The methodology of therapeutic communities

[Anonymous]

So what's everyone's opinion of therapeutic communities as a whole?  I've been reading some interesting stuff lately and wondered what both supporters and detractors think of the methodology of it all.

Here's a couple of things I was reading.


http://forum.rickross.com/viewtopic.php ... t=temerlin

Psychotherapy Cults: An Ethical Analysis

Kim Boland,Lewis & Clark College, Portland, Oregon

Gordon Lindbloom, Ph.D. Lewis & Clark College Portland, Oregon

Method

Existing studies of groups described by their observers as psychotherapy cults vary from ethnographic analyses to journalistic accounts. Their lack of a common framework of analysis limits comparisons and generalizations. For this study, we used eight categories of conduct in mental health practice that are cited in ethical codes or derive from them (American Psychological Association, 1989; Association for Specialists in Group Work, 1983; Corey, Corey, & Callahan, 1988; Keith-Spiegel & Koocher, 1985). These categories include confidentiality, dual relationships, informed consent, professional competency, dependency and autonomy, financial practices, professional development, and separation/termination. In each of these categories accepted standards of behavior are first compared with deviations frequently cited in the literature on individual and group therapy; then, practices reported in the literature on groups described as psychotherapy cults are identified and briefly discussed.

Evidence about the conduct of these groups in each area under scrutiny was drawn from information available in both popular and professional publications on three extinct groups that have been labeled as psychotherapy cults. They are Synanon, Center for Feeling Therapy, and Compulsions Analysis. In addition, written material on another group currently operating has been analyzed. The post-hoc, second-hand analyses of five groups provided by Temerlin and Temerlin (1982, 1986) were used. Further evidence was drawn from observations and interviews conducted by the first author with members of another group (Boland, 1989). The evidence and comparisons across categories of behavior are then succinctly described. A summary of the information is presented in Table 1 at the end of the article.



http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

Iatrogenic symptoms associated with a therapy cult: examination of an extinct "new psychotherapy" with respect to psychiatric deterioration and "brainwashing".

In 1982, the first and only discussion of psychotherapy cults appeared in the literature. Temerlin and Temerlin (1982) studied five "bizarre" groups which were formed when five practitioners of psychotherapy simultaneously served as friends, lovers, relatives, employers, colleagues, and teachers, all to patients who were themselves mental health professionals. In choosing the term "psychotherapy cult," the authors have noted similarities of the groups they reviewed to some religious cults, citing the three definitions of the "cult" in Webster's 1966 Third New International Dictionary: (1) a system for the cure of disease based on the dogma, tenets or principles set forth by its promulgator to the exclusion of scientific experience or demonstration, (2) great or excessive dedication to some person, idea or organization, (3) a religion or mystic regarded as mysterious or unorthodox. The psychotherapy cults studied by Temerlin and Temerlin varied from 15 to 75 mental health professionals held together by their idealization of a shared therapist and the activities which they conducted jointly: workshops, seminars, courses, businesses, professional ventures, and social life. As patients became more involved in the social and personal life of their therapists, they gradually withdrew from all friends and family, becoming increasingly dependent on the therapist and their new "siblings." Upon joining the group, many patients felt a sense of being loved and belongingness. The authors described the "cognitive pathology" of idiosyncratic group jargon which served to maintain an illusion of knowledge, sophistication, and personal growth, while removing all ambivalence and uncertainty. The authors concluded that psychotherapy cult membership is an iatrogenically determined negative effect of psychotherapy. Of the former cult members they interviewed, most had perceived themselves as deteriorating or at an impasse, or had experienced disillusionment with their therapists; however, they were unable to terminate unilaterally because of a pathological symbiosis with the group. This paper focuses on a now defunct school of psychotherapy which had both much in common with these psychotherapy cults and several contrasting qualities. First, the school was officially led by a junta of psychotherapists, in a deliberate attempt to avoid any taint of a personality cult. Second, the group of patients and therapists was far larger than any referred to in the original study. Third, most patients were not mental health professionals. Fourth, liberal usage was made of many novel techniques identified with the California psychotherapy scene.


This is what started me off looking into this.

http://www.hereinstead.com/sys-tmpl/htmlpage14/"


I offer one personal anecdote. About a year ago, my then 18 year old son brought home a friend of his to talk with me. Jeffrey smoked marijuana a few times a week, most often perhaps before going home to his often feuding parents. He was a bit goofy but sweet, and my son had worked on an after school project with him for two years and knew him quite well. Jeffrey had never been a great student, but he was doing better academically than ever before. He had a girl friend at another elite school, he'd been accepted at a decent university. He was happy,18, and in his last semester of high school. He and another dopey friend got arrested by undercover police for smoking a joint in Central Park, near their homes. Mayor Giuliani has increased marijuana arrests from about a thousand or so a year to forty thousand a year. Mainly teenagers and young adults get caught, including lots of middle class kids like Jeffrey. What happens? No one knows for sure, but this story may not be that unusual.



When Jeffrey's parents were told to come to the police station and get him out, they became very upset and worried. They sought out a competent professional to examine Jeffery, and were given the name of a top doctor. His name happened to be Dr. "E" (as in Addiction Expert). As you no doubt know, he is a professor at a prominent medical school and a long-time member of the American Society of Addiction Medicine.



Dr. E did not want to see Jeffrey, but only his parents. He listened to them and may have said that Jeffrey was in serious danger. In any event, he firmly told the parents that they and Jeffrey should all go to Phoenix House. When the three of them arrived at Phoenix House, the parents and Jeffrey were separated. The Phoenix House staff told the parents that they had seen many cases like this. They said that Jeffrey was in very serious trouble, he was on the way to becoming a drug addict, his life was in danger. They said that Jeffrey must immediately enter a Phoenix House program, and the parents could attend a group too, so as to better help their son. Jeffrey's parents told him that, given all these professionals' advice and experience, he had no choice: he was to begin treatment at Phoenix House in few days. During that time my son brought Jeffrey to me.



When Jeffrey came to my house a Dutch psychiatrist who specialized in drug cases happened to be there. This good doctor listened to the whole story along with me and was flabbergasted to hear that an eminent physician and medical professor had recommended Phoenix House for someone he=d never met. Jeffrey himself was most upset that almost overnight his parents had become deeply fearful and distrustful of him: they fully accepted the idea that he was in immediate danger of becoming a drug addict and destroying his whole life. He found this prognosis amazing, especially considering that he had never done any other drugs, and he didn't even like alcohol.



I then brought Jeffrey to another drug expert physician who interviewed him at length. He told Jeffrey that, in his opinion, Phoenix House would not be the best place for him, and that if Jeffrey wanted counseling or psychotherapy there were a number of alternatives to consider. The physician also said that, unlike private counseling or psychotherapy, Jeffrey's treatment by Phoenix House for drug abuse might well become part of his permanent medical and health insurance records -- with serious implications for career, reputation, and future health insurance. The physician also said he would say all this to Jeffrey's parents if he wished.



Jeffrey thought it all over that evening, and then bravely told his parents that he did not want to go to Phoenix House, and he wanted to consider other treatments. His parents went ballistic, and fought with each other and him. They then called Dr. E to ask him what to do. Dr. E said that now he did want to see Jeffrey. However, before, going to meet Dr. E, Jeffrey was directed to meet a girl, about his age, who had been in Phoenix House for a couple of years. She told him what a great place it was and how he could meet interesting people there. Jeffrey said she was also pretty good looking.



Jeffrey and his parents then went to Dr. E's office where it was announced that Jeffrey would be interviewed by another doctor -- who just happened to be Dr. E's wife. Jeffrey talked with her for quite a while. Then she came out and reported to the parents and Dr. E that Jeffrey certainly did not need to go to Phoenix house, but instead would be in treatment with ... her.

[Antigen]

Wow!  :eek:

The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.
-- Bertrand Russell

[Anonymous]

http://www.psychiatrictimes.com/p960714.html

Deception-Dependency-Dread

The manipulativeness of cults is similar to the debility-dependency-dread (DDD) syndrome explanation of how the Chinese communists were able to gain a high degree of control over American POWs during the Korean conflict (Farber and colleagues). Contemporary cults, which operate in an open society and do not have the power of the state at their disposal, cannot forcibly restrain prospects and run them through a debilitating regimen. Instead, they must fool them. They must persuade prospects that the group is beneficial in some way that appeals to the targeted individuals. As a result of this deception and the systematic use of highly manipulative techniques of influence (see Cialdini for an overview of social-psychological manipulation), recruits come to commit themselves to the group's prescribed ways of thinking, feeling and acting. By gradually isolating members from outside influences, establishing unrealistically high, guilt-inducing expectations, punishing any expressions of "negativity," and denigrating independent critical thinking, the group causes members to become extremely dependent on its compliance-oriented expressions of love and support. Once a state of dependency is firmly established, the group's control over members' thoughts, feelings and behavior is strengthened by the members' growing dread of losing the group's psychological support (physical threat also occurs in some groups), however much that support may aim at ensuring their compliance with leadership's often debilitating demands. Thus, the new DDD syndrome is one of deception, dependency and dread.

[Deborah]

Here?s some research on Iatrogenics and the negative effects of aggregating distressed teens in ?therapeutic communities?.
http://fornits.com/wwf/viewtopic.php?to ... t=20#49825
If the link doesn?t work, the paper is posted here:
http://fornits.com/wwf/viewtopic.php?to ... 250#164570

I personally don?t believe that ?communities? are inherently negative. It all depends on how the community is run, and if participation is forced or voluntary. We should all have the right to choose who we live with.
For instance, Soteria communities for Schizzy folks were a great idea.
http://fornits.com/wwf/viewtopic.php?to ... =40#102871

http://www.moshersoteria.com/

Other links for Soteria, including a video of residents
http://fornits.com/wwf/viewtopic.php?to ... =30#102868

I often daydream of teen communities/villages where they can escape the insanity in their homes, learn valuable skills, and explore their passions without constantly being under the suspicious microscope of fear mongering adults with all their damn interventions and zero tolerance.... which in many cases flies in the face of natural urges and development.