Purpose Therapeutic communities and psychologically informed environments have been shown to be effective in improving individual’s mental health and well-being by providing an empowering, structured and supportive environment where service users feel safe to communicate and change their maladaptive behaviour. Despite many studies supporting the use of these environments, much research is still needed to uncover what these services deem as their research priorities and how dissemination can be increased to be seen as evidence-based practice. The purpose of this study was to investigate research needs within these environments and the barriers they face in conducting research. Design/methodology/approach An online survey for staff working in relational environments was circulated through the Consortium of Therapeutic Communities mailing list. Respondents reported on their recent conducting of research as well as their research needs and priorities and barriers to conducting research. Findings Thirty-two individuals responded indicating that research had been conducted but not on areas that were considered a priority. Services believe there are huge gaps in existing research, specifically in the effectiveness and cost effectiveness of the services and the long-term impacts on the service users. Research needs to be conducted to understand patient and staff experiences, the outcomes of service users, comparisons across services and how to improve. The main barriers that were found preventing research included clinical demands and a lack of time, funding, infrastructure and expertise. Originality/value This paper offers an insight into what research services feel are necessary to inform practice and effectiveness and to provide an evidence base to justify and support the usefulness of the services.
Purpose The Cassel Hospital is currently an NHS in-patient and day-patient service that functions as a psychotherapeutic community. It has had an interesting historical journey through the past 100 years of its existence. The purpose of this paper is to highlight aspects of the therapeutic work at the Cassel that are seen to facilitate personal growth and development for both staff and patients working there. The authors reflect on their collective experiences of working therapeutically as patients and staff at the Cassel, in differing services and at different times. The authors seek to identify particular and distinct therapeutic aspects in the process of treatment. Design/methodology/approach The authors relate their own experiences of working at the Cassel Hospital, in an example of autoethnographic research. The authors provide unique personal details of this experience. In their discussions, the authors allude to some previous quantitative and qualitative research studies undertaken at the hospital. Using a collaborative approach, they arrive at a description of ways of working therapeutically at the Cassel. In the body of authors' reflections, they describe how they have tried to use their experiences, and knowledge gained at the Cassel, to advance the planning and development of clinical services elsewhere and to facilitate the functioning of some like-minded organisations. Findings The authors collaboratively develop a "Pick 'n' Mix" model of treatment that incorporates a range of therapeutic options from which each patient can chose to build a unique road to change, learning and development. Originality/value Each author relates their own unique, personal experiences of working at the Cassel Hospital. The authors discuss and explore their experiences together and arrive at a description of ways of working therapeutically there. In their reflections, each author describes how they have used their experience and knowledge from their time at the Cassel to advance the planning and development of clinical services elsewhere and to facilitate the functioning of some like-minded organisations.
Purpose-Four authors explore an evolving practice of psychosocial nursing at the Cassel Hospital and its likely relevance to therapeutic nursing in other settings. The authors do this by revisiting the Flynn (1993) paper entitled "The patients' pantry: the nature of the nursing task'', and add three personal reflections, from our differing perspectives, on this paper Design/methodology/approach-Rereading Caroline's paper focuses our differing reflections on understanding the relevance of evolving psychosocial nursing practice to the therapeutic work of the Cassel today, and to therapeutic work in other mental health settings. Findings-The first reflective piece is written by a retired medical staff member, the second is from a higher trainee in medical psychotherapy who worked there more recently and the third is written by two current psychosocial nurses working on the Adult Inpatient Service there. Research limitations/implications-This paper is a qualitative outline of a way of working that actively involves patients and nurses in exploring their own ways of thinking, feeling, relating and behaving. It can be a rich source of learning for the patients and the nurses involved. Practical implications-How can opportunities to work in this way in our very stretched National Health and Social Care Services be developed? Does the expertise still exist among nursing staff to work in this way? Social implications-Can psychosocial nursing, as outlined in this paper, help in keeping hope of therapeutic progress alive in mental health services? Originality/value-All three reflections are original and are written from current, recent and more distant experiences of working at the Cassel.
Purpose This article aims to make people aware of the Award and to give a bit of background to who Elly Jansen is. Design/methodology/approach Conversational, informational. Findings This study describes the Award and some of Elly Jansen’s early history and reason for funding the Award. Research limitations/implications The aim is to foster new research. Practical implications This should encourage particularly new writers and researchers to produce material on subjects related to therapeutic communities. Social implications The Award should open up writing and research to more people with lived experience as well as up-and-coming professionals. Originality/value The piece is original and describes an Award that is only just in its second year and not widely known as yet.
PurposeThere is little existing research on the long-term impact of a Therapeutic Community (TC) on staff and service users alike, particularly for a TC that no longer exists. With TCs becoming a "dying breed", often due to funding cuts, this information is as important as it's ever been. The purpose of this paper is to provide more evidence into the long-term effectiveness of TCs.Design/methodology/approachThe Acorn Programme at The Retreat, York, closed its doors in 2018 after 18 years as a TC for women with self-defeating behaviours. Staff and service users from across the span of the programme were asked about the impact of having been a member of the TC, four years after the physical unit had closed. The themes from their answers were drawn out using interpretive phenomenological analysis, which includes reflexivity from the Lived Experience Research - a former client from the Acorn Programme.FindingsThe themes arising could be grouped into several broad categories; impact on life, impact on interacting with others, impact in managing stressful events, impact in dealing with mental health services, useful things taken forward and negative impacts. It was clear that members had taken the ethos of Acorn forward into their work and personal lives, after having left the programme.Originality/valueThe message was clear, being a member of a TC does have a significant impact - mostly positive, although some negative - on the staff and service users involved. This stands the test of time, withstands other difficult life experiences and the TC lives on in the hearts and lives of the people who were part of it, long after the physical place has gone.
Purpose Therapeutic communities (TC) change the patient’s thinking and behavior by facilitating abstinence self-efficacy to attain substance temptation restraint. However, abstinence self-efficacy does not involve the capacity to generate strategies to achieve temptation restraint. TC also emphasizes the importance of self-help and mutual self-help, engaging peers to achieve temptation restraint. This study aims to explore the following: 1) explore how abstinence self-efficacy predicts temptation restraint; 2) how external peer hope influences abstinence self-efficacy and temptation restraint; and 3) how internal hope influences the moderating role of external peer hope. Design/methodology/approach A predictive and cross-sectional design was utilized to test the moderating effects of internal and external peer hope on the relationship between abstinence self-efficacy and temptation restraint. Process macro model 3 was used to explore the moderation of external peer hope and internal hope. Findings Results reflect a significant interaction of internal hope and external peer hope in moderating the relationship between abstinence self-efficacy and temptation restraint. Slope analysis suggests that combinations of high internal hope and high external peer hope, and high internal hope and low external peer hope positively interact with abstinence self-efficacy and temptation restraint. Originality/value This study provides empirical evidence on the role of locus-of-hope in substance use recovery in therapeutic communities in the Philippines. Furthermore, the findings provide valuable insights into the synergistic and compensatory mechanism of the locus-of-hope in therapeutic communities.
Purpose This paper aims to describe the role of playing in nursing work within a modified therapeutic community – the Cassel hospital. Design/methodology/approach The methodology behind the writing is a reflective practice, where the author draws on her own experience of working as a psychosocial nurse at the Cassel and make links with psychoanalytic theory to suggest reasons for the importance of playing in the treatment of patients with histories of abuse. The tumult and intensity of the emotional work with patients led her to think of playing in terms of the Carnivalesque, and to associated practices such as the use of clowning and ritual in the attempt to face the most difficult things. Findings Within a culture of enquiry such as the Cassel, being playful can help loosen rigid fears about just what will be found once we start enquiring into our inner worlds. Practical implications The implications can be extended beyond this to nurse education in general. Psychosocial nursing and, in particular, teaching about patients who self-harm are increasingly marginalised within nursing degrees, pushed out of the curriculum by the requirement for more physical health-care training within mental health nursing degrees. Originality/value This paper supports arguments in favour of adjusting nurse education to include greater emphasis on relational practice.
Purpose Community institutions (CIs) in Flanders offer support and guidance to young people who committed youth offences to reduce the risk of recidivism and to enhance the juveniles’ well-being. To pursue this dual goal, the CIs base their activities on the good lives model (GLM). Conflicts frequently occur during the daily life in CIs. Life space crisis intervention (LSCI) is used to deal with these conflicts. This paper aims to report on a theoretical study regarding the potential compatibility of LSCI and the GLM. Design/methodology/approach This paper is based on a theoretical study, grounded in literature and practice-based experience, regarding similarities and differences between and the compatibility of LSCI and the GLM. Findings LSCI and the GLM share a number of common aspects related to origin, theoretical background, the importance of human needs, the focus on the “here and now” and future planning. Originality/value It can be concluded that the GLM and LSCI are compatible and can be used in a complementary way. This does not mean that both could be “melted together”, but that they can be integrated and – as such – strengthen each other. In doing so, the GLM provides professionals a framework that can help them to determine forensic treatment goals and to elaborate forensic trajectories, in close cooperation with the young clients themselves. Simultaneously, LSCI, as a specific and concrete method, provides professionals with the necessary tools for daily practice during these trajectories.
Purpose This paper aims to give a unique, experiential patient perspective on Cassel Hospital’s outpatient treatment, Outreach; the authors were patients at the time of writing the paper. Design/methodology/approach A collaborative–autoethnographic approach immerses readers into the psychodynamic, psychosocial community-based treatment. Initially, this paper discusses lived-experience research and therapeutic community treatment, including a description of the Outreach programme and its rationale. The second part of the paper provides subjective accounts, reflections, written by three authors on the same week in treatment, using a diary format. Thematic analysis is used to identify themes emerging from the reflections. Findings The reflections highlight the importance of the relationships between the patients who relate to and impact one another. The argument is made that the patients, are the treatment. The reflections also demonstrate how treatment is embedded in patients' daily lives. Research limitations/implications Limitations lie in the small sample group. Also, the paper was written during the COVID-19 pandemic, a period that necessitated hybrid working. This contrasts with the typical treatment model at the Cassel, which is delivered in-person. This paper recommends further research exploring patient relationships, from the perspective of the patient, at Cassel. In addition, the authors have benefited from writing this paper and suggest that further research could examine the benefits of lived-experience-led research in community-based services like Cassel Outreach. Originality/value Originality lies in this patient-led, collective–autoethnographic perspective of the authors’ treatment, through which readers experience an immersive and first-hand account of life within a community-based therapeutic community.
Purpose The therapeutic community (TC) is an environmental intervention where principles of working together democratically can enhance self-agency. While availability of inpatient TCs within the UK National Health Service (NHS) has declined, shorter or alternative interventions using core TC approaches have shown promise in enacting change. The purpose of this paper is to report and reflect on the development and running of a pilot nano-TC. Design/methodology/approach Foundations Group was a 2-h TC group intervention set up and run within the NHS for 18 months in 2021–2022, and taking place on City Farm premises. The group was convened as part of the complex emotional needs service in a mental health NHS Trust in the South West of England. Over the study period, the group comprised 11 members, one peer member and three staff members. Findings The authors reflected on the TC stance of working democratically with a fluid hierarchy, taking a non-expert approach, and using support and challenge to enhance self-agency and belongingness. The authors have detailed the structure of the group session including use of community meetings, psychoeducation, creative sessions and reviews. Members took on roles within the group including chairing sessions. Originality/value This group was a novel service within the NHS Trust where it was conducted and may represent a standalone therapeutic group. The authors hope it will show that core TC principles can be applied in shorter interventions than have previously been used.
Purpose This study aims to enhance wider understanding of attrition in forensic environments by testing the hypothesis that “negative interpersonal relating” tendencies can predict attrition within a democratic therapeutic community (DTC). The person’s relating to others questionnaire (PROQ; Version 3), a measure of negative relating, is routinely administered to men upon admission to the TC. Design/methodology/approach A sample of 300 men who had completed the PROQ3 upon admission between 2014 and 2018 and had either completed therapy (N = 52), been de-selected during the assessment phase (N = 46) or had been de-selected at the core therapy phase (N = 202) were included in the study. Existing data sets for total PROQ3 score and the corresponding eight sub-scale scores were input and analysed on SPSS in two stages; using multinomial logistic regression and one-way Anova, respectively. Findings Analysis showed that significantly higher levels of negative relating were present in men that did not complete therapy, compared to those who completed, supporting the main hypothesis. Analysis of the PROQ3 sub-scale scores showed that men who were de-selected from therapy during the core therapy phase had significantly higher scores on the “closeness” scales (lower close, neutral close, upper close), compared to completers. Similarly, men who were de-selected during the assessment phase had significantly higher scores on the “lower distant” scale, compared to completers. Originality/value Results are discussed considering their implications for future policy and practice in the context of understanding and managing attrition within a TC.
Purpose The purpose of this paper is to examine the psychometric characteristics of male offenders who joined a democratic therapeutic community and their relationship to attrition. Design/methodology/approach Residents who left therapy prematurely during the assessment phase (N = 46) and residents who left therapy prematurely during core therapy (N = 202) were compared to residents who completed therapy (N = 52) on two psychometric measures: Raven’s Standard Progressive Matrices and The Blame Attribution Inventory. Findings A multinomial logistic regression analysis showed higher levels of external blame can predict attrition during therapy; those with higher levels of external attribution are significantly more likely to leave therapy prematurely, including both during the assessment phase and during core therapy. Raven's Standard Progressive Matrices score did not significantly predict whether an individual left therapy prematurely. Originality/value Support was found for existing research within the academic evidence base. The findings have both empirical and clinical utility, suggesting during the assessment phase of therapy, practitioners can identify residents that may require additional support to maintain engagement, minimising the potential for premature departure. The implications of the findings are discussed, with suggestions made for future research.
Purpose Therapeutic community (TC) is a primary approach that has been used in all Indonesian National Narcotics Board residential treatment centers since 2012. In TC, all daily activities are strengthened into habits and routines without strong therapeutic or educational reasons. But recently, the TC members become more critical and have growing individual needs. Thus, the Indonesian National Narcotics Board (INNB) tried to combine the TC approach with thematic group activities (TGA) intervention using an integrated individual approach to improve the outcomes. This study aims to evaluate the client’s behavioral changes after undergoing a TC approach added with TGA intervention for two months. Design/methodology/approach A mixed-methods study with the pre-post design was applied to 122 participants from six INNB rehabilitation centers. Pre-post behavioral changes were measured by using Client Evaluation of Self Treatment, University Rhode Island Change Assessment Scale, modified-Addiction Severity Index 3.0 and World Health Organization-Quality of Life instruments. Analysis was done by using univariate and bivariate on quantitative data, focus group discussion, and medical record review. Findings The participants’ mean age was 30.57 years, majority male, 50% graduated from senior high schools and were employed. Bivariate analysis resulted statistically significant (p-value < 0.05) in tendencies to seek treatment, participate more actively, maintain a good relationship with counselors during the program, and decrease the psychological problems of participants. The client’s social state, as well as adaptation to the program, were also amended. Originality/value TGA-added TC approach was proven to improve clients’ behavioral changes, particularly in social functioning, program involvement and psychological conditions, in people with substance use disorders.
Purpose This paper aims to tell something of the story of the “Hawkspur Experiment” (1936–1941), a therapeutic camp organised early in the modern history of therapeutic community as an intervention into the lives of young men who were viewed to be at risk of delinquency (Wills, 1967). Although it was to have a remarkable influence on group and therapeutic community practice and theory, the authors argue that its influence is not as well-remembered nor incorporated into contemporary therapeutic understanding and discussion as it should be. Design/methodology/approach This paper is a historical reflection based on systematic examination of the clinical and administrative records of Hawkspur Camp for men, and supporting documents held in the Planned Environment Therapy Archive. In addition, the authors use published primary and secondary sources. Findings Hawkspur Camp was a cross-disciplinary enterprise which brought together psychoanalytic thinking, social work, an interest in groups, political activism, a concern with the dynamics and working of democracy and the application of emergent social science methods. It was overtly an intervention into the criminal justice system but was also an intentional exploration of the therapeutic benefits of community living and of a “pioneering” lifestyle; a rigorous experiment in how psychoanalytic ideas might be used in group residential settings; and a politically grounded exploration of participative democracy as a fundamental therapeutic principle. Originality/value To the best of the authors’ knowledge, this paper presents the first findings from a systematic study of the records of Hawkspur Camp.
Purpose This study aims to raise awareness of the importance of the sociological aspects of therapeutic community work, including clarity about the nature of the task, the power of informal interactions between participants and the relevance of leadership.Design/methodology/approach Applying insights from historical research to present-day practice.Findings The Northfield experiments offer a number of insights into present-day practice of therapeutic communities and enabling environments. These include clarity about the task, the relevance of participant interactions outside of specifically therapeutic work and the importance of leadership.Social implications The therapeutic community/enabling environments approach has relevance to a wider sector of society than solely the therapeutic. More attention needs to be paid to leadership issues in the therapeutic community movement, as well as the therapeutic power of the mutual support networks amongst those receiving care.Originality/value Through the lens of the Northfield experiments, this paper offers a broadening of the sociological nature of therapeutic community practice, arguing that the purpose is to enable greater social adaptability, thereby enhancing relationships and deepening our awareness of ourselves. Implicit in this perspective is the recognition of the power of non-formal interrelationships in the service as well as the importance of leadership. It is also suggested that our experience in this way of working has a value in other organisations such as work places or schools. However, to achieve this, we need to adapt our language appropriately.
PurposeAdopting a sense of critical enquiry when examining historical sources, it is possible to gain a richer and broader sense of present practice. The aim of this study is to emphasise the importance of historical research to present practice in teasing out the different elements at work and how they developed. A core assumption is that our consciousness depends on our interactions with others.Design/methodology/approachThis study is part of ongoing research into the historical background of the practice of discerning compassion. The methods used include archival research and the reading of primary and secondary literature.FindingsIn particular, it becomes clear that this way of working is always going to be problematic for political authorities as it promotes the questioning of accepted beliefs. This study emphasises that the core concepts underlying enabling community practice reach deep into the past and involve events not usually associated with the traditional histories of the approach. In particular, exploring outside of the traditional mental hospital background reveals a greater involvement of women than previously demonstrated. There are processes that have deep historical roots, the culture of enquiry, the benefits of mutual support and the understanding that people flourish better interacting with each other in a supportive and trusting environment rather than through coercion and instruction.Research limitations/implicationsAs with all historical research, this paper is limited by the resources available to examine particular events.Practical implicationsRecognition of the importance of historical enquiry as relevant to present-day practice.Social implicationsHistorical enquiry helps to acknowledge the importance of social events in shaping our present understanding. As W.H. Rivers argues, we have to understand what happened in the past before comprehending why present sociological events occur.Originality/valueThis paper is a unique enquiry into the early historical antecedents of enabling community practice. It is intended to stimulate more research into the field and to stimulate debate about the relevance of particular aspects of practice. It refers to sources that are not usually part of such discussions and, by implication, suggests that there is more to be explored. It is not an exhaustive account and is to be supplemented by another paper on leadership.
Purpose This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use disorder (SUD). Design/methodology/approach A descriptive cross-sectional study was carried out in two selected residential treatment centers which follow the TC model as a rehabilitation approach. All the clients of the selected residential treatment centers were invited to take part in the study and data were collected from 75 consented male participants using an interviewer-administered questionnaire. The perceived effectiveness of the residential treatment was assessed using the Treatment Effectiveness Assessment instrument. Data were analyzed using descriptive statistics. Findings Most of the participants were Sinhalese (98.7%, n = 74) with a mean age of 27.0 ± 6.0 years. The average duration in which participants stayed at selected centers was 8.0 ± 4.0 months. Most of the participants reported that the encouragement during the program was sufficient (89.3%, n = 67), psychological support was satisfactory (89.3%, n = 67), freedom (69.5%, n = 52) and facilities were adequate (76.0%, n = 57) within the program. A higher proportion of participants said that the counselors and program guides were friendly (80.0%, n = 60), and participants were allowed to communicate with their family with restrictions (92.0%, n = 69). The mean perceived effectiveness score (score range 1–40) was 34.0 ± 7.0 and the four domain scores (score range 1–10) were substance use (9.0 ± 2.0), health (8.0 ± 2.0), lifestyle (9.0 ± 2.0) and community (9.0 ± 2.0). The majority (88.0%, n = 66) of the participants perceived a high level of treatment effectiveness. Originality/value There is a paucity of empirical evidence on effectiveness of TC model for individuals with SUD in South Asian countries including Sri Lanka. The findings of this study highlight that the participants perceived higher effectiveness of the residential treatment which follows the TC approach for Sri Lankan individuals with SUD.
Purpose The purpose of this paper is to understand deeply the important elements of the reintegration phase of recovery. Design/methodology/approach The participants were 14 people suffering from addiction to drugs, who met the criteria for substance use disorder according to the diagnostic and statistical manual of mental disorders, fifth edition. The data obtained by semi-structured interview were qualitatively analyzed by interpretive phenomenological analysis. Findings The results highlight the importance of relationships in therapy, identity reshaping, a deeper understanding of the causes of substance use, the importance of boundaries, the critical parameters of the transition to regularity and the important role of emotions. Originality/value The results are discussed on the basis of the enhancement of the therapeutic interventions that are followed at the reintegration stage, taking into account not only the peculiarities of this phase but also social factors such as stigmatization.
Purpose COVID-19 pandemic is affecting the well-being and the psychological resilience of different populations, particularly in the addiction field. This study aims to assess anxiety and its severity among patients and staff from different types of addiction services in Israel during this emergency. Design/methodology/approach The study was conducted during the period from March–July 2020. Participants included patients and staff (N = 282) from three different types of addiction services, were administered the State-Trait Anxiety Inventory, the multi-dimensional scale of perceived social support and demographic variables. In addition, a logistic regression model was applied to identify predictors of state anxiety by using statistical package for the social sciences software. Findings The results show that therapeutic communities clients reported more social support compared to other subjects. State anxiety has a positive strong correlation with trait anxiety both among patients and staff, and it was found as a crucial predictor of state anxiety in the regression equation. There is no statistically significant correlation between state anxiety and social support, gender or education among clients and staff as one. The state anxiety remains relatively stable and characterizes most people, staff and patients, men and women, medical staff members and other professionals. Research limitations/implications The current study has some contributions to the addiction field by understanding the psychological distress of a vulnerable population: substance users in treatment settings. The study population relied on convenient samples and future studies should be planned using a cross-sectional design and should take into account substance use measures. The findings are reinforcing the assumption that state anxiety was likely to increase during the coronavirus pandemic. Practical implications Adequate services should be planned to avoid relapse or mental deterioration of people who use drugs during health emergencies. Originality/value The research points out the unique and real difficulties of SUD clients, as well as the complexity and risks in their staff members’ works. The authors also saw that staff members need attention and maintenance; they are in the front line.
