The Therapeutic Community Program at Riggs: Overview and History
This blog was originally published May 17, 2016.
The Therapeutic Community Program at Riggs represents the practical application of the values at the core of our work. These include:
- Recognition, appreciation and enhancement of individual strengths and respect for individual differences
- An open setting to promote personal responsibility and freedom of choice in treatment
- The learning opportunities in a community of differentiated voices
- The importance of “examined living”
- An openness to innovation and creativity
- The importance of human relationships
Overview and History
The Therapeutic Community Program at the Austen Riggs Center provides an opportunity for patients to share their strengths with one another and with the staff in a partnership of mutual problem solving and learning. This exploration of strengths has, in different ways, always been a key component of the treatment philosophy from Riggs’ founding in 1919 to its present form today.
Though it would not be until decades later – in the 1940s and 1950s – that therapeutic communities in psychiatric hospitals would be formalized, many of the central tenets were in practice in the early days of the Austen Riggs Center. For example, Dr. Austen Fox Riggs believed that feelings could be kept under control through doing and required patients to participate in carpentry, weaving, painting and other handicrafts as part of their therapy. The work also emphasized the patient’s individual authority and contribution to the larger community; every patient was considered to be “a valued member of a united team” with the doctors, nurses and teachers.
In the early 1940s, English psychiatrists Drs. Wilfred Bion and John Rickman, who were working with traumatized soldiers in a military hospital, tried an experiment whereby they authorized the soldiers to create the governing structure on the hospital ward. Initially things fell into chaos, but patients soon began organizing to take care of practical tasks, mobilizing some of their strengths in the process.
The treatment philosophy behind therapeutic communities became a standard of care promoted by the World Health Organization in the 1950s, with Dr. Maxwell Jones at the helm as an ambassador of the movement. In the 1960s, Dr. Robert Rapoport’s seminal work, Community as Doctor, studied the function of therapeutic communities and outlined principles of therapeutic communities that persist today:
- Democratization – sharing of power/decision making between staff and patients
- Permissiveness – tolerating difficult behavior in the service of treatment
- Communalism – sharing mutual tasks
- Reality Confrontation – attention to behaviors as they are seen by others
It was during this time that Dr. Robert Knight was recruited from the Menninger Foundation as the new medical director of Riggs. The psychoanalytic focus Knight brought with him resulted in a more laissez-faire attitude that ultimately created turmoil in the community; nursing staff and patients were unclear about expectations. To address the turmoil, Knight made a historic decision to involve everyone, staff and patients, in working out a new philosophy and a set of procedures. Patients came together to plan a few parties to which they invited the staff, and in 1950, three patient/staff meetings were held, much like New England Town Meetings, with "free discussion of various aspects of community living.”
Staff clinician Dr. Margaret Brenman Gibson noted at the time, “There's a kind of gratitude to be treated like adults and I have the feeling that if we take this attitude consistently, that even if no concrete solutions are arrived at in the group discussion, that the whole atmosphere will change.”
Gibson’s feelings were realized as the therapeutic community at Riggs continued to develop; soon, the community created a formal patient government system with several committees to address issues within the community in partnership with the staff. A “Community Code” was collaboratively authored by patients and staff as well. And, by the mid-1950s, a work program for patients was created along with a sponsoring process to orient new patients.
Today, the Therapeutic Community Program enhances patient authority and fosters interpersonal learning, creating an environment where patients can use some of the insights that arise in psychotherapy to learn new ways of being in relationships. Nearly 50 group meetings are held each week, some within different residential programs, some open to all and some with the aim of addressing specific issues. These groups offer many opportunities to deepen understanding of how different ways of communicating affect the quality of relationships and help patients learn about ways to participate and contribute to the community as a whole.