Therapeutic Community Principles Research Articles

Therapuetic Community (TC) as Drug Rehabiliation Center Design Principles

Drugs are something that has been fought for for a long time and rehabilitation is one way to save victims from drug dependence. Therapy and rehabilitation methods using the Therapeutic Community approach are inseparable from the therapeutic communication carried out by addiction counselors which functions to create a comfortable atmosphere for residents who are drug addicts. This study aims to determine the community therapeutic variables at the rehabilitation center that are often used by patients: bedroom, common room and dining room at the drug rehabilitation center. This research method uses a comparative method by identifying the application of the therapeutic community principles in case studies. The buildings being compared include The Chiang Mai Cabin, the Lido BNN Drug Rehabilitation and Therapy Unit, the FAN Campus, West Java, and the Regional Mental Hospital, Bangka Belitung. The results showed that each room has a quality standard that must be met in order to increase the level of patient comfort at the Drug Rehabilitation Center. These results can help architects in designing drug rehabilitation centers with a therapeutic community approach.

Spiritually-oriented therapy for endogenous mental patients with comorbid addictive disorders

IntroductionSpirituality and religious commitment have a “protector” function among mental health patients who abuse psychoactive substances. The main task of spiritually-oriented therapy is not only to reactivate the internal control of a person, but to actualize their experience of communication with God before everything else.ObjectivesStudying the influence of spiritual life-related factors on efficiency of therapy of psychiatric co-morbidities.MethodsClinical and psychopathological, clinical follow-up, pathopsychological and statistic.ResultsThe research covered 26 patients (the main group) diagnosed with paroxysmal schizophrenia and schizo-affective psychosis in the prospective follow-up with alcohol addiction. All patients practiced Orthodox worldviews though to a different extent, and have been participating in the spiritually-oriented rehabilitation with a family-oriented module for two years. During psychosocial rehabilitation the patients took group and individual training with a multidisciplinary team of experts: psychiatrists, clinical psychologists, specialists in sociotherapy and members of the clergy. The rehabilitation employed the principles of therapeutic community, systematic family approach [Zoricic Z., 2019], notions of coping behavior or coping strategies [Verhagen P., 2019, Pargament, K.I. et al, 2014] as well as spiritually-oriented models of assistance to patients (for example, the religion-oriented strategy of forgiveness based on REACH model [Worthington E. L. et al, 2016]).ConclusionsDevelopment of a lengthy remission is dependent on changing lifestyle and patterns, and spiritual labor of penance and forgiveness is just as important.DisclosureNo significant relationships.

Анализ драматерапии, проходящей в отделении по восстановлению после зависимости абстинентами

This is the first part of an article dealing with an evaluation of the dramatherapy process. The first part introduces a long-term research project assessing the dramatherapy process at the 17B Addiction Recovery Unit of the Kroměříž Psychiatric Hospital. Building on therapeutic community principles, the treatment provided at the Unit is a medium-term addiction recovery programme (4 to 6 months). The part of the research discussed in this paper is focused on an evaluation of the dramatherapy process as seen by alumni (abstainers), who received therapy at the Unit between February 2014 and June 2017. The data was collected from semi-structured focus groups organized as part of alumni meetings at the Unit. The findings of the focus group analysis will be presented in the second part of the article. They are designed to describe the specific benefits of dramatherapy intervention in the treatment of addictions and the potential of the transfer of experience, obtained in dramatherapy interventions, for the abstainer's daily life from the perspective of alumni.

“I know you think I think – therefore I am”. Mentalisation based therapeutic community: a description

PurposeThe mentalisation based therapeutic community (MBTC) is a group experience which promotes the acquisition of the capacity to mentalise. Members of the community gain greater emotional stability and psychological robustness. The paper aims to discuss these issues.Design/methodology/approachMBTC works with three theoretical principles: the intrapsychic, interpersonal and social. It is a slow open group where each member completes a ten-week course. The approach is deliberately non-interpretive with an emphasis on personal responsibility and accountability in order to promote clarity of mind.FindingsThe authors’ experience is that the model engages group members with few drop outs.Originality/valueThe combination of mentalising and the use of therapeutic community principles within in MBTC has enhanced outcomes for group members.

Rates and correlations of change in three dimensions of recovery within a recovery model oriented therapeutic community.

This is a 10 year longitudinal study of recovery progress within a residential program based upon therapeutic community principles and a Seven Domains Enhanced Recovery Model (Young and Ensing, 1999). A broad suite of measures associated with one of three definitions of recovery (symptom, function, and personal focused recovery) were administered along three longitudinal courses. Normalized mean rates of change and mean shared variances for these scales were examined for three subgroups based on length of stay. Measures associated with the same definition of recovery correlated moderately to strongly but measures did not correlate between facets, suggesting relative independence between definition facets. The results of this analysis suggest the existence of qualitatively distinct subgroups with different change dynamics. The aggregate means of these facets showed correlated change, while individual recovery pathways did not, suggesting significant heterogeneity in individual pathways of recovery. These findings support the conceptualization of recovery as a complex, heterogeneous and multi-faceted process. Practically, these findings emphasize the need for holistic, flexible and individualized recovery supports and that research into these constructs should include at least these facets over a longitudinal time frame.

Do I matter?

Purpose– The purpose of this paper is to consider whether a common process linking seemingly disparate phenomena could explain how men from a low-secure unit (LSU) could stabilise, progress and return to their community.Design/methodology/approach– Reflective practice and a re-consideration of an LSU unknowingly operating as a therapeutic community.Findings– The Hawthorne Effect, social psychiatry and Bowman LSU share a common humanity whereby people matter. As a result, LSU's can offer more than containment.Originality/value– Therapeutic community principles can function in LSU's.

Early Report on the Effectiveness of a Recovery Model Oriented Therapeutic Community for Individuals with Complex and Persistent Recovery Challenges

This study summarizes the results of a 10 year longitudinal study of individual recovery progress within a residential program based upon therapeutic community principles and a Seven Domains Enhanced Recovery Model that emerged from a grounded theory analysis of real life recovery experiences (Young and Ensing, Psychiatr Rehab J 22:219-231, 1999). The four primary hypotheses of the study predicted significant and moderately sized effect sizes on a holistic set of measures, corresponding to the Enhanced Recovery Model. Results indicate support for all hypotheses; statistically significant and moderate to large effects were found in all domain measures for the participants, most of whom had multiple unsuccessful previous treatment attempts. These results indicate that this theoretical structure and residential model is effective in supporting recovery for individuals with complex and persistent challenges across the broad range of recovery domains. Conceptually, this also adds quantitative support for the Seven Domains Enhanced Recovery Model, complementing previous qualitative studies.

The democratic therapeutic and training communities of the Open Psychotherapy Centre: A multifactorial communal approach

This paper describes the structure, function and effectiveness of a multifactorial communal approach which is applied in the therapy department and the four training institutes of the Open Psychotherapy Centre in Athens. The therapeutic philosophy of this approach is based on the principles of group analysis, therapeutic community and emprosopon psychotherapy which are applied in combination with each other.

The Mulberry Bush School and UK therapeutic community practice for children and young people

Purpose – The purpose of this paper is to inform readers and researchers about the use of a “lived experience” of therapeutic community work as an effective intervention for severely emotionally troubled children. Design/methodology/approach – An explanation of the main developmental influences and how the Mulberry Bush School is continuing to incorporate new theories and approaches. Findings – How the Mulberry Bush as a specialist therapeutic residential provision can bring about excellent outcomes for severely emotionally troubled children. Research limitations/implications – The paper explores the work and legacy of the school's founder Barbara Dockar-Drysdale and of her collaboration with Donald Winnicott to create a lived experience of community as an agent of therapeutic change. The paper also provides descriptions and a case study of the current multi-disciplinary work of the school, including how neuroscientific research is influencing the evolution of the therapeutic task with traumatised children. Practical implications – The paper shows how a highly evolved model of integrated provision can support excellent outcomes for traumatised children and young people. Originality/value – To broaden and deepen knowledge about the use of therapeutic community principles in the treatment of severely emotionally trouble children and young people.

Forensic Nursing Interventions With Patients With Personality Disorder

Research findings suggest that nursing assessment and care and psychotherapy of forensic patients with personality disorder should be based on a holistic approach that addresses a wide range of their needs. Such an approach should be in collaboration with patients, informal carers, and other professionals and informed by appropriate education, training, clinical supervision, and support. Holistic care includes areas (such as physical health, cultural, spiritual, and psychosexual needs) that are addressed to a limited extent in the literature on patients with personality disorder. Despite limitations in research evidence, findings suggest that some patients with personality disorder benefit from psychotherapies, sometimes facilitated by nurse-therapists, and therapeutic community principles. These interventions should take account of patients' cultural and spiritual needs and perspectives. Helping patients to manage anger has potentially positive consequences for their physical health, personal and work relationships, and other areas. Research is needed to consider how to deliver holistic care with limited resources and in organizations, such as prisons, with conflicting goals.

Initial outcomes of a therapeutic community‐based outpatient programme in the management of personality disorder

PurposeThis study aims to describe the effectiveness of two arms of a personality disorder service: a modified mentalization based therapy (MBT) day programme and an open access service‐user network (SUN) support. Both arms utilised therapeutic community principles in service delivery.Design/methodology/approachPersonality disorder subtypes for all patients entering the modified MBT programme were diagnosed at a clinical assessment interview and corroborated through use of a standardized semi‐structured interview (SCID II). All patients were also allowed open access to a service user network community support group (SUN Project). Outcome measures were applied at baseline, mid‐therapy and end of therapy and included self‐report measures of depression, anxiety, general symptom distress, interpersonal function, social adjustment and patient satisfaction. Clinician‐rated measures of general health and functioning were also used. Data analysis used paired sample T‐tests and Wilcoxon Rank Sum tests, depending upon the assessment of parametric or nonparametric tests of trend. The open access nature of the SUN Project demanded a different data collection method. All members received a Standardized Assessment of Personality – abbreviated scale (SAPAS). Two validated empowerment questionnaires were sent to all SUN members that had achieved six months of membership: the first relating to the six‐month period before joining the SUN and the second to the six‐month period after joining the SUN Project. Paired sample T‐tests were used to compare sets of empowerment scores.FindingsPatients who completed 18 months of MBT‐tc treatment showed a statistically significant improvement on the clinician‐administered measures relating to psychological, social and occupational functioning, compared to baseline. Patients also reported statistically significant improvement in using the brief symptom inventory. All SUN members perceived significant increases in empowerment across the five score subscales. No completed suicidal acts were recorded within the period of analysis within either arm of the service.Originality/valueAn integrated therapeutic community day service appears to afford improvements in perceived empowerment and symptom severity for patients. Further data collection with a larger sample is needed to clarify whether these outcomes support the development of a wider integration of the relatively low cost SUN Project model and MBT within therapeutic communities.

An Exploratory Study of Spiritual Orientation and Adaptation to Therapeutic Community Treatment

ABSTRACT The purpose of this study was to determine the extent to which spiritual orientation was associated with adaptation to therapeutic community treatment. Spiritual orientation was assessed by the Spirituality Self-Rating Scale, a measure consistent with the conceptualization of spirituality typically reflected in Alcoholics Anonymous members’ views. Spiritual orientation was positively correlated with acceptance of therapeutic community principles and clinical progress. Further assessment of spirituality related characteristics and their relation to treatment outcomes is important in informing the design of interventions aimed at improving progress in the therapeutic community, particularly those aspects involving the relative value of integrating the 12-Step group approach in therapeutic community programs.

Nursing in a therapeutic community: the Fulbourn experience, 1955–1985

To explore the role of the mental health nurse in wards run on therapeutic community principles in one English provincial hospital. Under a pioneering Medical Superintendent, the restrictive regime for patients with mental health problems in Fulbourn Hospital was replaced by a new commitment to 'social therapy'. Ward doors were unlocked, patients were encouraged to undertake work-based activities and finally the wards were reorganised on 'therapeutic community' principles. This study used oral history methods to supplement evidence from published sources. A total of 27 oral history interviews were conducted between 2003-2008 and these data were analysed in the context of documentary material from local archives. The establishment of wards at Fulbourn run on therapeutic community lines posed considerable challenges to the customary working practices of their mental health nurses. The two themes highlighted in this paper were the symbolic meaning of the abandonment of nursing uniforms in favour of casual clothing and the hospital authorities' preparedness to accept the risks associated with implementing the philosophy of the therapeutic community. Oral history has a unique role to play in recording the detailed aspects of nursing practice which are often difficult to reconstruct from documentary sources alone. Nurses played a key role in the transformation of the therapeutic milieu of Fulbourn Hospital and their experiences have relevance to current debates in mental health care.

Service innovation: a virtual informal network of care to support a ‘lean’ therapeutic community in a new rural personality disorder service

This article presents a brief overview of service user-led informal networks of care in therapeutic community practice before discussing the design and evolution of a new kind of network in one of the pilot services of the Department of Health National Programme for the Development of Services for People with Personality Disorder (National Institute for Mental Health in England, 2003a). This network employs well-established internet messaging and chat room facilities uniquely structured and moderated to encompass therapeutic community principles and provide equality of access across a huge mixed urban and rural catchment area. Both hardware and software are inexpensive, easily transferable to similar services and could be modified to suit other applications. The success of this system in allowing challenging work to proceed in a much reduced therapeutic community programme may offer the prospect of many more community-based therapeutic communities at the heart of new personality disorder services.

Therapeutic Community Principles Guide Systemic Responses to Student Self-Injurious Behavior

A view of self-injurious behavior (SIB) informed by trauma theory and therapeutic community principles provides a framework to guide clinical practice, promote a safe living and learning environment, and inform policy development to support a collaborative university response to SIB. A dual emphasis of concern for the safety of the individual who self-injures and the impact of the behavior on the living and learning environment of others is illustrated in a case example.

Therapeutic Discipline? Reflections on the Penetration of Sites of Control by Therapeutic Discourse

This article addresses the way in which therapeutic practice in an English prison creates conditions whereby both prisoners and prison officers are caught up in networks and relationships of power that contribute to the constitution of particular subjects. The development of therapeutic practice, in relation to prisons and probation, is described and contextualised. Subsequently, the practices of group therapy in operation at Grendon prison - a rather unique institution built on principles of therapeutic community – are analysed with a focus on five ”practices of moulding,” namely, naming, confession, assessment and surveillance, tolerance and participation. The argument that psychotherapy, under conditions of imprisonment, is a form of repression or social control is discussed and dismissed as too simple a model to account for the relations of power and constitutive practices that effect all participants, not only prisoners. Members of staff, as well as prisoners, are shown to be caught up in the disciplinary web. Discipline, as opposed to control, is advocated as a more appropriate concept for understanding therapeutic practices in prison. The work of Thomas Mathiesen, on the concept of synoptic power, is introduced to help illustrate these dynamics. The article represents a shift in my own thinking, from scepticism to a pragmatic idealist position, that creates space for institutions like Grendon to be imagined as potential least worst options for people convicted of offences and obliged to serve “time”. It is my hope, argued for in the article, that Grendon can be conceived of as a “visionary space” with emancipatory potential.

Assessing the therapeutic impact of a community group on a secure hospital ward.

The constructs of ward staff and patients in a medium secure rehabilitation ward were assessed before and after an eight-month trial of a twice weekly community group. One of the aims of this group was to address day-to-day interpersonal issues and to encourage patients to take social responsibility for their actions and to learn to support one another. Another aim was to encourage staff and patients to consider the possibility of applying some therapeutic community principles on the ward. These aims were assessed using repertory grid techniques. The results were that over the eight-month pilot both staff and patient groups shifted towards viewing their ideal ward as a therapeutic community (TC). However qualitative information suggested that considerable difficulties arose in bringing about the necessary cultural changes. As a result both staff and patients felt confused and disempowered. Future attempts are highly recommended, however better resourcing, particularly in the form of employing a trained full-time individual to co-ordinate activities, is essential.

Community Meeting: Review, Update, and Synthesis

ABSTRACTThe community meeting is a frequent regular meeting in a psychiatric ward or institution that is attended by all staff and patients. It meets for the purpose of communication, ward management, or psychiatric treatment. The conditions of the current hospital psychiatric treatment environment are very different from the treatment environment where the therapeutic community concept was first established, particularly in terms of the shortened length of hospital stay and the emphasis on pharmacologic rather than psychotherapeutic methods of treatment. However, even with these changes, an admixture of psychopharmacologic treatment and therapeutic community principles has been advocated as an effective, realistic, and desirable treatment modality in today's hospital environment. A synthesis of an extensive literature review from both a theoretical and research perspective on the community meeting is presented. A schema has been developed listing elements for practice in today s hospital climate.

An examination of a staff group at a supra-regional deaf unit

We undertook a study on the staff group of an in-patient unit for deaf patients which is run on therapeutic community principles. The study addressed attendance patterns and attitudes of staff to the group, using a Questionnaire with open and closed Questions. About half of the staff found the group useful and attended with some regularity, while a minority expressed negative opinions and did not attend. There were conflicting views about the boundaries of the group and is purpose. The implications for setting up and running a staff group are discussed.

ARRIVE: an AIDS education/relapse prevention model for high-risk parolees.

An AIDS prevention training program for parolees recently released from prison with histories of drug injection was developed and evaluated. Key program elements included: a social learning approach to prevention which emphasized resistance skills training; a self-help orientation stressing individual responsibility; therapeutic community principles such as credible role models and community building; and job readiness training for the AIDS prevention/outreach field. A total of 394 eligible parolees (81% male, 19% female) were recruited, of whom 241 attended the program, including 164 completers. One year follow-up results showed that ARRIVE participation significantly decreased certain sexual and drug-related risk behaviors and improved parolees' community adjustment.