BACKGROUND OF THERAPEUTIC COMMUNITY

BACKGROUND OF THERAPEUTIC COMMUNITY

The correction-based therapeutic community (TC) is a widely described treatment

modality for (substance abusing) offenders. Its origins can be traced back to two major
independent traditions: the American drug-free hierarchical concept-based TC and the
British democratic Maxwell Jones-type TC. The hierarchical approach was modeled on
Synanon, founded by Charles Dederich. It developed as a self-help movement for the
treatment of substance abusers; primarily using behavioral modification techniques. The
democratic approach is most commonly associated with Maxwell Jones. It developed as
a professional group work method to treat people suffering from a range of psychiatric
difficulties, primarily using social learning principles.

50 Years After Its First Appearance, the TC Has Evolved Into a Successful
Treatment Model..

Seven out of every 10 men and eight out of every 10 women in the criminal justice
system are drug users - persons who used illicit drugs with some regularity prior to
entering the criminal justice system. The Federal Drug Use Forecasting system data
show that the use of all drugs except cocaine has increased since 1989, and cocaine
remains at the same level. Accordingly, the 1990s have seen major increases in arrests
of drug users, followed by pressure for funds to expand correctional capacity to treat
those inmates with serious drug problems. Interestingly, with this increase has come
increased public support for programs aimed at treating drug users and curbing drug-
related crime. There is a genuine public and government concern that without
treatment, most drug-involved offenders will resume their criminal activities and drug
use after release and inevitably will return to criminal justice system custody.

The 1994 Crime Bill included, for the first time, a substantial sum provided for treatment
of inmates in state and local correctional systems. The Residential Substance Abuse
Treatment for State Prisoners Formula Grant Program (abbreviated RSAT) legislation
created an opportunity for states to apply for funds to establish residential substance
abuse programs beginning in 1996. In conjunction with this legislation, Congress has
authorized spending $270 million for the first five years of the program, the largest sum
ever for the development and enhancement of substance abuse treatment programs in
state and local correctional facilities.
Largely because of research showing that prison-based therapeutic community
programs can significantly reduce recidivism and drug relapse, RSAT legislation
encourages the development of this residential treatment model, in addition to other
viable treatment approaches, including cognitive skills training, behavioral programming,
vocational methods and even 12-step programming.

Therapeutic Communities

Historically, the term "therapeutic community" (TC) has been used for several different
forms of treatment - sanctuaries, residential group homes and even special schools -
and for several different conditions, including mental illness, drug abuse and alcoholism.
For example, the British TC emerged primarily as a process for treating military
veterans as they returned from WWII with serious neurotic conditions from their
experiences in combat and as prisoners of war. The term was coined when Thomas
Main pioneered a therapeutic model combining community therapy with ongoing
psychoanalytic psychotherapy in 1946. This was a modification of therapeutic work
developed about the same time by Maxwell Jones and several others. By 1954, TC
ideas were influencing wards in British psychiatric hospitals.

At about the same time, the use of tranquilizers began to emerge as the dominant
"treatment" for institutionalized, mentally disordered persons. Drastic reductions in
psychiatric beds and other confinement beds occurred as facilities closed down. In the
1950s and 1960s, the TC movement shifted toward other milieus, notably corrections,
and TC principles began to guide offender programs in the United Kingdom. Grendon
Prison was built in 1959 specifically with a number of wings within which TCs would
experimentally operate to provide treatment for psychologically disturbed offenders.

THE DEMOCRATIC TC AND ITS APPLICATION IN PRISON (BRITISH TC)

The democratic TC is described as ‘a small face-to-face residential community using

social analysis as its main tool, which can be considered as one of the first attempts to
rehabilitate people (neurotic soldiers) by means of the ‘therapeutic use of groups’ and
some experimental treatment units during and just after World War II for neurotic
soldiers and ex-prisoners of war, initiated by Maxwell Jones. Jones is commonly
referred to as the ‘father’ of the democratic therapeutic community. Jones formulated
the axioms of his work as follows:
Photo Credit: TCTC (Maxwell Jones)

(1) two-way communication on all levels;

(2) decision-making on all levels;

(3) shared (multiple) leadership;

(4) consensus in decision-making; and

(5) social learning by interaction in the ‘here and now’.

Social learning could be described as Socratic learning, in which the facilitator simply
helps the participants to uncover the knowledge from within the group, rather than
introducing new knowledge through teaching. The Democratic TC has four central
principles:

(1) Permissiveness: residents can freely express their thoughts and emotions without
any negative repercussions (in the sense of punishment or censure).

(2) Democracy: all residents and staff members have equal chances and opportunities
to participate in the organization of the TC

(3) Communalism: face to face communication and free interaction to create a feeling
of sharing and belonging.
(4) Reality testing: residents can be, and should be, continually confronted with their
own image (and the consequent impact of that) as perceived by other clients and staff
members.

IMPORTANT PERSONALITIES IN THE DEVELOPMENT OF TC IN ENGLAND

(BRITISH TC)

In the mid-1940s Maxwell Jones, a British psychiatrist, became frustrated and

disillusioned with what he saw as the failure of traditional psychiatric treatment. He
founded a community to provide structure and content for therapeutic change in the
lives of individuals with long- standing mental disorders. In this community, Jones
successfully treated difficult psychiatric cases considered beyond treatment, such as
“chronic failures” and “troublemakers.”

Jones based his approach on the theory that a healthy group life would make healthy
individuals and considered all relationships to be potentially therapeutic. He also
believed that productive work was an essential component of treatment.

Jones’ model became the prototype for psychiatric TCs and spread throughout
England. The term “therapeutic community” came into use to describe this community
model of treatment.

Features common to this first TC model and today’s TC include

 A holistic approach that goes beyond the single-level approach of traditional

psychiatry or medication alone

 Belief that the community that is created affects the recovery of the individual

 Having clients actively participate in the community and engage in work that allows
them to resocialize successfully into society

 Using communication and relationships among all members of the community to aid
the recovery process.

THE CONCEPT-BASED TC AND ITS APPLICATION IN PRISON (AMERICAN TC)

A concept-based therapeutic community is ‘a drug-free environment in which people

with addictive problems live together in an organized and structured way to promote
change toward a drug-free life in the outside community. Every TC has to strive towards
integration into the larger society; it has to offer its residents a sufficiently long stay in
treatment; both staff and residents should be open to challenge and to questions; ex-
addicts can be of significant importance as role models; staff must respect ethical
standards, and TCs should regularly review their reason of existence.’ The hierarchical
TC was modeled on Synanon, a dynamic groupwork living initiative founded by Charles
Dederich in 1958. The essential elements of the American hierarchic drug-free
therapeutic community are extensively described as the most crucial, which stresses
the ‘purposive use of the peer community to facilitate social and psychological change
in individuals’. Parallel to the characteristics of the democratic TC, the following
principles can be summarized:

(1) Community: living together in a group and showing responsible concern and
belonging is the main agent for therapeutic change and social learning.

(2) Hierarchy: daily activities take place in a structured setting, where people ‘act as if’
they have no problems and where ‘older’ residents serve as role models.

(3) Confrontation: negative behavior, which interferes with the community concepts,
values and philosophy is confronted and put to limit. During confrontations in encounter
groups all feelings can freely and openly be expressed.

(4) Self help: the resident is the protagonist of his own treatment process. Other group
members can only act as facilitators.

Alcoholic Anonymous

It was founded in 1935 by two people who had alcoholism: Bill Wilson, a New York
stockbroker, and Bob Smith, a physician. They were both struggling and frustrated by
what they saw as the failure of the medical, psychiatric, and social service
establishments to help people with alcoholism effectively.
They met in Akron, Ohio, and their mutual sharing about their disorder sparked the idea
for an organization of persons with alcoholism helping other persons with alcoholism
stay sober. They came to believe that people with alcoholism could help one another
stay sober. Today, AA is a well-established international support group program based
on 12 Steps and 12 Traditions that support the individual through recovery.

A critical component of the AA program is sponsorship, wherein one AA member who

has been in the program for some time works with one or more newer members to
orient them to the program, offer feedback, and serve as a role model of recovery.

Features common to the TB patients groups, AA, and today’s TC include

 Self- help

 Helping others (mutual self- help)

 Role modeling

 A small- group format.

Synanon

It was founded in 1958 in California by Charles (Chuck) Dederich, a person recovering

from alcoholism. Dederich created Synanon (A drug rehabilitation program) to provide
an alternative to AA, which he thought was limited, especially for people who used illicit
drugs. (Narcotics Anonymous was struggling to establish itself at this time, with only a
few groups in California and New York; it did not stabilize into its present form until the
mid-1960s.) Synanon began as weekly group meetings, evolving within a year into a
residential program to treat people with any sort of substance use disorder.

Synanon was a groundbreaking, innovative organization that brought together large

numbers of people who lived and worked together in a quest for personal change at a
time when “addicts” were considered “incurable.”

Photo Credit: Getty Images

Synanon’s founding principles, which still apply to today’s TC, were that

 Treatment should provoke “dissonance,” meaning discord or conflict, to individuals’

self- image so they are no longer comfortable with who they are.

 A unique encounter group process was developed based on the premise that when
challenged, people examine themselves and learn new ways of behaving.

 A residential community supports the individual change process.

Definitions of Therapeutic Community

1. A TC is a structured method and environment for changing human behavior in the

context of community life and responsibility.

2. The Therapeutic Community (TC) is an environment that helps people get help while
helping others. It is a treatment environment: the interactions of its members are
designed to be therapeutic within the context of the norms that require for each to play
the dual role of client-therapist. At a given moment, one may be in a client role when
receiving help or support from others because of a problem behavior or when
experiencing distress. At another time, the same person assumes a therapist role when
assisting or supporting another person in trouble.

3. The TC is fundamentally a self-help approach, evolved primarily outside of

mainstream psychiatry, psychology, and medicine. Today, however, the TC is a
sophisticated human services modality, as evident in the range of its services, the
diversity of the population served, and the developing body of TC-related research.
History and Evolution of Therapeutic Community in the Philippines Setting

The history of the TC in the Philippines goes back to the 70’s when the former Drug
Abuse Research Foundation, Inc. or DARE adopted the model in the first Asian TC in
Trece Martires, Cavite called Bahay Pag-asa to treat heroin addicts. Within months after
the declaration of Martial Law by Marcos in 1971, DARE opened several more
residential treatment centers around Manila and in Baguio City. Through DARE, the TC
spread to Malaysia, Thailand and other Asian countries. Now there are community-
based and prison-based TCs in most of these countries.

Since its inception in the Philippines, the TC has been adopted as a drug treatment
model in many private for-profit programs in the Philippines. In the U.S., large not-for-
profit drug programs continue to use a water-down version of it, particularly the use of a
more loose social structure and selective applications of some of its traditional
behavioral-shaping tools. The outcome of such indiscriminate variations in the TC has
been catastrophic resulting in the breakdown of effective social control in many of these
programs. In the Philippines, government drug programs under the criminal justice
system have since applied the TC in some of the jails under the Bureau of Jail
Management and Penology (BJMP) and prisons of the Bureau of Corrections (BUCOR),
including the outpatient services for parolees and probationers by the Philippine Parole
and Probation Administration (PPA). Several police agencies such as the National
Bureau of Investigation (NBI) treatment center in Tagaytay and the old Bicutan
treatment center, formerly under the Philippine National Police (PNP), have also applied
their version of the TC. The latter two treatment centers, which have been absorbed by
the Department of Health (DOH), together with other government centers in other cities
and provinces, have implemented a variant of the TC adapted to their realities.

A big break for the spread of the TC in the criminal justice and other government drug
programs in the Philippines happened in 1997 when the PPA obtained funding from the
U.S. State Department’s Bureau of International Narcotics and Law Enforcement Affairs
(INL) to receive training on the TC from Daytop International. This multi-agency project
included the Dangerous Drugs Board (DDB), Department of Social Welfare and
Development (DSWD), PNP, NBI, BUCOR, BJMP, Quezon City Anti-Drug Abuse
Advisory Council, Paranaque Anti-Drug Abuse Council, the PPA, and a few private
TCs. This project lasted for several years and included study tours and internships by
some training participants in the Daytop facilities in the U.S.

Synthesis
Here are the module’s key ideas:

 A TC is a structured method and environment for changing human

behavior in the context of community life and responsibility.

 The Therapeutic Community (TC) is an environment that helps people

get help while helping others.

 The TC is fundamentally a self-help approach, evolved primarily outside

of mainstream psychiatry, psychology, and medicine.

Responsible for supervision includes drug testing counselling and support

services to help reintegrate these individuals into society

Community

It refer to the management and oversight of correctional facilities such as prison

and jails as well as the the supervision of individuals who have been sentenced
to serve time in these facilities or are under some form of community
supervision.

Correctional Administration

The primary goal of Correction Administration

To ensure public safety facilitate rehabilitation and maintain order within the correctional system

Why do criminal offenders need to be incarcerated

One of the primary methods used by criminal justice systems around the world to punish and
rehablitate individuals who have committed crime

Aim to rehabilitate persons deprived of liberty reduce to likelohood of reoffending

oversee educational vocational and councelling programs designed to help
persons deprived of liberty develop skills and address the underlying causes of
their criminal behavior

Community Supervision

Responsible for the tasked with supervising persond deprived of liberty to

prevent escape violence and other dissruptions within the facility

Persons Deprived of Liberty

It refer to placed on probation and parole which involve close supervision and
monitoring by probation or parole officer

Probation and Parole Supervision

It refer to responsible for the day to day operations of correctional facilities

including managing staff ensuring the safety and security of boh persons
deprived of liberty and staff

Prison and Jail Management

Identify one treatment that provide for criminal behavior.

Counseling and Therapy