Therapeutic

Community
“ You alone can do it, but you can’t do it
alone”

Charis Mae P. Rosal

 - is a participative, group-based approach to
long-term mental illness, personality disorders
and drug addiction.

 - it is based on milieu therapy principles and

includes group psychotherapy as well as
practical activities
• -

the approach was usually residential, with

the clients and therapists living together.
 The term was coined by Thomas Main in his 1946
paper, “ The hospital as a therapeutic institution”

Maxwell Jones- English psychiatrist

- Innovative approach to managing institutionalized
psychiatric patients
Synanon Movement
• Forerunner of the modern-day TC

• At that time drug dependents were considered

incorrigible

“Through mutual help among ex- drug dependents

residents who chose to live as Synanon community
members, many were able to remain abstinent from
all forms of substance abuse for periods of time”
• A community of ex drug dependents helping
each other recover and remain abstinent from
drugs
• Synanon leaders understood the power of
group dynamics to shape behavior and
conform community norms
• The source of primary healing power of the TC
lies not on a single individual but on the
compelling power of the group, the
community
The AIM of TC:
 The aim of TC: more democratic, user-led form
of therapeutic environment, avoiding the
authoritarian and demeaning practices of
many psychiatric establishments
 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
 have sometimes eschewed as limited
medication in favor of group-based therapies
Based on ideas of collective responsibility,
citizenship and empowerment, therapeutic
communities are deliberately structured in a
way that encourages personal responsibility
and avoid unhelpful dependency on
professionals
The living-learning experience, culture of enquiry
and importance of community meetings:

The day-to-day experience of living and

working together is felt to be as important as
formal therapy, and the structure is such that
the two are closely integrated and inform each
other-the-living-learning experience.
• An important underlying principle is that all
involved are encouraged to be curious about
themselves, each other, the staff, the
management structure, psychological
processes, the group process, the institution
and everything else pertinent to events and
relationships within the community.
Culture of Enquiry- an openness to
questioning, so that understanding is owned
by all
1. A typical day in a therapeutic community
starts and finishes with a community meeting,
usually chaired by a resident.
2. The agenda is driven by the attempt to bring
as much information into the large group as
possible, so that it is accessible to all
• The community meetings play an important
role in establishing a culture of open
communication, in which individuals can check
things out, paranoia is minimised and
expression of feeling is encouraged.
 Priciples of Effective Treatment
1. No SINGLE treatment is appropriate for all
individuals

2. Treatment services must be readily available

3. Effective treatment attends to multiple needs

of the individual, not just his or her drug use
4. An individual’s treatment plan must be
developed and assessed periodically and
modified as necessary to ensure that plan
meets the person’s changing needs.

5. Retaining client in treatment for an adequate

period of time is critical for treatment
effectiveness
6. Counselling (individual and/or group) and other
behavioral therapies are critical components of
effective treatment for addiction.

7.Medications are an important element of

treatment for many clients, especially when
combined with counselling and other
behavioral therapies.
8. Addicted or drug-abusing individuals with
coexisting mental disorders should have both
disorders treated in an integrated way.

9. Medical detoxification is only the first stage of

addiction treatment and by itself does little to
change long-term drug use.
10. Treatment does not need to be voluntary to
be effective.

11.Possible drug use during treatment must be

monitored continuosly
12. Treatment programs should provide
assessment for HIV/AIDS, Hepatitis B and C,
Tuberculosis and other infectious diseases,
and counseling to help clients modify or
change behaviors that place themselves or
others at risk infection.
13. Recovery from drug addiction can be a long
term process and frequently requires multiple
episodes of treatment.

14. Engaging the family while the addicted client

is in treatment should be a component of
treatment.
“ Helping Man Help Himself”
TC Philosophy