Learn / Mutual Support in Therapeutic Communities
Substance misuse can be extremely isolating. For some clients, rehab is a good time to break out of old patterns and start rebuilding interpersonal relationships. And, as valuable as talk therapies are, there are some skills you can only learn by engaging in mutual support. If your goal is to focus on those skills, you might benefit from joining a therapeutic community.
While many of these programs take place within rehab facilities, they take a unique approach to the healing process. Residents receive some level of professional care, which may include talk therapy, medical supervision, and various other programs. In addition to this, clients actively cultivate a community of mutual emotional support.
Therapeutic communities, or TCs, are “a form of long-term residential treatment for substance use disorders.”1 Originally—starting as early as the 1950’s—most of these organizations were run entirely by residents, who provided support to each other during recovery. This model uses “the peer community as the agent of recovery,”1 with an emphasis on healthy relationships between members.
In some of these earlier programs, members were prohibited from using medications of any kind, even to help with detox. Over time, and as public opinion has shifted, many facilities have adopted a more modern approach. Today, it’s quite common for TCs to be connected with more traditional rehab facilities. This allows clients to benefit from recent medical advances, while still connecting deeply with one other. If you attend one of these programs, you will also be asked to take on greater responsibilities than you would be in a more traditional rehab program.
In a therapeutic community, clients are often expected to participate in group activities, engage directly with one another, and even perform daily chores. These activities are intended to help you cultivate life skills and build healthy relationships. By behaving as an important part of a larger collective, you may become more confident in your own personal strengths.
As psychiatrist Penelope Campling explains, this philosophy is founded on the ideas of self-empowerment and collective responsibility. She writes, “therapeutic communities2 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.”
TCs conceive of the “community as [the] method”3 or mechanism of healing. In this model, clients are not only accountable for their own recovery; they also assume a certain level of responsibility for each others’ healing processes. There is “an emphasis on social learning4 and mutual self-help…This aid to others is seen as an important part of changing oneself.”
These programs often last longer than other forms of treatment, and your length of stay will likely be determined by your unique needs. At Start2Stop, a facility in London, offers a Secondary Care Programme for those who have completed 28-day inpatient treatment. “Everyone is different and the length of stay will depend upon individual circumstances,” says the provider. However, most clients stay on-site for approximately three months.
Research suggests that it is especially important for clients to prioritize aftercare following their stay in a TC. According to one study on therapeutic communities’ effectiveness,5 both “length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status.” This may be related to the well-documented importance of community for mental health.6 After you learn to engage with fellow residents in a TC, it may be difficult to return to a less communal setting.
While therapeutic communities share a particular approach, various TCs have slightly different philosophies regarding recovery. For instance, some of these programs are founded in the 12 Steps of A.A. or N.A. Others may host only teens, or offer gender-specific treatment. No matter who is part of your cohort, you can expect to participate in focused group activities.
It’s quite common for clients to engage in group therapy or support groups during their stay. You may also join in group outings or even shared meals. These experiences help residents cultivate a sense of community by both offering and receiving emotional support from peers. When this exchange occurs outside of traditional talk therapy, clients can practice interpersonal skills in a variety of contexts. This may help you prepare for life after rehab, when you’ll start interacting with people who aren’t necessarily in recovery.
A growing body of evidence suggests that mutual support between clients with substance use disorders7 is hugely beneficial. Experts have found that these relationships “fill a gap that often exists in both formal and informal treatment for individuals with SUD by focusing on recovery first and by helping to rebuild and redefine the individual’s community and life.”
You are more than your illness. Simply watching a movie with a friend, going on a hike, or talking about a good book can help you remember that. And during your time in residence at a TC, you may have more and more opportunities to engage in these activities.
Many therapeutic communities employ a “hierarchical model of care.” In this dynamic, clients gain more privileges as they work through predefined stages of recovery. These privileges often include access to the outside world, such as receiving an allowance, using a laptop, or going off site. For example, you might be allowed to spend a night away from the facility after being in the program for a certain period of time.
Because of this philosophy, TCs may be a good fit for people with responsibilities they can’t set down for months at a time. In particular, students and employed professionals may be able to keep up with school and work during treatment. Some clients might need to do this remotely, while others may be allowed to leave the facility during the day.
Unlike other rehab models, therapeutic communities actively encourage clients to reintegrate with the outside world4 before completing treatment. According to the National Institutes of Health, “as program participants progress through the stages of recovery, they assume greater personal and social responsibilities in the community. The goal is for a TC participant to leave the program not only drug-free but also employed or in school or training. It is not uncommon for program participants to progress in their recovery to take on leadership and staff roles within the TC.”
This flexibility should not be confused with a lack of structure. On the contrary, clients enjoy certain freedoms precisely because they remain accountable to themselves, each other, and their healthcare providers. At every stage of recovery, you’ll be expected to follow certain house rules.
Life in a TC strikes a delicate balance. On the one hand, you’ll slowly gain privileges that aren’t available in other rehab programs. And on the other hand, you’ll be expected to take on responsibilities that are rarely associated with inpatient treatment. These two components work in concert to empower clients. The daily practice of caring for yourself and others, while watching the impact of your behavior in real time, can have a huge impact on the recovery process.
Most therapeutic communities have a zero tolerance policy for substance use. You may undergo regular tests to confirm your sobriety. This practice is especially important for clients who spend significant time off site. By gathering data about your health, your clinicians can monitor your progress and make adjustments as needed.
If you do test positive for substances during your stay, you may have to leave the program permanently. While this may sound extreme, it’s in line with the philosophy of community accountability. In a TC, even more than in some other programs, your behavior has a drastic impact on the health of other residents. This strategy not only discourages substance misuse; it also protects clients from engaging in enabling behavior.
Living in a community means being partially responsible for the well-being of the whole group. With this in mind, most TCs require residents to take care of their own living spaces. These activities aren’t simply utilitarian; they’re also an exercise in interpersonal dynamics. A task as simple as sweeping the floor can become an act of caring for your cohort.
Each program has its own unique expectations of clients. At MARR, a TC in Georgia, clients “complete chores, buy groceries together, have dinner at the dining room table every night, and navigate day-to-day activities. This sense of community has proven to be a huge factor in the recovery process. It lets clients know they’re not alone while challenging their old habits at the same time.”
This practice teaches valuable life skills, helps clients develop healthier habits, and fosters strong relationships. It may also have a long-lasting positive effect on the psychological aspect of healing. Data suggests that life skills training8 and related activities may be an important preventive measure for those in recovery from substance use disorders.
TCs have a strong focus on building healthy habits into your daily routine. Because of this, you can expect to follow a clearly defined schedule during your time there. Although it will likely include much more free time than a traditional rehab, you’ll still have to abide by a curfew. This curfew may change over time, as you progress through the stages of recovery. And even if you’re able to spend the occasional night off-site, you’ll still likely need to return at a predetermined time. Much like regular drug testing, this practice helps clinicians gather data about your recovery process—specifically your ability to keep your commitments and respect healthy boundaries.
Significant research supports the idea that clients benefit from building community during recovery. Connecting with your peers not only gives you access to support; it also positions you to help the people around you. By empathizing with the people in your cohort, you may gain new insights into your own recovery process. As you develop mutual compassion and respect, you may also gain new confidence in your own role in the group.
However, much research is needed into the efficacy of TCs.9 Despite their lengthy history, there is little scientific data regarding their clients’ long-term recovery. One commonly cited study from the 1980s found that “nearly 30% of addicts treated in TCs maintain maximally favorable outcomes, while another 30% show significant improvement over their pretreatment status.” Because our clinical understanding of substance use has progressed so much since then, those findings may or may not reflect present-day outcomes.
More recently, a 2016 study found that “peer-led recovery support services 10 may be a helpful addition to traditional professional services. More research is needed to make definitive recommendations.” However, it’s important to note that this is an analysis of specific peer-led services which may or may not be available in every therapeutic community. Based on related information, it’s very likely that TCs continue to have a positive long-term effect on recovery. But—just like any healing modality—treatment in a therapeutic community may be best when combined with traditional modalities, such as talk therapy and medical care.
There’s no doubt that therapeutic communities offer a unique approach to recovery. This type of environment might be a good fit for clients who want to focus on improving their interpersonal relationships and developing life skills. And because residents may gain off-site privileges during their stay, this model may be especially appealing to people with certain commitments, such as work, school, or family responsibilities.
However, some clients may find that the lifestyle of a TC is incompatible with their own needs. For example, highly visible people—especially high-level executives and those with celebrity status—may require greater discretion. Others may need specialized medical care that isn’t available in this environment. And if you feel that you would benefit from more structure, or a greater level of protection from the outside world, you might consider attending a more traditional rehab program.
It’s also possible to take a combined approach, and attend a TC after completing detox or another inpatient treatment program. And, at any rehab, you can find ways to participate in a community both during and after the program. Even individual treatment programs may allow you to connect with loved ones during your stay. Whatever modality feels right for you, remember that healing your relationships is an important part of recovery.
To learn more about this approach, explore our list of therapeutic communities here.
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