The Therapeutic Community: Theory, Model, and Method

Contents......Page 8
List of Tables and Figures......Page 14
Acknowledgments......Page 18
PART I: Introduction......Page 20
1 Therapeutic Communities: Evolution and the Need for Theory......Page 22
Issues of Evolution......Page 23
Theory and TCs......Page 26
Some Caveats and Limits......Page 27
Conclusion......Page 29
2 In Search of an Essential Therapeutic Community Historical Sources......Page 30
Historical Sources......Page 31
A Genealogy of the Modern Addiction TC Program......Page 33
Broader (Nonspecific) Influences on the Addiction TC......Page 41
Contemporary TCs......Page 42
Definitions, Conceptions, and Theories of the Addiction TC......Page 45
Conclusion......Page 51
PART II: The Perspective and Approach......Page 54
The Presenting Disorder......Page 56
A Disorder of the Whole Person......Page 57
Biomedical Concepts and the TC Perspective......Page 61
Conclusion......Page 67
Cognitive and Behavioral Characteristics......Page 68
Perceptual Characteristics......Page 70
Emotional Characteristics......Page 71
Social Characteristics......Page 76
Deviant Coping Strategies......Page 79
Social Deviancy......Page 81
An "Addictive Personality"......Page 82
Conclusion......Page 83
5 View of Recovery and Right Living......Page 84
View of Recovery......Page 85
View of Right Living......Page 92
Conclusion......Page 103
6 The Community Approach......Page 104
Community and the TC Perspective......Page 105
Learning, Healing, and the Culture of Community......Page 107
Community as Method: Basic Components......Page 111
Conclusion......Page 117
PART III: The Model......Page 118
Settings, Resources, and the TC Perspective......Page 120
The Facility......Page 124
The Inner Environment......Page 127
Hallmark Features of the TC......Page 133
Conclusion......Page 137
8 The Social Organization......Page 138
TC Program Structure......Page 139
Systems in the TC......Page 143
Communication in the TC......Page 144
Social Organization and the TC Perspective......Page 146
Conclusion......Page 150
9 Work: Therapeutic and Educational Elements......Page 152
Work in the TC Perspective and Approach......Page 153
The Hierarchy of Resident Job Functions......Page 155
Uses of Work in the TC......Page 163
Conclusion......Page 168
Staff in the Perspective......Page 170
Treatment Staff: Roles and Functions......Page 171
Staff Meetings and Groups......Page 179
Support Staff Roles and Functions......Page 180
Staff as Community Members......Page 181
Conclusion......Page 182
Peers in the TC Perspective and Approach......Page 184
The Main Peer Roles......Page 186
Peer Roles in the Social Learning Process......Page 191
Peer Subgroups within the Community......Page 192
Conclusion......Page 196
Relationships: The Perspective and Approach......Page 198
Sexuality in the TC......Page 200
Romantic Relationships......Page 204
Friendships......Page 206
Relationships and Roles outside the Program......Page 208
Conclusion......Page 210
Program Stages and the TC Perspective......Page 212
The Program Stages: General Description......Page 213
Program Stages and the Treatment Process......Page 225
Conclusion......Page 227
PART IV: Therapeutic Community Methods......Page 228
14 Privileges and Sanctions......Page 230
Privileges in the TC Perspective and Approach......Page 231
Classes of Privileges......Page 232
Classes of Sanctions......Page 237
Disciplinary Sanctions in the Perspective and Approach......Page 240
Disciplinary Sanctions: Clinical Considerations......Page 249
Sexuality: Privilege and Sanction......Page 250
Conclusion......Page 251
General Inspection......Page 254
The House Run......Page 255
Urine Testing in the TC Perspective......Page 262
Conclusion......Page 265
Meetings in the TC Perspective and Approach......Page 268
The Morning Meeting......Page 270
The House Meeting......Page 275
The Seminar......Page 278
The General Meeting......Page 283
Conclusion......Page 287
Groups in the TC Perspective and Approach......Page 288
Group Process: General Elements......Page 290
The Main Clinical Groups......Page 295
The Main Groups for Teaching and Training......Page 299
Other Groups in the TC......Page 303
Conclusion......Page 305
The Uses of the Encounter......Page 306
Rules and Elements of the Encounter......Page 307
The Encounter Format......Page 310
The Encounter Process......Page 312
The Generic Role of Facilitators in the Encounters......Page 319
Varieties of Encounters......Page 322
Conclusion......Page 324
PART V: The Process of Change......Page 326
19 Individual Change: Behaviors, Cognitions, and Emotions......Page 328
Community Member Dimension......Page 329
Socialization Dimension......Page 330
Developmental Dimension......Page 333
Psychological Dimension......Page 334
Interrelated Dimensional Change......Page 337
Individual Differences and Dimensional Change......Page 338
Conclusion......Page 339
Classification of Essential Experiences......Page 340
Emotional Healing Experiences......Page 342
The Social Relatedness and Caring Experiences......Page 347
Subjective Learning Experiences......Page 351
Conclusion......Page 354
Perceptions Related to Treatment......Page 356
Perceptions of Progress......Page 359
Conclusion......Page 365
22 The Individual in the Community: Participation in the Change Process......Page 366
Participation and Community as Method......Page 367
Community Expectations and the Dimensions of Individual Change......Page 368
Levels of Involvement and Individual Change......Page 369
Conclusion......Page 373
The Concept and Characteristics of Internalization......Page 374
The Gradient of Internalization......Page 377
Internalization and the Limits of Change in the TC......Page 379
Internalization in the Change Process Beyond Treatment......Page 383
Conclusion......Page 385
24 The Treatment Process: A Conceptual Framework......Page 386
Community as Multiple Interventions......Page 387
Multidimensional Change in the Process......Page 389
Principles of Change......Page 391
Perceptual and Experiential Mechanisms in the Process......Page 394
Conclusion......Page 398
25 Therapeutic Communities: The Challenge of Evolution......Page 400
A Generic TC Model......Page 401
General Guidelines for Adaptations and Modifications of the TC......Page 404
Program Standards......Page 408
Theory, Practice, and Training......Page 409
Theory and a New Research Agenda......Page 410
Beyond Addiction: A Post Script......Page 411
References......Page 414
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B: Therapeutic Community Philosophies......Page 444
C: Assessment Instruments Available for Use in Therapeutic Communities......Page 446
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