Therapeutic Community
The following are some key points from What is a Therapeutic Community (Paper sourced from: Towards Better Practice in Therapeutic Communities, Appendix 1, ACTA to provide an overview of the background to the Therapeutic Community approach followed by Odyssey House. The complete article can be read here or you can read a brief overview of Odyssey’s approach here.
Origins of the therapeutic community as a healing principle have been claimed to be as far back as 2,000 years ago. In more recent times, Maxwell Jones describes the evolution of therapeutic communities in the UK as influenced by a psychiatric base, and in the USA by Alcoholics Anonymous and Synanon (Jones 1979). Little has been written about the evolution of the therapeutic community in Australia, however it is generally agreed the first residential rehabilitation program in Australia that was recognisable as a TC was WHOS (We Help Ourselves) which was established in New South Wales in 1974.
There are many definitions of the Therapeutic Community and De Leon (2000) notes the origins of the term “therapeutic community” are unclear. However, he identifies “therapeutic” as denoting the social and psychological goals, namely changing the individual’s lifestyle and identity, while “community” denotes the primary method or approach employed to achieve the goal of individual change. The community is used to heal individuals emotionally and to train them in the behaviours, attitudes and values of healthy living.
De Leon states that a therapeutic community is fundamentally a self-help approach. The basic approach is the use of the peer community amplified with a variety of additional services (De Leon 2000). De Leon identifies the key distinction of TCs as being the use of community as a method to promote the health, welfare and growth of the individual. The TC uses community as a method to help individuals change themselves. Its structure (social organisation), its people (staff and residents), and its daily regimen of activities (groups, meetings, work, recreation) are designed to facilitate healing, learning, and change in the individual (De Leon 2000).
Basic elements of the community as context are:
- Member roles – learning opportunities through the various social roles individuals assume as participants in the community;
- Membership feedback – a primary source of instruction and support for individual change is the membership’s observations and authentic reactions to the individual;
- Membership as role models – each participant strives to be a role model of the change process; and
- Relationships – in the TC relationships foster the recovery and personal growth in various ways.
Although the social organisation of the TC is grounded in self-help concepts, it is managed as an autocracy. Authority is formally and explicitly defined by community position and job junction and informally by community status (De Leon 2000).
A fundamental premise of the TC approach is that individuals change IF they fully participate in all the roles and activities of community life. Participation signifies more than meeting community expectations. Individuals change when they are totally involved in the community. Three levels of involvement (engagement, immersion, and emergence) depict the process of change as individuals move through the stages of the program (De Leon 2000).
In the TC perspective, self-help is both a philosophy and a requirement for recovery to occur. Self-help recovery means that individuals make the main contribution to the change process. In the TC, treatment is not provided to the residents so much as made available to them. The effectiveness of TC elements as change-inducing agents is dependent upon the individual. The residents must fully participate in the daily regimen in order to benefit from it (De Leon 2000).
