The idea of the therapeutic community (TC) recurs throughout history implemented in different incarnations. In its contemporary form, two major variants of the TC have emerged. One, in social psychiatry, consists of innovative units and wards designed for the psychological treatment and management of socially deviant psychiatric patients within mental hospital settings. In the other form, TCs have taken are as community-based residential treatment programs for addicts and alcoholics. This chapter explores the sources and evolution of these communities to illustrate how they contribute to the theoretical framework of the TC. It describes the direct and indirect influences shaping the essential elements of the modern TC. The early religious influences on the Oxford group and Alcoholics Anonymous (AA) reappear as elements of the modern TC. The search for an “essential TC” reveals a universal idea recurring in various forms throughout history: that of healing, teaching, support, and guidance through community.
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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.
In the recovery perspective of the therapeutic community (TC), lifestyle and identity changes reflect an integration of behaviors, experiences, and perceptions. The essential experiences can be conceptualized under three broad themes: emotional healing, social relatedness and caring, and subjective learning. Emotional healing refers to moderating the various physical, psychological, and social pains that residents experience in their lives directly or indirectly relating to their substance use. The essential experiences reflecting psychological safety are blind faith and trust, and understanding and acceptance. Trust problems are prominent in the lifestyles of substance abusers. Hallmark characteristics of substance abusers in general are their lack of self-understanding and self-acceptance. Personal isolation or unhealthy attachments with others characterize the past social relationships of residents in TCs. The key social relatedness and caring experiences are identification, empathy, and bonding. In the TC, social learning unfolds as an interaction between the individual and the community.
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.
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 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.
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.