THE THERAPUITIC COMMUNITY Introduction The therapeutic community (TC) for the treatment of drug abuse and addiction

has existed for about 40 years. Therapeutic Communities are drug-free residential settings that use a hierarchical model with treatment stages that reflect increased levels of personal and social responsibility. The goals are to effect a complete change of lifestyle, including abstinence from substances, to develop a personal honesty, responsibility and useful social skills and to eliminate antisocial attitudes and criminal behaviour. The organization of care in a therapeutic community is concerned with recognizing the value of a normal domestic environment within which people with disturbance in mood or behaviour may develop trusting relationships with care workers out of which healthy mental functioning may develop. History Under the influence of Maxwell Jones, Main, Wilmer and developed the concept of the therapeutic community and its attenuated form - the therapeutic milieu - caught on and dominated the field of inpatient psychiatry throughout the 1960's. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other's mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. 'TC's have sometimes eschewed or limited medication in favour of group-based therapies. CONCEPT: According to Kraft, " the therapeutic community is a very special kind of milieu therapy in which the total structure of the treatment unit is involved as part of the helping process". All social and interpersonal interactions in the hospital are main therapeutic tools used to bring about specific changes in the patient whereas in milieu therapy the emphasis is on the manipulation of the environment to bring changes in the patient's behaviour. Definition A therapeutic community is a drug-free environment in which people with addictive (and other) problems live together in an organized and structured way in order to promote change and make possible a drug-free life in the outside society. The therapeutic community forms a miniature society in which residents, and staff in the role of facilitators, fulfil distinctive roles and adhere to clear rules, all designed to promote the transitional process of the residents (Ottenberg 1993) Stuart and Sundeen defined therapeutic community as a therapy in which patients social environment would be used to provide a therapeutic experience for the patient by involving him as an active participant in his own care and the daily problems of his community. "Therapeutic community is one of the psychiatric nursing approaches where in the patient's social environment would be used to provide a therapeutic experience for him by involving him an active participant in his own care and the daily problems of his community". TYPES OF THERAPEUTIC COMMUNITY: a. Genuine therapeutic community of democratic / analytic 1

b. Therapeutic milieu of institutional c. Social therapy or concept-based therapy a) Genuine therapeutic community of democratic/ analytic: In these therapeutic communities, all the material and human resources in the hospital are actively engaged in a therapeutic program. Usually in residential buildings, the residents collaborate with staff in day-to-day decision making and running of the organization. b) Therapeutic milieu of institutional: These are wards or small units, where patients and staff have less control over the domestic and administrative decision making of the organization. c) Social therapy or concept-based therapy: Social relationships and social environments are the focus of care. Setting range from voluntarily run hostels Eg: Richmond fellowship at Bangalore to special hostels for alcoholics and drug addicts like T.T.Ranganathan foundation at Chennai. The residents have less control over the values, which permeate the organization than the previous two. Objectives To use patients social environment to provide a therapeutic experience for him To enable the patient to be an active participant in his own care and become involved in daily activities of his own community To help patient to solve problems ,plan activities and to develop the necessary rules and regulations for the community To increase their independence and gain control over many of their own personal activities To enable the patient to become aware of how their behaviour affects others Elements of therapeutic community Free communication Shared responsibility Active participation Involvement in decision making Understanding of the roles ,responsibilities ,limitations and authorities CHARACTERISTICS OF THERAPEUTIC COMMUNITY: The therapeutic community attempt to: Respect the individual client as a citizen with a capacity for autonomous action. Share decision-making with residents about day-to-day life of the community. Use the mechanism of meetings and groups to develop openess of community about problems, feelings and conflicts. Stress an ordinary domestic environment, in which, clients can enjoy in meaningful purposeful activity. PRICIPLES OF THERAPEUTIC COMMUNITY:

Responsibility for treatment belongs to the staff and client. Roles of staff and clients are equalized-may discuss either staff behaviour or clients behaviour. Democratic environment is fostered. Open communication is encouraged. Focus is on client assets. Peer pressure is utilized to reinforce rules and regulations. Interpersonal interactions are utilized to improve communication skills. Inappropriate behaviour are dealt with as they occur. Group discussion and temporary seclusion are favoured approaches for acting-out behaviour. Team approach is used. Clients are treated as part of team and share in the responsibility and process of making decisions. Clients are involved in all phases of treatment. Community government is set up- Use meetings to teach standards, values and behaviour, explore behaviour, make decision, use problem solving. Two main goals for clients- Learn to set limits, learn psychosocial skills. LIMIT SETTING: Behaviours that require setting limits Destructive- suicide, homicide, harm to person or property. Disorganization- psychotic behaviour-hallucination, delusions, disoriented, dissociative episodes of post traumatic stress disorder. Deviants- acting out, breaking rules, illegal activities. Dysphoric- depressed, withdrawn, elated, phobic, obsessive compulsive. Dependant- avoids responsibility for thoughts and behaviour. PSYCHO-SOCIAL SKILL DEVELOPMENT;