Ilse Goethals

Essential Elements of Treatment: A Comparative Study Between European and American Therapeutic Communities for Addiction

The purpose of this study was to investigate whether European and American therapeutic communities (TCs) for addiction, both traditional and modified, share a common perspective on what is essential in treatment using the Survey of Essential Elements Questionnaire (SEEQ). The European sample (N = 19) was gathered in 2009. For the American sample (N = 19), we used previously published research data. Despite comparable perspectives, European traditional TCs (N = 11) scored significantly higher than their American predecessors (N = 11) on four SEEQ domains. Cluster differences were more pronounced in Europe than in America.

Fixed and dynamic predictors of treatment process in therapeutic communities for substance abusers in Belgium.

BackgroundResearch on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients’ early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument.MethodsData was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients’ early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process).ResultsClients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients’ ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients’ ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores.ConclusionsSpecial attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients’ (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the induction stage of a TC program.

Core characteristics, treatment process and retention in therapeutic communities for addictions: a summary of four studies

Purpose – The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions. Design/methodology/approach – The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits. Findings – The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the seco...

Reflections of Caretakers on the Process of Implementation of Life Space Crisis Intervention at a Therapeutic Centre for Youngsters with Emotional and Behavioural Disorders

AbstractLife space crisis intervention (LSCI) is a therapeutic and verbal strategy used to intervene when children are in crisis. It has its roots in the work of Aichorn, Redl, Wineman and Bettelheim, and is part of the milieu-therapeutic tradition. In 2000, LSCI was introduced at the Orthopedagogical Observation and Treatment Centre, a school and day unit for 60 children with emotional and behavioural disorders affiliated with the Department of Orthopedagogy at Ghent University (Belgium). The particular position of orientation towards ‘therapeutic environments’ in the department’s history has encouraged the integration of LSCI in the daily activities of the departments’ school (Broekaert et al., Int J Ther Communities 30(2):122–145, 2009). In 2003, LSCI was implemented and studied in several Flemish Institutes. Positive effects were found on school results, attendance in the classroom and number of conflicts. In this article, the reflections of the caretakers are taken into account. Analyses of these reflections resulted in 4 major themes: content of job and tasks, the youth in the centre, working with the youth in the centre, and cooperation with colleagues and other teams. The results of this analysis will be discussed.

A religion too far: a historical and qualitative study on how ex-Synanon members value critical incidents that might have led to the downfall of their Utopia

Although Synanon has been extensively studied, attention has seldom been paid to the question of how the many ex-members who left Synanon before or at its dissolution ‘survived’ their community and indoctrination, and how they now evaluate their involvement. This article explores how ex-members react to their previous affiliation to Synanon, the cradle of the therapeutic community (TC) for addiction. A series of critical incidents, following Synanons public proclamation restyling itself as a religion, which led to the dismantlement of Synanon, are highlighted and contrasted with the achievements of the movement. For this research study, we used a social constructivist methodology. Following qualitative snowball targeted sampling, open interviews and text analysis, 14 statements, representing the main reactions, were retained. These served as the basis for a web-based survey. It was found that ex-Synanon members still believe in the positive realizations of their experience. On the other hand, they are no...