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Why Therapeutic Communities work

Why Therapeutic Communities work. Presentation at the EFTC Conference Prague September 20 th 2013 Martien Kooyman MD, PhD. Tony Gelormino. We have 150 residents with 7 staff We used to have 5. Mutual Help. Self Help. Responsible Concern.

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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. Encounter groups

  14. learning to help yourself with the help of others

  15. say what you feel and feel what you say

  16. say what you feel and feel what you say

  17. Group focus

  18. Group focus

  19. Without focus

  20. Without focus

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

  22. (Wexler, c.s., 1990) Results of Stay ‘N Out 41 40 27

  23. 5 year follow-up Donovan PrisonProgram - Amity TC California 86 83 42 Contr gr Gev. TG Gev. TG+ nazorg TG (Prendergast, c.s., 2004)

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

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

  26. Bowlby secure attachment

  27. 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

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

  29. 5 basic emotions Fear Anger Pain Pleasure Love

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

  31. When needs are fulfilled or expected to be fulfilled: fear, anger,pain When needs are fulfilled or expected to be fulfilled: pleasure,love

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

  33. emotional neglect physical or psychological trauma sexual abuse : fear of closeness and rejection `I do not have the right to exist `

  34. I am not good enough I am bad

  35. low self-esteem fear of rejection

  36. manipulative behaviour avoidance of rejection

  37. denial of addiction inability to ask for help

  38. Rex Haigh attachment containment communication involvement and inclusion agency

  39. Attachment: a culture of belonging

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