Ingredients of a turbo-charged TC

The further into the week I get, the more this magical mystery tour surprises me. And being a grumpy old psychiatrist who usually thinks he has ‘seen it all’ in therapeutic communities, I thought I was pretty immune to surprises in therapy groups!

It would take a book - or an anthropology PhD to capture the whole of this event, so I'm going to try just identifying a few themes and bullet point lists today. So here goes.

In common with other therapies:

TYPE OF THERAPY	OBSERVATIONS
TC	Very flat hierarchy, tolerance of extreme disturbance, emotional containment, everything done in groups, different planned and timetabled groups, rapid change of group mood, includes social and meal time together, staff cohesiveness, emphasis on personal responsibility, strong on belongingness, peer support outside community time, powerful but flexible group-held rituals. Deliberate playfulness and fun. All staff have been through the programme themselves (addiction TCs only)
Psychodrama	Protagonist, role of conductors (3 at once), warm-up, action, sharing. Often with planning and preparation of who the protagonists are to be. Deliberate playfulness and fun.
Primal Scream*	Produces deep states of regression, cathartic release, and physical (bodily) containment afterwards.
Group Analysis	Matrix, resonance, large group process (though not explicit)
Transactional Analysis (TA) – Cathexis model	Reparenting with much physical holding
Gestalt	Empty chair work
Reichian / body*	Primacy of mind-body relationship; touch +++
Dance*	Much time is taken up with dancing – from gentle rocking (often with others) and swaying while holding hands in circles - to folk dancing - to wild expressive ‘let it all hang out’ bopping. Nobody forced to participate, but the substantial majority do.
Music*	Often used for warm-up, and frequently chosen ad-hoc to represent dynamic material or for group mood regulation – everything from lullabys and ambient spiritual songs to heavy rock and punk. Also singing, guitar and accordion from group members, and use of five African drums for particular intense emotional episodes
Existential	Unconditional positive regard; genuineness; openness to whatever emerges
Psychoanalysis – Freudian/Neo-Freudian	Oedipal dynamics (though not explicit)
Kleinian	Primitive infantile states (though not explicit)
Jungian	Archetypes, collective unconscious, primordial human codes, ritual, spirituality, numinosity, mysticism
Bion	Nameless dread and containment of primitive and primordial emotional states (though not explicit)
Winnicott	Holding, good enough parenting, infantile limits; playfulness
Kohut and ego-psychology	Relationship with self
Systemic Family (Milan)	Whole families involved, all ages; reframing; usually sees the ‘index problem’ as shared; long period between sessions
Structural Family (Minuchin)	Paradoxical injunctions; recommendations of structural family change; long period between sessions; deliberate playfulness and fun
Brief Focal  Therapy (Davanloo)	Forceful interventions intended to produce strong emotional reactions
Provocative*	Forceful conductors: can become confrontational and aggressive
Cathartic*	Profound emotional expression encouraged and prized
Positive Environment	Extremely warm and accepting, non-judgemental relationships expected of all
Open Dialogue	Whole family seen together; network of support; no secrets and extensive openness
Soteria*	Approach to medication and diagnosis peer support
Hearing Voices network	Normalisation of psychotic experience
Eastern / Tao / Chinese	Balance; clearing blockage and restoring flow; valuing negative as well as positive
DBT	Zen attitude; non-judgemental
MBT	Continuous thinking about, and responding to, the emotional state of others in the group
CBT	Very little!
* I have little direct experience or theoretical training in these approaches – so my observations are very speculative!

In common with NO other therapies (that I have encountered, at least):

·        Amount of touching, holding, hugging, caressing, stroking, hand-holding, lying together – between everybody present

·        All staff are unpaid

·        The groups are free to participants (with donations welcome)

·        Extensive incorporation of music and dance

·        Shamanic rituals

·        Theoretical framework – ‘codes’, ‘tree of life’, ‘communitometer’, ‘quadrangle’, ‘pyramid’

·        Clinical sequence of ‘ancestor tales’, ‘communications’, ‘immersion’, ‘common ground’

·        All as part of desired ‘transition’ (which seems closer to what we would describe as ‘transformative change’)

In keeping with contemporary critique of mainstream mental health services:

·        Total avoidance of diagnosis

·        Aim to reduce use of medication, especially long-term neuroleptics

·        No stigma

·        Centrality of TRUST and HOPE

·        Not ‘superficial’

·        Has a clear spiritual, numinous and transcendental quality

·        Based on personal narratives

Probably unacceptable in modern mainstream mental services:

·        Risk (need I say more!!)

·        Informed consent probably impossible to obtain (nobody could explain the experience enough to prepare somebody for it)

·        Boundaries unclear

·        Non-professionalisation and lack of institutional backing

·        Economic model

·        Un-standardisable

·        Extreme spontaneity in the groups

·        Necessarily chaotic/complex/emergent processes (including the development of the method itself)

·        Lack of the right sort of evidence…

Enough for tonight. Major ritual tomorrow!