The living–learning experience, culture of enquiry and importance of community meetings

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چکیده

The term ‘therapeutic community’ is usually used in the UK to describe small cohesive communities where patients (often referred to as residents) have a significant involvement in decision-making and the practicalities of running the unit. Based on ideas of collective responsibility, citizenship and empowerment, therapeutic communities are deliberately structured in a way that encourages personal responsibility and avoids unhelpful dependency on professionals. Patients are seen as bringing strengths and creative energy into the therapeutic setting, and the peer group is seen as all-important in establishing a strong therapeutic alliance. The flattened hierarchy and delegated decision-making are sometimes misunderstood as anarchy by outsiders. However, staff in modern therapeutic communities are deeply aware of the need for strong leadership and their responsibility to provide a safe ‘frame’ for therapeutic work (Association of Therapeutic Communities, 1999). In the USA, the term ‘therapeutic community’ is more often used to describe user-run communities for substance misusers with: a hierarchical structure; a reward system; fierce encounter groups; and a simple explanatory model of addiction and its treatment. These are referred to as ‘concept’ or ‘behavioural’ therapeutic communities, as opposed to ‘democratic’ therapeutic communities, which are the main focus of this paper. Phoenix House and Daytop are two major concept therapeutic community programmes that grew from this movement in the USA and spread to many different countries (Kennard, 1998). In the UK, this model is currently being developed within the prison service. In common with democratic therapeutic communities, the primary mechanism by which these units aim to alter behaviour is by encouraging residents to take responsibility for themselves and for others. Democratic therapeutic community principles are applicable to a wide variety of client groups and settings, for example HMP Grendon Underwood (Cullen et al, 1997), which helps offenders within the prison system, and Peper Harow (Rose, 1990), for children with severe behavioural problems. This paper, however, focuses on the importance of the therapeutic community movement within the National Health Service (NHS).

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تاریخ انتشار 2001