From a social and psychological perspective the therapeutic community (TC) can be distinguished from other institutional or treatment settings in that its social environment is the treatment model. The main elements of this model, its social organization, and social relationships are utilized for a single purpose the reintegration of the individual into the larger macrosociety. The social organization of the TC model may be described in terms of four major components: program structure, systems, communication, and the daily regimen of schedule activities. In the TC, however, each component is utilized to facilitate the socialization and psychological growth of the individual members. This chapter provides an overview of these components and how they contribute to the TC treatment approach. Each of these components of the social organization reflects an understanding of the TC perspective and each is used to convey community teachings and promote self-examination and self-change.
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In the therapeutic community (TC), peers are the primary change agents. In their varied social roles and interpersonal relationships, residents are the mediators of the socialization and therapeutic process. This chapter details how peer roles and relationships are utilized by the community to facilitate the goals of socialization and psychological change. The socialization history of serious substance abusers is marked by negative peer influences. Functional roles in the TC are those involving performance demands, prescribed skills and attitudes, and defined relationships with others. Three prominent community member roles are peers as managers, as siblings, and as role models. A defining element of the TC model is the use of peer roles for social learning. The chapter describes how the various community and functional roles in the social organizations are utilized by peers to change themselves and others and how socially conditioned race-ethnic and gender roles and issues are addressed.
In the therapeutic community (TC) perspective, changing the whole person unfolds in the continual interaction between the individual and the community. This chapter provides the multidimensional picture of social and psychological change in terms of behaviors, cognitions, and emotions. Four major dimensions reflect the community’s objective view of individual change. The dimensions of community member and socialization refer to the social development of the individual specifically as a member of the TC community and generally as a prosocial participant in the larger society. The developmental and psychological dimensions refer to the evolution of the individual as a unique person, in terms of personal growth, personality, and psychological function. Each illustrates typical indicators of individual change in terms of objective behaviors, cognitions, and emotions. Changing the “whole person”, however, includes how individuals perceive and experience the program, the treatment, and themselves in the process.
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.
Privileges and sanctions constitute an interrelated system of community and clinical management through behavioral training. The management of the community is the responsibility of peers and staff. This chapter details the formal system of community privileges and sanctions prescribed by staff and the informal system of verbal affirmations and correctives implemented primarily by peers. Privileges are used to promote individual socialization and personal growth. It confirms the resident’s overall personal autonomy and ability for self-management. Money is a major problem in the lives of substance abusers. However, money difficulties also reflect social and psychological problems among substance abusers in therapeutic communities (TCs). Sanctions may be grouped into verbal correctives and disciplinary actions. Sanctions promote community awareness and peer self-management and maintain social order through addressing individual and collective infractions. Sexuality is approached differently from the other rule-governed behaviors in the TC.
In the therapeutic community (TC), program stages are prescribed points of expected change. Individual status can be described in terms of typical profiles at various points in the plan of the program. This chapter provides a description of the program stages as the main structural component of the TC model, specifically designed to facilitate the change process. In traditional long-term residential TCs, there are three main program stages, induction, primary treatment, and re-entry, consisting of several phases or substages. These stages are described in terms of main goals, stage-specific activities, and typical outcomes. Individuals who complete all stages of the planned duration of treatment are candidates for program graduation. Aftercare plans are a special activity of the late re-entry phase of the program. Each stage-phase marks signify where individuals are in their socialization and psychological growth.