Staff and service users’ evaluations of therapeutic principles at a High Secure Learning Disability Therapeutic Community (LDTC)
Creators: name: Capone, Georgina
Publisher: name: University of Lincoln
Year: 2024
Subjects: C800 - Psychology

description: Background: Growing evidence has been provided on the efficacy ofDemocratic Therapeutic Community (DTC) treatment in forensic LDpopulations (known as learning disability therapeutic communities, LDTC) inthe form of reduced violence, personality pathology and interpersonaldifficulties. Recently, the LDTC model has been introduced within a highsecure setting at one of three high secure hospitals in the U.K., for males witha dual diagnosis of mild LD and PD, and produced equally successful results.While a number of outcome studies exist, on-going difficulties have remainedin regard to applying a post-positivist approach to research design ofTherapeutic Communities (TCs) as the approach fails to capture its matrix ofinterrelated treatment components. Consequently, there has been a call forinvestigation of processes within DTCs to identify important treatmentmechanisms that support therapeutic change. While Haigh (2013) hasupdated the theoretical background on DTCs via formulating ‘quintessentialprinciples’ within a given therapeutic environment the principles have notbeen empirically validated within a TC setting.Study aims: To explore service user and staff members’ evaluations of thequintessence principles as outlined by Haigh (2013) and identify whether anyfurther important principles exist within the social climate of the LDTC that werenot captured by current TC theory.Design: A single case study design was employed, with the ‘case’ beingdefined as the LDTC based at one of three high secure hospitals in the U.K. Aqualitative approach was employed within the case study to enable initialanalysis of TC members’ experience of therapeutic principles, any additionalprinciples and to also permit identification of any shared experiences.The results of the qualitative analysis were used to develop a set of statementsthat can be used by future research to determine the importance of existing TCprinciples and additional elements identified in qualitative findings to TCmembers.Method: A qualitative approach was employed to enable analysis of TCmembers’ experience and evaluation of therapeutic principles in addition toidentification of shared experiences. Data were collected via semi-structuredinterviews with 12 participants (6 staff members and 6 service users). Theinterview transcripts were initially analysed via deductive content analysis(Mayring, 2001) in order to identify whether Haigh’s (2013) quintessenceprinciples were evident in the LDTC. Inductive thematic analysis (Braun &amp;Clarke, 2006) was then performed on remaining data, which also involvedcompletion of saliency analysis (Buetow, 2010) in the final stage to justifyselection of themes and ensure identification of codes that did not recur butremained important to the research questions posed.Results:The deductive content analysis identified all five quintessence principles wereexperienced in the LDTC environment by staff and service users. Some limits tothe principle of ‘agency’ were highlighted, with specific reference to difficultiesimplementing a flattened hierarchy in a forensic setting. Additional themes wereidentified via inductive thematic analysis and a saliency analysis indicated thefollowing themes as both important and recurrent; security and risk,responsivity, trust, more physical freedom. Further themes that were identifiedas important but not recurrent within the saliency analysis included: staff fit withLDTC, moving on, being reflective.The theme of security and risk was specifically related to the context of theLDTC functioning in a high secure environment and ‘trust’ was understood to fallwithin Haigh’s (2013) conceptualization of the containment quintessenceprinciple.While the remaining themes may not primarily contribute to the experience ofsecondary emotional development outlined by Haigh’s (2013) five quintessenceprinciples they remain important considerations within therapeutic environmentsin light of their role in facilitating enactment of TC principles within secureenvironments, such as the LDTC.Conclusions: This is the first research paper that has attempted to test whetherHaigh’s (2013) quintessence principles are evident within a given therapeuticcommunity. The single case study provides empirical evidence for thequintessence principles in a novel TC setting along with further elements in theenvironment that help support implementation of quintessence principles.Fundamentally, the study suggests important recommendations for futureresearch.