Overview of Therapeutic Community Concept

1. Rehabilitation

The noun rehabilitation comes from the Latin prefix re-,

meaning “again” and habitare, meaning “make fit.” When something
falls in to disrepair and needs to be restored to a better condition, it
needs rehabilitation. People seek rehabilitation after an accident or
surgery to restore their strength, or to learn to live without drugs or
other addictive substances or behaviours.

 Rehabilitation is for people who have lost abilities that

they need for daily life. Some of the most common causes
include

 Injuries and trauma, including burns, fractures (broken

bones), traumatic brain injury, and spinal cord injuries
 Stroke
 Severe infections

 Major surgery

 Side effects from medical treatments, such as from cancer treatments

 Certain birth defects and genetic disorders

 Developmental disabilities
 Chronic pain, including back and neck pain
  The overall goal of rehabilitation is to help you get your abilities back and
regain independence. But the specific goals are different for each person. They
depend on what caused the problem, whether the cause is ongoing or temporary,
which abilities you lost, and how severe the problem is. For example,

 A person who has had a stroke may need rehabilitation to be able to

dress or bathe without help
 An active person who has had a heart attack may go through cardiac
rehabilitation to try to return to exercising
 Someone with a lung disease may get pulmonary rehabilitation to be
able to breathe better and improve their quality of life

 When you get rehabilitation, you often have a team of different

health care providers helping you. They will work with you to figure
out your needs, goals, and treatment plan. The types of treatments
that may be in a treatment plan include

 Assistive devices, which are tools, equipment, and products that help
people with disabilities move and function
 Cognitive rehabilitation therapy to help you relearn or improve skills
such as thinking, learning, memory, planning, and decision making
 Mental health counselling
 Music or art therapy to help you express your feelings, improve your
thinking, and develop social connections
 Nutritional counselling
 Occupational therapy to help you with your daily activities
 Physical therapy to help your strength, mobility, and fitness
 Recreational therapy to improve your emotional well-being through
arts and crafts, games, relaxation training, and animal-assisted therapy
 Speech-language therapy to help with speaking, understanding,
reading, writing and swallowing
 Treatment for pain
 Vocational rehabilitation to help you build skills for going to school or
working at a job
2.History of Therapeutic Community

Under the influence of Maxwell Jones, Main, Wilmer and developed the  concept
of the therapeutic community and its attenuated form - the therapeutic milieu - caught
on and dominated the field of inpatient psychiatry throughout the 1960's. The aim of
therapeutic communities was a more democratic, user-led form of therapeutic
environment, avoiding the authoritarian and demeaning practices of many psychiatric
establishments of the time. The central philosophy is that clients are active participants
in their own and each other's mental health treatment and that responsibility for the daily
running of the community is shared among the clients and the staff. 'TC's have
sometimes eschewed or limited medication in favour of group-based therapies.

3.Therapeutic Community
“A therapeutic community is a drug-free environment in which people with
addictive (and other) problems live together in an organized and structured way in order
to promote change and make possible a drug-free life in the outside society. The
therapeutic community forms a miniature society in which residents, and staff in the role
of facilitators, fulfil distinctive roles and adhere to clear rules, all designed to promote
the transitional process of the residents” ( Ottenberg 1993)
Stuart and Sundeen defined therapeutic community as “a therapy in which
patient’s social environment would be used to provide a therapeutic experience for the
patient by involving him as an active participant in his own care and the daily problems
of his community”.  
The therapeutic community (TC) for the treatment of drug abuse and addiction
has existed for about 40 years.
TCs are drug-free residential settings that use a hierarchical model with
treatment stages that reflect increased levels of personal and social responsibility.
The goals are to effect a complete change of lifestyle, including abstinence from
substances, to develop a personal honesty, responsibility and useful social skills and to
eliminate antisocial attitudes and criminal behaviour .
 Objectives

 To use patient’s social environment to provide a therapeutic experience for him

 To enable the patient to be an active participant in his own care and become involved in daily
activities of his own community
 To help patient to solve problems ,plan activities and to develop the necessary rules and
regulations for the community
 To increase their independence and gain control over many of their own personal activities
 To enable the patient to become aware of how their behaviour affects others

 Elements of therapeutic community

 Free communication
 Shared responsibility
 Active participation
 Involvement in decision making
 Understanding of the roles ,responsibilities ,limitations and authorities

 Advantages of therapeutic community

 Patient develops harmonious relationships with other members of the community

 Gains self –confidence
 Develops leadership skills
 Learns to understand and solve problems of self and others
 Becomes socio-centric
 Learns to live and think collectively with the members of the community
 It provides opportunity to participate in the formulation of hospital rules and regulations that
affect patient’s personal liberties like bedtime, meal time, weekend permission, control of radio
or T.V, social activities , late night privileges.

 Disadvantages of therapeutic community

 Role blurring between staff and patient

 Group responsibility can easily become nobody’s responsibility
 Individual needs and concerns may not be met
 Patient find the transition to community difficult
4.Concept of Therapeutic Community

Concept of therapeutic community-the therapeutic community program help

participants learn how to be accountable for their choices and behaviour in a positive
caring environment.

Here are the 10 Key concepts .

 Help yourself/help each other

In the therapeutic community members work together to help each

other and themselves.

 Acting as if

If a person acts as a certain way long enough, he will begin to feel that
way and change his attitude in that direction.

 No we/they dichotomy

in the therapeutic community the differences are minimized. While

there is value in the differences among cultural and ethnic backgrounds,
all participants suffer from the common problems of addiction. All
members are given equal opportunity to succeed.

 Learn and model pro-social values

The learning process in the therapeutic community itself. The

community is the agent of change. In a healthy therapeutic community one
learns positive pro-social values and models them in the community.

 Establish a common belief system

In the therapeutic community there is a common belief that people can

and do change for the better if they so choose.
 Maintain accurate records

Record keeping means completing and turning in all paperwork to the

best of one's ability. Good record keeping helps residents and staffs run
the program well.

 Earn your privileges

One of the most basic beliefs in the therapeutic community is that you
earn what you get.

 Make a connection with the community

When residents first enter treatment, their connection is with the

community of the "street”. The therapeutic community is a new
environment and is quite different in terms of beliefs, values behaviours
and expectation. In the beginning the therapeutic community challenges
old beliefs and attitudes.

 Role modelling

Throughout your life, you have learned from others. Much of this
learning came from watching their behaviours. Sometimes you watched
on purpose and other times you may have been unaware that you were
learning from what you observed. In the therapeutic community it is often
said. "if you're going to talk the talk, walk the walk. When you learn by
watching others, you learning from what they model.

 Respect staff as rational authorities

In the past therapeutic community members have not seen or trusted

authority figures as guides and teachers. Staff in the therapeutic
community serve as positive role models and are considered rational
authorities. They provide reasons for their decisions and the meaning of
consequences staff facilitate and correct rather than punish, behaviours.
5.Hierarchical Format of Therapeutic Community

 Therapeutic Community - is a tool that the Administration uses to prepare

the client for reintegration to the community as a reformed, rehabilitated,
productive, drug-free and law abiding person.

 Operation of the Community - is the task of the residents, working under

staff supervision. There are sets of rules and community norms that members
upon entry commit to live by and uphold.

WHAT ARE THE SALIENT FEATURES OF TC?

1. The primary “therapist” and teacher is the community itself, consisting of peers
and staff, who, as role models of successful personal change, serve as guides in the
recovery process.

2. Therapeutic Community adheres to precepts of right living: Truth/honesty; Here

and now; Personal responsibility for destiny; Social responsibility (brother’s keeper);
Moral Code; Inner person is “good” but behavior can be “bad”; Change is the only
certainty; Work ethics; Self-reliance; Psychological converges with philosophical
(e.g. guilt kills)

3. It believes that TC is a place where: One can change – unfold; the group can
foster change; individuals must take responsibility; structures must accommodate
this; Act as if – go through the motion.

4. There are 5 distinct categories of activity that help promote the change:

 Relational/Behaviour Management

 Affective/Emotional/Psychological

 Cognitive/Intellectual

 Spiritual

 Vocational-Survival Skills
6.Phase of Therapeutic Community

Therapeutic community (TC) participants advance through three treatment stages on

the way to completing the program. In the first stage, the individual assimilates into the
TC and is expected to fully participate in all activities. Immersion into this drug-free
community is meant to disrupt the individual’s identification with and ties to his or her
previous drug-using life and replace these affiliations with new pro-social attitudes,
behaviours, and responsibilities, and increase his or her knowledge about the nature of
addiction.

The second treatment stage often incorporates evidence-based behavioural treatments

—including cognitive-behavioural therapy (CBT) and motivational interviewing—to
facilitate the process of change and enhance the "community as method" approach.
The overall goal is to change attitudes and behaviour, in still hope, and foster emotional
growth, including self-management ability. Other therapeutic activities, including
relevant interventions, address the person’s social, educational, vocational, familial, and
psychological needs.

In the third treatment stage, the participant prepares for separation from the TC and
successful re-entry into the larger community by seeking employment or making educational or
training arrangements with the TC’s help. Because recovery is an ongoing process, aftercare
services such as individual and family counselling are arranged to help individuals maintain the
changes they have made during treatment, and TC participants are strongly encouraged to
continue work in self-help groups after completing the program.