Therapeutic Community Model (TC Model)

Dr. Mahmooda Aftab

Introduction

Dr. Mahmooda Aftab

Rules

Dr. Mahmooda Aftab

What is TC?

Dr. Mahmooda Aftab

Dr. Mahmooda Aftab

Overview of the TC Model

TCs have evolved to serve an ever- increasing

range of special populations with substance use

disorders, including women with children, older

adults, adolescents, people with co-occurring

mental disorders, people with HIV/AIDS, people

who are homeless, and people involved with the

criminal justice system. Dr. Mahmooda Aftab

Training: Overall Goals

To provide a common knowledge base in TC model and to encourage training participants to work on their professional growth and development.

Dr. Mahmooda Aftab

Training: Overall objectives

1. Understand and be able to explain

 

The history, basic concepts, and components of the TC

 

The TC views of the disorder, the person, recovery, and right living

 

The social structure and physical environment of the TC

 

The TC treatment methods

 

The ways in which staff members help residents change their behavior, attitudes, and self- identity through the community-as-method and the self-help and mutual self- help learning processes

The expectations, roles, and competencies of all staff members Dr. Mahmooda Aftab

2. To experience increased self-awareness

3. To be able to identify their roles

4. To experience and understand the TC process through participation in role plays

Dr. Mahmooda Aftab

The TC Learning Approach   A mixture of presentations, discussions, and exercises

Small group work to create a sense of community and to promote self- help and mutual self- help

Time to reflect and write thoughts and feelings in a personal journal

Review and feedback

Dr. Mahmooda Aftab

Small-Group Exercise

What quality does each person in the group have in common with others?

What do you expect to get out of this training?

Which TC slogan would you like to adopt as your group slogan for the training?

Dr. Mahmooda Aftab

Tea Break

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Staff Competencies 1. Coordinator has knowledge of data-gathering tools as well as assessment

instruments that facilitate the evaluation of a member’s strengths as well as areas needing improvement.

2. Understanding and promoting upward mobility and the privilege system (Module 10).

3. Understanding and promoting self- help and mutual help (Module 4).

4. Understanding and practicing the concept of “acting as if” (Module 1).

5. Understanding and discouraging the concept of the “we–they dichotomy” (Module 7).

 

 Dr. Mahmooda Aftab

Staff Competencies

1. Understanding the relationship between belonging and individuality (Module 6).

2. Understanding and facilitating the group process (Module 8).

3. Maintaining accurate records (Module 10).

4. Understanding social learning versus didactic learning (Module 4).

5. Understanding the need for a belief system within the community (Module 3).

6. Understanding and practicing positive role modeling (Module 7). Dr. Mahmooda Aftab

Practicing “Acting as If”

When an individual acts in a certain way long enough, the thoughts and feelings that support the behavior will strengthen.

Feelings, insights, and altered self-perceptions often follow behavior change rather than precede it.

What is your slogan? Dr. Mahmooda Aftab

Exercise: What is a TC?

Structure & Environment

Dr. Mahmooda Aftab

A TC is a structured method and environment for changing human behavior in the context of community life and responsibility.

Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

1. The Origin of AA/NA

2. The Origin of Minnesota Model

3. Beginning and Evolution of TC

Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

Many individuals admitted to TCs have a history of social,

education/vocational skills, and positive community and family ties that have

been eroded by their substance abuse. For them, recovery involves

rehabilitation -- or re-establishing healthy functioning, skills, and values as

well as regaining physical and emotional health.

Other TC residents have never acquired functional life-styles. For these

people, the TC is usually their first exposure to orderly living. Recovery for

them involves habilitation -- learning for the first time the behavioral skills,

attitudes, and values associated with socialized living.

Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

TCs are residential facilities and located away from the drug-related environment. As a participant in the community, the resident in treatment is expected to adhere to strict and explicit behavioral norms.

Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

These norms are reinforced with specific contingencies

(rewards and punishments) directed toward developing self-

control and responsibility.

The resident will progress through a hierarchy of

increasingly important roles, with greater privileges and

responsibilities.Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

Other aspects of the TC's "community as

method" therapeutic approach focus on

changing negative patterns of thinking and

behavior through individual and group therapy,

group sessions with peers, community-based

learning, confrontation, games, and role-

playing.Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

TC members are expected to become role models who actively reflect the values and teachings of the community.

Routine activities are intended to counter the characteristically disordered lives of these residents and teach them how to plan, set, and achieve goals and be accountable.

Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

Participation in a TC is designed to help people appropriately and constructively identify, express, and manage their feelings.

The concepts of "right living" (learning personal and social responsibility and ethics) and "acting as if" (behaving as the person should be rather than has been) are integrated into the TC groups, meetings, and seminars.

These activities are intended to heighten awareness of specific attitudes or behaviors and their impact on oneself and the social environment.Dr. Mahmooda Aftab

The Beginning and Evolution of the TC

TCs are designed to emphasize the experience of community within the residence.

Newcomers are immersed in the community and must fully participate in it.

It is expected that in doing so, their identification with and ties to their previous drug-using life will lessen and they will learn and assimilate new prosocial attitudes, behaviors, and responsibilities.

Dr. Mahmooda Aftab

Treatment Stages

Stage 1. Induction and early treatment

typically occurs during the first 30 days to assimilate the individual into the TC. The new resident learns:TC policies and procedures; Establishes trust with staff and other residents; initiates an assisted personal assessment of self, circumstances, and needs; begins to understand the nature of addiction; begins to commit to the recovery process.

Dr. Mahmooda Aftab

Treatment Stages

Stage 2. Primary treatment 

often uses a structured model of progression through

increasing levels of prosocial attitudes, behaviors,

and responsibilities.

The TC uses interventions to change the individual's

attitudes, perceptions, and behaviors related to drug

use and to address the social, educational, vocational,

familial, and psychological needs of the individual.Dr. Mahmooda Aftab

Treatment Stages

Stage 3. Re-entry

is intended to facilitate the individual's separation from the TC and successful

transition to the larger society.

A TC graduate leaves the program drug-free and employed or in school. Post

residential aftercare services may include individual and family counseling and

vocational and educational guidance.

Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous are

often incorporated into TC treatment, and TC residents are encouraged to

participate in such groups after treatment.

Dr. Mahmooda Aftab

Today’s TCs

A mix of professionals

Evaluation research

Program and staff competence standards

Professional associations

Common components

Adaptations to new settings and special populations

Dr. Mahmooda Aftab

Therapeutic Communitiesfor Special Populations

WomenAdolescentsIndividuals with co-occurring mental health

disordersPopulations involved in the criminal justice

systemPersons living with HIV/AIDS

Dr. Mahmooda Aftab

Modified TCs

Research efforts have sought to determine how to modify TCs

to accommodate the realities and constraints of a managed care

health environment.

Major adaptations being tested include the impact of shorter

lengths of stay and the use of a day treatment model.

Dr. Mahmooda Aftab

Lunch Break60 Minutes

Dr. Mahmooda Aftab

14 Basic Components of a TC1. Community Separateness

 

2. Community Environment

 

3. Community Activities

 

 4. Staff as Community Members

 

 5. Peers as Role Models

 

 6. A Structured Day

  

7. Stages of the Program and Phases of Treatment 

Dr. Mahmooda Aftab

Exercise

Dr. Mahmooda Aftab

Health Break

Dr. Mahmooda Aftab

14 Basic Components of a TC

8. Work as Therapy and Education

  

9. Instruction and Repetition of TC Concepts

 

10. Peer Encounter Groups

  

11. Awareness Training

 ·  

12. Emotional Growth Training

 

 13. Planned Duration of Treatment

 

14. Continuation of Recovery After TC Program Completion 

 

Dr. Mahmooda Aftab

Exercise

Dr. Mahmooda Aftab

Journal Writing and Wrap-up

Dr. Mahmooda Aftab