Tuesday, August 24, 2010

Therapeutic Communities (TCs)--How some are thriving, some are dying off...and why

Daytop was one of the first therapeutic communities in the nation, and for many years, one of the most respected. Over the past couple decades, however, it appears to be in decline. Referral sources are holding back on sending clients there, financial problems have resulted in widespread layoffs, and rumors abound about poor quality treatment.

Yet the original notion of "community as method," which spurred the original TC movement in the 1960s, is still very relevant. Instead of the Betty Ford Center-kind of approach to treatment, TCs traditionally are more confrontational, less "cushy," and focus on two things: Your peers in treatment are the ones who can help you most (community as method of change) and Personal Responsibility. Everyone must work in a TC and the work (in kitchen, housekeeping, office, etc.) is considered part of learning to be responsible and carry one's weight. The underlying motivation for TC approaches is so "right on." So how has it gone so wrong and fallen into such disrepute?

1) Many of the original TCs (like Daytop) stayed foolishly loyal to "old ways" of doing things and failed to take into consideration what the research was showing. Very little "evidence-based" treatment in some of the old TCs.

2) Original recovering addicts who ran the TCs back in the 1960s and 1970s were promoted through the ranks (at least in Daytop) and became eventually top administrators. This failed to bring the most talented possible people into administration, because the person who came through the program and came up through the ranks was most often given priority for promotion over "outsiders."

3) Because there was little oversight or questioning of the TC strategies of heavy confrontation, sitting on metal chairs, learning experiences, "haircuts," etc., there arose abuses of power, many of which were protected rather than weeded-out.

The end result of these things in the TC movement was to retard the growth and renewal of such a great approach (community as method / personal responsibility).

I'd love to hear from people who are managing or working in therapeutic communities which have not fallen into the above traps but have evolved in a healthy, effective manner. I'd also love to hear from people who have observed some of the same things I have about the therapeutic community movement which are NOT working..


  1. Donna,
    I couldn't agree more with you about the decline of some TC programs. I have to be careful,now, about the programs in which I place my student interns because the old practices are antithetical to the best practices being learned by the students. I have had interactions with some TCs, however, that demonstrate a clear desire to implement the newer approaches, so I think this is the route of their survival. One outstanding characteristic of those that don't work is the insistence that one must be in recovery in order to work with the clients.
    Keep commenting - this is a good place to create discussion...
    Joan Standora

  2. But isn't it best practice for counselors to be in recovery?

  3. All things being equal, of course, it's a major benefit for the counselor to also be someone in recovery. That said, making it an (often unspoken) practice to give hiring preference to those who've "come through" that particular program, has the sad effect of missing out on talent that hasn't. I believe people can come to their wisdom and effectiveness as counselors through many avenues. Often people have struggles to overcome, whether involving addictions, compulsive behaviors of other sorts, or mental health issues. Empathy toward a recovering person can, therefore, exist even in a person who hasn't been through a T.C. So while there may be a small benefit to having been through that experience, it shouldn't be the first filter used in sifting through applicants.