Book contents
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- Part 3 Specific treatment approaches
- 13 Treating personality disorder: methods and outcomes
- 14 Skills-based therapies for personality disorder
- 15 Insight-oriented therapies for personality disorder
- 16 Treatment approaches for severe personality disorder
- 17 Mindfulness in the psychotherapy of personality disorder
- 18 Cognitive analytic therapy for borderline personality disorder
- 19 Contemporary therapeutic communities: complex treatment for complex needs
- 20 Nidotherapy: making the environment do the therapeutic work
- Index
19 - Contemporary therapeutic communities: complex treatment for complex needs
from Part 3 - Specific treatment approaches
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- Part 3 Specific treatment approaches
- 13 Treating personality disorder: methods and outcomes
- 14 Skills-based therapies for personality disorder
- 15 Insight-oriented therapies for personality disorder
- 16 Treatment approaches for severe personality disorder
- 17 Mindfulness in the psychotherapy of personality disorder
- 18 Cognitive analytic therapy for borderline personality disorder
- 19 Contemporary therapeutic communities: complex treatment for complex needs
- 20 Nidotherapy: making the environment do the therapeutic work
- Index
Summary
Summary In this chapter, we describe the principles of therapeutic communities and how they work. We discuss some of the challenges for both policy and research in relation to therapeutic community services for personality disorder. We emphasise the importance of listening to the voices of those who use therapeutic community services, as well as to professional voices, when evaluating such services.
Therapeutic communities are not a ‘brand’ of therapy, with a manual and an uncomplicated evidence base. Rather, they are a treatment culture and structure into which other therapies are incorporated as intensive programmes of integrated sociotherapy. They have long and far-reaching historical roots, and share features with numerous psychological, social and educational approaches and movements (Box 19.1). Whichever specific therapies are integrated (Box 19.2), the predominant focus is the supportive and challenging network of relationships that exists between the members, both staff and service users. This is what Foulkes (1964), the founder of group analytic psychotherapy, termed the dynamic matrix.
The diffuse and complex nature of this core concept presents some difficulties for a mental health system that requires treatments to be managed with a degree of precision and predictability, to be measurable and auditable, and to be described in a straightforward, learnable way as in a manual. This is as true for the day-to-day hurly-burly of interpersonal interaction as it is for setting up a service, and it can cause therapeutic communities to be repeatedly pressured to ‘justify’ their therapeutic value.
However, new techniques, processes and guidelines are now available that help to deal with these necessary complexities, and this account will draw attention to them. It focuses on therapeutic communities for personality disorder, but it also considers their use for psychosis, addictions, offending behaviour, and emotional and conduct disorders in children and adolescents. Treatment cultures and structural features of different services are being increasingly recognised to be more alike than different (Haigh & Lees, 2008).
- Type
- Chapter
- Information
- Clinical Topics in Personality Disorder , pp. 307 - 320Publisher: Royal College of PsychiatristsPrint publication year: 2012