What is a Therapeutic Community?

I was a staff member at the Ovis Farm Project in Devon, England, for three years. The Project is run on the Therapeutic Community model.The Therapeutic Community is a self help approach to treatment for people with addiction and related problems. It is a drug-free environment in which people recovering from drug and alcohol addiction are able to live together in an organized and structured way. The aim is to promote change and make possible a drug-free life in the community when they move on.1. The values of a Therapeutic CommunityThe Therapeutic Community believes that people can change and creates an environment that helps to facilitate change. The Therapeutic Community allows a person to grow by fostering an environment where people are valued and accepted.A strong sense of belonging to a nurturing community in an atmosphere of trust and security, is a central tenet of the therapeutic community. Members of the therapeutic community need to take responsibility for themselves, others and their environment.Members of the community must be positively motivated to change, and to accept the communitrules.
These rules uphold the values and norms of the community, which are a reflection
of those held by society.Therapeutic Community principles can be applied to the therapeutic care of a wide range of people2. The Physical Environment of a TCSome Therapeutic Communities operate in closed systems like a prison or, say, a nursing home for people recovering from mental illnesses. The residents of these, and similar institutions, may not have a say in whether they enter in institution, but they are generally able to volunteer for the Therapeutic Community. In a prison that operates this model, a separate wing may be used.Therapeutic Communities operate in purpose-built structures, as well as a range of converted buildings such as schools, churches, or a farm. The size, grounds and design of facilities also vary, but are generally adapted to the types of educational and vocational training offered by the Therapeutic Community. At Ovis Farm the residents were able to work with the farm manager on the work element of the programme. This probably represented one day each week. In its way, it was a unique feature that this project could offer because of its location.The residential capacity of a Therapeutic Community program commonly ranges from 50 – 150 residents. An ideal size is often described to be in the range of 80 – 120 residents. This suits big institutions but in recent years the Therapeutic Community model has been applied to smaller groups, like Ovis Farm, of maybe a dozen residents.Therapeutic communities are generally open environments where residents choose voluntarily to live for a period of 6 to 12 months, and in some cases, longer. Although strict limits are placed on residents’ comings and goings, residents who comply with all house rules and programme requirements may gradually earn privileges to leave the facility through day, overnight or weekend passes, particularly to visit parents, partners or children.The key interior spaces in a Therapeutic Community consist of areas where the operational, educational, and therapeutic activities of the program are held. Common spaces include lounges, training rooms, the dining room, and kitchen. Private spaces include administrative offices and conference rooms. The residents have their own private rooms, and some staff may live on site.3. The Social EnvironmentResidents take on more responsibility as they learn the concepts of the Therapeutic Community and are able to help fellow residents. It is their understanding and application of the Therapeutic Community concepts that gives a resident more responsibility, not the length of their residency. In this way, the group or peer dynamic is a persuasive influence on residents’ desire to become more responsible and accountable.Residents take on supervisory responsibility in the different departments in the community. For example, one may oversee the kitchens to ensure that the necessary provisions are ordered each week to fill the menu requirements. They would also ensure that the hygiene standards are met, and to help others prepare meals for the community. Another resident may look after the grounds or maintenance work.4. Resident ProfileMost residents of Therapeutic Communities are considered to have hit ‘rock bottom’ whether they voluntarily enter a community or arrive through the criminal justice system. Many residents have been drug addicted for years and have a history of criminal activity or other legal problems. Although many residents arrive with a host of health related problems, most Therapeutic Communities stipulate that residents must be healthy enough to undertake physical labour and participate in training programmes and other group-related activities.The admission process for Therapeutic Community residents should be rigorous. It typically involves an initial visit or phone call, admission to a waiting list, an orientation process, one or more intake interviews, and in many cases, medical, legal and psychological assessments, and consent to treatment. A thorough initial assessment may help reduce the drop out rate which is most critical during the first 30 days.5. Staff ProfileStaff participate as members of the community. Staff often share everyday tasks with the residents, as well as facilitate group meetings and one to one sessions. Staff are able to express their own reactions to events and situations, and accept challenge or criticism from residents. Many staff members in the smaller communities may have been former residents. In this way the traditional ‘them and us’ split between professionals and service users is broken down. This helps to develop a sense of trust and intimacy enabling residents to experience different relationships with authority or parental figures. Staff and senior residents are also able to act as role models, by being open and honest. This carries the risk of staff becoming over-involved, which makes staff supervision essential in this way of working.6. Education and TrainingThe elements of treatment at the Therapeutic Community typically include addiction treatment, education, primary medical and dental care, vocational skills training (e.g. cooking skills, carpentry, general maintenance, and computer skills), on- and off-site job placement, and in rare cases, on-site resident-run businesses. Christian run Therapeutic Communities will give some opportunity for residents to address their spiritual needs but will not insist that residents are Christians when they enter, or that they become Christians during their stay.7. The Daily TimetableResidents can expect a highly structured and demanding daily routine within the Therapeutic Community. The typical day includes a 6:30 or 7:00 AM wake-up call, morning and evening house meetings, job functions, therapeutic groups, life skill seminars, vocational training sessions, some personal time, recreation, and individual counselling when necessary.Weekend schedules are somewhat less demanding, although Saturday mornings may be taken with group meetings. A Christian run Therapeutic Community may have a commitment to attend a church service on Sundays. This is not just a spiritual consideration, it allows members of the Therapeutic Community an opportunity to increase their support network and generally meet positive people outside of their usual peer groups.Structure and routine are integral to the daily running of the Therapeutic Community8. Moving OnThe most important part of any recovery programme is probably preparing the resident for ‘re-entry’ into the community. This term sounds a bit like a space craft returning to the earth’s atmosphere. In some ways, this is a sound metaphor. If this is not done correctly the resident can burn up and disintegrate rapidly.Some Therapeutic Communities insist that no resident leaves the program without a full-time job including a place to live and a support network. Family reconciliation is often incorporated into re-entry. Maintaining a drug free lifestyle often means learning more coping skills so it is recognized that moving on is a transitional process. One of the supports most commonly identified as essential to resident success once they leave the Therapeutic Community is transitional housing (a half way house) and affordable longer term housing. This is a major obstacle in the UK (and many other countries) due to lack of good basic accommodation. Many Therapeutic Communities find creative ways of organizing this.