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This paper seeks to provide a history and a prehistory of the therapeutic community movement, and a series of questions still debated in the field.
Abstract
Purpose
This paper seeks to provide a history and a prehistory of the therapeutic community movement, and a series of questions still debated in the field.
Design/methodology/approach
The paper discusses the factors which favour the creation of therapeutic communities, drawing on Winnicott's views on democracy and the history of therapeutic community innovations. Some key factors are identified and their implications discussed.
Findings
The paper suggests that the therapeutic community impulse takes root where a number of individuals, with what Winnicott has called the “democratic tendency”, come together in response to a community's need for psychological care and support, and this can happen anywhere.
Originality/value
The paper offers a history and a prehistory of the therapeutic community movement, and draws out some of the implications for the future development of therapeutic communities and the nurturing of the therapeutic community impulse.
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Keywords
Mick J. Bloor and Neil P. McKeganey
Therapy is reflexive but not synonymous with therapists' accounting practices. It is displayed and engenders dominance but it is not an institutional rhetoric or a mechanism of…
Abstract
Therapy is reflexive but not synonymous with therapists' accounting practices. It is displayed and engenders dominance but it is not an institutional rhetoric or a mechanism of social control. Six properties of therapeutic work are enumerated — reflexiveness, interpretativeness, interventionalism, domination, habituation tendencies and selectivity. All apart from reflexiveness are subject to differences of form and extension in different therapeutic communities. These variations in therapeutic work and communities can be empirically mapped. Such a conception of therapeutic work may have applications to therapeutic work outside the therapeutic communities and any other institutional setting. Two data extracts empirically ground the discussion.
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This paper aims to provide a comparison of “old” democratic therapeutic communities, and “new” therapeutic communities for drug abuse.
Abstract
Purpose
This paper aims to provide a comparison of “old” democratic therapeutic communities, and “new” therapeutic communities for drug abuse.
Design/methodology/approach
The paper is a review of historical and cultural influences on therapeutic community development, with particular reference to leadership.
Findings
Free from bias, cultural, psychological or ideological, the next therapeutic communities should integrate elements of both old and new therapeutic communities, in a development strategy which assimilates, socializes and finally prepares the individual for full participation in the larger community. Within this strategy, a rational authority model is not inherently flawed but can provide a structured stage for corrective experience leading toward personal autonomy. Regardless of its particular form, however, the efficacy of the next therapeutic community will relate directly to the extent to which they incorporate the essential of its modern and ancient prototypes, that of community and healer and teacher.
Originality/value
The two main types of therapeutic community have tended to operate and develop separately. The author calls the rigid separation into question and identifies key shared elements.
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Rebecca Ranz, Rachel Dekel and Haya Itzhaky
The purpose of this paper is to focus on comparing background characteristics, self‐efficacy, and family support of immigrants from the Former Soviet Union (FSU) and of veteran…
Abstract
Purpose
The purpose of this paper is to focus on comparing background characteristics, self‐efficacy, and family support of immigrants from the Former Soviet Union (FSU) and of veteran Israelis who join therapeutic communities in Israel, and their adjustment to these communities. The aim of this research was to examine whether therapeutic communities are an appropriate rehabilitative setting for immigrants who come from a different cultural background.
Design/methodology/approach
The study sample consisted of 213 people with addictions, who were being treated in therapeutic communities in Israel: 110 were Israeli‐born and 103 were immigrants from the FSU. The data in the present study are based on questionnaires, which the participants completed upon their arrival into the communities: socio‐demographic data; perceived self‐efficacy in resisting the temptation of drugs; and family support. The dropout rates from the therapeutic communities were also examined.
Findings
The findings indicate that the addicts who immigrated from the FSU had lower self‐efficacy in resisting high‐risk drug situations as well as lower levels of family support, whereas the dropout rate from the treatment program was considerably higher among the Israeli‐born participants.
Originality/value
The findings suggest that the therapeutic community is an appropriate setting for addicts from the FSU, and that they had a lower dropout rate than did the Israeli‐born addicts. Thus, the main value of this research is that it suggests that the communities are an appropriate rehabilitative setting for the immigrants.
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Aleksandra Novakovic, Katie Francis, Jacqueline Clark and Linda Craig
Although long a feature of inpatient mental health ward routine, community meetings have not always attracted a clear sense of purpose and value. A common complaint from patients…
Abstract
Although long a feature of inpatient mental health ward routine, community meetings have not always attracted a clear sense of purpose and value. A common complaint from patients is that community meetings are useless and have no worthwhile purpose. It was thought that staff on acute wards would benefit from having a space to think about community meetings, and a work discussion group was provided over a duration of 18 months. It was hoped that this intervention would enable facilitators to think about these meetings and about their aims and benefits. This paper presents findings from the work discussion group: staff facilitators' experience of facilitating community meetings and patients' direct feedback to facilitators about their experience of these meetings. The conclusions made are that community meetings could provide a useful forum for patients and staff if they:• are of benefit to patients• provide a forum for development of the therapeutic alliance between patients and staff• contribute towards improvement of the ward milieu• provide a forum for staff to develop therapeutic skills• provide a forum for staff to develop working relationships with colleagues and different professionals in the team.
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Jan Lees, Rex Haigh and Sarah Tucker
The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).
Abstract
Purpose
The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).
Design/methodology/approach
Literature review shows comparison of TC and group-analytic concepts with illustrative case material.
Findings
Findings reveal many similarities between TCs and GA, but also significant divergences, particularly in practice.
Practical implications
This paper provides theoretical basis for TC practice, and highlights the need for greater theorising of TC practice.
Social implications
This paper highlights the importance of group-based treatment approaches in mental health.
Originality/value
This is the first paper to review the relevant literature and compare theory and practice in TCs and GA, highlighting their common roots in the Northfields Experiments in the Second World War.
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Reports about therapeutic communities usually focus on specific therapeutic activities: the various ways of the community functioning correctively, the communal-personal dynamics…
Abstract
Purpose
Reports about therapeutic communities usually focus on specific therapeutic activities: the various ways of the community functioning correctively, the communal-personal dynamics of the community, the dramaturgically graspable problems and the operating and integrative function of the staff. There is relatively little attention paid to the features of the structure composed of the systems of norms and values of these communities. The purpose of this paper is to focus on this normative dimension of the culture of a therapeutic community.
Design/methodology/approach
The authors wish to show this focus with the developmental process of the system of values, rules and norms of the therapeutic community of Thalassa House in Budapest, thinking mainly in self-psychological and ethical paradigm.
Findings
The way of operating values, norms and rules – the systems of metanorms – creates the cognitive matrix in which members of the community are both acting and perceiving parties, simultaneously suffering and interpreting the communal occurrence of self-pathologies. It develops the cooperative potential of the community along this “ethical” dimension. In the view, the structure of rules, norms and values operated in the culture of relationships of the community, as a consciously elaborated collective agent, has a specific effect in the healing of self-pathologies.
Originality/value
In the view, the efficiency of the actuation of norms depends primarily on the emergence of metanorms, that is of the ”how” of the application of norms. The values of the metanorms can be found both in the circumstances of the birth of self-according to the attachment theory and in the world of dialogical ethics.
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Training in therapeutic community and related approaches has not been widely available, and there is debate about the form this should take. This has had a negative impact on the…
Abstract
Purpose
Training in therapeutic community and related approaches has not been widely available, and there is debate about the form this should take. This has had a negative impact on the field. The paper aims to discuss this issue.
Design/methodology/approach
The authors consider the history of training in democratic therapeutic community methods in the UK in particular, and trace some of the reasons for its lack of development.
Findings
With the expansion of TC methodology into new areas, such as therapeutic and enabling environments, the ability to provide training in DTC approaches and techniques is increasingly important. The developing evidence base, and the increasing detail in which the method has been described, make dedicated TC training increasingly important.
Originality/value
Training in therapeutic community methods, and enabling and therapeutic environment approaches, provides a grounding in technique and theory that would otherwise be impossible to acquire for most workers, and can lead to a general increase in the level of competence and confidence in the way these environments operate.
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It is argued that COVID-19 epidemic has critically affected, from many points of view, the hyper-modern economic system, dominant in the globalized capitalist societies. This…
Abstract
Purpose
It is argued that COVID-19 epidemic has critically affected, from many points of view, the hyper-modern economic system, dominant in the globalized capitalist societies. This paper aims to describe the point of view of therapeutic communities, basing my reflections on the Italian experience.
Design/methodology/approach
The author would like to share a critical thought on three issues that this pandemic crisis has made manifest in Italian society: the return of the removed bodies, the feeling of excess represented by therapeutic communities and the emergence of the need for a common thought.
Findings
Body become again an object of studies and with it also the group, as grouping of the bodies. Also the community become a now old-object of studies, as grouping of bodies and groups in a human environment. The objectives of this study are presented as the substance of the democratic vision of society, which therapeutic communities have a responsibility to promote scientifically and ethically.
Originality/value
Therapeutic community is presented as transformative and evolutionary for individuals and groups that compose it, as equally conflictual and destructive, both internally and externally. The author thinks this is the substance of the democratic vision of society, which therapeutic communities have a responsibility to promote scientifically and ethically.
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This study aims to raise awareness of the importance of the sociological aspects of therapeutic community work, including clarity about the nature of the task, the power of…
Abstract
Purpose
This study aims to raise awareness of the importance of the sociological aspects of therapeutic community work, including clarity about the nature of the task, the power of informal interactions between participants and the relevance of leadership.
Design/methodology/approach
Applying insights from historical research to present-day practice.
Findings
The Northfield experiments offer a number of insights into present-day practice of therapeutic communities and enabling environments. These include clarity about the task, the relevance of participant interactions outside of specifically therapeutic work and the importance of leadership.
Social implications
The therapeutic community/enabling environments approach has relevance to a wider sector of society than solely the therapeutic. More attention needs to be paid to leadership issues in the therapeutic community movement, as well as the therapeutic power of the mutual support networks amongst those receiving care.
Originality/value
Through the lens of the Northfield experiments, this paper offers a broadening of the sociological nature of therapeutic community practice, arguing that the purpose is to enable greater social adaptability, thereby enhancing relationships and deepening our awareness of ourselves. Implicit in this perspective is the recognition of the power of non-formal interrelationships in the service as well as the importance of leadership. It is also suggested that our experience in this way of working has a value in other organisations such as work places or schools. However, to achieve this, we need to adapt our language appropriately.
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