At the core of the change process in the therapeutic community (TC) is the relationship between the individual and the community. Internalization is a familiar psychodynamic concept connoting learning that involves “taking in” the behavior and teachings of others. In the TC, internalization is evident when new learning becomes a “natural” part of the individual’s repertoire. In the TC internalization is inferred from patterns of behavioral, experiential, and perceptual change occurring over time. These may be described in terms of several broad characteristics: cognitive dissonance and behavioral conflict, generalization, learning to learn, and confirmatory experiences. The course of internalization can be characterized as a gradient that depicts changing levels or stages of internalization. Four stages refer to changes during treatment, compliance, conformity, commitment to program, and commitment to self. A change in identity is the distinctive marker of the integration stage.

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.

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 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.