1. Mediated Communication- promoting recovery and well-
being
Naama Katz
Supervised by: Dr Dalia Sachs, Professor Noomi Katz
Background and Rationale
In the past twenty years, the field of mental health rehabilitation has undergone a
professional and ideological transformation, the pinnacle of which was the passing of
various laws, such as the Rehabilitation of the Mentally Disabled in the
Community Law of 2000, the Equal Rights for People with Disabilities Law of 1998,
and the adoption of the Recovery Approach based policy (Schtruch et al., 2008;
Lechman, 2007; Lechman & Hadas-Lidor, 2007). This approach aims to enable people
coping with mental health disabilities (hereinafter "consumers") to live a meaningful
life wherever they choose. Following this legislative and social transformation in this
field, many mental health professionals choose to focus on rehabilitation. Also, there
has been a dramatic improvement in the services offered and in the capacities and
authority of these practitioners. (Anthony et al., 2002; Slade et al., 2014).
In order to complete the revolutionary change in approach, mental health professionals
need to make a change in their therapeutic perceptions. Many of them have become
accustomed to using therapeutic models not aligned with the Recovery Approach. In
order to facilitate this much needed change, unique training processes should be
implemented and offered to healthcare professionals of various fields, various
perceptions, backgrounds and knowledge levels.
In fact, in the past few years many attempts have been made to develop unique
rehabilitation training models, but so far it seems these have hardly scratched the
surface (Farkas & Anthony, 2010; Yerushalmi, 2010; Slade et al., 2014).
Consequently, despite the intensified efforts put into training programs based in the
Recovery Approach, the tools provided in these programs are extremely difficult to
implement, due to two factors: first, the semantic interpretation of the term
"Recovery". Many professionals seem to think that recovery means that the "patients"
are supposedly cured, whereas the Recovery Approach actually refers to a personal
process undergone by each of consumers. Secondly, "Recovery" seems to be an
abstract term, with no distinctive, applicable components.

2. In order to resolve these issues, this research suggests focusing on the rehabilitation
professionals' communication abilities, and designing a training program which would
help perfect their mediation skills. These skills will enable them to use the mediation
techniques suggested to them and enroll the consumers to partake in a joint therapeutic
process.
The mediation skills suggested in this study are based on theoretical approaches
(Feuerstein & Rand, 1998; Rand & Rynders, 1988; Feuerstein, 2011; Toglia, 1992),
and have been anchored by research (Hadad-Lidor & Weiss, 2004; Hadas-Lidor &
Keisar, 2007; Katz, 2011).
The mediation skills enable healthcare professionals to respond in a variety of methods
and guide the consumers on their way to recovery. Therefore, the development of a
training model based on mediation skills and adaptable communication can contribute
significantly to the promotion of recovery processes of the consumers and improve the
sense of professional efficacy of the rehabilitation professionals working with them.
This study offers a recovery aimed training model based on Feuerstein's Mediated
Learning Experience MLE (Hadas-Lidor & Weiss, 2004; Feuerstein, 1988; Feuerstein,
Rand & Rynders, 1988). The model was designed and implemented in a training
program titled "Recovery and well-being oriented communication" (RWOC),
established specifically for the purpose of this study. Participants of the program were
given structured tools enabling them to communicate with the consumers in a flexible
manner, based on MLE principles. The training program was documented and
evaluated using approved methods. The program's effects on workers' performance,
attidude and sense of professional efficacy where also evaluated.
The research also included a specialized preliminary pilot research group of lawyers
working at the Legal Center for Victims of Crime. The objective for including this
group was to examine whether this model can be implemented among professionals of
other fields, who are indirectly connected to the recovery process, as they support their
clients and promote their personal well-being.
Research Objective
This study's first and foremost objective is to improve the "rehabilitative mediating
communication" component among rehabilitation professionals, using a recovery-
based training program. A secondary goal is to examine the efficacy of said training
program and its effects on the following variables: rehabilitation professionals'

3. attitudes towards their consumers and the Recovery Approach, their Mediation
Skills, and their sense of occupational efficacy.
Research Variables
The efficiency of the RWOC training program, developed specifically for this study,
was evaluated using the following variables: attitudes towards consumers, and
towards recovery, mediation skills and sense sense of occupational efficacy.
All these variables were evaluated in both quantitative and qualitative methods.
Research Hypothesis
This study's hypothesis was that the training program will have a statistically
significant positive effect on the participants' positions both towards the consumers
and the Recovery Approach. Additionally, a statistically significant improvement was
predicted in the use rehabilitation professionals made in their communication abilities
and their sense of occupational efficacy.
Qualitative Research Questions
These were the qualitative research questions: what are the participants' positions
regarding the consumers prior to and after their participation in the training program?
How do the training program's participants perceive the recovery capabilities of the
consumers? How do they perceive the significance of communicating with the
consumers during rehabilitation process? Does this communication advance the
rehabilitation process?
Research Population
This research included two research groups: one group of two teams of mental health
rehabilitation professionals (n=39), who completed a 12-week training program. The
second group comprising of lawyers and interns from the Legal Center for Victims of
Crime (n=4). The latter was a pioneering research group aimed to examine the efficacy
of the communication model among professionals in fields other than rehabilitation
and mental health.
Research Method

4. This research is based on a mixed method research design. The data was gathered and
analyzed using two methods: quantitative and qualitative. The quantitative analysis
was based on a before-after experiment design (before and after taking part in the
training program). The qualitative evaluation of the program's efficiency was based
on focus groups before and after the training program took place. The objective of
holding the focus groups was to enhance the understanding of the participants'
perceptions and any changes made in them. The pioneering focus group, comprising of
lawyers from Legal Center for Victims of Crime, was only analyzed using a
qualitative method on the focus groups.
Evaluation Tools
The research hypotheses were examined using four questionnaires: one evaluating
perceptions regarding the Recovery Approach (RAQ-7), the second evaluating
positions regarding the consumers. the third evaluating occupational efficacy. The
fourth was developed specifically for this study, aiming to map the components of
mediation. As stated, the qualitative research questions were examined using two
focus groups: one comprised of mental health rehabilitation professionals, and the
other of lawyers from the Legal Center for Victims of Crime.
Research Process
The mixed research was based on quantitative and qualitative evaluations held in
different points in time. The evaluation was done according to the ABA ABA array,
which includes a double review of each intervention, and two measuring phases in
each of the organizations: two A phases, and a B phase in between them, which is the
intervention. Following the completion of the training program in both rehabilitation
services, a third organization was evaluated as a pilot group: the Legal Center for
Victims of Crime. First, an exclusively quantitative evaluation was held on the focus
group (Phase A), then the training program was held, adapted to the unique
requirements of the participants in this group (Phase B), and finally, another
quantitative evaluation took place (second Phase A).
Data Processing
The data provided in the questionnaires was processed using a one-way analysis of
variance.

5. In order to examine the differences in communication skills and in the application of
the recovery components and the sense of professional efficacy in different points in
time (before and after the training), ANOVA repeated measures were used.
In order to evaluate the correlation between the professional efficacy variable and the
program participants' positions regarding recovery and the consumers , a Pearson
Correlation was applied.
In order to process the qualitative data, the focus groups contents were analyzed using
qualitative research method principles (Shakedi, 2003; Creswell, 1988).
Findings
After completing the training program, the participants showed a statistically
significant improvement in their attitudes regarding the consumers as well as
regarding the Recovery Approach (p<.001). Another statistically significant
improvement was found in their sense of professional efficacy (p<0.01). These
findings were corroborated by the focus group (qualitative) analysis results. Having
completed the training program, the mental rehabilitation professionals were able to
define more clearly their role in promoting the consumers recovery process. This was
manifested in their ability to understand the values of the Recovery Approach and
their practical application, and in their ability to maintain a partnership-based
communication with the consumers.
Participants of the lawyers' group discussed the extent to which they can apply the
principles of personal well-being -advancing communication in their work at the Legal
Center for Victims of Crime. Another topic of discussion was the unique definition of
the professional "self" of the Center's team, and the structuring of dedicated work
processes and terminology that can help them help others, and combine therapeutic
components in the legal aid they provide.
Discussion and Conclusions
The findings of this study prove that a suitable training program can affect the
perceptions of those partaking in it. These results support findings of previous studies,
claiming that optimal training for mental health professionals should be based on a
few key principles: designing the program for adult participants (Knowels, 1988);
focusing on relevant professional contents (Stuart, Tondora & Hoge, 2004); enhancing
the participants' ability for independent, adaptable learning (Kozulin, 1994);

6. promoting the participants' skills and needs, and increasing the employees' awareness
to these skills and needs (Telem, 2008; Netzer, 2012).
These findings suggest that mediated communication influences the positions of
mental healthcare professionals. Another conclusion is the contribution of mediated
communication to the advancement of these subjects' sense of professional efficacy.
This study offers important theoretical, practical and methodological insights:
From the theoretical aspect, it suggests a comprehensive model, defining relevant
terms that contribute to professionals dealing with well-being promotion. The study
offers a better understanding of two fundamental concepts: recovery and personal
well-being. These findings demonstrate how important it is to fully grasp the meaning
of these concepts, with their similarities and differences. Another finding is the
suggested correlation between these two concepts: personal well-being is, according to
this research's finding, a result of the Recovery process.
This study also deepens the understanding of two key rehabilitation related issues: its
practitioners' personal attitudes and self-awareness. Our findings suggest a way of
influencing these attitudes by elaborating the practitioners' communication skills. This
Elaboration will prompt the professionals to take responsibility for the messages they
convey, and understand that the communication difficulties might be theirs and not the
consumers only ' or their illnesses'.
This research offers a structured model based on accepted mediation principles,
enabling the enhancement of mental health professionals' communication skills, self-
reflation, and mediation abilities. Therefore, the major contribution of this research is
the development of this model, which provides a theoretically and scientifically
anchored model, perfecting skills that are crucially required yet difficult to acquire.
Another theoretical contribution is applying the theoretical terminology to groups
outside the field of mental health (e.g. the Legal Center for Victims of Crime). Our
findings suggest that personal well-being based communication is beneficial to other
fields, such as professions associated with personal well-being promotion, regardless
of their background.
As for the practical aspect, this study offers a structured format for a training
program and ways for its evaluation. The training program includes a flexible array of
exercises, adapted to the participants' needs. This paper emphasizes the need for
improving communication skills that are the core ability for any professional, and yet
have largely been overlooked in professional training. We found that this specific

7. ability enables better familiarity with the cosumer or client, and alters the manner in
which he/she is perceived by the caretaker/handler. The nature of the communication
directly affects the employee's positions, and study participants all agreed that this
variable can and should be enhanced. Awareness to mediated communication and a
better understanding of its components can associate between the theoretical-
ideological perception and the actual work. Also, adapting the program to the specific
group of the Legal Center for Victims of Crime's lawyers, enables applying these
findings to a wide range of professionals working to promote their clients' personal
welfare.
This study also has a methodological contribution, as it provides new tools for
examination and evaluation of essential mediation skills (mapping the mediation
components). This evaluation tool that was developed for this research, enable the
mediator to receive feedback on his/her performance in this abstract domain.
Additionally, the combination of qualitative and quantitative analyses used in this
study deepens the understanding into the disparity in participants' views.