Why Therapeutic Communities work

1. Why Therapeutic Communitieswork Presentation at the EFTC ConferencePragueSeptember 20th 2013 Martien Kooyman MD, PhD

3. Tony Gelormino We have 150 residents with 7 staff We used to have 5

4. Mutual Help Self Help Responsible Concern

5. No violence No threat of violence No drugs No Alcohol No sexual acting out between residents

6. The importance of role models of older residentsand ex addicts in the staff

7. You alone can do itbut you can not do it alone

9. angry concern humor

11. Chuck Dederich In the groups the only persons confronting me are my wife and my brother. It worries me.

12. Medical Model doctor The doctor is responsible for the treatment patient The patient is not responsible for the disease

15. George De Leon Ownership Our House

16. All T.C. activities includingcleaning, cooking andadministration are therapy

18. No individual therapy

19. learning to help yourself with the help of others

20. Encounter groups

21. say what you feel and feel what you say

22. Group focus

23. Group focus

24. Without focus

27. Emiliehoeve (N = 172) N = 32 N = 62 N = 17 N = 61

28. Parent participation (PP) is related to longer time in the programme (TIP) and gives therefore more successful outcome (SO) PP longer TIP more SO

30. emotional neglect physical or psychological trauma sexual abuse

31. Alexander Bassin: Addicts have a failure identity and are unable to sustain long lasting relationships

32. Bowlby secure attachment

33. Inner working model • Children internalize early experiences of attachement in a inner working model • Child’s self-image: pos or neg • Child’s image of other: pos / neg

34. Daniel Casriel bonding (physical closeness and emotional openness) is a biological need

35. Basic biosocial needs • Bonding – Attachment • Physical well-being • Autonomy • Acknoledgement and self-esteem • Identity • Meaning and spirituality

36. When needs are not fulfilled or not expected to be fulfilled: fear, anger,pain When needs are fulfilled or expected to be fulfilled: pleasure,love

37. Negative attitudes I do not exist I do not need I am not lovable I do not have the right I am not good enough I can not change I am not responsible for my own life I am not your equal

38. I am not good enough I am bad

39. low self-esteem fear of rejection

40. manipulative behaviour avoidance of rejection

41. denial of addiction inability to ask for help

42. fear of closeness and rejection `I do not have the right to exist `

43. Rex Haigh attachment containment communication involvement and inclusion agency

44. Attachment: a culture of belonging Attachment is both sought and resisted or rejected

45. Containment: a culture of safety Strong emotions are tolerated clear rules are established

46. Communication: a culture of openness Honesty opportunity for questioning

47. Involvement and inclusion: a culture of participation All interactions belong to everybody Community meetings

48. Agency : a culture of empowerment interdependent finding a sense of self Active participation responsibility for each other

49. What is therapeutic in a therapeutic community?

50. The 15 therapeutic factors of a T.C.