Volume 31, Issue 1 (spring 2010)

Hybrid Vigour: Integration of Mindfulness-Based Cognitive Therapy (MBCT) into the Therapeutic Community

Mary Stanton and Rod Mullen

ABSTRACT: Fifty years of therapeutic community (TC) experience and practice have informed a theory of the essential elements necessary to facilitate change. Much of the success of the TC can be attributed to its flexibility: adapting to changing populations, diverse cultures, national and local health care priorities and funding while retaining the essence of the TC model. In recent years there has been a growing interest in the application of mindfulness-based meditation practices as an intervention in the treatment of psychological difficulties and physical illnesses. An extensive review of current literature, randomised controlled trials, and results from clinical studies provided our theoretical rationale for piloting mindfulness practices at Amity Foundation's TC in Tucson, Arizona. In this paper we illustrate how this innovative approach addresses a variety of challenges facing today's TCs while the basic tenant of ‘Community as Method' remains the essence of the process. The key elements of Mindfulness-Based Cognitive Therapy (MBCT) as a treatment approach are detailed, and we outline the modifications made to this approach in adapting MBCT to a residential TC setting. Initial outcomes illustrate the variety of ways that mindfulness-based meditation practices increase engagement and enhance the TC experience. Questionnaires administered pre- and post-session along with self-reporting of participants were used to establish baseline data, evaluate shifts in attitude, and assess the quality, relevance, and content of the course. Data collected from these attitude instruments are discussed in terms of directions for future research and potential implications for further development in the TC setting.


Structured Interviews in Drug-Free Treatment - A Validity Study of the DOK Interview

Mats Anderberg and Mikael Dahlberg

ABSTRACT: Within the field of addiction treatment it is common to use different kinds of structured interviews as a method for treatment planning and evaluation. For that reason it is important to empirically examine the methodological qualities concerning reliability and validity. This paper presents the results from a study of concurrent validity of the Swedish DOK interview via analyses of the agreement and association between data from the structured interviews DOK and ASI. Most of the interviews were carried out in therapeutic communities and the remaining inter-views came from outpatient care. The degree of agreement between the two different interviews was compared and analysed for a total of 79 items. The study demonstrates that 69 of the 79 items have high levels of agreement, as well as significant values for correlation when this factor has been considered. The client ratings show a systematically low level of agreement. That may indicate that they are not valid or accurate enough to form the basis for treatment planning or to be used for research. A second important conclusion to be made is that DOK and ASI in essence are comparable as structured interviews and thus interchangeable. Another implication of fundamental importance is to use relevant statistical methods for identifying strengths and weaknesses in these kinds of instruments in order to gain valid and reliable results.

 


A Comparison of Affirmations Given and Received by Minority and Non-Minority Status Men in a Correctional Therapeutic Community

Jessica Veneskey Linley, Keith Warren and Tamara S. Davis

ABSTRACT: Racial tension has been a persistent problem in the American correctional system. This poses a challenge to corrections-based therapeutic communities (TCs) since they depend heavily on peer interactions. This article presents three analyses of the differences in one type of peer interaction, the peer affirmation, as given and received by ethnic majority and ethnic minority residents in one American TC. In those analyses that control for auto-correlation, we find no statistically significant differences between ethnic groups. There is a small but statistically significant negative relationship between scores on the Level of Service Inventory-Revised (LSI-R) and affirmations given and received. The strongest predictor in all models is simply time spent in the TC.


Developing Therapeutic Communities for the 21st Century: Bringing Traditions Together Through Borrowing and Adaptation

Michael G. Young

ABSTRACT: A substantial body of research shows that Modified Therapeutic Communities (MTC) can be effective in dealing with addiction. MTCs have evolved to deal with clients who are considered quatra-diagnostic. These individuals suffer from co-occurring disorders involving homelessness, substance abuse, mental health and criminal behaviour. However, the diverse nature of these problems, and the complex makeup of the populations involved, adds to the challenge of simultaneously dealing with them in one therapeutic context. This paper explores a therapeutic community (TC) in Western Canada developed with the purpose of serving quatra-diagnosed clients starting with the least challenging of these problems, homelessness, followed with the expansion of services to other clients. This study identifies the fourth moment of TCs as a new direction in MTC development, which includes an emphasis on combining TC models and evaluation research in the provision of services to growing and diverse populations.


HMP Dovegate's Therapeutic Community: An Analysis of Reconviction Data

Sarah Miller and Jennifer Brown

ABSTRACT: This study reports the reconviction data for n=94 prisoners who had attended Her Majesty's Prison Dovegate therapeutic community (TC) and been released back into the wider community. The 48% reconviction rate amongst those liberated was lower than previously found in other prison treatment programmes. The majority of reconvictions (74.5%) were breaches of licence involving absconding. There were no reports of serious violent offending and only one report of sexual re-offending. Most re-offenders (87.5%) did so within a year of being released into the community. Analysis also revealed that 70% of reconvictions were committed by those who had spent less than 18 months in the TC suggesting a treat-ment dosage effect. Whilst the results are encouraging, limitations and problems with re-offending as a treatment outcome measure are discussed.


‘Being Real and Being Therapeutic' Revisited

Rachel Clements, Vishwanath Ramakrishna and Graham Mackay

ABSTRACT: Therapeutic communities' demand for staff reflexivity is not limited to the therapy hour, but extends to all the staff's daily interactions, meaning that previously reliable professional roles no longer apply. This paper brings alive the difficulty of working in such an environment through a discussion-style interview between two staff members, a psychiatric trainee and a social therapist, about their experiences of joining, and working in, a therapeutic community (TC). A thematic analysis draws three themes from the interview: ‘finding a way in', ‘the impact of authentic connection' and ‘inside and out'. The article argues that these themes all relate to the tension between being real and being therapeutic, and that, although living in this tension can make life difficult for staff members, it is not simply an unpleasant side-effect, but a key element of TC treatment.


Reviews

Sue Parker Hall (2009) Anger, Rage and Relationships. An Empathic Approach to Anger Management. Published by Routledge. Reviewed by Simon McArdle.

 

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