Pearce, S. (2014), "Editorial", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 35 No. 4. https://doi.org/10.1108/TC-10-2014-0034
Emerald Group Publishing Limited
Article Type: Editorial From: Therapeutic Communities: The International Journal of Therapeutic Communities, Volume 35, Issue 4.
Dr Steve Pearce
Welcome to the fourth issue of volume 35 of Therapeutic Communities. The issue includes an exploration of social capital and its relation to sustaining recovery after discharge from a TC, an experimental investigation of the connection between resident interactions and staff perception of role modelling that may have importance for the links between belongingness and responsible agency, and a detailed description of community meetings within the Sanctuary model. Finally a systematic review of addictions TC outcomes using a novel combination of approaches.
Clarke and Royes et al. present an appraisal of the community meeting in the Sanctuary model, and compare it to a TC approach. Readers familiar with community meetings in therapeutic communities will recognise their description, which for many TCs will be indistinguishable. For democratic therapeutic communities this paper constitutes a comprehensive description of the operation and function of community meetings along with some of the principles underlying the process, only the emphases being different; TC practice will perhaps emphasise empowerment and the flattening of the authority pyramid more. They also briefly outline some of the theory around trauma and attachment that support the usefulness of this method. They refer to grievances being aired, but leave open the question of how �non violence�, one of the underpinning principles of the model, is best ensured in order to encompass non aggression and prevent retraumatisation. Readers may want to refer to Veale et al. for a more detailed and critical view of the use of community decision making and in particular permissiveness in the context of treatment of traumatised individuals (Veale et al., 2014).
The article by Best et al. draws attention to the literature on social capital as applied to partially enclosed communities, such as many residential addictions TCs, and the advantages of bridging capital, the contribution and links made by a TC to the local community. Recovery is difficult to sustain after discharge from a TC if an individual has concentrated solely on relationships within the community (�bonding capital�), and TCs can address this by identifying ways they can contribute to the local community outside the TC. Best et al. carried out mapping exercises to demonstrate how this might be done. Their paper is relevant to all recovery oriented and therapeutic communities in which internal attachment is encouraged as a mediator of change, in order to help members sustain recovery after they leave the community.
Hodge et al. report an investigation into role modelling in a women's addictions TC in the USA. Using the giving of feedback, both positive and corrective, as a proxy for the development of responsible agency, they hypothesis that residents scoring highly on this measure will also be regarded as role models by staff. Ratings by staff were carried out two weeks after residents rated one another according to the frequency and type of feedback they thought their fellow residents gave. Role model status in the view of residents, if reliably linked to type and frequency of feedback, might provide details of the hypothesised mechanism for the link between belongingness and the generation of responsible agency. How this might operate in terms of staff perception is less clear. It is likely that staff views of residents affect the views of the community more widely; interestingly staff in this study only rated residents who received praise and gave critical feedback as role models, apparently not setting store by positive feedback given by the resident. The authors make suggestions for why this might be; one possibility is that some TCs prioritise negative over positive reinforcement, a potentially problematic strategy.
Finally Magor-Blatch et al. present a systematic review of TCs for substance misuse disorders. They survey studies completed since 2000, and use a broad set of inclusion criteria to cover the range of studies. In this way the paper fills a gap; it uses a rigorous and systematic method, the Cochrane Collaboration protocols, while including non randomised studies. Previous reviews have either been less rigorous in approach, or not included non randomised study designs. The resulting summary of recent studies conforming to rigorous design standards adds substantially to our knowledge of the effectiveness of the TC method. The number and quality of outcome studies in the addictions TC field is a challenge to TC researchers working with other populations.
Veale, D., Gilbert, P., Wheatley, J. and Naismith, I. (2014), �A new therapeutic community: development of a compassion-focussed and contextual behavioural environment�, Clinical Psychology & Psychotherapy, available at: http://dx.doi.org/10.1002/cpp.1897