 123 144.
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