Purpose – There is evidence that attachment style and clinical outcomes are related within Therapeutic Communities (TCs). This study sought to examine any possible relationships between self-reported adult attachment style, therapy programme engagement and measures of psychological distress and dissociation on admission and discharge within a residential TC. Design/methodology/approach – Ex-clients of the TC were contacted by post and invited to take part in this service evaluation. Additional data was sourced from a database of routinely collected outcome measures. Of 281 ex-clients, the final sample in this study was N=32. Findings – When attachment style is conceptualised dimensionally, participants identified most strongly with a fearful attachment style, and least with a preoccupied or secure style. A range of attachment styles were reported. A significant association was apparent between self-reported secure attachment and reduced levels of psychological distress upon discharge from the TC. The potential for changes in client attachment patterns following TC membership is discussed. Originality – To date, this is the first known study to report on the relationship between self-reported adult attachment style and psychological outcomes specifically for women with self-defeating behaviours within a TC. Research limitations/implications – The small sample size and correlational nature of this study means that results should be interpreted cautiously. Nevertheless, results are of clinical relevance for inpatient or residential therapy programmes (including TCs). Such programmes should routinely assess client attachment style to ensure appropriate interventions and adaptions are implemented.
{"title":"Attachment style and clinical outcome within a DBT-informed Therapeutic Community","authors":"B. J. Dunlop, M. McFetridge","doi":"10.1108/tc-06-2020-0014","DOIUrl":"https://doi.org/10.1108/tc-06-2020-0014","url":null,"abstract":"Purpose – There is evidence that attachment style and clinical outcomes are related within Therapeutic Communities (TCs). This study sought to examine any possible relationships between self-reported adult attachment style, therapy programme engagement and measures of psychological distress and dissociation on admission and discharge within a residential TC. Design/methodology/approach – Ex-clients of the TC were contacted by post and invited to take part in this service evaluation. Additional data was sourced from a database of routinely collected outcome measures. Of 281 ex-clients, the final sample in this study was N=32. Findings – When attachment style is conceptualised dimensionally, participants identified most strongly with a fearful attachment style, and least with a preoccupied or secure style. A range of attachment styles were reported. A significant association was apparent between self-reported secure attachment and reduced levels of psychological distress upon discharge from the TC. The potential for changes in client attachment patterns following TC membership is discussed. Originality – To date, this is the first known study to report on the relationship between self-reported adult attachment style and psychological outcomes specifically for women with self-defeating behaviours within a TC. Research limitations/implications – The small sample size and correlational nature of this study means that results should be interpreted cautiously. Nevertheless, results are of clinical relevance for inpatient or residential therapy programmes (including TCs). Such programmes should routinely assess client attachment style to ensure appropriate interventions and adaptions are implemented.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"19 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82546309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Núria Riera-Oliver, Carmen Jiménez, J. Rey, A. Calvo, T. Sánchez-Gutiérrez
PurposeThe use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for patients who experience a craving, and relapses during the course of the disorder are common. The purpose of this paper is to describe the socio-demographic and clinical features of alcohol-dependent patients by sex and alcohol use status and to analyze the percentage of patients who remained abstinent after 10 months of psychological treatment.Design/methodology/approachIn total, 50 alcohol-dependent patients were enrolled (34 men and 16 women). The patients attended a psychological treatment program at a therapeutic community, Projecte Home Balears, Spain. This paper used the European Addiction Severity Index to collect socio-demographic data and data on alcohol and other drugs and the Trait Meta-Mood Scale-24 to measure emotional management.FindingsSignificant differences were observed in occupation (χ²= 9.9; p = 0.007) and duration of alcohol use (U = 137.000; p = 0.005) by sex and hospitalizations during the previous months (χ²= 15.477; p = 0.009) and type of chronic disorder (χ²= 7.6; p = 0.022) and duration (in months) of the longest period of abstinence after treatment in facilities (U = 219.500; p = 0.097) by alcohol use status. The survival analysis showed that 25% of relapses happened after 4.5 months of treatment; at 7.3 months, 50% of the sample remained abstinent.Originality/valueWomen had used alcohol for longer since age at onset than men. Furthermore, after 7.3 months of intensive therapy, 50% of alcohol-dependent patients were abstinent.
{"title":"Analysis of the duration of abstinence after treatment for alcohol dependence in a therapeutic community: differences between the sexes","authors":"Núria Riera-Oliver, Carmen Jiménez, J. Rey, A. Calvo, T. Sánchez-Gutiérrez","doi":"10.1108/tc-11-2019-0016","DOIUrl":"https://doi.org/10.1108/tc-11-2019-0016","url":null,"abstract":"PurposeThe use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for patients who experience a craving, and relapses during the course of the disorder are common. The purpose of this paper is to describe the socio-demographic and clinical features of alcohol-dependent patients by sex and alcohol use status and to analyze the percentage of patients who remained abstinent after 10 months of psychological treatment.Design/methodology/approachIn total, 50 alcohol-dependent patients were enrolled (34 men and 16 women). The patients attended a psychological treatment program at a therapeutic community, Projecte Home Balears, Spain. This paper used the European Addiction Severity Index to collect socio-demographic data and data on alcohol and other drugs and the Trait Meta-Mood Scale-24 to measure emotional management.FindingsSignificant differences were observed in occupation (χ²= 9.9; p = 0.007) and duration of alcohol use (U = 137.000; p = 0.005) by sex and hospitalizations during the previous months (χ²= 15.477; p = 0.009) and type of chronic disorder (χ²= 7.6; p = 0.022) and duration (in months) of the longest period of abstinence after treatment in facilities (U = 219.500; p = 0.097) by alcohol use status. The survival analysis showed that 25% of relapses happened after 4.5 months of treatment; at 7.3 months, 50% of the sample remained abstinent.Originality/valueWomen had used alcohol for longer since age at onset than men. Furthermore, after 7.3 months of intensive therapy, 50% of alcohol-dependent patients were abstinent.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"73 2 1","pages":"87-100"},"PeriodicalIF":0.2,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83430666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose The purpose of this paper is to investigate the theoretical potential of applying Jungian/analytical psychology concepts to a contemporary therapeutic community (TC) within the national health service. Design/methodology/approach A literature review concerning a Jungian understanding of group psychotherapy and TCs was undertaken. A summary and discussion of a detailed written account of a previous Jungian TC was then conducted. A comparison between a modern-day TC and Jungian approaches was then conducted with an ending discussion on the feasibility of incorporating Jungian ideas into modern work. Findings While Jung is thought to have a wholly negative view of groups and group psychotherapy, this was not found in the case. Furthermore, post-Jungian authors have attempted to use ideas from analytical psychology in their group work. While there are some aspects that could be implemented with relative ease in the modern TC, a complete shift into this different way of working would be a challenge and its current evidence base would not support this. Originality/value To the best of author’s knowledge, there are no other academic papers that have considered this subject.
{"title":"Can analytical psychology be applied to the therapeutic community?","authors":"A. Howe","doi":"10.1108/TC-07-2020-0015","DOIUrl":"https://doi.org/10.1108/TC-07-2020-0015","url":null,"abstract":"\u0000Purpose\u0000The purpose of this paper is to investigate the theoretical potential of applying Jungian/analytical psychology concepts to a contemporary therapeutic community (TC) within the national health service.\u0000\u0000\u0000Design/methodology/approach\u0000A literature review concerning a Jungian understanding of group psychotherapy and TCs was undertaken. A summary and discussion of a detailed written account of a previous Jungian TC was then conducted. A comparison between a modern-day TC and Jungian approaches was then conducted with an ending discussion on the feasibility of incorporating Jungian ideas into modern work.\u0000\u0000\u0000Findings\u0000While Jung is thought to have a wholly negative view of groups and group psychotherapy, this was not found in the case. Furthermore, post-Jungian authors have attempted to use ideas from analytical psychology in their group work. While there are some aspects that could be implemented with relative ease in the modern TC, a complete shift into this different way of working would be a challenge and its current evidence base would not support this.\u0000\u0000\u0000Originality/value\u0000To the best of author’s knowledge, there are no other academic papers that have considered this subject.\u0000","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"48 1","pages":"101-111"},"PeriodicalIF":0.2,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82238907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose To analyze networks of social interactions between the residents of a therapeutic community (TC) for women and the way, in which such interactions predict the discussion of issues that arise in treatment. Design/methodology/approach In total, 50 residents of a corrections-based TC for women were surveyed on the peers with whom they socialized informally, shared meals, shared letters from home and discussed issues that arose in treatment over a 12 h period. The data were analyzed using exponential random graph models (ERGM). Findings Reciprocity occurred in all networks while transitivity (a tendency of two residents who are connected to both connect to a third peer) occurred in all networks measuring informal social interactions. When controlling for reciprocity and transitivity, residents avoided spending social time or sharing meals with the same peers. There was no evidence of homophily by race, age or years of education. Homophily by entrance time and case manager occurred in social time. Case manager homophily occurred in the discussion of treatment issues but disappeared when controlling for social time and sharing letters from home. Research limitations/implications Social networks in this TC arise from factors endogenous to the TC itself. It should be possible to determine the characteristics of optimal social networks in TCs. External validity is limited. Practical implications It should be possible to intervene to optimize the social networks of TC residents. Originality/value This is the first ERGM analysis of both informal and formal interactions in a TC.
{"title":"Social and programmatic interactions in a therapeutic community for women: an exponential random graph model analysis","authors":"Q. Cao, L. Liao, K. Warren","doi":"10.1108/tc-08-2019-0008","DOIUrl":"https://doi.org/10.1108/tc-08-2019-0008","url":null,"abstract":"\u0000Purpose\u0000To analyze networks of social interactions between the residents of a therapeutic community (TC) for women and the way, in which such interactions predict the discussion of issues that arise in treatment.\u0000\u0000\u0000Design/methodology/approach\u0000In total, 50 residents of a corrections-based TC for women were surveyed on the peers with whom they socialized informally, shared meals, shared letters from home and discussed issues that arose in treatment over a 12 h period. The data were analyzed using exponential random graph models (ERGM).\u0000\u0000\u0000Findings\u0000Reciprocity occurred in all networks while transitivity (a tendency of two residents who are connected to both connect to a third peer) occurred in all networks measuring informal social interactions. When controlling for reciprocity and transitivity, residents avoided spending social time or sharing meals with the same peers. There was no evidence of homophily by race, age or years of education. Homophily by entrance time and case manager occurred in social time. Case manager homophily occurred in the discussion of treatment issues but disappeared when controlling for social time and sharing letters from home.\u0000\u0000\u0000Research limitations/implications\u0000Social networks in this TC arise from factors endogenous to the TC itself. It should be possible to determine the characteristics of optimal social networks in TCs. External validity is limited.\u0000\u0000\u0000Practical implications\u0000It should be possible to intervene to optimize the social networks of TC residents.\u0000\u0000\u0000Originality/value\u0000This is the first ERGM analysis of both informal and formal interactions in a TC.\u0000","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"15 1","pages":"69-79"},"PeriodicalIF":0.2,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91067266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the clamour within the drug treatment field in the UK – and throughout much of Europe – increases, leading agencies are arguing for a review of the current legislation and a change in focus away from criminal justice and towards a more public health understanding of addiction. Therapeutic communities have found themselves united with many drug users-led campaigns to argue for a wholesale restructuring of the legislative, policy and funding arrangements which recognises the role of recovery-oriented interventions within the mix. Given these on-going debates, it is perhaps useful to understand how the current arrangements were established [1].,In 1850s, the sale of opium – like alcohol – was largely unregulated. It was widely used, in a variety of preparations, by all classes for medical and non-medical purposes. A pennyworth of opium was as likely (perhaps more likely) as a pound of potatoes to find its way into the weekly shopping basket.,By the 1920s, the Fu Manchu novels of Sax Rohmer – with their tales of innocent English virgins being seduced into crime and sexual perversion by an evil Chinese genius who lurked within the opium dens of Edwardian Britain – had redefined opium as a drug of the outside, the deadly, an agent in the enslavement of innocence.,This dramatic change was largely brought about by the introduction of an array of new medications and a move away from traditional “herbal” remedies. This change was accelerated by the experiences of the First World War and underpinned by the print media and laid the foundations of the legislation and policy of the present day.
{"title":"A brief history of British drug policy: 1850-1950","authors":"Rowdy Yates","doi":"10.1108/tc-11-2019-0013","DOIUrl":"https://doi.org/10.1108/tc-11-2019-0013","url":null,"abstract":"As the clamour within the drug treatment field in the UK – and throughout much of Europe – increases, leading agencies are arguing for a review of the current legislation and a change in focus away from criminal justice and towards a more public health understanding of addiction. Therapeutic communities have found themselves united with many drug users-led campaigns to argue for a wholesale restructuring of the legislative, policy and funding arrangements which recognises the role of recovery-oriented interventions within the mix. Given these on-going debates, it is perhaps useful to understand how the current arrangements were established [1].,In 1850s, the sale of opium – like alcohol – was largely unregulated. It was widely used, in a variety of preparations, by all classes for medical and non-medical purposes. A pennyworth of opium was as likely (perhaps more likely) as a pound of potatoes to find its way into the weekly shopping basket.,By the 1920s, the Fu Manchu novels of Sax Rohmer – with their tales of innocent English virgins being seduced into crime and sexual perversion by an evil Chinese genius who lurked within the opium dens of Edwardian Britain – had redefined opium as a drug of the outside, the deadly, an agent in the enslavement of innocence.,This dramatic change was largely brought about by the introduction of an array of new medications and a move away from traditional “herbal” remedies. This change was accelerated by the experiences of the First World War and underpinned by the print media and laid the foundations of the legislation and policy of the present day.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"1 1","pages":"57-66"},"PeriodicalIF":0.2,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90717144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this paper is to illustrate the evolution of discerning compassion and how it was used in the Ingrebourne Therapeutic Community.,This paper is derived from a PhD thesis which was researched through interviews and archival research. The fundamental finding was that the therapeutic community approach was almost unique in providing a structured approach to implementing discerning compassion.,The therapeutic community approach for discerning compassion, in which the response to distress aims to promote flourishing.,This paper offers a model that has implications on how care is delivered in other settings.,There is little literature that explores the role of compassion in therapeutic communities or in care environments of any form. The approach taken here places compassion in a historical and philosophical setting and contrasts it with the kindness expressed in traditional psychiatric care that promoted “tranquility”.
{"title":"If they will have me, I think I will stay a while: compassion and containment illustrated by the Ingrebourne Therapeutic Community","authors":"T. Harrison","doi":"10.1108/tc-11-2019-0015","DOIUrl":"https://doi.org/10.1108/tc-11-2019-0015","url":null,"abstract":"The purpose of this paper is to illustrate the evolution of discerning compassion and how it was used in the Ingrebourne Therapeutic Community.,This paper is derived from a PhD thesis which was researched through interviews and archival research. The fundamental finding was that the therapeutic community approach was almost unique in providing a structured approach to implementing discerning compassion.,The therapeutic community approach for discerning compassion, in which the response to distress aims to promote flourishing.,This paper offers a model that has implications on how care is delivered in other settings.,There is little literature that explores the role of compassion in therapeutic communities or in care environments of any form. The approach taken here places compassion in a historical and philosophical setting and contrasts it with the kindness expressed in traditional psychiatric care that promoted “tranquility”.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"150 1","pages":"37-46"},"PeriodicalIF":0.2,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74492071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Therapeutic communities (TCs) use social learning between peers in treating substance abuse. One mechanism for fostering social learning is peer affirmations for prosocial behavior. The purpose of this study is to use consistency of affirmations as a test of whether social learning does occur.,Using the results of a social network survey of 50 women in a corrections-based TC, the authors compared affirmations and nonprogrammatic compliments exchanged between residents as two directed social networks. The authors evaluated consistency of judgment using the hubs and authorities algorithm, and tested to see whether more senior residents are more likely to be hubs, thereby showing more consistent judgment.,More senior residents show greater consistency with peers in program affirmations but not in nonprogrammatic compliments. Hub status in the network of affirmations increases most rapidly in the first 200 days of residence, with slower increases thereafter.,This study is limited to one survey of the women in one TC. The external validity of the findings is therefore unclear. The results suggest that social learning of TC principles and prosocial behavior does occur and that it is not simply a function of popularity among peers. This seems to happen most rapidly in the first 200 days, suggesting that programs much shorter than six months may limit this process.,This is the first use of the hubs and authorities algorithm with a social network drawn from a therapeutic community and the first attempt to verify social learning through a social network analysis.
{"title":"Senior therapeutic community members show greater consistency when affirming peers: evidence of social learning","authors":"K. Warren","doi":"10.1108/tc-11-2019-0014","DOIUrl":"https://doi.org/10.1108/tc-11-2019-0014","url":null,"abstract":"Therapeutic communities (TCs) use social learning between peers in treating substance abuse. One mechanism for fostering social learning is peer affirmations for prosocial behavior. The purpose of this study is to use consistency of affirmations as a test of whether social learning does occur.,Using the results of a social network survey of 50 women in a corrections-based TC, the authors compared affirmations and nonprogrammatic compliments exchanged between residents as two directed social networks. The authors evaluated consistency of judgment using the hubs and authorities algorithm, and tested to see whether more senior residents are more likely to be hubs, thereby showing more consistent judgment.,More senior residents show greater consistency with peers in program affirmations but not in nonprogrammatic compliments. Hub status in the network of affirmations increases most rapidly in the first 200 days of residence, with slower increases thereafter.,This study is limited to one survey of the women in one TC. The external validity of the findings is therefore unclear. The results suggest that social learning of TC principles and prosocial behavior does occur and that it is not simply a function of popularity among peers. This seems to happen most rapidly in the first 200 days, suggesting that programs much shorter than six months may limit this process.,This is the first use of the hubs and authorities algorithm with a social network drawn from a therapeutic community and the first attempt to verify social learning through a social network analysis.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"9 1","pages":"5-13"},"PeriodicalIF":0.2,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82020186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper aims to bring back into view some of the original ideas from which the Therapeutic Community (TC) developed today. If we forget the origins of therapeutic communities way back in the past, we cannot be in the best position to make decisions for the present. The underlying principles of the TC are a combination of social science ideas, psychotherapeutic practices and a political urgency to do something for disadvantaged people. There is a need to try to keep all branches of the past roots in play together.,Learning from the past.,The past has a relevance that must not be forgotten in present reflection.,This is a reflective exercise at the heart of the therapeutic community practice.
{"title":"Leading from below? Decisions, responsibility and creativity as a group dynamic","authors":"R. Hinshelwood","doi":"10.1108/tc-12-2019-0017","DOIUrl":"https://doi.org/10.1108/tc-12-2019-0017","url":null,"abstract":"This paper aims to bring back into view some of the original ideas from which the Therapeutic Community (TC) developed today. If we forget the origins of therapeutic communities way back in the past, we cannot be in the best position to make decisions for the present. The underlying principles of the TC are a combination of social science ideas, psychotherapeutic practices and a political urgency to do something for disadvantaged people. There is a need to try to keep all branches of the past roots in play together.,Learning from the past.,The past has a relevance that must not be forgotten in present reflection.,This is a reflective exercise at the heart of the therapeutic community practice.","PeriodicalId":43236,"journal":{"name":"Therapeutic Communities","volume":"56 1","pages":"47-55"},"PeriodicalIF":0.2,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80728527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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