TCIE 6 Strengths and Weaknesses (Spain)

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VI. The strengths and weaknesses of therapeutic communities

I would like to add a third section to this sixth chapter: the challenges I believe TCs have today in Spain.


The strengths

Up to our date, 2005, no study has been performed in Spain on the costs and benefits of TCs, but I think, and studies from other countries (1) lead me to believe that one of the strengths is that the economic benefits highly exceed treatment costs of the clients at the TCs. M. Kooyman stated that society saved a 200 % of the financial cost.

  • The treatment\'s approach takes into consideration the person as a whole..
  • Even though the specific goal is the treatment of the individual\'s disorder, the broader aim is to transform lifestyles and personal identities.
  • It makes it possible for the client to break with the world of drugs and its environment.
  • It enables the client to follow a personal and social process, and from the possibility to experience relationships with total honesty and to face problems arising from friendship, loneliness, violence and its causes, responsible love, responsibility, self-esteem.
  • It is a reality in which the client learns how to constructively use the community\'s resources and at the same time prepares him/her for an efficient use of the services outside the community. The TC by providing a psychological "home" (a microsociety), helps the clients to return gradually to the outside world.
  • The TC helps to change the social and personal factors of the client\'s identity.
  • Being part of the TC, the client gets to understand the meaning of belonging and so he/she learns to find his/her place.
  • Learning about oneself as well as the social learning experienced in the daily interaction between the person and the community has a healing effect. During the process the person becomes aware and believes that he/she can change and improve his own life
  • Most of the staff works in the TCs. Their strength comes from different sources: from their education, from the teamwork which keeps all interventions coherent and professional , from the type of relatinship that is established between the therapist and the client, and from impartiality, as there is no coercion coming from any political or religious-confessional decision. The fact that the therapeutic staff are people with a university degree and others that are rehabilitated people with a common basic theoretical as well as practical training, adds value to the therapeutic work.
  • It makes it possible to recover hope and capacity to face the future without addictions.
  • They work with the families, when there is one. This is a great help for the client and to the family, this enables the family to know what needs to be done. It is also very helpful for the family to meet other families suffering the same problems. The help they provide each other is of importance
  • Being able to make use of the therapeutic file.
  • The participation of volunteers is also important, not only as an economic support, but also as another model for the clients, different from that of the therapists, given the cost-free status and the solidarity of volunteers.
  • Usually TCs are very well integrated in their local environment, with very good relationship with the neighbors and with the members of the outside community.
  • The good relationship with other professionals, not members of the TC (psychiatrists, other rehabilitation centers (alcohol, compulsive gambling, etc.)).
  • The internal therapeutic assessment of the processes (the permanent assessment made at the TC , the assessment made by the Proyecto Hombre National Assessment Commision and the outside therapeutic assessment of results(three studies made by the Universitat de les Illes Balears, the Universidad de Santiago de Compostela and the Universidad de Oviedo) (2).
  • New experiences on special support for women, such as the TC for mothers and children, the Dona Project and other supports for couples.
  • The Proyecto Hombre Training School, which takes care of the basic and contiuous education to all the staff members of the programs and the TCs.
  • The recent set up process to obtain the Quality System Standard ISO 2001.
  • The economic audits.
  • The ability to change and adapt ourselves to new social realities and profiles. TCs for adolescents, for clients with methadone support or not, with psychiatric treatment or not, for women with small children, etc.
  • The strengths of the special TCs are their flexibility and their ability to achieve positive results in communities with people of very different profiles living together.
  • All the therapeutic tools.
  • The relationship with other TCs, Spanish, European or World Federations. Being able to share and compare activities work and the new iniciatives.
  • The relationship with other professionals not working at TCs.


Weaknesses

  • Time. A process needs time and the client wants to have results "now". This makes that the process, that is a strength can also become a weakness.
  • Finance: a daily problem to face.
  • Danger of behave in a mechanical way. It is possible that the clients adapt themselves in such a way to the TC that, instead of doing a personal process, they do and say what they believe they are expected to do or say. At the same time the mechanization is a danger to the staff members and makes them also do or say what they think is excpected in each case instead of what is really needed.
  • A permanent threat of losing the self-help identity which uis unique, adopting in its place the characteristics of a conventional public health organization.
  • For the special TCs a weakness is the important number of clients who do not have a family.
  • The number of clients with physic and/or mental deterioration is a reality and a weakness of the special TCs, specially at the time of reinsertion.
  • The difficulty and the possible lack of individualization of the process.


Challenges

This third part, that I have added, could mean strength or weakness, depending on the circumstances. It will depend on how these challenges are approached.

  • The staff (professional therapists, professional ex-drug addicts, instructors for free time, for nights, teachers, medical specialists, for example psychiatrists. Because of the multidiciplinarity of the staff, it is important that every one is aware of their role, their interrelation (for example guidelines for a client\'s treatment need always to be the same so that the a patient cannot manipulate any staff member). The center of attention is the client and not any other aspect.
  • Keeping the spirit, the atmosphere of the TC, the spirit of the self-help method and not being negatively influenced by the clients. If the TC really belongs to everybody then it is essential that everybody, both clients and staff, contribute positively and not vice versa.....
  • That all the members of the TC (staff and clients) be models of the education at the TC.both in recovery and proper lifes,
  • That the original model and method does not lose efficiency in the adaptation process. It is important to maintain the unique characteristics of its identity and efficiency.
  • Evaluation of the processes and the results.
  • Research on the treatment\'s duration and the internalized recovery, on the economics, on the treatment and on the treatment process and its improvement. (4)
  • Keep the identity through the generic model of the TC theoretically supported, with its coded practice standards, a pro-active organized training plan, and a research agenda to be able to improve its theory and practice. (5) The importance of the continuous training of the staff, specially the specific training to deal with certain profiles of clients.
  • For me the basic challenge is the maintenance of the essential part of the TC, both with the new realities we face as well as on an organizational level, on types of clients treated, on the psychotherapy level and to do all of it with intelligence, with common sense, with "wisdom". Or even better: The basic challenge is having the good sense not to lose the core identity of the TCs. Being open to the possibility of changes in the TC. We need to know how to respond to its frailty and to the inside and outside questions; because if you can lock yourself up in the fidelity of the own identity, you can also open yourself to the inside and outside requests. Talking about Judaism Ricoeur (6) says: "Due to wisdom Israel\'s singularity contacts with the universality of cultures", and exactly this has saved its own singularity. I mean, as Ricoeur does, that the essential subject for the TCs is to safeguard its own identity and at the same time to be in contact with the different psychotherapies, management models, etc. – being aware of that this, according to Ottenberg (7) can lead to "confusion and the loss of confidence among clients as well as among the professional teams". Using our wisdom, excluding all sort of isolation and haste that would kill all kind of hope. Using intelligence, common sense and "wisdom" we will avoid fanatism and fundamentalist.
  • I would like to close with an sentence by Harold Bridger (8): "One of the main problems of the world today is that people want to arrive without experiencing the way". Undoubtedly, to follow the therapeutic community process implicating yourself and living intensely the experience is a challenge to everyone. It is a challenge that makes you suffer but, at the same time strengthens you, makes you mature and helps you to understand that living your own life, your own historical and current reality, loving it and working on it is a person\'s best possibility.
  1. M. Kooyman, Proyecto Magazine nº 51, pages 26-27
  2. The evaluation of the efficacy of the Proyecto Hombre Program, Madrid 2001
  3. G. de Leon page 466
  4. G.de Leon page 465
  5. G.de Leon , The TC and the addictions, Desclée de Brouwer, Bilbao 2004 page 466
  6. Ricoeru, P. (Lectures, 3 Aux frontières de la philosophie, Seuil, Paris, 1997, page 321)
  7. Ottenberg, R. (I National Congress, Proyecto Hombre Association, Madrid, 1995, page 76)
  8. Bridger, H. A. de Dominicis "La comunita terapeutica per tossicodipendenti" Ceis, Roma, 1997, page 7
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