THERAPEUTIC COMMUNITY 

CURRICULUM

Participant’s Manual

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Rockville, MD 20857
Acknowledgments

Numerous people and organizations contributed to the development of this curriculum (see appendices A

and B). The curriculum was prepared for the Substance Abuse and Mental Health Services 

Administration (SAMHSA) by JBS International, Inc. (JBS), under Knowledge Application Program (KAP) 

contract numbers 270-99-7072 and 270-04-7049 with SAMHSA, U.S. Department of Health and Human 

Services (DHHS). Christina Currier served as the Center for Substance Abuse Treatment (CSAT) 

Government Project Officer, and Andrea Kopstein, Ph.D., M.P.H., served as the Deputy Government 

Project Officer. Lynne MacArthur, M.A., A.M.L.S., served as JBS KAP Executive Project Co-Director, and 

Barbara Fink, R.N., M.P.H., served as JBS KAP Managing Project Co-Director. Other KAP personnel 

included Dennis Burke, M.S., M.A., Deputy Director for Product Development; Candace Baker, M.S.W.,

Senior Writer/Publication Manager; Wendy Caron, Editorial Quality Assurance Manager; Frances 

Nebesky, M.A., Quality Control Editor; Leah Bogdan, Junior Editor; and Pamela Frazier, Document 

Production Specialist. Sandra Lundahl, M.P.H., served as Lead Training and Curriculum Designer with 

AFYA, Inc., under a subcontract to JBS.

The Therapeutic Community: Theory, Model, and Method, by George De Leon, Ph.D., was used as a 

primary source for this curriculum with the permission of Springer Publishing Company, Inc., New York, 

NY. Dr. De Leon provided consistent support for this project.

Disclaimer

The opinions expressed herein do not necessarily reflect the official position of CSAT, SAMHSA, or 

DHHS. No official support of or endorsement by CSAT, SAMHSA, or DHHS for these opinions or for 

particular instruments, software, or resources described in this document is intended or should be 

inferred. 

Public Domain Notice

All material appearing in this publication except that taken directly from copyrighted sources is in the 

public domain and may be reproduced or copied without permission from SAMHSA. Do not reproduce or 

distribute this publication for a fee without specific, written authorization from the Office of 

Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication may be accessed electronically through the following Internet address: 

www.kap.samhsa.gov. For additional free copies of this curriculum, please call SAMHSA’s National 

Clearinghouse for Alcohol and Drug Information (NCADI) at (800) 729-6686 or (800) 487-4889 (TDD). 

Recommended Citation

Center for Substance Abuse Treatment. Therapeutic Community Curriculum: Participant’s Manual. DHHS 

Publication No. (SMA) 06-4122. Rockville, MD: Substance Abuse and Mental Health Services 

Administration, 2006.

Originating Office

Practice Improvement Branch, Division of Services Improvement, Center for Substance Abuse Treatment, 

Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 

20857.

DHHS Publication No. (SMA) 06-4122

Printed 2006
iii

Contents

Participant Orientation ......................................................................................................PM 1

Introduction...............................................................................................................................PM 1

The TCC Learning Approach ...................................................................................................PM 2

Overview of the Participant’s Manual......................................................................................PM 3

Getting the Most From Your Training Experience ...................................................................PM 3

Modules

Module 1: Introduction to the Therapeutic Community Curriculum.................................. PM 1-1

Module 2: The History and Evolution of the Therapeutic Community.............................. PM 2-1

Module 3: Treatment and Recovery—The TC View ........................................................ PM 3-1

Module 4: The Community-as-Method Approach ............................................................ PM 4-1

Module 5: The TC Social Structure and Physical Environment ........................................ PM 5-1

Module 6: Peer Interpersonal Relationships ...................................................................... PM 6-1

Module 7: Staff Roles and Rational Authority ................................................................... PM 7-1

Module 8: TC Treatment Methods .................................................................................... PM 8-1

Module 9: Work as Therapy and Education....................................................................... PM 9-1

Module 10: Stages of the TC Program and the Phases of Treatment ................................. PM 10-1

Module 11: How Residents Change in a TC ...................................................................... PM 11-1

Appendices

Appendix A: TCC Expert Panel ................................................................................................. A-1

Appendix B: TCC Contributors...................................................................................................B-1
PM 1

Participant Orientation

Introduction

Background

Leaders in the therapeutic community (TC) model of treatment have identified a critical need for 

entry-level staff training in the basics of the TC model. 1 In response, the Substance Abuse and 

Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT) 

convened an expert panel in 2000 to serve as a planning committee for a generic TC curriculum 

(TCC) and to provide guidance during its development (see appendix A for a list of expert panel 

members and appendix B for a list of other contributors). This document is the result of that 

collaboration.

TCs have evolved to serve an ever-increasing range of special populations with substance use 

disorders, including women with children, older adults, adolescents, people with co-occurring 

mental disorders, people with HIV/AIDS, people who are homeless, and people involved with 

the criminal justice system. In addition, the TC approach has been passed down rather informally 

through succeeding generations of TC program staff, allowing a shift away from the foundations 

of the TC model2 and necessitating a concrete and standardized method of training both clinical 

and nonclinical staff.

In an interview with Therapeutic Communities of America News, the Director of CSAT, H. 

Westley Clark, M.D., J.D., M.P.H., CAS, FASAM, advised that, as the TC model continues to 

evolve, TC practitioners and administrators should stay anchored to the essential premises of 

TCs so that changes are based on “your [TC practitioners’] own information, your own 

traditions, your own histories so you don’t get fads . . . [but] progressions that are logical, 

sustained, and meaningful.”3

The TCC was developed to facilitate such logical and meaningful evolution of the TC model by 

providing TC staff members with an understanding of the essential components and methods of 

the TC and helping them understand and appreciate that they are part of a long tradition of 

community as a method of treatment.

Language

In presenting generic TC concepts and methods, TCC developers use terms that are accepted 

widely in TCs. In some cases, several alternative terms (provided by TCC reviewers) are 

included. You may find that your TC uses terms that differ from those used in the TCC.

Although the number of outpatient programs using the TC model is increasing, most TC 

programs remain residential. For this reason, developers use the word “resident” throughout the 

document rather than TC “participant,” “member,” or “client.”
PARTICIPANT’S MANUAL

PM 2

TCC Goals and Objectives

Goals:

$ To provide a common knowledge base for all staff members working in TCs 

$ To encourage you to work on your professional growth and development.

Objectives: As you progress through the TCC training, you will 

$ Understand and be able to explain

– The history, basic concepts, and components of the TC

– The TC views of the disorder, the person, recovery, and right living

– The social structure and physical environment of the TC

– The TC treatment methods

– The ways in which staff members help residents change their behavior, attitudes, and 

self-identity through the community-as-method and the self-help and mutual self-help 

learning processes

– The expectations, roles, and competencies of all staff members

$ Experience increased self-awareness

$ Be able to identify concerns about your roles and the ways to obtain additional information, 

support, or training

$ Experience and understand the TC process through participation in simulations and role 

plays of TC methods

$ Experience an enhanced sense of belonging to a TC.

The TCC Learning Approach

The 11 modules in the TCC can be delivered over several consecutive days or can be offered 

over the course of several weeks or months. Each module also can be used separately to target a 

specific training need. Your trainer will provide you with a specific agenda.

The TCC learning approach includes

$ A mixture of presentations, discussions, and exercises to simulate the self-help and mutual 

self-help learning processes used in TCs.

$ Frequent use of a static small-group exercise format.

$ Simulations and role plays to understand better the TC method.

$ Time to reflect on and write your thoughts and feelings in a personal journal. This journal 

is yours to keep; your trainer will not collect it, and you will not be expected to share what 

you have written unless you choose to do so.

$ An assessment of your learning to be completed in your small groups at the end of each 

session.

$ A wrapup exercise to help make the transition home or back to work on a positive note.

$ Brief “prework” assignments to prepare for the next session.
PARTICIPANT ORIENTATION

PM 3

The TCC is not an immersion approach but can complement your agency’s immersion training. 

You will find that the TCC is highly interactive but that it is more didactic than the immersion 

trainings you may have experienced. The developers have tried to balance presentations and 

exercises, and your trainer will allow you to take breaks as needed.

Experiential exercises and group simulations can trigger emotional responses. Your trainer will 

provide basic support and guidance appropriate to a training situation as issues arise during the 

training but will not be able to provide individual counseling. If you feel that you need more 

support, you can

$ Talk to a coworker, friend, or family member

$ Talk to a sponsor or therapist

$ Request referral to your program’s employee assistance program.

The TCC is an entry-level training to familiarize new staff members with basic TC principles 

and methods. It does not take the place of immersion or other clinical skills training or ongoing 

clinical supervision. 

Overview of the Participant’s Manual

Each module of your Participant’s Manual includes

$ PowerPoint slides printed three to a page with space for you to write notes

$ Resource Sheets containing additional information, case studies, and exercises

$ A summary of the main points of each module

$ A learning assessment to complete with your small group (the module review).

Your trainer will give you a notebook to use as your personal journal.

Getting the Most From Your Training Experience

Here are suggestions to get the most from the TC training:

q Speak to your supervisor before the training begins. Find out what his or her expectations 

are for you.

q Think about what you want to learn from each module.

q Come to each session prepared, do any prework that was assigned, and review the 

summaries for the modules to be presented.

q Be an active participant. Participate in the exercises, ask questions, write in your journal, 

and think about what additional information you want.

q Speak to your supervisor after the training. Talk to him or her about what you learned to be 

sure you understand how the information relates to your job.

q Discuss with your supervisor ways that you can put your learning into practice, and 

continue to follow up with him or her.

q Have fun!
PARTICIPANT’S MANUAL

PM 4

 

1 De Leon, G. Therapeutic Communities: Theory, Model and Method. New York: Springer Publishing Company, 

Inc., 2000. Chapter 1, page 6.

2 De Leon, G. Therapeutic Communities: Theory, Model and Method. New York: Springer Publishing Company, 

Inc., 2000. Chapter 1, page 6.

3

Therapeutic communities and high functioning: An interview with Dr. H. Westley Clark, Director of the Center for 

Substance Abuse Treatment. Therapeutic Communities of America News, Spring/Summer 1999.
PM 1-1

Module 1: Introduction to the Therapeutic Community 

Curriculum

Module 1 Goals and Objectives

Goals: To develop a training community; to provide participants with an overview of the TCC’s 

goals and objectives, structure, and learning approach; to introduce participants to the 

Therapeutic Communities of America (TCA) Staff Competencies; and to introduce participants 

to one TCA Staff Competency: “acting as if.”

Objectives: Participants who complete Module 1 will be able to

$ Explain the overall goal and the objectives of the TCC

$ State at least five TCA Staff Competencies

$ Define the concept “acting as if” and describe at least one way staff members can 

demonstrate this concept in their work with TC residents.

Content and Timeline

Introduction 30 minutes

Presentation: Overview of the TCC 30 minutes

Exercise: Small-Group Formation 45 minutes

Break 15 minutes

Presentation: TCA Staff Competencies 20 minutes

Presentation: TCA Staff Competency—Understanding and 

Practicing the Concept of “Acting as If”

10 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 3 hours, 10 minutes
PARTICIPANT’S MANUAL

PM 1-2

Slides Notes

OH #1 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 1

Introduction to the TCC

OH #1 –2

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?

OH #1 –3

“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 selfperceptions often follow behavior change 

rather than precede it.
MODULE 1

PM 1-3

Slides Notes

OH #1–4

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?

OH #1–5

Prework for Module 2

• Read Resource Sheet #2-1: 14 Basic 

Components of a TC

• Research the history of your TC
PARTICIPANT’S MANUAL

PM 1-4

Resource Sheet #1-1: TC Recovery Maxims

The following recovery maxims, also called slogans or unwritten philosophies, are used in the 

TC to give residents a motto to live by and reflect on during each day. 

Love.

Honesty.

Act as if.

Guilt kills.

Blind faith.

Hang tough.

Step by step. 

No free lunch.

Keep it simple.

One day at a time.

Responsible concern.

No gain without pain.

Clean bed, clean head.

Compensation is valid.

Remember who you are.

To be aware is to be alive.

Trust in your environment.

You get back what you put in.

Nothing is constant but change.

What goes around, comes around.

You are your brother’s/sister’s keeper.

You can’t keep it without giving it away.

Do your thing and everything will follow.

You alone must do it, but you can’t do it alone.

It is better to understand than to be understood.

Be careful what you ask for—you might just get it.

If you think you are looking good, you are looking bad.

If you think you are looking bad, you are looking good.

Remember where you came from to know where you are going.
MODULE 1

PM 1-5

Resource Sheet #1-2: TCA Staff Competencies

The following competencies are from the TCA Web site (www.therapeuticcommunitiesof 

america.org). The first competency is outside the scope of the TCC and will not be discussed.

1. Coordinator has knowledge of data-gathering tools as well as assessment instruments that 

facilitate the evaluation of a member’s strengths as well as areas needing improvement.

2. Understanding and promoting upward mobility and the privilege system (Module 10).

3. Understanding and promoting self-help and mutual help (Module 4).

4. Understanding and practicing the concept of “acting as if” (Module 1).

5. Understanding and discouraging the concept of the “we–they dichotomy” (Module 7).

6. Understanding the relationship between belonging and individuality (Module 6).

7. Understanding and facilitating group process (Module 8).

8. Maintaining accurate records (Module 10).

9. Understanding social learning versus didactic learning (Module 4).

10. Understanding the need for a belief system within the community (Module 3).

11. Understanding and practicing positive role modeling (Module 7).

The TCC provides important general knowledge about competencies 2 through 11. Trainers 

demonstrate each competency throughout the training and provide opportunities for participants 

to practice each competency.

Please note that participants will need training in addition to the TCC to develop 

completely the skills needed to become a fully competent TC staff member.
PARTICIPANT’S MANUAL

PM 1-6

Summary of Module 1

TCC Goals and Objectives

Overall Goals

• To provide a common knowledge base for all staff members working in TCs 

• To encourage training participants to work on their professional growth and development

Overall Objectives

Participants who complete the TCC will

1. Understand and be able to explain

• The history, basic concepts, and components of the TC

• The TC views of the disorder, the person, recovery, and right living

• The social structure and physical environment of the TC

• The TC treatment methods

• The ways in which staff members help residents change their behavior, attitudes, and selfidentity through the community-as-method and the self-help and mutual self-help learning 

processes

• The expectations, roles, and competencies of all staff members

2. Experience increased self-awareness

3. Be able to identify concerns about their roles and ways to obtain additional information, 

support, or training

4. Experience and understand the TC process through participation in simulations and role plays 

of TC methods 

5. Experience an enhanced sense of belonging to a TC.

TCA Staff Competencies

Competencies are skills, knowledge, abilities, personal qualities, and behaviors that are critical to 

completing work. TCA Staff Competencies are listed on Resource Sheet #1-2.
MODULE 1

PM 1-7

TCA Staff Competency—Understanding and Practicing the Concept of 

“Acting as If”

“Acting as if” means residents and staff members must behave as the persons they aspire to be 

rather than the persons they have been. All TC members are expected to behave in ways that 

demonstrate the values of the community. 

The psychological principle that underlies acting as if is that, when individuals act in a certain 

way long enough, eventually the thoughts and feelings that support the behavior also will 

strengthen. Feelings, insights, and altered self-perceptions often follow behavior change rather 

than precede it.

Staff members can encourage residents to practice acting as if by

• Expecting residents to behave in prosocial ways

• Instructing residents to use their groups to discuss the resistance they feel when acting in 

ways that do not feel normal and comfortable

• Asking a resident to perform a job function he or she does not like and asking the person to 

do it with a positive attitude.
PARTICIPANT’S MANUAL

PM 1-8

Review of Module 1

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• State the overall goals and objectives of the TCC?

• State at least five TCA Staff Competencies?

• Define the concept “acting as if” and describe at least one way staff members can 

demonstrate understanding this concept?
PM 2-1

Module 2: The History and Evolution of the Therapeutic 

Community

Module 2 Goals and Objectives

Goals: To learn about the origin and history of the TC and to understand the changes in the TC 

approach since its creation. 

Objectives: Participants who complete Module 2 will be able to

• Define “therapeutic community”

• Identify at least 7 of the 14 basic components of a TC

• Identify at least three contributions made by forerunners to today’s TC

• List at least three examples that illustrate how TCs have evolved into the mainstream of 

human services.

Content and Timeline

Introduction 10 minutes

Exercise: What Is a Therapeutic Community? 20 minutes

Presentation: The Beginning and Evolution of the TC 60 minutes

Break 15 minutes 

Presentation: Today’s TCs 30 minutes

Presentation: The 14 Basic Components of a TC 60 minutes

Summary and Review 30 minutes

Journal Writing and Wrapup 20 minutes

Total Time 4 hours, 5 minutes
PARTICIPANT’S MANUAL

PM 2-2

Slides Notes

OH #2 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 2

The History and Evolution of the

Therapeutic Community

OH #2 –2

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.

OH #2 –3

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 
MODULE 2

PM 2-3

Slides Notes

OH #2–4

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

OH #2–5

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)?

OH #2 –6

Prework for Module 3

• Read Resource Sheet # 3-1: Case Study of 

Ray—Disorder of the Whole Person
PARTICIPANT’S MANUAL

PM 2-4

Resource Sheet #2-1: 14 Basic Components of a TC

1. Community Separateness

• TC programs are housed separately from other agency or institutional programs. 

• TC programs are located in settings that allow residents to disconnect from networks of drugusing friends and to relate to new drug-free peers. 

• TC programs have their own names, often created by residents.

2. Community Environment

• The TC environment has many common areas for holding group activities and promoting a 

sense of community. These areas include the dining room, recreation room, family rooms, 

and group rooms. 

• Displays and signs throughout the TC illustrate the philosophy or creed of the program and 

messages of recovery and right living. The displays serve as constant reminders of TC 

practices and principles and promote affiliation with the community. Examples of displays 

include the daily schedule and a bulletin board that list participants’ names, seniority, and job 

functions.

3. Community Activities

• Treatment and educational services take place in the context of the peer community. 

Virtually all activities occur in groups or meetings where residents can interact and learn 

from one another.

• Group activities include

− At least one daily meal prepared, served, and shared by all members 

− Daily group meetings and seminars

− Jobs performed in groups

− Organized recreational activities

− Ceremonies and rituals, such as birthday celebrations and phase graduation celebrations.

4. Staff as Community Members

• Each staff member is a part of the community. He or she is a manager of and elder in this 

community and helps residents use the community. A staff member is not a “healer” who 

stands apart from the community.

• Staff members function as consistent and trustworthy rational authorities and as role models, 

facilitators, and guides in the community-as-method approach and the self-help and mutual 

self-help learning processes.

• Staff members must be oriented to the TC through initial and continuing training.
MODULE 2

PM 2-5

5. Peers as Role Models

• Senior residents are expected to demonstrate the desired behaviors and reflect the values and 

teachings of the community. They serve as role models for new and junior residents. 

• The strength and integrity of the community as an arena for social learning depend on the 

number and quality of its peer role models.

• Residents serve in leadership and teaching roles in the community.

6. A Structured Day

• Each day has a formal schedule of therapeutic and educational activities with prescribed 

formats, fixed times, and routine procedures.

• Order, routine activities, and a rigid schedule counter the characteristically disordered lives 

of residents and leave little time for negative thinking and boredom—factors that often 

contribute to relapse.

7. Stages of the Program and Phases of Treatment

• The TC treatment protocol is organized into three major stages (orientation, primary 

treatment, and reentry) and phases of treatment tha t reflect a developmental view of the 

change process.

• The program stages and phases of treatment allow for individual goals to be established and 

incremental learning to take place.

8. Work as Therapy and Education

• Consistent with the TC’s self-help approach, all residents are responsible for the daily 

operation of the facility, which includes cleaning, meal preparation, maintenance, schedule 

coordination, and meetings. 

• Job assignments provide residents with a sense of responsibility and affiliation with the TC.

• Jobs provide opportunities for self-examination, personal growth, and skill development.

9. Instruction and Repetition of TC Concepts

• TC concepts embody the TC values and belief system, which are antidotes to the values and 

beliefs of drug and prison subcultures.

• The concepts, messages, and lessons are repeated and reinforced in group sessions, meetings, 

seminars, and peer conversations, as well as in suggested readings, on signs posted in the TC, 

and in writing assignments.

10. Peer Encounter Groups

• The peer encounter group is the main therapeutic group format, although other group formats 

are used. 
PARTICIPANT’S MANUAL

PM 2-6

• Encounter groups are conducted to heighten residents’ awareness of attitudes and behaviors 

that need to be changed.

• The peer encounter group process includes confrontation, conversation, and closure.

• Encounter groups provide an opportunity to teach TC recovery principles, such as

− Feeling compassion and responsible concern

− Being honest with self and others

− Confronting the reality of addiction and one’s behavior

− Seeking self-awareness as the first step in making behavior changes

− Using other people for emotional support and caring.

11. Awareness Training

• All therapeutic and educational interventions involve raising residents’ consciousness of the 

effect of their conduct and attitudes on themselves and others.

12. Emotional Growth Training

• TC residents learn to identify feelings, express them appropriately, and manage them 

constructively in stressful situations.

• The interpersonal and social demands of living together in the TC provide many 

opportunities to experience this training.

13. Planned Duration of Treatment

• A period of intense treatment is needed to ensure the internalization of TC teachings.

• The length of time residents must be in the TC program depends on their progress in 

achieving individualized behavioral goals in each program stage and phase of treatment.

14. Continuation of Recovery After TC Program Completion

• Completion of primary treatment is followed by aftercare services (e.g., vocational, 

educational, mental health, and family support services) that must be consistent with the TC 

views of recovery, right living, self-help, and support of a positive peer network.
MODULE 2

PM 2-7

Summary of Module 2

Definition of a TC

A TC is a structured method and environment for changing human behavior in the context of 

community life and responsibility. (Source: Richard Hayton. The Therapeutic Community. 

Kansas City, MO: Mid-America Addiction Technology Transfer Center, 1998.)

History and Evolution of the TC

Several programs contributed to the development of TCs. TC staff members are part of a long 

tradition of people helping others recover from substance abuse. 

Elton Mayo, M.D., and Joe Pratt, M.D., conducted small-group meetings for TB patients in the

early 1900s. In this approach

• Patients discussed their conditions and what they could do to get better. 

• TB patients in better health served as role models and encouraged patients to believe they 

could get better.

Features common to both TB patient groups and today’s TC are

• Self-help

• Helping others (mutual self-help).

AA was founded in 1935 by two people who had alcoholism: Bill Wilson, a New York 

stockbroker, and Bob Smith, a physician. They were both struggling and frustrated by what they 

saw as the failure of the medical, psychiatric, and social service establishments to help people 

with alcoholism effectively.

They met in Akron, Ohio, and their mutual sharing about their disorder sparked the idea for an 

organization of persons with alcoholism helping other persons with alcoholism stay sober. They 

came to believe that people with alcoholism could help one another stay sober. Today, AA is a 

well-established international support group program based on 12 Steps and 12 Traditions that 

support the individual through recovery.

A critical component of the AA program is sponsorship, wherein one AA member who has been 

in the program for some time works with one or more newer members to orient them to the 

program, offer feedback, and serve as a role model of recovery.

Features common to the TB patients groups, AA, and today’s TC include

• Self-help

• Helping others (mutual self-help)
PARTICIPANT’S MANUAL

PM 2-8

• Role modeling

• A small-group format.

In the mid-1940s Maxwell Jones, a British psychiatrist, became frustrated and disillusioned with 

what he saw as the failure of traditional psychiatric treatment. He founded a community to 

provide structure and content for therapeutic change in the lives of individuals with longstanding mental disorders. In this community, Jones successfully treated difficult psychiatric 

cases considered beyond treatment, such as “chronic failures” and “troublemakers.”

Jones based his approach on the theory that a healthy group life would make healthy individuals 

and considered all relationships to be potentially therapeutic. He also believed that productive 

work was an essential component of treatment.

Jones’ model became the prototype for psychiatric TCs and spread throughout England. The 

term “therapeutic community” came into use to describe this community model of treatment.

Features common to this first TC model and today’s TC include

• A holistic approach that goes beyond the single-level approach of traditional psychiatry or 

medication alone

• Belief that the community that is created affects the recovery of the individual

• Having clients actively participate in the community and engage in work that allows them to 

resocialize successfully into society

• Using communication and relationships among all members of the community to aid the 

recovery process.

Synanon was founded in 1958 in California by Charles (Chuck) Dederich, a person recovering 

from alcoholism. Dederich created Synanon to provide an alternative to AA, which he thought 

was limited, especially for people who used illicit drugs. (Narcotics Anonymous was struggling 

to establish itself at this time, with only a few groups in California and New York; it did not 

stabilize into its present form until the mid-1960s.) Synanon began as weekly group meetings, 

evolving within a year into a residential program to treat people with any sort of substance use 

disorder.

Synanon was a groundbreaking, innovative organization that brought together large numbers of 

people who lived and worked together in a quest for personal change at a time when “addicts” 

were considered “incurable.”

Synanon’s founding principles, which still apply to today’s TC, were that

• Treatment should provoke “dissonance,” meaning discord or conflict, to individuals’ selfimage so they are no longer comfortable with who they are.

• A unique encounter group process was developed based on the premise that when 

challenged, people examine themselves and learn new ways of behaving.

• A residential community supports the individual change process.
MODULE 2

PM 2-9

Daytop Village and Phoenix House were early TC programs that were influenced by the 

Synanon model.

Daytop Village 

• Was founded in New York City by Monsignor William O’Brien, Dan Casriel, M.D., and 

David Deitch

• Began providing residential treatment for convicted felons in 1963

• Uses a phased system of treatment with the goal of returning the individual to the community

• Focuses on right conduct and right living

• First used the term therapeutic community to describe the New York Daytop Village in 1965.

Phoenix House, founded in 1967, is currently the Nation’s largest nonprofit organization devoted 

to the treatment and prevention of substance use disorders. Phoenix House

• Uses the traditional TC three-stage method of treatment

• Applies the philosophy of mutual self-help to enable people who abuse substances to 

overcome their addictions in a structured environment

• Seeks to empower residents with skills and self-confidence so that they can lead independent, 

productive, and rewarding lives.

Today’s TC

TCs have evolved into the mainstream of human services. Indicators of this evolution include

• A mix of professionals: TC staff members include a mix of professionals, some who have 

experienced recovery through a TC, as well as traditionally trained professionals.

• Evaluation research: The growing body of literature and research has established the TC as 

an effective treatment modality. 

• Standards: There is movement toward program and staff competence standards, credential 

requirements, and uniform training.

• Professional associations: TC professional associations have been established.

• Adaptations: The TC approach has been adapted for special settings, special populations, 

and public funding requirements, yet it retains common features of the generic TC.

All TCs have 14 basic components, which are listed and described on Resource Sheet #2-1: 14 

Basic Components of a TC. However, TCs have adapted to changing needs in a number of ways; 

a TC may have modified its program by

• Shortening the duration of stay

• Adapting to settings such as 

− Prisons and jails

− Outpatient clinics

− Day treatment programs
PARTICIPANT’S MANUAL

PM 2-10

− Opioid (medication-assisted) treatment programs

− Alternative schools

− Community-based homeless shelters

• Adapting its program to meet the needs of special populations such as

− Adolescents

− Criminal offenders

− People who are homeless

− Women and their children

− Pregnant or postpartum women

− Parents

− Adults or adolescents with co-occurring mental disorders

− Adults or adolescents with HIV/AIDS

− Older adults

− Individuals with brain and spinal injuries.

Many TCs have added special services needed to serve these populations, including

• Childcare 

• Parenting education

• Family therapy

• Individual therapy

• Vocational counseling

• Housing assistance

• Pharmacotherapy.

Special services in today’s TCs 

• 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, have developed a sense of belonging within the 

peer community, and have an understanding of the TC approach.
MODULE 2

PM 2-11

Review of Module 2

In your small groups, discuss and quiz one another on the following (feel free to take notes on 

this page). Can you 

• Recite the definition of a TC?

• Identify at least three contributions made by forerunners to today’s TC?

• State at least three indicators of the TC model’s evolution into the mainstream of human 

services?

• State at least 7 of the 14 basic components of a TC?
PM 3-1

Module 3: Treatment and Recovery—The TC View

Module 3 Goal and Objectives

Goal: To enable participants to understand how the TC views those who use drugs or alcohol 

and the changes in behavior and values necessary for recovery in a TC.

Objectives: Participants who complete Module 3 will be able to

• Describe three distinctive features of the TC: TC language, community-as-method, and 

rational authority

• Give an example of the TC views of the disorder, the person, recovery, and right living

• State at least three assumptions of the TC belief system

• Explain one way staff members can demonstrate that they understand the need for a belief 

system.

Content and Timeline

Introduction 20 minutes

Presentation: Distinctive Features of TCs 30 minutes

Presentation: TC View of the Disorder and the Person 30 minutes

Exercise: Case Study of Ray—Disorder of the Whole Person 30 minutes

Break 15 minutes

Presentation: TC View of Recovery 15 minutes

Presentation: TC View of Right Living 10 minutes

Exercise: Role Play—Right Living 30 minutes

Break 15 minutes

Presentation: TCA Staff Competency—Understanding the Need 

for a Belief System Within the Community

10 minutes

Summary and Review 30 minutes

Journal Writing and Wrapup 20 minutes

Total Time 4 hours, 15 minutes
PARTICIPANT’S MANUAL

PM 3-2

Slides Notes

OH #3 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 3

Treatment and Recovery—

The TC View

OH #3 –2

Distinctive Features of TCs

• TC lingo or language

• Community-as-method

• Rational authority

• TC views of the disorder, the person, recovery, 

and right living

OH #3 –3

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
MODULE 3

PM 3-3

Slides Notes

OH #3 –4

Exercise: Case Study of Ray

What are examples of Ray’s

• Cognitive and behavioral issues?

• Perceptual issues?

• Emotional issues?

• Social issues?

OH #3 –5

TC View of Recovery

• Gradual building or rebuilding of a new life

• Changes in thinking, feeling, values, behavior, 

and self-identity

OH #3–6

TC View of Right Living

• Honesty in word and deed

• Responsible concern for others

• Work ethic

• Active and continuous learning
PARTICIPANT’S MANUAL

PM 3-4

Slides Notes

OH #3–7

TCA Staff Competency

Understanding the need for a belief 

system within the community

OH #3 –8

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?

OH #3 –9

Prework for Module 4

• Read Resource Sheet #4-1: Community-asMethod
MODULE 3

PM 3-5

Resource Sheet #3-1: Case Study of Ray—

Disorder of the Whole Person

Ray is a 28-year-old salesman who began smoking and drinking alcohol at the age of 14 and 

using marijuana and other substances when he was a junior in high school. At age 19 he was 

introduced to crack cocaine and started to freebase with others by the time he was 21. Cocaine 

became his substance of choice, although he continued to drink alcohol with his buddies while 

watching TV and videos.

Education

Ray’s elementary school years were extremely positive, and he loved to go to school. When he 

entered junior high, he had trouble with math but did not receive extra tutoring so he got behind 

in his work. Ray was quiet and did not feel comfortable or secure in the large metropolitan 

junior/senior high school complex. Gradually all his grades started to slip, and he started 

associating with other students who were not doing well.

When Ray was in 9th grade, his guidance counselor tried to intervene, but Ray felt disappointed 

because she did not understand his problems and home environment, which was becoming 

increasingly tense. Ray did not participate in school or religious activities, but he occasionally 

played sports at the city’s afterschool programs.

During Ray’s high school years, his life was fraught with disappointments, failure in school, and 

conflict at home. He increasingly became withdrawn, insecure, and fearful. His high school 

friends did not do well in school, and they often skipped school together to smoke cigarettes and 

drink alcohol. Ray dropped out of high school in his senior year after failing all of his courses. 

He was depressed and felt like a failure.

Family Life

Although Ray’s father drank on and off for many years, family life had been fairly routine. His 

father worked for the city’s maintenance department, and his mother was a homemaker caring 

for Ray and his two younger brothers. 

During Ray’s junior high school years, his father became physically and emotionally abusive 

after he lost his job of many years because of a departmental budget cut in poor economic times. 

His violence escalated, and he was arrested when the neighbors called the police. Ray’s mother 

would not let him back in the house when he was released. Ray then lost contact with his father 

and did not see him again until Ray was released from the TC. 

Ray’s mother became preoccupied with maintaining the two jobs that she needed to support 

herself and her sons and spent less and less time with Ray and his brothers. 
PARTICIPANT’S MANUAL

PM 3-6

Work History

After dropping out of high school, Ray worked for 8 retailers over the next 10 years. He had a 

generally pleasant and outgoing personality. His income fluctuated considerably because he 

worked on commission. Ray frequently changed jobs after being scolded for not making his sales 

quotas. He was fired from his last two jobs for erratic attendance and being dishonest about his 

sales volume. Ray expected a lot from his bosses and felt that they should do a better job of 

training him.

Ray frequently would cancel appointments with prospective clients when his lunch hour with 

buddies lasted late into the afternoon. He frequently lied to his coworkers and bosses about an 

incredible series of misfortunes that caused him to miss important sales meetings.

Although Ray did not get high on the job, he often left work early on Fridays and did not come 

in on Mondays because he had been freebasing, drinking, and smoking marijuana over the 

weekend. He would often become angry and tell his drinking buddies what a terrible boss he had. 

He felt that his bosses had let him down because they would not support him when his sales 

volume declined, even though he spent extra hours on his successful sales. He believed he should 

have gotten bigger bonuses for his successful sales.

Because of his sense of disappointment that started in early in life, Ray began to mistrust people 

in general and particularly those in authority. He had trouble working with his bosses and other 

coworkers because of this mistrust.

Relationships

Ray had been seeing a family counselor sporadically for the past 3 years at the insistence of his 

girlfriend, whom he met when he was 21. Tina was a college graduate who worked long hours at 

her job as assistant manager of a bank. She started using marijuana and consuming alcohol to 

socialize when going to parties with Ray. Gradually Tina’s use increased at home as a way to 

express her love for him and strengthen their relationship. 

Ray and Tina started living together when Ray was out of work and could not afford to live on 

his own any longer. He felt dependent on Tina emotionally and financially.

Ray frequently did not come home after work and would not tell Tina where he had been. He 

never told Tina when he changed jobs. She usually found out when he would make a big sale and 

tell her about the good news at his new job. He developed a pattern of lying to Tina about his 

whereabouts. Ray viewed lying to her as a way of showing he was independent and did not have 

to account for his time. 

Ray often said that he forgot where he had been. Sometimes he would create a story about his 

whereabouts because it was more interesting than admitting he had slept all day after a night of 

drinking and drugging. He also lied to Tina about how much money he made and used more 

money on drugs.
MODULE 3

PM 3-7

Ray liked to meet his buddies over the weekend to watch TV at the local bars. He promised Tina 

that he would not get drunk, but he would often come home late on Sunday and then call in sick 

on Monday morning after she had left for work. He had many drinking buddies, but no one he 

considered to be a friend.

Tina believed it would be better to have Ray at home than in the bars, so she insisted that he 

invite people over to their apartment to watch games on TV. That was fine with Ray, and their 

home soon became a hangout for drinking and doing drugs during the weekend and increasingly 

during the week. When their life started to revolve around alcohol and drugs, their relationship 

became full of arguments and conflicts. 

From time to time, Tina would ask about Ray’s father or want to invite his mother or brothers 

over for dinner. Her attempts to know more about Ray’s family resulted in intense emotional 

outbursts, bordering on violence. When asked about it the next day, Ray would deny that he had 

had an outburst and say that she was exaggerating.

Criminal Behavior

Ray began to steal to support his drug use and lifestyle when his sales commissions were below 

his living expenses. His first arrest occurred when he got into a fight in a bar and was found in 

possession of marijuana. The second arrest came when he was in the car with a friend who had 

been drinking. When they were pulled over by a police officer, his friend was arrested for driving 

while intoxicated and Ray was arrested for possession of cocaine.

The court-ordered evaluation recommended a long-term TC. Ray felt lucky to have gotten off 

easy and anticipates that his stay in the TC will be a breeze.

Questions

Cognitive and Behavioral Issues

New residents of TCs typically use poor judgment and have difficulty making decisions. They 

also have trouble solving problems. New residents typically have poor awareness of themselves 

and how their actions affect themselves and others. 

What are examples of Ray’s cognitive and behavioral issues?

Perceptual Issues 

New residents typically do not see themselves as worthy people or as valuable members of 

society. They have low self-esteem and describe themselves as social deviants or victims of a 

society that owes them privileges and a living.

What are examples of Ray’s perceptual issues?
PARTICIPANT’S MANUAL

PM 3-8

Emotional Issues

New residents have difficulty identifying and talking about their feelings, except for showing 

anger and hostility to hide underlying feelings such as fear, hurt, disappointment, or sadness. 

They have difficulty restraining themselves from emotional outbursts or aggressive behavior 

when they feel denied, impatient, or provoked. They are unable to tolerate frustration or 

emotional discomfort. They typically experience a great deal of guilt or shame and exhibit low 

self-esteem.

What are examples of Ray’s emotional issues?

Social Issues

New residents have been enmeshed in a drug-using peer group and, possibly, a criminal 

subculture. Often, they have no drug-free friends and associates and may be alienated from 

family members. They often are disengaged from mainstream culture and social institutions but 

have a sense of entitlement regarding what society owes them. 

What are examples of Ray’s social issues?

Motivation To Change

Discuss how the TC can motivate a resident like Ray to change. Use the following four 

categories of TC activities for your discussion:

Behavior management or behavior shaping: The TC engages residents in a learning process that 

involves developing prosocial behavior through the community-as-method approach. Positive 

behavior is modeled and rewarded, and negative behavior is sanctioned.

Enhancement of emotional and psychological life: The TC provides a supportive environment in 

which residents can explore feelings and help one another identify self-defeating patterns of 

behavior and experience personal growth.

Enhancement of intellectual and spiritual life: Residents are encouraged to grow by thinking 

through their problems and learning about a world greater than themselves.

Improvement of work and vocational skills: Strong emphasis is placed on developing living and 

work skills so residents can be self-supporting and contribute to society after they leave the TC.
MODULE 3

PM 3-9

Resource Sheet #3-2: Role Play of Right Living

Scenario

Ray has been court ordered to treatment in a 6-month TC program. He thinks life will be easy for 

the next 6 months. 

Ray is transported to the program by the sheriff’s department and released to the program staff. 

He soon sees guys he knew from his high school days, which makes him feel right at home. 

After intake, Ray is introduced to Frank, a senior resident in treatment who is responsible for 

orienting Ray to some aspects of the program. 

Ray is surprised at how seriously Frank is taking this responsibility. Ray starts to give Frank 

trouble and says that he expects the TC to train him and help him find a better job. Ray says that 

he is tired of sales and it is about time for someone to prepare him for a secure, high-paying job 

with regular hours.

Frank responds by acknowledging Ray has had a tough life and assures him he will be able to 

reach his goals. He explains some of the basic rules in a gentle way and says, “Don’t worry about 

tomorrow. We will take it 1 day at a time. You will have jobs in the community here that will 

help you establish good work habits and relationships with coworkers and bosses.” 

The Role Play

The role play begins with Frank introducing himself to Ray, followed by an explanation of right 

living. Frank uses the following as a guide to explaining right living:

• Honesty in word and deed: Honest expression of emotions and reactions reveals residents’ 

true self-identities to others and to themselves.

• Responsible concern for others: By challenging and supporting others, residents show that 

they care for them and for themselves. Responsible concern is necessary for self-help and 

mutual self-help and repudiates the code of the street.

• Work ethic: Self-reliance, excellence, earned rewards, pride, and commitment enable 

residents to become productive members of society.

• Active and continuous learning: Continuous learning about themselves and the world 

strengthens residents’ ability to maintain recovery.
PARTICIPANT’S MANUAL

PM 3-10

Summary of Module 3

Distinctive Features of a TC

A common language: Common terms and expressions help bond staff members and residents and 

ensure that everyone understands and reinforces the same concepts and practices.

Use of community-as-method: The community-as-method approach is a social learning process, 

meaning that residents learn from observing one another and themselves. The community 

established in the TC functions as a facilitator of change. The community’s structure creates a 

familylike atmosphere conducive to psychological, behavioral, and social change.

Rational authority: Professional clinical staff members have the authority to make all decisions 

related to residents, including resident status, discipline, promotion, transfer, discharge, furlough, 

and treatment planning. Staff members must use this authority in a consistent, trustworthy, 

compassionate, and rational way by explaining the reasons for their decisions.

Distinct TC views of the disorder, the person, recovery, and right living.

TC Views

TC View of the Disorder 

Substance use disorders are viewed as disorders of the whole person in which virtually every 

aspect of a person’s life is affected. 

TC View of the Person 

TC residents are viewed as people who must and are able to change their behavior and become 

productive members of society.

TC View of Recovery

The TC defines recovery as the gradual building or rebuilding of a new life and results in 

changes in behavior and self-identity. Recovery is an incremental process that includes

• Becoming honest and responsible

• Recognizing the need to change

• Eliminating self-defeating behavior and thought patterns

• Learning to recognize and manage feelings without the use of drugs or alcohol

• Changing social identity

• Increasing self-awareness and awareness of others and their environment

• Developing a prosocial value system.
MODULE 3

PM 3-11

The behavioral goals for residents are to

• Develop self-discipline and impulse control

• Show compassion to others

• Achieve success and satisfaction in their personal and work life

• Become role models for new and junior residents

• Become responsible and productive members of society.

TCs have many maxims or sayings that remind staff members and residents about the goals for 

recovery. See Resource Sheet #1-1: TC Recovery Maxims, in Module 1.

TC View of Right Living

TC residents are encouraged to accept the principles of right living, including

• Honesty in word and deed: Honest expression of emotions and reactions reveals residents’ 

true self-identities to others and to themselves.

• Responsible concern for others: By challenging and supporting others, residents show that 

they care for them and for themselves and repudiate the code of the street.

• Work ethic: Self-reliance, excellence, earned rewards, pride, and commitment enable 

residents to become productive members of society.

• Active and continuous learning: Continuous learning about themselves and the world 

strengthens residents’ ability to maintain recovery.

TCA Staff Competency—Understanding the Need for a Belief System 

Within the Community

A TC operates with a set of beliefs, values, and guidelines that constitute its belief system. This 

system is the foundation for the positive social learning process. Staff members must 

demonstrate understanding of the TC belief system to be effective members of the community. 

Key assumptions of the TC belief system are that 

• The TC treatment approach is effective.

• Residents can change and become responsible members of mainstream society.

• The community-as-method approach facilitates change. The TC, rather than a single 

therapist or counselor, is the healing force that facilitates individual change.

• Each member of the TC must assume responsibility for his or her behavior.
PARTICIPANT’S MANUAL

PM 3-12

Review of Module 3

Review

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

$ Describe three distinctive features of the TC: TC language, community-as-method, and 

rational authority?

$ Give an example of TC views: view of the disorder, view of the person, view of recovery,

and view of right living?

$ State at least three assumptions of the TC belief system?

$ Explain at least one way staff members can demonstrate that they understand the need for a 

belief system?

Small-Group Activity

Create a poster that illustrates one of the TC views. See Summary of Module 3 for definitions of 

each view.
MODULE 4

PM 4-1

Module 4: The Community-as-Method Approach

Module 4 Goal and Objectives

Goal: To understand the community-as-method approach to behavior change.

Objectives: Participants who complete Module 4 will be able to

• Differentiate between social learning and didactic learning

• Describe one way staff members can demonstrate the understanding of social learning

• Identify the eight basic concepts that explain how the community-as-method approach 

facilitates behavior change

• Define self-help and mutual self-help

• Describe one way staff members can demonstrate the understanding of self-help and 

mutual self-help.

Content and Timeline

Introduction 20 minutes

Exercise: Social Learning 30 minutes

Presentation: TCA Staff Competency—Understanding Social 

Learning Versus Didactic Learning

10 minutes

Presentation: The Eight Basic Concepts of Community-asMethod40 minutes

Break 15 minutes

Exercise: Role Play of the Community-as-Method Approach 45 minutes

Presentation: TCA Staff Competency—Understanding and 

Promoting Self-Help and Mutual Help

20 minutes

Summary and Review 25 minutes

Journal Writing and Wrapup 20 minutes

Total Time 3 hours, 45 minutes
PARTICIPANT’S MANUAL

PM 4-2

Slides Notes

OH #4–1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 4

The Community-as-Method Approach

OH #4–2

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?

OH #4 –3

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”
MODULE 4

PM 4-3

Slides Notes

OH #4–4

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?

OH #4 –5

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.

OH #4 –6

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
PARTICIPANT’S MANUAL

PM 4-4

Slides Notes

OH #4 –7

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 4

PM 4-5

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

Overview

The TC is distinguished from other treatment approaches by the use of the community as the 

primary method of treatment to bring about positive prosocial and psychological changes in 

individuals. In a TC

• The daily regimen and social milieu of the TC are designed to facilitate emotional healing, 

social learning, and changes in behavior patterns and self-identity, 24 hours a day, 7 days a 

week.

• All community members (staff members and residents) create a social learning 

environment.

• TC residents experience being in a supportive familylike atmosphere that allows them to 

heal emotionally and change their lifestyles and self-identities.

• Recovery occurs through interactions with peers and through the self-help and mutual selfhelp learning process.

Eight Basic Concepts of Community-as-Method

1. Member roles: Residents gradually become integral members of the community by acting 

in a variety of work and community roles and contributing to all the activities of daily life 

in the TC.

2. Continual feedback from peers and staff members: Residents are observed by all members 

of the community and are held accountable for their own actions. They receive continual 

feedback (both reinforcing and corrective) from peers and staff members, expressed with 

authentic and responsible concern for their well-being and progress.

3. Role models: Residents adopt principles of recovery and right living and gradually aspire to 

become role models for others. As they progress through the program, residents provide 

feedback to others about what the others need to change about themselves and serve as 

examples of such change.

4. Friendships and healthy familylike relationships: At the beginning, residents attempt to 

continue their deceitful patterns and want merely to “hang out.” As they progress through 

the phases of treatment, they learn what friendship is by sharing their feelings and thoughts 

and by challenging others. The friendships may last a lifetime and become the basis for the 

residents’ new social networks.

5. Collective learning: Residents work, learn, and heal in group settings such as meetings, 

classes, work teams, and recreational activities. Virtually all the learning and healing 
PARTICIPANT’S MANUAL

PM 4-6

experiences, essential to recovery and personal growth, take place with positive peer role 

models.

6. Internalization of the TC culture and language: Residents gradually adopt and internalize 

the language used in the TC. This is a sign of their assimilation into the culture of the TC 

change process and of the progress they are making.

7. Hierarchical work structure and communication system: The hierarchical work structure 

and communication system teach members to be responsible and to work, following 

organizational rules and procedures. Residents become people on whom others can depend, 

by adhering to procedures, accepting and respecting supervision, and behaving as 

responsible members of the TC. The system of sanctions and privileges guides residents’ 

learning as they experience the positive and negative consequences of their actions.

The hierarchical structure of the TC, the chain of command, is similar to the organization 

of mainstream culture. It is designed to teach residents the skills and behaviors they will 

need to be successful outside the TC. Gradually and with practice, residents are able to 

generalize what they have learned in the TC to the outside world.

The communication system in the TC, including such activities as surveillance, data 

collection, reporting, and giving feedback, is designed to promote productive, prosocial 

behavior, as well as to correct self-defeating behavior.

8. Open communication and personal disclosure: Residents gradually engage in open 

communication and personal disclosure when they feel that the TC is a safe environment. 

Residents eventually learn how to communicate with others and to reveal their inner 

thoughts, which help them build self-esteem, develop trust and relationships with others, 

heal, become self-aware, and grow. This process begins initially with staff members and 

then in group settings with peers.

Sharing feelings in public is an important part of the self-help recovery process. Sharing 

feelings is part of the mutual self-help recovery process as well because residents realize 

that they are not alone and that other people experience the same feelings. 

No secrets exist in the TC. When rules are broken, the infraction is discussed publicly to 

ensure that everyone feels safe and to maintain the integrity of the community.
MODULE 4

PM 4-7

Resource Sheet #4-2: Role Play—Explaining the 

Community-as-Method Approach

Roles

Christina is an experienced staff member who has been working in a TC for more than 5 years. 

She is working with Michael, a new staff member, who will be responsible for facilitating new 

resident orientation groups.

Michael has been working as a house manager for 4 months. His previous substance abuse 

treatment work experience was with adolescents in a corrections facility.

Sarah, a new resident, asks questions and makes comments about the community-as-method 

approach. She is interested in the community but feels anxious about being integrated into the 

TC and is concerned that she may be rejected. She also is hostile because she feels her 

individuality may be suppressed. Sarah has been in treatment before, but in outpatient settings.

Observers watch the role play and notice what is going well and what is not in the 

communication among Christina, Michael, and Sarah.

Scenario

Christina and Michael are working together to orient Sarah. They explain the importance and 

significance of the community-as-method approach and encourage Sarah to participate actively 

in the TC process.

Christina should begin by introducing the community-as-method approach.

Michael should give three examples of how community-as-method works in this facility.

When the role play is finished, the observers give feedback to Christina and Michael.
PARTICIPANT’S MANUAL

PM 4-8

Resource Sheet #4-3: The TC Crossword Puzzle

1 

2 3

4 5

6

7

8 9 10

11

12 13 14

15

16 17

Across

2 By sharing their feelings, residents will develop 

these (3 words along with 12 & 15 across)

4 What distinguishes the TC from other 

treatment methods (3 words along with 5 & 7 

across)

6 Provided continually by peers and staff 

members

8 Occurs when residents feel safe 

(2 words along with 11 across)

16 Opposite of secrets (see 17 down)

Down

1 Residents contribute to all activities in the TC 

by participating in these (3 words)

3 Chain of command

9 What a resident aspires to be

10 Meetings, classes, and work teams are 

examples of this (2 words along with 13 down)

14 A sign of progress that occurs gradually

17 Opposite of secrets 

(2 words along with 16 across)
MODULE 4

PM 4-9

Summary of Module 4

TCA Staff Competency—Understanding Social Learning Versus 

Didactic Learning

Social learning: Learning that occurs by identifying with others and through participation, 

observation, and interaction with others to change thoughts, feelings, and behavior patterns.

Didactic learning: Learning new information through formal instruction (classes, seminars). 

Didactic learning generally occurs as a one-way presentation of new information from an 

“expert” to a “student.”

Community-as-Method

What distinguishes the TC from other treatment approaches is the use of the community as the 

primary method of treatment to bring about positive prosocial and psychological changes in 

individuals (the community-as-method approach). Major elements of the community-as-method 

approach include the following:

• The daily regimen and social milieu of the TC are designed to facilitate emotional healing, 

social learning, and changes in behavior patterns and self-identity. 

• All community members (staff members and residents) create a social learning 

environment.

• TC residents experience being in a supportive familylike atmosphere that allows them to 

heal emotionally and to change their lifestyles and self-identities.

• Recovery occurs through interactions with peers and through the self-help and mutual selfhelp learning processes.

See Resource Sheet #4-1 for a detailed list of the eight concepts of community-as-method.

TCA Staff Competency—Understanding and Promoting Self-Help and 

Mutual Help

Self-help: Each individual assumes primary responsibility for his or recovery. Residents 

participate fully and contribute to the TC process to change their own behavior.

Mutual self-help: Residents assume responsibility for helping their peers recover and as a way to 

reinforce and maintain their own recovery. Being part of a self-help and mutual self-help 

learning community teaches residents to 

• Understand themselves

• Take responsibility for their lives

• Adopt the behaviors, attitudes, and values of healthy living.
PARTICIPANT’S MANUAL

PM 4-10

Review of Module 4

Review

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• Differentiate between social learning and didactic learning?

• Describe one way staff members can demonstrate understanding of social learning?

• Identify the eight basic concepts that explain how the community-as-method approach 

facilitates behavior change?

• Define self-help and mutual self-help?

• Describe one way staff members can demonstrate understanding of self-help and mutual 

self-help?

Small-Group Activity

Complete the crossword puzzle on Resource Sheet #4-3.
PM 5-1

Module 5: The TC Social Structure and Physical Environment

Module 5 Goals and Objectives

Goals: To understand how the TC social structure and the physical environment promote 

residents’ return to a healthier lifestyle in mainstream society and to understand that rules, 

structure, work, meetings, and other components of the daily routine, as well as features of the 

physical facility, are integral components of the TC approach to treatment.

Objectives: Participants who complete Module 5 will be able to

• State at least three reasons why rules are important in TCs

• Explain four aspects of the TC social organization (structure, systems, communications, 

and daily schedule) and explain how each aspect benefits TC residents

• Explain the purpose of each type of resident meeting: morning, house (or general), closing, 

and seminar

• Explain how the physical environment of the TC benefits residents

• Explain how rules related to security and access contribute to residents’ healing and 

recovery process.

Content and Timeline

Introduction 20 minutes

Exercise: Rules 30 minutes

Presentation: TC Rules—Cardinal, Major, and House 15 minutes

Presentation: Structured Socialization 45 minutes

Break 15 minutes

Presentation: Resident Meetings 30 minutes

Exercise: Simulation of a Morning Meeting 30 minutes

Presentation: Seminars 15 minutes

Break 15 minutes

Presentation: The Physical Environment of the TC 15 minutes

Presentation: Access and Security 15 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 4 hours, 45 minutes
PARTICIPANT’S MANUAL

PM 5-2

Slides Notes

OH #5 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 5

The TC Social Structure and 

Physical Environment

OH #5 –2

Exercise: Rules

Tell your partner about

• Three rules you have in your household

• The benefits of having these rules

OH #5 –3

TC Rules

• Cardinal

• Major

• House
MODULE 5

PM 5-3

Slides Notes

OH #5 –4

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.

OH #5 –5

TC Social Organization

• Structure

• Systems

• Communication

• Daily regimen of scheduled activities

OH #5 –6

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
PARTICIPANT’S MANUAL

PM 5-4

Slides Notes

OH #5 –7

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

OH #5 –8

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

OH #5 –9

Closing Meetings

• Conduct community business in a structured 

fashion

• Provide closure to the day’s activities

• Make announcements

• Assess mood
MODULE 5

PM 5-5

Slides Notes

OH #5–10

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

OH #5–11

Access and Security

TCs are not locked facilities but restrict 

access to provide security for residents 

and promote recovery.

OH #5–12

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?
PARTICIPANT’S MANUAL

PM 5-6

Resource Sheet #5-1: Morning Meeting Simulation

The Morning Meeting: Overview

The purposes of the morning meeting are to

• Start the day in a positive way

• Motivate residents

• Enhance the sense of community.

Components of a Morning Meeting

• Coming-together ritual: All members of the community start the meeting by saying “good 

morning, family” and reciting the community’s creed or philosophy.

• Social awareness: Current events outside the TC and local weather reports are briefly 

presented.

• Thought of the day: A brief thought designed to focus the community on personal growth 

or problemsolving is presented; for example, a department head may present “trusting each 

other” and allow residents time to reflect on how they will incorporate this thought into the 

day.

• “Up” ritual or energizer: This is a group activity, such as singing or playing a game, to 

energize and engage members. It is not simply entertainment but is intended to reinforce 

recovery and concepts of right living.

• Closing ritual: This is a shared activity that signals the end of the meeting. For example, 

some TCs have adopted theme songs that residents sing together with locked arms to close 

the meeting.

Morning Meeting Rules

• Maintain an emphasis on the “here and now.”

• Only one person may speak at a time.

• Individuals speak only for themselves, but they may encourage others to participate.

• Attention is focused on being positive and uplifting.

The Role of TC Staff Members

• All staff members on duty sit in the back of the room to observe.

• Staff members assess resident participation, overall group energy, attitudes, and affect.

• Staff members may contribute humor or an uplifting thought.

• Staff members and resident community leaders meet later in the day to discuss

− The degree to which the residents in charge of the meeting were prepared and 

appropriate
MODULE 5

PM 5-7

− The need for any treatment plan adjustments for the residents.

Morning Meeting Simulation: Participant Roles

• Staff member: One participant acts as the staff member and assists in planning the morning 

meeting. The staff member writes the agenda on newsprint, guides the coordinators if 

necessary, tells a joke or adds humor, and intervenes if a resident acts out.

• Two resident coordinators: Two participants are responsible for conducting the meeting. 

The resident coordinators begin the meeting by greeting group members with “Good 

morning, family” and ask residents to recite the TC philosophy. The coordinators state the 

purpose of the meeting, remind participants of the rules, and conclude with the closing 

ritual.

• Resident #1: This resident is responsible for the social awareness component and presents 

the weather report and one current event.

• Resident #2: This resident is responsible for the thought for the day.

• Resident #3: This resident is responsible for the “up” ritual or energizer and may lead the 

group in singing a song intended to reinforce recovery or a concept of right living.

• Remaining participants: The remaining participants play the parts of residents and may 

complain or pretend to be bored, tired, or hostile at the beginning of the meeting.

The resident coordinators begin the simulation of the morning meeting with the coming-together 

ritual.
PARTICIPANT’S MANUAL

PM 5-8

Summary of Module 5

TC Rules

Rules guide the actions of residents, establish healthy boundaries, and allow prosocial behavior 

to be reinforced. By following rules, residents gradually learn to maintain a physically and 

psychologically safe community. Rules create a safe and predictable community that allows 

personal growth and recovery to occur. 

Cardinal rules protect the physical and psychological safety of the community and are strictly 

enforced. Violating a cardinal rule nearly always results in automatic dismissal from the TC. 

Cardinal rules include

• No physical violence

• No threats of violence or intimidation

• No drugs or alcoholic beverages

• No sexual activity.

Major rules are essential to the recovery process. Residents who break major rules are subject to 

learning experiences designed by staff members. Breaking a major rule more than once threatens 

the physical and psychological safety of the community. Usually, only one episode of breaking 

major rules is tolerated. Major rules include

• No stealing or other illegal activity

• No vandalizing or destroying property

• No contraband.

House rules are similar to society’s expectations, are related to prosocial behavior patterns 

residents are expected to adopt gradually, and include

• Following instructions

• Being punctual

• Maintaining appropriate appearance

• Using proper manners

• Not lending or borrowing money or other possessions.

Structured Socialization

Structured socialization is a step-by-step process through which residents learn prosocial 

behavior and attitudes that allow them to become productive members of mainstream society. 

The TC social organization helps residents learn this process and includes the following four 

aspects:
MODULE 5

PM 5-9

• Structure

• Systems

• Communication

• Daily regimen of scheduled activities.

Structure

Structure enables residents to learn

• A step-by-step approach for success: For residents who have a history of real and perceived 

failures, the step-by-step staged approach to treatment provides opportunities to succeed 

and receive positive reinforcement.

• How their behavior affects others: For residents who are indifferent to the consequences of 

their behavior, the highly structured procedures force them to be aware of their 

surroundings and the effect of their behavior on others.

• To recognize and address their underlying issues: The social structure exposes residents to 

various roles that can reveal emotional, attitudinal, and behavioral problems.

• Positive interactions with authority: For residents who have had difficulties with authority 

figures, the structured program provides many opportunities to have positive interactions 

with staff authority figures.

System

TC systems help residents learn to

• Function in a hierarchical social system: For residents who are mistrustful, cynical, or 

fearful of systems, the TC provides opportunities to learn how to function in a hierarchical 

social system.

• Follow through: For residents with poor accountability, TC systems monitor their behavior 

as they learn to be responsible for their actions and follow through on work and promises.

• Make gradual progress: For residents who tend to give up, the TC teaches tolerance, 

patience, and gradual progress to meet goals. Adherence to procedures requires residents to 

control their impulses, delay gratification, handle frustration, and manage emotions.

Communication

Open communication and a communication system enhance residents’ healing and learning 

because

• Breakdowns are discussed: All breakdowns are reported and discussed to further residents’ 

healing and learning processes.

• Provoked reactions are resolved: Information and reactions (thoughts, feelings, and 

questions) are discussed openly and resolved to further the healing and learning processes.

• Positive affiliation is achieved: Informal peer communication is the primary way residents 

start to experience a sense of community with the TC.
PARTICIPANT’S MANUAL

PM 5-10

Daily Regimen of Scheduled Activities

• To be productive: For residents who lack structure in their lives, the TC teaches goal 

setting, how to establish productive routines, the completion of chores, and time 

management.

• The benefits of consistent performance: For residents who have trouble achieving longterm goals, the TC routine teaches that goal attainment occurs one step at a time and 

rewards consistent performance.

• What to do with free time: The full schedule provides certainty and reduces anxiety 

associated with free time that typically triggered drug-related behavior in the past.

• To minimize self-defeating thoughts: For residents who may be withdrawn, the structured 

day lessens their preoccupation with self-defeating thoughts.

Meetings

Meetings are organized components of the day. Participation in meetings is part of the healing 

and recovery processes and contributes to a sense of orderliness and purpose. Meetings provide a 

structured way to address individual and collective concerns and to reinforce the main messages 

of recovery.

Daily meetings help staff members account for each resident and to assess individual or group 

moods. Residents who are withdrawn or not participating are considered at risk for dropping out, 

violence, or suicide. TC meetings include the following:

• Morning meetings are brief (30 to 45 minutes) and are led by residents to start the day on a 

positive note.

• House or general meetings are held as needed to address communitywide problems.

• Closing meetings are held every night to disseminate information and plan for the next day. 

Seminars are considered meetings and 

• Educate residents about various topics

• Provide intellectual stimulation

• Help residents examine their personal values

• Stimulate insightful thinking

• Help residents understand the TC and its philosophy

• Raise awareness of important recovery issues

• Help members develop the ability to express themselves, building confidence and selfesteem

• Enhance residents’ attention spans and listening and speaking skills. 

TC Physical Environment

The physical environment of the TC is structured to enhance residents’ sense of community and 

to help them learn to take care of themselves and their environment. It is important for staff 
MODULE 5

PM 5-11

members to reinforce the importance of taking care of the TC environment and to serve as role 

models for the residents.

Indoor areas (such as the residents’ rooms and common areas) are used to reinforce the sense of 

community and foster a sense of home and ownership. Residents must keep these areas clean and 

orderly and are encouraged to take pride in keeping these areas neat and attractive.

Access and Security

TCs are not locked facilities, but they have restricted access for security purposes and as part of 

the therapeutic process. The TC is designed to separate residents from their previous 

surroundings socially, physically, and psychologically. Residents must disengage from the 

people, places, and things associated with their previous lifestyle.
PARTICIPANT’S MANUAL

PM 5-12

Review of Module 5

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• State at least three reasons why rules are important in TCs?

• Explain the four aspects of the TC social organization and explain how each aspect benefits 

TC residents?

• Explain the purpose of each type of resident meeting: morning, general or house, and 

closing?

• Explain how the physical environment of the TC benefits residents?

• Explain how rules related to security and access contribute to residents’ healing and 

recovery process?
PM 6-1

Module 6: Peer Interpersonal Relationships

Module 6 Goal and Objectives

Goal: To understand how to promote positive interpersonal relationships within the TC.

Objectives: Participants who complete Module 6 will be able to

• Identify three goals for changes in residents’ relationships with peers, family, and authority 

figures

• Define at least three ways staff members can help residents learn and experience healthy 

relationships

• Define the concept of “role model” and identify at least three behaviors role models are 

expected to display

• Explain at least three ways residents benefit from being role models

• Explain what residents learn by living in a diverse community

• Identify at least two issues that apply primarily to women and at least two that apply 

primarily to men and explain how TC staff members can address these issues

• Define “belonging” and “individuality” and describe one way staff members can demonstrate 

understanding of these concepts.

Content and Timeline

Introduction 20 minutes

Exercise: Healthy Relationships 30 minutes

Presentation: Promoting Healthy Relationships 45 minutes

Break 15 minutes

Presentation: Being a Role Model 30 minutes

Exercise: What Does Being a Role Model Look Like? 35 minutes

Presentation: Diversity 40 minutes

Presentation: Gender Competency 20 minutes

Break 15 minutes

Presentation: TCA Staff Competency—Understanding the Relationship 

Between Belonging and Individuality in the Community

10 minutes

Exercise: What Does It Mean To Belong? 20 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 5 hours, 20 minutes
PARTICIPANT’S MANUAL

PM 6-2

Slides Notes

OH #6 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 6

Peer Interpersonal Relationships

OH #6 –2

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

OH #6 –3

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
MODULE 6

PM 6-3

Slides Notes

OH #6 –4

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

OH #6 –5

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

OH #6 –6

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
PARTICIPANT’S MANUAL

PM 6-4

Slides Notes

OH #6 –7

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

OH #6 –8

Role Models 

• “Act as if” when necessary

• Show responsible concern for others

• Seek and assume responsibility

OH #6 –9

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
MODULE 6

PM 6-5

Slides Notes

OH #6–10

Living in a TC with people of all 

backgrounds promotes recovery 

and right living.

OH #6–11

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

OH #6–12

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
PARTICIPANT’S MANUAL

PM 6-6

Slides Notes

OH #6–13

TCA Staff Competency

Understanding the relationship 

between belonging and 

individuality

OH #6–14

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?

OH #6–15

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 6

PM 6-7

Summary of Module 6

Residents typically have had poor relationships with family, peers, members of the opposite sex, 

romantic partners, and people of different ethnic and cultural backgrounds. Residents typically 

have not had positive role models to teach and guide them toward prosocial behavior. The TC 

provides a supportive familylike atmosphere in which residents can learn to develop healthy 

relationships and be guided by positive peer and staff role models. 

Staff members are expected to help residents learn and experience healthy relationships by

• Encouraging mutual self-help

• Encouraging conversations between and among residents that focus on the changes they are 

experiencing

• Encouraging residents to seek advice from and give advice to one another

• Encouraging residents to share knowledge about topics they know more about than their 

peers and to assist others

• Asking residents to conduct concept seminars or workshops in their specialties

• Organizing structured tutoring and asking residents to help others on a one-on-one basis or in 

small groups in language, mathematics, reading, and writing

• Assigning senior residents the task of “pulling in” and orienting new members

• Promoting familylike relationships and healthy peer friendships

• Teaching and encouraging responsible concern and caring as well as compassionate and 

mutually supportive relationships

• Observing residents as they re-create the roles they played in their families and providing 

opportunities for residents to increase their self-awareness of the behaviors and attitudes 

associated with those roles

• Encouraging residents to be role models and leaders.

Role Models

A role model behaves according to TC expectations of recovery and right living and sets a 

positive example for residents to follow. Positive peer role models are expected to

• Show others how to change

• Talk about benefits gained from right living and the positive influences of the TC

• Provide feedback to others

• Demonstrate the concepts of “act as if,” “responsible concern,” and “seek and assume.”

Role models are at the heart of the TC change process; what residents see in their peers they 

perceive as possible within themselves. Having residents as role models guarantees that 24-hour 

social learning takes place. Through consistent role modeling senior residents teach new 

residents to show respect for authority and to accept constructive criticism, feedback, and 

guidance. As role models, residents experience personal growth and increased status in the peer 
PARTICIPANT’S MANUAL

PM 6-8

community. All members of the community, both staff members and residents, serve as role 

models to maintain the integrity of the TC program and to encourage social learning. 

Diversity 

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

TC requires that all residents eat, work, and learn together, which makes perceived differences 

seem insignificant and leads to focusing on common issues. 

Living together in a TC provides opportunities for conflict. The TC promotes conflict resolution 

as an opportunity for self-learning. Through public disclosures of personal pains and challenges, 

residents recognize common problems and feelings. This recognition fosters acceptance of 

individuals despite their differences.

TC staff members are expected to

• Focus on similarities among residents, such as common perceptions, feelings, and issues 

related to substance use disorders and efforts at recovery, shifting the focus from differences 

such as age, gender, and race

• Provide opportunities for equal mobility for residents of all backgrounds (which may contrast 

with their experience in mainstream society)

• Discourage negative peer groups

• Serve as role models and examples of people who are working on self-awareness of prejudice 

and stereotypes.

Gender Issues

Issues that are common to women living in a TC include

• In general, fewer women than men live in a TC. The issues women face in the TC often 

mirror those they face in the larger society.

• Society often judges women with substance use disorders more harshly than it judges men. 

Therefore, women in a TC may have more complicated issues related to their self-image and 

stronger feelings of shame and guilt about using drugs and alcohol.

• Women who were abused by men verbally, physically, or sexually, either as children or 

adults, may not feel physically or psychologically safe around men.

• When compared with men who use drugs or alcohol, women with substance use disorders 

typically have

− Lower self-esteem

− More anxiety and depression

− Fewer marketable job skills.
MODULE 6

PM 6-9

Issues that are common to men living in a TC include

• Lack of positive male role models to prepare them for fatherhood or healthy relationships 

with peers and women

• A tendency to conceal insecurities, ignorance, and fears about sexuality

• More reluctance than among women to admit or talk about sexual abuse

• Rigid machismo and aggressive behavior

• Difficulty with emotiona l expression and exposing personal vulnerabilities.

TC staff members are expected to

• Be sensitive to gender-related issues 

• Not discriminate or show favoritism 

• Offer special group sessions 

• Serve as role models and examples of people who are working on self-awareness and 

sensitivity to gender-related issues

• Participate in inservice training.

TCA Staff Competency—Understanding the Relationship Between 

Belonging and Individuality in the Community

Belonging is a feeling and sense of identification with other residents of the TC. A feeling of 

belonging fosters participation with and responsibility for other residents of the community.

Individuality is a sense of self and the expression of traits and talents that are unique to an 

individual.
PARTICIPANT’S MANUAL

PM 6-10

Review of Module 6

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• State three goals for changes in residents’ relationships with peers, family, and authority 

figures?

• Describe at least three ways staff members can help residents learn and experience healthy 

relationships?

• Define the concept of “role model” and at least three behaviors role models are expected to 

display?

• Explain at least three benefits residents experience when serving as a role model?

• Explain what residents learn by living in a diverse community?

• Identify at least two issues that pertain primarily to female residents and two that pertain 

primarily to male residents and how TC staff members can address these issues?

• Define “belonging” and “individuality” and one way staff members can demonstrate the 

understanding of these concepts?
PM 7-1

Module 7: Staff Roles and Rational Authority

Module 7 Goal and Objectives

Goal: To understand the expectations and roles of TC staff members and the importance of being 

consistent and trustworthy rational authorities.

Objectives: Participants who complete Module 7 will be able to

• Identify at least three roles, behaviors, or attitudes that are expected of all TC staff

members

• Define how staff members serve as role models and describe one way staff members can 

demonstrate how to serve as positive role models

• Explain at least two reasons why it is important for staff members to act as rational 

authorities

• Describe at least two ways staff members can make and communicate decisions to 

demonstrate rational authority

• Explain the reason for a decision in terms of the TC views of the disorder, the person, 

recovery, and right living

• State at least one reason why a staff member may choose not to communicate a decision 

immediately to a resident

• Describe two ways staff members can discourage a we–they dichotomy in their TC

• Identify at least four ways TC staff members can take care of themselves.

Content and Timeline

Introduction 20 minutes

Presentation: Expectations of All TC Staff Members 60 minutes

Presentation: TCA Staff Competency—Understanding and Practicing Positive 

Role Modeling

10 minutes

Exercise: Authority Figures in Your Life 30 minutes

Break 15 minutes

Presentation: Rational Authority 60 minutes

Exercise: Case Study of Veronica 90 minutes

Lunch Break 45 minutes

Presentation: Promoting Residents’ Use of Community for Learning 20 minutes

Exercise: Role Play of Rational Authority 20 minutes

Break 15 minutes

Presentation: TCA Staff Competency—Understanding and Discouraging the 

Concept of the We–They Dichotomy

10 minutes

Presentation: Taking Good Care of Yourself 30 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 7 hours, 45 minutes
PARTICIPANT’S MANUAL

PM 7-2

Slides Notes

OH #7 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 7

Staff Roles and Rational Authority

OH #7 –2

TC Staff Members

All TC staff members

• Play important roles in the treatment process

• Are considered integral members of the TC

OH #7 –3

TCA Staff Competency

Staff members serve as 

positive role models.
MODULE 7

PM 7-3

Slides Notes

OH #7 –4

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

OH #7 –5

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

OH #7 –6

Staff Members as Rational Authorities

Staff members establish themselves as rational 

authorities by the way they make, communicate, 

and follow up on decisions.
PARTICIPANT’S MANUAL

PM 7-4

Slides Notes

OH #7 –7

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

OH #7 –8

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?

OH #7 –9

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 7

PM 7-5

Resource Sheet #7-1:

WFTC’s Standards for Residential Treatment Services

A Model Staff Code of Ethics

The primary obligation of all staff members is to ensure the quality of services to clients in 

treatment. The relationship between staff members and the client is a special one, and it is 

essential that staff members have both the maturity and the ability to handle the responsibility 

entrusted to them.

All staff members must be aware that they are part of a profession that must carefully watch over 

its own activities and those of its clients. This Code of Ethics relates to staff at all times, both at 

and away from their work.

Behavior Toward Clients

Staff Members Must:

1. Conduct themselves as mature and positive role models.

2. Maintain all client information in the strictest confidence with regard to all applicable laws 

and agency rules.

3. Provide all residents with a copy of the residents’ Bill of Rights and ensure that all aspects 

are understood and implemented by both the staff and the clients.

4. Respect all clients by maintaining a nonpossessive, nonpunitive, and professional 

relationship with them.

5. Provide service regardless of race, creed, religion, gender, national origin, sexual 

preference, age, disability, political affiliation, previous criminal record, or financial status, 

respecting the position of clients in special circumstances.

6. Recognize that the best interest of the client may be served by referring or releasing that 

person to another agency or professional.

7. Prohibit any sexual relationship of any kind between staff and clients (and clients’ 

families).

8. Compensate adequately a client for any work performed personally for a staff member.

9. Prevent the exploitation of a client for personal gain.

Reprinted with permission from WFTC, Inc. For more information, check its Web site at 

www.wftc.org.
PARTICIPANT’S MANUAL

PM 7-6

Resource Sheet #7-2: 

WFTC’s Standards for Residential Treatment Services

A Model Bill of Rights for Members and Clients

All members and clients of residential treatment programs have the absolute right to the 

following:

1. A supportive drug-free environment.

2. Treatment without regard to gender, race, national origin, color, creed, political affiliation, 

sexual orientation, marital status, religion, ancestry, identity, age, military or veteran status, 

mental and physical disabilities, medical conditions, previous criminal record, or public 

assistance status.

3. Dignity, respect, health, and safety at all times.

4. Knowledge of the program philosophy and methods.

5. Information given accurately of all the current rules and regulations of the program as well 

as the sanctions, disciplinary measures, or any modification of rights.

6. Access to a Board-approved grievance procedure to register complaints about the 

administration of all rules and regulations, sanctions, disciplinary measures, and 

modification of rights.

7. Definition of all fees and costs to be charged, the method and schedules of payment, and 

the availability of money and personal property during the program and on leaving.

8. Confidentiality of information regarding participation in the program and of all treatment 

records in accordance with the laws of the land.

9. Examination of personal records with Board-approved guidelines and the reinsertion of 

counterstatement of clarification to rebut recorded information.

10. Discharge of themselves from the program at any time without physical and psychological 

harassment.

11. Personal communication with relatives or friends of whereabouts on admission and 

thereafter according to the rules of the program except when prohibited as a documented 

part of the treatment plan.

12. Protection from real or threatened corporal punishment; from physical, emotional, and 

sexual abuse; and from involuntary physical confinement.

13. Provision of nutritious food, safe and adequate lodging, physical exercise, and adequate 

personal hygiene needs.

14. Medical care from qualified practitioners and the right to refuse the medical care offered.

15. Access to legal advice or representation where required.

16. Regular contact with any child accompanying the member into the program.

17. Clear definition of responsibilities when working in the position of staff member together 

with adequate training, adequate staff support, and supervision (including evaluation and 

feedback), with no exploitation and the right to decline the position without any 

recrimination.

18. Guidance and assistance when leaving the program for any reason, about other health care 

and assessment services, sources of financial aid, and places of residence.
MODULE 7

PM 7-7

19. Freedom from exploitation (including parents and family) for the benefit of the agency or 

its staff.

Reprinted with permission from WFTC, Inc. For more information, check its Web site at 

www.wftc.org.
PARTICIPANT’S MANUAL

PM 7-8

Resource Sheet #7-3: Case Study of Veronica

Review questions 1 through 8 at the end of this case study. Be prepared to discuss these 

questions in your small group.

Background

Veronica is a 32-year-old woman who has been a TC resident for 4 months. Veronica’s parents 

were heavy drinkers and smoked marijuana in her presence throughout her childhood and 

adolescence. They believed that they provided a loving family environment for Veronica and her 

siblings. 

When Veronica was 10 years old she began taking sips of alcohol. By the time she was 13, she 

had experimented with cigarettes and marijuana with peers. At age 15, cigarettes, alcohol, and 

marijuana use had become an integral part of her lifestyle. At age 19, she started using crack 

cocaine. By the time she was 25, Veronica was psychologically and emotionally dependent on 

crack.

Veronica usually had a job but did not stay longer than 1 year at any single place. All her peers 

smoked, drank alcohol, and used drugs. She had several roommates for approximately a year at a 

time and stayed with her parents when she had nowhere else to live. When she was between ages 

25 and 32, Veronica’s parents increasingly became concerned about her substance use and lack 

of ability to hold down a job or to live with someone for more than a year. Conflicts and 

arguments between them increased, and Veronica felt they were trying to tell her how she should 

live her life.

During her last stay at home, Veronica was out of work and in debt. Her parents noticed that she 

was stealing from them. They finally realized her drug use was out of control after an episode in 

the emergency room when Veronica experienced a severe drug-induced asthma attack. 

Veronica’s parents learned about the TC from friends. Her parents gave her an ultimatum and 

said they would no longer allow her to live with them or help her financially until she received 

treatment for her drug use. Veronica acquiesced and entered a residential TC when she was 32.

Initial 3 Months in the TC

From the beginning, Veronica had difficulty with TC staff members and was critical of TC 

concepts. She was assigned to the kitchen crew and was defiant toward her crew leader and 

would not follow directions on assignments. She would loiter in the lounge and engage other 

residents in complaining about the menial work they had to do. 

Senior residents and staff members spoke with Veronica and emphasized that “to make it, you 

have to learn to do things you don’t want to do; eventually you’ll get what you want.” She was 

encouraged to “act as if” and told that would help her recover and go through the program more 

quickly. After being spoken to by senior residents several times and being reported, Veronica 

finally appeared to be accepting the TC methods and concepts of right living. In reality, she had 
MODULE 7

PM 7-9

become only less vocal and had decided to pretend to go along because she wanted to leave the 

TC.

Veronica typically overreacted to staff decisions and started to cry when she thought she was 

treated unfairly. Staff members observed that she demanded an immediate explanation when a 

request from her was refused. To help Veronica cope with her tendency to blame others for her 

problems and her demand for immediate answers, staff members decided to withhold 

explanations for their decisions for 1 week and asked her to discuss her feelings in a group 

session. Staff members clearly and compassionately explained why they were withholding the 

explanation and what they expected of her. Veronica gradually began to follow directions and 

usually did an adequate job.

Promotion

Veronica was promoted to assistant department head; however, her problems and issues with 

authority reemerged within 4 days. She constantly argued with the department head and 

supervisory staff. She complained about staff members and the department head to her 

crewmembers.

When her department head became aware of the problem, it was viewed as a natural growth 

issue and not a threat to her well-being, her crewmembers, or the psychological safety of 

community members. Veronica was asked to speak with other members of the community who 

could serve as role models. She was encouraged to work on her interpersonal skills and to talk to 

the most positive people in the community to hear about ways they were working through similar 

situations. In group meetings Veronica was encouraged to vent her anger; community members 

let her know they had confidence in her ability to learn and believed in her potential to succeed. 

As Veronica’s department head, role models, and staff members reached out to her, she became 

more defiant. In encounter group sessions, Veronica said that the problem was that the 

department head did not know how to run the kitchen. She felt that this person was a poor 

teacher and leader. 

Senior staff members and appropriate members of the peer hierarchy, as part of the process of 

establishing themselves as trustworthy and rational authorities, investigated Veronica’s 

complaints. Community members were asked to give feedback on how Veronica was 

progressing. As a result of the investigation and community feedback, it was determined that 

Veronica’s department head was indeed using the tools of the program and Veronica was not 

being honest. Veronica was asked to stop talking negatively about the department head and to 

discuss her past work experiences and supervisors in her group sessions.

Veronica’s negativity continued. She would not discuss her situation in the appropriate group 

sessions and continued to complain about her supervisor to peers in the dorms and in the lounge 

area. She continually received reprimands, which she perceived as unfair.
PARTICIPANT’S MANUAL

PM 7-10

Decision To Demote

After 2 weeks, senior staff members decided that Veronica should not remain in a leadership 

position. Her behavioral patterns were undermining her recovery and the health of the 

community. Staff members decided that she must be removed as assistant department head. She 

was reassigned as an entry crewmember. 

A senior staff member and a senior resident informed Veronica of this decision. As they told 

Veronica of their decision, they provided specific examples of how her negativity was affecting 

new residents. Two new residents asked to leave her crew and wanted to leave the TC because 

they believed Veronica when she said the department head was not competent. 

The senior resident and staff member also calmly, compassionately, and firmly said that they 

expected her to work on accepting constructive feedback from group members, positive role 

models, and her supervisors. They expected her to give constructive feedback to others when she 

had a specific complaint. She would not be allowed to loiter in the lounge area. All her 

conversations with peers were to be focused on her self-growth and development. 

The senior resident and staff member also prepared Veronica to discuss her demotion at the 

evening house meeting. The purpose of the announcement at the house meeting was to enhance 

and encourage community learning and to maintain a healthy healing environment. Community 

members were expected to support Veronica and help her achieve her goals.

Results

Veronica spent 2 weeks as an entry-level crewmember. During this period she participated in all 

TC groups and started to see the behavior pattern that had been established in her at a very young 

age. She learned how this behavior pattern was preventing her from keeping a good job and 

finding compatible roommates. She gradually became less defensive and her externalization of 

the causes of her behavior diminished. Veronica started to reveal past work situations and 

discuss issues that had impeded her ability to function in a prosocial way. She became receptive 

to constructive criticism, feedback, and appropriate self-disclosure. Veronica began to complete 

her work assignments without complaint and even offered to help others on occasion. She began 

to give feedback and to confront other members.

She began to demonstrate that she could “walk the walk” and, with humility, “talk the talk.”

On the job, Veronica spoke to crewmembers within a positive context. She reached out to staff 

members and peers in charge of the crew whenever she felt distressed. She began to develop a 

pattern of openness toward authority figures. She demonstrated over a 2-week period that she 

was trustworthy and felt better about herself and others when she was able to cooperate with her 

peers and supervisors.
MODULE 7

PM 7-11

New Job and Expectations

After 2 weeks, Veronica was promoted to her new job as an expediter. She is expected to 

demonstrate that she grew as a result of her recent learning experience. She is challenged in her 

new position because she is an authority figure and is held accountable for reporting other 

residents’ rule violations. She is expected to confront her peers’ negative behavior and write 

reports on everything she observes. She has to act in accord with TC concepts and be a role 

model. She has continual contact with her supervisors. Eventually, even with a few setbacks, 

Veronica will overcome her mistrust of authority figures. 

Questions

Use Resource Sheet #7-4: Guide to Rational Decisionmaking as you answer the questions. Make 

notes on this page, and highlight relevant passages in the case study.

1. The main issue being highlighted in this case study is Veronica’s mistrust of authority 

figures. What behavior does she display? 

2. How do the staff members establish themselves as rational authorities by the way they 

make decisions? 

3. How do the staff members establish themselves as rational authorities by the way they 

communicate decisions?

4. What are examples of staff followup of decisions that were made? 

5. How do staff members express empathy and demonstrate compassion for Veronica?

6. How would you explain the reasons for the decision to demote Veronica? Explain this 

decision in terms of the TC views of the disorder, the person, recovery, and right living (see 

Summary of Module 3, PM 3-10, for the TC views).

7. How does Veronica benefit from her demotion and subsequent promotion?

8. How is community-as-method used in this case?
PARTICIPANT’S MANUAL

PM 7-12

Resource Sheet #7-4: Guide to Rational Decisionmaking

Staff members establish themselves as rational authorities by the way they make, communicate, 

and follow up on decisions.

Making Rational Decisions

When staff members make decisions, the intent must be to

• Protect the TC healing environment

• Promote the community-as-method approach

• Further the self-help and mutual self-help learning processes

• Teach, guide, and correct residents’ behavior 

• Encourage and support residents in their personal growth and development

• Serve as role models of rational decisonmaking, helping residents learn from staff members 

how to become rational authorities in their own lives—in work and with their families.

A rational decision is

• Made in response to a specific action and serves a specific purpose

• Grounded in the TC views of the disorder, the person, recovery, and right living

• Not arbitrarily or unequally administered.

Communicating Rational Decisions

The way in which a decision is communicated is as important as the decision itself. In 

communicating a decision, staff as rational authorities must

• Consider whether privacy is needed to communicate a decision or whether a group meeting is 

appropriate

• Prepare the resident; if a decision about a resident will be announced at a group meeting, 

notify the resident in advance

• Demonstrate self-control and not make or communicate a decision while reacting to a 

negative situation

• Explain the clinical reason for the decision, how the behavior problem is related to recovery, 

and how the intervention is related to the problem

• Express clearly and compassionately what behaviors and attitudes are expected of residents.

At times staff as rational authorities may not explain a decision immediately to a resident. This 

postponement may be used to give a resident practice in delaying gratification and tolerating 

uncertainty and, primarily, move a resident to a higher level of interaction and connection with 

the community.
MODULE 7

PM 7-13

Referring a resident to the community for an explanation of a staff decision can be effective 

because

• In exploring the situation with peers, a resident can gain a deeper understanding of the 

reasons for the staff corrective.

• If residents know they will get the same answer from their peers as they would have from 

staff members, they receive a strong message about the fairness of and need for the decision.

• The community offers positive peer support.

• The peer community reinforces proper behavior because residents remind one another of the 

consequences of inappropriate behavior.

• When peers provide an explanation for a decision—whether based on their experiences or 

understanding of how the community operates—the message may be more effective than if 

delivered by staff members.

• The peers’ explanation reinforces the intended message for all peers and enhances the 

general perception of the community as teacher.

• The peers’ explanation can foster development of blind faith as a basis for learning trust—

gaining information from the peer community that helps a resident eventually understand that 

the staff member’s decision reinforces trust in both the community and the rational authority 

of staff.

When the reason for withholding an explanation is to help a resident establish a stronger 

connection with the peer community, all staff members must support the learning experience.

Following Up on Rational Decisions

Emphasize that rational authorities always follow up on their decisions because

• Following up on decisions helps ensure that the resident understands and accepts the 

decision.

• Failure to follow up and follow through weakens morale and undermines the integrity of the 

TC treatment process.

• By seeing a model of rational followup, residents learn to follow through on their own work 

assignments and goals.

It is important to remember that the decisionmaking process in the TC is not perfect and can 

serve as an example for residents of how staff members and other authority figures are human 

and make mistakes. When TC staff members handle mistakes openly, residents can learn to cope 

with less than ideal situations in their lives.
PARTICIPANT’S MANUAL

PM 7-14

Resource Sheet #7-5: Scenario of Self-Help and 

Mutual Self-Help

Danielle has been a resident of a TC for approximately 1 month and has had a difficult time 

communicating with the community and staff about the negative behavior of others. Night staff 

members reported that Danielle allowed her roommate, Shayna, to break the rules (bringing food 

into the room from the commissary, staying up past lights out) and did not tell anyone.

Staff members decided to restrict Shayna’s phone privileges and also to restrict Danielle’s phone 

privileges. Danielle is angry and upset because she does not understand why she is being held 

accountable for the behavior of her roommate. She thinks the decision is unfair because she did 

not break a rule. Also, she is angry because staff members suggested that she discuss the decision 

with a senior resident.

Staff members instruct Danielle to talk with Veronica who has been in the TC for 6 months. 

When Danielle talks with Veronica, Veronica tells her that the same thing happened to her 3 

months ago. They talk for a while, after which Danielle understands her responsibility in holding 

her peers accountable for their negative behavior.

Why did staff members not explain the decision directly to Danielle and ask her to talk with a 

senior resident instead? 

Why did staff members ask Danielle to speak with Veronica?
MODULE 7

PM 7-15

Resource Sheet #7-6: Role Play of Rational Authority

Instructions

Review Summary of Module 3, PM 3-10, and Resource Sheet #7-1.

The person playing the staff member should choose one of the three scenarios below.

Role play the scenario, incorporating the following:

• As the staff member, give the resident at least four reasons for the decision. Explain the 

decision in terms of the TC views of the disorder, the person, recovery, and right living. 

• Follow the guidelines for effectively communicating the decision.

Scenarios

Scenario 1: Denial of a Job

Timothy is at the stage in the program where he is seeking outside employment. His employment 

history is erratic. He receives an offer to work as a busboy in a popular nightclub. It is an entrylevel job that pays minimum wage, but Timothy is excited about working in an environment 

where he may meet the performers. The staff member denies Timothy’s request to take this job. 

Timothy is angry and believes that the staff member is preventing his return to the community.

Begin the role play with the staff member informing Timothy that he may not accept the job 

offer in the nightclub. 

The role of the person playing Timothy is to listen to the explanation and respond to questions, if 

asked. 

Scenario 2: Denial of Overnight Stay

Jasmine has been in treatment for 10 months. She has tried to follow the rules of the program 

during her stay. She has advanced through treatment fairly quickly and is progressing toward her 

treatment goals. Jasmine has completed 40 half- and full-day supervised visits with her family.

She submits a pass for an overnight stay with her family, and it is approved. On the Thursday 

before her weekend pass, drugs and alcohol are found in the community room. No one admits to 

bringing the drugs into the community. As a consequence, the staff closes the house down and 

cancels all social functions and passes. Jasmine is extremely disappointed and cannot understand 

why she has to be punished for the actions of another resident.

Begin the role play with the staff member informing Jasmine that she may not visit her family 

this weekend. 
PARTICIPANT’S MANUAL

PM 7-16

The role of the person playing Jasmine is to listen to the explanation and respond to questions, if 

asked. 

Scenario 3: Denial of Advancement

Marco has been in treatment for 3 months. He has been very quiet during his stay in treatment. 

He has not gotten into trouble or behaved inappropriately; however, he has not used the group 

processes to talk about himself or the behaviors that brought him into the program. Most of the 

other residents would say that Marco is nice but that they did not know much about him. Staff 

members and residents have not confronted Marco about his lack of self-disclosure.

Marco is due to move to the next phase of treatment. He expects to be advanced because he has 

not caused any trouble. He is surprised and disappointed to find out that he is being held back. 

He does not understand what he is doing wrong.

Begin the role play with the staff member informing Marco that he will not be advanced. 

The role of the person playing Marco is to listen to the explanation and respond to questions, if 

asked. 
MODULE 7

PM 7-17

Resource Sheet #7-7: Taking Good Care of Yourself

Residents bring many serious issues and difficult behaviors to treatment. As a result, you may 

experience many emotions, both positive and negative, in the course of a day. Listening to 

residents’ problems and feelings may bring up difficult thoughts and feelings in your own life. 

Burnout (emotional and physical fatigue resulting from stress) can occur when the difficulties 

and stress of work begin to interfere with your personal life.

The following suggestions may help you take the best possible care of yourself:

Physical Health

• Eat well to maintain high energy and avoid illness.

• Consume fresh fruits and vegetables daily.

• Avoid prepared and fast foods that are high in sodium, sugar, and fat.

• Exercise regularly. 

Rest and Relaxation

• Set aside time to rest and relax.

• Take regular vacations.

• Develop interests, hobbies, and friendships away from work.

Healthy Boundaries

• Keep work and personal lives as separate as possible. You should not spend your free time 

at the TC.

• Maintain clear boundaries with residents. You are not at the TC to be a resident’s “friend” 

or personal “savior.”

• Do not “hang out” with residents after hours. 

− Sharing stories from your life and even just joking around after hours or during your 

workday can blur boundary lines, which can confuse residents. 

− Residents may start to see you as a friend rather than a rational authority; this could 

lead to a resident’s expecting special treatment, an unhealthy situation for both of you.

• If you are a member of a 12-Step program,

− Do not attend meetings that residents or former residents attend.

− If you do find yourself at a meeting with residents, do not share personal issues at the 

meeting. If you need to talk, pull someone aside after the meeting or call your sponsor. 

− Attend “counselor only” meetings that are not listed in directories. 
PARTICIPANT’S MANUAL

PM 7-18

Personal Support System

• Be aware that your own recovery or personal growth issues can affect your work.

• Develop and use a personal support system away from work. This may consist of friends, 

family, religious affiliation, your partner, or a 12-Step program.

• If needed, seek therapy to cope with personal issues and keep them separate from work; 

check whether your TC offers an employee assistance program.

• Do not work in isolation. Working with a treatment team offers great support.

• Discuss your feelings and issues with others who are working in similar situations. Sharing 

with others in a similar situation lowers stress level and helps keep an objective 

perspective.

• Learn to recognize when you need help, and ask for it.

• Work closely with your supervisor; be open about any difficulties you are having.

Questions

What do you do now to take care of yourself?

What additional things could you do to take good care of yourself?
MODULE 7

PM 7-19

Summary of Module 7

Expectations of All TC Staff Members

Although the essential therapeutic relationship in the TC is the residents’ relationship to the peer 

community, all TC staff members, regardless of their job function, play important roles in the 

treatment process and are considered integral members of the community.

Staff members are expected to

• Promote community-as-method and support self-help and mutual self-help

• Teach, inspire, and correct

• Support positive goals and planning through counseling

• Ensure the highest quality treatment possible and residents’ safety

• Develop their own self-awareness and continue to grow personally and professionally

• Serve as role models and demonstrate the principles of recovery and right living.

TCA Staff Competency—Understanding and Practicing Positive Role 

Modeling

Staff members can serve as positive role models by

• Admitting to the community when they do not know something or have made a mistake

• Following the same standards the residents are expected to follow, such as

– Not cursing

– Being on time for appointments

– Doing what is asked even when they do not wish to

– Being courteous and polite

– Keeping commitments

– Demonstrating pride in their work.

Rational Authority

Staff members also serve as role models of rational authority. Residents learn from staff 

members how to become rational authorities in their own lives—at work and with their families.

When staff members establish themselves as consistent, trustworthy, and compassionate rational 

authority figures, residents can

• Explore and then begin to overcome fear, distrust, disappointment, and anger they have felt 

toward authority figures

• Accept teaching and guidance to correct self-destructive behaviors and attitudes.
PARTICIPANT’S MANUAL

PM 7-20

Staff members establish themselves as rational authorities by the way they make, communicate, 

and follow up on decisions (see Resource Sheet #7-4: Guide to Rational Decisionmaking).

TCA Staff Competency—Understanding and Discouraging the 

Concept of the We–They Dichotomy

Although the TC has a hierarchical communication system and work structure, it is also a 

horizontal or flat system; everyone is considered a member of the TC. Staff members have 

professional expertise and ultimate responsibility for the functioning of the community, but they 

must be careful not to stress the difference in status between staff members and residents. Any 

behavior by a staff member that makes a client feel “less than” is unacceptable in the TC.

Staff members can discourage a we–they dichotomy by

• Adhering to the same rules residents must follow

• Participating in meals and activities with residents, not as buddies but as trustworthy and 

rational authority figures

• Demonstrating respect for the views, talents, and capabilities of residents

• Being open to confrontation from residents in an appropriate group format (often known as 

“hats off”)

• Being willing to listen to, learn from, and acknowledge a resident who provides 

constructive feedback.

Staff Self-Care

Working in a TC is rewarding but difficult work. Residents bring serious issues and difficult 

behaviors to treatment. Staff members may experience many emotions, both positive and 

negative, in the course of a day.

Listening to residents’ problems and feelings may bring up difficult thoughts and feelings in the 

staff members’ past or present lives. When the difficulties and stress of work begin to interfere 

with their personal and family lives, staff members can suffer from burnout (emotional and 

physical fatigue because of stress).

It is important that TC staff members realize the demands made on them and find positive ways 

to maintain their well-being and cope with stress (see Resource Sheet #7-7).
MODULE 7

PM 7-21

Review of Module 7

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• State at least three expectations of all TC staff members?

• Define staff members as role models and describe one way staff members can demonstrate 

how to serve as a positive role model?

• Give at least two reasons why it is important for staff members to act as rational 

authorities?

• Describe at least two ways staff members can make and communicate decisions to 

demonstrate rational authority?

• Explain the reason for a decision based on the TC views of the disorder, the person, 

recovery, and right living?

• State at least one reason why a staff member may not communicate a decision immediately 

to a resident?

• Describe two ways staff members can discourage a we–they dichotomy in their TC?

• Identify at least four ways TC staff members can take care of themselves?
PM 8-1

Module 8: TC Treatment Methods

Module 8 Goal and Objectives

Goal: To learn about TC treatment methods designed to encourage prosocial and psychological 

change in residents. 

Objectives: Participants who complete Module 8 will be able to

• Define “affirmations,” “pushups,” and “privileges”

• Define “sanctions” and explain their purpose

• Define “verbal correctives” and name at least three types

• Define “interventions” and name at least five types

• Name and describe at least three types of educational groups 

• Name and describe at least four types of clinical groups 

• Give at least five examples of provocative and evocative group process tools

• Explain the three major phases of the encounter group process

• Describe at least one way staff members can facilitate group process.

Content and Timeline

Introduction 20 minutes

Presentation: Overview of TC Treatment Methods 5 minutes

Presentation: Community Tools 60 minutes

Exercise: Community Tools 45 minutes

Break 15 minutes

Presentation: TC Groups 30 minutes

Presentation: Group Process Tools 30 minutes

Exercise: Role Play of Identification, Empathy, and Compassion 45 minutes

Lunch Break 45 minutes

Presentation: Encounter Group 30 minutes

Exercise: Mock Encounter Group 90 minutes

Break 15 minutes

Presentation: TCA Staff Competency—Understanding and 

Facilitating the Group Process

10 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 8 hours 
PARTICIPANT’S MANUAL

PM 8-2

Slides Notes

OH #8 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 8

TC Treatment Methods

OH #8 –2

Review

• Community-as-method

• Self-help and mutual self-help

• TC social structure and systems

OH #8 –3

Community Tools

Reinforcers

• Affirmations

• Pushups 

• Privileges

Sanctions

• Verbal correctives

• Interventions
MODULE 8

PM 8-3

Slides Notes

OH #8 –4

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?

OH #8 –5

TC Groups

Educational Groups

• Personal growth

• Job skills

• Clinical skills

• Life skills

• Reentry

Clinical Groups

• Encounter

• Probe

• Marathon

• Static

OH #8 –6

Group Process Tools

Provocative

• Used to challenge and 

confront

Evocative

• Used to support and 

encourage
PARTICIPANT’S MANUAL

PM 8-4

Slides Notes

OH #8 –7

Encounter Groups

Residents learn to

• Show compassion and responsible concern

• Confront reality

• Be honest

• Seek self-awareness

• Resolve issues and concerns

OH #8 –8

Encounter Group Phases

• Confrontation

• Conversation

• Closure

OH #8 –9

TCA Staff Competency

Understanding and 

facilitating group process
MODULE 8

PM 8-5

Slides Notes

OH #8–10

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?

OH #8–11

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
PARTICIPANT’S MANUAL

PM 8-6

Resource Sheet #8-1: Community Tools

Community Tools Notes & Examples

Reinforcers

Affirmations and Pushups

Affirmations are oral encouragements offered 

spontaneously by peers to acknowledge one another and 

their efforts to change.

Pushups are similar to affirmations but are used to 

encourage and reinforce any sign of progress in a resident 

who is having trouble.

Privileges

Privileges are explicit rewards given by staff members to 

acknowledge positive changes in behavior and attitudes as 

well as for overall progress in the program.

Sanctions

Oral or Written Correctives

Oral correctives are instructions or statements delivered by 

both peer and staff members to facilitate learning when 

residents do not meet TC expectations for recovery and 

right living.

Oral correctives are primarily peer (but sometimes staff 

member) reactions to behavior that may not violate TC 

rules but is still unacceptable.

Oral pullups

• Are statements from one or more peers to remind a 

resident of a lapse in expected behavior or attitude

• Require the person receiving the pullup to

– Listen without comment

– Immediately display the correct behavior
MODULE 8

PM 8-7

Community Tools Notes & Examples

– Express thanks for the feedback.

Bookings

• Are written notes, submitted by peers or staff through 

the proper chain of communication, that raise the 

community’s awareness of a resident’s negative 

behavior or attitude

• Also are called “written pullups.”

Talking-tos

• Are stern oral correctives delivered by a peer under 

staff supervision

• Point out the inappropriate behavior and how it 

affects the resident and the community

• Generally occur after pullups and bookings have 

failed to change behavior.

Reprimands

• Are sometimes called “oral haircuts”

• Are the most severe oral correctives

• Are given by staff only and are delivered in a critical 

tone with punitive intent

• Require the resident to stand quietly in front of the 

staff member and several peers, picked by staff 

members, and listen respectfully while making eye 

contact.

Interventions

Interventions are consequences decided by staff members 

for the violation of a rule or when a resident consistently 

fails to meet TC expectations.

Interventions for minor infractions

Learning experiences

$ Are special assignments tailored to the resident to 

help him or her achieve a specific behavior or 

attitude.
PARTICIPANT’S MANUAL

PM 8-8

Community Tools Notes & Examples

Demotions

$ Are changes to a lower status in work hierarchy, 

usually the result of negative attitudes 

$ May be a transfer from a double room back to a dorm 

room for a violation of a minor rule.

Speaking bans

$ Are used to interrupt negative communication

$ Require one or more residents to refrain from 

speaking to certain others for a given period.

Losses of privileges

$ Are commensurate with the severity of the offense 

and the resident’s stage in the program

$ Are effective only if the resident cares about the 

privilege.

Interventions for major infractions or serious 

problems in the community

Losses of phase status

$ Are also called being “shot down”

$ Move the resident back one or more phases in the 

program.

House changes

$ Involve transferring a resident to another facility

$ May be appropriate when the behavior problem 

seems specific to a particular facility

$ Are more strategic than punitive

$ May be combined with other disciplinary action.

Administrative discharges

$ From the program occur for violating a cardinal rule, 

repeatedly violating other rules, or posing a threat to 

the safety of community residents

$ May include referral to another TC or to a different 

treatment modality.
MODULE 8

PM 8-9

Community Tools Notes & Examples

House bans

$ Take away all privileges from all facility residents for 

a period

$ Are used when negative attitudes are pervasive in the 

facility

$ Make all residents suffer for the misbehavior of a few

$ Remind every resident of his or her responsibility for 

maintaining the TC’s therapeutic atmosphere.

Bench

$ Typically signifies that a resident is being separated 

from the community and may be asked to leave

$ Is used when

– A resident has violated a serious rule

– A resident wants to leave the TC to

o Give him or her a chance to think about his or 

her decision

o Separate him or her from the community at a 

time when he or she may have a negative 

effect on others

– A resident seems dangerously angry or agitated, 

as a timeout

– A resident needs to be separated from the 

community for his or her or others’ safety for any 

reason.

Relating booth

$ Is a desk with two chairs in a TC common area

$ Requires a resident who has committed an infraction 

to sit in one chair for a period and talk to another 

resident who reviews the person’s behavior or 

attitudes and reminds the person of the concepts of 

recovery and right living

$ May require an “intercessor” or mediator to ensure 

that the communication is open and healthy

$ Also is used to train residents in positive 

interpersonal skills.
PARTICIPANT’S MANUAL

PM 8-10

Resource Sheet #8-2: Sample Intervention Form

Name of the resident

Date

Behavior to be changed

Description of the intervention

Rationale: Clinical/therapeutic value

Outcome: What happened

Resident’s comments about the reason 

for the intervention and the outcome
MODULE 8

PM 8-11

Resource Sheet #8-3: Exercise—Community Tools

Instructions

Discuss the following questions for each scenario. Refer to Resource Sheet #8-1 for a review of 

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 in terms of the TC views of the disorder, the person, recovery, and 

right living.

• How will the community benefit from the intervention?

Scenarios

Scenario 1

Ron has been in the program for 3 weeks. He has kitchen cleanup duty, and he has not put the 

cookware away correctly. Sam is a staff member and sees what Ron has done. What should Sam 

do?

Scenario 2

Andrea, a staff member, sees Rae, a resident, sleeping during a group meeting. What should 

Andrea do? 

The next day Andrea again sees Rae sleeping in a group meeting. What should Andrea do? 

On the third day, Rae answers Andrea in a hostile manner after Andrea asks her a simple 

question. What should Andrea do?

Scenario 3

Linda has been in treatment for 2 months. She has difficulty waking up on time and is typically 

late for breakfast. Her peers have spoken to her and have challenged her in encounter group. She 

says she wants to get up on time but is just too tired. She says she is “not a morning person.” 

What would you, as her counselor, do?

Scenario 4

Linda continues to oversleep almost every morning. She has been given both oral and written 

pullups, but she has not changed her behavior. In addition, she is increasingly late to seminars 

and meetings. Her counselor is frustrated and comes to you, her supervisor, for advice. What 

would you do?
PARTICIPANT’S MANUAL

PM 8-12

Scenario 5

Samantha was given oral pullups about her continued unwillingness to perform her commissary 

job functions. She blames others for her problem. The other residents of the commissary have 

submitted written pullups about Samantha’s performance. As her counselor, what would you do?

Scenario 6

Daniel has been in treatment for 9 months. He accompanied a junior resident out on a pass and 

allowed him to deviate from the conditions of the pass. Daniel did not report this deviation on 

returning to the program. The junior resident reported the deviation 3 days later out of feelings of 

guilt. Once confronted, Daniel acknowledged the deviation. You are the director of the TC. What 

would you do?
MODULE 8

PM 8-13

Resource Sheet #8-4: Group Process Tools

Group process tools are used to

• Stimulate emotional reactions and self-disclosure

• Break down denia l and increase self-awareness

• Promote participation in the group process

• Demonstrate and practice responsible concern for self and others.

Provocative Tools Evocative Tools

Controlled hostility or anger: Expressing 

angry feelings to intensify awareness.

Engrossment: Exaggerating behavior to 

penetrate denial.

Humor or mild ridicule: Promoting laughter so 

residents recognize their false social images, 

prejudices, and stereotypes.

Identification: A feeling of relatedness 

between two people who have had a common 

experience and share similar feelings. 

Identification is demonstrated when residents 

express that they understand the feelings of 

another resident because they have had a 

similar experience.

Compassion: A feeling of concern for a person 

who is suffering. Compassion is demonstrated 

when a resident comforts another who is 

experiencing painful emotions.

Empathy: The ability to put oneself in 

another’s shoes and convey an understanding 

of his or her feelings.

Affirmation: Words and gestures of support, 

encouragement, and approval to acknowledge 

residents’ efforts to learn and change.

Provocative and Evocative Group Process Tools

Projection: Observing and interpreting behavior based on one’s thoughts and feelings.

Pretend gossip: Talking about a resident as if he or she were not present to provide feedback 

without direct confrontation.

Carom shot: Speaking to another resident who has a similar problem with a third resident to 

avoid direct confrontation with the third resident. 

Lugs: Mildly criticizing to raise awareness without causing a resident to become defensive.
PARTICIPANT’S MANUAL

PM 8-14

Resource Sheet #8-5: Role Play of Identification, Empathy, 

and Compassion

Scenario 1

Jennifer

Jennifer has been in Phase 1 of Stage II for 3 months and expects to advance to Phase 2. 

However, she has not followed program rules and has not spoken in encounter groups. Staff 

members decide to hold her in Phase 1 and provide her with specific behavioral goals to achieve 

before advancing to the next phase of treatment.

When Jennifer became aware she was being held back, she ran out of the room and told Freda, 

her counselor, that she wanted to leave. She went to her room to pack her things. 

Freda

Freda went to Jennifer’s room, found her angrily gathering her belongings, and attempted to 

calm her. Freda explained the decision in terms of the TC views of the disorder, the person, 

recovery, and right living. To help Jennifer understand the benefits of the decision, Freda 

scheduled a group meeting with three other residents who also have experienced being held 

back.

Residents

Resident #1 is a new TC resident and expresses compassion.

Resident #2 is a peer and expresses identification.

Resident #3 is a senior resident and expresses empathy.

Observer

One participant serves as observer to provide feedback on what went well and what could be 

changed during the role play.

Begin the role play with Freda explaining the reasons why Jennifer will not advance to Phase 2 

of treatment.
MODULE 8

PM 8-15

Scenario 2

Mario

Mario has been in the TC for 12 months and has been seeking employment actively for 5 weeks. 

He has submitted numerous applications throughout the city.

Mario interviewed for a position as a front-desk attendant in a hotel and was optimistic that he 

would get the position. He contacted the hotel after 1 week and found out that he had not been 

chosen.

Ken

Ken is Mario’s counselor. He noticed Mario was upset and asked him what happened. Mario 

shared his disappointment and frustration with Ken. Ken asked him to share what happened with 

three other residents who also are looking for work.

Residents

Resident #1 expresses compassion.

Resident #2 expresses identification.

Resident #3 expresses empathy.

Observer

One participant serves as observer to provide feedback on what went well and what could be 

changed during the role play.

Begin the role play with Mario expressing his disappointment and frustration.
PARTICIPANT’S MANUAL

PM 8-16

Resource Sheet #8-6: Mock Encounter Group

See Resource Sheet #8-4 to review group process tools. 

Use these tools in the mock encounter group.

Mock Encounter Group Seating

• Arrange the chairs in a circle (with no empty seats). 

• The person to be confronted sits opposite the person who will confront him or her. 

• Residents representing peer strength and residents who have been in the TC for more than 6 

months sit next to the person being confronted.

• The facilitator sits in a chair that is equidistant from the confronter and the person being 

confronted.

Rules of the Mock Encounter Group

• Do not threaten, verbally attack, or call anyone names.

• Do not help the person being confronted.

• Do not leave the room or engage in side conversations.

• Use language that expresses your true feelings.

• Be completely honest and show responsible concern for all members of the group.

Mock Encounter Group Phases

Confrontation

• The facilitator asks the resident who wrote a slip to state his or her observations and 

reactions to the resident’s behavior (a slip is a written concern a resident has about another 

resident).

• Encounter group members may provide additional observations.

• Provocative tools are used to focus on the issues and to evoke the feelings of the person 

being confronted.

• The resident being confronted is expected to listen and respond to his or her peers’ 

comments.

• The confrontation phase is over when the resident acknowledges and accepts the group’s 

reaction to his or her behavior.

Conversation

• Encounter group members encourage the resident being confronted to focus on the 

behavior or attitude being discussed. 

• Encounter group members encourage the resident to talk about his or her feelings. 
MODULE 8

PM 8-17

• Encounter group members use evocative tools to deepen the resident’s understanding of the 

problem.

• The conversation phase is over when the resident displays an understanding of the 

confrontation. He or she will 

– Label his or her feelings

– State his or her self-defeating pattern of behavior or attitude

– Ask for help in making personal changes.

Closure

• Encounter group members provide positive encouragement, feedback, suggestions, and 

support to the resident being confronted.

• Suggestions are given to help the resident learn how to enact positive changes.

• Encounter group members speak with warmth, support, and affirmation to balance the first 

two phases.

• The closure phase is over when the resident makes a commitment to change and states what 

he or she will do differently.

Role of the Staff Person

• Supervise the preparation and selection of residents.

• Facilitate the process (if this is the practice in your TC).

• Observe the process and residents’ reactions and behaviors.

• Obtain feedback from other staff members and/or senior residents if you had to be absent 

from the group.

• Decide whether and when emergency intervention is required.

After an Encounter Group Session

• It is important for the entire TC to participate in 30 minutes of socializing (snacks are 

provided) to continue the closure phase of supporting, affirming, and encouraging residents 

to change their behaviors and attitudes.

• Senior peer role models reach out to residents who may be upset about their experience.

Scenarios

Scenario 1: Demonstration

Lou is 22 years old and has been a TC resident for 2 months. He is assigned to the kitchen crew. 

For the past 2 weeks, Joe has pulled him up on a daily basis for sitting down during kitchen 

cleanup. His behavior has not changed, and Joe has written a slip about Lou that Joe reads at the 

beginning of the encounter group. 
PARTICIPANT’S MANUAL

PM 8-18

The role play begins when Joe says to Lou: “Lou, I am concerned about you. I have asked you 

every day to help with kitchen cleanup, but you ignore me. I am worried about you because you 

don’t seem to be participating. You are sitting down when everyone else is still working.” 

Other crewmembers state their observations, explain their frustration because Lou is not doing 

his work, and express their concern for him.

Participants who are experienced TC staff members play Lou and Joe. They demonstrate the 

encounter group process of confrontation, conversation, and closure.

The facilitator, played by the trainer

• Arranges the seating 

• Begins the mock encounter group by reviewing the rules

• Asks Joe to speak directly to Lou about his behavior

• Leads the group encounter process through the three phases: confrontation, conversation, 

and closure, using group process tools.

Other participants may participate and use the group process tools listed in Resource Sheet #8-4. 

Scenario 2: Tanya and Marie

Tanya is 38 years old. She has been a resident of the TC for 5 months and is assigned to be an 

expediter. This is the second TC she has been in. She dropped out of the first program 4 years 

ago, relapsed within 6 weeks, and started using crack cocaine again. Marie also has been in the 

TC for 5 months and is the head of the kitchen department.

The role play begins when Marie says to Tanya: “Tanya, you have been dropping hints that you 

don’t think you need to complete the program and that it is time to leave. I am concerned about 

you and worried that you will start using drugs again. When you say you are going to leave, I 

feel that you don’t care about us and that you are thinking only about yourself.” 

Other residents state their observations, explain how Marie’s comments and behavior are 

affecting them, and express their concern for her.

Participants who are new staff members play Tanya and Maria. 

The facilitator 

• Arranges the seating

• Begins the mock encounter group by reviewing the rules

• Asks Marie to speak directly to Tanya about her behavior

• Leads the group encounter process through the three phases: confrontation, conversation, 

and closure, using group process tools.

Other participants may participate and use the group process tools listed in Resource Sheet #8-4.
MODULE 8

PM 8-19

Summary of Module 8

TC treatment methods consist of community tools, specific techniques that include reinforcers 

and sanctions, and group process tools that include provocative and evocative tools.

Community Tools

(Specific techniques are described in Resource Sheet #8-1: Community Tools.)

Community tools are specific techniques that include reinforcers to encourage prosocial 

behaviors and sanctions to discourage rule-breaking behavior.

Reinforcers

Reinforcers include

• Affirmations

• Pushups

• Privileges.

Affirmations and pushups are important because they not only encourage change in the person 

receiving the feedback but also serve as a self-reinforcer to the resident giving the affirmation or 

pushup. 

Changing one’s behavior to seek privileges is the first step of a process that leads to internalized 

change. Tangible privileges act as incentives for residents to try new behaviors; once a resident 

engages in a new behavior, he or she is likely to find it reinforcing socially and emotionally. The 

behavior then becomes personally relevant and valuable and can be internalized.

Sanctions

Sanction is a general term used to include consequences for self-defeating behaviors and 

attitudes. Sanctions provide the opportunity for residents to learn from mistakes. The entire 

community is made aware of sanctions that are delivered, providing vicarious learning for 

residents and strengthening community cohesiveness. Peers are expected to detect, confront, and 

report violations of rules and self-defeating behaviors and attitudes. This is critical to the selfhelp and mutual self-help learning processes.

Sanctions include oral or written correctives and interventions.

Oral or written correctives include

• Pullups

• Bookings

• Talking-tos

• Reprimands.
PARTICIPANT’S MANUAL

PM 8-20

Interventions are consequences decided by staff members for violations of rules or when a 

resident consistently fails to meet TC expectations. Interventions vary in severity depending on 

the TC rule that has been violated. The staff member’s objective is to use the least severe 

consequence necessary to maximize learning. Interventions are not punitive but are part of the 

learning process. The desired outcome, usually a behavior change, must be clear. If the 

intervention does not result in a change of behavior, another community tool must be used. 

Staff members are expected to explain the rationale for their decisions in terms of the TC view of 

the disorder, the person, recovery, and right living. Interventions must be documented in the 

resident’s record and must be justified clinically.

Interventions for minor infractions include 

• Learning experiences

• Demotions

• Speaking bans 

• Losses of privileges.

Interventions for major infractions and serious problems in the community include

• Losses of phase status

• House changes

• Administrative discharges

• House bans

• Bench

• Relating (or confrontation) booth.

Groups in the TC

TC groups can be classified as educational or clinical.

Educational Groups

Educational groups encourage personal growth, provide work-related skills training, teach the 

group process, and include

• Personal growth groups to teach residents how to explore concepts in an intellectual or 

conversational format

• TC job skills groups to teach residents about specific jobs required in the TC and the proper 

way to perform these jobs

• Clinical skills groups to teach new residents how to use group process tools via simulated 

or mock encounter groups

• Life skills groups to teach specific skills that residents need to succeed in mainstream 

society

• Reentry groups to prepare residents to move back into the community.
MODULE 8

PM 8-21

Clinical Groups

Clinical groups provide residents with the opportunity to

• Express intense emotions

• Gain insight into their behavior and that of other residents

• Relate to other residents’ experiences and situations

• Receive healing affirmations from peers and staff

• Model appropriate group behavior

• Exhibit leadership.

A set of rules applies to all TC clinical groups to protect the psychological and physical wellbeing of residents. These rules prohibit

• Physical violence

• Oral threats or gestures of violence

• Cultural stereotyping

• Disclosure of information outside the TC.

Clinical groups include

• Encounter groups to help raise residents’ awareness of their self-defeating behaviors and 

attitudes 

• Probe groups to obtain information from residents about critical events that have occurred 

in their lives

• Marathon groups to enhance residents’ motivation to address critical issues in their lives 

and begin the process of resolving experiences that have impeded their growth and 

development

• Static groups to support a small group of people on a specific issue and to monitor their 

change over time.

Group process tools

(Specific techniques are described in Resource Sheet #8-4: Group Process Tools.)

Provocative tools are used to challenge and confront residents and include

• Controlled hostility or anger

• Engrossment

• Humor or mild ridicule.

Evocative group process tools are used to support and encourage residents and include

• Identification

• Compassion

• Empathy.
PARTICIPANT’S MANUAL

PM 8-22

Group process tools that are both provocative and evocative include

• Projection

• Pretend gossip

• Carom shot

• Lugs.

TCA Staff Competency—Understanding and Facilitating the Group 

Process

Groups in the TC play a significant part in the change process. The peer encounter group is the 

main therapeutic group format, although other group formats are used. In groups, residents learn 

about themselves and the recovery process by identifying and coping with feelings about people 

and life situations.

The TC group process addresses the underlying issues and the wide range of psychological and 

educational needs of residents that arise during work and when living in a community. Groups 

focus on peer interaction that reinforces the self-help and mutual self-help processes. Feedback 

from other residents is an essential part of the group process for fostering change. Staff members 

and senior residents serve as facilitators of the process.

Staff members can facilitate the group process by

$ Keeping the group on track to prevent it from taking a negative direction

$ Ensuring the psychological and physical safety of group members by enforcing group rules

$ Engaging inactive residents in the group process

$ Allowing residents to do most of the “work” in a therapy or process group; facilitator input 

should be minimal.
MODULE 8

PM 8-23

Review of Module 8

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

$ Define affirmations, pushups, and privileges?

$ Define and explain the purpose of sanctions?

$ Name and define three types of verbal correctives?

$ Name and define five types of interventions?

$ Name and describe three types of educational groups?

$ Name and describe four types of clinical groups?
PARTICIPANT’S MANUAL

PM 8-24

$ Describe five examples of group process tools?

$ Name and describe the three phases of encounter groups?

$ Describe at least one way staff members can facilitate the group process?
PM 9-1

Module 9: Work as Therapy and Education

Module 9 Goal and Objectives

Goal: To understand that the primary purpose of work in a TC is to reveal and address residents’ 

attitudes, values, and emotional growth issues.

Objectives: Participants who complete Module 9 will be able to

• State the primary purpose of work in a TC

• State at least two ways work in a TC benefits residents

• Describe at least three ways staff members can promote healing and learning for residents 

through work

• Explain the way residents progress through the peer work hierarchy

• Explain the purpose of the structure board

• Explain the rationale for work-related decisions in terms of the TC views of the disorder, the 

person, recovery, and right living.

Content and Timeline

Introduction 20 minutes

Presentation: The Value of Work in the TC 30 minutes

Presentation: How Staff Members Can Promote Healing and 

Learning Through Work

15 minutes

Presentation: Peer Work Structure and Hierarchy 20 minutes

Break 15 minutes

Exercise: Case Study of Ray at Work 45 minutes

Presentation: The Structure Board 10 minutes

Exercise: The Structure Board 45 minutes

Presentation: Work-Related Decisionmaking 30 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 4 hours, 30 minutes
PARTICIPANT’S MANUAL

PM 9-2

Slides Notes

OH #9 –1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 9

Work as Therapy and Education

OH #9 –2

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.

OH #9 –3

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
MODULE 9

PM 9-3

Slides Notes

OH #9 –4

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 selfhelp

• Help residents be role models

OH #9 –5

Peer Work Structure 

and Hierarchy

• Crewmember

• Crew leader

• Advanced peer leadership

– Expediter

– Department head

– Coordinator

• Junior staff trainee candidate

OH #9 –6

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 selfhelp?
PARTICIPANT’S MANUAL

PM 9-4

Slides Notes

OH #9 –7

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.

OH #9 –8

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?

OH #9 –9

Prework for Module 10

• Resource Sheet #10-1: Case Study of Marcus 

Advancing Through the TC Program Stages
MODULE 9

PM 9-5

Resource Sheet #9-1: Case Study of Ray at Work

Review page PM 3-5, Resource Sheet #3-1: Case Study of Ray—Disorder of the Whole Person.

Ray’s Work-Related Behaviors When He First Entered the TC

Personal habits: Ray was notorious for being late to work and often had an unkempt appearance.

Work habits: Ray’s work performance was inconsistent and unpredictable. He frequently had to 

be reminded of scheduled meetings and deadlines. 

Interpersonal relationships: Ray was rebellious and quick to start arguments with his coworkers. 

He complained about his boss to his coworkers but would not talk at staff meetings.

Self-management: Ray was frustrated when customers did not order immediately after his sales 

presentation. He wanted instant success and would not accept suggestions about how to develop 

a long-term sales strategy.

Work values: Ray’s attitude toward work was erratic. At times he appeared motivated and 

performed fairly well; at other times he cut corners and did not follow up according to company 

procedures. His primary motivation to work was to make money so he could buy drugs.

Part I

Which of the following characteristics of new TC residents do you think apply to Ray?

• Mistrust and lack of respect for authority

• Lack of interpersonal skills

• Poor work habits and a poor work ethic

• Poor self-esteem

• A pessimistic outlook on life and the future (“Life is terrible, and everyone is against me.”)

• A rebellious attitude (“No one tells me what to do.”)

• Lack of emotional self-management (e.g., easily irritated, passive, aggressive)

• Use of drugs or alcohol to cope with stress at work.

Part II

Read the scenarios assigned to your group and decide as a group how you could

$ Encourage self-help

$ Be a role model

$ Educate and explain

$ Promote community-as-method and mutual self-help.
PARTICIPANT’S MANUAL

PM 9-6

Scenarios

Scenario 1: Crewmember

During Ray’s first weeks in the TC he received extensive instruction from staff about the 

essential elements of the TC approach. 

Ray worked as a kitchen crewmember for 5 weeks and was inconsistent in his work 

performance. He was unable to control his emotions on several occasions and was unable to 

communicate well with others.

Ray received considerable attention from staff members and was made aware of his unreliable 

performance and the consequences this behavior had on others. He was held accountable in his 

encounter groups.

Scenario 2: Crew Leader

Ray advanced to crew leader when he demonstrated more responsible and consistent behavior as 

a crewmember. 

As crew leader, Ray was presented with many opportunities to learn how to be responsible and 

accountable and to manage others. Staff members presented situations to him that furthered his 

self-knowledge and revealed underlying problems.

In his encounter group sessions, Ray became more aware of how his behavior affected others.

Scenario 3: Expediter

After 1 month of serving as a crew leader, Ray was becoming committed to the community and 

showing concern for the welfare of others. He was promoted to expediter, which provided the 

opportunity to reinforce TC rules and principles.

In the role of expediter, Ray was trained to observe others and to report problems, such as when 

rules were broken or when someone had a problem relating to authority or to staff members. Ray 

became familiar with all aspects of the TC. He learned how to cope with disapproval and 

criticism from his peers and how to hold others accountable. 

He observed how staff members and senior residents spoke to new residents and started imitating 

their behavior and repeating their words. In his encounter groups, Ray became aware of the 

effect on others when he failed to report misbehavior or did not complete his reports accurately 

and on time. 

Ray gradually learned to be responsible for himself and others.
MODULE 9

PM 9-7

Scenario 4: Department Head 

After 1 month as an expediter, Ray demonstrated readiness to accept direct responsibility for an 

area of work and staff supervision to strengthen his management skills for the outside world. 

The role of department head provided opportunities for Ray to be tested in all areas, including 

his relationship with others, self-management, and work values. It allowed him to be tested on 

underlying personal issues that had surfaced over the past several months. 

In the TC, residents keep meticulous records of all events. Each activity that occurs is reported in 

writing. In his role as department head, Ray reviewed the logs every day to ensure that incidents 

were handled appropriately.

As department head, Ray was faced with a turning point decision: “Am I part of this community, 

or will I continue to seek instant gratification and to evade responsibility?”

Ray began to feel responsible for maintaining the TC as a healthy and safe community. He 

realized that he did not need staff members to watch him constantly to make sure he was acting 

responsibly.

Scenario 5: Coordinator

After 2 months of serving as department head and successfully resolving an intense conflict with 

a new resident, Ray was promoted to coordinator. He demonstrated that he could walk the walk 

and talk the talk. 

In his role as coordinator, Ray directly supervised expediters, led meetings, reviewed resident 

schedules, and was involved in disciplinary actions. 

Ray served as a successful resident role model, which enhanced his self-identity and helped new 

residents. 

Although Ray achieved the highest ranking resident management position, he still performed a 

wide range of tasks, such as mopping floors, conducting room runs, and serving food. He 

demonstrated proper procedures and was learning to be a consistent role model for others. 

Ray learned to handle his newly acquired status, power, and independence while continuing his 

personal growth through self-reflection and guidance from peers and staff. 

Ray became eligible for junior staff training.
PARTICIPANT’S MANUAL

PM 9-8

Resource Sheet #9-2: The Structure Board

Instructions

Using this Resource Sheet as a guide, construct a structure board for your facility, including:

• The titles used in your facility 

• The first names of the people currently serving in those positions.

Add positions, departments, and crews that exist in your facility.

Senior Coordinator

Coordinator Chief Expediter Coordinator

Department 

Head

Department 

Head

Department 

Head

Department 

Head

Crew Leader Crew Leader Crew Leader Crew Leader

CrewmemberCrewmemberCrewmemberCrewmember

Department 

Head

Department 

Head

Administration

Maintenance
MODULE 9

PM 9-9

Summary of Module 9

Work as therapy and education is a hallmark of the TC approach. In non-TC approaches, clients 

receive treatment before going back to work, and work is considered separate from treatment. In 

the TC perspective, work is an essential element of treatment; observing how a resident behaves 

at work reveals underlying issues. A resident’s ability to work successfully in mainstream society 

is critical to the TC’s “whole person” concept of recovery.

The Value of Work in the TC

Although residents perform tasks necessary to the 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 as residents prepare to leave the TC.

Work in a TC benefits residents in many ways:

• Residents can practice work skills in a controlled and structured setting.

• Residents are in an environment where it is safe to act out, discuss their feelings, and increase 

their self-awareness.

• The work hierarchy and the fact that residents are responsible for the functioning of the TC 

increase a resident’s sense of affiliation with the community.

• Residents are challenged continually to change by being put in job situations with increasing 

performance demands and expectations.

• The TC work hierarchy approximates the real world of work; moving up in the TC work 

hierarchy requires skills similar to those needed to advance in a job or career in the outside 

world.

How Staff Members Promote Healing and Learning Through Work

Staff members are expected to

• Encourage self-help: Staff members must not do the work for residents even when the staff 

members feel rushed or have a need to be needed.

• Be a role model: Residents observe staff members’ work habits, work ethic, and how they

− Dress at work
PARTICIPANT’S MANUAL

PM 9-10

− Relate to other staff members

− Manage their emotions.

• Educate and explain: Staff members must take the time to explain what is expected of 

residents and the peer work hierarchy.

• Promote the community-as-method approach and mutual self-help.

• Encourage residents to be responsible and productive workers.

• Change job assignments of residents regularly: Residents need to explore different roles, 

new experiences, and increasing levels of responsibility.

• Help residents be role models: Staff members encourage

− Motivation

− Achieving one’s personal best

− Cooperating and working with others as a team 

− Friendly and healthy competition

− Respect toward subordinates and superiors

− Adhering to a work ethic

− Conflict resolution.

Peer Work Structure and Hierarchy

The TC provides an orderly and rational process for residents to progress through the peer work 

structure and hierarchy, as follows:

• Crewmember: When TC residents first enter the community, they are assigned to a specific 

crew. They are asked to perform simple tasks and are assessed to determine their attitudes, 

personal and work habits, and basic self-management skills, such as following directions and 

accepting supervisor’s authority.

• Crew leader: When residents have shown initiative and the willingness to take on more 

responsibility, they may be assigned to be crew leaders and given responsibility for 

supervising other residents. Crew leaders focus on improving work relations and selfmanagement, while promoting a strong work ethic.

• Advanced peer leadership: Residents who have performed well in crews or as crew leaders 

may advance to more responsible positions such as expediter, department head, and 

coordinator. In these positions, residents are responsible for maintaining the safety and 

healing environment of the TC by making sure rules are followed and systems are 

maintained. They are considered peer leaders who are role models for right living.

• Junior staff trainee candidate: Many TCs allow eligible residents to become candidates for 

training as junior staff members in the final treatment phase.

The Structure Board

The structure board is a visual representation of the TC structure and is placed in a highly visible 

location, such as outside the coordinator’s office or in the lounge. The board includes residents’ 
MODULE 9

PM 9-11

names, their work positions, and their program stage and phase of treatment. Being included on 

the structure board enhances residents’ sense of belonging to the TC. 

Work-Related Decisionmaking

The work structure and hierarchy represent levels of responsibility (and leadership) that

• Facilitate incremental behavior change

• Reward positive behavior

• Maintain community activities on a daily basis.

Assignments and promotions are considered carefully for each resident. Progression (or 

regression) in the hierarchy depends on the behavior and attitudes exhibited by the resident while 

working, as well as his or her participation in other aspects of community life.

Staff members’ decisions must be made on the basis of what is the best learning experience for 

the resident, not what benefits the community.
PARTICIPANT’S MANUAL

PM 9-12

Review of Module 9

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

$ State the primary purpose of work in a TC?

$ State at least three ways work in a TC benefits residents?

$ Describe at least three ways staff members can promote healing and learning for residents 

through work?

$ Explain the way residents progress through the peer work hierarchy?

$ Explain the purpose of the structure board?

$ Explain the rationale for work-related decisions in terms of the TC views of the disorder, the 

person, recovery, and right living?
PM 10-1

Module 10: Stages of the TC Program and the Phases of 

Treatment

Module 10 Goal and Objectives

Goal: To understand what residents are expected to achieve to complete each stage of the TC 

program successfully.

Objectives: Participants who complete Module 10 will be able to

• List the three stages of the TC program and explain how residents progress through each 

stage

• Describe at least two goals of each stage and phase of the TC program

• Describe at least one benefit to residents of the staged approach to treatment

• Explain decisions to advance a resident through the stages and phases based on the TC 

views of the disorder, the person, recovery, and right living

• Explain the relationship between TC program stages and phases and the privilege system 

and state at least one way staff members demonstrate their understanding of this 

relationship

• Explain the importance of maintaining accurate records and state at least one way staff 

members fulfill this requirement.

Content and Timeline

Introduction 20 minutes

Presentation: Preprogram Assessment 15 minutes

Presentation: Stages of the TC Program—Overview 10 minutes

Presentation: Stage I, Orientation or Induction 20 minutes

Exercise: Case Study of Marcus Advancing Through the Program 

Stages—Stage I, Role Play

25 minutes

Break 15 minutes

Presentation: Stage II, Primary Treatment 20 minutes

Exercise: Case Study of Marcus Advancing Through the Program 

Stages—Stage II

25 minutes

Presentation: Stage III, Reentry 20 minutes

Break 15 minutes

Presentation: Program Completion 20 minutes

Presentation: TCA Staff Competency—Understanding and Promoting 

Upward Mobility and the Privilege System

10 minutes

Presentation: TCA Staff Competency—Maintaining Accurate Records 20 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

Total Time 4 hours, 35 minutes
PARTICIPANT’S MANUAL

PM 10-2

Slides Notes

OH #10–1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 10

Stages of the TC Program and the 

Phases of Treatment

OH #10–2

Preprogram Assessment

• Structured interview

• Medical evaluation

OH #10 –3

Staged Approach to Treatment

Allows time for residents to

• Practice prosocial behaviors and attitudes

• Experience success or failure through a trialand-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
MODULE 10

PM 10-3

Slides Notes

OH #10–4

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)

OH #10–5

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

OH #10–6

TCA Staff Competency

Understanding and promoting upward 

mobility and the privilege system
PARTICIPANT’S MANUAL

PM 10-4

Slides Notes

OH #10–7

TCA Staff Competency

Maintaining accurate records

• What are examples of good recordkeeping?

• What are examples of poor recordkeeping?

OH #10–8

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?

OH #10–9

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 10

PM 10-5

Resource Sheet #10-1: Case Study of Marcus

Advancing Through the TC Program Stages

Part I: Preprogram Assessment

Background

Marcus is a 38-year-old high school dropout. He has three children from two different women 

and has never married. He stays in contact with his oldest child, 20-year-old son, Jamal, but he 

never sees his two daughters, ages 18 and 16. Marcus grew up in a household with eight children 

and his mother, who constantly criticized him and his siblings.

Marcus has had menial jobs for a few months at a time, but he usually was fired for being late 

and verbally abusive to his supervisor. Taking drugs, selling drugs, and stealing have been his 

way of life since he was 17 years old and dropped out of school. Marcus has been arrested for 

drug-related activities eight times over the past 20 years. He is addicted to crack cocaine, uses 

sedative drugs to “come down,” and drinks heavily. Marcus has not been abstinent for longer 

than a few months at a time. He lives with several friends who also have substance use disorders.

In the last 7 years Marcus has entered TC residential treatment three times and dropped out each 

time. His pattern has been to leave treatment within the first 60 days and to relapse into old 

substance use and petty theft. Eight months ago, Marcus left an outpatient program before 

completing it because he was unwilling to comply with the rules of the program, a violation of 

his probation agreement. At an appointment with his probation officer (PO), the PO told Marcus 

that this time he must complete a TC program and stay abstinent or he will go to prison for 2 

years. 

Preprogram Assessment

Marcus’ PO makes the formal referral to the TC but does not accompany him to the intake 

interview. When asked the first question, Marcus replies that he has given up on himself but will 

give treatment another shot to avoid prison. His defeatist attitude is evident. He has a negative 

view of TCs and recovery and displays a tough guy image during the intake interview. When the 

intake worker asks Marcus a question, his response is, “You have that information. My PO sent 

it to you in his report.”

Marcus eventually cooperates and gives the information required to determine his eligibility for 

the TC program and signs a release of information form allowing the TC to report to his PO. The 

intake worker’s report is sent to the supervisor of admissions. The intake worker calls the PO to 

notify him of the disposition.

Are there any factors in Marcus’ history that make him inappropriate for TC treatment? 
PARTICIPANT’S MANUAL

PM 10-6

Part II: Role Plays

Instructions for Role Plays

In your small group, choose participants to play each of the following roles. These roles will be 

used in all scenarios. Participants can switch roles for each scenario:

Marcus: Is requesting a move to the next program stage or phase of treatment. Marcus provides a 

summary of his accomplishments and rationale for why he should be advanced. Within the 

general outline of the role play, feel free to improvise.

A staff member: Asks questions to determine whether Marcus has achieved the goals for each 

stage of the program or treatment phase. The staff member explains his or her decision to Marcus 

in terms of the TC views of the disorder, the person, recovery, and right living.

A peer role model: Supports Marcus and helps him identify his strengths and challenges.

A facilitator/timekeeper: Keep tracks of time and ensures each person contributes to the role 

play. 

An observer: Observes the small-group dynamics and, at the end, comments on it.

Each small group has 20 minutes for the role play. 

Scenarios

Stage I scenario

Marcus believes that he knows everything about the TC because he has been in three other TC 

programs. As he enters his first orientation session, Marcus says, “I know the rules; I’ve been 

through this before.” He believes that the staff members and senior residents conducting the 

orientation do not have anything to teach him. During the first 10 days he complains to staff 

daily about being put through induction. He is defiant in orientation sessions. When a senior staff 

member reprimands Marcus for being critical in the orientation sessions, for walking out, and for 

overall lack of cooperation, Marcus says, “I know you are trying to help me, but I already know 

this stuff.”

Over time, Marcus begins to participate more appropriately in the orientation sessions and listens 

even though he believes this program will be no different from his past TC experiences. He still 

makes it clear that he does not want to be in the TC, but he does not want to go to jail. He says, 

“Maybe I just have to follow the rules and do what everyone tells me.”

Marcus makes friends with Eddie, a Stage II resident, who also comes from a large family and 

has the same ethnic background. Marcus also makes friends with Cheree, a new resident, who is 

very optimistic about being in the TC. Marcus asks Eddie for help: “I really don’t know what 

they want from me; just keep telling me what I need to do over and over again if you have to.” 
MODULE 10

PM 10-7

Marcus also states in group, “This is my last chance. If I don’t finish this program, I’m going to 

jail. I would rather follow the rules for the next 6 months than go there.”

When Marcus has been in treatment for 30 days, he requests advancement to Stage II.

Stage I Goals

To meet Stage I goals successfully and to move to Stage II, a resident demonstrates

• Understanding of TC policies, procedures, philosophy, and expectations

• Trusting relationships with at least some of his or her peers and TC staff members

• An initial understanding of his or her circumstances and need for support and assistance in recovery

• An understanding of the TC view of substance use disorder as a disorder of the whole person

• A beginning understanding of what is needed for recovery

• A willingness to commit to the recovery process, including agreeing to remain in treatment

• Some self-discipline.

Stage II, Phase 1 scenario

In Stage II, Marcus continues to have a negative attitude and is unwilling to engage fully in the 

treatment process. He has been late to meetings, seminars, and group sessions. He has been 

called into the coordinator’s office because peers have reported that he constantly complains. He 

is confronted in encounter group sessions for this behavior but remains emotionally unreachable 

and refuses to acknowledge that complaining is self-defeating. He repeatedly says, “Nobody 

understands what I’m going through. It’s ha rd for someone my age to start life from scratch. 

Nobody in this program has it as tough as me. I may be better off in prison than to hear all of you 

criticizing me all the time.” Marcus personalizes constructive criticism and wants sympathy and 

pity from his peers. He dwells in the past by indulging in self-pity about his life circumstances 

and refuses to acknowledge complaints and feedback about his behavior. 

Over time, and with learning experiences and encounters, Marcus begins to make some changes. 

He responds to his peers during encounter groups and says what he feels, instead of staying silent 

and nodding his head in agreement. He can state what is expected of him, but he still complains 

that nobody really understands what he is going through.

Marcus begins to acknowledge his difficulty with being confronted and hearing criticism. He 

says, “I hate hearing this stuff from you. I feel like I felt when my mother was calling me 

stupid.” He starts to listen to comments about his behavior in the encounter group and 

occasionally acknowledges the feedback. He also makes considerable improvement in being 

punctual and is on time to each meeting, seminar, and encounter group session.

When Marcus has been in Phase 1 of Stage II for about 3 months, he requests advancement to 

Phase 2.
PARTICIPANT’S MANUAL

PM 10-8

Stage II, Phase 1 Goals

To meet Phase 1 goals successfully and to move to Phase 2, a resident usually is expected to

• Conform to the rules and procedures of the TC

• Participate consistently in daily activities

• Acknowledge orally the seriousness of his or her substance use and other problems

• Accept increasing responsibility in work assignments.

Stage II, Phase 2 scenario

During Phase 2 Marcus demonstrates behaviors that are consistent with a middle phase role 

model. He reaches out to new residents struggling with issues of recovery and gives them 

positive and constructive feedback whenever possible. He helps new residents assigned to his 

crew. 

Marcus seems to be developing a sense of responsibility and responsible concern toward himself 

and others, which is most evident when he cofacilitates encounter sessions, morning meetings, 

and seminars. He is open to constructive criticism and confrontation in his encounter sessions 

and has learned to be respectful of authority figures. 

Marcus shares his thoughts and feelings in each group session. Although he occasionally lapses 

back into self-pity, he usually catches himself when complaining or being defensive during 

encounter groups and apologizes for his reaction. Marcus helps new residents assigned to his 

crew. 

When Marcus has been in Phase 2 for 2 months, he asks to be advanced to Phase 3.

Stage II, Phase 2 Goals

To meet Phase 2 goals successfully and to move to Phase 3, a resident usually is expected to

• Set a positive example for other residents

• Accept TC staff members as rational authorities

• Accept responsibility for his or her behavior, problems, and solutions

• Cofacilitate group sessions and meetings with senior residents

• Earn increasingly more privileges and hold increasingly responsible jobs in the community.

Stage II, Phase 3 scenario

In Phase 3, Marcus is given the responsibility of being chief expediter and is learning how to 

give directions and receive supervision. Marcus cofacilitates encounter group sessions, morning 
MODULE 10

PM 10-9

meetings, and seminars for Phase 2 residents. Gradually, Marcus practices leadership skills and 

realizes that he can lead a productive life.

While on a visit to his brother’s house, Marcus spent some time with an old using buddy, saying 

that he was “bored with watching TV”; his friend stopped by and asked him to hang out for a 

while. He admits this in a group and talks about how he was tempted to use drugs with his friend, 

“just that once,” but did not. He expresses some frustration and anger that he cannot be with his 

old friends, some of whom he has known since he was a child. Group members confront him 

about his behavior. Although Marcus listens, he does not respond and isolates himself from the 

community for a few days. 

Over time, and with repeated feedback from his peers, he begins to participate in the community 

again and acknowledges that he knows his peers are “true friends” and are looking out for him. 

Marcus begins to express hope in group sessions and speaks with enthusiasm about getting a job

and being successful in his recovery outside the TC. He is in the process of completing his 

general equivalency diploma (GED) and looks forward to continuing his education by applying 

for admission to a trade school.

When Marcus has been in Phase 3 of Stage II for 3 months, he asks to be advanced to Stage III, 

reentry.

Stage II, Phase 3 Goals

To meet Phase 3 goals successfully and to move to Stage III, a resident usually is expected to

• Be an active participant in group sessions and meetings and frequently cofacilitate groups with other 

senior residents

• Adopt self-management skills and develop the ability to handle privacy appropriately

• Become involved with school or vocational training

• Develop a positive social network of peers during furloughs

• Become an established role model and provide leadership in the community.
PARTICIPANT’S MANUAL

PM 10-10

Part III: Marcus in Stage III and Program Completion

Marcus has been in treatment for 9 months. His attitude significantly improved in Stage II. He 

struggled, but with the support of his peers and program staff, he became engaged in the 

treatment process. He learned why he was unsuccessful in his past treatment experiences and the 

steps he needs to take to prevent relapse when he returns to the community. 

Marcus not only learned how to help himself, he also became a positive role model in the 

community. He now helps new residents in the program and gives them positive and constructive 

feedback.

Marcus is very proud that he has advanced to Stage III of the program, where he will continue to 

practice leadership skills. He has experienced many achievements while in the TC that have been 

validated by his peers and staff member feedback. He realizes that he can lead a productive, 

prosocial lifestyle. 

Marcus maintains a highly structured schedule of school, work, and TC activities. He has 

reconnected with his children and visits them regularly. Marcus completed his GED, is enrolled 

in a trade school, and is working at a part-time job. He is planning to move into an apartment 

with another resident who is also in reentry. Marcus has been attending NA meetings in the local 

community and has a sponsor. He is active in his home group and has led several meetings. 

Marcus says that he and his brothers talk about their experience growing up with a mother who 

was constantly critical of them but that he now understands that he must take responsibility for 

himself and his success outside the TC.

Marcus applies and is approved for graduation from the TC. He will be moving out of the TC 

soon and will attend the program’s spring graduation ceremony.

Typical Criteria for TC Graduation

Residents who have completed the TC program successfully and are eligible for graduation

• Have remained alcohol and drug free

• Are employed or are in school or a training program

• Have resolved or are in good standing regarding their legal problems

• Have resolved most of their practical problems, like housing, health, and family estrangement

• Accept that they need to continue to work on particular problem areas and on themselves in general

• Have a regular therapist, if necessary

• Are attending NA or AA meetings regularly

• Are committed firmly to continued abstinence.
MODULE 10

PM 10-11

Summary of Module 10

Preprogram Assessment

TCs conduct a preprogram assessment of potential residents, consisting of a structured interview 

conducted by a clinical staff member and a medical evaluation conducted by the TC’s medical 

staff or a contract physician.

The structured interview and medical evaluation 

• Identify factors that may make a person inappropriate for TC treatment, such as

− Current suicidal thoughts or multiple suicide attempts

− History of arson

− Violent behavior

− Mental disorders that would impede the person’s ability to participate in the TC 

program

− Acute physical illness that must be treated before admission

• Identify the person’s need for ongoing psychiatric care, such as medication management

• Assess the person’s need for medical or ambulatory detoxification

• Identify the person’s need for ongoing medical care

• Obtain information about the person’s prior treatment experiences

• Obtain preliminary information about the person’s alcohol and drug use

• Obtain preliminary information about a person’s social history, including

− Employment status and history

− Family and relationship history and current status

− Legal status

− Education

• Prepare the person for long-term treatment.

Stages and Phases

Treatment in a TC is divided into several distinct levels that can be called program stages and 

phases of treatment. As a resident makes incremental changes in behavior and attitude, he or she 

progresses to the next program stage or treatment phase. The information contained in this 

module is based on a generic TC. Participants’ TCs may use different terms for stages and 

phases, but the underlying concepts should still apply.
PARTICIPANT’S MANUAL

PM 10-12

The three stages of most TC programs include

• Stage I, Orientation or Induction

• Stage II, Primary Treatment (divided into Phases 1, 2, and 3)

• Stage III, Reentry (divided into early, middle, and late reentry phases).

The community sets intermediate behavioral goals for residents during each stage of the TC 

program (see Resource Sheet #10-1 for lists of goals). The goals of one stage must be met before 

a resident can advance to the next stage. Residents may request movement to the next stage of 

the program or phase of treatment when they believe the goals of their current stage or phase 

have been achieved. The final decision to advance a resident is made by staff members, with 

significant input from other residents in the community. Residents may be returned to a previous 

stage or phase if their behavior deteriorates and they do not progress. A TC staff member makes 

this decision with community input.

Residents benefit from the staged approach to treatment because it is gradual and allows time for 

residents to

• Practice prosocial behaviors and attitudes

• Experience success or failure through trial and error 

• Be supported and guided by the community 

• Internalize new behaviors and attitudes and become accustomed to living them on a daily 

basis.

TCA Staff Competency—Understanding and Promoting Upward 

Mobility and the Privilege System

Privileges are explicit rewards for residents who advance through the stages of the TC program 

and the phases of treatment. The privilege system teaches residents that rewards are based on 

earning, not entitlement. 

TCA Staff Competency—Maintaining Accurate Records

It is critical that residents’ records adequately reflect the treatment process, from intake and 

assessment through discharge. Residents’ records are used to communicate relevant information 

with referral sources and other relevant stakeholders (with residents’ written consent).
MODULE 10

PM 10-13

Review of Module 10

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• List the three stages of the TC program and explain how residents progress through each 

stage?

• Describe at least two goals of each stage of the TC program?

• Describe at least one benefit to residents of the staged approach to treatment?

• Explain decisions to advance a resident through the stages based on the TC views of the 

disorder, the person, recovery, and right living?

• Explain the relationship between TC program stages and the privilege system and state at 

least one way staff members demonstrate their understanding of this relationship?

• Explain the importance of maintaining accurate records and state at least one way staff 

members fulfill this requirement?
PM 11-1

Module 11: How Residents Change in a TC

Module 11 Goal and Objectives

Goal: To understand the process of internalizing behavior and self-change. 

Objectives: Participants who complete Module 11 will be able to

• Identify at least four types of self-change expected of TC residents

• Describe the positive change in self-identity expected from the TC program

• Define the internalization of behavior change and provide at least three examples of evidence 

that internalization is occurring

• Describe at least three essential experiences that are necessary for residents to internalize 

change

• Describe at least two essential perceptions that are necessary for residents to internalize 

change

• Explain how active participation and involvement are necessary in each stage of the TC 

program for residents to internalize change.

Content and Timeline

Introduction 20 minutes

Presentation: Self-Change 30 minutes

Presentation: Self-Identity 15 minutes

Presentation: Internalization 15 minutes

Break 15 minutes

Presentation: Essential Experiences 45 minutes

Presentation: Essential Perceptions 30 minutes

Presentation: Active Participation and Involvement in the TC 10 minutes

Summary and Review 20 minutes

Journal Writing and Wrapup 20 minutes

TCC Graduation or Completion Ceremony and Celebration 30 minutes

Total Time 4 hours, 10 minutes
PARTICIPANT’S MANUAL

PM 11-2

Slides Notes

OH #11–1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Module 11

How Residents Change in a TC

OH #11–2

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.

OH #11–3

Self-Identity

• How individuals perceive themselves

• How individuals believe they differ from others

• Individuals’ perceived degree of self-worth and 

sense of purpose
MODULE 11

PM 11-3

Slides Notes

OH #11–4

Internalization

The process of accepting, practicing, 

and applying what has been learned 

in the TC to new situations inside and 

outside the program

OH #11–5

Internalization

• Essential experiences 

• Essential perceptions

• Active participation and involvement in the TC

OH #11–6

Essential Experiences

• Emotional healing

• Social relatedness and caring

• Subjective learning of self-efficacy and 

self-esteem
PARTICIPANT’S MANUAL

PM 11-4

Slides Notes

OH #11–7

Essential Perceptions

• TC treatment is effective.

• I am making progress.

OH #11–8

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? 
MODULE 11

PM 11-5

Resource Sheet #11-1: The Process of Self-Change and 

Internalization

Instructions

In your journal, write about a change you have made recently in one or more of the following 

categories:

• Self-care: Personal habits and attitudes essential to self-care

• Self-control: The control or elimination of impulsive behavior

• Self-management: Successfully managing feelings and attitudes that influence how one 

copes with problems and challenging situations

• Self-understanding: The ability to make connections between past experiences and present 

behavior patterns, attitudes, and feelings

• Self-concept: The positive perception of oneself.

Check all the situations in the following list that caused the change:

q Affiliation with a community or group that values the changed behavior

q Having a role model 

q Being removed from a situation or proximity to a person who prevented the desired change 

from occurring

q Instruction on how to make the change

q Adopting a new value or ethic that supports the change

q Becoming older, wiser, and more mature

q Becoming responsible for oneself or others in a way that requires the change to occur

q Becoming aware of the consequences of not making the change

q Gaining insight or becoming aware of feelings that had prevented the desired change from 

occurring

q Experiencing a general sense of positive well-being or a decrease in mental distress.

Is the change now a natural part of your daily life?

Can you maintain the change in new situations?
PARTICIPANT’S MANUAL

PM 11-6

Resource Sheet #11-2: Case Study of Marcus as a

Role Model

Overview

Marcus’ self-identity significantly changed during Stage II. He struggled, but with the support of 

his peers and TC staff members, he became engaged in the treatment process because he 

experienced success and developed a positive sense of self-worth and purpose in life. He is now 

fully committed to continuing his self-learning and to helping others. He helps new residents 

who come into the program and are struggling with the same issues he experienced when he 

began the program.

In Stage III, Marcus continues to use the tools and concepts of the program. He is advancing in 

the community and is expected to volunteer to accept additional responsibilities. He will find 

part-time employment and will continue to live in the TC while he prepares long-range plans.

Many residents speak about how they view Marcus as their role model. They look up to him and 

aspire to be like him. Staff members also acknowledge the progress Marcus has made in 

changing his behavior and attitude. They have asked Marcus to lead peer groups for new 

residents to assist them in accepting the rules and expectations of the program. Marcus has even 

expressed interest in taking addiction counseling classes to prepare himself to return eventually 

to the program as a counselor.

As a role model, Marcus demonstrates personal insight and wisdom. He leads the community 

process method by demonstrating the principles of recovery and right living. A major shift in 

Marcus’ transformation was that he no longer considered living in a TC as a way of “doing time” 

for past criminal behavior. He participated in the TC and internalized that he is worthy as a 

person and is someone who can make a difference in the world. As a role model, Marcus 

enhances the spirit of a healthy community.

Marcus’ Development as a Role Model

Marcus follows TC rules and practices:

• He performs well in his job functions and participates in meetings and group processes.

• He develops a sense of trust in the community-as-method approach and is willing to be 

guided in the process of self-help and mutual self-help.

• He asks his counselor and senior residents for advice and shares what he learns with his 

peers.

• He encourages his peers to seek advice from their counselors and senior residents.
MODULE 11

PM 11-7

Marcus aspires to live a drug-free lifestyle and consistently follows the practices of right living:

• He values honesty, openness, and truth. He gives constructive feedback to his peers daily 

and insists that they follow the rules. He holds peers accountable in encounter groups and 

reports violations to expediters.

• By acting in this way, Marcus is reinforcing the principles of recovery and right living for 

himself and encouraging others to adopt these behaviors as well. New and junior residents 

are aware when he is around and change their self-defeating conversations and actions.

Marcus promotes positive peer interactions:

• He discusses his feelings and encourages his peers to talk about their problems.

• He understands the ups and downs of the recovery process and is compassionate when he 

speaks to residents who are engaged in self-defeating behavior, but he still holds them 

accountable.

• He knows that by helping his peers to be accountable for their actions, he is helping himself 

stay accountable.

• Junior residents seek him out to confide in him and ask his opinion.

Marcus takes responsibility and initiative:

• He begins to take responsibility for fatherhood. He requests meetings and group sessions 

with his former girlfriends and their children, and he listens to them talk about their 

perceptions of the past. This process was initiated by Marcus and is considered a 

demonstration of his desire to challenge and change himself.

• He begins to talk about his family with other residents and shares his concerns and sense of 

guilt that he has not provided for his children as he should have. Other residents admire his 

courage and integrity and ask him how his sessions are going.

Marcus celebrates his achievements:

• In Stage III (early reentry), Marcus completes his GED. The announcement of this 

accomplishment is made at a special house meeting and at a dinner held to celebrate special 

achievements. At the dinner, his TC family acknowledges Marcus’ determination and what 

he means to his brothers and sisters in the TC. Marcus makes a brief speech and says that 

he no longer sees himself as a criminal and a failure. His simple yet authentic statement 

offers hope to others.

Marcus applies what he has learned to situations outside the TC:

• He moves into an apartment with another TC resident in the late reentry phase. He 

graduates from the TC program 7 months after moving out.

• He continues to participate in TC activities and shares his challenges and accomplishments. 

Junior residents aspire to be like Marcus and start to believe that his accomplishments are 

possible for them, too.
PARTICIPANT’S MANUAL

PM 11-8

Marcus continues his recovery process after program completion:

• He starts counselor courses at a community college. He receives an associate’s degree and 

passes his State chemical dependency counselor credential certification examination. He 

visits his former TC and tells residents about his plans.

• He applies for a junior counselor job in a TC other than the one in which he had 

participated. As a result he gains a broader perspective of the TC approach to treatment. He 

also has the opportunity and challenge of getting to know new people and to apply what he 

learned in a new setting.

• After 2 years, he leaves and is hired by the TC in which he was a resident and continues his 

counseling career. He supervises senior residents and continues to serve as a role model by 

participating in all aspects of TC life.

• He attends NA and AA meetings at least three times a week. He stops smoking cigarettes. 

He becomes friends with a woman, Stella, who has no history of drug use or criminal 

activity, and they develop a close relationship. Stella encourages him as he makes and 

maintains changes in his continual pursuit of self-awareness, personal growth, and 

development. They share common values of right living. Stella has never been married and 

has no children. Marcus’ children have met Stella and are developing a relationship with 

her.

• Although Marcus sounds like a model case, he has ups and downs. He is using the tools he 

learned in the TC and is in individual psychotherapy to continue his progress. He discusses 

his issues during staff meetings and inservice training and provides inspiration to other staff 

members.

Summary

Marcus is an example of a resident who worked hard to complete the TC program. He did not cut 

corners, run away from obstacles, or avoid or deny his problems. By aspiring to the ideal but 

staying in touch with reality, he is managing life’s stressors constructively. 

Marcus is proactive in his continued psychotherapy. He learns that guilt and shame were 

imprinted at a deep level when he was growing up and that they reemerged when he moved out 

into mainstream society. He knows he needs to continue to build his confidence and remain 

vigilant about his continued growth.
MODULE 11

PM 11-9

Summary of Module 11

When change occurs, residents do not adopt behaviors and attitudes simply to comply with TC 

rules. They make fundamental changes in the way they live and perceive themselves. Residents 

are expected to make changes in the following areas:

Self-care: Residents must learn personal hygiene, grooming, and appropriate dress, as well as 

habits and attitudes essential to maintaining recovery. Improved self-care represents a change in 

feelings and perceptions of self-worth.

Self-control: Residents must learn to restrain impulsive behavior (such as cursing, making 

threats, lashing out, or leaving) in response to what other people say or do. Improved self-control 

represents understanding that one’s problems are not caused by other people.

Self-management: Residents must learn to think about consequences before taking action, to 

delay instant emotional gratification, and to develop healthy emotional coping skills. Improved 

self-management represents an understanding that one has self-defeating behaviors to control.

Self-understanding: Residents must understand the connections between their past experiences 

and present behavior, attitudes, and feelings. Improved self-understanding represents an ability to 

see patterns in one’s life.

Self-concept: Residents must develop a positive sense of self-worth and a sense of purpose in 

their lives. An improved self-concept occurs when residents realize they can change their own 

lives and make a difference in other people’s lives.

Self-identity refers to how individuals perceive themselves, how they believe they differ from 

others, and the degree of self-worth and sense of purpose they experience.

A transformation is expected to occur in a residents’ self-identity, from a person who uses drugs 

or engages in criminal behavior to that of a productive, worthy, and active member of 

mainstream society.

Residents experience identity change when they

• Recognize that their existing self-identity is false and based on the past

• Realize that others will understand and accept them if they express their true thoughts and 

feelings

• Experience accomplishments in the TC program that allow a new self-identity to emerge.

Internalization of change is the process of accepting, practicing, and applying what residents 

have learned in the TC to new situations inside and outside the program. Internalization requires 

the disruption of previous thought and behavior patterns, which may evoke anxiety, anger, 

skepticism, resistance, or defiance as the resident struggles to let go of old patterns. A resident 

who is simply adapting to the TC may not be internalizing change.
PARTICIPANT’S MANUAL

PM 11-10

Internalization occurs when

• Learned changes become a natural part of a resident’s daily activities.

• Learned changes are self-initiated and applied to new situations.

• New learning takes place quickly, and few mistakes are made.

• Skepticism of TC teachings decreases.

• Frequency and severity of rule-breaking decrease.

• Participation in TC activities increases.

• A resident displays a positive work ethic in a job or school outside the TC.

• A resident uses problemsolving and coping skills in new or demanding situations.

To internalize change residents must

• Have certain essential experiences

• Have certain essential perceptions

• Actively participate and become involved in the TC.

Essential experiences include

• Emotional healing from past physical, psychological, and social distress

• Social relatedness and caring within a healthy and prosocial environment

• Subjective learning that promotes self-efficacy and self-esteem.

Essential perceptions include

• TC treatment is effective.

• I am making progress.

Residents must participate actively and become involved in the TC. The process of 

internalization does not occur automatically as residents advanc e through the stages of the TC 

program. Residents must become immersed totally and full participants in the activities of the 

TC.
MODULE 11

PM 11-11

Review of Module 11

In your small group, discuss and quiz one another on the following (feel free to take notes on this 

page). Can you

• Identify at least four types of self-change expected of TC residents?

• Describe the positive change in self-identity expected from the TC program?

• Define the internalization of behavior change and provide at least three examples of 

evidence that internalization is occurring?

• Describe at least three essential experiences that are necessary for residents to internalize 

change?

• Describe two essential perceptions that are necessary for residents to internalize change?

• Explain how active participation and involvement are necessary in each stage of the TC 

program for residents to internalize change?
A-1

Appendix A:

TCC Expert Panel 

Sue Burgess

Training Manager

Walden House, Inc.

San Francisco, CA

David Deitch, Ph.D.

Director 

Pacific Southwest Addiction Technology 

Transfer Center

University of California

San Diego, CA

George De Leon, Ph.D.

Center for Therapeutic Community 

Research 

National Development and Research 

Institute; and 

Clinical Professor of Psychiatry

New York University School of Medicine

New York, NY

Liliane Drago, M.A., CASAC

National Training Director

Phoenix House Foundation, Inc. 

Shrub Oak, NY

Anthony Gelormino, CASAC

Supervisor of Special Programs

Daytop Village, Inc. 

New York, NY

Sharon L. Gottovi, M.A., LPC, LMFT, 

LSATP

Former Director of Clinical Operations

Second Genesis

Silver Spring, MD

Rich Hayton

Senior Prevention Specialist

JBS International, Inc.

Silver Spring, MD

David Kressel, Ph.D.

Principal Investigator

National Development and Research 

Institute

New York, NY

Glen Lambert, LCSW, MSWAC

Executive Director

Odyssey House Utah, Inc.

Salt Lake City, UT

Kevin McEneaney

Executive Vice President

Phoenix House Foundation, Inc.

New York, NY

Richard E. Steinberg, M.S.

President

West Care Foundation, Inc.

Las Vegas, NV

Edna Salcedo Talboy, M.S.

Consultant

Monett, MO

Linda R. Wolf Jones, D.S.W.

Former Executive Director

Therapeutic Communities of America

Washington, DC

Joan Ellen Zweben, Ph.D.

Executive Director

East Bay Community Recovery Project

Berkeley, CA
B-1

Appendix B:

TCC Contributors

Gaudenzia, Inc., TCC Pilot Test Coordinators and Participants

Gaudenzia, Inc., a large therapeutic community with more than 40 program sites in Pennsylvania 

and Delaware, organized and provided Master Trainers for a 5-day pilot test of the Therapeutic 

Community Curriculum (TCC). Ten Gaudenzia staff members participated in the pilot test as 

trainees. Input from the Gaudenzia trainers and participants was invaluable to the development of 

the TCC.

Pilot Test Coordinators and Trainers

Michael Harle, President/CEO

James Sease, Training Coordinator

Dave Stockton, Trainer

Cecilia Velasquez, Trainer

Donald Garnett, Monitor

Pilot Test Participants

Christine Abdur-Rahim

Donna Broadnax

Bernard Burno

Michael Eshkibok

Kristen Klinger

Rosemary Madl-Young

Jeremy Marcavage

Florence Paige

Darren Skinner

Charlene Wilson

Field Reviewers

Sue Burgess

Training Manager

Walden House, Inc.

San Francisco, CA

George De Leon, Ph.D.

Center for Therapeutic Community 

Research 

National Development and Research 

Institute; and 

Clinical Professor of Psychiatry

New York University School of Medicine

New York, NY

Liliane Drago, M.A., CASAC

National Training Director

Phoenix House Foundation, Inc.

Shrub Oak, NY

Anthony Gelormino, CASAC 

Supervisor of Special Programs

Daytop Village, Inc.

New York, NY

Rich Hayton, M.A.

Senior Prevention Specialist

JBS International, Inc.

Silver Spring, MD

David Kressel, Ph.D.

Principal Investigator

National Development and Research 

Institute

New York, NY
PARTICIPANT’S MANUAL

B-2

Kevin McEneaney

Executive Vice President

Phoenix House Foundation, Inc.

New York, NY

Robert Neri, CAP, LMHC

Chief Clinical Officer

WestCare Foundation, Inc.

Las Vegas, NV

Dave Stockton, M.H.S.

Central Region Director

Gaudenzia, Inc.

Harrisburg, PA

Cecilia Velasquez, M.H.S., CAC Diplomate 

Director of Prison Services

Gaudenzia, Inc.

Chester, PA

Additional Contributors

Allen Bernhardt, M.S.W., CSW, CSAC, provided substantial input to the TCC. We appreciate 

Mr. Bernhardt’s knowledge, experience, and dedication to the therapeutic community model. 

The TCC was enriched by his contributions.

Sharon L. Gottovi, former Director of Clinical Operations for Second Genesis, Inc., graciously 

arranged for the authors to visit the Crownsville, Maryland, Second Genesis site on two

occasions. Ray Brown, the Director of the site, and his staff members and residents provided 

valuable perspective and input.