This chapter presents a conceptual framework of the treatment process in the therapeutic community (TC). The essential elements of the perspective, model, and method are reformulated into the three broad components of the treatment process. First, the multiple interventions in the process consist of the program structure, the people, daily regimen of activities, and social interactions in the TC. Second, individual change is multidimensional, described in terms of objective social and psychological domains as well as subjective perceptions and experiences. Third, social and behavioral learning principles and subjective mechanisms such as critical experiences, perceptions, and internalization are integral in the process itself. The main elements of the treatment process in the TC have been described in terms of community interventions, behavioral dimensions, and the essential perceptions and experiences. All change in the TC is viewed from a behavioral orientation in terms of learning and training.

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.