The Tidal Model of Mental Health Recovery

The Tidal Model of Mental Health Recovery

Nancy Brookes


Phil Barker was born in Scotland by the sea, and thus began the influence of and interest in water, the ultimate metaphor of life (Barker, 1996a, p. 239). He credits his father and grandfather with “the warmth of nurture and the discipline of boundaries,” who helped him to appreciate that “life was an answer waiting for the right question,” and he, like them, became a philosopher (Barker, 1999b, p. xii). Life in this context also contributed to his enduring curiosity and the philosophy of the everyday, which resonate throughout the Tidal Model.

Barker trained as a painter and sculptor in the mid-1960s, and won the prestigious Pernod Award for Young Painters in 1974, by which time he had already become a psychiatric nurse. He continues to paint word pictures in metaphor. Barker credits art school with introducing him to ‘learning from Reality,’ the reality of experience, which became the focus of his philosophical inquiries. His fascination with Eastern philosophies, which began at art school, flows through the Tidal Model with echoes of chaos, uncertainty, change, and the Chinese idea of crisis as opportunity. This early involvement in the arts also helps to explain Barker’s view of nursing as “the craft of caring” (Barker, 2000c, 2000e; Barker & Whitehill, 1997).

Following art school, Barker worked as a commercial artist and mural painter, supplementing his income with laboring work on the railroads and in factories. His “ocean of experience” surged in a new direction in 1970, when he took a position as an “attendant at the local asylum.” His fascination with the human dimension, the lived experience, and the stories of people challenged by mental distress prompted him to transfer his interest in the arts and humanities to nursing.

Barker’s early progress through nursing, although unusual, was typical of the times and the context. Nursing per se was temporarily submerged when he began to study and practice various psychotherapies such as cognitive behavioural therapy and family and group therapy. Barker’s doctoral research featured cognitive behavioral work with a group of women living with depression (Barker, 1987). However, around this time, Barker became uncomfortable with the application of therapies to people experiencing problems in living, and the “uncertainty principle” resurfaced for him. His curiosity about life and persons provoked questions about the people with whom he was working and their resilience and integrity. He was learning from them what it meant to experience distress, and he wondered what recovery meant to people? Questions re-emerged around:

During his tenure as Professor of Psychiatric Nursing Practice at the University of Newcastle, these questions framed his research agenda and culminated in the development of the Tidal Model.

As the UK’s first Professor of Psychiatric Nursing Practice, Barker continued to maintain a practice and develop the Tidal Model. Throughout his nursing career, Barker has wondered about the proper focus of psychiatric nursing and the role of care, compassion, understanding, and courage in helping people experiencing extreme distress or loss of self, or in spiritual crisis (Barker, 1999b). The Tidal Model was developed within this context and history. The narrative knowledge base for the Tidal Model, although particular, is not exclusive and it leaves room both for development and for other viewpoints.

Barker has published in the area of psychiatric and mental health nursing since 1978. A prolific writer, he has written 14 books, over 50 book chapters, and more than 150 academic papers. He was assistant editor for the Journal of Psychiatric and Mental Health Nursing for a decade. Barker was made a Fellow of the Royal College of Nursing (UK) in 1995, only the fourth psychiatric nurse to be so honored. He received the Red Gate Award for Distinguished Professors at the University of Tokyo in 2000. In 2001, he received an Honorary Doctorate from Oxford Brookes University in England, and a room was named in his honor at the Health Care Studies Faculty at Homerton College, Cambridge. He has held visiting professorships at several international universities, for example, Australia (Sydney), European (Barcelona), and Japan (Tokyo). He was visiting professor at Trinity College Dublin from 2002 to 2007. In 2006, he received the inaugural “Lifetime Achievement Award” from Blackwell journals, publishers of the Journal of Psychiatric and Mental Health Nursing.

Barker has travelled widely with his wife and professional partner Poppy Buchanan-Barker, in response to interest in the recovery paradigm underlying the Tidal Model, conducting workshops and seminars in Australia, Canada, New Zealand, Japan, Finland, Denmark, Turkey, Germany, and Ireland as well as the United Kingdom. A popular commentator on the human condition, he brings to radio, television, and the popular press his passion for and curiosity about the recovery process and personhood.

Currently, Barker is an Honorary Professor at the University of Dundee, Scotland, where he maintains a private psychotherapy practice. He and his wife have developed the recovery paradigm at Clan Unity, an international mental health recovery and reclamation consultancy in Scotland.


The Tidal Model is focused on the fundamental care processes of nursing, is universally applicable, and is a practical guide for psychiatric and mental health nursing (Barker, 2001b). The theory is radical in its re-conceptualization of mental health problems and needs as unequivocally human, rather than psychological, social, or physical (Barker, 2002b, p. 233). The Tidal Model “emphasizes the central importance of: developing understanding of the person’s needs through collaborative working, developing a therapeutic relationship through discrete methods of active empowerment, establishing nursing as an educative element at the heart of interdisciplinary intervention” (Barker, 2000e, p. 4) and seeking to resolve problems and promote mental health through narrative approaches (Stevenson, Barker & Fletcher, 2002, p. 272).

The Tidal Model is a philosophical approach to recovery of mental health. It is not a model of care or treatment of mental illness, although people described as mentally ill do need and receive care. The Tidal Model represents a specific worldview. It helps the nurse begin to understand what mental health might mean for the particular person in care, and how that person might be helped to begin the complex voyage of recovery.

The Tidal Model is not prescriptive, rather, a set of principles—the Ten Commitments—serve as the metaphorical compass for the practitioner (Buchanan-Barker & Barker, 2006, 2008). They guide the nurse in developing responses to meet the individual and contextual needs of the person who has become the patient. The experience of mental distress is invariably described in metaphorical terms. The Tidal Model employs the universal and culturally significant metaphors associated with the power of water and the sea, to represent the known aspects of human distress. Water is “the core metaphor for both the lived experience of the person…and the care system that attempts to mould itself around a person’s need for nursing” (Barker, 2000e, p. 10).

Barker describes an “early interest in the human content of mental distress… and an interest in the human (phenomenological) experience of distress,” which is viewed in contexts and wholes rather than isolated parts (Barker, 1999b, p. 13). The “whole” nature of being human is “re-presented on physical, emotional, intellectual, social and spiritual planes” (Barker, 2002b, p. 233). This phenomenological interest pervades the Tidal Model with an emphasis on the lived experience of persons, their stories (replete with metaphors) and narrative interventions. Nurses carefully and sensitively meet and interact with people in a “sacred space” (Barker, 2003a, p. 613).

A feature of Barker’s nursing practice has been his exploration of the possibilities of genuine collaborative relationships with users of mental health services. In the 1980s, he developed the concept of “caring with” people, learning that the professional-person relationship could be more “mutual” than the original nurse-patient relationship defined by Peplau (1969). Barker further developed this concept during the 1990s in a working relationship with Dr. Irene Whitehill and others who used mental health services (Barker & Whitehill, 1997). This work led to the “need for nursing” and “empowerment” studies as well as a commitment to publish the stories of people’s experience of madness, and their voyage of recovery, complete with personal and spiritual meanings (Barker, Jackson, & Stevenson, 1999a; Barker & Buchanan-Barker, 2004b). Barker enlisted the support of Dr. Whitehill and other “user/consumer consultants,” to evaluate how “user friendly” were the original processes of the Tidal Model. The involvement of “user/consumer consultants” is seen in several ongoing projects, and presents a distinctive feature of continued development of the Tidal Model.

Barker’s longstanding appreciation of Eastern philosophies pervades his work. The work of Shoma Morita is a specific example of how the philosophical assumptions of Zen Buddhism were integrated with psychotherapy (Morita, Kondo, Levine, & Morita, 1998). Morita’s dictum—“Do what needs to be done”—resonates in many of the practical activities of the Tidal Model. In contrast to the zealous “problem-solving” attitude embraced by much of Western psychiatry and psychology, Morita believed that it was futile to try to “change” oneself or one’s “problems,” which come and go like the weather. Instead, the focus should be on answering the questions:

People have the capacity to live and grow through distress, by doing what needs to be done. For people who are in acute distress—especially when they are at risk to self or others—it is vital that nurses relate directly to the person’s ongoing experience. Originally Barker called this process engagement, but has now redefined the specific interpersonal process as “bridging.” This term emphasizes the need to build, creatively, a means of reaching the person; crossing in the process, the murky waters of mental distress (Barker & Buchanan-Barker, 2004b).

The Tidal Model can also be viewed through the lens of social constructivism, recognizing that there are multiple ways of understanding the world. Meaning emerges through the complex webs of interaction, relationships, and social processes. Knowledge does not exist independently of the knower, and all knowledge is situated (Stevenson, 1996). Change is the only constant, as meaning and social realities are constantly renegotiated or constructed through language and interaction. Barker believes that “all I am is story; all I can ever be is story.” As people try to explain to others “who” they are, they tell stories about themselves and their world of experience—revising, editing, and rewriting these stories through dialogue with another. Barker first discussed this idea with his mentor, Hilde Peplau, in 1994, who agreed by saying “people make themselves up as they talk” (Barker, 2003a; Barker & Buchanan-Barker, 2007b).

Barker credits many thinkers with influencing his work, beginning with Annie Altschul and Thomas Szasz. His view of mental health problems as problems of living popularized by Szasz (1961, 2000) and later Podvoll (1990) is a perspective that he prefers to diagnostic labeling and the biomedical construction of people and illness (Barker, 2001c, p. 215). He agrees with Szasz that it is futile to try to “solve problems in living.” Life is not a problem to be solved. Life is something to be lived, as intelligently, as competently, as well as we can, day in and day out (Miller, 1983, p. 290). The challenge for nursing is to help persons live “intelligently” and “competently.”

Travelbee’s (1969) concept of the Therapeutic Use of Self flows through the Tidal Model and provides an anchor for the “proper focus of nursing.” Three main theoretical frameworks underpin the Tidal Model:

The pragmatic emphasis on strength-based, solution-focused approaches acknowledges the important influence of Steve de Shazer and solutionfocused therapy.

The Tidal Model draws its core philosophical metaphor from chaos theory, where the unpredictable—yet bounded—nature of human behavior and experience can be compared to the flow and power of water (Barker, 2000b, p. 54). In constant flux, the tides ebb and flow; they exhibit non-repeating patterns yet stay within bounded parameters (Vicenzi, 1994). Barker (2000b) acknowledges the “complexity [of] both the internal universe of human experience and the external universe, which is, paradoxically, within and beyond the individual, at one and the same time” (p. 52). Within this complex, nonlinear perspective, small changes can create later unpredictable changes. This hopeful message directs nurses and persons to identify small changes and variations. Chaos theory suggests that there are limits to what we can know, and Barker invites nurses to cease the search for certainty, embracing instead the reality of uncertainty. Know that “change is constant,” one of the Tidal commitments identifies and celebrates change in people, circumstances, relationships, and organizations (Barker, 2003b; Buchanan-Barker & Barker, 2008). This perspective also presents challenges in trying to understand people, relationships, and situations. It directs inquiry in qualitative, non-linear ways, such as action research, grounded theory, phenomenology, and critical theory (Barker, 1999a).

Annie Altschul, the Grande Dame of British psychiatric nursing (Barker, 2003a, p. 12), along with Hilda Peplau, was one of Barker’s mentors. Altschul’s influence—especially her early appreciation of system theory—is evident in the Tidal Model, as is her interest in understanding rather than explaining mental distress and her belief that people need more straightforward help than many of the psychiatric theories suggest.

Barker credits Peplau, the mother of psychiatric nursing, with his becoming “an advocate for nursing as a therapeutic activity in its own right” (Barker, 2000a, p. 617). Peplau introduced her interpersonal paradigm for the study and practice of nursing in the early 1950s and defined nursing as “a significant, therapeutic, interpersonal process” (Peplau, 1952, p. 16). A defining characteristic of the Tidal Model is an emphasis on the narrative in the person’s own voice.

The empirically derived Empowering Interactions framework suggests that improvement in the person’s situation and lifestyle is possible, building on strengths is better than focusing on problems, collaboration is key, participation is the way, and self-determination is the ultimate goal (Barker & Buchanan-Barker, 2004a; Barker, Stevenson & Leamy, 2000, p. 8). Eight respectful, empowering interactions also bring generally invisible nursing interactions into the practice arena (Michael, 1994). De Shazer’s (1994) influence is evident as he asserts that change and intervention “boils down to stories about the telling of stories, the shaping and reshaping of stories so that troubled people change their story” (p. xvii).

The strength base of the Tidal Model emphasizes searching for and revealing solutions, and identifying resources. The theory integrates the need for nursing studies, collaboration, empowerment, interpersonal relationships, narrative, strength-based, and solution-seeking approaches, and is systemic. The solution-focus, a model of questions, provides specific direction for nurses. In the Holistic Assessment, nurses explore the person’s present “problems” or “needs,” the scale of these problems/needs, what is currently part of a person’s life that might help to resolve problems or meet needs, and what needs to happen to bring about change (Barker, 2000e; Barker & Buchanan-Barker, 2007a). Nurses help identify and mobilize persons’ strengths and resources, and the person’s goals direct the work of the healthcare team (Barker, 2000e; Stevenson, Jackson, & Barker, 2003). The 10 Commitments (Box 32-1) also support this perspective and direction. This is a significant re-framing of the view of the person-in-care and the proper focus of nursing.

Box 32-1   The Ten Tidal Commitments: Essential Values of the Tidal Model

The Tidal Model draws on our values about relating to people. These frame our efforts to help others in their moment of distress.

The values of the Tidal Model reflect a philosophy of how we would hope to be treated should we experience distress or difficulty in our lives.

As more people around the world have become involved in exploring the Tidal Model for their work, in different settings, the need to re-affirm the core values of the Tidal Model has become more apparent. We have come to appreciate how both the “helper” (whether professional, friend, or fellow traveller) and the person need to make a commitment to change. This commitment binds them together.

The Ten Commitments distils the essence of the value base of the Tidal Model.

These Ten Commitments need to be firmly in place in any team or individual practitioner who wishes to say it is developing the practice of the Tidal Model.

1. Value the voice: The person’s story is the beginning and end point of the whole helping encounter, embracing not only the account of the person’s distress, but also the hope for its resolution. The story is spoken by the voice of experience. We seek to encourage the true voice of the person—rather than reinforce the voice of authority.

    Traditionally, the person’s story is ‘translated’ into a third person, professional account, by different health or social care practitioners. This becomes not so much the person’s story (my story) but the professional team’s view of that story (history). Tidal seeks to help people develop their own unique narrative accounts into a formalized version of ‘my story,’ through ensuring that all assessments and records of care are written in the person’s own “voice.” If the person is unable or unwilling to write in his or her own hand, then the nurse acts as secretary, recording what has been agreed, conjointly, is important—writing this in the “voice” of the person.

2. Respect the language: People develop unique ways of expressing their life stories, representing to others that which the person alone can know. The language of the story—complete with its unusual grammar and personal metaphors—is the ideal medium for illuminating the way to recovery. We encourage people to speak their own words in their distinctive voice.

    Stories written about patients by professionals are traditionally framed by arcane technical language of psychiatric medicine or psychology. Regrettably, many service users and consumers often come to describe themselves in the colonial language of the professionals who have diagnosed them. By valuing—and using—the person’s natural language, the Tidal practitioner conveys the simplest, yet most powerful, respect for the person.

3. Develop genuine curiosity: The person is writing a life story but is in no sense an “open book.” No one can know another person’s experience. Consequently, professionals need to express genuine interest in the story so that they can better understand the storyteller and the story.

    Often professionals are interested only in “what is wrong” with the person, or in pursuing particular lines of professional inquiry—for example, seeking “signs and symptoms.” Genuine curiosity reflects an interest in the person and the person’s unique experience, as opposed to merely classifying and categorizing features, which might be common to many other “patients.”

4. Become the apprentice: The person is the world expert on the life story. Professionals may learn something of the power of that story, but only if they apply themselves diligently and respectfully to the task by becoming apprentice-minded. We need to learn from the person what needs to be done, rather than leading.

    No one can ever know a person’s experience. Professionals often talk “as if” they might even know the person better than they know themselves. As Szasz noted: “How can you know more about a person after seeing him for a few hours, a few days, or even a few months, than he knows about himself? He has known himself a lot longer!” The idea that the person remains entirely in charge of himself is a fundamental premise” (Szasz, 2000).

5. Use the available toolkit: The story contains examples of “what has worked” for the person in the past, or beliefs about “what might work” for this person in the future. These represent the main tools that need to be used to unlock or build the story of recovery. The professional toolkit—commonly expressed through ideas such as “evidence-based practice”—describes what has “worked” for other people. Although potentially useful, this should be used only if the person’s available toolkit is found wanting.

6. Craft the step beyond: The professional helper and the person work together to construct an appreciation of what needs to be done “now.” Any “first step” is a crucial step, revealing the power of change and potentially pointing toward the ultimate goal of recovery. Lao Tzu said that the journey of a thousand miles begins with a single step. We would go further: Any journey begins in our imagination. It is important to imagine—or envision—moving forward. Crafting the step beyond reminds us of the importance of working with the person in the “me now”: addressing what needs to be done now, to help advance to the next step.

7. Give the gift of time: Although time is largely illusionary, nothing is more valuable. Often, professionals complain about not having enough time to work constructively with the person. Although they may not actually “make” time, through creative attention to their work, professionals often find the time to do “what needs to be done.” Here, it is the professional’s relationship with the concept of time which is at issue, rather than time itself (Jonsson, 2005). Ultimately, any time spent in constructive interpersonal communication, is a gift—for both parties). There is nothing more valuable than the time the helper and the person spend together.

8. Reveal personal wisdom: Only the person can know himself or herself. The person develops a powerful storehouse of wisdom through living the writing of the life story. Often, people cannot find the words to express fully the multitude, complexity, or ineffability of their experience, invoking powerful personal metaphors to convey something of their experience (Barker, 2002b). A key task for the professional is to help the person reveal and come to value that wisdom, so that it might be used to sustain the person throughout the voyage of recovery.

9. Know that change is constant: Change is inevitable because change is constant. This is the common story for all people. However, although change is inevitable, growth is optional. Decisions and choices have to be made if growth is to occur. The tasks of the professional helper are to develop awareness of how change is happening and to support the person in making decisions regarding the course of the recovery voyage. In particular, we help the person to steer out of danger and distress, keeping on the course of reclamation and recovery.

10. Be transparent: If the professional and the person are to become a team, then each must put down their “weapons.” In the story-writing process, the professional’s pen can all too often become a weapon: writing a story that risks inhibiting, restricting, and delimiting the person’s life choices. Professionals are in a privileged position and should model confidence by being transparent at all times, helping the person understand exactly what is being done and why. By retaining the use of the person’s own language, and by completing all assessments and care plan records together (in vivo), the collaborative nature of the professional-person relationship becomes even more transparent.

Barker, P. J. (2003b). The 10 Commitments: Essential Values of the Tidal Model. Retrieved February 23, 2008, from



The Tidal Model begins from four simple, yet important starting points:

1. The primary therapeutic focus in mental health care lies in the community. A person’s natural life is an “ocean of experience.” The psychiatric crisis is only one thing, among many, that might threaten to “drown” them. Ultimately, the aim of mental health care is to return people to that “ocean of experience,” so that they might continue with their life voyage.

2. Change is a constant, ongoing process. However, although people are constantly changing, this may be beyond their awareness. One of the main aims of the approaches used within the Tidal Model is to help people develop their awareness of the small changes that, ultimately, will have a big effect on their lives.

3. Empowerment lies at the heart of the caring process. However, people already have their own “power.” We need to help people “power up,” so they can use their own personal power to take greater charge of their lives, using this in constructive ways.

4. The nurse and the person are united (albeit temporarily) like dancers in a dance. When effective nursing happens, as W. B. Yeats (1928) might have remarked, “How do we tell the dancer from the dance?” This reminds us that genuine caring encounters involve “caring with” the person, not just “caring about” the person, or doing things that suggest we are “caring for” them.


In the Tidal Model, the person is represented by three personal domains: Self, World, and Others. A domain is a sphere of control or influence, a place where the person experiences or acts out aspects of private or public life. More simply, a domain is a place where someone lives.

The domains are like the person’s home address. Their house or flat has several rooms, but the person is not to be found in each of these rooms all the time. Sometimes the person is in one room, and sometimes in another. The personal domains are similar. Sometimes the person is mainly spending time in the Self Domain, and at other times is mainly spending time in the World or Others domains.

The Self Domain is the private place where the person lives. Here the person experiences thoughts, feelings, beliefs, values, and ideas, etc., that are known only to the person. In this private world, the distress called “mental illness” is first experienced. All people keep much of their private world secret, only revealing to others what they wish them to know. This is why people are often such a “mystery” to us, even when they are close friends or relatives.

In the Tidal Model, the Self Domain becomes the focus of our attempts to help the person feel more “safe” and “secure,” where we try to help the person address and begin to deal with the private fears, anxieties, and other threats to emotional stability, which are related to specific problems of living. The main focus is to develop a “bridging” relationship and to help the person develop a meaningful Personal Security Plan. This work becomes the basis of the development of the person’s “self-help” program, which will sustain the person on return to everyday life. The World Domain is the place where the person shares some of the experiences from the Self Domain, with other people, in the person’s social world.

When people talk to others about their private thoughts, feelings, beliefs, or other experiences known only to them, they go to the World Domain.

In the Tidal Model, the World Domain becomes the focus of our efforts to understand the person and the person’s problems of living. This is done through the use of the Holistic Assessment. At the World Domain, we also try to help the person begin to identify and address specific problems of living, on an everyday basis. This is done through use of dedicated One-to-One Sessions.

The Others Domain is the place where the person acts out everyday life with other people—family, friends, neighbors, work colleagues, professionals, etc. Here the person engages in different interpersonal and social encounters, within which the person may be influenced by others, and may—in turn—influence others.

The organization and delivery of professional care and other forms of support is located in the Others Domain. However, the key focus of the Tidal Model is dedicated forms of group work—Discovery, Information-Sharing, and Solution-Finding.

By participating in these groups, the person develops awareness of the value of social support, which (s)he can both receive from and give to others. This becomes the basis of the person’s appreciation of the value of mutual support, which can be accessed in everyday life.


The Tidal Model emphasizes the unpredictability of human experience through the core metaphor of water.

This metaphor illustrates many of the elements of the psychiatric crisis and the necessary responses to this human predicament. “Storms at sea” is a metaphor for problems of living; “piracy” evokes the experience of rape or the “robbery of the self” that severe distress can produce. Many users describe the overwhelming nature of their experience of distress as akin to “drowning,” and this often ends in a metaphorical “shipwreck” on the shores of the acute psychiatric unit. A proper “psychiatric rescue” should be akin to “lifesaving” and should lead the person to a genuine “safe haven,” where the necessary human repair work can take place.


1. A belief in the virtue of curiosity: the person is the world authority on their life and its problems. By expressing genuine curiosity, the professional can learn something of the “mystery” of the person’s story.

2. Recognition of the power of resourcefulness: Rather than focusing on problems, deficits, and weaknesses, Tidal seeks to reveal the many resources available to the person—both personal and interpersonal—that might help on the voyage of recovery.

3. Respect for the person’s wishes, rather than being paternalistic, and suggesting that we might “know what is best” for the person.

4. Acceptance of the paradox of crisis as opportunity: Challenging events in our lives signal that something “needs to be done.” This might become an opportunity for change in life direction.

5. Acknowledging that all goals must, obviously, belong to the person. These will represent the small steps on the road to recovery.

6. The virtue in pursuing elegance: Psychiatric care and treatment are often complex and bewildering. The simplest possible means should be sought, which might bring about the changes needed for the person to move forward.


1. Why this—why now? We need to consider, first of all, why the person is experiencing this particular life difficulty now? The focus of care is very much on what the person is experiencing now, and what needs to be done now to address, and hopefully resolve, this problem.

2. What works? We need to ask “what works” (or might work) for the person under the present circumstances? This represents the “person-centered” focus of care. Rather than use standardized techniques or therapeutic approaches, which may have general value, we aim to identify either what has worked for the person in the past, or what might work for the person in the immediate future—given their history, personality, and general life circumstances?

3. What is the person’s personal theory? Finally, we need to consider how this person understands her or his problems. What “sense” does the person “make” of her or his problems? Rather than giving the person a professionalized explanation of her or his difficulties—in the form of some theory or diagnosis—we try to understand how the person understands their experience. What is the person’s personal theory?

4. How to limit restrictions? We should aim also to use the least restrictive means of helping the person to address and resolve their difficulties. Although this is often taken as read, the Tidal Model tried to identify how little the nurse might do to help the person, and how much the person might do to help bring about meaningful change. Together, these might represent the least restrictive intervention.


As needs flow with the person across artificial boundaries, care is seamless, always with the intention of the person returning his or her “ocean of experience” within his or her own community. Across the care continuum, people may need critical or immediate, transitional or developmental care. Practical immediate care addresses searching for solutions to the person’s problems, generally in the short term, and focuses upon “what needs to be done, now.” People enter the care continuum for immediate care when experiencing an initial mental health crisis, possibly entering the mental health system for the first time, or with people already familiar to the system when a crisis occurs. Transitional care addresses the smooth passage from one setting to another, when the person is moving from one form of care to another. Here, nursing responsibilities include liaising with colleagues and ensuring the person’s participation in the transfer of care. The other end of the continuum is developmental care, where the focus is on more intensive and longer-term support or therapeutic intervention.

*Barker, P. J., & Buchanan-Barker, P. (2007a). The Tidal Model: Mental health, recovery and reclamation. Newport-on-Tay: Clan Unity International.

*From Barker, P. J. (2000d). The Tidal Model—Humility in mental health care. Retrieved March 12, 2008, from

Retrieved March 11, 2008, from

*Barker, P. J. (n.d.). A beginner’s guide to the Tidal Model. Retrieved March 12, 2008, from’s%20Guide.htm

From Barker, P. J., & Buchanan-Barker, P. (2007a). The Tidal Model: Mental health recovery and reclamation (pp. 30-31). Newport-on-Tay: Clan Unity International.

From Barker, P. J. (2000e). The Tidal Model Theory and practice (pp. 22-24). Newcastle: University of Newcastle.


Barker’s longstanding curiosity about the nature and focus of psychiatric nursing and the stories of persons-in-care led to the development of a theoretical construction of psychiatric nursing, or a meta-theory, that could be further explored through empirical inquiry (Barker, Reynolds, & Stevenson, 1997, p. 663). Over five years, from 1995, the Newcastle and North Tyneside research team developed an understanding of what people experiencing problems in living might need from nurses. They began to use their emergent findings in 1997 as the basis for the development of the Tidal Model.

Barker supports learning from, using, and integrating extant theory and research, as well as the experience of reality—“evidence from the most ‘real’ of real worlds” (Barker & Jackson, 1997). An example is the “need adapted” approach to caring with people in schizophrenia developed from Alanen’s studies. One understanding that underpins Alanen’s work and flows through the Tidal Model is that people and their families need to think of psychiatric admission to a psychiatric facility as a result of problems of living they have encountered and not as a mysterious illness that is within the patient (Alanen, Lehtinen, & Aaltonen, 1997).

The power of the nurse-patient relationship demonstrated through Altschul’s pioneering research in the early 1960s and Peplau’s paradigm of interpersonal relationships contribute to the empirical base of the Tidal Model. Altschul’s study of nurse-patient interaction in the 1960s provides empirical support for “the complex, yet paradoxically ‘ordinary’ nature of the relationship” (Barker, 2002a). Altschul’s study of community teams in the 1980s raised questions about the “proper focus of nursing” and the “need for nursing,” and both Altschul and Peplau provided evidence related to interprofessional teamwork.

Two of Barker’s theory-generating studies provide an empirical base for the Tidal Model. The “need for nursing” studies (Barker, Jackson, & Stevenson, 1999a, 1999b) examined the perceptions of service users, significant others, members of multidisciplinary teams, and nurses and sought to clarify discrete roles and functions of nursing within a multidisciplinary care and treatment process and to learn what people value in nurses (Barker, 2001c, p. 215). They demonstrated that professionals and persons-in-care wanted nurses to relate to people in ordinary, everyday ways. There was universal acceptance of special interpersonal relationships between nurses and persons, echoing Peplau’s (1952) work. “Knowing you, knowing me” emerged as the core concept in these studies. The nurse is expected to know what the person wants even if it is not verbalized or is not clear, and needs are constantly changing (Jackson & Stevenson, 2004, p. 35). Professional nursing performance is described in three roles identified as (1) ordinary-me, (2) pseudo-ordinary/engineered-me, and (3) professional-me. The relationships are fluid, requiring nurses to “toggle” or switch back and forth from highly professional to distinctly ordinary presentations of self, and relationships differ depending upon the role (Jackson & Stevenson, 1998, 2000). The pseudo-ordinary or engineered-me is likened to a see-saw (Jackson & Stevenson, 2004, p. 41). Sometimes people need someone to take care of them, other times someone to take care with them (Barker et al., 1999a, 1999b). The studies suggested that nurses respond sensitively to persons’ and their families’ rapidly fluctuating human needs. They need to “tune in to what needs to be done now,” to meet the person’s needs (Barker, 2000e). Nurses are translators for the person to the treatment team and the “glue” that holds the system together (Stevenson & Fletcher, 2002, p. 30).

The second study focused on the nature of empowerment and how this is enacted in relationship between nurses and persons-in-care. It resulted in the Empowering Interactions Model (Barker, Stevenson, & Leamy, 2000). This was developed with Flanagan’s Critical Incident Technique (Flannagan, 1954) within a cooperative inquiry method (Heron, 1996), using a modified grounded theory approach (Glaser & Strauss, 1967). It developed Peplau’s assumptions about the importance of specific interpersonal transactions, and provided guidance and strategies for nurses within collaborative nurse-person relationships. Strategies include:


Nurses are involved in the process of working with people, their environments, their health status and their need for nursing (Barker, 1996a, p. 242). The Tidal Model rests on the assumptions that:

Two basic assumptions underpin the Tidal Model. First, “change is the only constant,” nothing lasts. All human experience involves flux and people are constantly changing. This suggests the value of helping people become more aware of how change is happening within and around them in the “now” (Barker & Buchanan-Barker, 2004a). Second, people are their stories. They are no more and no less than the complex story of their lived experience. The person’s story is framed in the first person, and the story of how they came to be here experiencing this “problem of living” contains raw material for solutions (Barker & Buchanan-Barker, 2004a).

The Tidal Model assumes that when people are caught in the psychic storm of “madness,” it is “as if” they risk drowning in their distress or foundering on the rocks; it is “as if” they have been boarded by pirates and have been robbed of some of their human identity; it is “as if” they have been washed ashore on some remote beach, far from home and alienated from all that they know and understand.


Nursing is continuously changing, internally and in relation to other professions, in response to changing needs and changing social structures. The nature of Barker’s relationship with users of services confirms his appreciation of nursing as a social, rather than professional, construct. “If any one thing defines nursing, globally, it is the social construction of the nurse’s role” (Barker, Reynolds, & Ward, 1995, p. 390). Nursing as nurturing exists only when the conditions necessary for the promotion of growth or development are being put in place (Buchanan-Barker & Barker, 2008). Nursing is an enduring human interpersonal activity and involves a focus on the promotion of growth and development (Barker & Whitehill, 1997, p. 17) and present and future direction (Barker & Buchanan-Barker, 2007a). Barker tried to extend Peplau’s original definition, by defining the purpose of nursing as trephotaxis—from the Greek, meaning “the provision of the necessary conditions for the promotion of growth and development” (Barker, 1989). More recently, he has distinguished psychiatric nursing from mental health nursing. “When nurses help people explore their distress, in an attempt to discover ways of remedying or ameliorating it, they are practicing psychiatric nursing. When nurses help the same people explore ways of growing and developing, as persons, exploring how they presently live with and might move beyond their problems of living, they are practicing mental health nursing” (Barker, in press).

Nursing is a human service offered by one group of human beings to another. There is a power dynamic in the “craft of caring,” one person has a duty to care for another (Barker, 1996b, p. 4). Nursing is a practical endeavor focused on identifying what people need now; collaboratively exploring ways of meeting those needs; and developing appropriate systems of human care (Barker, 1995, 2003a). The proper focus of nursing is the “need” expressed by the person-in-care, which “can only be defined as a function of the relationship between a person-with-a-need-for-nursing and a person-who-has-met-that-need” (Barker, 1996a, p. 241; Barker et al., 1995, p. 389). These responses are the phenomenological focus of nursing (Barker et al., 1995, p. 394; Peplau, 1987). This focus is on human responses to actual or potential health problems (American Nurses Association, 1980). These may range across behavior, emotions, beliefs, identity, capability, spirituality, and the person’s relationship with the environment (Barker, 1998a).

Nursing’s exploration of the human context of being and caring suggests nursing as a form of human inquiry. Being with and caring with people is the process that underpins all psychiatric and mental health nursing, and this process distinguishes nurses from all other health and social care disciplines (Barker, 1997). Nursing complements other services and is congruent with the roles and functions of other disciplines in relation to the person’s needs (Barker, 2001c, p. 216).

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Feb 9, 2017 | Posted by in NURSING | Comments Off on The Tidal Model of Mental Health Recovery

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