Therapeutic community
On the one hand, the therapeutic community is a therapeutic field. It uses the entirety of all therapeutic forces at work in a hospital. At the same time, it is the community of all patients who support each other in their therapy process. A therapeutic community is a temporary community . People with comparable problems decide to use the power of the community to “treat” one another under the guidance of experts.
precursor
Theater performances in so-called madhouses in Paris at the end of the 18th century for therapeutic purposes were the first attempts to take people with mental health problems seriously and to integrate them into the social context. In the years following the French Revolution, Philippe Pinel staged a "psychodramatic" process to cure a patient from the obsession that he should be executed.
In 1891, Pierre Janet used hypnosis and the repetition of traumatic events through scenic productions to trigger cathartic processes in his patients. Around 1813 separate theaters were built in psychiatric hospitals in Aversa , Naples and Palermo ; Scotland and England followed this tradition.
The first therapeutic communities were established in the 19th century. The Ludwig Binswanger d. Ä. The Bellevue Sanatorium, founded in 1857 in Kreuzlingen , Switzerland, is a prototype.
In 1905 Joseph H. Pratt gathered his tuberculosis patients in groups at Massachusetts General Hospital in Boston and instructed them on hygienic measures. In the 20s and 30s he placed the group at the center of his psychiatric work and used it to discuss the importance of emotion in the healing process.
In the winter of 1917/18 Jakob L. Moreno worked with Tyrolean refugees in Baden near Vienna and developed the first approaches to his sociometry . In 1921 EW Lazell was doing group analysis with World War II veterans at St. Elizabeth's Hospital in Washington, DC. In the same year Alfred Adler and Rudolf Dreikurs developed case conferences in Vienna in which teachers, parents and children discussed the problem areas together. Against Freud's opposition , Trigant Burrow developed the first approaches to group psychoanalysis in the 1920s .
Classic applications
The psychiatrist and psychoanalyst SH Foulkes combined psychoanalytic and sociological concepts for group analysis . As a major in 1942, he introduced group therapy for rehabilitation of so-called war neurotics at the Northfield Military Center military hospital. To do this, he restructured the entire clinic into a "therapeutic community". Team meetings and patient meetings were viewed as a group process. Administration, kitchen, house and nursing staff, doctors and patients were all involved in the therapeutic process and were responsible for the patient's recovery.
Tom Main and Wilfred Bion have contributed greatly to the development of therapeutic communities with their group therapy methods.
Other classic therapeutic communities are the US-founded Synanon movement for drug addicts, in whose housing project in Santa Monica (California) over 300 participants lived together drug-free. The daytop village of the psychiatrist Dan Casriel (founder of bonding psychotherapy), which was inspired by this, was also one of the first important therapeutic communities in the USA.
In Germany, the now historical Bad Herrenalber Clinic Model by Walter Lechler is an important example of therapeutic communities that has been used in several psychosomatic clinics in recent psychotherapy history. It combined principles of therapeutic community with the spirituality of the Alcoholics Anonymous 12-Step Self-Help Movement and Bonding Psychotherapy .
Basics
Tom Main described the following requirements:
- "The hospital is to be seen as a psychosocial whole, the individual parts of which are related to and interact with one another, so that therapy, care and administration are to be seen as a common clinical activity.
- Psychoanalytically oriented work in hospitals requires an organizational structure that can develop as spontaneously as possible and unhindered by external constraints from within the community.
- Individuals and patients actively participate in the design and development of this organization.
- Therapy in the clinic takes place in a multi-person treatment situation of which the doctor is only a part.
- In order to achieve its goals, the hospital needs a lively exchange with its environment.
- The difficulties in coexistence that arise in the community and the disturbances in the relationship between hospital and the environment require further analysis. "
Reflecting on everything that happens in the therapeutic community is the basis for social learning. Group life becomes the central element of the therapeutic process.
Therapeutic community works on two levels:
- It promotes the memory of old hurtful experiences and associated feelings and thus offers the opportunity to work on them in a therapeutic process - in order to increasingly shape an autonomous, self-determined life.
- The social climate of the therapeutic community enables new, positive life experiences - this allows old deficits to be filled.
Psychoanalysis and Therapeutic Community
The Therapeutic Community was developed by psychoanalysts and social psychologists . Accordingly, transference and countertransference , free association , resistance and defense etc. receive a lot of attention ( group analysis ). Another focus is communication theory ( Watzlawick ). As a result of the large group , all social issues and conflicts also occur in mirror image in the therapeutic community.
Values of the therapeutic community
A therapeutic community is a lived system of values. These values include:
- honesty and openness
- Justice in give and take
- Personal growth as a prerequisite for rights and duties
- Trust in the healing power of the community
- Trust in the power of will and consciousness
- Responsibility for yourself and others
- Sense of community
- Participation in terms of the UN Convention on the Rights of the Child
Rules are derived from these values, to which patients and employees jointly undertake.
Methods
Central elements in the life of the therapeutic community are:
- daily community session in which everyday therapeutic life is discussed
- subsequent team meeting in which the previous community meeting is reflected on
- Group therapy , core group with up to ten patients
However, the following basic democratic elements are also used:
- Morning sessions that relate to the clinic and everyday therapy
- General plenary to say goodbye and to welcome new patients (weekly, with all employees and patients, open to visitors)
- Patient assembly
- Large therapeutic group (forum or committee) to improve communication skills and support in difficult processes
- Distribution of joint tasks and areas of responsibility
- Sponsorship systems for guidance
- Lectures on basic questions of health and illness, treatment concept, transfer of clinical experience to everyday life, healthy eating habits, etc.
- Leisure activities on the weekend
- Participation of patients in improvement and complaint management
Self-government and authority
The therapeutic community grants as much freedom as possible and uses as little coercion as necessary. For this purpose, a system of self-administration will be created. Patient committees, general assemblies, team discussions, norms, rules, agreements, and agreements, tasks and responsibilities are part of the therapeutic community.
The patients are challenged to get involved through concrete action and through spontaneous expression and living out of feelings within the framework of the rules (no violence). Learning by doing, participatory observation, mutual support, joint work and leisure are essential elements.
This open form is also suitable for people with personality disorders.
Employee
All employees are part of the therapeutic community. The nursing staff is of paramount importance, just like all other employees in the house, from administrative staff to gardeners. Because they usually have much closer and more intensive contact with the patient than the "therapists". Their work is significantly upgraded compared to that of the doctors. In joint and often public team discussions, all employees reflect on their work across hierarchies and functions. Planning takes place to a large extent together with the patient. Decisions are made jointly where possible. The therapists are members of the group, the patients are co-therapists. This places high demands on the therapists in terms of maturity, openness and cooperation. The continuity of the group of therapists ensures a safe, reliable framework.
application
The principle of the therapeutic community is applied in all possible variations and degrees in psychiatry, drug therapy, psychosomatic clinics , and addiction therapy. It is also used in youth welfare. In both Austria and Germany there are therapeutic communities which, as inpatient facilities, combine education, pedagogy and psychotherapy.
See also
literature
- Adam Blatner: A Historical Chronology of Group Psychotherapy and Psychodrama . 2007.
- Dan Casriel: rediscovery of feelings. To a shout from happiness. 12 & 12, Oberursel.
- Hans Kayser, Helmut Krüger, Wolfram Mävers: Group work in psychiatry. Experiences with the therapeutic community. 2nd revised and expanded edition. Thieme, Stuttgart et al. 1981, ISBN 3-13-492602-4 .
- Hermann R. Hilpert: About the contribution of the therapeutic community to inpatient psychotherapy. / The contribution of the therapeutic community to inpatient psychotherapy. In: Journal of Psychosomatic Medicine. 29, 1, 1983, ISSN 1438-3608 , pp. 28-36, (foundations by T. Main).
- Maxwell Jones: Principles of the Therapeutic Community. Social learning and social psychiatry. Published by Edgar Heim . Huber, Bern et al. 1976, ISBN 3-456-80341-9 .
- Andreas Ploeger: The therapeutic community in psychotherapy and social psychiatry. Theory and practice. Thieme, Stuttgart 1972, ISBN 3-13-484001-4 .
- John T. Salvendy: The Borderline Patient in the Group: Basic Findings. In: Group Psychotherapy and Group Dynamics. 28, 1992, ISSN 0017-4947 , pp. 349-355.
- Lewis Yablonsky : The Therapeutic Community. A successful way out of drug addiction (= addiction problems in education and therapy 8). Beltz, Weinheim et al. 1990, ISBN 3-407-55736-1 .
- Tom J. Wolff: Make love with life and become who you are. Healing community and biodanza. Ryvellus, Saarbrücken. 2016. ISBN 978-3-89060-686-6 .