Therapeutic Community Principles Research Articles

Maintenance of therapeutic community principles in an age of biopharmacology and economic restraints

The therapeutic community has changed significantly since its development in England more than 40 years ago. However, the halimarks of the therapeutic milieu, such as patient participation in decision making, a multidisciplinary staff, and a belief that the environment is the treatment agent, remain part of many psychiatric settings. The therapeutic community will continue to undergo alteration to adapt to changes in society. It will continue to be a viable treatment modality as long as the value system of the organizational culture and the internal structure of the community are included as basic concepts. Systems theory and organizational culture concepts are used to explore the factors that enhance the functioning of a therapeutic community in an era of biological treatment and rising health care costs.

Coping with Institutional Life at the Old People’s Therapeutic Community

A research project at a Finnish old people's home was carried out in 1983-1989, its aim being to explore whether therapeutic community principles can be applied to the institutional care of the elderly. Some aged seemed to adapt better to the community than others. In 1987 the group "excellent coping in institution" (N = 14) was formulated for this study, on the basis of favorable outcome, good adaptation to aging, nonproblematic behavior and a high subjective satisfaction with life. Using logistic regression analysis, the properties of this group were compared with the group "problem coping in institution" (N = 32). The following variables discriminated the excellent coping group best: therapeutic community activity, current mental health, and a socio-economically deprived childhood. This result suggested that active and mentally strong elderly coped better with the "homelike" therapeutic community method executed between 1983-87, which focused only on a pleasant atmosphere in which the old people could live together. Therefore the treatment policy has been partially reorganized since 1987, so as to include special attention for passive and mentally fragile residents. The modified therapeutic community that was developed seems to help coping in geriatric institutions if its working methods permit 1) active participation, 2) passive rest and reminiscence, and 3) support, holding, and even psychiatric intervention.

An old people's home as a therapeutic community

Isohanni M. An old people's home as a therapeutic community.The therapeutic community method is generally applied in the treatment of institutionalized psychiatric patients, but its application is very limited in the care of old people. In our post-industrial society the number of elderly people is continously increasing. As a consequence of the expanding of the age pyramid at its apex, the need for high-quality institutional care for the elderly is increasing. This was one of the major background factors which initiated an action research at a Finnish old people's home in 1983; its aim was to resolve whether therapeutic community principles could be applied. The results suggest that many classical therapeutic community practices are useful, although in the everyday programme possible senility, the need for rest, and cognitive limitatins among elderly residents must be taken into consideration. Most elderly people in an old people's therapeutic community are appreciative residents. The general atmosphere ...

Alcoholism in the elderly

Alcoholism is a more common problem in the elderly than has been recognized. Manifestations are more subtle than in younger alcoholics, and problems are primarily social rather than medical. Treatment approaches directed at the psychosocial stresses associated with aging are the most successful. The principles of the therapeutic community have also been effective in eliminating alcoholism and other behavioral disorders in elderly alcoholics.

Development of a mental health programme in the Central Coast of New South Wales, Australia.

The Central Coast Programme is considered to have begun in December 1969 with the arrival and commitment of Dr Donald Scott-Orr (specialist psychiatrist) in the Central Coast, and with the parallel commitment of the then Medical Superintendent of Morisset Hospital, Dr Howard Gorton to support the development of a regional programme for the Central Coast. It was decided not to re-establish any clinics and so avoid waiting lists. There was an emphasis on groups as a means of interaction and a family orientation in the work. In the early years the role of the nurse was changing. Initially, the extramural role was expected by the hospital to be 'following-up' patients. However, the service was based on commitment to a community rather than hospital. Increasingly the nurses' work was directly referred to them independently of hospital admissions. Staff visited general practitioners (GPs) on the Central Coast in their surgeries and regular letters were sent keeping the GPs informed of changes in the service. Consultations and transactions were recorded on referral forms and files were opened on all persons concerning whom the service was consulted. A client's name was always linked with the name of their general practitioner who was encouraged to make telephone contact freely to seek consultative support in connection with problems in their practice. Priority for crisis intervention and orientation towards family and group was backed up by domiciliary visits and widespread communication and consultation. The attempt was made to use therapeutic community principles for the in-patient programme. The processes of care were seen as being as important as the content of care in assuring an optimum quality care. There is a continuing need to focus on the flexible interchange between intra- and extra-mural staff in providing continuity for clients in care and integration with primary care services and agencies. In January 1978 Dr Max Chapman was appointed director of the psychiatric and mental health services on the Central Coast and he is currently in that position.

Brief psychotherapy in a closed-door hospital

O presente estudo cuida de pacientes "difíceis" da clínica psiquiátrica e psicoterápica: os pacientes que apresentam o fenômeno da atuação, cuja aproximação terapêutica tem se demonstrado problemática, mesmo com o advento das modernas técnicas de psicoterapia e das comunidades terapêuticas. Os diagnósticos psiquiátricos destes pacientes variam: são neuróticos, apresentam transtornos de pesonalidade, são psicóticos e quase sempre com graves doenças secundárias: alcoolismo e toxicomania (Códigos Classificação Internacional de Doenças 295 a 299, 300. 301, 303 e 304). Propõe-se, à luz da compreensão psicanalítica destas pessoas, um tratamento psicoterápico breve, focal, com o auxílio de uma hospitalização em regime fechado. Para a avaliação dos resultados do método psicoterápico diádico, criaram-se critérios de cura coerentes com a proposta terapêutica, e equiparam-se estes critérios clínicos a valores numéricos. Utilizando 36 pacientes internados, verificou-se até que ponto eles alcançavam estes critérios. Cada paciente recebeu um escore - valor numérico - que expressou o seu desempenho durante o tratamento em regime de internação, e sua conduta pós-alta hospitalar, durante um seguimento médio de 21 meses. Estes 36 pacientes puderam ser divididos em dois grupos: os de evolução favorável (obtivemos 36,1%) e os de evolução desfavorável. Por meio de uma amostra sistemática composta por 41 pacientes que não foram submetidos ao método, internados no mesmo período de tempo, no mesmo hospital, e pareados com nossa casuística, fêz-se uma comparação estatística entre os percentis obtidos nas evoluções dos dois grupos. O valor do teste estatístico, o chi quadrado, não foi significante. O exame das proporções correspondentes a cada patologia em separado sugeriu fortemente que o tratamento estaria indicado nas neuroses e nas psicoses, mas que seria realmente ineficaz nos transtornos de personalidade; não foi feita a análise estatística para cada patologia em separado, sendo esta uma perspectiva de estudo futuro. O trabalho é complementado com uma análise crítica dos aspectos teóricos e das conclusões estatísticas.

Psychotherapy and structural changes in psychiatric institutions. Practical and therapeutic aspects

The introduction of the principle of a therapeutic community into a since then traditionally working hospital resulted in the observation of certain collective mechanisms of defence (similar to the reaction towards analytical psychotherapy), such as (1) isolation of the concerned patient and staff groups from the other groups, (2) a disavowal of the principles of therapeutic community, and (3) the formation of reaction with building up frontiers between progressive and conservative-minded teams. Only intense efforts could overcome the resistance. The re-organisation of a mental hospital according to the model of a therapeutic community has to be looked at as a process affording many steps and many years. From the social point of view mental hospitals are regarded as ‘repression areas for madness’ (Kisker), where our society expects the staff to act as a guardian for security and order; that means from a psychoanalytical aspect: to be charged with the function of anticathexis.

Social systems intervention.

I have outlined the techniques of social systems assessment and intervention developed as a result of intervening directly in the problems of the immediate social environment of over 1,600 routine psychiatric patients. The techniques are based on an application of therapeutic community principles to real life settings outside the hospital. Concepts of leadership, role structure, and patterns of communication and reinforcement apply equally well to the social system of a childless married couple and to the neighborhood in which they live. The assessment of a social system should lead to an understanding of its structure and functioning, the external precipitants of its disturbance and the conflicts internal to the system.

Therapeutic Community Principles within the Hospital, and in the Outside Community

Therapeutic Community Principles within the Hospital, and in the Outside Community

The therapeutic community--fact or fantasy?

Therapeutic community principles have in recent years become increasingly and often enthusiastically applied. They have also attracted an extensive literature, including, among many, studies by Maxwell Jones (1952 and 1962), Cumming and Cumming (1962), and the contributions to two symposia: in Boston, edited by Greenblatt, Levinson, and Williams (1957) and in this country by Freeman (1965).

Authority and permissiveness in the psychotherapeutic community: theoretical perspectives.

Back to table of contents Previous article Next article ArticlesNo AccessAuthority and Permissiveness in the Psychotherapeutic Community: Theoretical PerspectivesRichard Crocket†, M.D., F.R.C.P., D.P.M.Richard Crocket†Hornchurch, England†Consultant in Psychological Medicine, Ingrebourne Centre, Hornchurch, Essex.Search for more papers by this author, M.D., F.R.C.P., D.P.M.Published Online:30 Apr 2018https://doi.org/10.1176/appi.psychotherapy.1966.20.4.669AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - APT - American Journal of Psychotherapy $35.00 Add to cart PPV Articles - APT - American Journal of Psychotherapy Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byTherapeutic Communities: The International Journal of Therapeutic Communities, Vol. 38, No. 2Maintenance of therapeutic community principles in an age of biopharmacology and economic restraintsArchives of Psychiatric Nursing, Vol. 6, No. 3Psychiatric Quarterly, Vol. 56, No. 1Journal of Social Policy, Vol. 5, No. 3Effective Day Center TreatmentPsychosomatics, Vol. 11, No. 1Our place: Design for a day program.1 January 1969 | American Journal of Orthopsychiatry, Vol. 39, No. 5 Volume 20Issue 4 1966, pp. 561–717Pages 669-676 Metrics PDF download History Published online 30 April 2018 Published in print 1 October 1966

Therapeutic community practice.

Back to table of contents Previous article Next article ArticleNo AccessTHERAPEUTIC COMMUNITY PRACTICEMAXWELL JONESMAXWELL JONESSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.122.11.1275AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByMisplaced enthusiasm with neglect of Human Rights ‐ Beneficence is not enough25 May 2021 | Criminal Behaviour and Mental Health, Vol. 31, No. 3Journal of Forensic Psychology Research and Practice, Vol. 19, No. 3Forty-five years of schizophrenia: personal reflections25 July 2016 | History of Psychiatry, Vol. 17, No. 3International Journal of Group Psychotherapy, Vol. 43, No. 4Maintenance of therapeutic community principles in an age of biopharmacology and economic restraintsArchives of Psychiatric Nursing, Vol. 6, No. 3Anti-therapeutic dimensions of a community meeting in a therapeutic milieuPsychiatric Quarterly, Vol. 55, No. 4International Journal of Group Psychotherapy, Vol. 31, No. 2Hospitalized Adolescents and Therapeutic Milieu: Denial of Conflicts versus Normality as Average26 April 2017 | Canadian Psychiatric Association Journal, Vol. 17, No. 6_suppl2The Descent of Milieu Therapy26 April 2017 | Canadian Psychiatric Association Journal, Vol. 17, No. 1, Vol. 2 / 1Therapeutic Community Experiences in Different Settings *26 April 2017 | Canadian Psychiatric Association Journal, Vol. 14, No. 1International Journal of Group Psychotherapy, Vol. 19, No. 2The Role of the Social Worker in the Psychiatric Hospital: In and Out of a Therapeutic CommunityAustralian Journal of Social Work, Vol. 21, No. 2THERAPEUTIC COMMUNITIES AND ADMISSION CENTRES: WHAT OF THE FUTURE?1 April 1968 | Medical Journal of Australia, Vol. 1, No. 16 Volume 122Issue 11 May 1966Pages 1275-1279 Metrics PDF download History Published online 1 April 2006 Published in print 1 May 1966