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De Leon, G. (2000). The therapeutic community: Theory, model, and method. New York City: Springer Publishing Company.


This newly published volume provides a single theoretical framework for therapeutic communities for addictions and related problems. Its uniform approach to the subject makes this volume accessible to mainstream public health, science, and education fields. A comprehensive formulation of the TC, this volume is the product of clinical and research experience within the long-term residential TC, commonly viewed as the "traditional" model. With its documented effectiveness, the traditional model of the TC serves as the prototype for the current diversity of TCs.







The Therapeutic Community: Theory, Model and Method

George De Leon

May 11, 2000 marks the publication of The Therapeutic Community: Theory, Model and Method (Springer Publishers, N.Y.), authored by the director of The Center for Therapeutic Community Research (CTCR), George De Leon, Ph.D. Dr. De Leon is recognized as the leading researcher on the therapeutic community approach to treating substance abuse and related disorders. A recipient of the NIDA Pacesetter award (1993), Dr. De Leon has been a NIDA grantee for over 25 years. For the last 9 years, he has been the Director and a Principal Investigator of NIDA-funded CTCR at the National Development and Research Institutes (NDRI) in New York City.

As stated in the text, “NIDA’s commitment to therapeutic community research helped to established the scientific credibility of the modality as a bona fide social psychological treatment approach. NIDA's funding of TC studies provided an uninterrupted opportunity to acquire the experiences and information needed for this book project.”

The TC is fundamentally a self-help approach, which has 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.

Notably missing in the clinical and research literature, however, has been a single theoretical framework that presents the TC for addictions and related problems as a uniform approach accessible to mainstream public health, science, and education. The present volume was conceived to fill this gap. It presents the first comprehensive formulation of the therapeutic community as a theory, model, and method. It evolved from clinical and research experience obtained primarily in the long-term residential TC, which is commonly viewed as the "traditional" model and, with its documented effectiveness, still serves as the prototype for the current diversity of TCs.

The theory, model, and method of the TC formulated in the present volume canguide clinical practice, research, and program development.

First, it defines “therapeutic community” as a unique self-help,albeit, bona fidesocialpsychological approachto the treatment of addictions and related problems. The term“therapeutic” denotes the social and psychological goalsof TCs, namely changing the individual's life style and identity. The term “community”denotes the primary method,or approach, employed to achieve the goal of individual change. The community is used to heal, teach, and train individuals in how to behave, think, perceive and experience themselves.

Second , it identifiesthe essential elementsof the TC approach as the collection of concepts, beliefs, assumptions, program components, and clinical and educational practices common to TC programs. The "essentiality" of these elements is derived from multiple sources: the author's own observations and research of TC programs over some 25 years, the manuals of many contemporary TC programs, and the conceptual and historical literature of both addiction and psychiatric therapeutic communities.

Third, the essential elements organizedinto a single framework consist of three components: the perspective, model, and method. The perspectivedepicts how the TC viewsthe substance abuse disorder, the individual substance abuser, the recovery process, and right living. The modelpresents what the TC is as a treatment program: its structure, social organization, and daily regimen of activities, all of which are grounded in the perspective. It distinguishes the unique, self-help element of its approach–community as method, in whichindividuals are taught touse the peer community to learn about themselves. Thus, all activities in the TC are interventionsdesigned to produce therapeutic and educational changes in individual participants, and all participants are the mediators of these changes.

                        Fourth, it relates the three main components of the frameworkperspective, model, and method—to the process of change. All the elements of the TC are intended to facilitate individual changes in lifestyle and identity. How these changes unfold reflects the individual's interaction with community and the internalization of its teachings.

The volume is organized into five major parts spanning 25 chapters that detail the history, conceptual framework, and practice of the therapeutic community and review the related research. Part A outlines the evolution of the TC and the current issues compelling the need for an explicit theoretical formulation of the therapeutic community.

Part B details the perspective and approach of the TC in terms of its view of the addiction as a disorder of the whole person, the social and psychological characteristics of the substance abusers addressed in the TC, its developmental view of recovery and goals of right living. The fundamental components of its unique TC treatment approach are outlined, summarized in the phrase “community as method.

Part C details the “nuts and bolts” of the TC program model. Seven chapters describe how the physical and social environment and the components of resident work foster a culture of therapeutic change; how the varied social roles of peers and staff and interpersonal relationships mediate socialization and therapeutic change; and how the program stages structure the process of change in accordance with the TC view of developmental recovery.

Part D organizes the daily regimen of activities in the TC as specific methods designed to impact both the individuals and the community. Community and clinical management activities consist of privileges, disciplinary sanctions, security and surveillance. Community enhancement activities include the main facility-wide meetings. Therapeutic-educational activities consist of the various forms of group process along with supplemental groups such as relapse prevention, vocational and life skills training, and social and health education.

Part E presents an in depth conceptual formulation of the TC as a uniquesocial psychological approach. The treatment process in the TC is framed as the dynamic relationship between the community as a context of planned and unplanned multiple interventions and multidimensional change in the individual. Thus, interrelated changes in behaviors, attitudes, experiences, and perceptions gradually evolve into lifestyle and identity change as individuals fully immerse themselves in the community and internalize its teachings. Social and psychological principles, naturalistically mediated in the context of community life, explain how individuals learn in the TC. However, the ongoing interaction between the individual and the community captures the essence of the treatment process in the therapeutic community.

The concluding chapter of the volume addresses issues of evolutionary change in the TC. It briefly outlines how the theory, model, and method can be adapted to retain the unique identity of the TC as it moves further into the mainstream of human services.



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