6. Overview of the TC Model
TCs have evolved to serve an ever- increasing
range of special populations with substance use
disorders, including women with children, older
adults, adolescents, people with co-occurring
mental disorders, people with HIV/AIDS, people
who are homeless, and people involved with the
criminal justice system.
Dr. Mahmooda Aftab
7. Training: Overall Goals
To provide a common knowledge base in
TC model and to encourage training
participants to work on their professional
growth and development.
Dr. Mahmooda Aftab
8. Training: Overall objectives
1. Understand and be able to explain
The history, basic concepts, and components of the TC
The TC views of the disorder, the person, recovery, and right living
The social structure and physical environment of the TC
The TC treatment methods
The ways in which staff members help residents change their behavior, attitudes,
and self- identity through the community-as-method and the self-help and mutual
self- help learning processes
The expectations, roles, and competencies of all staff members
Dr. Mahmooda Aftab
9. 2. To experience increased self-awareness
3. To be able to identify their roles
4. To experience and understand the TC process
through participation in role plays
Dr. Mahmooda Aftab
10. The TC Learning Approach
A mixture of presentations, discussions, and exercises
Small group work to create a sense of community and to
promote self- help and mutual self- help
Time to reflect and write thoughts and feelings in a personal
journal
Review and feedback
Dr. Mahmooda Aftab
11. Small-Group Exercise
What quality does each person in the group
have in common with others?
What do you expect to get out of this training?
Which TC slogan would you like to adopt as your
group slogan for the training?
Dr. Mahmooda Aftab
13. Staff Competencies
1. Coordinator has knowledge of data-gathering tools as well as assessment
instruments that facilitate the evaluation of a member’s strengths as well as
areas needing improvement.
2. Understanding and promoting upward mobility and the privilege system
(Module 10).
3. Understanding and promoting self- help and mutual help (Module 4).
4. Understanding and practicing the concept of “acting as if” (Module 1).
5. Understanding and discouraging the concept of the “we–they dichotomy”
(Module 7).
Dr. Mahmooda Aftab
14. Staff Competencies
1. Understanding the relationship between belonging and individuality
(Module 6).
2. Understanding and facilitating the group process (Module 8).
3. Maintaining accurate records (Module 10).
4. Understanding social learning versus didactic learning (Module 4).
5. Understanding the need for a belief system within the community
(Module 3).
6. Understanding and practicing positive role modeling (Module 7).
Dr. Mahmooda Aftab
15. Practicing “Acting as If”
When an individual acts in a certain way
long enough, the thoughts and feelings that
support the behavior will strengthen.
Feelings, insights, and altered self-
perceptions often follow behavior change
rather than precede it.
What is your slogan?
Dr. Mahmooda Aftab
17. A TC is a structured method
and environment for changing
human behavior in the context
of community life and
responsibility.
Dr. Mahmooda Aftab
18. The Beginning and Evolution
of the TC
1. The Origin of AA/NA
2. The Origin of Minnesota Model
3. Beginning and Evolution of TC
Dr. Mahmooda Aftab
19. The Beginning and Evolution
of the TC
Many individuals admitted to TCs have a history of social,
education/vocational skills, and positive community and family ties that have
been eroded by their substance abuse. For them, recovery involves
rehabilitation -- or re-establishing healthy functioning, skills, and values as
well as regaining physical and emotional health.
Other TC residents have never acquired functional life-styles. For these
people, the TC is usually their first exposure to orderly living. Recovery for
them involves habilitation -- learning for the first time the behavioral skills,
attitudes, and values associated with socialized living.
Dr. Mahmooda Aftab
20. The Beginning and Evolution
of the TC
TCs are residential facilities and located away
from the drug-related environment. As a
participant in the community, the resident in
treatment is expected to adhere to strict and
explicit behavioral norms.
Dr. Mahmooda Aftab
21. The Beginning and Evolution
of the TC
These norms are reinforced with specific contingencies
(rewards and punishments) directed toward developing self-
control and responsibility.
The resident will progress through a hierarchy of
increasingly important roles, with greater privileges and
responsibilities.
Dr. Mahmooda Aftab
22. The Beginning and Evolution
of the TC
Other aspects of the TC's "community as
method" therapeutic approach focus on
changing negative patterns of thinking and
behavior through individual and group therapy,
group sessions with peers, community-based
learning, confrontation, games, and role-
playing.
Dr. Mahmooda Aftab
23. The Beginning and Evolution
of the TC
TC members are expected to become role models who
actively reflect the values and teachings of the
community.
Routine activities are intended to counter the
characteristically disordered lives of these residents
and teach them how to plan, set, and achieve goals
and be accountable.Dr. Mahmooda Aftab
24. The Beginning and Evolution
of the TC
Participation in a TC is designed to help people appropriately
and constructively identify, express, and manage their
feelings.
The concepts of "right living" (learning personal and social
responsibility and ethics) and "acting as if" (behaving as the
person should be rather than has been) are integrated into the
TC groups, meetings, and seminars.
These activities are intended to heighten awareness of specific
attitudes or behaviors and their impact on oneself and the social
environment.Dr. Mahmooda Aftab
25. The Beginning and Evolution
of the TC
TCs are designed to emphasize the experience of
community within the residence.
Newcomers are immersed in the community and
must fully participate in it.
It is expected that in doing so, their identification
with and ties to their previous drug-using life will
lessen and they will learn and assimilate new
prosocial attitudes, behaviors, and responsibilities.
Dr. Mahmooda Aftab
26. Treatment Stages
Stage 1. Induction and early treatment
typically occurs during the first 30 days to assimilate
the individual into the TC. The new resident learns:
TC policies and procedures;
Establishes trust with staff and other residents;
initiates an assisted personal assessment of self,
circumstances, and needs;
begins to understand the nature of addiction;
begins to commit to the recovery process.
Dr. Mahmooda Aftab
27. Treatment Stages
Stage 2. Primary treatment
often uses a structured model of progression through
increasing levels of prosocial attitudes, behaviors,
and responsibilities.
The TC uses interventions to change the individual's
attitudes, perceptions, and behaviors related to drug
use and to address the social, educational, vocational,
familial, and psychological needs of the individual.
Dr. Mahmooda Aftab
28. Treatment Stages
Stage 3. Re-entry
is intended to facilitate the individual's separation from the TC and successful
transition to the larger society.
A TC graduate leaves the program drug-free and employed or in school. Post
residential aftercare services may include individual and family counseling and
vocational and educational guidance.
Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous are
often incorporated into TC treatment, and TC residents are encouraged to
participate in such groups after treatment.
Dr. Mahmooda Aftab
29. Today’s TCs
A mix of professionals
Evaluation research
Program and staff competence standards
Professional associations
Common components
Adaptations to new settings and special
populations
Dr. Mahmooda Aftab
30. Therapeutic Communities
for Special Populations
Women
Adolescents
Individuals with co-occurring mental health
disorders
Populations involved in the criminal justice
system
Persons living with HIV/AIDS
Dr. Mahmooda Aftab
31. Modified TCs
Research efforts have sought to determine how to modify TCs
to accommodate the realities and constraints of a managed care
health environment.
Major adaptations being tested include the impact of shorter
lengths of stay and the use of a day treatment model.
Dr. Mahmooda Aftab
33. 14 Basic Components of a TC
1. Community Separateness
2. Community Environment
3. Community Activities
4. Staff as Community Members
5. Peers as Role Models
6. A Structured Day
7. Stages of the Program and Phases of Treatment
Dr. Mahmooda Aftab
36. 14 Basic Components
of a TC
8. Work as Therapy and Education
9. Instruction and Repetition of TC Concepts
10. Peer Encounter Groups
11. Awareness Training
·
12. Emotional Growth Training
13. Planned Duration of Treatment
14. Continuation of Recovery After TC Program Completion
Dr. Mahmooda Aftab
