National Personality Disorder
What is a Therapeutic Community?
A brief explanation from the Association of 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, deep 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.
Central to all TCs is the belief that people can change, and that in order to realize 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 accept the TCís rules. These rules uphold the values and norms of the community, which are a reflection of those held by society.
A TC is an informal, casual environment. Members and staff are not 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 or individual therapy, 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 individualís 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 are expected to take responsibility for themselves (for example, in terms of personal cleanliness, tidiness and appropriateness of behaviour) and to participate in the running of the TC. This includes duties such as cleaning, 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, for example membersí 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 therapeutic for each other. The goal is to improve membersí interpersonal functioning; first within the therapeutic community, and ultimately in the wider community. Feedback from peers enable members to reflect on the way their conduct affects others, and members may practice new behaviours and ways of relating and begin to gain increased self-esteem and knowledge of themselves.
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 societyís most vulnerable and socially excluded adults, children and young people. Problems include mental illness, learning difficulties, substance misuse, severe emotional and behavioural difficulties and offending behaviour.
Do TCs work?
There is considerable research evidence for the effectiveness of TCs for those people with personality disorder, offending behaviour and substance misuse. Evidence for TCs working with adults with severe and enduring mental health problems, learning difficulties and children and young people can be extrapolated from broader relevant research and from feedback from clients, their family and friends and relevant professionals. In addition, the durability and the demand for places in these TCs highlights the important role they play within the health and social care system. Expanding and improving the research evidence for the effectiveness of the service is high priority for all TCs, and the organisations supporting them.
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