The 9 Competencies

The Nine Competencies of a Traditional Therapeutic Community

First published in 1981, Revised in November 2014      

by David H. Kerr

I have met with the “father” of the therapeutic community, Dr. Maxwell Jones[1]. Jones started the first therapeutic community in England in the 1940s, designed for returning veterans from the Second World War. Jones explained to me that the best way to help people was to engage them in helping themselves and others in a communal setting. This was the same design used at the Yale Psychiatric Institute and was later to be used by many TC’s around the world.  

The therapeutic community emphasizes a person’s relationship with the surrounding community as a prime indicator of health and well-being. The tenants of AA and NA are important, and meetings organized under the twelve steps are common in many TCs even today. Positive behavior and attitudinal change are promoted and practiced and expected in the long-term TC and this encourages a positive demonstrated lifestyle change by program completion. This is in contrast with today’s focus on the “patient” or “client” as the recipient of help rather than as the key to providing help.  With that in mind, there are nine competencies listed below that should be understood and practiced by a counselor/coach working in a therapeutic community or TC:

Competence 1: Understanding and promoting upward mobility and the privilege system

Definition of Competence: Nothing in a therapeutic community except basic human rights is awarded without being earned by the member i.e. there is no “free-lunch” in the TC. The system of advancement and rewards, as well as imposed sanctions is clearly spelled out and understood by each new TC member. Examples of some privileges that must be earned in a therapeutic community include passes or furloughs, letter writing, dating, advancement in the community structure, visits, eligibility for work, school, etc. It is the belief in the therapeutic community that when status and recognition are earned and owned, the positive effects are much more permanent. Privileges that are unearned are soon taken for granted, promoting an attitude of selfishness in community members that doesn’t bode well for recovery.

Competence 2: Understanding and promoting self-help and mutual-Help

Definition of Competence: Members of a community working together to help themselves and each other; a self-help environment is a supportive environment with loving concern rather than selfishness; an environment emphasizing human understanding; an environment that emphasizes self-responsibility and deemphasizes people being serviced or the traditional service model.

Competence 3: Understanding and promoting the concept of “no we-they dichotomy.”

Definition of Competence: Attempts should be made to create a structure that reduces the barriers between “helper” and “helpee.” The “helpee,” or student member, should be looked at as possessing equal capabilities and potential as the “helper,” or staff facilitator or coordinator or coach. In a therapeutic community, members help themselves and each other; while staff, facilitate this process. The fact that the staff is usually paid and members are not makes it impossible to eliminate this dichotomy completely. However, fostering this dichotomy encourages the traditional service model.  Here the student members are seen more as helpless patients. The staff assumes the role of providing advice and counsel rather than coaching and support. To the extent that this dichotomy between staff and student member exists, the TC effectiveness is diminished.

Competence 4: Understanding and practicing the concept of “acting as if”[2]

Definition of Competence: If a person acts a certain way long enough, that individual soon will feel that way and, in fact, reorient his lifestyle in that direction. The therapeutic community emphasizes acting pleasant or happy, even though members (or staff) may have problems or feel bad. This “act-as-if” philosophy supports a positive therapeutic community environment that, in turn, supports other members acting and thinking positively. Despondent and depressing attitudes or clownish or negative behaviors are often infectious and counterproductive in a small community. One individual’s problems or issues can easily become a major crisis for the entire therapeutic community family.

Competence 5: Understanding the relationship between belonging and individuality

Definition of Competence: “Without something to belong to, we have no stable self, and yet total commitment and attachment to any social unit implies a kind of selflessness. Our sense of being a person can come from being drawn into a wider social unit; our sense of selfhood can arise from little ways in which we resist the pull. Our status is backed by the social buildings of the world, while our sense of personal identity often resides in the cracks.[3]” Generally, the priority of the initial phase of the therapeutic community is on ownership and belonging, while individuality and self-realization are stressed in the latter phase of the therapeutic community. The term “belonging” connotes a sense of ownership and identification with the community and the people therein. Fostering belonging encourages members’ belief that the therapeutic community will help them. Belonging also encourages team activities and group spirit, which enhances self-esteem. It also encourages a search for personal identity, which requires support and nurturing, as does encouraging a sense of ownership in the program; belonging and individuality maintain a dialectic relationship throughout the therapeutic community program. Emphasis is placed initially on “belonging,”while “individuality” is stressed at a later stage in the recovery process. Too much weight placed on the area of belonging, however, encourages cultist and unchecked devotion to a cause; while overemphasis on individuality may support selfishness, causing members to lose sight of the need for support for and help from others.

Competence 6: Understanding of social learning versus didactic learning

Definition of Competence: Social learning or experiential learning in a TC is best described as the natural process of “growing up” or maturing. Didactic learning occurs with cognitive or intellectual communication of ideas or thoughts from one individual to another. In the therapeutic community, didactic learning takes place in the form of seminars, schooling, or lectures; while social learning embraces TC concepts, including, but not limited to, role modeling, peer pressure, learning by experience, and the “family concept” and social order. Didactically offering advice, or providing a service to a student member, by advising him/her what to do is not considered in a TC the most effective way to enhance personal growth, although it might be necessary from time to time. Social learning, however, as in osmosis, is a process by which TC members absorb information, suggestions, and TC concepts to improve their behavior and attitude. While this process supports didactic learning, the TC is most effective when there is practice of new behaviors and continuing feedback from other student members and staff during the normal functioning in the residential community.

Competence 7: Understanding the need for a belief system within the community

Definition of Competence: Most cultures or societies are guided by a written or unwritten set of beliefs, values, mores, spiritual guidelines, rules and regulations, or laws. Most therapeutic community proponents agree with the definition mentioned above, that in the TC, something greater than the individual member is at work in their lives, facilitating and enhancing the positive social learning process. Each therapeutic community, however, has a slightly different set of beliefs; and, in fact, some belief systems may be radically different than others. As long as the therapeutic community belief system is reflective of the larger society’s system of values, mores, and beliefs, and is ethical, there is no need to question or criticize a programs particular set of beliefs. This concept is designed to separate a cult of radical beliefs from a TC that reflects the positive norms of the larger society.

Competence 8: Understanding and practicing positive role modeling

Definition of Competence: The behavior and attitude of a staff coach must exert a positive influence over the community members. Since much learning and growth occurs through the process of modeling behavior or imitating others, it is important that the coach understands the need to set a positive example. A positive example does not mean inflicting the coach’s personal values and mores on the student member. Both staff and student members must be encouraged to be positive models.  For example, if there are primarily black members in a community, it is more natural to hire black staff members to facilitate more effective identification and role modeling. If most TC student members are recovering people with mental health issues, then there should be some long term clean and sober certified recovering addicts who have overcome their mental health issues employed as staff members.

Competence 9: High Expectations

Definition of Competence: This is another essential process that must function at a high level in the TC. The TC expects much of its student members and its staff, and although incoming student members bring with them a long and troubling past, they should not be seen as helpless. These student members are not to be referred to as “patients,” The concept of “high expectations” demonstrates why it is not appropriate for TCs to use the word “patient,” a word that describes a helpless person. Once the “patient” label is tacked on, the concept of “high expectations” becomes questionable since we then have a “we-they” or counselor-patient environment possibly limited by a counselor’s expectations. That said, the TC must recognize the different levels of functioning of student members needing support and coaching, so as to guide the process of self-help and mutual-help based on individual needs.

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[1] The therapeutic community: A new treatment method in psychiatry” Maxwell Jones http://www.amazon.com/The-therapeutic-community-treatment-psychiatry/dp/B0007DRAGM

[2] “Success or failure depends more upon attitude than upon capacity; successful men act as though they have accomplished or are enjoying something. Soon it becomes a reality. Act, look, feel successful, conduct yourself accordingly, and you will be amazed at the positive results.”  From William James. http://www.brainyquote.com/quotes/authors/w/william_james.html#QvrC3hdqA8XUOHZX.99

[3] Erwin Goffman, Asylums, Garden City: Doubleday and Company Inc., 1961

More Evidence of Marijuana’s Harmful Effects on Young Brains

 

By David H. Kerr              

  

Marijuana is a tricky drug.  Most smokers are skeptical that regular use could change their brain function in a harmful and permanent way.  Marijuana is now accepted by our culture and regular users will often use the argument that it is less harmful than alcohol.  A growing body of research though is beginning to show its long term negative effects on young users.

 

“Evidence of long-term effects is also building. A study released in 2012 showed that teenagers who were found to be dependent on pot before age 18 and who continued using it into adulthood lost an average of eight I.Q. points by age 38. And last year at Northwestern, Dr. Breiter[1] and colleagues also saw changes in the nucleus accumbens among adults in their early 20s who had smoked daily for three years but had stopped for at least two years.

 

They had impaired working memories as well. “Working memory is key for learning,” Dr. Breiter said. “If I were to design a substance that is bad for college students, it would be marijuana.”

 

How do you compete with marijuana though?  What steps can parents take to best assure that their pre-teen children don’t begin pot use in their early teen and high school years?  It is an uphill battle considering our growing cultural norms tolerating pot use.  Now in November 2014, there is plenty of visual and first hand evidence of increased pot use by teenagers.

 

The new drug culture influences our children through the different drug oriented clicks and groups during high school and college.  It’s not that pot users are advocating that others should use marijuana.  In some cases yes, but I believe that it spreads mostly through curiosity by the upcoming students about pot and their eagerness to become part of “the group.”  Some are now calling drug use and abuse an epidemic in our society that is very difficult to stop. 

 

Children are curious about everything as they grow up and they tend to want to find out for themselves about many things including drugs.  When Mom says “no to drugs” child thinks “that means I should try it.”  Saying no to drugs is a simple but ineffective prevention tactic that can’t replace the need for child and parent to communicate in a non-punitive way.  This is a better way to promote a child’s learning on his/her own about drugs without having to dig in deeper through dangerous personal experience.  The problem with this is that the child often knows more about drugs than the parent and this becomes obvious during the discussion.

 

Still, there are things that a parent might do to help teens have the best chance of growing up without the use or abuse and/or dependency on marijuana and other drugs including alcohol.  Here are my five suggestions:

1. Understand that what you do and your attitude will have the most impact on your children.  If you smoke pot for example, it’s more likely that at least one of your children will do the same. 
2. By the time your children enter high school, it will be more difficult to start learning about who they are.  Continuing to lecture and preach will likely reduce or eliminate what could be critical and effective communication between you and your children at this age. But it’s never too late to change your own behavior as a parent by demonstrating the kind of positive actions and attitudes you would like to see in your children.
3. Work to communicate with your pre-teen or teenager.  When children are between the ages of 2 and 11, they will likely benefit from consistent discipline, sanctions, support and guidance[2].  After this age however, your teenager will respond better to general discussions about what interests them, letting them take more charge of the conversation. Look for what interests your teenager and gently and carefully encourage a non-judgmental discussion about these topics building a rapport.  Once this happens, the door opens for you to speak your mind without treating your teen as a child.  It’s hard for us parents to make this transition from baby “sanction-talk” to young adult “communication-talk.”
4. Never abrogate your responsibility as a parent to do what is right for your teenager though and that may very well mean discipline or sanctions from time to time.  Know when to use these sanctions and mean what you say.  Teens will push relentlessly for what they want when they want it and it’s still your job to draw the line in a fair and balanced way.
5. Try to be flexible and have time for your teenager when he/she needs you rather than brushing him/her off at that critical time because of your own busy schedule. Be careful not to be petty in your discipline and learn how to begin a more adult to adult relationship with your teen.  Remember that it’s your teenager’s job function to push you; to disregard what you say; to rebel from time to time; to skulk and grump around and to test you constantly.  Your job is to swallow hard; to count to 10 and to back off from responding to the traps set for you by your teen.  If you don’t feel that “wise thought out response” welling up in you after an argument, say nothing and return to the discussion later.  Give it some thought.

 You know that your teen can use pot and other drugs the moment he/she leaves your house.  You have no control except for your relationship.  Searching his/her room only confirms your suspicion about the drug use but what do you do when you find it?  The answer – talk yes, BUT  LISTEN MORE!  Learn and understand = More effective parent

 

Early and sustained parent to child communication, following the above steps, may be the most effective way to guide and “parent” your child towards a mature and healthy drug free lifestyle.  Healthy children often have a busy schedule and no time for drugs.

 

The NY Times article below by Abigail Sullivan Moore is well worth a read!