 |
 |
 |
 |
 |
 |
CLUES TO THE FUTURE OF
THE TC
Page Two
A page from
organizational psychology is instructive here. One of the most highly
replicated findings in organizational psychology pertains to employee
satisfaction. When asked: "what is the number one attribute which promotes job
satisfaction?" The overwhelming response appears counter-intuitive. It is NOT
salary, comfort, tenure, etc. Rather, it is being part of decision-making
processes that are directly related to the individual's work functions. Or put
another way: having a central role in shaping one's own destiny; having a voice
and being heard. The work "structure" and job hierarchy at the core of all
functional TCs are natural platforms upon which to maximize this fundamental
motivation of human behavior.
One particular decision
that each recovering addict must make over the course of his recovery is how to
fill the psychic and behavioral void which the cessation of drug use and its
related lifestyle has by definition created. From the addict's perspective, so
very much is taken away in the early phases of treatment. Throughout the course
of treatment, he must be given a range of options on how to fill it -- how to
productively occupy time, maintain interest, fuel motivation, obtain enjoyment,
pleasure and satisfaction. As we know too well, boredom is the drug's ally. And
I am speaking here, of course, outside of the critical life functions which
must be addressed and stabilized -- education, work, family, shelter,
establishment of an on-going recovery network, etc.
Art and exercise are two
mediums through which I have seen individuals mobilize and find purpose.
Creating art for art's sake -- not as a way of interpreting and resolving
unconscious conflicts in a therapeutic process -- allows the individual to see
beauty in the world and, perhaps, to begin to see beauty in the self.
At Odyssey House here in
New York City, we have engaged clients -- many with co-morbid disorders (chronic
addiction and schizophrenia or bi-polar disorders) -- in an active art program
and have recently mounted three art exhibits, two of paintings and one of
sculptured masks. The process of creating art has in itself been highly
therapeutic. Themes, such as self portraits, bring some structure to each
project, but then clients are encouraged to make numerous decisions on how to
fashion their personalized work. The art show itself becomes a vehicle of
self-pride, as clients glow in the revelation of their powerful expressions. The
art program engenders hope and possibility, bringing the individual closer to
their own creative abilities and those in the cultural worlds in which they
reside.
Exercise represents one
of the most powerful antithesis to addiction. Building the body -- stamina,
strength, and improved appearance -- becomes the antidote to the physical
destruction of addiction. Exercise teaches discipline, patience, the delay of
gratification, and most formidably increases self-esteem. A vigorous,
consistent exercise routine serves as an inoculation against drug abuse. When
great effort is daily (and sometimes painfully) exerted in the pursuit of a
positive physical goal, the thought of abusing one's body, one's new-found
sense of physical health, strength, and well-being, becomes dissonant. That
dissonance only grows and may reinforce relapse prevention efforts.
Completion of the
26-mile NYC marathon last November by 15 individuals in residential treatment
at Odyssey House for heroin and cocaine addiction invigorated not only the
athletes, their friends, coaches, and families, but the entire therapeutic
community.
Vigorously engaging the
intellect can also be more strategically utilized in therapeutic communities.
While high school education, college preparation, vocational training, and job
placement are now common elements of a holistic treatment regimen, what I refer
to as "engaging the intellect" is something wholly different. Here, I am
speaking about reading classic works of literature and holding weekly book club
sessions; engaging clients in chess tournaments, while having an expert teach a
weekly strategy course; forming debate teams and then addressing issues which
impact clients' lives (e.g., the legalization/decriminalization of drugs);
holding a daily news events meeting with a daily reading of the nation's best
newspapers. Such activities engage the individual, helping him see and feel his
own worth while reinforcing his abilities to learn, communicate, and question.
They also take the individual "out of himself" -- dismantling the egocentric
worldview of the addict while giving powerful perspective to pain, challenge,
and fortune.
And now a final point.
Attachment or transference to the group, while natural for some, is difficult
for others. Premature dropout may often be attributed to the individual's
difficulty in forming a bond to the group.
Individual psychotherapy
in the earliest stages of treatment can be a useful tool in transitioning the
individual from a largely careless, egocentric world to that of the functional
group. The bond between the individual and psychotherapist may offer
reassurance and stability where the group environment is experienced as overly
demanding, pressured, and unkind. It is critical here, however, to view the
psychotherapeutic relationship in the service of the group process -- a
place for the individual to discuss the challenges of group identity and
bonding. As the latter takes hold, the former can be de-emphasized.
In comparison to other social, psychological, and medical interventions for human disturbance (e.g., psychoanalysis, behaviorism, family therapy), the therapeutic community may be presently conceived as transitioning out of adolescence and into early adulthood. While still strong-willed, confident, argumentative, with a hefty dose of hubris, the therapeutic community approach is no longer viewed as a rebellious reaction against convention (that is, the medical model) but rather as a legitimate, powerful, and cost-effective methodology for treating some of the most intractable human disorders. To maintain its vibrancy, and ultimately its relevance, we must strive to support and encourage its evolution.
