Phases of treatment for the individual

Starting treatment

During the induction phase the new resident will be introduced into the group activities and be offered informal support by fellow residents, who play a key role in explaining the norms and expectations of the therapeutic community. During this early phase of treatment the new resident will be feeling his or her way, forming attachments to one or two residents, but still wary of the groups.

Middle phase

After the first month or two the new resident will begin participating more actively in the groups, taking part in the full life of the community with certain role responsibilities (see above), helping and supporting other residents. During this phase the resident will probably experience situations similar to those that triggered the behaviour that led to his or her admission. These situations could include having to deal with authority, fear of failure, feeling rejected or abandoned, situations evoking rivalry and competition, etc. As before, these may trigger violent impulses towards the self or another person, or the experience of other symptoms of distress. Through the group meetings the resident is confronted with the effects of their behaviour on fellow residents and the meaning of the behaviour or symptoms is explored, making full use of the insights and understanding of fellow residents. Through this repeated process the resident gradually comes to experience himself and others differently. As one resident wrote: 'Bit by bit, almost grudgingly, the fact dawned on me that I wasn't surrounded by forty sticks of furniture but by Jim, Gary, Jane...'.(!Z>

Ending treatment

There are various types of ending. Some residents may leave prematurely, unable to cope with therapy; some may be 'voted out' by the community for a serious or repeated transgression of community rules. Such endings do not necessarily indicate a treatment failure, although the longer residents remain the more likely they are to benefit. Residents who complete treatment usually plan their leaving, agreeing a date with the rest of the community. Residents can develop a strong attachment to and dependency on the community, which means that special attention needs to be paid to ending. Many communities have leavers' groups or a designated re-entry phase in which the problems of separating and re-establishing a life in the outside world are discussed by residents approaching the end of their stay. Increasingly therapeutic communities are also developing aftercare programmes. These take various forms including weekly group sessions and individual support with practical needs. In the case of prison-based therapeutic communities for ex-addicts the provision of drug-free housing and vocational training have been found to improve success rates.(18)

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