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:
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What is a ‘therapeutic community’?
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How does a ‘therapeutic community’ operate?
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What is the daily routine within a
‘therapeutic community’?
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How does TC life benefit the individual?
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When was the concept of ‘therapeutic
community’ created and how has it evolved?
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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!
To visit our Facebook page please click on the link below:
During April and May 2014, experienced addiction counselor and motivational
speaker Neil Paul has presented five 'life-coaching' sessions at SHAFA HOME,
Delhi. The sessions' themes have revolved around challenging negative thoughts
& behaviours and developing the necessary skills to establish a healthy
relationship with ourselves, our peers and our conception of a Higher Power.
These sessions last approximately two hours and take a discussion-cum-Q and A
format. Sessions are attended by all residents and staff members.
In our first session we
considered the various ways substance-abuse had affected our work-life,
family-life and health. Several members were asked to stand and give a short
introduction regarding the effect their addiction had in these three core areas
of life. We learnt that not only had it affected our lives in these areas, it
had also viciously corroded our rational thinking and problem-solving skills.
In active addiction, we
filled our minds with negative self-agreements such as how useless we were and
our inability to be productive members of society. Neil Paul's second session
aimed at eradicating our false justifications, in order to rebuild our
self-esteem and confidence. With the collaborative efforts of one of our senior
counsellors, a slide-show presentation highlighted positive vs. negative
attitudes, the 3 types of behaviour: passivity, assertiveness and aggression
and "how to assertively say no". One resident asked how to be
assertive successfully. Many of us felt that in asserting our needs we fall
short of our intention by coming across as threatening and arrogant. In an
animated and heated discussion, we could figuratively feel light bulbs switch
on above our participants' heads as they learnt a variety of techniques to
identify 'relationship-forging' and 'relationship-destroying' manners of
behaving. The discussion then transiently progressed to the topic of assertion.
We were given a list of implementable strategies on how to assertively and
firmly decline a request without offending or disrespecting our peers. 
Both staff and residents
alike experienced the second session to be tremendously useful! Life in active
addiction skewed our ability to firmly say "no" when faced with
situations compromising our physical and emotional well-being. 
