Abstract
The term ‘therapeutic community’ is usually used in the UK to describe small cohesive communities where patients (often referred to as residents) have a significant involvement in decision-making and the practicalities of running the unit. Based on ideas of collective responsibility, citizenship and empowerment, therapeutic communities are deliberately structured in a way that encourages personal responsibility and avoids unhelpful dependency on professionals. Patients are seen as bringing strengths and creative energy into the therapeutic setting, and the peer group is seen as all-important in establishing a strong therapeutic alliance. The flattened hierarchy and delegated decision-making are sometimes misunderstood as anarchy by outsiders. However, staff in modern therapeutic communities are deeply aware of the need for strong leadership and their responsibility to provide a safe ‘frame’ for therapeutic work (Association of Therapeutic Communities, 1999).
Highlights
In the USA, the term ‘therapeutic community’ is more often used to describe user-run communities for substance misusers with: a hierarchical structure; a reward system; fierce encounter groups; and a simple explanatory model of addiction and its treatment
An important underlying principle is that all involved are encouraged to be curious about themselves, each other, the staff, the management structure, psychological processes, the group process, the institution and everything else pertinent to events and relationships within the community. This is known as the ‘culture of enquiry’ – an openness to questioning, so that understanding is Penelope Campling is the Consultant Psychotherapist and Clinical Director at Francis Dixon Lodge Therapeutic Community (Gipsy Lane, Leicester LE5 0TD)
This is a phenomenon often seen in patients with personality disorders: typically, one staff member is privy to the vulnerable side of the patient – made to feel special and drawn into a rescuing role – while the rest of the team feel irritated by the patient’s destructive behaviour and are more in touch with the manipulative aspect of his or her personality
Summary
The term ‘therapeutic community’ is usually used in the UK to describe small cohesive communities where patients (often referred to as residents) have a significant involvement in decision-making and the practicalities of running the unit. An important underlying principle is that all involved are encouraged to be curious about themselves, each other, the staff, the management structure, psychological processes, the group process, the institution and everything else pertinent to events and relationships within the community This is known as the ‘culture of enquiry’ – an openness to questioning, so that understanding is Penelope Campling is the Consultant Psychotherapist and Clinical Director at Francis Dixon Lodge Therapeutic Community (Gipsy Lane, Leicester LE5 0TD). Exclusive discussions in which a resident divulges significant material to another resident or staff member are usually discouraged in order to avoid ‘splitting’ This is a phenomenon often seen in patients with personality disorders: typically, one staff member is privy to the vulnerable side of the patient – made to feel special and drawn into a rescuing role – while the rest of the team feel irritated by the patient’s destructive behaviour and are more in touch with the manipulative aspect of his or her personality. The pressure to talk and to think about feelings rather than act on them eventually leads to a less brittle superego and more effective impulse control
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