While it is frequently asserted that the therapeutic community rests on psychoanalysis, there has been very little discussion in the literature of the fundamental place of language in the treatment Hinshelwood, ; Gale, And yet, like psychoanalysis, a therapeutic community methodology, particularly in its application to psychiatric patients, rests profoundly on speech.
A therapeutic community, as other communities, is held together in some way by language and it is in the community that the thread of speech comes alive. It is not just that the language of this particular community is technical, or specialised in some sense.
Of course there is a degree of specialised language in any subgroup, and therapeutic communities and even particular therapeutic communities within one organisation, are no exception. But the relationship which each member has to the meaning of his or her experience, and to the life of the community and its history, are all connected to his or her participation in language. Difficulty lies in the meaning that the words have for the patient and the connections that he or she makes between thoughts and words. Today community-based therapeutic communities have the potential to be at the forefront of provision in terms of putting users at the centre of treatment and listening to their views.
The treatment environment in a therapeutic community is one which values patients' experiences to a unique degree.
Through close partnership working, the integration of psychological and psychiatric approaches, as well as psychotherapy in its group analytic and individual psychodynamic forms, is possible. The potential for cooperation and multidisciplinary care planning and review, involving the patient, other users, psychiatrist, psychotherapist, social worker, the family and other key workers, is at its optimal in non-residential or small residential settings. Furthermore, because of the intensity of the programme, it is possible to monitor the effects of medication and through regular reviews manage change Gale and Sanchez, a.
About patients each year live in CHT's communities. CHT achieves an average annual occupancy level of Most of those referred suffer from schizophrenia, and remain in residence for an average of two years ibid. Therapeutic community treatment of traumatised soldiers: the historical context. Working with psychologically disturbed former soldiers, sailors and airmen is, in a sense a return to one of the key moments in the development of TCs Gale et al. It was during the Second World War in two military hospitals, Northfield Hospital in Birmingham and Mill Hill Hospital, to which part of the Maudsley Hospital had been evacuated at the outbreak of the war.
Four leading psychoanalysts, Wilfred Bion, Sigmund Foulkes, Tom Main and Maxwell Jones -who were to have an enormous influence on the TC movement as a whole- all worked in these military hospitals. In fact their influence went beyond the TC movement. Bion, whom David Kennard has described as one of the most influential post war contributors to psychoanalytic theory was later to develop his theory of group basic assumptions at the Tavistock Clinic and strong links were formed, during the Second World War between the Tavistock Clinic and the Army Shephard, ; Kennard, John Bowlby saw this as a crucial intervention which had the effect, additionally, of introducing a degree of democracy into the military hierarchy Shephard, As a result psychoanalysis has justifiably been described as the founding idea of TCs Hinshelwood, However, at Northfield Hospital there was already a degree of eclecticism which amounted to something of a hotch potch of psychoanalyisis, group dynamics and dramatherapy, as well as what we might now recognise as cognitive behavioural therapy cognitive behavioural therapy CBT Shephard, This paper is a case study in the development of an innovative TC project over a three year period and is significantly relevant to our contemporary situation, as it confronts the psychological effects of combat, military training and culture on servicemen and women.
It records successful outcomes over the three year period and details of the period In CHT was approached by The Homeless Fund to set up a dispersed therapeutic community for homeless ex service personnel. A pilot was established with six beds, funded by the National Lottery Charities Board. Following the pilot year the project has developed to 21 beds and is funded principally by annual grants from The Royal British Legion, the Army Benevolent Fund and other charitable trusts, together with statutory funding from Supporting People.
It summarised the benefits from the funding-funded relationship as follows:. Home Base has a number of original features. It has kept the Ministry of Defence MoD and ex service charities on board, while managing to maintain the distance from the military necessary for effective therapeutic interventions and operational independence. It is an interagency initiative which integrates a psychoanalytic perspective in the treatment of homelessness and its habitual symptoms of alcohol and substance abuse.
It has also developed a therapeutic community treatment which successfully bridges the gap between psychotherapy and practical skills training for work. Home Base was formed to provide psychotherapy, rehabilitation and accommodation within the psychosocial environment of a therapeutic community. It does this through partnerships with registered social landlords RSLs and other organisations. Since its inception Home Base has been an active collaborator in the Ex-Service Action Group on Homelessness and has also developed strong links with the Confederation of British Service and Ex-Service Organisations, the MoD and the Department of Communities and Local Government in order to provide the best possible support to venerable members of the exservice community.
Currently Home Base provides 21 places and outcomes are measured through continuous data collection analysis and individual assessments of clients. In weekly individual psychotherapy sessions clients mental and emotional disorders are treated through the use of psychological techniques to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, change in behaviour leading to improved social and vocational functioning, and personality growth.
This is achieved by helping the patient attain insight into the repressed conflicts which are the source of difficulty. Through the use of CBT the patient's dysfunctional behaviour is changed, using positive reinforcement, developing increased self-efficacy and more realistic and positive attitudes. Figure 1. The treatment path of clients. In weekly group psychotherapy sessions clients are guided by a therapist to confront their personal problems together.
The interaction among clients is an integral part of the therapeutic process. Group therapy focuses on interpersonal interactions, so relationship problems can be addressed. The aim of group psychotherapy is to help with solving the emotional difficulties and to encourage the personal development of the participants in the group. Members of the group share with others the personal issues which they are facing in adjusting to civilian life. Here participants can talk about event they were involved in during their time in the armed forces, during the time they were homeless or even during the last week.
Members in the group learn to feel less alone with their problems and the group can become a source of support and strength in times of stress for the participant and a laboratory for new behaviours. The community get together to share a meal together each month. This is an important event in the life of the community and provides a setting in which clients can develop relationships and social skills. Often patterns of behaviour appear that indicate the difficulties clients have in forming or maintaining relationships. The aims of this kind of social event are manifold, ranging from community building to provoking reflection on relationships and nurturing strategies.
The monthly house meetings focus mainly on the day to day life of the community. The aim is to help clients engage with the community in practical ways and increase the level of responsibility they take for their life. Tenancy breakdown is common amongst homeless people. These groups focus on helpings clients, from the beginning of their placement, to think about the long term; about moving to permanent accommodation and how to sustain tenancies. It is a forum in which mutual support is given and strategies are shared in order to find suitable accommodation and sustain it.
Soon after admission clients are assessed for work and their training needs identified. In most cases a referral is made to weekly sessions at Project Compass and the Transitional Spaces Project. Here work training opportunities are provided. This aims at helping clients learn the skills to run their own business, cultivating fruit and vegetables and selling it in a local market.
Home Base has strong links with other agencies.
This is due to the co-operation which exists within the ex-service community. In addition, it has also developed relationships with other organisations such as Homeless Link. Table 1 Referring agencies. Over the last three years we see a marked increase in those entering the programme with depression, PD and alcohol addiction.
Whereas those with anxiety have decreased.
This indicates a general trend towards referrals with more severe disorders. Figure 7. Comparison of clients diagnoses over the past three years. The majority of clients when entering treatment have not received any previous psychological treatment. The minority that have had some form of treatment will usually have received treatment for an addiction. Figure 8. The majority of clients are in need of training in order to be able to gain, secure and sustain employment. The majority of clients are able to gain employment after approximately one year in the community.
Figure 9. The average length of stay is 20 months. Length of stay depends on treatment progress and the availability of move on accommodation. The majority of clients that leave the community move to independent accommodation successfully. Although four out of 11 people did not complete treatment we still achieved above the Supporting People criteria for success. Figure Table 3 Case studies of two clients.
Despite common attributes, existing therapeutic communities have various origins. In the UK, while those that flourished in hospitals are largely gone, care in the community has meant that new smaller therapeutic households have become an integral part of the provision for the mentally ill in the community. The democratic and psychoanalytically-orientated communities such as those run by Community Housing and Therapy lay emphasis on the tension between permanence and temporality in meaning. Full speech parole pleine is the way in which patients enter into a shared world and make sense of their experiences from a perspective of a common understanding.
It is a community made up of staff and patients, and the struggle to articulate meaning is shared by all through involvement. This involvement is focused primarily on continually interpreting the world despite the onslaught of unconscious processes, particularly those projections associated with foreclosure. Thus the therapeutic community is a hermeneutic project, in which perceptible things and rationality are viewed as just a small part of the picture but a part which points patients towards the truth of the unconscious.
Fundamentally this existential project has a deep spiritual resonance and the response of veterans to the demands of everyday living serve as a metaphor for states of mind as, for example, homelessness. Over the last year we have seen people with more severe problems being referred to Home Base, particularly those with depression, a personality disorder and addiction. The increased level of morbidity contributed to a slightly longer stay than in previous years and length of stay averaged at 20 months.
Adby, M. Funding better performance: Supporting performance improvement through the funding relationship. London: The Performance Hub, British Royal Legion. Communities and Local Government. Rough sleeping 10 years on: from the streets to independent living and opportunity. Discussion paper. Department of Health. Improving access to psychological therapies IAPT commissioning toolkit. London: Department of Health Publications, Gale, J. The dwelling place of meaning. In: S. Tucker Ed.
Dialogue and dwelling pp. London: Jessica Kingsley Publishers, Reflections on the treatment of psychosis in therapeutic communities. Therapeutic Communities, 26 4 , a , If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.
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Examines the role of the Defense Department's personnel support programs and focuses on nine tools for increasing sense of community: group symbols. Buy Increasing a Sense of Community in the Military: The Role of Personnel Support Programs by Colette Van Laar (ISBN: ) from Amazon's.
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