Pioneered in the late 1950′s, the Therapeutic Community (TC) movement brings a way out of self-destructive behavior for those who were thought often to be beyond recovery.
Pioneered in the late 1950′s, the Therapeutic Community (TC) movement brings a way out of self-destructive behavior for those who were thought often to be beyond recovery. The primary goal of a TC is to foster individual change and promote positive growth. This is accomplished by changing an individual’s lifestyle through a community of concerned people working together to help themselves and each other.
Being part of something greater than oneself is an especially important factor in facilitating positive growth. TC’s offer a holistic approach in regards to treating the whole person and not just the addiction.
Clients in a TC are members, as in a family setting, they are not patients, as in an institution. These members play a significant role in managing the TC and act as positive role models for others to emulate.
High expectations and a high level of commitment from both TC members and staff are needed to make this positive change a success. Insight into one’s problems is gained not only through group and individual interaction, but also by learning through experience, failing and succeeding, and by understanding accountability – all considered to be the most integral influences toward achieving a lasting change.
The goal of the TC is to help the individual gain the ability to return to society and lead productive lives.
Members of Therapeutic Communities of America are actively involved in research studies which have determined the efficacy of their efforts. Treatment improves the relationships, career prospects, and health of those directly impacted by addiction, and provides an impressive return on the dollar to society.
Positive treatment outcomes have also been shown to reduce health care costs as well as lessen incidents of crime and increasing work productivity.
Therapeutic Community Core Values
These Core Values were identified through a process of consultation conducted by the Community of Communities (2008). Members of over one hundred TCs across sectors and client groups agreed ten value statements that underpinned their practice and shaped the TC approach.
Attachment - Healthy attachment is a developmental requirement for all human beings, and should be seen as a basic human right.
Containment – A safe and supportive environment is required for an individual to develop, to grow, or to change.
Respect - People need to feel respected and valued by others to be healthy. Everybody is unique and nobody should be defined or described by their problems alone.
Communication – All behaviour has meaning and represents communication which deserves understanding.
Interdependence – Personal well-being arises from one’s ability to develop relationships which recognise mutual need.
Relationships – Understanding how you relate to others and how others relate to you leads to better intimate, family, social and working relationships.
Participation – Ability to influence one’s environment and relationships is necessary for personal well-being. Being involved in decision-making is required for shared participation, responsibility, and ownership.
Process – There is not always a right answer and it is often useful for individuals, groups and larger organisations to reflect rather than act immediately.
Balance - Positive and negative experiences are necessary for healthy development of individuals, groups and the community.
Responsibility – Each individual has responsibility to the group, and the group in turn has collective responsibility to all individuals in it.
Core Standards for Therapeutic Communities – Service Standards for Addiction Therapeutic Communities, 1st Edition (2006)
1) The whole community meets regularly
2) All community members work alongside each other on day to day tasks
3) All community members share social time together
4) Members of the community share meals together
5) Community members take a variety of roles and levels of responsibility
6) Informal aspects of everyday living are integral to the work of the community
7) All community members can discuss any aspects of life within the community
8) All community members regularly examine their attitudes and feelings towards each other
9) All community members share responsibility for each other
10) All community members create an emotionally safe environment for the work of the community
11) Community members are involved in the selection of new staff members
12) All community members participate in the process of a new client member joining the community
13) Community members are involved in making plans with a client member for when he or she completes the program
14) There is an understanding and tolerance of disturbed behaviour and emotional expression
15) Positive risk taking is seen as an essential part of the process of change
16) The therapeutic community has a clear set of boundaries, limits or rules which are understood by all members
14 Basic Components of a Therapeutic Community (TC) – Therapeutic Community Curriculum: Trainer’s Manual, U.S. Department of Health and Human Services
1. Community Separateness
· TC programs are housed separately from other agency or institutional programs.
· TC programs are located in settings that allow residents to disconnect from networks of drug using friends and to relate to new drug-free peers.
· TC programs have their own names, often created by residents.
2. Community Environment
· The TC environment has many common areas for holding group activities and promoting a sense of community. These areas include the dining room, recreation room, family rooms, and group rooms.
· Displays and signs throughout the TC illustrate the philosophy or creed of the program and messages of recovery and right living. The displays serve as constant reminders of TC practices and principles and promote affiliation with the community. Examples of displays include the daily schedule and a bulletin board that list participants’ names, seniority, and job functions.
3. Community Activities
· Treatment and educational services take place in the context of the peer community. Virtually all activities occur in groups or meetings where residents can interact and learn from one another.
· Group activities include:
- At least one daily meal prepared, served, and shared by all members
- Daily group meetings and seminars
- Jobs performed in groups
- Organized recreational activities
- Ceremonies and rituals, such as birthday celebrations and phase graduation celebrations.
4. Staff as Community Members
· Each staff member is a part of the community. He or she is a manager of and elder in this community and helps residents use the community. A staff member is not a “healer” who stands apart from the community.
· Staff members function as consistent and trustworthy rational authorities and as role models, facilitators, and guides in the community-as-method approach and the self-help and mutual self-help learning processes.
· Staff members must be oriented to the TC through initial and continuing training.
5. Peers as Role Models
· Senior residents are expected to demonstrate the desired behaviors and reflect the values and teachings of the community. They serve as role models for new and junior residents.
· The strength and integrity of the community as an arena for social learning depend on the number and quality of its peer role models.
· Residents serve in leadership and teaching roles in the community.
6. A Structured Day
· Each day has a formal schedule of therapeutic and educational activities with prescribed formats, fixed times, and routine procedures.
· Order, routine activities, and a rigid schedule counter the characteristically disordered lives of residents and leave little time for negative thinking and boredom—factors that often contribute to relapse.
7. Stages of the Program and Phases of Treatment
· The TC treatment protocol is organized into three major stages (orientation, primary treatment, and reentry) and phases of treatment that reflect a developmental view of the change process.
· The program stages and phases of treatment allow for individual goals to be established and incremental learning to take place.
8. Work as Therapy and Education
· Consistent with the TC’s self- help approach, all residents are responsible for the daily operation of the facility, which includes cleaning, meal preparation, maintenance, schedule coordination, and meetings.
· Job assignments provide residents with a sense of responsibility and affiliation with the TC.
· Jobs provide opportunities for self-examination, personal growth, and skill development.
9. Instruction and Repetition of TC Concepts
· TC concepts embody the TC values and belief system, which are antidotes to the values and beliefs of drug and prison subcultures.
· The concepts, messages, and lessons are repeated and reinforced in group sessions, meetings, seminars, and peer conversations, as well as in suggested readings, on signs posted in the TC, and in writing assignments.
10. Peer Encounter Groups
· The peer encounter group is the main therapeutic group format, although other group formats are used.
· Encounter groups are conducted to heighten residents’ awareness of attitudes and behaviors that need to be changed.
· The peer encounter group process includes confrontation, conversation, and closure.
· Encounter groups provide an opportunity to teach TC recovery principles, such as:
- Feeling compassion and responsible concern
- Being honest with self and others
- Confronting the reality of addiction and one’s behavior
- Seeking self-awareness as the first step in making behavior changes
- Using other people for emotional support and caring.
11. Awareness Training
· All therapeutic and educational interventions involve raising residents’ consciousness of the effect of their conduct and attitudes on themselves and others.
12. Emotional Growth Training
· TC residents learn to identify feelings, express them appropriately, and manage them constructively in stressful situations.
· The interpersonal and social demands of living together in the TC provide many opportunities to experience this training.
13. Planned Duration of Treatment
· A period of intense treatment is needed to ensure the internalization of TC teachings.
· The length of time residents must be in the TC program depends on their progress in achieving individualized behavioral goals in each program stage and phase of treatment.
14. Continuation of Recovery After TC Program Completion
· Completion of primary treatment is followed by aftercare services (e.g., vocational, educational, mental health, and family support services) that must be consistent with the TC views of recovery, right living, self- help, and support of a positive peer network.