CarnevaleQuaresima

Introduction

/in , , /by

When Stefania Marinelli contacted us approximately two years ago, also on Robert Hinshelwood’s suggestion, with a proposal to edit a monographic issue of Funzione Gamma on the subject of the therapeutic community, we felt both pleased and a bit worried. We were convinced that it would offer an important opportunity to explore a subject so dear to us, but that was also an extremely complex one. The years of efforts put forth by the on-line journal www.therapiadicomunita.org, and the practice shared by numerous friends and colleagues to whom we are bound by strong ties of affection and esteem, and who accepted our invitation to collaborate, reassured us we could offer readers an overview of the status of the therapeutic Read more

CarnevaleQuaresima

Leading from below? Decisions, responsibility and creativity as a group dynamic

/in , /by

Abstract

The institution tends to organise the individual in standard ways. And individuals are vulnerable to being organised for the convenience of the institution. Probably psychiatric patients needing hospitalisation are especially vulnerable to this coercive influence.
This has for long been known as a ‘top-down’ authority. A smallish group or single leader at the top of the organisation’s hierarchy makes decisions for those lower down to follow. For 50 years or so from the 1940s, there was, in Western society, an attempt to reverse this structure with what is called ‘bottom-up’ authority. The therapeutic community was one Read more

CarnevaleQuaresima

Building a course of therapeutic treatment

/in , /by

Abstract

The author offers a reflection on the internal/external dialectic dynamic as a central element in the organisation of the therapeutic community’s task. This dialectic regards the psychic and relational life of patients who, upon admittance to the community, distance themselves from the healthy or pathological objects of investment that have accompanied them to that point and enter a new context of treatment and relations. In this passage they also carry within themselves their own psychic and relational styles, proceed by trial and error in the attempt to either keep these alive or else try out new ways of being in the world. Communities also experience the tension between the social exterior, with its rules and contradictions–at times so pivotal to the development of a psychopathology, Read more

CarnevaleQuaresima

Therapeutic Factors?

/in , /by

Abstract

Re-examination of the therapeutic factors in group treatment is not a rhetorical exercise. Developments in our understanding of the group psychic apparatus suggest that this unconscious dimension structures the subject’s psyche from birth onward. Moreover, given the current socio-cultural context’s increasing inability to anchor subjectivity to Read more

CarnevaleQuaresima

Underpinnings of the therapeutic community: individual/group dialectic, between clinical organisation and daily life

/in , /by

Abstract

This contribution offers a general overview that departs, above all, from a relationship with the Mito&Realtà network, and describes the underpinning of the community architecture, highlighting the basic arrangement and internal articulations that work together to achieve the clinical, rehabilitative and social aims that form its mission. The TC is presented as a complex organism and course of treatment defined in space and time, and that develops from an initial moment of reception (trial period, assessment process and rehabilitative therapeutic contract), into individual, group interventions (assemblies, meetings, various group typologies) and interventions with families, a phase of insertion, attachment and start of detachment from the social network. Great importance is Read more

CarnevaleQuaresima

Therapeutic community: a complex treatment model. The identity of institutions and the subjects of therapy

/in , , /by

Abstract

The paper means to repropose Therapeutic Community importance and adequacy as treatment process and therapeutic Method. An intensive treatment process to those people who have clinical and existential situations of a certain seriousness and complexity, wich can not find a result so articulated in other treatment contexts and methods. We describe the characteristic of treatment model and therapeutic community professional operative organisation so that this very specialistic offer does not lose its own Identity, risking to devaluate both clinic and treatment Subjects. Assessment, clinical decision, treatment guidelines and clinical Research, when they are based on the experience of a therapeutic Model highly professional actually tested during the time as for Therapeutic Community one, Read more

CarnevaleQuaresima

Caregiver Training

/in , /by

Abstract

Homo sapiens inherited enormous genetic potential, selected over a great arc of time, which has proved indispensable to his survival but at times also manifests useless or even irritatingly awkward vestigial aspects that create a sort of dissonance, an evolutionary mismatch. Aggressiveness is one of those potentially problematic aspects that, if it is properly channelled does not necessarily have to lead to violence and destructiveness, but can become a resource, a way of adapting effectively to civilised contexts. Humans have evolved the ability to bring conflict to a symbolic level, Read more

CarnevaleQuaresima

Community therapy. Focusing on the foreign body. Effects on patients and caregivers

/in , /by

Abstract

Therapeutic communities are now and have for several decades been used for a wide array of disorders that range from substance abuse to personality disorders, and from subacute to chronic psychosis. These disorders are often intertwined and causes an overly dense diagnostic framework.

It is possible to observe two different perspectives which converge into the therapeutic  community system and allow us to pinpoint two pivotal factors of treatment. The first one, which we could define as individual, privileges the protective and facilitating function of the setting, which tends to be seen as a third element, between patient and caregiver, and therefore such that it can permit a one-to-one relationship that would otherwise be made difficult by the intensity of the transference From another standpoint (1), however, collective and group factors must be stressed, insisting on the Read more

CarnevaleQuaresima

Consultation in support of the professional ego?

/in , , /by

Abstract

The authors describe their experience as consultants that supported the professional ego in favour of the clinical teams of Il Porto Therapeutic community. In providing their support to the team, the authors tried to take care of this space for mutual advices and reflection, protected from the daily anxiety of pressing clinical decision-making, to facilitate the elaboration of thoughts so as to finally express what, in an operational context marked by urgency and rapid response, the group did not have the mental time or space to put in words.

Formation, in the field of treatment, consists primarily of improving tolerance to the uncertainty, insecurity and dependency of subjects (patients/guests of the community) that are always difficult to define or control through treatment protocols. As Donald Meltzer (1) posits, one passes from the omnipotence/omniscience that underpins the fantasy of controlling the subject to Read more

CarnevaleQuaresima

The democratic therapeutic community: soft or tough on violence?

/in , /by

Abstract
The therapeutic environment needs to aim both to set limits on pathological behaviour (such as, violence) and also promote psychosocial skills. To achieve this, ‘a stable, coherent social organisation which provides an integrated, extensive treatment context’ is required (Abroms, 1969), and the Democratic Therapeutic Community (DTC) is one such organisation.

Following Tom Main, however, it is the ‘culture’ of the DTC, rather than its ‘structure’, which characterises the distinctive therapeutic nature of the setting (Main, 1983). Therefore, in this paper, using examples from a secure setting, the author will illustrate how some of the DTC ideology translates into clinical practice.

The DTC’s cultural ‘DNA’ needs to be capable of replicating itself accurately on a daily basis, so as to avoid reverting to a place where ‘automatic, unthinking retaliation’ prevails- the meeting of like with like- hatred with hatred, anger with anger or lust with lust (Lambert, 1981). Thereby, it can embody, and present to its patients, a sustained, ‘culture of enquiry’ (Main, 1983), Read more

CarnevaleQuaresima

Democratic therapeutic communities for the future. How can we face epochal changes without distorting our mission?

/in , , /by

Abstract
Today therapeutic communities live in a condition of uncertainty and precariousness, due to a tangle of epochal changes, from a cultural, political and economical angle. The financial trouble led to cuts in mental health services, increasing regulation and administrative demands. The fact of facing this phenomenon of increasing stiffening, particularly on a political and institutional ground, pushed the therapeutic communities to implement an additional effort to “adapt” to this situation in a reasonable and sustainable way, without putting at risk the principles and values on which their clinical practice and research was founded.

The authors examine these issues talking briefly about the organisations who are all members of an extended family, then analyse some of the Read more

CarnevaleQuaresima

The “Visting in italy” project: origins, organisation and prospects

/in , , , , , , , , , /by

Abstract

Visiting has its theoretical roots in the research of Lewin, and began in England in the early 2000s when the Community of Communities network, led by Rex Haigh, introduced this project structured on both peer- and self-review for monitoring the quality of treatment settings (for adults, minors, prisoners, etc.) and earning accreditation and financing from the National Health Service.

The Italian Visiting project, which Mito&Realtà designed, proposed and formally introduced in 2010, has the aim of encouraging communities to get to know each other through a process of assessing therapeutic and structural factors for the purpose of better identifying TCs’ weaknesses and strengths and encouraging immediate action with regard to problems by defining annual improvement goals and collaborating with the other participating TCs. This shared involvement is aimed at the creation of a TC network to counter isolation and establish a set common quality standards (benchmarks). The ultimate goal is to generate a circular exchange of good practices, procedures and materials, making more evolved experiences accessible to communities that have been unable to Read more