What’s Therapeutic About the Therapeutic Community?
By Director of Patient Care Margaret Parish, PhD
Communities are inherently therapeutic – at least potentially. Social networks support longer, healthier, happier lives. Many research studies suggest that even relatively introverted people do better, emotionally and physically, when they feel connected to other people. The connections do not have to be deep and the contact does not have to be frequent, it just needs to be felt as connectedness.
Designing a treatment center as a therapeutic community involves harnessing the creative power of social networks. Such a community offers various forums for learning, working, and playing together; for supporting others and finding support; for contributing and participating and making decisions that influence the way the community works. Members find their own unique ways of belonging and making a difference.
What distinguishes an explicitly “therapeutic” community, beyond ordinary social support, is the commitment to considering everything that happens as an opportunity to learn together. Community members are invited to reflect and speak openly about the ways they experience one another – to consider how anyone’s actions affect others.
This is an important part of knowing yourself better, because just as you cannot see your own face, you cannot always tell how you are coming across to other people, or know what your actions mean in a social context. Behavior is communication, but it is not always consciously intended, and sometimes its meaning has to be decoded by other people who feel its impact. This is why having people around who are willing to tell you honestly how you are affecting them is a great contribution to self-understanding. Especially when combined with psychotherapy and family therapy, you begin to see links between current problems and what happened in the past, or between current group dynamics and those in the original social group, the family. Patterns identified in this way are not always easy to change, but seeing them can be remarkably freeing.
For better or worse, no one is alone. A human infant cannot survive without emotional connection, even if it is fed and sheltered. You become who you are in relation to specific other people, carrying remnants of old relationships forever, even in solitude; and repeating old patterns in new relationships in the form of expectations, preferences, and habits. Without meaning to, you enlist other people to fill familiar roles in your life and you relive old stories, perhaps trying to get back something that has been lost or perhaps trying to change an unwanted outcome.
No one is alone, but sometimes you probably want to be. Other people are annoying. In fact, annoyance is part of what can make communities therapeutic. Learning to tolerate others, adapting to their needs, asserting your own needs, negotiating – all this must be practiced in a community and is good training for future relationships, whether intimate or casual or fleeting.
Getting used to tolerating other people, and being tolerated by them, also helps you access support when you need it. You are probably annoying sometimes too. But you are not only annoying. People may appreciate things about you that you haven’t appreciated yourself, encouraging the development of new interests and skills. And even when you need to be alone, solitude is best when it is clearly chosen and not absolute, when there are other people around if you need them.
A social network is a safety net. In a dyad it can seem as if everything depends on that one person, making a conflict or a loss feel devastating. A community offers an alternative to, a container for, and a respite from the intensity of an exclusive relationship. It provides others to turn to when one person is too annoying or too annoyed, or when you need a break, or when you have divergent interests.
Of course, groups of people can be destructive too, even in therapeutic communities – they can engage in scapegoating, bullying, silencing, groupthink. Resisting these inclinations requires attention and commitment to noticing when people do tilt toward the destructive, and speaking up about it. Learning to see destructive processes and to join in stopping them also develops skills that are useful in many social environments. Participation in a therapeutic community builds responsible citizenship.
Because it is grounded in respect for individual freedom and responsibility, a therapeutic community is an excellent environment for individualized psychiatric and psychotherapeutic treatment. Ways of behaving – for patients and clinicians – are not tightly controlled or prescribed. Instead, we rely on collective commitment to the work of learning from experience, and on the holding capacity of the community itself.