| Photo by WhoIimo on Unsplash
Fifth of 5-part series
The American psychologist Louis Cozolino argued that the human brain is a neuroplastic, social brain. Our brain evolved within a social context that started from attachment with caregivers as infants and then the family and community, a history that extended far back in time to our early ancestors. Mental health problems have biopsychosocial roots, and healing often occurs within a social context, such as counseling, group therapy, and the therapeutic community. The quality of those human interactions determines the range of human experience, from pleasant to traumatic, and how they may potentially alter our physical brain and the workings of the mind. The structures and functions of the brain may be altered through chemical use, as with psychiatric medication or substance abuse, and through experience, as with trauma or psychotherapy.
According to Cozolino, “exposure to people changes people.” Harnessing multiple levels of transferential experiences in TC could achieve changes in feeling, thinking, and behavior. This social context makes TC a social learning environment. TC staff must facilitate and regulate the intensity of residents’ interactions, thus providing opportunities for a healing experience that leads to behavior change, insight, and attachment with other residents.
Humans embark on behavioral change when motivated and feeling physically and psychologically safe. These are necessary conditions for preparing people to change problematic behaviors. Safety and the ability to create a safe treatment environment must be foremost in the minds of TC implementors. A TC staff must have a flexible mind that can adapt its approach according to a resident’s stage of change.
READ: Part 1 – The Therapeutic Community (TC) for Addiction: An Issue of Relevance
Knowing how the power of words and well-formed sentences can more effectively influence a resident’s mindset than screaming at the person must lead us to reevaluate the effectiveness of the loud and jarring old TC approach. It’s probably not that “addicts have a hearing problem”; instead, the TC staff has speech impediments that prevent him from getting the addict’s attention.
To effect therapeutic movement, Motivational Interviewing points out the “discrepancy” between what a client says as his goal and his actual behavior. This technique works well when the therapist has already built a high level of rapport with the client. TC clinicians employ the same principle called cognitive dissonance when using various TC tools, albeit more diffused and with little emphasis on building a positive relationship with residents. A retooling of the TC methods and retraining of TC staff to be in tune with more motivational approaches are needed.
“Humans embark on behavioral change when motivated and feeling physically and psychologically safe. These are necessary conditions for preparing people to change problematic behaviors. Safety and the ability to create a safe treatment environment must be foremost in the minds of TC implementors.”
Traditional TC groups must be reimagined, such as Static Group, a group psychotherapy; Psychosocial Probe, an extended group therapy that can be reformulated to explore trauma; and Encounter Group, which can be restructured to resolve interpersonal conflicts among residents and facilitate understanding of the roots of their negative emotions. All must conform to the trauma-informed practice of keeping the group process safe.
We need a peer-driven TC with a rational, trauma-informed approach that provides a balanced implementation of behavior-shaping, psychological, cognitive, spiritual, and vocational TC tools.
1 comment
Thanks, Dr. Ferdie, for your series.
Hopefully, we can put up what we discussed before, a “Philippine Therapeutic Community for Addiction (PTCA)” with Sorsogon as the pilot province. Of course, it will be under your guidance and supervision. We have to treat addiction as a Filipino disease and not a crime punishable by EJK processes. EJK is the acronym for Extra-Judicial Killing. It is a sad practice in our homeland. Hopefully, we can launch it in late 2025, as a component of our HMO project, which is the first step to revive a “Medical Center,” as patterned after the American Med-Center constructed in the City of Manila in the 1900s.