Terápiás közösségek/therapeutic communities
About therapeutic communities
Therapeutic community is a term applied to a participative, group-based approach to long-term mental illness that includes group psychotherapy as well as practical activities, and which may or may not be residential with the clients and therapists living together. The term may have first been used in the 1940s by Harry Stack Sullivan, but the modern community was pioneered by Tom Main, Maxwell Jones, R. D. Laing and the Philadelphia Association, David Cooper and Villa 21 and Joshua Bierer, and gained some reputation for success in rehabiliDavid Coopertation and patient satisfaction in Britain and abroad.
A terápiás közösségekről
A terápiás közösség fogalma egy résztvevő, közösség-alapú megközelítésre utal, melyet krónikus pszichiátriai betegségek vagy szenvedélybetegségek kezelésére alkalmaznak. Az ilyen közösségekben folyhat csoport pszichoterápia, de leginkább a hétköznapi tevékenységeken keresztül zajlik a közösségen belüli élet, amit a lakók és a terapeuták/stábtagok együtt alakítanak. A fogalom először Harry Stack Sullivan-nél jelent meg a 40-es években, de a modern terápiás közösségek leginkább az olyan úttörők nevéhez fűzödnek mint Tom Main, Maxwell Jones, R. D. Laing, David Cooper, Joshua Bierer, akiknek a kezdeményezései elismerést és az érintettek elégedettségét váltották ki rehabilitációs sikereiken keresztül Angliában és külföldön.
Terápiás közösségekről szóló cikkek, tanulmányok/ articles, studies about therapeutic communities
David Burns Manuscript
edited by Brent Potter
- For more than fifteen years an experiment has been carried out in London to show that people diagnosed psychotic who might otherwise be in mental hospital could live in household of varying types with students, medical student, therapists and various others. I lived in these communities for five years, from early 1970 until late 1975 and was in association with them until late 1977. This is a report on my time there, on the structure of communities, on the experience of living there, and on the philosophy that lay behind it.
- The household communities, operating since 1964 under the auspices of the Philadelphia Association (PA), are founded on the principle of offering asylum, where one can have, if one desires and wants, a pleasant room of one’s own, while other people see to it that the basic human needs are cared for: food, warmth and shelter. In the PA we try to hold a balance between care, concern, attention, mindfulness and letting be...
- The events of the first half of the twentieth century shook many fundamental systems of meaning, particularly the relationship between the individual and the community. Psychiatrists who showed a willingness to confront these issues at home, after the war, called themselves social psychiatrists. They were often to be found working in milieu settings that were quite different from the traditional psychotherapeutic setting and the traditional psychiatric hospital. Psychoanalytic psychotherapy and all its offshoots were grounded in an approach to the patient that focused almost exclusively on the individual. The relational aspects of therapy were implicit in the relationship between therapist and patient, but the main source of problem and motivation for change was seen as being intrapsychic - within the individual. The social and political contexts were not relevant and were largely disregarded.
The Therapeutic Community in the 21st Century INTRODUCTION
- The principles that guide the democratic therapeutic community— as distinguished from “concept therapeutic communities” so common in the United States for the treatment of substance abuse—are rooted in Moral Treatment of the 18th century and the fundamental ideals of the Enlightenment—apparent in both the U.S and the U.K.
THE EVOLUTION OF THE THERAPEUTIC COMMUNITY
- The creation of Therapeutic Communities in the Military Hospitals of the UK for the treatment of psychological casualties of war during the Second World War is described. The personnel and the methods utilised are discussed and the lessons learned are summarised. It is argued that this was not an entirely new phenomenon. The author describes previous usage of similar methods in residential communities for disadvantaged or delinquent youth in the period between the two world wars and, prior to this, the eighteenth century “era of moral treatment” in mental hospitals in the UK and USA.
THE ART AND CHALLENGES OF LONG-TERM AND SHORT-TERM DEMOCRATIC THERAPEUTIC COMMUNITIES
- This paper, cowritten by Kingsley Norton, since 1989 Director of Henderson Hospital (a therapeutic community founded by Maxwell Jones in 1947 in the United Kingdom), and Sandra Bloom, Founder of the Sanctuary Model in the United States, compares and contrasts the practice of the democratic therapeutic community (TC) as applied to the notion of long-term care (up to twelve months), to that of the democratic therapeutic milieu (TM) as applied to shortterm care (up to one month).
DEMOCRATIC DEVELOPMENT OF STANDARDS: THE COMMUNITY OF COMMUNITIES—A QUALITY NETWORK OF THERAPEUTIC COMMUNITIES
- As the inevitability of regulation and accountability dawned on the British Therapeutic Community movement at the end of the 1990s, a polarised debate took place. The product of that debate is now an action research based system of audit, with its principles and methods based on therapeutic community practice. This paper is written four years after the discussions started, and describes how the “Community of Communities” was conceived, what its methods are, some of the results from it first year of operation, and reflection about the nature of the process itself.
A CULTURE OF ENQUIRY: RESEARCH EVIDENCE AND THE THERAPEUTIC COMMUNITY
- This paper presents data from a systematic review and meta-analysis of 29 published studies of therapeutic community effectiveness using controls, including 8 randomised control trials. Meta-regressions suggest that the two types of therapeutic community, democratic and concept-based, and the age of the study, are the key sources of heterogeneity in the collection of studies analysed. Otherwise, heterogeneity is low and the meta-analysis confirms the effectiveness of therapeutic community treatment with overall summary log odds ratio for the 29 studies of ¡0.512 (95% ci ¡0.598 to ¡0.426).
THE THERAPEUTIC COMMUNITY AS AN ADAPTABLE TREATMENT MODALITY ACROSS DIFFERENT SETTINGS
- Simple core statements of the therapeutic community as a treatment modality are given, including a “living-learning situation” and “culture of enquiry.” Applications are described in work with children and adolescents, chronic and acute psychoses, offenders, and learning disabilities. In each area the evolution of different therapeutic community models is outlined. In work with young people the work of Homer Lane and David Wills is highlighted. For long term psychosis services, the early influence of “moral treatment” is linked to the revitalisation of asylums and the creation of community based facilities; acute psychosis services have been have been run as therapeutic communities in both hospital wards and as alternatives to hospitalisation. Applications in prison are illustrated through an account of Grendon prison. The paper also outlines the geographical spread of therapeutic communities across many countries.
Takács István Gábor: Cafe Fix – Az ártalomcsökkentés frankfurti példája
- 2004 második negyedévében abban a szerencsében volt részem, hogy egy frankfurti ártalomcsökkentő intézményben dolgozhattam, mely idő alatt egy metadon fenntartó kezelésben részesülő kábítószer-függők számára létesített lakóközösségben laktam. Jelen beszámoló a frankfurti ártalomcsökkentő módszerek áttekintése után ennek a két intézménynek a részletes bemutatásával foglalkozik.
- The Greek word "Soteria" means something like "salvation", or "protection". It was chosen by Loren Mosher and Alma Menn as the name for a new community-based milieu-therapeutic approach to acute schizophrenia that they inaugurated in the seventies in San Francisco. Despite the fact that our own theoretical background was (and is) quite different from Moshers and Menns, and that we also introduced certain modifications of their initial proceedings, we wanted to testify our indebtedness for their pioneering work by adopting this same name.
A Soteria Bern "gyengéd" szobája - részlet
- Az alábbi részlet Elisabeth Aebi-Luc Ciompi és Hartwig Hansen "Soteria im Gespräch" című könyvéből való. Az alább közölt részben Elisabeth Aebi a berni Szociálpszichiátriai Egyetmi Klinika tudományos munkatársa beszélget a Soteria Bern munkatársaival.
(Aebi E., Ciompi L, Hansen H. (1996) Soteria im Gespräch - Über eine alternative Schizophreniebehandlung, Psychiatrie Verlag)
Feldmár András: Apró részletekben #47
"1974-75-ben egy évet töltöttem Londonban, s ezalatt jónéhány terapeuta közösségben jártam (annak idején hét, a Menedékhelyben bemutatott archwayi csoporthoz hasonló volt belőlük) Laing-gel, Redlerrel és másokkal együtt tanulva és dolgozva. Ezek a háztartások a Kingsley Hall-kísérletből nőtték ki magukat, amely során Laing és más pszichiáterek és terapeuták összeköltöztek és együtt éltek olyan emberekkel, akik különben elmebetegekként kórházak pszichiátriai osztályaira kerültek volna. Laing elítélte azt a sebességet, amivel a szakmabeliek skizofrénnek vagy pszihotikusnak diagnosztizálnak embereket és rögtön elkezdik gyógyszerezésüket. Ő meg akarta tudni, milyen együtt élni és együtt lenni olyan emberekkel, akik nincsenek legyógyszerezve, s akiknek a szenvedését a szakma elmebetegségnek bélyegezné. A Kingsley Hall-ban, csakúgy, mint a Menedékhelyben, nem lehetett megkülönböztetni a beteget a terapeutától." (a teljes cikk olvasásához kattints a címre)
- "I spent a year from 1974 to 1975 in London , attending to several of the therapeutic communities (there were seven of them at the time, not unlike the Archway community shown in Asylum ), studying and working with Laing, Redler, and others. These households were offshoots of the original Kingsley Hall experiment, during which Laing and other psychiatrists and therapists moved in with and lived together with a number of people who otherwise would have been hospitalized as mental patients on wards of psychiatry. Laing disapproved of his profession's haste in diagnosing people as schizophrenic or psychotic , and immediately medicating them. He wanted to know what it was like to live with, to hang out with unmedicated people whose suffering the profession would label mental illness . In Kingsley Hall, like in Asylum , there was no way to tell apart patient from therapist."
David Cooper: Villa 21 - an experiment in anti-psychiatry
- "With the foregoing considerations in mind I undertook to run a ward in a large (2,000 bed) mental hospital just north-west of London on lines that would be bound to differ from the conventional ones. My experience of conventional psychiatric wards had been that these were places in which alienation, estrangement, and subtle violence were rife. Patients in such wards met with a massive reinforcement of the invalidation process that had commenced prior to their admission. It was in the admission ward that the ritual of initiation into the 'career' of being a mental patient was usually completed. It could perhaps, however, become the final exit from this process. The inception of the unit in Villa 21 in January 1962 was brought about in an effort to satisfy three principal needs with which I was confronted in the actual situation in the mental hospital in which I worked." (to see the full version of the article click on the title)
Terápiás lakóközösségek/therapeutic communities
Akeela, Inc , Anchorage, AK
Association of Therapeutic Communities
Philadelphia Association
Soteria and Other Alternatives to Acute Psychiatric Hospitalization
Soteria Zwiefalten (német nyelvű weboldal)
Soteria Gießen (német nyelvű weboldal)
Soteria Netzwerk (összefoglaló oldal a német nyelvterületen található Soteria kezdeményezések egy részéről)
Toll-Haus Köln (német nyelvű weboldal)
Német nyelvű irodalom/articles in German language:
Ute Wehde . Das Weglaufhaus Zufluchtsort für Psychiatrie-Betroffene . Berlin, Antipsychiatrieverlag, 1991
Kerstin Kempker (Hrsg.) . Flucht in die Wirklichkeit - Das Berliner Weglaufhaus . Berlin, Antipsychiatrieverlag, 1998
Ingo Runte . Begleitung höchstpersönlich - Innovative milieu-therapeutische Projekte für akut psychotische Menschen . Bonn, Psychiatrie-Verlag, 1. Auflage 2001
Elisabeth Aebi, Luc Ciompi, Hartwig Hansen (Hrsg.) . Soteria im Gespräch . Psychiatrie-Verlag Bonn 1996, 3. Auflage
Loren R. Mosher, Voyce Hendrix . Dabeisein . Das Manual zur Praxis in der Soteria, Psychiatrie-Verlag Bonn 1994
Ingo Runte . Begleitung höchstpersönlich - Innovative milieu-therapeutische Projekte für akut psychotische Menschen . Bonn, Psychiatrie-Verlag, 1. Auflage 2001
Bettina Kroll . Mit Soteria auf Reformkurs - Ein Alternativprojekt bewegt die Akutpsychiatrie . Gütersloh, Jokob van Hoddis Verlag, 1998
Giorgio Mambretti, Jean Séraphin . Die Medizin auf den Kopf gestellt - Und wenn Hamer doch Recht hätte? . Turin (Italien), Edizioni Amrita, 1999
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