Therapeutic Community



The concept was first developed by Maxwell Jones in 1953.
"It is a therapy in which patients social environment would be used to provide a therapeutic experience by involving him as an active participant in his own care and daily problems of his own community"-Stuart & Sundeen
"Therapeutic community is defined as scientific structuring of the environment in order to effect behavioral changes and to improve psychological health and functioning of the individual"- (Skinner, 1979)
·         To use patients social environment to provide a therapeutic experience for him
·         To enable the patient to be an active participant in his own care and become involved in daily activities of his community
·         To help patients solve problems, plan activities and develop the necessary rules and regulations for the community
·         To enable the patient become aware of how their behaviour affects others
Elements of therapeutic community
·         Free communication
·         Shared responsibilities
·         Active participation
·         Involvement in decision making
·         Understanding of roles, responsibilities, limitations and authorities
Characteristic of a therapeutic community
·         Respect the individual client as a citizen with a capacity for autonomous action
·         Share decision making with residents about day to day life of community
·         Use mechanism of meetings and groups to develop openness of communication about problems, feelings, and conflicts
·         Stress an ordinary domestic environment in which client can enjoy meaningful purposeful activity
·         Responsibility for treatment belong to the staff and client
·         Role of staff and client is equalized
·         Democratic environment is fostered
·         Open communication is encouraged
·         Interpersonal interaction are utilized to improve communication skills
·         Inappropriate behaviour are dealt with as they occur   Team approach is used
·         Clients are treated as a part of team and share their responsibility
·         Two main goals for clients, - learn to set limits, learn psychosocial skills
·         Focus is own client assets
Components of therapeutic community
Daily community meeting:
l.    Composed of 60-90 patients
2.   Meeting regularly for one hour
3.   Focus discussion on day to day life in the unit
4.   Patients feelings and behaviour is noted by other members
Patient government or ward council:
·         Purpose is to deal with practical unit such as house keeping functions, activity planning
·         A group of 5-6 patients with specific responsibilities, such as house keeping, physical exercise, personal hygiene, meal distribution, a group to observe suicidal patients, etc. staff members should be available always
·         All decisions should be fed back through community meetings
Staff meetings/review:
·         patients are excluded and only staffs are present
·         Staff would examine their own responses, expectations, and prejudices
Living and learning opportunities:
·         learning opportunities are to be provided within the social milieu, which should provide realistic learning experiences for the patients
·         Harmonious relationship with other members of community   Gains self confidence
·         Learns to understand and solve problems of self and others
·         Develop leadership skills
·         Becomes socio-centric
·         Learns to live and think collectively with the members of the community
·         Provides opportunities to participate in the formulation of hospital rules and regulations
·         Role confusion between staff and patient
·         Group responsibility can easily become nobody's responsibility
·         Individual needs and concerns may not be met Role of nurse
·         Providing and maintaining safe and conflict free environment through role modeling and group leadership
·         Sharing responsibilities with patients
·         Encouraging patient to participate in decision making function
·         Assist patient to assume leadership role
·         Gives feedback

·         Supervisory function



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item Therapeutic Community
Therapeutic Community
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