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At least 19 recordsLinked to original sources
PubMed1979

The therapeutic community as a research ward: myths and facts.

The clinical research ward run as a therapeutic community has been criticized as inefficient and scientifically unsound. This article discusses the therapeutic community as a research ward and identifies certain misconceptions which underlie many criticisms. The following myths are discussed and refuted: (1) There is an insurmountable community-research chasm. (2) The therapeutic community induces stress that interferes with research. (3) Patient passivity is engendered by research and this is destructive to the therapeutic community. (4) Symptoms are exacerbated by a research ward that is disruptive to the community. (5) Normal research subjects cannot live in a therapeutic community without pathologic psychic changes. These inaccurate myths are seen as a reflection of attempts to oversimplify very complex clinical and research issues. The use of mythology to simplify experiments, to artificially "clarify" complex issues, or to "protect" patients is seen as a disservice. The therapeutic community and research are syntonic when both receive appropriate support.

Adult↗
PubMedDate not supplied

Individual and community: normative conflicts in the development of a new therapeutic community for older persons.

This paper examines the role of ideology in the establishment of a new therapeutic community for geriatric patients in a state mental hospital. Contradictory role expectations, reflected both in staff-staff and in staff-patient relationship, interfered with the program's achieving its stated goals. In order to apply a humanistic approach to programs for elderly patients, realistic goals-encompassing the range of patient competence-must be set within a reasonable time framework, and the program must provide for an appropriate range of structure.

Aged↗
PubMed1979

A feminist approach for the treatment of drug-abusing women in a coed therapeutic community.

Experiences with female addicts in a feminist awareness group within a coed therapeutic community are reported. The group met for 16 months and was based on a variety of therapeutic techniques and educational presentations. The intervention resulted in more communication and trust among the women, increased interest in health-related concerns, a reduced sense of alienation, and gains in self-respect. The article discussed the issues and implications of resistance to the group, timing, development of indigenous leadership, training for feminist therapists, and the use of outside professional consultants in therapeutic communities.

Adolescent↗
PubMed1979

Objective personality changes in residents of a therapeutic community.

The authors tested several groups of drug-abusing young adults who were residents of a drug-free therapeutic community. Three instruments were used: staff ratings, sociometric ratings by members of the community, and MMPI scores. All three measures showed objective evidence of decreasing psychopathology correlated with length of time in treatment, demonstrating the effectiveness of the therapeutic community in the rehabilitation of drug abusers. Individuals who left before completing treatment had MMPI scores indicating inability to develop social relationships; this elucidates a probable cause of the dropout phenomenon.

Adult↗
PubMed1979

The therapeutic community and methadone: a way of achieving abstinence.

The combination of a therapeutic community (TC) and gradual methadone detoxification of 3 to 4 months to treat long-term methadone patients is described. Most patients have done poorly on methadone and come only after serious drug and alcohol abuse or criminal behavior. An individualized treatment plan is implemented which includes individual, group, and family therapy; psychotropic drugs; blind methadone detoxification, and the techniques used in contemporary TC's. Of 215 admissions, 44% have been fully detoxified from methadone over an average of 3 1/2 months (94 patients). Of 94 patients detoxified, 20 (21%) returned to methadone treatment elsewhere and 15 (16%) stayed on such treatment.

Adult↗
PubMed1979

Staff and patients evaluate their therapeutic community.

A committee of staff and patients conducted an informal evaluation of a therapeutic community on a 16-bed psychiatric unit. The committee reviewed the history, original intent, current purpose, and effectiveness of meetings held on the unit; when problems were identified, suggestions for change were formulated. The evaluation served to increase the efficiency of meetings and to counteract what the authors termed the "drift phenomenon," or the tendency of the original purpose or structure of a meeting to change over time. The process also fostered an atmosphere of mutual respect and an enhanced sense of purpose among the patients and staff who worked on the committee.

Attitude of Health Personnel↗
PubMed1979

Therapeutic communities, old and new.

The author attempts to clarify two largely different uses of term, Therapeutic Community (TC). By "old" TC he describes a movement which originated in psychiatry in the United Kingdom at the end of World War II. This was an attempt to establish a democratic system in hospitals where the domination of the doctors was replaced by open communication of content and feeling, information sharing, shared decision making, and problem solving shared as far as possible with all patients and staff. Daily meetings of all patients and staff formed the nucleus of this process. In recent years developments in the areas of systems theory, learning theory, and organization development have contributed to a better understanding of social organization and change. The "new" TCs derive from the more recent developments in the treatment of substance abuse. Central to this movement is Synanon and its many modification which use the clients' peer group to solve their own problems, largely eliminating mental health professionals. Linked with these "new" TCs is the development of Asklepieion units in prisons, which use Synanon "games" along with transactional analysis. An attempt is made to distinguish the methodologies used in TCs, "old" and "new".

Alcoholics Anonymous↗
PubMed1979

Outcome research in therapeutic communities for drug abusers: a critical review 1963-1975.

Twenty-five publications, conference presentations, and unpublished reports on outcome of therapeutic communities for drug abusers are reviewed for the period 1963 to 1975. A wide variety of methodological limitations are noted, including retrospective designs, unclear definition of outcome variables, low follow-up completion rates, lack of descriptive data on either the treatment processes or the patients, inadequate sampling procedures, lack of comparison control groups, and the absence of data to validate self-reports. Some speculations are offered on the reasons for such methodological inadequacies and a model proposed for future studies.

Alcoholism↗
PubMed1979

The modification of personality disturbance in a therapeutic community for drug abusers.

Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty-five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.

Adult↗
PubMed1979

A token economy in the framework of a hospital therapeutic community -- practice and psychosocial implications.

A token economy (TE) aimed at enhancing self care, work habits, and social participation was initiated in conjunction with the restructuring of a chronic ward into a therapeutic community. Recorded data over a year revealed a differential impact of the TE on various patients. An attempt is made to characterize differential response modes to the TE and to delineate their correlates. Both participants in the program and therapeutic agents were interviewed as to their attitudes towards the TE. Beneficial effects were demonstrated mainly in patients with a relatively late onset of psychiatric illness, but a favorable attitude towards the TE was displayed by both patients and staff members. Implications for psychosocial readaptation are discussed taking into account humanistic and psychodynamic points of view. The reconsideration of possible merging of different therapeutic techniques seems to be desirable.

Activities of Daily Living↗
PubMed1978

The relationship between duration of treatment in a therapeutic community for drug abusers and subsequent criminality.

The conviction rates for the first 61 admissions to a therapeutic community for drug dependence were obtained for a period two years prior to admission and two years after discharge, by searching in the Criminal Records Office at Scotland Yards. A long-stay group (n = 20) which had remained in residence more than six months was compared with a medium-stay group (n = 20) which had remained from one to six months and a short stay group (n = 21) which had remained less than one month. The long-stay group had a pre-admission conviction rate of 60 per cent, which was significantly reduced to 10 per cent during the follow-up period. The conviction rate of the medium-stay group was reduced from 70 per cent before treatment to 45 percent after treatment; that of the short stay group remained constant at 57 per cent before and after treatment. It is suggested that periods of more than six months treatment in the community are effective in reducing subsequent criminality.

Adult↗
PubMed1978

[Steps toward a therapeutic community in a psychiatric hospital (author's transl)].

The psychiatric hospital is conceptualized as a social organism with its own development. Every important change or new development follows certain laws. When those steps of phases of development are known their unfolding can be guided more easily. Resistance must be expected and tends to hinder the planned development. There is also a risk of wrong or defective development, endangering the overall goal. The different systematic phases, resistances or risks in changing a psychiatric hospital from a traditional-custodial to a milieu-active institution are summarized in a table. The described milieu therapy is that of a therapeutic community; its conceptualization is briefly discussed. Milieu therapy as a term is at the same time understood in a inclusive and in a complementary way: Inclusive in so far as all therapeutic procedures in a hospital are coordinated via milieu therapy; complementary in the sense that all activities which take place beside the classical therapies (pharmacotherapy; psychotherapy, etc.) are understood as therapeutic activities.

Hospitals, Psychiatric↗
PubMed1979

Therapeutic community dropouts: criminal behavior five years after treatment.

Two hundred and two male dropouts, mainly heroin abusers averaging 3 to 6 years out of treatment, were sampled from the 1970-1971 Phoenix House admissions by race and time in program (less than 1 month to more than 2 years). Criminal justice arrest records were compared between three pre- and all posttreatment years. Percent and rate of arrest declined significantly in followup. Magnitude of reductions was uniform across race and legal status, varied by age, but increased systematically by time in program. Results replicated and extended earlier findings, confirming long-term positive change in criminal behavior associated with length of stay in the therapeutic community.

Adult↗