Introduction
The focal point of this paper is to describe the manner through which participation in the activities of a Therapeutic Community promotes change and recovery from behavioral health disorders. The therapeutic Community uses Cognitive Behavioral Therapy (CBT), which is the term used for intense short-term psychotherapy for a range of problems including substance abuse, anxiety disorder, marital conflict, depression, fears, and personality problems.
Using the tools of cognitive assessment, specific distortions are addressed by the therapist who then guides the patient in correcting thinking patterns. Essentially therapy is aimed at getting patients to interpret what they are facing today rather than childhood experiences. CBT makes the patient learn self-help skills, which are practiced in ‘homework’ that helps in changing the way a patient thinks and feels, presently. Treatment is focused on the now and is action-oriented and practical, aimed at gaining confidence in facing real-life issues.
Before treatment
Under Therapeutic Community, before treatment starts, self-assessment forms filled by the patient help determine what problems the patient is facing now along with the history of treatment/problems. There is mutual agreement on problems to focusing on and the level of symptoms. This way, progress can be tracked across treatment. There is comprehensive information on several issues available through books and other media, which the patient is advised to access.
There is a lot of information on anxiety, depression, and other conditions, to keep updated. Periodic reviews to keep the treatment in perspective and to understand the possible need to fulfill small goals for a positive outcome in the context of both physical and mental health. Without feeling overawed, the patient is made to sense his emotions, as they are the starting point for all experience.
The process of treatment
As part of Therapeutic Community therapy, more skillful clinicians help the patient with an agenda for treatment and self-exposure sessions or homework – but avoid being rigid in recommending any response. The reason is that life happens between sessions –and the cues for response are embedded in the un-simulated situations that real life brings. Clients may fight, experience the ‘high’ of good news like a promotion at work or pregnancy or some unforeseen event for which they have not been prepared in the previous therapy session.
Clients can come back to therapy sessions less sure of themselves and it can be a challenge for therapists to interrupt routine therapy sessions and engage clients with a different view on the circumstances and assign them home tasks like breathing sessions and happy experiences, which help in coping with uncertainty and low self-esteem.
One example is a middle-aged woman who saw her role as a caregiver to her aging mother becoming unmanageable. She seemed not to comply with her home assignments convinced that she was not going anywhere with her own and others’ happiness. She was challenged by her therapist to take more responsibility for her happiness so she could take better care of others. This helped and later home assignments strengthened her beliefs. Therefore, in a way homework compliance can be viewed as an adjustment to life if properly discussed with patients. Homework reveals key pathology and thus opportunities for new perceptions. (Freeman et al 2007)
Homework therapy
Homework or skills learned in treatment are a crucial component of the Therapeutic Community. However, its relevance is clear when seen alongside an improvement in symptoms. Studies have thrown up evidence of a more effective outcome of Therapeutic Community treatment with homework therapy than that without. However, many therapy session records show that homework compliance has not been measured giving a lopsided picture of its capability. As a result, much of homework therapy is considered as an ‘uncontrolled variable’ in Therapeutic Community as there is no clear measurement of its effectiveness as a process.