Work is one of the most distinctive components of the therapeutic community (TC) treatment model. Indeed, the telling mark of the TC social environment is the vibrancy of its work activities. Work in the TC is a fundamental activity used to mediate socialization, self-help recovery, and right living. This chapter describes how work mediates essential educational, therapeutic, and community goals. For disadvantaged, antisocial, or nonhabilitated substance abusers, many of whom have few work skills, social identity and self-esteem are first acquired through participation in the work structure of the TC. Work in the TC addresses characteristics of the person and the disorder. These characteristics can be classified into related categories: personal habits, work habits, work relations, self-management, and work value. Job functions are utilized in three main ways: for skills training and education, for therapeutic change, and to enhance the peer community.
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As components of the therapeutic community (TC) treatment model, the stages define the program’s plan for moving individuals toward the goals of social and psychological change. This chapter describes the process of change in the TC in terms of participation and levels of involvement. It focuses on participation and community as method through the program stages. The chapter outlines some relations between the social and psychological dimensions of individual change and the community expectations for participation. It also describes the process of multidimensional change through treatment in terms of levels of involvement in the community. Participation and involvement link community as method to the individual in the change process. The terms engagement, immersion, and emergence label the individual’s level of involvement in the community. Perceptions related to self and identity are incremental through the levels of involvement.
The therapeutic community (TC) for addictions descends from historical prototypes found in all forms of communal healing. A hybrid, spawned from the union of self-help and public support, the TC is an experiment in progress, reconfiguring the vital healing and teaching ingredients of self-help communities into a systematic methodology for transforming lives. Part I of this book outlines the current issues in the evolution of the TC that compel the need for a comprehensive formulation of its perspective and approach. It traces the essential elements of the TC and organizes these into the social and psychological framework, detailed throughout the volume as theory, model, and method. Part II discusses the TC treatment approach, which is grounded in an explicit perspective that consists of four interrelated views: the drug use disorder, the person, recovery, and right living. The view of right living emphasizes explicit beliefs and values essential to recovery. Part III details how the physical, social organizational, and work components foster a culture of therapeutic change. It also outlines how the program stages convey the process of change in terms of individual movement within the organizational structure and planned activities of the model. Part IV talks about community enhancement activities, therapeutic-educational activities, privileges and sanctions, and surveillance. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. Part V depicts how individuals change through their interaction with the community, provides an integrative social and psychological framework of the TC treatment process, and outlines how the basic theory, method, and model can be adapted to retain the unique identity of contemporary TCs.
In the therapeutic community (TC), the therapeutic and educational component that focuses specifically on the individual consists of the various forms of group process. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. This chapter provides an overview of general elements and forms of group process in the TC. Conventional psychotherapy and group therapy have not been particularly effective with substance abusers entering TCs for various reasons. Group tools are certain strategies of verbal and nonverbal interchange that are employed by participants to facilitate individual change in group process. There are two main classes of group process strategies: provocative tools and evocative tools. Provocative tools, hostility or anger, engrossment, and ridicule or humor, are most pointedly used to penetrate denial and break down deviant coping strategies such as lying.
Encounter group is a profoundly significant component of the therapeutic community (TC) approach, illustrating by example some of the TC’s basic teachings: compassion and responsible concern, the necessity for confronting reality, absolute honesty, and self-awareness as the essential first step in personal change. The encounter group is pre-eminently a verbal forum employing everyday personal and social vernacular. All encounter groups in the TC are similar in their preparation, structure, and process. An encounter unfolds as a process characterized in terms of four phases: the confrontation, the conversation, the closure, and the socializing phase. Ideally, each encounter accomplishes its general purpose of strengthening group cohesion and its goals for specific individuals. Depending upon its purpose or group composition, the encounter can be modified in intensity and format and the extent of staff involvement as facilitators.
The quintessential element of the therapeutic community (TC) approach is community. It is the element of community that distinguishes the TC from all other treatment or rehabilitative approaches to substance abuse and related disorders. TCs differ profoundly from other communities in their rationale and purpose. This chapter discusses the general characteristics of community as a treatment approach: its relationship to the TC perspective, its healing and learning properties, and its social and cultural features. It translates this approach into a specific method the components of which are the “active ingredients” in the treatment process. Residents in TCs have been labeled as bad or rebellious kids, dangerous addicts or criminals, failures or losers, sick or crazy. The negative social labels become embedded in self-perceptions regarding their social and personal identities. The community approach fosters change in the social and personal elements of identity.