Training

The need for specialized training for leading or working as a staff member in a therapeutic community has been a matter of some debate. (32) There is an argument that the emphasis on egalitarianism and democratization means that this form of treatment is best delivered by people without special training who can just 'be themselves'. Unqualified social therapists often form a key part of the staff complement. However, the other argument is now increasingly accepted, that while being oneself is an important part of the staff role (see above), therapeutic community work requires a high level of skill and knowledge in a number of areas, together with a well-developed capacity for open honest discussion and reflection.

Training courses exist in the United Kingdom, Finland, Norway, The Netherlands, and Greece, but there is no set standard or curriculum. One of the most popular short courses in the United Kingdom and The Netherlands is a brief residential simulated therapeutic community. Here, 20 to 30 health professionals live together for a few days in the roles of residents with a 'staff group working with them. This provides a valuable opportunity to experience at first hand the workings and impact of this form of treatment.

More formal training should include the following contemporaneous components:

• practical experience of working in a therapeutic community

• supervised practice

• theoretical tuition in individual, group, and organizational functioning and models of therapeutic change

• personal therapeutic experience

• experience as a resident in a therapeutic community.

Norton and Fainman(33) have also made the case for a placement in a therapeutic community to be part of professional training in psychiatry and psychotherapy. The benefits include learning at first hand about the treatment of personality disorders, experience of group-based treatment, and working as a member of a multidisciplinary team, thus gaining first-hand experience of institutional dynamics and the way individuals react to their wider social networks.

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