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Why Therapeutic Communities work

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

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

  3. Mutual Help Self Help Responsible Concern

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

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

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

  7. angry concern humor

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

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

  10. George De Leon Ownership Our House

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

  12. No individual therapy

  13. learning to help yourself with the help of others

  14. Encounter groups

  15. say what you feel and feel what you say

  16. Group focus

  17. Group focus

  18. Without focus

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

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

  21. emotional neglect physical or psychological trauma sexual abuse

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

  23. Bowlby secure attachment

  24. 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

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

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

  27. 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

  28. 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

  29. I am not good enough I am bad

  30. low self-esteem fear of rejection

  31. manipulative behaviour avoidance of rejection

  32. denial of addiction inability to ask for help

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

  34. Rex Haigh attachment containment communication involvement and inclusion agency

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

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

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

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

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

  40. What is therapeutic in a therapeutic community?

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