2. TERAPEUTIC COMMUNITIES
Emerged from the Substance Abusers themselves.
TCs serve the most serious substance abusers;
Severity of Substance abuse, psychological dysfunction and social deviancy
TCs address the disorder of the whole person and focus on recovery goals:
changes in life style and identities
3. 1. View of Disorder- The Therapeutic Community Perspective
•Cognitive, behavioral, emotional, medical, social and spiritual problems
•Physical dependency must be seen within the context of the individual’s
psychological status and life style
•Problem is the person, not the drug (?)
4. 2. View of the Person - The Therapeutic Community Perspective
Rather than drug use patterns, individuals are distinguished along
dimensions of psychological dysfunction and social deficits.
Some shared characteristics in seriously addicted persons
•Poor tolerance for frustration, discomfort, delay of gratification
•Low self-esteem
•Problems with authority
•Problems with responsibility
•Poor impulse control
•Unrealistic
•Difficulty coping with feelings
•Dishonesty, manipulation, self-deception
•Guilt (self, others, community)
•Deficits (reading, writing, attention, communication)
5. 3. View of Recovery - The Therapeutic Community
Perspective
The goals of treatment are total changes in lifestyle and
identity.
Some assumptions about recovery
•Recovery is developmental learning
•Self-help and mutual self-help
•Motivation
•Social learning
•Treatment is an episode in the recovery process
6. 4. View of Right Living . The Therapeutic Community Perspective
Certain precepts, beliefs and values as essential to self-help recovery, personal
growth and healthy living.
•Truth/Honesty (in Words and in Actions)
•Here and Now (Living in the present)
•Personal Responsibility for their recovery and life style
•Social Responsibility ("Brother's/Sister's Keeper
•Work ethic (Economic self reliance, standards of excellence)
•Moral Code Concerning Right and Wrong Behavior
•Inner Person is "Good", but Behavior Can be "Bad"
7. The TC Approach: Community As Method
The purposive use of community to teach individuals to use the community
to change themselves
Community as Method in TC have four interrelated components
Community is the context of peer and staff relationships, and the daily regimen
of activities.
Community sets the expectations for individual’s participation.
Community assesses the individual’s progress in meeting these expectations.
Community responds to individual’s meeting expectations.
8. Community, the individual and the Process of Change
Individuals use the context and expectations of the
community to learn and change.
Meeting community expectations requires continual self-
change in behaviors, attitudes and emotional management.
Avoidance of, or difficulties in, meeting community
expectations also results in individual growth through
continual self-examination, re-motivation to engage in
theatrical and error learning and re-commitment to the
change process.
9. Community, the individual and the Process of Change
Individuals use the context and expectations of the community to learn and
change.
Meeting community expectations requires continual self-change in behaviors,
attitudes and emotional management.
Avoidance of, or difficulties in, meeting community expectations also results in
individual growth through continual self-examination, re-motivation to engage
in theatrical and error learning and re-commitment to the change process.
10. Components of a Generic TC Program
•Community separateness
•A community environment
•Community activities
•Staff roles and functions
•peers as role models
•A structured day
•Work as therapy and education
•Phase format
•TC concepts
•Peer encounter groups
•Awareness training
•Emotional growth training
•Planned duration of treatment
•Continuity of care
11. Variants of TCs The extent to which the program is guided
by TC perspective and approach (Community as Method)
Standard TCs: Guided by perspective and method but may
in corporate other evidence informed practices to enhance
community as method.
Modified TCs: Guided by TC perspective and method but
adapted for special populations and settings. Incorporates
special services like addicted people
TC Oriented; Not guided by TC perspective or community
as method. Uses selected elements of the TC (eg. a
community meeting, peer support group etc.) but mainly
services and practices not specific to the TC.
12. General Summary of Modifications of TC Practices and Program
Elements for Special Populations and Settings
The treatment goals planned; duration of treatment, flexibility of the
program structure and in the intensity of peer interactions all
accommodate individual differences.
Successful implementation of TC program models within special
settings requires accommodation to the goals, procedures, personnel,
general practices, and restrictions of these settings.
Special services and interventions are integrated into the program as
supplemental to the primary TC treatment (Community as method).
13. General Guidelines of Adaptations of the TC
Adhere to the perspective on recovery and right living and to the fundamental
approach—community as method.
Retain basic components of the generic model including its social organization,
work structure, daily schedule of meetings, groups, seminars and recreational
activities and program phases.
Integrate the variety of staff conceptually in the TC-perspective and approach
through intensive and continuous cross training.
14. TC is an Evidenced Based Treatment
“Weight” of the research evidence from all sources supports the conclusion
that the TC is an effective and cost-effective treatment for certain subgroups of
substance abusers, particularly those with severe drug use, social and
psychological problems.
Evidenced based social psychological principles and practices are embedded
within Community as method.(Indirect Evidence)
Other Evidenced informed strategies can be incorporated to enhance, not
substitute for, community as method, the primary approach.
15. C7. Breaking Away
addictive substances,
substances not more alltime in
“my” mind
8. Sobriety 9. Stability
10. Change of
identity
What methods you could use
in Denying stage and how? A1-3
What methods you could use in
Internal motivation stage
and how?
B4-B6
What methods you could
use in Break down and build
up a new identity stage and
how?
C7-C9
How to use community
and peers as resources?
How to use community
and peers as resources?
16. Principles and Practice of Motivational Interviewing with
addicted people
How to start discussion with a service user who by her
telling that she is drinking too much every week?
Service user told to the social worked that her boyfriend
told her to visit addiction-clinic. She told to the social
worker, that she is drinking about three bottles of sider
every evening meanwhile watching television with her
boyfriend. She told also to social worker about her
medication for her depression.
17. "Your drinking is in the range that we call 'risky drinking' because it can cause
health risks for you. These risks include…
“It is important to reduce your drinking to acceptable level; it is recommendable
not drink more than seven drinks per week and no more than three drinks on
one occasion."
The social worker could ask for her a response to this advice to ensure that the
patient understands the need to take action:
"What do you think about what I just said? How do you feel about reducing
drinking below risky levels?
Motivational interviewing helps the service user identify the thoughts and
feelings that cause her to continue addiction behaviors and help her to develop
18. What a social worked has to be able to do?
•Express empathy and avoid arguments
—For example, as part of a discussion about drinking less with heavy drinker,
the social worker can state, "I understand that is has been difficult for you to
avoid situations with risks in the past (drinking at home meanwhile watching
TV).
Many of my patients find this to be difficult meanwhile drinking mostly at
home?
I think it is still important for us to try to find ways for you to work on this.
What do you think how you can do to avoid drinking to drink less or not drink
at all?"
19. •To help
The social worker can help the patient understand the difference between her
behavior and her goals. For example, consider stating,
"You have told me that you would feel better, If you cut down on your mental
medication. I think that you know that being sober would help with this.
Why do you think it is hard for you to find more time to exercise not drinking
life style?”
20. •Roll with resistance and provide personalized feedback.
When patients express reasons for not achieving goals, the
social worked can help them find ways to succeed. For
example, consider stating, "I know you are tired when you
get home from work, but do you think you could try walking
out in a nearest park for an hour instead opening your cider
can? Do you have to buy ciders at all?
Why you still visit ciders/beers department in your local K-
market?”
•Support self-efficacy, elicit self-motivation
—For example, the social worker can state, "Let's talk about
what you can do more to enjoy your sober free-time with
your boy-friend?
21. Create case study 2 students in a group. Time 1hour to prepare 10 minutes
presentation,.
Please create a drama presentation. Other students will give you feed-back
Five pairs for motivational interviewing.
1.
2.
3.
4.
5.
22. One group (pair) for practicing each of stages with Leon’s
therapeutic community. What kind of work
method/questions could help the service user to reach
his/her aims mn your given stage
Please create a drama presentation. Other students will give
you feed-back
A1
A2
A3
B
B5
B6
C7
C8
C9
23. References
De Leon, G. (2000). The Therapeutic Community: Theory, Model, and Method. New York: Springer Publishing
Company. New York
The Therapeutic Community Approach:Essential Elements and Adaptations for Special Populations andSettings.
GEORGE DE LEON Ph.D.
Center for Therapeutic Community Research @ NDRI Clinical Professor of Psychiatry; NYU School of
Medicine
Presented FADAA/FCCMH ANNUAL CONFERENCE AUG 7-9, 2013, ORLANDO, FLORIDA’
https://www.chance2changetreatmentcentre.com/admissions?gclid=EAIaIQobChMI4teOsNj12AIVgZgYCh3Trw8PE
AEYASAAEgJKqvD_BwE
PÄIHDEAVOKUNTOUTUS slides
Versio 24.1.2018
Tuula Hiltunen
Lorraine. Lorraine:My Story.Mission Agency Ltd.2011.Web.Thursday, September 27.
