Therapeutic communities

Therapeutic Community

 

There are five therapeutic communities (TCs) operating in Oxfordshire and Buckinghamshire as part of the Complex Needs Service. They provide medium and high intensity treatments. Before you join a therapeutic community you will need to be a member of an Options or Getting Ready Group for at least a month – see link above. Treatment in the therapeutic communities lasts for 18 months. During their time in one of the therapeutic communities, members support one another by phone when the community is not meeting.

Medium intensity treatment.

Groups in Adderbury (outside Banbury), High Wycombe and Witney meet once or twice a week for up to 7 hours in total per week.

High intensity treatment.

The Aylesbury and Oxford TCs meet two or three days a week. An information sheet for the Oxford service can be found here: (Oxford Service)

These programmes involve coming under our care programme and looking carefully at what psychiatric medication you are on. This means that you need to be sure that it is for you, and that you are ready to do it. We will help you with this in the Options or Getting Ready group and talk to other mental health staff, if we need to and if you agree.

How do Therapeutic Communities work?

It may seem strange to suggest that the environment could play a significant part in a treatment programme. The idea of a therapeutic community is that community interaction is the factor which brings about change and community means, of course, other people. It is by belonging to a group of peers that a person becomes more self-aware and can adapt his or her behaviour. The therapeutic community represents the idea that it is other people, a human society, which forms the basis for treatment, because psychotherapy is a dialogue between people. (from Gale, J. (2003). The natural environment as an element in a therapeutic community treatment programme Therapeutic Communities 24 (3): 205-15.)

An example timetable

9.30 – 10.30        Opening community meeting

10.30 – 10.45      Break

10.45 – 12.15      Small group

12.15 – 1.15        Lunch

1.15 – 1.55          Large group

2.00 – 2.30          Closing community meeting

Other features of the programme

‘Special’ meetings – are called in some communities if a member needs help between groups

 

Out of hours support system – a central part of the programme. Members support one another by phone when not meeting.

 

Communal cooking, shopping, living: this is known as the ‘Living learning experience’

 

Joining programme – also known as the Options Groups.

 

Leaving programme – also known as the Moving on Group

There are other interventions for people for whom a therapeutic community would be less suitable or who do not require this intensity of therapy – see ‘Services’ section.

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What is a Therapeutic Community?

A brief explanation from the Consortium for Therapeutic Communities

A Therapeutic Community (TC) is a place whose primary aim is to help people with their emotional and interpersonal problems. The way this help is structured is guided by a set of values and beliefs about the way people should treat each other and be treated, based on self-awareness, interdependence, mutual respect and assumption of personal responsibility. These shape the principles which underpin TC practice. TCs differ in the details of their approach, depending on the client group.

What are the values of TCs?

Central to all TCs is the belief that people can change, and that in order to realise their potential as individuals and active citizens, they require an environment that fosters personal growth. They need to form relationships with others in an atmosphere of trust and security, they need to be valued, accepted and supported by those around them and they need to take real responsibility for themselves, others and their environment. A strong sense of community membership and belonging are critical to the process; in order to benefit from participation in a TC the member must be positively motivated to change, and to work within the TC’s rules. These rules uphold the values and norms of the community, which are a reflection of those held by society.

What do TCs do?

 A TC is an informal environment. Members and staff are not necessarily immediately distinguishable from each other and there is a distinct communal atmosphere. The TC offers a safe environment with a clear structure of boundaries and expectations.

 TCs have a daily structure that incorporates all practical arrangements for maintaining and developing the community, as well as a varied programme of formal and informal therapeutic activity. These may include group therapies, creative therapies, social or cultural activities, and educational or work placements. All members of the TC are involved in the daily programme that contributes to both the individual’s needs as well as those of the community as a whole.

Everyone is expected to contribute to the life of the TC according to his or her ability. Members take responsibility for themselves (for example in terms of appropriateness of behaviour) and participate in the running of the TC. This may include duties such as cooking, gardening and administrative tasks, which are assigned by the whole community. Members and staff meet together regularly to discuss the management and activities of the community and to make decisions affecting them; members’ joining or leaving are particularly important. Members take on increasing responsibilities as their confidence and abilities develop during their time in the community.

 Members tend to learn much through the routine interactions of daily life, and the experience of being there for each other. The goal is to improve members’ interpersonal functioning, first within the therapeutic community, and ultimately in the wider community. Feedback from peers enables members to reflect on the way their conduct affects others, and practice new behaviours and ways of relating and begin to gain self-esteem and increasing knowledge of themselves.

 Who can TCs help?

TC principles can be applied to the therapeutic care of a wide range of people in different settings. TCs can be residential or day facilities. They can be located across all sectors in Health and Social Care, including the Prison Service. They help some of society’s most vulnerable and socially excluded adults, children and young people.  Problems TCs can help include mental disorder, learning difficulties, substance misuse, severe emotional and behavioural difficulties and offending behaviour.

Four TC Principles (Rapoport 1960)

  1. Communalism –  (sharing of mutual tasks, close interdependency) promotes interaction with others, responsibility sharing, the abandonment of fixed social roles and attitudes, and the development of new relationships.

  2. Democratisation – (flattened hierarchy, sharing of decision making) allows self-management to emerge and altruism to flourish as a patient (called a member) is allowed to contribute meaningfully to the treatment of others.

  3. Permissiveness – (difficult behaviour is tolerated) allows for catharsis (ventilation), self-disclosure, and the assumption of self-responsibility

  4. Reality confrontation – (presentation of behaviour as it is seen by others) promotes self-awareness and the development of identity and self-concept, and encourages learning through interpersonal feedback.

References

Haigh, R. (1999) The Quintessence of a Therapeutic Environment. Five Universal Qualities, Therapeutic Communities. Past, Present and Future p. 246-257, (ed.) P Campling and R. Haigh, London and Philadelphia: Jessica Kingsley.

Hinshelwood, R.D. (1979) The Community as Analyst, Therapeutic Communities: reflections and progress (ed.) R.D. Hinshelwood and N. Manning, p.103-112, Routledge and Kegan Paul: London, Boston and Henley.

Rapoport, R.N. (1960) Community as Doctor London: Tavistock Publications.

Bibliography

Chiesa, M., Iacoponi, E., & Morris, M. 1996, “Changes in health service utilization by patients with severe personality disorders before and after inpatient psychosocial treatment.”, British Journal of Psychotherapy, vol. 12, no. 4, pp. 501-512.

Davies, S., Campling, P., & Ryan, K. 1999, “Therapeutic community provision at regional and district levels”, Psychiatric Bulletin, vol. 23, no. 2, pp. 79-83.

Davies, S. & Campling, P. 2003, “Therapeutic community treatment of personality disorder: Service use and mortality over 3 years’ follow-up”, British Journal of Psychiatry, vol. 182, no. Suppl44, p. s24-s27.

Lees et al (1999) Therapeutic Community Effectiveness: A Systematic International Review Of Therapeutic Community Treatment For People With Personality Disorders And Mentally Disordered Offenders. NHS Centre for reviews and dissemination

Websites

Association of Therapeutic Communities website: http://www.therapeuticcommunities.org/

 A summary of evidence: Therapeutic Community Effectiveness