# Presentation: 150929

## Module 1

- Introduction to the TCC

## Small-Group Formation

- What quality does each person in the group have in common with others?
- What do you expect to get out of this training?
- Which TC slogan would you like to adopt as your group slogan for the training?

## “Acting as If”

- When an individual **acts** in a certain way long enough, the **thoughts** and **feelings** that support the behavior will strengthen.
- Feelings, insights, and altered self-perceptions often **follow** behavior change rather than precede it.

## Journal Writing and Wrapup

- What are your expectations about the TCC training?
- What thoughts or concerns do you have about your role as a TC staff member?
- What would you most like to know more about?

## Prework for Module 2

- Read Resource Sheet #2-1: 14 Basic Components of a TC
- Research the history of your TC

## Module 2

- The History and Evolution of the
- Therapeutic Community

## What Is a Therapeutic Community?

- 	A TC is a structured method and environment for changing human behavior in the context of community life and responsibility.

## Indicators of the TC Model’s Evolution Into Mainstream Human Services

- A mix of professionals
- Evaluation research
- Program and staff competence standards
- Professional associations
- Common components
- Adaptations to new settings and special populations

## Special Services in a TC

- Enhance the effectiveness of the TC approach rather than modify or replace basic TC components and practices
- Are incorporated into the TC environment only if they are consistent with the TC perspective and can be well integrated into the daily regimen of TC activities
- Are provided only when residents are stable and have developed a sense of belonging within the peer community and understand the TC approach

## Journal Writing and Wrapup

- How important is it to me that I feel a part of a long tradition of people helping others to recover through the use of community?
- How can I, in my role, best contribute to the community environment (component 2) in my TC?
- How do I see myself as a community member (component 4)?

## Prework for Module 3

- Read Resource Sheet # 3-1: Case Study of Ray—Disorder of the Whole Person

## Module 3

- Treatment and Recovery— The TC View

## Distinctive Features of TCs

- TC lingo or language
- Community-as-method
- Rational authority
- TC views of the disorder, the person, recovery, and right living

## TC Views

**View of the Disorder**
- Disorder of the whole person
- Virtually every aspect of a person’s life is affected

**View of the Person**
- TC residents are able to change their behavior and become productive members of society

## Exercise: Case Study of Ray

- What are examples of Ray’s
- Cognitive and behavioral issues?
- Perceptual issues?
- Emotional issues?
- Social issues?

## TC View of Recovery

- Gradual building or rebuilding of a new life
- Changes in thinking, feeling, values, behavior, and self-identity

## TC View of Right Living

- Honesty in word and deed
- Responsible concern for others
- Work ethic
- Active and continuous learning

## TCA Staff Competency

- Understanding the need for a belief system within the community

## Journal Writing and Wrapup

- How do you feel about what you have learned?
- What new ideas did you get from this module?
- What thoughts or concerns do you have about your role as a member of the TC?

## Prework for Module 4

- Read Resource Sheet #4-1: Community-as-Method

## Module 4

- The Community-as-Method Approach

## Exercise: Social Learning

- Recall a situation in which you learned a valuable life lesson from peers, family members, or coworkers.
- What did you experience as you listened to each person share?

## TCA Staff Competency

**Social Learning****	**
- Identifying with others
- Learning and changing behavior through participation, observation, and interaction with others

**Didactic Learning**
- Formal instruction
- One-way presentation of new information from an “expert” to a “student”

## Eight Basic Concepts of Community-as-Method

- How is each concept implemented in your facility?
- How can you, as a staff member, promote each concept?

## Exercise: Role Play of Community-as-Method

- Christina, an experienced TC staff member
- Michael, a new staff member
- Sarah, a new resident
- Observers

- Staff members will explain community-as-method and give examples to the new resident.

## TCA Staff CompetencyUnderstanding and promoting self-help and mutual help

**Self-Help**
- Residents are responsible for participating and contributing to the TC process to change their behavior

**Mutual Help**
- Residents assume responsibility for helping their peers
- Mutual self-help reinforces one’s recovery process

## Journal Writing and Wrapup

- Which of the eight concepts do you feel you need to know more about? Why?
- Which concept are you most comfortable implementing in your role?

## Module 5

- The TC Social Structure and Physical Environment

## Exercise: Rules

- Tell your partner about
- Three rules you have in your household
- The benefits of having these rules

## TC Rules

- Cardinal
- Major
- House

## Structured Socialization

- Structured socialization is the step-by-step process through which residents learn prosocial behavior and attitudes that allow them to become productive members of mainstream society.

## TC Social Organization

- Structure
- Systems
- Communication
- Daily regimen of scheduled activities

## Resident Meetings

- Resident meetings are used to
- Enhance sense of community
- Provide structure
- Resolve issues
- Communicate to all members of the TC
- Assess individual and collective moods of the TC

## Morning Meetings

- Are intended to be uplifting
- Engage residents who may be withdrawn
- Motivate residents
- Start the day in a positive way
- Enhance residents’ sense of community

## House (or General) Meetings

- Address issues and problems that pose a physical or psychological threat to the community
- Discuss community concerns and ways to correct community problems

## Closing Meetings

- Conduct community business in a structured fashion
- Provide closure to the day’s activities
- Make announcements
- Assess mood

## The Physical Environment

- The physical setting of the TC allows residents to
- Disengage from previous lifestyle
- Attain positive affiliation
- Achieve self-discipline
- Reinforce recovery principles and right living

## Access and Security

- TCs are not locked facilities but restrict access to provide security for residents and promote recovery.

## Journal Writing and Wrapup

- What information from this module did you find most useful?
- In what ways might you use this information in your role as TC staff member?
- How are you feeling about your role in this training community?

## Module 6

- Peer Interpersonal Relationships

## Exercise: Healthy Relationships

- Think and write about
- Positive, healthy relationships you have had with family, friends, coworkers, and authority figures
- Benefits of having healthy relationships
- Ways to initiate and maintain healthy relationships

## Promoting Healthy Relationships

- Staff members are expected to understand
- Residents’ relationship-related issues
- How the TC recovery process addresses these issues
- Treatment goals related to developing healthy relationships

## Promoting Healthy Relationships

- Staff members are expected to encourage mutual self-help by
- 	Promoting familylike relationships among peers
- 	Promoting healthy peer friendships
- 	Encouraging residents to become role models 	and leaders
- 	Helping residents use the community to 	develop relationship skills

## Promoting Healthy Relationships

- Think of a specific resident
- Think of 3 possible goals related to changes in that person’s relationships
- Identify 3 ways you will try to help the resident meet these goals

## Being a Role Model

- A role model
- Behaves according to TC expectations of recovery and right living
- Sets a positive example for other residents to follow

## Senior Residents as Role Models

**Junior residents**
**learn new behaviors**

**Senior residents model new behaviors for others**

**Senior residents experience personal growth and learning as a result of modeling**

**Senior residents provide additional learning and assistance for other residents**

## Role Models 

- “Act as if” when necessary
- Show responsible concern for others
- Seek and assume responsibility

## Benefits to Residents of Being a Role Model

- Personal growth and self-learning
- Increased status in the peer community
- Leadership skills
- Identity change
- Increased self-esteem

## Living in a TC with people of all backgrounds promotes recovery and right living.

## What Do Residents Gain FromLiving in a Diverse Community?

- Self-knowledge
- Decreased fear of difference
- Self-acceptance
- Knowledge of how common issues can outweigh differences
- Mutual self-help

## Gender Competency

- TC staff members must
- Be sensitive to gender-related issues
- Not discriminate or show favoritism
- Be aware of and prevent discrimination in the community
- Offer special group sessions
- Serve as role models

## TCA Staff Competency

- Understanding the relationship between belonging and individuality

## Journal Writing and Wrapup

- What new information or insight regarding diversity did you get from this module?
- How do you think you can use this information in your TC role?
- How are you feeling about your role in this training community?

## Prework for Module 7

- Read Resource Sheet #7-3: Case Study of Veronica
- Read Resource Sheet #7-4: Guide to Rational Decisionmaking
- Read Resource Sheet #7-7: Taking Good Care of Yourself

## Module 7

- Staff Roles and Rational Authority

## TC Staff Members

- All TC staff members
- Play important roles in the treatment process
- Are considered integral members of the TC

## TCA Staff Competency

- Staff members serve as
- positive role models.

## Exercise: Authority Figures in Your Life

- Think about
- Someone who was a positive authority figure in your life
- What you learned from this person
- The characteristics that describe this person

## Staff Members as Rational Authorities

**Program Management**
**Staff**
- Make decisions related to
- Resident status
- Discipline
- Promotions
- Transfers and discharges
- Furloughs
- Treatment planning

**Program Support**
**Staff**
- Make decisions related to their area of expertise
- Support the clinical decisions of the program management staff

## Staff Members as Rational Authorities

- Staff members establish themselves as rational authorities by the way they make, communicate, and follow up on decisions.

## TCA Staff Competency Understanding and discouraging the concept of the we–they dichotomy

- Adhere to community rules
- Participate in meals and activities
- Demonstrate respect for residents
- Be open to confrontation from residents
- Be willing to listen and learn

## Journal Writing and Wrapup

- What was the most useful information you gained from this module?
- What do you think is the most difficult part of your role as a TC staff member and/or a rational authority?

## Prework for Module 8

- Resource Sheet #8-1: Community Tools
- Resource Sheet #8-4: Group Process Tools
- Resource Sheet #8-6: Mock Encounter Group

## Module 8

- TC Treatment Methods

## Review

- Community-as-method
- Self-help and mutual self-help
- TC social structure and systems

## Community Tools

**Reinforcers**
- Affirmations
- Pushups
- Privileges

**Sanctions**
- Verbal correctives
- Interventions

## Exercise: Community Tools

- What tool do you think should be used?
- Who uses the tool—peer or staff member?
- How will the resident benefit from the intervention?
- Explain your decision as it applies to TC views.
- How will the community benefit from the intervention?

## TC Groups

**Educational Groups**
- Personal growth
- Job skills
- Clinical skills
- Life skills
- Reentry

**Clinical Groups**
- Encounter
- Probe
- Marathon
- Static

## Group Process Tools

**Provocative**
- Used to challenge and confront

**Evocative**
- Used to support and encourage

## Encounter Groups

- Residents learn to
- Show compassion and responsible concern
- Confront reality
- Be honest
- Seek self-awareness
- Resolve issues and concerns

## Encounter Group Phases

- Confrontation
- Conversation
- Closure

## TCA Staff Competency

- Understanding and
- facilitating group process

## Journal Writing and Wrapup

- What new information or insight regarding TC treatment methods did you get from this module?
- How do you think you can implement this new information in your TC role?
- How are you feeling about your role in this training community?

## Prework for Module 9

- Review Resource Sheet #3-1: Case Study of Ray—Disorder of the Whole Person
- Read and complete
- Resource Sheet #9-1: Case Study of Ray at Work
- Resource Sheet #9-2: Structure Board

## Module 9

- Work as Therapy and Education

## Primary Purpose of Work in a TC

- The primary purpose of work in a TC is to reveal and address residents’ attitudes, values, and emotional growth issues.

## Work in the TC Is Used To

- Shape personal behavior
- Promote positive interpersonal relationships
- Create a sense of community
- Instill attitudes that promote right living
- Teach job skills

## Role of Staff Member

- Make thoughtful work assignments
- Encourage self-help
- Act as a role model
- Educate and explain
- Promote community-as-method and mutual self-help
- Help residents be role models

## Peer Work Structure and Hierarchy

- Crewmember
- Crew leader
- Advanced peer leadership
- Expediter
- Department head
- Coordinator
- Junior staff trainee candidate

## Exercise: Case Study of Ray at Work

- How would you
- Encourage self-help?
- Be a role model?
- Educate and explain?
- Promote community-as-method and mutual self-help?

## Decisionmaking

- Job assignments/promotions carefully consider a resident’s needs for growth and learning.
- Progression or regression in the work hierarchy depends on a resident’s work behavior and attitude.

## Journal Writing and Wrapup

- How has your TCC work assignment contributed to or enhanced your experience as part of the training community?
- How are you feeling about the training community at this point?

## Prework for Module 10

- Resource Sheet #10-1: Case Study of Marcus Advancing Through the TC Program Stages

## Module 10

- Stages of the TC Program and the Phases of Treatment

## Preprogram Assessment

- Structured interview
- Medical evaluation

## Staged Approach to Treatment

- Allows time for residents to
- Practice prosocial behaviors and attitudes
- Experience success or failure through a trial-and-error learning process
- Be supported and guided by the community
- Internalize new behaviors and attitudes and become accustomed to living them on a daily basis

## Stages of the TC Program

- Stage I—Orientation/Induction
- Stage II—Primary Treatment
- (Phase 1, Phase 2, Phase 3)
- Stage III—Reentry
- (early phase, middle phase, late phase)

## Program Graduates

- Have remained alcohol and drug free
- Are employed or are in school or a training program
- Have resolved legal problems
- Have resolved most of their practical problems
- Accept that they need to continue to work on particular problem areas and on themselves in general
- May have a regular therapist
- Are attending AA or NA meetings regularly
- Have a firm commitment to continued abstinence

## TCA Staff Competency

- Understanding and promoting upward mobility and the privilege system

## TCA Staff Competency

- Maintaining accurate records
- What are examples of good recordkeeping?
- What are examples of poor recordkeeping?

## Journal Writing and Wrapup

- How comfortable am I making decisions about a resident’s advancement or regression from stage to stage and phase to phase?
- How competent am I at recordkeeping? In what ways could I improve?

## Prework for Module 11

- Read and complete Resource Sheet #11-1: The Process of Self-Change and Internalization
- Read Resource Sheet #11-2: Case Study of Marcus as a Role Model

## Module 11

- How Residents Change in a TC

## Self-Change

- Residents do not adopt behaviors and attitudes simply to comply with TC rules.
- Residents make fundamental changes in the way they live and perceive themselves.

## Self-Identity

- How individuals perceive themselves
- How individuals believe they differ from others
- Individuals’ perceived degree of self-worth and sense of purpose

## Internalization

- The process of accepting, practicing, and applying what has been learned in the TC to new situations inside and outside the program

## Internalization

- Essential experiences
- Essential perceptions
- Active participation and involvement in the TC

## Essential Experiences

- Emotional healing
- Social relatedness and caring
- Subjective learning of self-efficacy and self-esteem

## Essential Perceptions

- TC treatment is effective.
- I am making progress.

## Journal Writing and Wrapup

- What was the most useful information you gained from this module?
- How do you think this information might help you in your work?