Tuesday, June 17, 2014

The therapeutic community -My analysis of the TC model based on my experience within the therapeutic community

SHAFA HOME uses the ‘Therapeutic Community’ (TC) modality in its de-addiction treatment. It is the most prolific, largest and well-known centre in India to have implemented this form of treatment into practise. SHAFA HOME’s aim is to detoxify, correct and rehabilitate its patients within a community setting.
This article will give you an insight into the TC model of de-addiction treatment. These main topics are addressed:
-          What is a ‘therapeutic community’?
-          How does a ‘therapeutic community’ operate?
-          What is the daily routine within a ‘therapeutic community’?
-          How does TC life benefit the individual?
-          When was the concept of ‘therapeutic community’ created and how has it evolved?
-          Why is there a ‘need for the ‘therapeutic community’?
What is a ‘therapeutic community’?
A simplified explanation of the Therapeutic Community is a group of people who by following certain salient inter-personal principles and guidance have overcome their maladaptive, compulsive and obsessive behaviours produced by their past isolated and hazardous lifestyle (demonstrated within their substance addiction). 
After having learned and implemented the knowledge that has aided their self-improvement during their treatment period in their day-to-day living, they endeavour to help their younger peers establish and enhance upon their own self-improvement. Thus a continuous chain-of-assistance continuously exists. Within the TC the majority if not all of the volunteer and senior staff are recovering addicts themselves. At SHAFA HOME we believe that only a recovering addict can best understand and help another addict on their journey.
How does a TC operate?
The TC works on the fundamentals of total autonomy, self-management and equality of all; regardless of gender, colour, religion, upbringing etc. It also functions on secularism.
TC functions upon trust, mutual concern, responsibility and honesty. In the TC, all residents work together for a common purpose; to observe and correct each other’s unacceptable behaviour in a mature and non-judgemental manner, without feelings of superiority or domination over anyone else. This is called the ‘confrontation and pull-up programme’ at SHAFA HOME. The ‘programme’ is by far the most important activity undertaken in the TC.

The TC operates on 2 levels: that of a family and also of a small society. On a social level residents in the TC represent the demographic diversity of the general population. On a family level newcomers play the role of children, as they grow older in the treatment programme, they become an older sibling, then a parent and lastly a grandparent; watching over and directing the entire family.
 In the community, there are different jobs associated with different family roles. The newcomer starts as a general worker assigned to a department. Over time, as they demonstrate their personal growth, capability to handle responsibility and act with discretion, they progress to becoming part of the RamRod team (TC ‘policing’ team), then to becoming a department head (HoD), an acting-chief, chief and lastly co-ordinator before their discharge from treatment.
In SHAFA HOME there are 8 departments altogether. House-keeping, record-keeping and kitchen. In our “senior house” in Uttarakhand there are 5 more departments: maintenance, pet-care, landscape, creative and PQS (programme quality section). 
The fundamental goal of skills development is for mental and emotional growth. This growth is tantamount to maturity. These different roles and responsibilities all add to this. During the TC programme duration, the different roles undertaken by the resident increase their inter-personal skills [along with empathy, compassion and assertiveness], self-efficacy beliefs (“I CAN” beliefs) and self-worth and confidence.
Not only do residents progress up the ‘family and job hierarchy’ they also progress through the attainment of the 4 stages during the span of the 12-month treatment. Each stage has its own specific requirements, the resident needs to meet and demonstrate before its attainment. The 1st stage (which is normally given when the individual shows they are able to take personal responsibility), 2nd stage (given at 3 months), 3rd stage (after 6 months depending on personal accountability) and 4th stage (after the re-entry stage, when an individual is ready to face the outer world). This stage is more about ‘Follow-up‘ and ‘Future Planning‘. An individual is supposed “to give it back“, to share with others what he has learnt by providing his voluntary services. 
The TC a peer-conducted environment. This means it is self-governed by the residents for the residents. While there are senior and voluntary staff members, they play a ‘behind the scenes’ role; taking care of administrative duties and paperwork, conducting Individual Counselling sessions (I.C’s) with residents and facilitating sessions. The staff gives their feedback to the director of the TC, who oversees the entire management and functioning of the community.
The TC places a heavy emphasis on living within rules and regulations. A TC has major cardinal rules and house rules. If boundaries are encroached then there are sanctions; the intensity depending on the breach of conduct. This requirement to remain within the bounds of the rules and regulations conditions and shapes the resident to behave correctly.

What is the daily routine in a TC?
The TC follows a 17 hour day wherein residents wake up at 6am and sleep at 11pm. Within the day residents work within their designated departments, participate in the therapeutic sessions, complete their “programme”, engage in I.C’s with their counsellor, eat their meals, have free-time and then meet with their peers to evaluate their day before sleep. SHAFA HOME’s full routine is available on request.  
How does TC life benefit the individual. How does TC life ‘treat’ the patient?
First and foremost, we need to be aware that using the addict’s active addiction period, their behaviours and actions had isolated themselves from the world. Their social skills were negligible along with the motivation to partake in constructive activity (anything other than the procuring and using of their substances). TC life tackles apathy, perceived helplessness and inferiority through “hands-on” kinaesthetic learning to achieve self-improvement. A resounding notion in the TC is that personal growth is only ever demonstrated through an individual’s actions rather than his words.
 In a TC an individual learns how live within a family unit and in a society. This group setting allows a person to improve their ability to compromise and also teaches them the importance of following and respecting rules and regulations. Life in a TC pushes an individual to develop his ability to make rational and logical decisions; only doing things that will benefit himself and his community. An individual also learns the immense importance of thinking before speaking, considering the impact of his words and actions. Small but extremely important deficiencies in an individual’s character are highlighted and addressed in a TC.
Life in a TC also puts weight on the importance of ‘respecting others’. Since each individual resident learns and improves from his peers, there is a need to respect and be grateful for the input of others. 
The TC puts a great emphasis on positive reinforcement; if an individual demonstrates good actions then they will get good given back to them; in the form of privileges and progression through the hierarchy. Negative behaviour and actions have their ‘consequences’ and sanctions. Addicts did not have a sense of “positive fear” during their substance period that should have kept them within their limits. The TC uses ‘learning experiences’ (consequences) to input this ‘positive fear’. If they behave with half-measure i.e. (do not work to their potential) or demonstrate outright breaches of conduct, then a sanction is given as preventative measure that avoids the repetition of that same negative behaviour occurring in the future. Sanctions include regression within the hierarchy (“being shot down” from their role), removal of privileges, washing the entire communities dishes singlehandedly, temporary isolation from others etc. Though these seem harsh, they prove effective in preserving residents’ ongoing personal growth and progression through treatment.   
Over the span of the 12-month treatment program; being in a TC environment improves an individual’s independence, self-confidence, self-esteem, discipline, patience and reliability. Living in a TC also provides a person with the basic life-skills and elementary employability-skills they need to establish themselves in life. The tight adherence to rules and regulations also instils a value system within the individual. This ‘value system’ heightens an individual’s morality and ethical standing. It also inculcates an individual to be grateful and thankful of the small things in his day-to-day life that prior, he would not have thought twice of.
 The distance and limited contact they have with outside society gives the individual ample time to focus on his personal transformation. The distance also gives the individual a necessary period of reflection to carefully consider what he had inflicted upon his family and loved ones.
Basically an individual learns the importance of establishing balance in his life –, a balance of work-time and leisure-time, consuming a nutritionally balanced diet, when to speak and when to listen, when to assert oneself and when to understand another etc.  
Living a life of moderation and temperance is a key theme in TC life. The individual learns there is a time, manner and place for everything.  There is also a manner of speaking properly and asserting one’s needs and opinions without disturbing the balance and atmosphere of the community.
When was the concept of TC created and how has it evolved since its creation?
The idea of the therapeutic community dates back 200 years ago as a self-help community that teaches, heals and supports the individual through teacher-to-pupil modelling and learning.
In effect, it was the first treatment program designed to address an individual’s dysfunctional and non-productive living style. The root cause of this is their maladaptive behaviours.  
The earliest modern TC’s were established in the USA in 1960 with treatment programme duration of 2-3. Since then, the TC has exploded on a worldwide-level and has an average stay of 12 months. Some centres offer outpatient services while the majority provide an in-patient service.
No two TC’s are alike. Each self-contained community follows its own daily routine and activity structure. The common binding notion is seen in the goal it sets to accomplish for the individual – to learn the necessary behaviours to successfully live life and face challenging moments without the need to pick up a drink or drug to cope. 
Why there is a need for the TC?
You may be thinking, when there are different treatment options regarding de-addiction, like the 12-steps, why send my dear one to a ‘therapeutic community’? What does a TC do that another centre does not?
TC can be likened to a ‘finishing school’ for people who cannot demonstrate social dexterity and emotional intelligence. Personal mannerisms, body-language, thought-patterns and speaking style are dissected, discussed and improved upon. These manifest an individual’s personality traits such as impatience, dishonesty, arrogance etc. (problems which any addict faces in active using). These behavioural traits are a platform leading the individual to obtaining and consuming substances.
The TC has proven to be a powerful treatment approach for substance abuse and related living problems. It offers long-term and intense treatment in a ‘half-way house’ setting. Although residents are not exposed to the outer world until the very last stages of treatment, the system of the TC models the real world in a safe environment, where help is constantly on hand. Being in a TC teaches an individual how to live and tackle life’s inevitable issues at the point they arise. The resources to overcome problems lie within the individual. It is their responsibility to unlock their potential.
While the 12-step programme of Alcoholics and Narcotics Anonymous is effective for many recovering addicts, these 12-step rehabs put primary emphasis on staying sober by attending AA/NA meetings, reading the list of prescribed literature and doing the written step-work associated 12-step programme. Personally speaking, from my own opinion I have attended 12-step rehabs and meetings and find that this model of treatment theorizes what should be done in order to remain sober. It dissects what and wherefores of sobriety at an intellectual level, rather than implementing the knowledge preached, this treatment approach is less dynamic. With the TC model, recovery is a double blend of implementing new thinking patterns, behaviours and newly acquired life-skills along with the theoretical knowledge and education of how to stay sober.        
 In TC, the aim is placed on a person’s entire psychological and lifestyle change, a process which only begins with sobriety. Sobriety is the tool to allow the mind to think and act clearly, rationally and logically. This psychological change cannot be achieved through intellectual or literary means; rather it involves “hands-on” action...change by doing! Newly demonstrated, positive skills are mastered by repetition. Only then does progress solidify and flourish.
Rather than preaching to the patient methods and tricks of living a substance-free life, the TC teaches the individual how to behave and live in harmony with others; In the TC, there is a strong need is to re-educate a person on what is correct behaviour and incorrect behaviour, re-encourage a person to view themselves and the world from a different angle, be willing to accept help and guidance from those who have turned their lives around for the better.

It is clearly up to you to decide whether you feel the ‘Therapeutic Community’ experience will benefit your loved one. Our website, YouTube and Facebook page has videos and more information regarding our treatment. Do not hesitate to visit us to find out more!

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