Therapeutic Community Program

The Importance of a Supportive Environment

People will usually find it easier to deal with their problems if they are in a supportive environment.
Atherapeutic community program aims to create the right conditions for people to change
undesirable behaviors and learn new ways of doing things. It can be very useful for helping the
individual deal with problems such as addiction. The focus is on the life of the individual and not just
on their specific symptoms. This type of environment is artificially created, but the individual will be
able to take what they learn and use this in the outside world.

Therapeutic Community Defined

This is a type of community where people live together as a form of therapy. Such environments are
drug free and highly structured. Within such a community the individual can feel safe to explore new
coping mechanisms and learn to cooperate with other people. It is like a miniature society in which
members can grow and develop.

Milieu Therapy
The therapeutic community is closely associated with Milieu therapy. This is a form of psychotherapy
where the emphasis is on using the environment as a therapeutic tool. The word milieu is French
and meansmiddle place or middle ground. The idea of a middle ground tends to conjure up images
of a safe place, and this is exactly what such a therapeutic setting is meant to be. Here the individual
is viewed as possessing the inner strengths to change their own behavior. Their surroundings will
encourage them to take advantage of these inner strengths and put them to work. The lofty goal of
milieu therapy is that every element of the individuals environment should be therapeutic in nature.

How a Therapeutic Community Program Works

Most therapeutic programs involve participants living together with therapists. In some communities
a therapist will be there all the time, but this is not always the case. This community is run by
consensus, and the role of the therapist is just to facilitate. The individuals within the program are put
into a position where they have to fit in with the rest of the group. Peer pressure can work as a
powerful force in ensuring that people adapt. If they fail to do this then life will become difficult.

It is usual for this type of program to include:

* Regular community meetings and discussions. This gives the members the opportunity to discuss
problems and evaluate the behavior of each other.
* Coping skills workshops and other types of learning. The individual will not only learn new
strategies but will also be able to experiment by using these within the community.
* Community government. This is where all the members of the community make collective
decisions.
* Care plans based on the individual needs of each client.

The Benefits of a Therapeutic Community Program

This type of environment works to help the individual in a number of ways including:

* People within such a community have a much better idea of how their behavior impacts other
people
* Members can develop leadership skills
* The individual will develop a better understanding of other people
* Life is highly structured and this means that members can feel safe
* The individual is empowered and so able to take responsibility for their own behavior
* Members are motivated to solve problems due to challenges faced in the community
* There is a focus on living rather than dealing with symptoms
* The confidence of the individual increases as they see their importance within the community
* Members learn how to corporate with others
* The individual feels that they have some control over the rules that govern their life in the program
* Membership of such a community is often a joyful experience

Important Elements of a Therapeutic Community

In order for this type of community to be truly therapeutic it needs to involve certain elements
including:

* A complete ban on all intoxicants

* A focus on shared responsibility
* Members should be protected as much as possible from potential stressors
* Each individual takes responsibility for their own behavior and be willing to follow the rules
* The group is encouraged to solve problems together
* Participation by all members in decision making
* A clear understanding of roles within the community; including the role of the therapist
* Agreed upon rules which are enforced by the group
* Open communication
* Regular feedback on the behavior of participants
* Individuals are encouraged to confront anyone who is behaving poorly within the community

The Importance of a Safe Community

In order for the individual to change they will need to feel safe to do so. In the outside world there
can be many pressures that keep people locked in undesirable behavior. The stress of just trying to
make it though the day may be all they can manage. Trying to change in such an environment can
be a challenge. The therapeutic community is created in such a way that people are protected from
many stressors. There iscomfort in routine and predictabilitysomething that is often missing in the
outside world. They will have fewer temptations and while they are a member of the community there
are usually no pressing work worries or bills to pay. The community is completely focused on therapy
and growth. This gives the individual a lot more freedom to try new ways of dealing with life.

Addiction Treatment and Milieu Therapy

It is generally accepted that the setting in which addition treatment takes place is important. This is
why rehabs will put a lot of effort into creating a therapeutic environment. These programs are not
always spoken of as milieu therapy but they are based on the same principles. The benefit of such
an approach is that it moves the focus away from merely treating the symptoms of addiction to
building a life in recovery.

Halfway Houses as a Therapeutic Community

Some people who leave rehab go on to spend some time in a halfway house. These are sometimes
referred to as dry houses because intoxicants will not be allowed. Residents can stay in a halfway
house for periods of a year or more. In many instances such facilities provide a therapeutic
community where residents can further develop coping mechanisms. Such places also provide a
safe environment from which he individual can build a successful recovery.
Behavior Therapy
Humans Can Change Their Behavior
Behavior therapy is based on the idea that maladaptive behaviors can be eliminated by the adoption
of new healthier behaviors. One important idea is that the individual will choose to do things based
on past consequences of their actions. In other words they have learnt to behave in a certain way; if
this is the case then they will be able to unlearn negative behaviors.

If past experience of doing something led to a positive outcome, the individual will be more likely to
do it again in the future. This explains why people begin abusing substances; once they associate
alcohol or drugs with reward they will have an increasing desire to abuse again in the future. Reward
and punishment can be used as tools to encourage people to adopt healthier behaviors. It has led to
techniques such as aversion therapy and token economy.

The Goals of Behavior Therapy to Treat Addiction

The goals of behavior therapy for treating addiction are:

* Modify behavior in relation to substance abuse

* Improve skills for healthy living
* Modify attitudes towards alcohol and drug abuse
* Help the individual get more from rehab and other treatments
* Encourage people to stay in treatment longer
* To enhance the effects of medications

Types of Behavior Therapy Used to Treat Addiction

There are a variety of different behavior therapies that can help individuals dealing with addiction
including:

* Overt sensitization involves pairing maladaptive behavior with undesirable consequences. A good
example of this would be the drug Antabuse which is given to alcoholics to encourage them to stop
drinking. If they touch alcohol while taking this drug it will make them very sick. Electrical shocks can
also be used and this method may involve less risk than Antabuse.
* Covert sensitization is another type of aversion therapy. Here there is no attempt to pair an actual
negative consequence with the behavior, but instead the individual just mentally pictures a negative
consequence.
* Cognitive-Behavioral Therapy works by helping the client understand their thoughts and emotions.
The individual learns that while they might not always be able to control what happens in the outside
world, they will be able to control their thoughts and feelings about it.
* A token economy is where the individual receives rewards for good behavior. This is usually in the
form of tokens which they can later exchange for items or privileges.
* Motivational interviewing involves challenging and encouraging the addict to take action to change
their behavior. The client is encouraged to gain a deeper understanding of their addiction, and the
means by which they can escape.

Behavior Therapy Techniques

There are a variety of techniques that the behavior therapist can use. These activities can increase
the clients understanding of their present circumstances and encourage them to adapt new
behaviors. Usefulbehavior therapy techniques include:

* Role playing allows the client to improve their understanding of social interactions and alter their
behavior in response to this. A good example of this would be using role play to develop drink refusal
skills.
* Behavior modification is where the client receives a reward for desirable behavior.
* Self-monitoring is where the individual details their actions in a journal throughout the day. This
journal is then usually shared with the therapist. A good example of this would be the client who is
asked to record how much they are drinking.
* Scheduling of activities involves the client agreeing to take part in certain activities before the
next session. These activities will be of a positive nature where the individual will be encouraged to
change their normal behaviors.
* Behavior contracts is where the individual signs a contract not to engage in the undesirable
activity again. If they break the contract there will usually be consequences attached to this. There
can also be incentives for sticking to the terms of the contract.

Cognitive Behavioral Therapy

In recent years there has been increasing interest in cognitive behavioral therapy (CBT) as a means
to help clients escape addiction. It is a type of talking therapy where the emphasis is on empowering
the individual to take charge of their own thoughts and feelings. Many of the problems the individual
will experience will be due to faulty thinking or belief about themselves or others. A good example of
this would be the individual who thinks they are unlovable. Such negative thinking can lead people
into addiction.

By examining thoughts and feelings more closely the client, with the help of the therapist, is able to
understand themselves a lot better. One of the advantages of CBT is that it can lead to
breakthroughs in a relatively short period of time although this is not always the case. During the
treatment the client is encouraged to examine those thoughts that are leading them to engage in
substance abuse. Once they see that their flawed thinking has been the source of much of their
problems they will find it a lot easier to break away from addiction.

Pros and Cons of Behavior Therapy as an Addiction

Treatment
While behavior therapy can be highly effective, it is probably not going to work for everyone. Some
individuals may lack the insight to be able to benefit from CBT. Techniques such as self-monitoring
require a high degree of self-honesty and many individuals struggle with this. There is also the worry
that aversion therapy may prove harmful, in particular, overt techniques that produce vomiting or
involve electrical shocks. Antabuse can lead to death if the individual has consumed too much
alcohol.

There is no doubt that behavior therapies can help the individual beat their addiction. This is why
such techniques have been widely adapted in rehabs and other treatment programs. CBT receives a
lot of praise for its ability to get the individual to take charge of their own life. Such empowerment
can not only help them escape addiction, but to also build a successful life in recovery.