![The Theory and Practice of Democratic Therapeutic Community Treatment The Theory and Practice of Democratic Therapeutic Community Treatment](https://123library.org/images/books/242523.png?w=254&h=360&fit=&c=2&assets_cache=20240420025113)
BOOK
The Theory and Practice of Democratic Therapeutic Community Treatment
(2017)
Additional Information
Book Details
Abstract
Democratic therapeutic communities have been set up all over the world, but until now there has not been a manual that sets out the underlying theories, and describes successful practice. Based on their own substantial experience and expertise, the authors of this new textbook explain how to set up and run modern therapeutic communities as effective evidence-based interventions for personality disorder and other common mental health conditions.
Including detailed templates and practical information alongside a wider historical context, this encyclopaedic handbook will enable clinicians to develop and implement a democratic therapeutic community model with confidence. Highlighting the importance of belonging to a wider community, this book also shows how to ensure the needs of patients are considered and met, and that patients themselves can see in detail what this approach entails. This is an invaluable resource for clinicians and service commissioners working in the field of recovery from personality disorder, as well as those working in mental health and healthcare. This book also provides a useful model for professionals working in prisons and the justice system, long-term drug and alcohol rehabilitation and education, and students of group analytic, psychotherapy, and counselling courses.
This book is a wonderful blend of academic prose and radical thinking. It is about the person as well as the 'illness', and engaging with someone who is struggling with themselves, whatever the chemistry of their brain. This is how-to advice on a level playing field of 'democracy', where the person will always have to take a personal responsibility for how they handle their relationships. Psychiatry has to be about lessons for living and not just a top-down medicalisation that removes the skills of decision-making and agency. Read it and learn not just about humans in distress but reflect on our profession in disorder.
Bob Hinshelwood, Emeritus Professor of Psychoanalysis, University of Essex
This superb and important book, written by two of the most knowledgeable and experienced proponents of Therapeutic Communities, tracks their history, theory and detailed workings from assessment to treatment. It is a book that teaches us emancipating approaches which holds the key to a more humanised psychiatry.
Dr Heather Castillo, Independent Consultant and author of Personality Disorder: Temperament or Trauma and The Reality of Recovery in Personality Disorder
The NHS is looking for a new interpersonal model of health care provision that will heal patients and retain staff. The values of the Therapeutic Community (empowerment, creativity, search for meaning and democracy) are core parts of what is currently missing. This book is a 'must read' and 'must act' for any thoughtful purchaser, patient or provider - before it is too late.
John Cox, Past President, Royal College of Psychiatrists, Professor Emeritus, Keele University, UK
Dr Steve Pearce is a Consultant Psychiatrist and Programme Director for personality disorder services in Oxfordshire and Buckinghamshire. He is Editor-in-Chief of the International Journal of Therapeutic Communities, Chair of the NHS England Residential Personality Disorder Clinical Reference Group, Past President of the British and Irish Group for the Study of Personality Disorder, and Past Chair of the Royal College of Psychiatrists Quality Network for Therapeutic Communities.
Rex Haigh is a Consultant Psychiatrist for personality disorder services in East Berkshire. He is also Honorary Professor of Therapeutic Environments and Relational Health in Nottingham University's School of Sociology and Social Policy. He is Founder and Past Chair of the Royal College of Psychiatrists Quality Network for Therapeutic Communities, Founder and Chair of the Royal College of Psychiatrists Enabling Environments Network and Past President of the Association of Therapeutic Communities.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
The Theory and Practice of Democratic Therapeutic Community Treatment by Steve Pearce and Rex Haigh | 3 | ||
Acknowledgements | 6 | ||
Preface | 12 | ||
Part 1 - History | 17 | ||
1. A History of Therapeutic Communities | 18 | ||
Geel and the mentally afflicted pilgrims | 18 | ||
Moral treatment | 19 | ||
Therapeutic education and social pedagogy | 19 | ||
Wartime UK experiments, 1939–45 | 21 | ||
Social psychiatry | 22 | ||
Criminal justice and offending behaviour | 24 | ||
Concept Houses, drug-free and addiction TCs | 25 | ||
Antipsychiatry and ‘unlabelled living’ | 26 | ||
Personality disorder TCs | 26 | ||
Part 2 - Concepts | 29 | ||
2. Why Therapeutic Communities | 30 | ||
Critical theory | 33 | ||
Antipsychiatry | 34 | ||
Critical psychiatry | 37 | ||
Biomedical domination and the role of the pharmaceutical industry | 41 | ||
The loss of meaning and context | 42 | ||
Reductionist research paradigms | 44 | ||
Postpsychiatry | 44 | ||
Other relevant ‘movements’ in psychiatry | 45 | ||
The quintessence of a therapeutic environment | 48 | ||
3. TC-Specific Theory | 53 | ||
Specific therapeutic factors in democratic therapeutic communities | 53 | ||
Therapeutic methods in democratic therapeutic communities | 55 | ||
The function/structure-based approach – Rapoport | 55 | ||
The culture of enquiry – Tom Main | 57 | ||
Flattening of the authority pyramid and the analysis of all events – David Clark | 57 | ||
A living-learning situation – Maxwell Jones | 58 | ||
The milieu and the use of member expertise | 59 | ||
Confidentiality and respect/no secrets/openness | 59 | ||
4. Belongingness | 62 | ||
Belongingness and Maslow’s hierarchy of needs | 62 | ||
Belongingness as a therapeutic factor | 64 | ||
Therapeutic environments in which belongingness operates | 65 | ||
Therapeutic communities and belongingness | 66 | ||
5. Responsible Agency | 71 | ||
The wedge theory of responsibility and choice | 72 | ||
Self-efficacy | 73 | ||
Empowerment | 73 | ||
The nature of responsible agency | 73 | ||
Willed action and the nature of desire | 75 | ||
The muscle model of the will | 75 | ||
Other techniques promoting responsible agency | 78 | ||
Responsibility without blame | 79 | ||
Links between blame and shame | 82 | ||
Implications for DTC practice | 82 | ||
6. Social Learning | 85 | ||
Reinforcement | 85 | ||
Social learning | 87 | ||
Relevance to TC practice | 92 | ||
7. Emotional Progression and Narrative | 94 | ||
Emotional progression in DTC | 94 | ||
Stages of emotional progression | 95 | ||
8. The Use of Psychodynamic Theory and Techniques | 105 | ||
Object relations theory | 105 | ||
Splitting and borderline functioning | 106 | ||
Unconscious defence mechanisms, and their relevance to TC practice | 107 | ||
Paralleling behaviour | 110 | ||
Interpretation | 110 | ||
Transference and transference interpretation | 111 | ||
Boundaries and containment | 112 | ||
Therapist activity in democratic therapeutic communities | 113 | ||
9. Group Analytic Influences and Theories | 114 | ||
The roots of group analysis | 114 | ||
The basic law of group dynamics | 117 | ||
Key group analytic concepts relevant in therapeutic communities | 118 | ||
Transference and countertransference in groups | 122 | ||
Group analytic interpretation | 123 | ||
Group-as-a-whole | 123 | ||
Differences between therapeutic community groups and group analytic groups | 124 | ||
Interpersonal group psychotherapy and Yalom’s therapeutic factors | 125 | ||
10. Group Process and Systems | 128 | ||
The primacy of groups | 128 | ||
The impact of social psychology research on TC theory and practice | 130 | ||
Leadership in DTCs | 134 | ||
Systems theory influences | 135 | ||
Systems theory in non-family groups | 138 | ||
11. Evidence for Therapeutic Community Effectiveness | 139 | ||
Concept (drug-free) TC research | 139 | ||
Democratic TC research | 141 | ||
TaCIT – a randomised controlled trial of democratic therapeutic community treatment | 150 | ||
Future research directions | 151 | ||
12. General Approach and Principles | 152 | ||
Application of theory | 153 | ||
Milieu therapy | 153 | ||
Democratisation | 153 | ||
Permissiveness | 156 | ||
Reality confrontation | 157 | ||
Communalism | 157 | ||
Social analysis of events | 158 | ||
Culture of enquiry | 159 | ||
Freeing of communications | 159 | ||
Flattened hierarchy | 161 | ||
The living learning experience | 162 | ||
Part 3 - Practice | 163 | ||
13. Phases and Timing | 164 | ||
Phase 1: Engagement and stabilisation | 165 | ||
Phase 2: Assessment and preparation | 174 | ||
Phase 3: Intensive treatment | 177 | ||
Phase 4: Rehabilitation and recovery | 179 | ||
14. Assessment and Selection | 181 | ||
Dimensional approaches and severity | 182 | ||
The importance of groups | 183 | ||
Intolerance of groups | 185 | ||
Members who may adversely affect the culture | 185 | ||
The possibility of harm from DTC treatment | 186 | ||
Heterogeneous group formation | 187 | ||
Selection processes | 187 | ||
Dropout from DTC treatment | 188 | ||
15. Democratic Therapeutic Community Structure | 189 | ||
Assessment and preparation | 189 | ||
Joining and leaving | 192 | ||
Therapeutic community size | 195 | ||
Weekly structure | 195 | ||
Daily structure | 195 | ||
Special/crisis meetings | 196 | ||
Mentoring and peer support | 197 | ||
Meeting structure | 199 | ||
The place of play in DTC | 203 | ||
Specialist psychotherapeutic approaches | 204 | ||
Milieu time | 205 | ||
Therapy breaks | 206 | ||
Moving on groups | 207 | ||
Follow-up | 208 | ||
16. Boundary Maintenance | 209 | ||
The implementation of boundaries in DTC | 209 | ||
Time boundaries | 210 | ||
Disturbances and distractions in groups | 210 | ||
Hierarchy of consequences of boundary violations | 211 | ||
Relational risk management and positive risk management | 214 | ||
Concurrent psychological treatment while a member of DTC | 216 | ||
Other boundaries | 216 | ||
Drugs and alcohol in DTC | 220 | ||
Medication in DTC | 222 | ||
Abuse of prescribed medication and medicinal substances | 227 | ||
Somatisation and somatoform disorders | 228 | ||
Special treatment | 228 | ||
17. Quality of Relationships and Therapeutic Method | 230 | ||
A different kind of relationship | 230 | ||
Flattened hierarchy | 230 | ||
Authenticity | 231 | ||
Working alongside | 231 | ||
Acting ‘as if’ | 232 | ||
Uncertainty | 232 | ||
Safety and transparency | 232 | ||
Management of personal information for TC staff | 233 | ||
Making the diagnosis of personality disorder | 234 | ||
Co-morbidity with mental illness in personality disorder DTC treatment | 236 | ||
18. The Use of Psychoeducational and Humanistic Methods | 238 | ||
Mindfulness | 238 | ||
Mentalisation | 238 | ||
Coping skills | 239 | ||
Assertiveness and communication skills | 239 | ||
Descriptions of approaches used in the large group | 240 | ||
Action methods | 241 | ||
Approaches derived from transactional analysis | 243 | ||
Diagnostic personality disorder group | 245 | ||
Family and Friends (carer’s) programme for personality disorder | 245 | ||
19. Antitherapeutic Processes | 248 | ||
The difference between group/peer pressure and TC process | 248 | ||
Bullying and scapegoating | 249 | ||
Subgroup formation | 250 | ||
Persecutory interventions | 251 | ||
On not ‘trusting the process’ (or group) | 252 | ||
Summary | 252 | ||
Part 4 - Organisational Aspects | 253 | ||
20. Organisational Relationships | 254 | ||
Commissioning | 254 | ||
Management | 256 | ||
Governance and regulation | 257 | ||
Referrers and colleagues | 257 | ||
Local neighbours | 258 | ||
Professional network organisations | 259 | ||
21. Organisational Development | 260 | ||
Planning a therapeutic community service for personality disorder | 260 | ||
Formation of the team | 262 | ||
Premises | 264 | ||
Induction and initial training | 265 | ||
Continuous improvement | 266 | ||
Organic growth | 267 | ||
Innovation | 268 | ||
Part 5 - Training | 271 | ||
22. Training – Introduction | 272 | ||
Practitioner requirements | 272 | ||
A curriculum of therapeutic community training | 273 | ||
23. Experiential Training for Working in Therapeutic Communities | 275 | ||
The living learning experience | 275 | ||
Other group relations courses | 277 | ||
Personal therapy | 278 | ||
24. Supervised Clinical Practice | 279 | ||
Pre-briefs and debriefs | 279 | ||
Formal supervision | 280 | ||
Sensitivity groups and staff groups | 280 | ||
Profession-specific supervision | 281 | ||
Appendix 1 - Definitions | 283 | ||
Appendix 2 - Community of Communities | 291 | ||
Appendix 3 - Enabling Environments | 302 | ||
Appendix 4 - DTC Preparatory Group Documents and Policies | 315 | ||
Appendix 5 - DTC Programme Documents | 322 | ||
Appendix 6 - Moving On Group | 342 | ||
Appendix 7 - Family and Friends Programme Information Sheet | 344 | ||
Appendix 8 - Training Resources | 346 | ||
Further Reading | 360 | ||
References | 361 | ||
Subject Index | 376 | ||
Author Index | 382 |