Long-term therapeutic community
The role and place of TS in the social reintegration of persons with various types of mental pathology.
In traditional psychiatric hospitals, the ideas and principles of TS are mainly used in the organization of care for the mentally ill , first of all, with a psychotic level of disorders, as well as people with severe personality disorders. Later, TS for persons with mental disorders united into a network, which made it possible to talk about the formation of a whole TS movement. TCs are now an integral part of the national mental health services in the UK, Germany, Norway, Sweden, Greece, Finland and Italy.
TS activity, its structure most fully reflects the definition given by the Association for Therapeutic Communities (Campling, 2001): it is a place where people with special needs or problems live together in an attempt to find a more adaptive way of being among others. Living together means cooking food together, playing together, doing sports, creativity and treatment together.
The therapeutic community for substance abusers is a community of people whose rehabilitation and readaptation takes place in a structured environment, through long-term inpatient living on the basis of refusing to take psychoactive substances. Therapeutic communities are defined as a psychoactive drug-free environment where people with addiction problems live together in an organized and structured way, preparing for the upcoming life without psychoactive substances in an external society.
In the therapeutic community of the RC “Transformation”, there are strictly regulated norms and rules that are mandatory for every member of the TS, including employees. The TC model has nine required elements. These elements are based on the theory of social learning, which is used by the community to promote behavioral and worldview change. Elements: active participation, feedback from TC members, role modeling, collective ways to guide individual change, common norms and values, structuredness and consistency, open communication, individual-group relationships, unique terminology.
Tasks of the therapeutic community
Speaking about the role of TS in the RC “Transformation”, it should be noted that the main task of this method is the reintegration of a person into society and the development of his ability to adapt. Maintaining existing connections with people around and establishing new ones is considered a serious therapeutic tool. The aim of the TS is not to cure the disease in itself, but to provide space for the comprehensive development of the client’s personality. Group work carried out within the framework of the TS, which includes the “mirroring” mechanism, when colliding with another, allows you to experimentally find the boundaries of your “I”; to distinguish between the inner world and reality (for example, it is my desires that haunt me or that other people haunt me); to distinguish between your own experiences and the desires and experiences of another, to combine conflicting feelings directed at the other; to understand how a member’s own behavior affects other members of the group – all this is significant in the adaptation of the client. DC clients are involved in the maximum possible participation in the everyday life of the vehicle (for example, making a list of products and buying them, managing the budget when choosing food, organizing leisure activities, keeping rooms in order, observing hygiene rules).
TS takes a different approach to the concept of care. It is not about work being done in place of the client, but about helping him do his job on his own, including confrontation with reality. For example, the counselor’s job is not to clean the floor in his room instead of the patient, but to help him finish his work himself.
The most important principle of building relationships in the vehicle between customers and staff is partnership.
One of the important areas of TS activity is milieu therapy or therapeutic environment. The organization of the therapeutic environment presupposes the presence of a space for the client to explore his inner world, an analysis of his relationships with others, the ability to place his anxiety and aggression without destroying himself or others. This space is a place in which he can place all parts of his personality, including those that he cannot fit into a family or ordinary society. Figuratively speaking, the closed hospital of the Transformation Center can be viewed as a place where an addict can place his anxieties, a “container” of anxiety of society and family. By providing adequate care for a socially helpless client, inpatient counselors enable them to explore and realize their full potential. In TS, the situation of the therapeutic environment serves as a safe framework for the exploration of oneself and others, on the one hand, allowing conflicts and competition, on the other, limiting the ways of expression and the destructiveness of these attempts.
Therapeutic Community Guidelines
Traditionally, the medical model focuses on the patient outside the context of his relationship with
the people around him. Doctors and loved ones are concerned about the patient’s condition, and few are interested in the feelings and condition of the family members who carry the main burden. This, in turn, leads to an ever-increasing helplessness of the patient and the exhaustion of those who care for him. Meanwhile, for the first time, differentiation, separation of oneself from others, self-awareness of a person occurs in a family group, where it is necessary to share space with other people. In this case, you can understand where your own “I” is located and where the other person begins. In other words, this is the emergence of boundaries: “I need another in the same territory as me, then I have the opportunity to observe the other and, seeing the relations of others, I can see a part of myself, as in a mirror.” In contrast to the traditional psychiatric hospital, TS proceeds from a collectivist model of considering the problem of mental health, placing the focus on the patient’s interaction with the people around him. This approach is based on communalism – the joint activity of all members of the community to maintain life in it.
The next important TC principle is open, honest communication between all members of the therapeutic community – staff and clients. Employees of the RC “Transformation”, in turn, are in a situation of continuous analysis of what is happening in the TS, studying the nature of conflicts, experiences, emotional recovery.
Another of the TS principles – confrontation with reality, implies mutual feedback from all members of the therapeutic community.
Another, no less important, principle is the approach to treatment as a learning process. This refers to learning to understand oneself, coping with strong feelings, communicating with the outside world and its representatives in everyday life, life skills (self-service, communicating with family, employer, shop assistant, etc.) necessary for independent living. In our TS, the range of listed activities is complemented by educational programs, vocational training and retraining at the stage of re-socialization.
As the experience of TS in different countries shows, the most successful model of TS development is one in which TS is viewed as a form of treatment that provides the opportunity to use individual, group or family options for work, which and is practiced in the RC “Transformation”.
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