Therapeutic Community

Manual

Edited and Developed by

Fernando B. Perfas, Ph.D., CASAC

Addiction Training Consultant
New York, USA
2016

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ACKNOWLEDGMENT

The materials used in this Manual were originally put together by a team of
Phoenix House staff in New York consisting of Dr. Fernando Perfas, Robert
Wright, and Liliane Drago, who led the group and was then Phoenix House
National Training Director. Dr. David Deitch, Phoenix House Chief Clinical
Officer back then, served as consultant. The Manual has been edited and
expanded by Dr. Perfas since.

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Preface

I’m grateful to have been part of the team that worked on this Manual project at
Phoenix House. Sadly, not many people appreciated the effort and the Manual
was never disseminated or put to good use. The primary purpose for putting it
out was to provide clear guidelines for TC implementation and work toward a
more standardized TC practice across the agency.

The current edition of the Manual has been extensively revised and edited from
the original version by Dr. Fernando B. Perfas to better suit the needs of TCs
across the globe. This Manual is distributed and can be downloaded for free.
Different TCs can adopt the manual in its entirety or make adjustments to suit
particular needs of a TC. The idea is to provide a template for a TC Manual that
TC programs can work on and, hopefully, develop a more standardized TC
practice within their agency.

While the intent in putting this manual together is to adhere to the fundamental
principles of therapeutic community or what makes a TC a TC, efforts were also
made to update the TC and help create one that values “safety,” respect for
human dignity, and an appreciation for evidence-based practices in addiction
recovery.

By means of a thoughtful practice of TC principles, many of the cognitive-

behavioral elements of the TC within the living-learning (or social learning)
framework become more evident. I hope this Manual serves as a handy guide
for a rational and effective practice of TC by TC practitioners from both sides of
the aisles: the experientially and academically or professionally trained.

For more discussions of topics covered by the Manual, readers are referred to
the References listed in the Appendix.

The editor may be reached at [email protected] for a digital copy of the

Manual.

Thank you and may your TC grow!

Fernando B. Perfas

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TABLE OF CONTENTS

The Therapeutic Community (TC)…………………………………………………..7

What is a TC? ……………………………………………………………………………7
Example of TC Values …………………………………………………………7
A Brief History of the Therapeutic Community ………………………….7
The Theoretical Perspective …………………………………………………8
The Substance Use Disorder ……………………………………………..8
TC Norms and Values ………………………………………………………..12
The TC Method: Community as Healer …………………………………..13
Elements of the TC Model …………………………………………………..15
Physical Setting and Facilities ……………………………………………..16
Community as Method: How the TC Social Hierarchy Works ……….17
Intake and Assessment ……………………………………………………..18
Inclusionary Criteria ……………………………………………………….19
Exclusionary Criteria ………………………………………………………20
Emotional Interview ………………………………………………………….20
Assessment …………………………………………………………………….21
The Trans-disciplinary Team and Case Conference ……………………22
The Phases of Treatment ……………………………………………………23
Phase One: Orientation …………………………………………………..23
The Big Brother/Sister ……………………………………………….24
Phase Two: Primary Treatment ………………………………………..24
Phase Three: Re-Entry ……………………………………………………25
Phase Four: Continuing Care ……………………………………………25
Program Completion …………………………………………………………26
The TC Structure ………………………………………………………………26
Rational Authority ……………………………………………………………27
The Role of the Counselor in a Therapeutic Community ……………..28
Mutual Help and Peer Role Models ……………………………………….28
Job Functions ………………………………………………………………….29
Entry Level: Kitchen and Service Crews ………………………………30
Second Level: Office Positions and Facility Maintenance …………31
Third Level: Crew Chiefs or Ramrods ………………………………….31
Fourth level: Expediters ………………………………………………….32
Fifth Level: Department Heads …………………………………………33
Sixth level: Coordinators …………………………………………………34
Recreation ………………………………………………………………………34

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Contingency Management or Motivational Incentives ……………….35
Learning Experiences (LE) ………………………………………………….37
Schedule of Behavioral Sanctions & Learning Experiences…………..38
Verbal Admonitions (Verbal Haircut) ………………………………….38
An Example of Escalating level of Interventions (Sanction) ……..41
Talk to ……………………………………………………………………41
Pull-up/Reminder ……………………………………………………..41
Admonition/Verbal Haircut …………………………………………41
Learning Experience ………………………………………………….42
Types of Tasks ………………………………………………….43
Redefining the Prospect Chair or Chair …………………………………..44
Meetings ………………………………………………………………………..45
Morning Meeting …………………………………………………………..46
Other TC Meetings …………………………………………………………49
House Meeting …………………………………………………………49
General Meeting ……………………………………………………….50
End of the Day (Wrap-up) Meeting ………………………………..52
Seminars ……………………………………………………………………..52
Concept Seminar……………………………………………………….53
Pro and Con Seminars ………………………………………………..53
Guest Speaker Seminars …………………………………………….53
Book Celebrations …………………………………………………….54
Seminar Games ………………………………………………………..54
Mock Speaking Seminars ……………………………………………54
The Encounter or Concern Group ………………………………………….54
Goals ………………………………………………………………………….55
Phases of Encounter Group ……………………………………………..56
Verbalization of Feelings/Concern ………………………………...57
Exploration ……………………………………………………………..57
Resolution and Commitment ………………………………………57
Socialization ……………………………………………………………58
Group Rules …………………………………………………………………58
Processing Anger and Conflict ………………………………………….58
Tools of the Group …………………………………………………………59
The Responsibilities of the Facilitator …………………………………60
Skills for Staff Group Facilitator ………………………………………..60
The Other Traditional TC Therapeutic Groups ………………………… 62
The Static Group …………………………………………………………..62

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 The Probe …………………………………………………………………..63
The Extended Group and Marathon ………………………………….64
The Peer Confrontation Group ………………………………………..66
The TC Process ……………………………………………………………….67
Recommended Services and Enhancements to TC……………………70
Individual Counseling …………………………………………………...70
Caseload or Static Group ……………………………………………….70
Medical and Dental Services …………………………………………..70
Psychiatric Services ………………………………………………………70
Double Trouble Support Groups ………………………………………70
Gender Responsive Services ……………………………………………70
Trauma-informed Approach ……………………………………………71
Seeking Safety Therapy for PTSD & Substance Use Disorder …..71
Relapse Prevention ……………………………………………………….71
Emotional Management Groups ………………………………………71
Vocational Services ………………………………………………………71
Mindfulness-based Meditation/Reflection/Spirituality …………..71
Grief, Loss, and Bereavement Groups or Counseling ……………..71
Integrating Evidence-Based Practices into the TC ……………………72
What is Evidence-Based Practice? …………………………………….72
Factors for Consideration ……………………………………………….72
Appendix ………………………………………………………………………………74
List of Seminars and Seminar Guides ……………………………………74
Seminar Types ………………………………………………………………..74
Concept Seminars …………………………………………………………74
Seminar Games ………………………………………………………….120
Mock Speaking Seminar ……………………………………………….135
Pro and Con Seminars…………………………………………………..137
Morning Meeting Sign-up Sheet ………………………………………..140
Cardinal Rules and Basic House Rules ………………………………….141
Group Rules and Objectives ……………………………………………...142
TC Philosophy ……………………………………………………………….143
References ……………………………………………………………………144

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 The Therapeutic Community
What is a Therapeutic Community (TC)?

 A TC is a community whose “milieu” (routine, activities, interpersonal

relations, norms & values, and social structure) is specifically designed to
bring about healing and personal change in its members
 A social environment in which participants actively and interactively learn
and practice new life skills, in a social learning process.
 Within this social environment residents live by pro-social norms and
values necessary for a productive, responsible, drug-free life.
 The “community” is the main source of therapeutic process or healing.

Examples of TC Values:

 Emotional and physical safety for everyone in the community

 Respect for all individuals, differences, and cultures
 Honesty in all transactions
 Achievement and learning are the focused of activities
 Restraint and Discipline in our actions
 Patience to hear and encourage each other
 Compassion/empathy expressed in our daily life toward each other

A Brief History of the Therapeutic Community

There are two types of therapeutic community. The first, which was developed
in the United Kingdom, was started by British psychiatrists to treat traumatized
British soldiers during World War II. Later, in the late 195os, an alcoholic and a
group of chronic heroin addicts experimented with a variant of the 12-step
support group. The leader of the group, Charles Dederich, who was a recovering
alcoholic and a member of Alcoholics Anonymous (AA), evolved a highly
emotionally confrontational group process which was effective in effecting
behavior change and curtailing drug-taking behavior. To minimize the risk of
relapse to substance use and help newly “cleaned” members establish longer
periods of sobriety, the group established the first residential therapeutic
community for substance abusers in California. Synanon was born in 1958 and
became the precursor to other TCs. Synanon was known for its no holds barred
group therapeutic approach which was called the Game. Later TC generations

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disagreed with some of the practices at Synanon and parted ways to establish a
more mainstream TC approach to treating substance abusers.

The TC for addiction has spread to all corners of the globe and the most prolific
in spreading the TC was the New York-based Daytop Village. Other U.S.-based
TCs such as Phoenix House and Odyssey House have also contributed in
spreading the TC movement to other parts of the world.

The TC model has been used to treat a spectrum of substance abuse clients
from juveniles, to the homeless, women with special needs, incarcerated drug
abusers, and chronic drug abusers.

For detailed accounts of the history and global dispersion of the therapeutic
community, please refer to Perfas (2014); Rawlings & Yates (2001); Campling &
Haigh (1999); De Leon (2000) in the References which is found in the Appendix.

The Theoretical Perspective

The therapeutic community, or TC, is based upon a theoretical perspective,

which provides a foundation for all aspects of treatment. This perspective
encompasses specific views regarding the substance use disorder, the
individual, and the recovery process (De Leon, 2000).

The Substance-use Disorder

Substance use disorders have bio-psycho-social causes and consequences, all of

which must be addressed for recovery efforts to be successful. They include the
following:

Biological:

 Unusual early response to the substance or experience, e.g., easy

development of tolerance to alcohol or other substances
 Attention deficit/hyperactivity disorder and other learning disabilities
 Biologically based mood disorders (depression and bipolar disorders)

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  Genetic predisposition, such as addiction or alcoholism among biological
family members

Psychological:

 Low self-esteem
 External locus of control (looking on the outside of one’s self for solutions)
 Anger or passivity
 Post-traumatic stress disorders (victims of abuse or other trauma)
 Impulsivity and risk-taking
 Childhood conduct disorders
 Problems/difficulties with emotional regulation

Social:

 Ready access to the substance or experience

 Abusive or neglectful home environment
 Peer norms or misperception of peer norms
 Membership in an alienated, oppressed, or marginalized group
 Life events, including chronic or acute stressors

Depending on their severity, substance use disorders can affect the whole
person, including behavior, emotional and mental health, identity, and lifestyle.
A stable recovery requires change in all the life areas that are affected.
However, the cause and effect of substance abuse can vary greatly among
individuals, so treatment must be individually tailored.

The TC perspective holds that the problem presented by the disorder is not the
drug itself, but its underlying causes and ensuing consequences. Therefore, the
type of drug abused is less significant than these factors. Detoxification and
medication-assistance is considered only part of the recovery process.

The Individual

People with substance use disorders -- regardless of the drugs they use, their
backgrounds, ages, or lifestyles – typically share many of the same challenges.
They often need help with trusting others, self-esteem, tolerance for discomfort

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or frustration, coping with feelings and controlling their impulses, dealing with
authority, interpersonal and communication skills, and productivity.

However, these individuals also have strengths, which may include intelligence,
artistic, musical or athletic talents, wit and sense of humor, creativity,
leadership skills, etc. Treatment will be most effective when the individual’s
strengths are used to help them address their challenges. In the active
environment of the TC, there are many opportunities to do this.

Although people with substance use disorders may have much in common, each
presents with varying degrees of bio-psycho-social etiologies, a unique set of
strengths and challenges, and each must be addressed as an individual.

Recovery

Compatible with the perspectives on the disorder and the individual, TC theory
holds that a successful recovery is made through changes in all the life areas
that have been cause and effect of the substance use disorder. These may
include trauma and other emotional problems, family discord, mental health
problems, immersion in a drug and/or criminal subculture, lack of personal and
social resources, homelessness, domestic violence, criminality, and educational
and vocational problems.

The milieu of the TC includes activities geared to address each of the following
domains:

 Emotional and psychological

 Cognitive
 Spiritual
 Education and vocational
 Behavioral
 Social
 Family
 Biomedical

The TC perspective on recovery posits that the client must be active in and
responsible for their own recovery. The resident is given the ability to be active

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in their recovery by participating in the TC milieu. Professional helpers in the TC
support and guide, but the residents are expected to do the work.

Self-help and mutual help is a fundamental part of the TC approach. Self help
means that the person takes responsibility for his or her recovery; mutual help
refers to people with a common problem helping each other.

The TC is designed to foster both of these processes. Responsibility is learned

by taking on obligations within the TC as a member of the community and
residents are expected to help each other. The abundance of group activities
encourages the mutual help process in which residents play an active role and
imparts a sense of empowerment.

TC theory is consistent with behavior theory and social learning theory. Behavior
theory holds that changing behavior can be accomplished by rewarding
behavior; behavior change becomes generalized to other situations when it
becomes rewarded in other ways by other people.

The TC is an active learning environment; much learning occurs by doing.

Positive and new behavior is rewarded, initially by the program and staff, but
typically residents find new behaviors rewarding in many other ways as well,
through the social approval of others and a sense of self pride. The behavior
then becomes established and independent of the direct rewards given by the
program.

Social learning theory, as defined by psychologist Albert Bandura (1977),

postulates that much of human behavior is learned through the observation of
models who demonstrate desirable behavior. Research has found that when
the observed behavior of models is rewarded, it is much more likely to be
imitated.

In the TC, residents who demonstrate recovery-oriented behavior and attitudes

are put in leadership positions so they may serve as role models for newer
members of the community. In an effective TC, every opportunity is used to
encourage residents to demonstrate role model behavior and to publicly reward
such behavior.

Maxwell Jones (1968), a pioneer in the development of the TC, uses the term
social learning to describe interpersonal exchanges that are opportunities to
become “corrective emotional experiences.” The real-world simulation provided
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in the TC milieu inevitably recreates conflicts and problems of the past. When
properly handled, these become “living-learning situations” that allow residents
to resolve important issues in their lives. According to Jones, every social
interaction or crisis presented in the TC is grist for the therapeutic mill, and an
opportunity for learning and changing.

For more detailed discussions of psychological theories and the TC refer to

Perfas (2014); De Leon (2000); Campling and Haigh (1999) in the References.

TC Norms and Values

The TC perspective holds that human beings are fundamentally good, even
though behavior may be “bad.” The inborn goodness of human beings is
susceptible to corruption through experience and faulty learning; conversely,
good behavior can be achieved through experience and relearning. This view of
human nature encourages residents to pursue their full potential. It allows them
to forgive themselves for past errors, as well as the past errors of others.

The TC has an explicit set of ethics and values or concepts that it teaches and
upholds. Some of these ethics and values are expressed in a set of sayings and
maxims that are posted on the walls, discussed in seminars and other forums,
and reflected in the TC’s norms and rules. These ethics and values are typically a
direct contrast to those of drug- and criminal-sub-cultures. Some of these teach
moral values of right and wrong and others are pro-recovery prescriptions.

Some of them include:

 Honesty - considered a fundamental requirement for effective treatment,

a stable recovery, a law abiding lifestyle, and healthy interpersonal
relationships.
 “Act as if (and soon you will become)” – asks residents to try new
behavior, because attitude and emotional change often follows behavior
change.
 “I am my brother’s keeper” – relates to the value of social responsibility,
that each person is affected by -- and therefore has a vested interest in --
the well-being of other community members. In particular, this ethic is

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 used in the TC to encourage residents to behave kindly and supportively
towards each other.
 Personal responsibility - residents are asked to take responsibility for
their acts and destiny. Blaming others or lamenting circumstances
beyond their control is discouraged. Residents are asked to approach
problems by first looking at what they may do to improve the situation.
 “No free lunch” - extols the virtue of work, responsibility, and earning
your keep.
 “Pride in quality” - the value to doing your best at all times, no matter
how menial the task, as all actions are a reflection of self.
 “What goes around comes around” - treat others as you want to be
treated, teaches the reciprocity of human action or the” law of karma.”
 “Responsible concern”- caring for another person sometimes involves
pointing out or challenging them when their behavior is self-destructive.
This concept requires one of the most significant departures from street
values of all. It is difficult for many residents to accept initially, as it
violates the taboo against "snitching." However, when members actively
challenge the negative behavior and attitudes of others, they help peers,
while also consolidating their own behavioral and attitudinal change.
Risking the rejection of peers who have not adopted recovery-oriented
values and behavior is a critical ability or skill for individuals in recovery.
 An emphasis on the "here and now" – residents are encouraged to
spend their energy on things they can change and control, rather than
those they cannot, and to forgive themselves and others for past
mistakes.
 “Know thyself” – reflection, self-awareness, and understanding are
needed to grow and to avoid the mistakes of the past.

The TC Method: Community as Healer

In the TC model, the community is “healer,” both the agent of change and the
context in which recovery occurs. According to De Leon (1997), the TC is
distinguishable from other therapeutic approaches in “the purposive use of the
peer community to facilitate social and psychological change in individuals.” All

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activities within the community are designed to foster learning and facilitate
therapeutic change.

The key elements include:

 Use of participant roles. Each resident assumes an active and prescribed

role in the community. These roles are targeted at the developmental
level of each individual and new roles, entailing more responsibility and
status, are awarded as participants make therapeutic progress.
 Use of membership feedback. The primary source of therapeutic change
is feedback provided by other members of the community. Such
feedback involves giving honest, authentic reactions to others.
 Use of members as role models. Members are expected and supported
to serve as role models of the change process for others.
 Use of collective formats for guiding individual change. Most learning
occurs in a social context. Education, training, and therapeutic activities
take place in group settings.
 Use of shared norms and values. The successful functioning of the TC
requires that all members adhere to a shared set of beliefs and standards
of behavior regarding self-help recovery. These consensually accepted
standards are expressed in the language of the TC and are mutually
reinforced by members.
 Use of structure and systems. There are a set of rules, procedures, and
structures that promote order and safety in the community. Living within
these parameters enables participants to develop self-discipline and
impulse control.
 Use of open communication. The sharing of experiences of community
members is regarded as essential to the therapeutic process. The use of
public forums in which members discuss feelings, experiences, and
behavior and its consequences promotes social learning and self-help.
 Use of relationships. Engagement in the therapeutic change process is
facilitated by the development of positive relationships with peers and
staff members. The community is referred to as the “family.” Peer
relationships also provide the core social support network upon which
recovery can be maintained when they return to the greater community.
 Shared terminology. Many concepts and values of the TC are expressed
by means of a special terminology or lingo. Often these terms use simple
words to represent complex psychological or treatment processes. The

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 use of this terminology strengthens affiliation with the community and is
often a measure of integration into the community.

Elements of the TC Model (De Leon, 2000)

 Community separateness. A TC should be housed separately from other

programs in order to maintain its integrity as a community.
 A community environment. The physical environment of the TC has
ample communal space for group activities. Decor speaks to the mission
and essence of the community. Visual reminders of the community’s
values are posted in the form of signs, slogans, and pictures.
 Community activities. With few exceptions, e.g., individual counseling,
all therapeutic activities and educational services are held in group
settings.
 Peers as role models. All TC members are expected and encouraged to
serve as role models for others.
 Staff as community members. All staff members in the TC, regardless of
role, are members of the community and expected to act as role models.
 A structured day. Each day has a structured schedule of activities and
responsibilities. This structure promotes self-regulation, discipline,
responsibility, and personal accountability.
 Work as therapy. All members have a job in the community. These jobs
teach skills and promote responsibility as well as psychological and social
development. Jobs are used clinically to address the particular challenges
of individual residents.
 Phase format. Treatment is organized into sequenced phases that
specify target milestones and achievements.
 TC concepts. TC ethics and values are embodied in a set of concepts and
maxims that are taught and continuously reinforced in community life.
Some of these include, “Honesty,” “Love”, “No Free Lunch,” “No Gain
Without Pain”, “You are Your Brother’s Keeper,” “What Goes Around,
comes Around” and many others.
 Concern Groups or Encounter Groups. These group therapy sessions
allow residents to address the interpersonal issues that arise in the
context of community life. These may be conflicts or concerns for each
other’s recovery and well-being. The group process promotes cohesion

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 and good relations in the community and helps individuals develop self-
awareness, interpersonal skills, and coping skills.
 Awareness training. Therapeutic activities are geared to increase
residents’ awareness of self and the world.
 Emotional growth training. Emotional development is promoted by a
variety of activities that are geared to the identification, expression, and
management of emotions. Opportunities for emotional growth are
provided by the interpersonal and social demands of community life and
are facilitated by therapeutic activities, such as Concern or Encounter
groups.
 Planned duration of treatment. Length of stay is generally six to twelve
months, though can be longer or shorter.
 Continuity of care. Maintaining and furthering the gains made in
residential treatment requires continuing care in the greater community.

Physical Setting and Facilities

 A warm, homey environment. Appealing paint colors, comfortable

furnishings, personalized bedrooms, pictures on the wall, tablecloths
and flowers on dining tables all create the physical sense of safety
needed for healing.
 Communal areas. A TC should have many places for group activities,
including at least one space where the entire community can assemble
together at once. Lounges, living areas, patios and recreation
facilities, and rooms large enough for up to 12 people for group
therapy are needed.
 Minimize isolated areas – Limit areas where residents can isolate or
hide as this can invite clandestine activity and seclusion from the rest
of the community.
 Room for privacy. There should be accommodations for privacy for
toileting, showering and changing, and individual counseling.
 Community feel. Pictures and posters that communicate what the
community is about, resident artwork and artifacts help to create a
feeling of connection.

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  Cleanliness and order. The facility should be spotlessly clean, neat,
and in good repair. Clients and staff are responsible for care and
cleaning of the facility.

Refer to Perfas (2012; 2014); De Leon (2000); Rawlings & Yates (1999) for
discussions on the elements and principles of the TC.

Community as Method: How the TC Social Hierarchy Works

The social structure or hierarchy of the TC is the key element for implementing
a “peer-driven” treatment process in a TC. For this reason, the TC for addictions
is sometimes referred to as a hierarchical TC. The concept of “community-as-
method” is operationalized by how TC staff are able to operate effectively at the
three levels of staff operation (the community level, individual resident level,
and the level of feelings and emotions) and how the social structure is organized
and functions as the backbone of the community. The TC’s hierarchical
organization facilitates the daily operations of the TC while creating the context
for implementing the TC tools.

Aside from facilitating the operational functions of the TC, the social structure is
also the most important means of empowering residents. The structure is a tool
for helping residents achieve emotional and social maturity as the TC becomes
the microcosm of society at large. An inherent assumption in this model is
resident “self-efficacy.” The TC views its residents as capable individuals with
varying levels of motivation and dysfunction, but never as helpless or worthless
individuals. The hierarchical system gives every resident a chance not only
according to their talent but also based on their efforts and desire to prove
themselves “deserving” of trust and responsibility in the running of the
community.

Since the integrity of the TC as a treatment model hinges on the proper

operations of the social structure, failure to form and sustain it often creates
problems for the community. Like any human organization, the TC has its
flaws. The social structure is vulnerable to the vagaries of human nature and
can become corrupted. Setbacks in the TC, however, are viewed as potential
learning experiences for both the individual and the community.

17
There are four overlapping operational functions that must interact to facilitate
community-as-method and sustain its proper functioning: (1) replication of the
TC structure within work departments, (2) supervision of the social hierarchy, (3)
the functions of the resident coordinator on duty (COD), and (4) the functions of
the staff-on-duty (SOD). The Figure below provides a visual aid for
understanding how the TC is organized and how it functions.

Components of the TC Hierarchical Social Structure

For a detailed discussion on how community-as-method is operationalized in a

TC, refer to Perfas (2014); (Rawlings & Yates (2001); De Leon (2000).

Intake and Assessment

Assessment
The assessment is the process by which a counselor and the program identify
and evaluate an individual’s strengths, weaknesses, and areas of concern for the

18
determination of the appropriate level of care and the development of the
treatment plan.

Assessment is an ongoing process, since there is the need to continuously

evaluate the client’s progress at specific points in treatment. Generally, a
comprehensive assessment is conducted in a series of focused interviews,
beginning prior to admission and within the first 30 days of treatment. Testing,
and/or client referral information reviews can also provide relevant information.

The intake assessment begins with a review of the information provided by the
referring agency. A screening interview with the potential resident is conducted,
gathering information in the following areas:

a. Demographics
b. Education and work history
c. Family History
d. Placement history
e. Legal information
f. Medical history
g. Behavioral/conduct problems
h. Drug and alcohol use
i. Psychiatric history
j. Financial information
k. Current physical health status

If available, family members are invited and included in the intake assessment
and oriented to the program and family services. If questions regarding the
suitability of the applicant are raised during the intake process, a second
interview is conducted by a psychologist to evaluate whether the client would
benefit from participation in the TC program.

Inclusionary Criteria

Individuals with a history of behavioral problems and substance abuse who

demonstrate a need for treatment in a long-term, highly structured residential
treatment program are candidates for the TC if they meet the following criteria:

a. Be able to function in an open and voluntary setting

19
 b. Ability to speak the dominant language
c. Have undergone detoxification, if needed
d. Those with co-occurring psychiatric and substance use disorders may be
accepted, as may those with histories of severe trauma and those who
have been stabilized on psychotropic medication.

Exclusionary Criteria

These are reasons an applicant may be denied admission, though there are no
hard and fast rules:

a. Fire-setting
b. Active self-mutilation
c. Active suicidal ideation
d. History of suicide attempts
e. Serious violent behavior
f. Sexual predatory behavior
g. Severe psychotic symptoms
h. Active homicidal ideation
i. Severe impulse control problems
j. Untreated tuberculosis or other infectious disease
k. Grave disability or medical condition
l. IQ below 70

The presence or absence of some these problems does not necessarily preclude
admission to the program. Rather, they are considered in light of the pattern
and history of such behavior, as well as contributing factors, such as substance
abuse, remorse, behavior during the interview, and placement history.
Individuals who have a history of leaving other programs without permission
and those with very minimal drug use histories are generally accepted, though
these factors are important considerations in the admission decision. In some
cases, additional information, e.g., mental health records, are required before
admission is made.

Emotional Interview

Prospective intake to the TC undergoes an emotional interview conducted

mostly by peers before he becomes a member of the community. The primary
20
purpose of the interview is to probe the intake’s treatment motivation for
entering treatment. The goal is to help the new intake develop insight into his
real problem by breaking into his defenses (i.e., denials, rationalizations, etc.).
The interviewers are recovering from addiction and have undergone the same
interview process themselves.

The interview delves into the intake’s past history, such as his drug history,
medical and psychiatric history, family history, legal and criminal history,
educational and vocational history and how all these areas are related to his
current situation or has contributed to the reason for seeking treatment. The
intake must acknowledge the intrinsic reasons why he needs help more than the
external forces that pushed him to seek help.

To pass the interview, the intake must be willing to live by the norms and values
of the community, follow its rules, participate in treatment, and contribute his
share in supporting the daily operations of the community.

For more details on Emotional Interview, refer to Perfas (2012).

Assessment

A more comprehensive assessment is conducted during the first 30 days after

acceptance into the treatment program. The clinician’s knowledge of problems
related to substance abuse guides the assessment process and to an accurate
diagnosis, the most important aspect of the assessment.

To assist in the assessment process are several useful assessment tools that
focus the interview and capture client data in a formalized way, which can be
summarized when the assessment is completed. Some examples of these tools
are: the Addiction Severity Index (ASI), the Client Evaluation of Self and
Treatment (CEST), and the Global Appraisal of Individual Needs (GAIN).

The assessment guides the development of the initial treatment plan. Effective
treatment intervention cannot be implemented without the client information
that a thorough assessment provides. The assessment will highlight the areas
that need attention during treatment and will determine what services and
interventions need to be provided. It is through a careful assessment that
treatment is individualized through the treatment plan.
21
Although all the clients may participate in most of the TC activities, some
activities may be emphasized on more than others; some activities and services
may be assigned for some clients, but not all. The individual counselor will
monitor the client’s participation in these services and activities. The client’s
experience in the community and engagement in the activities assigned in the
treatment plan will be addressed in individual counseling.

In addition to the diagnosis of a substance use disorder, it is important to

identify other co-occurring psychiatric disorders. The presence of such
disorders needs to be addressed in the treatment plan. In conjunction with
psychiatric services that may be provided, accommodations in the TC
treatment, and specific use of TC and other interventions, can all be used to
treat the client with co-occurring disorders. For example, in a client with PTSD,
assignment to a trauma group, anti-anxiety medication, an exercise program,
and a job assignment working in an office under a supportive supervisor may all
be used to help address the PTSD. A job function that involves leadership for a
client who has made progress, but struggles with depression, can be helpful as a
way of boosting self-confidence and developing social skills, paired with a group
that teaches emotional management and coping.

The Trans-disciplinary Team and Case Conference

TC programs are best equipped with a trans-disciplinary staff that may consist
of:

 Counselors
 Social workers
 Psychologists
 Psychiatrists
 Teachers
 Nurses
 Physicians
 Vocational counselors
 Recreation, art, or music therapists

22
The collaboration of the team is needed for effective treatment planning and
review. Case conferences are typically conducted with the whole treatment
team at the following points:

 In the development of the initial treatment plan

 During treatment plan review and updates, phase transitions, discharge
planning
 Serious or chronic problem behavior, lack of responsiveness to treatment

The case conference may also include:

 Referral source
 Family members
 Client

The Phases of Treatment

Phase One: Orientation

The first phase of treatment is designed to help new clients become members
of the community and to engage them in treatment. The most important
aspect of this process is the development of positive relationships with the
primary counselor, peers, and the rest of the program staff.

Activities include individual sessions with the counselor, formal and informal
group activities with peers, recreation, program orientation, in which programs
rules, structure and rationale are explained, and motivational interviewing
sessions, in which clients are assisted to resolve their ambivalence about
change.

Time away from the program is limited as much as possible during this time.
This is both to shield the client who is vulnerable to drug use or other high-risk
behavior and to help facilitate the client’s assimilation into the community.
Time outside of the program, both on home passes and recreational trips, is
earned as the resident demonstrates stability and adjustment to the program.

23
Residents are “promoted” when they demonstrate a successful adjustment to
the program, which includes some connection to staff and peers, and
understanding of and general compliance with program rules.

The Big Brother or Sister

The new resident is assigned an older resident as a big brother or sister upon
entry. The Big Brother or Sister is responsible for “showing them the ropes,”
orienting them to the program, introducing them to others, answering their
questions, and accompanying them to as many functions as they can share,
e.g., sitting together in meetings, seminars, etc. Typically, the Big Brother or
Sister has responsibility for their “little” brother or sister until he or she
completes Orientation, but in many instances, the mentoring relationship
continues.

Phase Two: Primary Treatment

The primary treatment phase is devoted to the client working on goals

identified on his or her treatment plan. These goals involve personal
development and the acquisition of emotional, social, educational, and/or
vocational competencies. This process includes more than the resolution of
problems. The guiding principle is that the elimination of drug use and other
self-destructive behavior is only made possible when the resident is empowered
with the skills and abilities needed to achieve a more positive and fulfilling life. It
is at the primary phase of treatment where the global changes which are the
target of the TC approach are worked on.

The active role of the client in the community and his or her treatment
promotes a sense of self-efficacy that is critical for recovery and growth.

Successful completion of this phase is based upon the resident making as much
progress on the treatment plan as possible. Residents may not meet all of their
treatment goals, and in some instances, they may exceed expectations.
However, in order to complete the primary treatment phase, the client is
typically deemed to have a good chance of maintaining emotional stability,
sobriety, productivity, and pro-social behavior in the community, with less
program support.

24
Phase 3: Re-entry

The goal of this phase is to prepare the resident for life in the community,
independent of the program. Much of the focus is on the development of a
positive social support network, an active lifestyle that consists of productive
(e.g., work and/or school) and recovery-oriented activity (e.g., involvement in
self help groups), good self-care, and a safe, recovery-supportive living
arrangement.

The re-entry phase typically begins in residence, with the resident given
frequent passes to go home or to an alternative living arrangement, and to
recreational and social events. Careful planning for these outings and
debriefing when they return to the facility/center is important to help the client
develop the skills that are needed to maintain recovery in the community.

For each outing, and with help of the staff, the client develops an itinerary,
delineating where, how, and with whom time will be spent. Attention is paid to
the avoidance of people, places, and things that may pose as serious risks for
relapse on one hand, and on the other, engagement in activities that will further
the client’s recovery and successful adjustment to the community.

Upon return to the facility, the client’s experience is processed individually or in

group, exploring difficulties and successes, urges to use, triggers, and of course,
any lapses. Urine screening is regularly administered.

Treatment activities geared toward successful transition are particularly

important in re-entry. These include relapse prevention groups, family
counseling, linkages to self-help and supportive services in the community, and
educational and/or vocational assistance. The re-entry phase is completed
when the client has made a successful transition to the community. This usually
consists of a stable place to live, connection with supportive family members or
significant others, employment or school, a drug-free social support group, and
continuing treatment on an outpatient basis.

Phase 4: Continuing Care

When feasible, it is best practice to provide ongoing support to clients in the

community, in the form of continuing follow-up care. A continuing care
program may provide a range of supports, ranging from professional services
such as individual, group, and family counseling, recovery coaching and
25
mentoring, connection with self-help and recovery mutual-help groups,
referrals to other services, to social activities and recreation.

Program Completion – Recovery Celebration

Given the variety of ways in which clients may be referred to a TC, there are also
a variety of lengths of stay. Some clients may stay for periods as short as a
month, often dedicated by a court mandate or other referral stipulations. In
such instances, all the phases delineated here cannot be completed, unless the
individual voluntarily opts for longer treatment. However, once residents have
completed the requirements of their particular length of stay, they will be issued
a certificate of completion and referred for outpatient follow-up.

Residents that complete all the phases above, from orientation to re-entry, will
be honored at a recovery celebration. It is a festive event, to which families,
friends and staff are invited. The term “graduation” only implies the formal
completion of treatment although recovery is an ongoing process and one that
may go beyond the end of formal treatment.

The TC Structure

STAFF

ons Coordinator
Dept Heads
s Identity
Change
--------------------
Eyes & Ears of
Expeditors Community
---------------------------a-t-i-o--n--/S
Se p ar --u--p-ervision
Crew Leader Responsibility/Limited
-------------------------------------A
--u--t-h--o-r-i-t-y-----
Office Positions/Fac. Maint. Trustworthiness
--------------------------------------------------------------
Kitchen and Service Crews Conformity/Follow Directions
----------------------------------------------------
-

26
The organizational structure of the therapeutic community provides the
environment within which treatment occurs, and every aspect of it is based
upon the TC perspective. The structure basically resembles a pyramid. The
community is run largely by its resident members, who occupy all levels of the
pyramid except the very top, which is occupied by the staff.

The levels of the pyramid, from the bottom to the top, reflect the increasing
degrees of responsibility that members take on during their residency.
Members enter the TC at the bottom and, ideally, progress up through the
levels toward the top. Promotion up the hierarchy is given as reward for good
work, much in the same way as employees in the real world are promoted in
work organizations. However, in the TC, increases in status are also given for
treatment progress and role model behavior in the community.

Rational Authority

Final authority in the TC rests in staff members, who occupy the top of the
pyramid. They make all major decisions regarding the disposition of residents
and management of the facility. In keeping with the notion of community as
healer, the authoritative role of the staff is clinically significant.

Many residents have had authority figures that have ranged from autocratic and
abusive to permissive or nonexistent. Positive relationships with caring and
reliable authority figures can be a corrective emotional experience

The TC prescription to be a “rational authority” means that the authoritative

figure should give logical, clear reasons for the rules and behavioral boundaries
he or she sets, in a nonjudgmental and respectful tone. Part of the learning
process inherent in the TC structure is to accept authority and to use
appropriate procedure when there is reason to disagree.

The TC should provide a sanctioned process for clients to air grievances and to
accommodate questions on why certain rules or procedures are in place. It is
important for staff members to appreciate the clinical significance of this
interchange and to respond in a way that promotes both impulse control and
the ability to defer to authority, but also the skills to be appropriately assertive.

27
 The Role of the Counselor in a Therapeutic Community

The role of professional counselors in a therapeutic community is somewhat

different from what it might be in some other settings, such as a hospital or
clinic. In particular, the therapeutic community departs from the traditional
medical model, in which drug abusers are perceived as "patients," who passively
receive "treatment" from all-knowing professional "experts." Instead, the
therapeutic community is itself the main instrument of treatment and the
individual residents are expected to take responsibility for their own recovery.

Nonetheless, professional counselors have important parts to play within the

community structure. They must, for example, serve as sources of rational
authority and role models for the residents and monitor the implementation of
the TC treatment program. The quality of the relationship with the counselor is
a significant factor in whether client stays in treatment. This relationship, also
referred to as the “therapeutic alliance” is more important to the success of
treatment than the particular clinical technique used. The use of unconditional
positive regard and empathy is critical in establishing a positive relationship
with the client.

Mutual Help and Peer Role Models

Peer role models – community members to be emulated – are crucial

instruments of self-help and mutual-help. Role modeling occurs during virtually
all kinds of community activity. By reflecting the values and expectations of the
TC, role models provide their peers with concrete demonstrations of socially
appropriate behavior. Newer residents are encouraged by older ones, who have
community status and privileges, and who are assertive and self-confident.
Modeling is most effective when the "learners" perceive similarities between the
role model and themselves.

Role models display two main attributes. First, they "act as if." That is, they
behave as if they are the persons they should be, rather than the persons they
have been. Despite any resistance and other negative feelings they may have,
they consistently strive to engage in positive behavior and maintain the values
of the community, including motivation to work, a positive regard for staff as
authority, and an optimistic outlook toward the future.

28
"Acting as if" is considered an important mechanism for psychological change.
Research shows that altered feelings and insights often follow, rather than
precede, behavior change. Those who use their free will to "act as if" often find
that they "become as if." Changed behavior becomes internalized, facilitating
changes in feelings, attitudes, and values.

The second major attribute of role models is to show responsible concern for
their peers, actively helping them to break off self-destructive behavior. Role
models must be willing to identify and not condone any negative behavior by
their peers, and report such behavior even if reporting will result in sanctions for
their peers.

Job Functions

Job functions – jobs that are not only useful in the community, but also
contribute to recovery -- are integral to the TC structure and every resident has
one.

The structure of the TC is meant to simulate the vocational organization of the

greater society. Members enter the system at the bottom, where jobs entail
relatively minor responsibility, more physical labor, few rewards, and little
status. Higher-level job functions require more responsibility, skill, and
leadership, and are accompanied by commensurate status and privilege.
Advancement requires hard work, discipline, and good work skills. But
somewhat in contrast to the outside world, upward mobility in the TC also
requires psychological growth and progress toward treatment goals.

Privileges and job status are earned. Privileges, status, social approval, and
other extrinsic and intrinsic rewards provide incentives for upward mobility.
Temporary downward mobility, with its attendant loss of privileges and status,
serves as a sanction and deterrent. Since similar incentives and sanctions exist
in the outside world, behavior change can be generalized to the real world.

Job functions not only teach specific work skills but also foster broad social and
psychological competencies such as self-confidence, coping, interpersonal,
communication and leadership skills. They address a broad spectrum of work-
related challenges, including poor work habits, lack of organizational skills,

29
"street images” (style of self-presentation), difficulty following direction,
problems with authority, and poor impulse control.

Consistent with Maxwell Jones’ notion of the “living learning environment”,

problems that individual members have in performing their jobs become the
subject of discourse in Encounter or Concern Groups. The dilemmas residents
find on the job in the TC are problems they very likely encountered in the past
and will in the future, unless they learn a new way of behaving. Every resident
has their own unique struggles on the job and in the TC in general, and the
creation of this real life “laboratory”, provides the opportunity for each
individual to work on personal issues relevant to his or her life after treatment.

The hierarchy of functional jobs can be organized in different ways, depending

on the size and attributes of the community, but there are generally six levels.
The jobs at each level provide specific challenges that can be used as clinical
tools to help residents master particular skills. Movement up the successive
levels is inherently therapeutic in itself.

Entry Level: Kitchen and Service Crews

The kitchen crew assists in community meal preparation (e.g. peeling potatoes
and vegetables) and kitchen and dining-room maintenance (e.g. setting tables,
washing dishes). The service crew participates in janitorial work. In some rural
TCs, farm work is an entry-level job.

Therapeutic Functions:

 conformity to community rules

 following directions
 acceptance of authority
 impulse control
 coping with frustration
 handling responsibility
 performing tasks with “pride in quality”
 completing tasks
 punctuality

Note that when residents are new to the community, it is desirable to give them
simple tasks that are easy to complete. It is also important to put them in

30
situations where they are both visible to the staff and more senior peers, and
where they are not alone.

At this level, members are also introduced to the concept of "pride in quality."
That is, they should do every job to the best of their ability, because their work
is a reflection and extension of themselves. No job is so menial as to be
unworthy of pride in self.

Residents are instructed to follow all directions on the job. If they are unhappy
or angry about job demands, they are encouraged to process the issue in the
Encounter or Concern Group. This enables them to develop impulse control and
coping abilities. Once they take the issue to the group, they are helped to voice
and resolve problems assertively and appropriately, and usually learn much
about themselves and others in the process.

Second Level: Office Positions (Legal, Medical, Administrative) and Facility

Maintenance

Office positions consist of record keeping and other forms of clerical work.
Facility maintenance includes painting, plumbing, carpentry, and the like.

Therapeutic Functions:

 handling greater responsibility

 coping with work pressure and challenges
 increase in self-esteem
 increase in self-efficacy
 development of interpersonal and coping skills (work is more demanding
and requires cooperation with coworkers)
 more internalized motivation; work is more personally rewarding.

Third Level: Crew Chiefs or Ramrods

As crew chiefs or ramrods, members first encounter the challenge of leadership

in the TC. Crew chiefs are responsible not only for their own performance, but
also for the performance of other crew members, and must develop both a
greater sense of accountability and better social skills.

This level calls for skills in planning, problem solving, organization, and
interpersonal relations. If a new crew chief has relatively poor interpersonal
31
skills and low self-esteem, these deficiencies will often show up as either
excessive aggressiveness or excessive passivity in dealing with subordinates.
Encounter and Concern Groups and other forces within the TC social structure
can, over time, curb these extremes and help residents develop a more
appropriate assertiveness instead.

Therapeutic Functions:

 increase ability to handle more responsibility, including responsibility for

others
 greater coping skill
 greater interpersonal skill
 increase self-confidence
 development of assertiveness
 increase personal accountability
 learning to cope with work pressures and challenges

Fourth Level: Expediters

Expediters are the "eyes and ears" of the community. They must monitor and
direct resident activities, and enforce community rules.

Expediters must cope not only with the demands of greater responsibility, but
also with the stress of multiple and sometimes conflicting demands. The most
significant source of stress for the adolescent with this job function is the need
to be perceived favorably by peers at all cost. Such stress is a natural
consequence of their developmental stage working under several supervisors
(both resident and staff) at the same time.

One of the major goals at this level is strengthening personal identity and the
internalization of the community's values and norms, which comes as a direct
result of enforcing community rules. Expediters who have not yet relinquished
street-oriented values and attitudes will find it difficult to challenge the
negative behavior of others. This conflict will either lead to changes in the
expediters’ own values and attitudes, or the expediters perform poorly.
Moreover, because expediters must separate from former friends and take a
positive role in the community as a whole, their identity and "image" may be
challenged. Expediters who hold on to a "street" image will be at odds with their
role and will be likely to provoke confrontations with both peers and staff.

32
Therapeutic Functions:

 ability to handle more responsibility, including responsibility for others

 greater coping skill
 greater interpersonal skill
 increase self-confidence
 development of assertiveness
 greater personal accountability
 increase in leadership skills
 ability to withstand negative peer pressure
 identity change (identification with TC culture)

Fifth Level: Department Heads and Chief Expediter

Department heads supervise crews and crew chiefs or ramrods. The chief
expediter supervises the expediters.

This level requires substantial leadership skills, including the ability to give
directions, to accept and delegate responsibility, to manage systems of people
and activities, and to cope with conflicting demands and relatively high levels of
stress. The department head must not only concern themselves with the
completion of tasks, but also treatment performance, e.g., program compliance
and behavior, of the crews in their charge.

In addition, members who have reached this level should have developed
enough self-confidence and assertiveness, and should have internalized
community norms and values well enough, that they can serve as role model
and coach for newer and younger members, and embody the behavior and
attitudes of recovery. They must also be able to withstand the peer pressure
and possible disapproval of less positive members -- a critical task for former
substance abusers.

Therapeutic Functions:

 same as above, at a higher degree, plus

o greater proximity and interactions with staff
o greater voice in community affairs
o higher level of trust given by staff
o development of leadership with empathy

33
Sixth Level: Coordinators

Coordinators supervise the department heads and the chief expediter. But just
as important, they report directly to, and interact with, the professional staff.

The members at this, the highest level in the TC, are expected to have mastered
the tasks of each prior level and to demonstrate consistency in all capacities,
especially a higher degree of emotional growth. They must have strong
motivation for work and service, well-developed leadership skills, and resilient
powers to deal with stress and challenges of all kinds. By virtue of their highly
visible role and the scope of their responsibility that encompasses the entire
community, they are not only expected to be role models, but also show
genuine concern for the larger community.

Therapeutic Functions:

 same as above, at a higher degree, plus

o close interaction and coordination with staff
o increased voice in the clinical and operational aspects of the TC
o performs both clinical and administrative functions with regards to
TC operations in conjunction with staff

Recreation

The activities of a therapeutic community cannot be limited to work, school,

and other formal functions. The TC structure must be flexible enough to allow
time and opportunity for informal socializing and other recreational activities.
Physical exercise, through sports, gym workouts, informal games, dancing, and
the like is important for the well-being of residents. They also need
opportunities for social interaction, such as participating in clubs and interest
groups. One of the great advantages of such recreational activities is to
demonstrate that there are many enjoyable things you can do instead of taking
drugs.

34
 Contingency Management or Motivational Incentives

One of the basic concepts in a TC is that behavior can be modified by managing

its consequences or “contingencies.” Positive behavior can be reinforced by
providing positive consequences and removing negative ones. Negative
behavior can be discouraged by imposing negative consequences, withholding,
or taking away positive ones. However, new residents or those with low or no
motivation to change find little reason to try new adaptive behaviors. They can
be easily engaged in treatment by systematically catching them do the “right
thing” no matter how small and immediately rewarding the behavior, such as
“rising on time,””fixing bed properly,” “being on time,” “participating in
seminars,” etc. Contingency Management or Motivational Incentives are better
implemented in the very early part of treatment when new residents do not yet
qualify for TC privileges. This concept is embodied in a system of rewards and
learning experiences.

Rewards

By now it has been well-established by research that rewards are far more
effective in promoting learning and behavior change than punishment. There
are a number of ways that rewards can be incorporated in the TC milieu.

The types of rewards that can be given are:

Motivational Incentives – small prices, public acknowledgments, points

 Tangible – prizes, candy, vouchers, tokens, etc. given for specific,
targeted behavior, such as attending or being on time for activities,
completion of particular tasks, e.g., treatment goals, a negative urine
screen, etc.
 Status – advancements in job function or program stage.
 Privilege – time off, time out of program, recreational outings, parties,
movies, etc.
 Social – verbal praise and public recognition

35
 Tangible Social Self

Prize Bowl Promotion in status Behavior Chart/ Behavioral

Plan
Vouchers that can be Responsibilities/role
exchanged for goods.
Privileges – rooms, jewelry Awards
Radios, TV, phone, letters Public acknowledgement Self-acknowledgement Essay
Food, e.g., candy, chips, soda, Praise
etc.
Letter of commendation Self-rewards
Celebrations
Trips

Behavior-shaping principles should serve as guidelines for using Contingency

Management:

1. Rewards should be used more than negative sanctions, on a ratio of 5:1.

2. Reward should be given as quickly as possible following the desired
behavior.
3. Rewarding small steps towards the desired behavior is an effective way of
encouraging behavior change.
4. The use of tangibles is encouraged for discrete behaviors in the early
stages of the treatment process, when clients are not yet demonstrating
some of the complex behaviors required for status and other program
privileges.
5. The reinforcement value of various “rewards” varies between individuals.
It is advisable to have an idea of what clients consider to be positive or
desirable.
6. The criteria for the reward must be clear and objective for the purpose of
giving the reward and for the person who receives it.
7. The simultaneous use of different types of rewards, as enumerated
above, is likely to be most effective.
8. Once a reward is given, it should not be taken away as a sanction, but
may be suspended when a resident is on a learning experience and
restored when the resident is deemed deserving again.

See Perfas (2012) for more discussion on Contingency Management in the TC.

36
 Learning Experiences (LE)

Sanctions, called learning experiences, may need to be imposed upon residents

who break the rules and/or in any way threaten the emotional or physical safety
of others in the community. It is important for the sense of safety in the
community that all residents know that the rules are consistent and will be
upheld.

The use of learning experiences helps set boundaries for behavior and
communicates what is acceptable in the community and what is not. True to
their name, learning experiences should be tools to stimulate learning and
insight, not retribution or punishment. They should help residents to recognize
the inappropriateness of their behavior, to reflect on the motivation for that
behavior (what they wanted at the time), and to consider how they might have
handled the situation differently.

The choice of learning experience depends upon the severity of the infraction.
The most stringent, expulsion, is generally used only when a cardinal rule has
been broken. That is, a resident may have threatened or used violence,
destroyed community property, sold or used drugs, or indulged in sexual acting-
out behavior in the facility. *

Less severe learning experiences are imposed when a resident breaks house
rules or regulations, refuses to accept authority, is late, rude, steals, acts out,
etc. A job demotion, an undesirable work detail, the loss of a privilege, a
written, social, or other task assignment, a written or spoken apology, are all
examples of learning experiences.

As much as possible, there should be every effort to insure that the resident
learns an alternative to the behavior in question. If the learning experience only
punishes, it will be of very minimal value in changing behavior.

It is never permissible to take away basic rights, such as food, shelter, sleep,
exercise, bathroom needs, etc. There must be careful supervisory oversight of
this process, to insure that learning experiences are based on clinical rationales,
not a staff member’s frustration or personal feelings towards the client or the
particular infraction. Any learning experience that involves degradation,
humiliation, or shame is unethical and always unacceptable.

37
Interventions should only be used until an improvement in behavior and
attitude is observed. Most often 3-4 days is sufficient. If more than 10 days
seem to be needed, a case conference should review the situation.

*Should expulsion (administrative discharge) be used, the staff must take care
to ensure that the client will be safe throughout the process and receive
appropriate follow-up care. An assessment of the client’s mental health should
be made before discharge. Families and referral sources must be informed,
referrals to other services must be given, safe transport must be arranged, and
transfer to a responsible adult should be assured in the case of adolescents.
Clients who are to be discharged should be separated from the rest of the
community as these plans are being made to protect both the client and the rest
of the community from untoward emotions and behavior.

Schedule of Behavioral Sanctions (Behavior-Shaping) & Learning

Experiences (LE’s)

The following are the categories and list of behavioral sanctions and learning
experiences:

1. Verbal Admonitions or Verbal Haircut

 To show responsible concern to peers

 To raise awareness, express disapproval of behavior & show
concern, and get commitment for change
 Incremental and escalating level of intervention, starting from
less intrusive approach
 The expressed disapproval is on the behavior not the person,
and never demeaning or abusive

A verbal admonition is a form of giving “responsible love and concern” to an

errant community member involved in unproductive behavior. The objective is
to raise awareness regarding the target behavior, express disapproval and
concern for its consequences to the person and or the community, and get
“commitment” on what the person will do to change the behavior. The

38
language, tone, volume, and demeanor used in the intervention can range from
neutral and supportive to serious and stern, as the situation requires. Profane,
abusive, insulting, and demeaning language and demeanor are absolutely
forbidden in any of these interventions. The optimal effectiveness of these sets
of interventions depends on how well they are implemented using an
incremental and escalating process of addressing target attitude and behavior.

A formula for giving verbal admonitions:

I. Preparations:

Step 1: Know the person beforehand (read his file if necessary), the
nature of the offense, and number of occurrences
Step 2: Have a plan, and if you are part of an intervention team, agree on
a plan
Step 3: It’s not the place for venting hostilities or settling score
Step 4: Conduct the intervention privately, and treat the person with
respect, although you might have to be serious or stern in language. The
intervention team must conduct themselves with formality (respectable
demeanor, clothing, language).

II. Implementation:

Step 1: Invite the person to sit before a panel of peers (with staff if
necessary)
Step 2: Team leader states in clear and simple words the problem
behavior being addressed and the underlying attitude manifested. For the
rest of the panel, each must follow through and elaborate on the
consequences if the behavior remained uncheck. Remember, express
disapproval of the behavior and its consequences but not of the person.
This is not a dialogue but a moment of teaching, so the person only sits
and listens.

a. Stating the problem behavior and underlying attitude:

Johnny, intimidating your peers and creating an unsafe

environment is totally inappropriate and unacceptable
behavior. Coming off as a thug in a place like this is not the best

39
 way to get respect and show your self-respect. It shows a lack
of concern for yourself and others. There are many ways of
getting what you need or want in this house and intimidation
and being a thug is definitely not one of those.

b. Elaborating on the nature of the behavior and magnifying its

consequences:

Johnny, we are not in the streets or prison anymore where we

have to keep watching our back and keeping up a tough-guy
image. You needed that image in those places, but not here.
You don’t need to push people away anymore. Can you imagine
what this place would look like if we all have to act like we’re in
a prison or the street? In those places, we don’t have time to
think or have some peace because we are worried who is going
to attack us next. I’m sure you don’t really want to bring this
house down or be responsible for its failure.

c. Offering help:

I don’t claim to know what is causing you to act this way, or

what might be bothering you. Whatever it is, I’m sure you have
someone in this house who cares about you. Why don’t you talk
to that person? This is your family and it is not out to get you
but it’s here to help you help yourself. Try to find and learn new
ways of meeting your needs or getting what you want, and we
are here to help you with that. We expect you to talk to at least
one person about this problem.

d. Asking for commitment:

What commitment can you make to show us you are willing

to look at this problem and correct it?

Step 3: Plan for providing peer support. Generally, it is the community

norm that when a member is addressed formally or given verbal
admonition for bad behavior, peers would talk to him or her to provide
emotional support.

40
III. Follow-up

Step 1: Process the intervention with the team, focusing on how each
panel member did, and what each might do differently next time. Assess
the impact of the intervention: Did the intervention go as planned, and
what was its immediate impact? This follow-up and debriefing is an
excellent teaching tool, especially for the less experienced panel member.

IV. Getting emotional patch-up or support

Step1: Encourage community member/s to talk and provide support to

members who have been given a verbal haircut immediately after.

An example of escalating level of intervention:

a. Talk to - an informal “chat” with a resident regarding an

inappropriate but not so serious behavior given by a member of the
“upper structure.” Generally, to raise awareness about the
unacceptable behavior.
b. Pull-up or Reminder – a formal and private behavioral intervention
that involves giving a reminder about the person’s “pattern of
inappropriate behavior.” Usually the behavior has been addressed
previously through “talking to.” It is conducted by a member of the
“upper structure” and a peer, preferably from the same
Department.
c. Peer Redirection or Admonition (Verbal Haircut/Reprimand) – a
formal and private admonition about “recurrent” attitude and/or
behavior. Usually, the behavior has been previously addressed
through “talking to,” “pull-up,” but the behavior persisted. It is
conducted by the most senior member of the “upper structure,”
e.g. coordinator or chief, department head, a peer, and a Staff.
Depending on the circumstances, a physical learning experience
with “peer-interaction” component, e.g. relating, announcements,
etc. or “written tasks” may be dispensed. To create another level of
escalation of intervention, the first instance of peer redirection or
admonition may not involve a physical learning experience. Should

41
 another behavioral incident of similar nature arise, an LE may be
prescribed as part of the intervention.

2. Learning Experience (LE)

 An active form of learning from mistakes

 Individual situation and community issues are taken into
consideration
 Dispensed in the sprit of restitution and means of personal
redemption for transgression against community norms
 Community involvement and support is necessary
 Never meant to brand or stigmatize
 Monitored and supervised by staff

A very serious issue for consideration in implementing the “learning experience”

is its anticipated therapeutic value for the individual. That said, punitive
elements in the guise of an LE is absolutely counter to the true meaning of the
concept of LE. In dispensing an LE, situational factors must be seriously
accounted for, e.g. the person’s clinical condition, psychological state, relative
time in the program, the “state” and ability of the “community” to provide
support, and knowledge and skills of staff to evaluate and supervise the process.
An important component of the LE is setting concrete and observable
parameters for achieving its goals which the client must aspire for. The goals are
discrete and must not be mixed up with other forms of behavior the client
continues to manifest. For example, if the client is on an LE for disrespectful
behavior and was later caught, while still on LE, sneaking to the kitchen to steal
food, those are two distinct target behaviors for intervention and should not be
dismissed as evidence that he has not “learned his lesson”, so “let’s keep him”
on his LE.

Another crucial element necessary for the healthy implementation of the LE is

staff monitoring and client accountability in terms of readiness to get off from
an LE. It is staff’s lack of skills to come up with tightly designed LE’s and be able
to monitor them closely that leads to the degeneration of LE’s into the most
atrocious TC tool.

From a philosophical perspective of the traditional place and role of learning

experience in TC, it is historically a form of restitution for offenses committed

42
against the community, for transgression of its norms and values. As such, the
intent of LEs is not to brand or stigmatize the offender, but rather to allow the
person to redeem him or herself in the eyes of peers or the community for
his/her failings through work and productive endeavors. When LEs are practiced
in this spirit, it is less of a punishment than a vehicle for learning from mistakes
and acquiring greater self-understanding.

Lastly, LE’s should not stigmatize clients and yet it can inadvertently put clients
under a category of “undesirable elements” in the community, which is a status
reminiscent of street life that many are comfortable with. In effect, we are
abetting their dysfunctional persona. Moreover, keeping clients on an LE for
more than two-weeks often defeats its “learning” quality. After having been on
the cleaning crew or the “pots” for a week, what is there more to learn? It’s the
lack of “focused” goals, mixed with propensities to use LE as punitive tool, that
get’s us stuck. As a general rule, if it’s well-supervised, residents should stay on
an LE for no more than three to four days. Extended period of a week or more
for serious transgressions (cardinal rule) may be imposed, provided close
supervision is put in place.

The narrative for dispensing and explaining the LE, connecting it to the person’s
behavioral shortcomings and facilitating open acceptance and openness, is as
important as the actual LE itself, if not more.

The following are suggested types tasks for learning experiences:

a. Task-Oriented Learning Experiences

1. Pots and Pans

2. Grounds
3. Facility Upkeep – Cleaning
4. Time keeping – wake-up calls, lights out calls

b. Task Assignments

1. Composition or Essay to be read before the family

2. Bibliotherapeutic assignment – reading and reporting on a topic
3. Cognitive Behavioral Assignment – an assignment to engage on
a task related to the problem behavior that includes a strategy

43
 chosen by the client. This may include, for example, an anger
management strategy, a coping skill assignment, or a problem
solving analysis. Cognitive behavioral mapping techniques are
useful here. For example: “a resident who disrespected an
expediter,” as an LE, he may be asked to draw two boxes with
one box listing all the advantages of being respectful to others
and another for the disadvantages of being disrespectful and
present it before a group or the community.

c. Peer Interaction

1. Relating table/corner
2. Bans
3. Announcements

d. Demotions

1. Loss of status
2. Suspension of privileges

See Perfas (2012) for more detailed discussions on Learning Experience and
Behavior-Shaping Strategies.

Redefining the Prospect Chair or Chair

The therapeutic community (TC) has employed “sitting on a chair,” or the Chair
for short, as a tool for reflection or containment of a potentially explosive
situation involving clients undergoing treatment. The practice has its origin
when in the early TCs potential members seeking admission to the community
were asked to sit 0n the “prospect chair” for several hours for self-examination
to delve into their reasons for seeking help. This is a prelude to what comes
next, the emotional interview or the interview, which is an important ritual for
joining the community. The interview involves probing, among other things, the
new intake’s real reasons for seeking treatment, his drug or criminal history, and
how his lifestyle had lead to his problems up to that point (Perfas, 2012).

44
In the course of the evolution of the TC, the Chair has served other functions. It
also has been used to isolate or contain behavior of individuals who engaged in
defying community rules or as a tool to calm a person in the verge of lashing out
or as a form of a “learning experience” to make a person reflect on his poor
behavior. The chair has proven useful in containing disruptive behavior and also
in allowing a person space when going through a momentary crisis or to help
him de-escalate physically and emotionally. The effectiveness of the chair in
achieving these outcomes hinged on keeping the process safe. However, over
reliance on the use of the chair as an intervention tool has led to abuses. TC staff
often f0und it more convenient to send a person to the Chair rather than spend
time to talk and help the person de-escalate or achieve insight on the meaning
of his behavior and its consequences. Instead of exploring other options,
sending a disruptive client to the Chair was much simpler. Consequently, the
use of the chair degenerated into a punitive tool.

Preliminary inquiry into the usefulness of the Chair by Dr. Perfas revealed that
when certain conditions existed and proper guidelines were followed when
using the Chair as a cognitive-behavioral tool, residents or clients who were
subjected to it reported positive outcomes. When used as a punitive tool to
isolate, brand, punish, they reacted to the stigmatizing implications of being put
on the chair negatively. When used as a time-out or a tool for self-reflection,
accompanied by a well-thought out briefing or orientation, sitting on the chair
primed the residents to engage in more productive thinking processes. When
supplemented with structured activities, such as guided essays and
motivational-focused counseling, the outcome of prolonged sitting on the Chair
tended to be even more positive. Intention (implicit or explicit) was important
for it communicated to the residents what the staff was thinking and they
deduced from this the real motives of being asked to sit on the chair.

To take away the punitive label attached to the Chair, it is recommended that
the term Reflection Chair be used in lieu of the Prospect Chair or Chair.

Meetings

Three community-wide meetings are held every day in nearly every TC. While
these meetings vary in function and format, they share certain underlying goals
(the four A’s):

45
  To take attendance, for control and accountability.
 To assemble the community, in order to show residents that they are
part of a whole, create a sense of community, and facilitate staff
observation.
 To assimilate residents into the orderly environment of the community.
 To affirm the community itself as healer.

Morning Meeting (60 minutes)

Every morning after breakfast, staff and residents assemble for an hour
morning meeting. The main purpose of this meeting is to create and increase
motivation -- to establish an upbeat mood that encourages residents to meet
their daily challenges with a positive attitude.

- practice responsible concern among each other

- bring awareness to non-compliant behavior

- provide an opportunity for community interaction, fostering a sense of unity

and belonging

- learn to take risk through positive involvement

The morning meeting consists of a sequence of activities that are ritualized,

planned and participated by all residents. Advance planning is absolutely
essential. The resident tasked to run the meeting, usually a senior resident, is
given time to plan and rehearse, and all events must be reviewed in a pre-
morning meeting by staff. It is also a TC tradition that staff members
sometimes put on the morning meeting as a way to demonstrate how it is done
but also to reinforce being a part of the community.

While specific elements may vary, the following are often included:

The TC Philosophy

The program philosophy (see appendix) is recited at the beginning of every

morning meeting by all members who rise and recite it together. The
philosophy speaks to the mission of the community and is intended to be
inspirational.

46
Word of the Day

A word selected for discussion of its meaning, and examples of how it is used in
a sentence are provided.

Public Announcements

Announcements that pertain to activities or special events for the day, changes
in schedule, trips outside the facility, the menu for the day, etc. are broadcast.

Community Pull-up

Expression of concern over community lapses by community members, and an

invitation from the community to voluntarily admit to the pull-up by standing
and receiving guidance from members who elaborate on the significance of the
behavior and need for greater awareness to avoid such lapses.

Public Affirmation

Acknowledgement for commendable behavior by some members. Those being

affirmed stand up and are acknowledged for their commendable behavior.

Concept of the Day

A single inspirational concept is presented each day. The presentation is often

built around the "word of the day," and lasts no more than one or two minutes.

The News – weather, sports, horoscopes, upbeat headlines

Residents read some of these highlights from the daily newspaper and commit
them to memory and report them with their own spin to the news. This is brief
and there is an emphasis on the humorous. At times, residents may use props
or costumes to make this fun.

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Skits, Jokes, Mock Awards, etc.

These are brief, but creative presentations that are designed to be funny, but
not at the expense of any individual resident or staff member. (Ridicule is
forbidden.) Again, costumes and props may be used here.

Songs/Dance

Upbeat songs are sung collectively. These should not be songs that celebrate
drugs or violence, or songs that complain, "Oh, How I Miss My Momma!"

Games

Parlor-type games, a short game that all in the room can play, can be used as
well.

These activities are designed to be motivating, inspirational, and fun. Staff can
learn how residents are feeling by observing their participation in the meeting --
the extent of their enthusiasm, their ability to interact with others, and their
ability to be "good sports." The best sign of a successful morning meeting is
hearing the Morning Meeting song hummed at lunch!

The Use of Process Observations

Clients may be assigned to be “process observers” in any of these meetings as a

means of enriching their quality and learning to get the pulse of the community
at the start of the day.

To do this, the process observers are asked to write down what they observe
and how they feel about it (they are not to judge it). For example, “I saw that
the girls did not speak much and that the boys spoke a lot and laughed a lot. I
wonder if the girls were intimidated. (not “the girls should be more assertive” or
“the boys should not be so loud.”)” These observations can then be briefly

48
processed so that participants are more aware of their behavior in the sessions
to follow.

For more on Morning Meeting see Perfas (2012).

Other TC Meetings

House Meeting

When a serious breach of the house rules threatens the integrity of the
community, a house meeting is called to address the issue. The senior members
of the staff usually admonish the community and single out the members
whose behaviors have caused difficulties in the community. Bans might be
placed to curtail the unhealthy interactions among some residents. For
example, residents who have been observed flirting or “playing games” with
each other or congregate and plot anti-community activities are banned from
having private contact with each other. During the house meeting, bans against
certain privileges due to poor behavior might be announced for the entire
community. A ban is a containment tool used to prevent the escalation of
undesirable behavior or to impose restrictions on access and use of in-house
and out-house privileges (e.g. television, computers, swimming pool, trips to
shopping malls, movies, etc.) The house meeting, in this case, is used as an
assembly to warn the residents about potentially disruptive behaviors and
remind the community to be vigilant. Care must be taken in imposing bans as a
result of poor behaviors by a few that curtail community members’ from
exercising some earned privileges. This can dampen motivation among those
who are not at fault or are “doing well,” especially if the ban is perceived as
“unfair.” Careful crafting and presentation of the rationale for imposing bans
must take into account its unintended consequences to the community at large.
Selective phased restorations of banned privileges based on the resident’s
motivation and responsiveness should be implemented immediately.

In some cases, however, the house meeting is used as an opportunity to make

special public commendations for those members who have achieved
exceptional accomplishments for themselves or the community. House
meetings are also called for important community announcements, such as job
changes, graduation, promotion to higher treatment phases, birthdays,
anniversaries, etc.

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General Meeting

When serious violations of the cardinal rules are committed, a special house
meeting is called to address the offenders’ errant behaviors in a general meeting
(GM). A general meeting is called for offenders who commit violations of the
cardinal rules, such as taking drugs, instigating or getting involved in physical
fights, or having sex with another resident. These behaviors are serious threats
because they undermine the established order and safety of the community.

Procedure

The GM is called and led by the senior member of the staff, usually the facility
Director or his assistant. It is highly orchestrated and ritualistic. Any violation of
the cardinal rules poses a threat and a challenge to the sanctity of the TC. It
rouses anger, disappointment, doubt, fear, feelings of vulnerability, frustration,
guilt, etc. The first and foremost goal of the GM is to restore order and safety to
the community. Secondly, it allows the offending member to account to the
community, express remorse for bad behavior, and declare intentions to rectify
mistakes through restitution. The genuine expression of remorse and making
restitution are means of redeeming one’s self and becoming part of the
community again. Finally, the GM allows the rest of the community to express
the pent up feelings provoked by the offender’s dangerous behavior. Drug
taking behavior reminiscent of a drug addict’s past will usually elicit feelings of
vulnerability along with a host of other emotions, which must be brought out
into the open. The cathartic function of the meeting is necessary to restore the
community’s psychic balance, after experiencing the trauma of betrayal by one
or several members.
To prepare for and execute the GM, the community leaders engage in the
following process:

Fact Finding

The extent of the problem is assessed to determine who among the community
members are involved in the incident. Questions are posed such as: Who knew
about the problem but did not do anything to rectify it? Who knew and actively
abetted the guilty parties? Those deemed guilty of the offense by omission or
commission are directed to sit on prospect chairs. Community members who are
implicated or suspected of complicity are asked to “drop” (reveal in writing)

50
their guilt. If several members are involved in the incident, they are subjected to
a structured confrontation (a private probe into the alibis, motivation, and
rationalizations of residents accused of serious wrongdoing) by the staff or
senior members of the community in order to establish the extent of their guilt
or innocence. Since each person accused of complicity is confronted separately,
several versions of the event may emerge. This process allows the staff to piece
together their stories and look for a consistent pattern amidst lies or denials.
The confrontation serves a clinical purpose by allowing the guilty person(s) a
chance to be honest. It also allows the staff to determine genuine feelings of
remorse or denial of the problem.

Setting up the General Meeting

When staff feel satisfied that they have established the facts and found the
guilty parties and the extent of the problem, they proceed to prepare for the
ritual of the GM. Meanwhile, the offenders remain seated on the prospect chair.
Sitting in the chair raises anxiety and dissonance, priming the person for the
learning experience to come. At this point, staff members have already briefed
the parties involved in the incident regarding what is to take place and what the
community expects from them during the GM. Those who are deemed to be
continued threats to the safety of the community because of their steep denial,
lack of remorse, and refusal to admit their guilt in the face of incontrovertible
evidence, are generally denied the GM. Instead, arrangements are made for
their referral out of the community.

Members of the staff meet before the GM to devise a plan, establish their roles,
clarify issues that have to be addressed, and establish goals that must be
achieved.

Conducting the General Meeting: The Ritual

The senior member of the staff, usually the Director, leads the GM. He sets the
tone of the meeting and leads the community in openly expressing opinions and
feelings regarding the transgressions against the cardinal rules. He demands
accountability from the community for allowing such transgressions to occur in
their midst, and urges them to reflect on their failure to exercise enough
awareness and responsible concern for those who “fell.” The leader invokes the
spirit of communal living, where each is expected to be his brothers’ keeper: the

51
failure of one reflects the state of being of the entire community. The fallen
brother or sister represents a mirror image of the tenuous hold that some
members have on sobriety.

See Perfas (2012) for the full discussion of the House Meeting and the General
Meeting.

End of the Day (Wrap-up) Meeting

The meetings convene after dinner every night for thirty minutes. These
meetings are run by senior residents under staff supervision, and their main
purpose is to conduct necessary community business including:

 introduction of new residents

 recognition and celebration of residents who have completed the
program
 small job changes (including promotions and demotions)
 rewards
 learning experiences (reading assignments only)
 recognition and commendations of individuals (push-ups)
 announcements, awareness, reminders to the community
 medical, school, and legal trips for the next day
 Community discussion: How has our community been today?

It is particularly important for the planners of the meeting to consider who the
community should be getting acknowledgement for positive behavior. It can be
very effective to notice the small steps towards behavior change and
improvements in behavior.

The final “How has our community been today?” is a powerful mechanism for
creating a sense of community and a therapeutic culture. This should be a
participatory discussion facilitated, but not a lecture, by the staff.

Seminars (30 -60 minutes)

Seminars are geared to cognitive change and intellectual stimulation. They

educate residents about topics related to recovery and change, examine ethics

52
and values, and encourage consequential and critical thinking, and self-
expression. It is an important vehicle for educating residents on the TC
philosophy and culture.

Among the forms that seminars may take are the following:

Concept Seminars

A single concept or maxim is written on the blackboard, discussed by the

presenter, and then analyzed by members. The concept may be positive and
constructive, such as, "I am my brother’s keeper." But occasionally it may be a
negative concept, worthy of criticism, such as, "Silence is golden." One measure
of a concept seminar is the number of members who actively participate.

There are no right or wrong answers, and debate can be used to examine all the
facets of an issue. All who join in with "This is what it means to me..." are
accepted. Concept seminars examine ethics and values, and are intended to be
a thoughtful examination of the issues at hand, facilitating more consequential
thinking and reasoning.

For clients who have rejected or question the values of their families or the
mainstream culture, this type of seminar allows them to look at all sides of an
issue and then form their own informed opinions.

Pro and Con Seminars

A current issue (such as school condom distribution or clean needle exchange) is

offered, and the community is divided into two groups to debate the pros (for)
and the cons (against) the proposition. Halfway through the seminar, the
groups switch, and argue the opposite position. Even if a person favors or
opposes a particular stand, he or she must argue both sides.

This procedure teaches individuals to see both sides of an issue. It also helps
prepare for group therapy sessions, when residents must learn to be objective
about themselves and must "hear" another point of view.

Guest Speaker Seminars

An outside speaker may be invited to speak on a topic that is relevant to the

entire community. This opportunity serves to expose residents to new people,

53
issues, and ideas. The program shouldn’t be limited to a one-way lecture.
Members should be encouraged to ask questions and make comments of their
own.

Book Cerebrations

This type of seminar is similar to a reading group. A book is read and discussed
thoughtfully by participants. This can be the whole book of fiction or non-
fiction, a chapter, or something altogether different, like a poem.

Seminar Games

There are many audience-participation games that can increase community

awareness, stimulate the intellect, and yet at the same time provide
entertainment. These include charades, Pictionary, Trivial Pursuit,
improvisational theater, and spelling bees.

Mock Speaking Seminars

This type of seminar is a simulated public forum, presented by members. The

first half is devoted to role playing. Three members assume different roles: the
first is a moderator, the second talks about life before entering the TC, and the
third describes life in the TC. The second half can be a repeat of the first, with
three different participants. The last ten minutes is devoted to constructive
criticism by the rest of the community.

The main objectives of this seminar are to facilitate public presentation, to tell
one’s “story”, and to improve speaking skills. It also reinforces the changes
residents have made and allow them to see how far they have come. Making
public statements about their change process and any commitment to the
continuation of recovery helps increase the speaker’s personal motivation.

The Encounter or Concern Group

The Encounter or Concern Group is a form of group process that helps members
address problems related to living together in the community. This may include
issues related to their roles, interpersonal behavior, boundaries, expectations,
and social obligations.

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The goals of Encounter are to:

• Raise awareness about behavioral issues

• Resolve personal and interpersonal problems
• Improve interpersonal skills and relationships
• Identify ineffective behavior and commit to changing that behavior
• Understand the connection between feelings, thoughts, and behavior
• Gain insight into the causes and consequences of one’s problematic
behavior

The group dynamics helps participants understand issues related to their self-
concept, relationships, behavior, feelings, etc. Fellow group members serve as
“mirrors” for each other, providing a reflection of each other’s behavior and
attitudes. Through group feedback, participants learn how others see and
experience their behavior.

The focus of the group is on “here and now” issues. They may be related to
conflicts residents have with one another, concerns they have about each other,
or it may be that a resident wants the group to help him or her out with a
concern they have about themselves. Although some behaviors have their
roots in the past, they are examined in the context of the “here and now.”

To keep the process safe and moving, the group facilitator must adhere to the
phases of the Encounter Group and when to move from one phase to the next.
It requires practice and experience to help group members navigate these
phases. The group begins by reading the rules of the Encounter and reminding
the group members that the facilitator (usually staff assisted by senior residents
as “group strengths” or co-facilitators) can stop the process at anytime, usually
when a member or members engage in an unsafe behavior, e.g. making threats
or excessive use of foul language or getting up from their seats or leaving the
group without staff approval.

Although the group has elements of a group therapy, it is not the place for
facilitators to engage in psychotherapy by delving heavily and at length into
historical issues instead of helping members make connections between the
“there and then” and “here and now” or how past issues are played out in
current behavior patterns. Behaviors that manifest in the group indicative of
serious psychopathology are grist for other psychotherapeutic groups or
individual therapy.

55
The Phases of the Encounter Group used in this Manual is a model developed by
Perfas (2012).

The Four Phases of Encounter Group

Verbalization/Expression of Feelings or Concerns

 Goal: Emotional relief or “catharsis”
 Community emotional safety valve
 Take all the “garbage out” to feel better and see better
 Coaching terms: “how did he/she make you feel?”

Exploration
 Goal: Develop insight on one’s behavior, feeling, and thinking
 The “search for truth,” “what really took place,” “what personal issues got played out,”
“identify feelings provoked,” “what others have observed regarding behavior and
attitude,” “giving feedback or creating consensus” “establishing individual area of
accountability”

Resolution & Commitment

 Goal: To provide closure
 Make commitment for change and resolution for action to be taken, “I will talk to my
peers or counselors about my issues” or “You may want to talk about this in your static
group.”
 Offer of help from others, “I’ll get back to you or you can talk to me”
 Show concern or provide affirmation or offer suggestions
 Hugs and handshakes

Socialization
Goal: Reaffirm relationship and the unity of the community
Continuation of Resolution and Commitment
Be able to move on
Process the experience and solidify learning
Give feedback and encouragement

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Phases

1. Verbalization or Expression of Feelings

This model of the Encounter Group has emphasized the importance of

emotional relief through “catharsis.” This involves an honest self-expression of
emotions that have been provoked during an inter-personal interaction with
another person. Such an expression, however, should be non-assaultive,
demeaning, abusive, or involved implicit or explicit threats. The emphasis is on
the honest expression of “feelings provoked or created” and clear statement of
what took place. There should be no ill intention to hurt or seek retribution, only
verbalize negative feelings. Ultimately, the first phase of the encounter should
pave the way to resolving conflict by facilitating the verbal release of “pent-up”
feelings that often cloud thinking and judgment.

2. Exploration

When the first phase of the encounter goes well, it facilitates movement to the
next phase where exploration of the behavior which was pointed out in the first
phase occurs. In the Exploration Phase salient behaviors that came out from
both parties in the encounter are explored, with the goal of raising deeper
awareness of the connection between behavior and feelings and attitude. If the
encounter involves conflict between two persons, an important task for the
group before moving to the next phase, is to determine the nature and areas of
accountabilities of each party involved in the “conflict.” Focusing and putting
the blame of the conflict on one person, when clearly the case is one of “it takes
two to tango,” would create problems for the next phase. This process of
sorting out who is “accountable for what,” oftentimes, can be tedious,
especially when there is a great deal of “blame-shifting” among those involved.
Another danger is the use of a subtle ploy to exploit the exploration phase to
look for excuses for a bad behavior. The facilitators and co-facilitators should be
experienced and skilled to catch and re-direct the tendency of residents to make
excuses or blame others, and address resistance to taking responsibility for their
actions.

3. Resolution and Commitment

Openness to receive feedback regarding the behavior being brought to one’s

awareness and the underlying feelings or attitude pointed out by the group

57
during the exploration phase helps move the process to the next phase,
Resolution and Commitment. Having understood the connection between their
behavior and feelings or attitude and how adequately or inadequately they
responded to situations that precipitated conflict, the parties are ready to move
on toward resolution and commitment to practice new behavior.

4. Socialization

The final phase of the encounter, which occurs outside the group itself but a
necessary extension to facilitate closure, is called the Socialization Phase. Since
there is limited time to patch things up between parties involved in the
encounter during the group session, a post-group social time that allows greater
time to hash-out thing that were said and remain unsaid in the group, helps
people achieve closure and move on. This is a time for “mending fences” and
rebuilding friendship, and consolidating gains from the encounter experience.
This is a structured social time where encounter group members are expected
to use for social interactions.

Group rules:

o Respect fellow group members and their safety

o Speak for yourself and let others speak for themselves
o Let others speak, one at a time
o Stay in the group at all times
o Stay in seat, unless asked by facilitator to move
o Listen to the feedback of others, even if you don’t agree
o Hold all said in group in confidence
o All in the group are equal
o Uphold personal dignity
o When necessary, express disapproval of behavior but not the person

Processing Anger and Conflict

The Encounter or Concern Group should be a safe place for members to express
angry feelings and resolve conflicts. The group can be a place where group
members learn to effectively communicate and resolve interpersonal problems.
To make this a constructive process, follow the following guidelines:

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  Encourage the expression of anger with “I statements”, e.g., “I felt angry
(hurt, etc.) when you ignored me.”
 Encourage precise descriptions of behavior. Help group members
reframe name-calling, labeling, or assumptions about intent.
 Use anger and conflict to help members develop better self-awareness
and interpersonal understanding. (“When people ignore us, we may feel
unimportant.”)
 Do not allow aggressive venting that does not communicate or lend itself
to conflict resolution. Ask group member to describe what happened and
how they felt.

Tools of the Group

In order to encourage the participation of residents in the group, they are

taught how to use a variety of tools to move the group process along. These
include:

Identification

• The sharing of common experiences

• Promotes “universality”, commonality
• Reduces shame and isolation
• Breaks down role barriers, status differences
• Facilitates disclosure, self acceptance
• Therapeutic for all participants

Compassion

• To share deeply in another’s pain

• Promotes sense of being understood and cared for
• Facilitates disclosure

Empathy

• To put one’s self in another person’s shoes

• To see and feel the world as another does and communicate that
understanding
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 • Highly effective to facilitate disclosure
• Reduces sense of isolation
• Shows active listening
• Best tool to maintain conversation

The Responsibilities of the Facilitator

It is the responsibility of the facilitator to:

 Maintain physical and emotional safety in the group

 Remind the group of group rules when needed
 Stop the process when the group becomes unsafe or before things get
out of control
 Educate members about the goals and objectives of the group
 Keep the group focused and on task
 Move the group through transitions to phases at the right time
 Summarize periodically to establish and clarify what members
understand
 Get everyone engaged and elicit full group participation

Maintaining Safety

By far the most important responsibility for the staff facilitator is to maintain
the psychological and physical safety of the group. The facilitator must first and
foremost guide the group so that safety is assured. Any emotionally charged
interchange must be tempered with attention to the well-being of each
member, ensuring that meaningful and productive communication is taking
place, and is balanced with compassion and support.

For example, when a group member is dealing with difficult material in a group,
the facilitator may ask, “Are you open to feedback?” and if the answer is yes,
then, “Who would you like feedback from?”

Skills for Staff Group Facilitators

The following skills are useful in any type of group for staff facilitators:
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1. Open-ended question: a question that elicits more than a yes or no
response. Example: “Tell us more about . . .”
2. Affirming: comments that reinforce the client’s strengths, abilities, or
efforts to change. Example: “It must have been difficult for you to share
your real feelings in the group. . .”
3. Reflective listening: restatement of what the client said that accurately
clarifies and captures the meaning, thereby conveying an attempt to
understand and demonstrate empathy.
a. Repeat reflection: simply repeating the client’s words
b. Rephrase reflection: using different words (possibly changing the
emphasis) to repeat the client’s words
c. Paraphrase reflection: more sophisticated reflection that can include
reflecting both the words and meaning intended by the speaker, and
both sides of the ambivalence.
4. Summarizing: a paragraph that captures the entire conversation to the
point using reflection.
5. Interpreting: offering possible explanations for behavior; identifying
patterns and connections between feelings, thoughts, and behavior
6. Reflecting feelings: verbally communicating understanding of feelings
7. Supporting: providing encouragement and reinforcement.
8. Empathizing: intuitively sensing the subjective world of others, being
able to adopt the frame of reference of the others, and communicating
this understanding to clients so they feel understood.
9. Facilitating: opening up clear and direct communication within the
group; helping members effectively participate in the group.
10. Initiating: promoting group participation and introducing new directions
in the group.
11. Goal setting: planning specific goals for the group process and helping
participants define concrete and meaningful goals.
12. Evaluating: appraising the ongoing group process and individual and
group dynamics.
13. Giving feedback: expressing concrete and honest reactions to members’
behaviors
14. Suggesting: offering information or possibilities for action that can be
used by clients in making independent decisions.
15. Protecting: actively intervening to insure that clients will be safeguarded
from unnecessary psychological risks.

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 16. Disclosure: sharing with clients personal reactions that relate to the here-
and-now occurrences in the group.
17. Modeling: demonstrating desired behaviors through actions taken in the
group.
18. Linking: promoting member interaction and facilitating exploration of
common themes.
19. Blocking: being able to intervene effectively, without attacking anyone,
when clients engage in counterproductive behavior in the group.
20.Challenging: asking a member to look at discrepancies between their
words and actions or body and verbal messages, or to look at an issue in a

different way; pointing to conflicting facts and perceptions; to encourage

deeper self-understanding.

For detailed discussions on the Encounter Group see Perfas (2012) and De Leon
(2000).

The Other Traditional TC Therapeutic Groups

The Static Group

Held once a week, this group is facilitated by a staff member with residents who
are in his counseling caseload ---this group is sometimes referred to as
“caseload group.” There are several static groups in a large TC that are
simultaneously in session on a designated day of the week. Essentially, every
member of the TC is assigned to a particular static group that he attends
throughout his stay in the TC, hence the term “static.” The static group provides
immediate emotional support to a resident, particularly during the early phases
of treatment when he has to grapple with adjusting to the rules, norms, and
lifestyle of the TC, plus his own personal issues and the temptations to give up
and leave the TC. The weekly two-hour session is spent in providing support to
members in distress, discussing and providing assistance on how to cope with
the life and culture of TC and their concerns about families they have left
behind, or disclosing certain personal issues and conflicts that have to be
resolved. The group is primarily supportive with members providing feedback,
awareness, identification, affirmation, etc. to help each member gain insight or

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awareness about himself. The group may focus on an individual’s past, but the
discussion is always brought back to how past history is played out in one’s
behavior in the here and now.

The Probe

The probe focuses on exploring the resident’s psychosocial background, with

the primary goal of helping him achieve a new level of awareness and
understanding of the connections of his “here and now” behavior with past
history or unconscious motivations. It provides staff with clinical information
about the resident that is useful in designing treatment interventions. The
group is facilitated by one or two experienced staff members, who have
reviewed beforehand the case histories of the participants. The probe may be
employed as a treatment intervention for a group of residents with similar
coping problems, behavior patterns, and similar psychosocial issues. The
participants should have spent at least a few weeks in the residential program
before exposure to the probe. Since a certain level of honest self-disclosure is
necessary for a productive probe, the participants must have overcome some of
their initial resistance to the treatment program. The group process can become
emotionally intense, especially if the group achieved a high degree of
cohesiveness. The group normally has between 8 to 10 participants and lasts
between 8 to 12 hours. A TC member may go through a probe more than once
in the course of his treatment.

To increase its effectiveness as an exploratory group for new residents, its

content and group format must be structured. The staff facilitator must review
each resident case file thoroughly to identify critical life areas, e.g., parental
history of substance abuse, history of abuse or neglect or other trauma
experiences, unresolved loss or grief, criminal history and prison experiences,
etc. The facilitator must be adept in facilitating group process by ensuring
physical and emotional safety and making the group a source of emotional
support for members as they explore their life experiences and provide as little
details as possible about traumatic events but focusing instead on their
unresolved feelings. The group facilitator and co-facilitator should make it a
point that no members are re-traumatized by inappropriate responses from the
group or by poorly handled self-disclosures.

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The Extended Group and Marathon

The extended group and marathon last for more than twelve hours of
continuous group process, with short breaks for meals and brief sleep periods.
These groups are usually composed of fifteen to twenty persons and facilitated
by at least two highly experienced staff members. They involve great
preparation on the part of the facilitators and participants. The participants
must have spent at least four months in residential treatment and have shown a
good level of emotional stability before they are considered for this group. Their
preparations include, among other things, an introspective autobiography,
written confidential declarations of transgressions (guilt) against TC norms or
rules, and a list of personal issues with which they have trouble coping. These
written works are submitted to the facilitators prior to the extended group or
marathon for review and evaluation.

The facilitators conduct a thorough review of the participants’ psychosocial

backgrounds and treatment progress. A profile of each participant is drawn. Key
issues, developmental landmarks, and crucial life events are identified. These
materials are committed to memory by the facilitators. The information guides
them during the group session and allows them to make interventions that
meet some of the personal goals of individual participants, while remaining
faithful to the group process. Great efforts are invested by treatment staff in the
preparations and in the actual group process to make the experience positive
and productive for each participant.

The participants are selected on the basis of their readiness to benefit from a
potentially intense and intimate group process. After several months in TC, the
residents are already well adjusted to the TC environment and able to
demonstrate the ability to self-disclose and handle strong emotions. These are
prerequisites for the group and contribute to making the group experience
highly productive.

The actual group session begins with an encounter group for the participants.
This process clears up any possible emotional obstacles to the interpersonal
communication among participants in the ensuing extended group or
marathon. The facilitators usually have prepared a few loosely arranged
activities designed to keep the group process moving, and achieve some desired
effects that help facilitate self-disclosure or the expression of suppressed

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feelings. The facilitators are keenly focused on content as well as the group
process, always providing calculated interventions to keep the focus in the “here
and now.” In some instances, psychodrama or gestalt therapeutic techniques
are employed to create the desired ambiance in the group and achieve certain
clinical goals, such as confronting or resolving thorny life-long issues by the
participants. As in the probe, the facilitators must keep the group process
emotionally and physically safe. Self-disclosure is limited and focused on the
general issue and not on the details of the experience. Unnecessary and
inappropriate probing or confrontations by members are re-directed and
emotional support is readily provided for those who take risk in self-disclosure.

Some of the immediate goals of the group process are: (1) group cohesiveness,
(2) feelings of universality or mirror effects, (3) mutual support, (4) taking risk in
self-disclosure, (5) emotional safety, and (6) “corrective emotional experience.”

Some of the tools or techniques used in the group process are: (1) confrontation
(2) identification, (3) projection, (4) empathy, (5) affirmation, (6) role-modeling,
(7) psychodrama or gestalt therapeutic techniques, (8) alter-ego techniques, (9)
awareness exercises.

At the conclusion of the extended group or marathon, the members are hosted
to a post-marathon reception by the entire community, where they are given
the chance to relate or express their impressions of the group experience. They
are encouraged to talk among themselves in a post-marathon group about the
insights or self-awareness that surfaced during the group. This debriefing
experience is important because it consolidates some of the psychological gains
from the extended group or marathon experience, and identifies areas in which
participants may need on-going help.

These traditional TC groups are largely lost and seldom practiced in many TCs
and supplanted by traditional psychotherapy. Their value in helping residents
develop great personal insight and experience, for the first time, the power of
human relationships is unmatched. When run well, these groups, especially the
marathon produce outcomes the equivalent of many hours of traditional
psychotherapy. Experienced group facilitators who know the “arts and science”
of these groups are now a rarity.

65
See Perfas (2014) on discussions about TC Therapeutic Groups and Attachment
Theory.

The Peer Confrontation Group

Considered not part of the traditional TC groups, peer confrontation group,

nonetheless, has been around almost as long as the TC. Its present form, where
group membership is based on time-in-treatment stratification of TC
population, is a recent innovation. Its approach relies on positive peer pressure,
demanding accountability from members whose behavior or performance in
the program have much to be desired. This group is one of the few TC groups
not always led by staff instead it may be facilitated by a senior resident, usually
a Coordinator. TC residents are classified into three levels of peer groups
according to time-in-treatment, as follow: (1) younger members, (2) middle
peers, and (3) older members. These comprise the three peer confrontation
groups, held weekly for an hour and a half.

This group requires a redefinition of purpose or goal from one of confrontation

to providing peer support for those residents who are struggling in their
treatment. Hence, the group should be renamed “Peer Support Group.” The
group should focus on treatment progress (or the lack of it) and how a resident
achieves (or fails to achieve) status in the community relative to his peers. Since
residents tend to identify and contrast their own performance with others with
equal time in treatment (peer group), it is not easy to deny one’s failure or
difficulties in living up to community expectations. This type of peer
identification is harnessed in the group to allow residents to explore their lack of
progress and offer help to those who repeatedly fail in certain areas of their
treatment. Commitment to make improvements is elicited, and support is
offered to struggling members of the group. Role modeling is operant in this
group’s dynamics, especially when led by a senior resident. Moreover, those
members of the peer group perceived to do well often take active role in the
group and in giving helpful feedback and support to those who are lagging
behind in treatment.

See Perfas (2012)for a full discussion of the TC Therapeutic Groups.

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 The TC Process

To skillfully use TC as method, it is important to understand how all the TC

elements work in conjunction with each other. It is the “gestalt” of all of the
components described up to this point working together that creates a
therapeutic process in a well-functioning TC.

Diagram 1 depicts the flow between TC structure and process:

1. Residents’ behavior is observed daily. Behavior noted includes hygiene,

school and job performance, participation in community activities, and
behavior with peers, teachers, family members, and staff. To be most
effective, this requires consistent monitoring and involvement of all the
staff in the community.

2. Positive and negative behavior is noted and reported in several ways.

It may be reported to the House Management Office via an incident slip
by a staff member or client if a resident was late for school or did not
make his or her bed, to the staff in a teacher’s report that a client scored
highly on an exam, to a client’s counselor when there is concern about a
client’s inability to get out of bed in the morning.

3. Behavioral reports are reviewed and a disposition is made about how

it should be treated. Behavior may result in a reward, a learning
experience, a referral to a particular staff member or professional, or a call
to a family member. To be most effective, this must take place as soon as
possible after the behavior has occurred.

4. Behavior and its disposition are documented. Documentation is

important so there is a record of the behavior and how it was dealt with,
so there can be follow-up and patterns over time can be ascertained. This
also lends itself to relevant staff being informed of the behavioral issues
of the clients in their care.

5. Behavior and its disposition are shared with the rest of the community
or selected members. Rewards or sanctions for many behaviors are
shared in the Morning Meeting and during the evening Wrap-up to
continuously use the social learning process and encourage some

67
 behaviors and discourage others. Additionally, it is important to inform
clients that there are consequences for violation of the norms of the
community to maintain a sense of safety and security. Bringing up
behavioral issues to the community’s attention are opportunities to
enjoin the members to provide support to those who are faltering in their
commitment or efforts to change.

6. The client is encouraged to discuss the behavior in counseling, on the

job, in school, in groups, etc. The TC approach goes beyond behavior
shaping to help address relevant cognitive and emotional issues. In
particular, once a resident has been given a learning experience for a
behavioral problem, it is important to make meaning of the behavior by
exploring feelings and thoughts related to it and to help the client
develop alternatives.

7. Behavior continues to be observed. Improvements or regressions are

noted. It is important to reward improvement, even small ones, and to
respond immediately to regression.

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 Diagram 1: TC Process

Behavioral Monitoring/
Data Collection Daily Review and Social Learning Process
(How information is shared with the
Processes Disposition community.)
(Requires regular observation of both (Determine intervention)
positive and negative behavior.) Intervention –
Reward or
Learning
Experience

 House and room runs  Complex/Coordinator  House meeting

’s Office
 Incident  Staff Documentation  General Meeting
reports/slips/logs
 Behavior reports by  Staff meeting  Case File  Groups
- peers  Case conference  Individual  Seminar
Incident Folder
- staff  Resident Review  Log book  Departmental Meeting
Committee
- family  Incident slips  Job Functions
- work supervisors
- teachers

 Observation of Cognitive and Emotional

performance in other Processing
program activities (The behavior and its outcomes
are processed for meaning by
individual.)
- groups  Groups
- seminars  Individual counseling
- job functions Behavior continues to  Seminars
be observed  Staff
- individual  Peers
counseling
 Support network
 Educational
 Vocational

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 Recommended Services and Enhancements to TC

The core TC activities have been described up to this point. However, in most
TC Houses, many other types of services are provided that enhance the TC
approach. Many of these are evidence-based practices that are geared to
particular issues or populations. The most widely used of these enhancements
are listed below.

 Individual Counseling – residents in TCs should receive 30-60 minutes of

individual counseling with their primary counselor regularly. Typically,
this counseling is geared to assisting the client to develop the treatment
plan, monitor progress on the treatment plan, update the treatment plan,
and to assist with any problems that arise in the course of treatment.
 Caseload or Process Groups – These are ‘static” groups that meet
continuously over time and process any issues that residents need or
want to talk about. The regularity of the group fosters development of
the group, group cohesiveness, and intimacy between members so that
issues can be worked on over time.
 Medical and Dental Services – residents should be given medical and
dental evaluations and medical and dental services provided, either on
site or by a local provider. Many TCs have an on-site nurse.
 Psychiatric Services – new residents who have a psychiatric history or
symptoms should be given a psychiatric evaluation. Those who take
psychotropic medication are regularly monitored, either on-site or by a
local provider.
 Double Trouble Support Groups – support groups for residents with co-
occurring disorders that address problems with medication, symptom
management, and any other problems related to having more than one
disorder.
 Gender-Responsive Services – As much as possible TC programs must
strive to be gender-responsive. Ideally, this means that services are
provided separately to males and females. When that is not possible due
to space, staffing or funding limitations, there is every effort to be
mindful of the way that gender issues impact the community and the
treatment process. Steps must be taken to address gender issues and to
provide gender-responsive services. This is a particularly salient issue for
women and girls, who are usually the minority in co-ed programs, many
of which have been typically designed with a male perspective.

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 Trauma-informed Approach - Given the high rate of trauma histories of
substance-abuse clients or residents, TC programs must increasingly use
an understanding of trauma to inform policies and treatment practices.
Having a trauma-informed approach requires training of all staff and
using the understanding of trauma to inform a wide range of decisions
and practices.
 Seeking Safety Therapy for PTSD and SUD – This evidence-based
practice is a cognitive-behavioral treatment for post-traumatic stress
disorder and substance use disorders. It is first stage recovery work which
does not explore the details of traumatic experiences and instead teaches
clients coping skills for recovery from either or both disorders.
 Relapse Prevention – This evidence-based cognitive behavioral
treatment teaches clients about the process of relapse and the strategies
to avoid it. Clients with co-occurring disorders can be taught how to
avoid relapse to any disorders using the same principles.
 Emotional Management Groups – Educating residents or clients about
feelings and emotions and employing Dialectical Behavioral Therapy
(especially developed for borderline personality disorder) both teach
clients how to manage emotions.
 Anger Management Groups – TC residents, particularly boys and men,
have significant difficulty managing anger. These cognitive behavioral
groups teach clients self-management strategies. A number of curricula
are used.
 Vocational Services – such as vocational assessment, counseling, referral
to vocational training, job placement, etc. are critical for most adult
clients and often needed for older adolescents who have completed high
school.
 Mindfulness-based Meditation or Reflection or Spiritually-based
activities – increasing number of studies find these practices effective in
supporting recovery from addictive behaviors.
 Grief, Loss, and Bereavement Groups or Counseling – a significant
number of substance-abuse clients have issues of loss connected to their
substance use history.

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 Integrating Evidence-Based Practices into the TC

What is Evidence-Based Practice?

Treatment approaches must pass the test of science to be considered legitimate

intervention. Many current treatment tools in addiction, such as Motivational
Interviewing, Relapse Prevention, Contingency Management, Seeking Safety, etc.
are considered evidence-based because they were found to be effective using
experimental design studies. The challenge posed in TCs when trying to adopt
or integrate these practices into existing TC treatment programs is keeping
fidelity of practice. Without a thoughtful strategy the applications of these
interventions are likely to interfere with proper TC operations on one hand and
dilute the interventions on the other. It requires knowledge of the TC as well as
expertise in the applications of evidence-based practices to make the
integration of these practices into a TC as a seamless process as possible.

Factors for consideration

The following are important factors that must be taken into account when
attempting to apply evidence-based interventions in a TC:

1. The TC Context

Understanding how evidence-based interventions can be incorporated within

the TC milieu without compromising its basic tenets or principles and keeping
the fidelity of TC and evidence-based practices.

2. The Consumers

This concerns the general profile and background of clients being served and
the relevance or suitability of the evidence-based materials to a particular client
population.

3. The Curriculum or Subject Matter

This pertains to the organization of the subject matter and the level of cognitive
sophistication necessary to grasp the materials, such as reading level or
education.

4. Training and Preparations

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Are there prerequisites the clients must meet to benefit from the intervention,
such as completing program orientation or moving up through treatment levels,
etc.? What professional training required of staff or facilitator to implement the
intervention?

5. Implementation

What strategies are put in place to make the intervention a parallel process with
the TC recovery agenda or goal?

6. Outcome Evaluation

How outcome evaluation will be conducted? How evaluation measures reflect

the effectiveness of the intervention in helping achieve client’s treatment goals,
TC operational and treatment goals, and provide indicators of how the
interventions can be improved.

7. Enhancements

How outcome evaluations are utilized to enhance TC goals and improve the
implementation and practice of the TC?

For a full discussion of the above subject refer to Perfas (2014).

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 APPENDIX

A List of TC Seminars & Seminar Guides

Don’t Look Outside

A Fool and his Yourself
money

A Rose By Any
Other Name

Concept Seminars

Concept seminars teach TC values and perspectives and have traditionally been
the mainstay of TC education in primary treatment. They can be used as a tool
to improve retention and treatment outcomes by helping residents to:

a. Develop the knowledge and skills needed for recovery

b. Assess their ethics and values and adopt those that are compatible with
recovery.
c. Think Consequentially
d. Use the TC and self-help process effectively.

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 e. Understand recovery tasks and the link between TC practices and
recovery.
f. Increase self-confidence and the ability to self-express.
The teaching of TC concepts helps the resident adopt the values and ethics of
the community. In concept seminars, residents discuss and examine issues
related to ethical and drug-free living, contrasting their previous values and
lifestyles with those promoted by the TC. The goal is to help residents adopt a
positive value system, compatible with recovery and assimilation into
mainstream society.

TC concepts are used to identify and explore important psychological and social
tasks in recovery. Discussion of TC concepts includes working on these tasks in
the community and giving residents information that can help them effectively
engage in the TC process. Concept seminars can increase motivation by linking
quality of the resident's future life and what is being learned in treatment.

An important function of the concept seminar is that it stimulates critical

thinking and self-expression. All residents' opinions are encouraged, so any
resident, from the newest to the most senior, can participate. Since many
residents are not confident in their ability to speak clearly or intelligently, it is
important to reinforce any participation. Eventually, the ability to speak in front
of a group is an accomplishment and a boost to self-esteem.

Although TC seminars should make up the bulk of TC education in primary

treatment, those in later stages of treatment should participate as well. Older
residents who are role models in the community can usually present a more
sophisticated and credible view of the concept than younger residents. And, as
in group, older residents themselves benefit from teaching younger residents,
as it reinforces their own attitudes and behavior. Having to teach a concept
often makes one understand it more thoroughly than he/she had previously.

Concept seminars are most effective when they are conducted often and
subjects are repeated frequently. Attitude change is most facilitated by
repetitive, consistent and persuasive information. In fact, TCs have traditionally
filled their daily schedules with basic concept seminars when houses are
"closed" or "tightened up" (usually in response to a high level of resident rule
breaking) with the goal of getting residents "plugged in" again, by reinforcing
the fundamentals of treatment.

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Seminar Format

Much like group, concept seminars should be a group process, not a lecture.
The leader should facilitate a thought-provoking and stimulating discussion. Do
not read from these outlines during seminar to your group. This curriculum is
a guide for the leader, to be read prior to leading seminar and perhaps silently
referred to during seminar.

1. Define the Concept - "What the concept means to me..."(3-5 minutes)

The leader should present the concept and

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.
c. Add to what members are saying, if necessary, to get a clear and
thorough description of the concept.

 Encourage different definitions so the full meaning of the concept

is described.

 Take care to acknowledge the most modest of contributions,

particularly of younger residents.

 Negative comments can be positively addressed by such responses

as, "I can see why you might feel that way. How do other people
feel about it?" Rather than get into a "we" (staff) versus “them”
(residents) situation, turning it back to residents will usually result
in a more positive resident addressing the negative comment and
serving as a role model in the process.

2. Explore the Concept: (45 minutes)

Here you want residents to thoughtfully examine the concept and look at
various applications of it.

 Open this exercise by asking provocative questions such as those

provided or ones you may wish to develop.

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  Questions should be asked that make residents think and look at the
concept in its relationship to treatment, and their past and future.

In framing questions that will make the seminar most effective, keep the
following objectives in mind:

a. moral and ethical aspects of the concept

b. how the concept is applied in the TC
c. the relevance of the concept to recovery and life after treatment

The leader's role is to stimulate discussion by asking questions and to keep the
conversation interesting and focused. He or she may want to clarify comments
made by residents, add information and ask follow-up questions. The questions
for discussion included for each concept are just examples of questions that may
stimulate discussion. The answers provided for the questions are intended
for the leader's orientation, not to be read to residents during seminar.

Although the concept seminar should be lively and stimulating, it is not a

debate.

3. Closure (10 minutes)

Here the leader should

 ask participants to summarize what they concluded from the

conversation.
 write these or abbreviated phrases on the board. It will help
residents incorporate the information.
 sum up the conversation
 try to end on a positive inspirational note

This is another place to note comments made by residents, particularly those of

whom were particularly positive, of those who spoke who usually don't or those
of new residents.

The leader may also relate the implications of the discussion to a situation in the
community, e.g., being brother's keeper to some members, and/or the
relevance of the concept to the recovery process.

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Concept: Honesty

1. Define the concept: "What the concept means to me...”

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.

Definitions may include:

 Telling the truth to ourselves and others.

 Not hiding who we are or what we've done.
 Being our true selves.
 Confronting who we are.
 Living a law-abiding life.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions (see page 3) about the concept.

What role does honesty play in our recovery?

Honesty is probably the concept most central to the TC philosophy. Without it,
personal change is impossible. Being honest in treatment is critical because
without confronting who they really are or allowing others to see them for who
they really are, residents cannot change those undesirable aspects of
themselves.

As drug abusers, most residents have been dishonest because they had to hide
what they were doing and had to support a lifestyle they could not legally or
honestly disclose. Drug abusers usually lie to those around them and break the
law to keep using drugs.

To be successful in recovery means breaking dishonest behaviors, from self-

deception, lying in relationships, to illegal activity. Honesty with one's self and
self-awareness are needed to avoid the individual negative patterns of behavior
which will lead back to drugging. Residents must understand that engaging in
crime will bring them into circles of negative people, which will lead them to

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relapse as well as jail. Honest behavior is needed to hold a legal job and stay
away from crime.

Healthy, fulfilling relationships are not possible without honesty, since trust is
not possible without honesty. Most drug abusers have hurt people who have
loved them with their dishonesty. Fear and low self-esteem underlie the
inability to be honest in interpersonal relationships, which needs to be worked
on in treatment. A stable recovery requires supportive friendships and,
eventually, intimate relationships with positive, drug-free people.

Dishonesty is wrong. Whether involvement in criminal behavior or in

interpersonal relationships, it involves manipulating others for the dishonest
person's benefit. Treating others as you would like to be treated is a related
ethical issue.

Becoming honest gives people freedom from the anxiety associated with
dishonesty. Being dishonest makes people look over their shoulder, worrying
about being caught. Honesty relieves that burden.

Honesty is one of the best measures of personal growth in treatment. When a

resident can talk about something that is unflattering, shows their vulnerability
or makes them look "uncool," they are doing real work - hence the adage,
"When you're looking bad, you're looking good."

How does the TC help you become honest?

Groups help people become honest about themselves and become self-aware.
Job functions teach people learn the value of honest work and ethics, which can
help them obtain and keep employment in the outside world. Seminars raise
awareness about ways residents may be dishonest and suggest how those
behaviors may be changed. The pressure to admit to guilt helps people become
honest about who they are, their mistakes and negative behavior. Privileges
given for honest behavior encourage honesty, while sanctions for dishonesty
are intended to motivate residents to become honest.

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Can anyone share an example of how being honest has helped you so far in
your recovery?

(Open this up to group for discussion).

How can dishonesty sabotage your treatment?

Treatment will not work without honesty. The "real" person is being hidden and
therefore not subject to the change process. In staying dishonest, the resident
is simply "doing time" and will leave the same person as he/she came in. Most
of the time, being dishonest in treatment leads people to leave, as it is difficult
for people to stay when they're not working the program. Yet even people who
are "jailing" it and stay an extended period of time will not achieve the personal
change needed for a successful recovery.

Does being honest when others are not leave us open to being taken
advantage of?

This is a common fear among people who are still holding on to their street
code. In this environment, honest behavior is valued and protected. If there are
instances when it is not, the community must be made aware, as this threatens
everyone's recovery. To keep this a community where being honest is safe, all
residents must confront dishonesty, negative “contracts,” jail mentality and the
like. Confronting and dealing with negative people is something residents need
to learn to do in treatment if they are to avoid being influenced by negative
people when they return to the outside community. If they are serious about
recovery, residents need to stay away from people who would compromise their
honesty, in treatment and out.

Do we have to be honest with everyone here? Can't we just be honest with a

few we trust?

It is important to be honest all the time here. Although they may not become
close friends with every one of their fellow residents, it is a good thing to avoid
limiting their friendships (spread their action). They may be mistrustful and
tend to prejudge people different than themselves. Being honest with just a
few people leads them into negative “contract” and threatens their treatment
should those people leave and never allow them to develop the social skills they

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need to interact effectively with different people. To be successful after
treatment, people must be able to relate to a variety of people from all walks of
life.

Is the world outside mostly honest or dishonest? Should it matter to us?

Why or why not?

There is both honesty and dishonesty in the world. Many who have been
involved in crime and drugs tend to overestimate the percentage of people
involved in these activities. And while there is definitely a dishonest element in
the world at large, there are probably a lot more honest people and institutions
in the world than many residents think.

What should matter most to residents right now is their own honesty, that of
their peers and of this community. In the TC, dishonesty can be challenged and
corrected by confronting others in groups, booking incidents and making pull-
ups, which helps residents develop the assertiveness and confidence needed to
deal with negativity anywhere.
In the outside world, it is important that the TC graduate be in an environment
that does not reward dishonesty, as that would threaten his/her recovery. The
resident should appreciate that in the community at large, there may be times
when dishonesty in his/her midst can be addressed, using the skills acquired in
the TC, and at other times by simply avoiding those situations to protect his/her
own well-being.

Can we lie when we're in a tight situation and it won't affect anyone else?

Residents should be taught that lying is lying, no matter whom they think it
affects or how small the matter is. Once they start telling small lies or white
lies, it becomes easier to stop being honest about a lot of things and that is the
quickest way to compromise their recovery. Lying "a little bit" inevitably leads
to lying a lot, just as, for the addict, using "a little bit of drugs" will lead to a full
blown relapse very quickly.

When people begin to tell the truth all the time, they realize the positive
consequences are greater than negative ones. Eventually honesty becomes
more comfortable than dishonesty.

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Can honesty be misused?

Honesty should not be used as a weapon. To deliberately hurt people with

words is an act of aggression, i.e., "I honestly feel like killing you." Or "To tell you
the truth, I find you ugly." Residents need to strive towards assertive behavior
by expressing honest feelings and needs and asking that they be
accommodated. Aggressive behavior is demanding, inconsiderate of others'
feelings, either uses or implies force, or is intended to be hurtful.

Should we lie to avoid hurting someone's feelings?

In the TC, the answer is no. Part of the growing process for residents is to get
feedback on the negative aspects of their behavior. However, it is also
necessary to use responsible concern with peers and not to give a lot of negative
feedback without also giving them some positive concern. Another is telling the
truth to spite or with malice.

Residents also need to understand the difference between dishonesty and tact.
Being tactful means we think about the impact of our words on other people's
feelings and are careful how we say things. In group, people get feedback on
the effect of their words on other people, which teaches them important social
skills for the future.

What has a lack of honesty meant in your life? How do you see honesty
playing a role in your future?

(Open this up to group discussion).

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Personal change requires honesty.

 Criminal behavior will lead back to drug use.
 Positive relationships depend on honesty and trust.
 Honesty is a sign of growth in recovery.
 Treatment will not work without honesty.

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  Recovery will not last without honesty.
 We have to learn to confront dishonesty so we can deal with it when we
leave treatment.
 Honesty can be much more comfortable than dishonesty.
 Aggressive language or behavior should not be rationalized as honesty.

b. Comment on noteworthy contributions.

c. Close on a inspirational note, for example:

 Try making one honest statement that is really hard for you to do
today. Tell someone how it felt.
 Sit down and make a list of things you have been dishonest about.
Think about how you can change them.
 Turn your recovery around today. Admit to your guilt.
 Let's make sure this family is a place where honesty is always safe
because that furthers all our growth.

Concept: Pride in Quality

1. Define the concept: "What the concept means to me...

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

 Taking care to do the best job you can because it is a reflection of you.
 Taking responsibility for the things around you and caring about the
quality of those things.
 Caring about yourself and the things you do.
 Doing your best.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

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What does the pride in quality concept teach us?

The concept of pride in quality encourages residents to do their best at any task,
as anything they do is a reflection of themselves. It also encourages residents to
strive to overcome the difficulties they may have in accomplishing challenging
tasks. It teaches that no matter how menial the task, anything ventured is
worthy of the best effort, as it is a reflection of self. Taking pride works in the
way as "act as if'; when people do quality work, even when they don't feel like it,
they eventually start to get good feelings about the work and themselves -
resulting in increased self-esteem and gratification in accomplishment.

How does taking pride in scrubbing a floor relate to your recovery?

The pride concept is related to the fact that often when people first change their
behavior, attitude and feelings change follows. Given that, scrubbing the floor
well or doing any task well can give people immediate good feelings - that of
pride in quality. Taking pride in work is a first step toward self-esteem. People
who take pride in their work are usually the most successful in our society;
because they do excellent work, they are well rewarded. In the TC, residents
who do good work in their lower level jobs are promoted to higher level job
functions, as are people in the outside world, so no job is unworthy of pride in
quality. Self-esteem grows when people achieve status and know their
advancement is based on hard work.

Before you came to treatment, did you take pride in anything?

(Open this up to group discussion).

How will pride be important when you leave treatment?

The ability to take pride in all one's activities will result in success, at work, in
relationships, in sports and hobbies, and any other endeavors. Many residents
have skills or talents that they don’t know they posses. Having positive things in
one’s life that bring good feelings keeps people away from drugs and other self-
destructive habits.

Can you take pride in yourself if you feel you have nothing to be proud of?

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Most residents come into treatment without any accomplishments that they
feel good about. It should be pointed out that they can take pride and feel good
about everything they are doing right now, from being in treatment, to taking
good care of their rooms, doing their jobs well, making contributions to groups
and seminars, etc. In other words, taking pride today can help them feel good
about themselves right now, regardless of their past or current status.
Members also need to acknowledge the things they have done well and not just
dwell on the negative aspects of their past.

What about taking pride in being a good dealer or con-man?

Residents should be made to think about whether they can feel good about
doing something well that has hurt themselves and other people. It can be
pointed out, however, that if they had the ability to do something well, even
something negative, it demonstrates that they have some intelligence and skills
that can be used for positive ends.

2.) Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Any task you do is worthy of pride, because it is a reflection of you.

 Taking pride in everything you do increases self-esteem.
 Taking pride in your work results in promotions, privileges and status in
the TC and the outside world.
 Taking pride helps in recovery because it helps people to be successful
in positive endeavors.
 Taking pride can help you feel good about yourself in the here and now,
regardless of your past or current status.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 You can start the growing process today by taking pride in the next
thing you do.

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  You can change the way you and the world sees you by always doing
your best.
 Feeling good starts with you.
 We can make this community be the best it can be, if we all take pride in
what we do here.

Concept: Blind Faith

1. Define the Concept: "What the concept means to me..."

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.

Definitions may include:

 A willingness to go along with the program though you may not fully
understand or believe in it.
 To trust that more experienced peers and the staff can guide you in
the recovery process.
 To be willing to stay with it when the going gets tough in the belief
that treatment does work.

2. Explore the concept: Questions for Discussion

Ask residents these or other questions about the concept.

What does the blind faith concept teach us?

Blind faith addresses the residents' need for immediate gratification and the
difficulties they may have "buying in" to treatment. Personal change takes time
and work; the blind faith concept teaches residents to have trust that treatment
will work, though they may not fully believe or understand it.

Blind faith is also related to the "act as if " concept, (act as if and soon you will
become) which also asks that people engage in behaviors they may not like but
are good for them. Both concepts are based on the knowledge that if we first

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change our behavior, most often attitude change will follow (usually because we
find the behavior really works).

The blind faith concept also addresses the difficulty many residents have with
authority and in trusting others. Residents need to look at how these issues
played a role in their lives before treatment and how to wisely choose those
worthy of trust, especially authority figures, in the future.

The blind faith concept can be likened to the belief in God or a higher power
which many find useful in recovery and life. The belief in something greater
than yourself can be helpful.

Why does the TC teach the blind faith concept?

The TC teaches the blind faith concept because most residents come and resist
treatment for reasons including denial, fear of treatment and change, mistrust
of authority, and difficulty understanding all the information coming their way.
Although this initial reluctance is understandable, it can waste a great deal of
time.

The blind faith concept asks people to suspend their disbelief and go along with
the program. It is based on the knowledge that people who stay in the program
and participate in its activities will start to understand and benefit from it. A
related concept:”Do your thing and all else will follow.”

When did having blind faith in treatment help you the most?

(Open this up to group discussion).

When we have blind faith, does that mean we accept anything we're told
without question?

Although TC rules tell people to follow directions, the daily schedule and the
structure without question, there is an appropriate time and place to ask
questions about TC practices. This can be in program orientation, seminars, and
in one-on-one with staff and knowledgeable residents. Residents should be
encouraged to ask questions in the right time and place.

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Should you have blind faith anywhere? Why is this program a good place to
have blind faith?

Putting blind faith in everything could be dangerous. Some people exploit the
faith placed in them for their own selfish ends. Although many new residents
may not want to go along with some of the demands of treatment, most would
probably agree that the goal of recovery promoted by the program is in their
best interest.

How might having blind faith in the program affect your life in the future?

Having blind faith can help people stay in the program, especially in the
beginning of treatment, which is the hardest time. We know that the longer
people stay in the program, the better the chances that they will finish it and the
better their chances for success in recovery.

Learning to have blind faith can teach residents to trust others and accept
authority, which will be important on the job and other social situations where
cooperation with other people is needed.

It also teaches patience and fortitude, to hang in there when situations are
tough, when you can trust that in doing so, things will get better with time.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Blind faith asks that we go along with the program though we may not
fully understand it or trust the process.
 The blind faith concept suggests that in time we will understand and
benefit from the program.
 Blind faith helps us trust, accept authority, develop patience and
fortitude.
 One who has blind faith may and should question the process when one
feels she/he needs to, but should do it in the right time and place.

b. Comment on noteworthy contributions.

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c. Close on an inspirational note, for example:

 You may not have ever trusted anyone in your life. Maybe it is time to
trust someone. You can't do it alone.
 People or things you've trusted before may have failed you, but don't let
that stop you from trusting people who can help you.
 Blind faith can get you started in the right direction. If you go with it,
eventually you will start to feel and understand it.

Concept: You Can't Keep it Unless You Give it Away

1. Define the Concept: "What the concept means to me..."

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

 Your own personal growth requires that you share what you know
with others.
 By helping others, you help yourself.
 Being a role model and a teacher is part of the growth process in the
TC.
 It is in giving that you receive

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why does the TC teach the concept "You Can't Keep it Unless You Give it
Away?”

This concept encourages residents to help others and to act as role models. It is
the crux of the self-help process; that is, people with a common problem
supporting and helping each other overcome their problem (as opposed to

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having a professional "cure" the person with the problem who is helpless and
passive in the process).

The concept also teaches residents the value and need for social support,
something they will need for a lifetime to sustain recovery.

The concept maintains that by supporting, helping and sharing information with
others, residents help themselves, as they reinforce their own knowledge,
attitudes and behavior.

Ask people to share experiences with this concept - how they feel they “give
it away" and how they feel this has helped themselves and others.

(Open this up to group discussion.)

Do you have to be an older resident to “give it away”?

Younger residents can "give it away" in many ways, by reaching out to other
residents who need support, by making contributions in house activities and by
doing what they are supposed to be doing in the community.

Why might an older resident not "give it away"?

Older residents who do not "give it away" should be confronted with responsible
concern. They may be holding guilt, thinking about splitting or preoccupied
with something other than their treatment. It is a danger sign.

How does "giving it away" help you "keep it"? What is "keeping it"?

By “giving it away" residents are consolidating their knowledge, attitudes and,

feelings about recovery. Having to explain something to another person often
helps one understand it more clearly themselves. It also helps one "own" their
recovery, as they become active agents of change in the community.

"Keeping it" refers to maintaining and furthering one's own growth in recovery.

Should we "give it away" for any reasons other than "keeping it"?

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Helping others is right in and of itself. It is the opposite of the street code most
residents came in with. Reaching out to a peer may literally save his/her life.
Helping others gives us good feelings about ourselves as human beings.

Does this concept have any relevance to your life after treatment?

In order to sustain one's recovery after treatment, one must maintain a network
of social support, consisting of treatment peers and recovering people in the
community (such as people in AA and NA). Therefore, one must still "give it
away" and also seek out help from peers. This concept teaches a strategy for
lifelong recovery.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 "You Can't Keep it Unless You Give it Away" refers to the basis of
recovery in a self-help program - people with a common problem
helping each other.
 By helping others, we help ourselves.
 Anyone in this community, from the youngest to oldest resident, can
give it away.
 We need to be concerned with residents who do not give it away,
particularly older residents.
 Helping others and accepting help from others is something we have to
do forever to maintain recovery.
 Helping others is a good and right thing to do.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Remember how you felt when someone reached out to you. Try giving
it back.
 Think what this community would be like if no one "gave it away". Think
what it would be like if we all did.
 Let's all "give it away" today.

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  Helping others, just for the sake of helping others, gives us good
feelings. It also helps us grow as human beings.

Concept: You are Your Brother's Keeper

1. Define the concept: "What the concept means to me...."

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.
Definitions may include:

 We are all responsible for the growth and well-being of our fellow
members.
 In the TC, we all help each other.
 Helping others is part of our own recovery.
 Recovery is something we cannot do alone.
 We have to be concerned when other members are not making
progress in their treatment.

2. Explore the concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why should we be responsible for the growth and well-being of our
"brothers and sisters"?

Being our "brother's/sister's keeper" is the basis of self-help; that is, people in
recovery get better by helping and supporting one another. When residents are
their "brother's/sister's keeper" they not only help others, they also help
themselves, since they "can't keep it unless they give it away". When they help
others in recovery, they solidify their understanding of and commitment to their
own recovery. Also, when they keep their peers positive and plugged-in to the
program, it creates a positive dynamic that helps the whole community. If the
community is not upbeat and nurturing, we all need to ask ourselves, "Are we
being our brother's/sister's keeper?" Being our "brother's/sister's keeper" is a big
part of "doing your thing".

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Being 'brother's/sister's keeper" is a value that is a sharp contrast to the values
of the street. On the street, people are out only for themselves and will hurt
others to get what they want or need. Helping others, sometimes with no
obvious or immediate payback, makes us better human beings. What would
happen in this community and in the world at large if no one helped others?

Long-term recovery requires that people act as "brother's/sister's keeper" to

their peers and that they have people in their lives who will act similarly.
In what ways can we act as "brother's/sister's keeper"?
Open this up to group discussion. Desirable responses include:

a. Talking to people in group.

b. Talking to people about how they are doing, especially if they seem in
need or are new.
c. Pulling people up.
d. Pulling people in.
e. Using incident slips.
f. Teaching people what you know about the program and recovery.
g. Doing whatever it takes to keep people in the program!

Note that some of these may be taken as punitive by some, in that they may
result in disciplinary measures as in “booking” someone out of concern for
untoward behavior. Residents may resist booking people for fear of being
branded a "snitch". These are street values that need to be overcome in
recovery.

Helping others means not letting them engage in negative behavior. However,
when residents do this, they need to do it with responsible concern and make
sure they also give the person emotional support to deal with the
consequences.

What is responsible concern?

All of the above (a-g) are examples of responsible concern. Responsible concern
refers to efforts intended to help others in their recovery. Being responsible in
giving concern means doing the right thing for others despite the risk of getting
rejected by the very people you are trying to help. At times, concern in the TC
may result in emotional distress. The giver might find it difficult to give the kind

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of help a person needs and yet he must stay steadfast in doing what is right and
helpful.

Should you be "brother's/sister's keeper" for people who don't seem to care
about their own recovery?

Most residents, at one point or another, may not seem to care about their
recovery. It is at this time that people need the encouragement and support to
stay in treatment and work the program most. Almost everyone who has
stayed in treatment and done well can remember a time when he/she might
have left had it not been for a helpful peer.

Ask people to share experiences with this concept - when they were helped
by one of their "brothers" or "sisters", or how they helped someone else.

Open this up to group discussion.

Are their limits to being your "brother's/sister's keeper"?

Residents should never endanger their own sobriety by trying to help someone
who continues to resist help. Keeping quiet about someone else's wrongdoing
in the TC or doing something one is not comfortable with is where one draws
the line to set limits and speak to someone who can help. One should
understand that although he may be able to help and support his peers,
everyone is responsible for his/her own recovery. A related concept: “You alone
must do it, but no one can do it alone.”

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Being brother's/sister's keeper means helping and supporting peers with

their recovery.
 Being brother's/sister's keeper helps your peers, you and the
community.
 Helping others is a good thing to do.

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  Being brother's/sister's keeper is a strategy used by people who are
successful at recovery.
 Being brother's/sister's keeper sometimes involves a sensitive, gentle
approach; sometimes it involves teaching, and sometimes it requires
challenging someone’s crooked ways.
 One should never jeopardize his own recovery or enable someone’s
dysfunctional behavior in an effort to act as brother's/sister's keeper.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Let's all be our brother's/sister's keeper today and see what it does to
our community.
 If you've never had a "brother" or "sister" and never thought it possible,
reach out. You'll find one here.
 None of us can do recovery alone. We all need each other.

Concept: Act-as-if

1. Define the concept: "What the concept means to me..."

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

 If you behave in a positive manner, you will become a positive person.

 Behavior change brings attitude change.
 Trying new behavior, even when you don't want to, will help you
become the person you want to be.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why is the "act-as-if" concept a part of the TC philosophy?

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Almost all who come to the TC have a hard time adopting many of the behavior
that is expected and couldn't see themselves ever really changing in ways that
are necessary for recovery. Rather than trying to figure out why new behavior is
difficult or wait until there is a genuine internal desire to change, the TC
prescription of "act-as-if' is simple and it works!

Once positive behavior is tried, people usually find it works better than negative
behavior, brings many rewards and, eventually, it feels more comfortable. It is a
growth process and takes some time to work, but it is the quickest path to real
personal change.

Does the "act-as-if " concept ask us to ignore our feelings?

Temporarily, yes. Residents are asked to act in ways that may not reflect how
they truly feel at the moment. Yet they are always encouraged to talk about
how they really feel and where they are having difficulty in the appropriate time
and place, e.g., groups, with peers, etc.

"Acting-as-if ' teaches residents to control their feelings, not to "stuff ' them.
Most came in with little control of their emotions and tend to act their feelings
out, without regard for consequences. The "act as if' concept asks that they
behave as expected and cope with their negative feelings, much as they will
have to do in the real world. Residents must learn to deal with their underlying
negative feelings in an appropriate manner, which will not result in unwanted
consequences. This helps them develop coping skills and emotional strength,
while they also try new ways of behaving.

How can "acting-as-if" be useful in our lives?

"Acting-as-if” can have a powerful, positive effect in residents' lives. Morning

Meeting is a good example of "acting-as-if'. Many enter Morning Meeting
feeling down, but after allowing themselves to participate in singing, be
entertained and laugh, they begin to feel happy and motivated for the day. In
many instances, acting upbeat and positive can make people actually feel
upbeat and positive.

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Acting depressed and negative can, likewise, keep people feeling down and can
have undesirable effects on their jobs, with relationships, etc., which can lead to
more unhappiness. Our behavior has a boomerang effect; we get back what we
give. If we want positive outcomes in our lives, we have to act accordingly.

Doing well in life after treatment requires that people "act-as-if,” on the job, in
social situations, etc. In many instances, it serves us well to act in a positive
manner when we may not feel that way.

Can people share examples of how "acting as if" had worked for them?

(Open this up to group discussion.)

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Acting as if can change the way we feel.

 Acting as if can help us grow.
 Acting as if can have positive consequences in our lives.
 Acting as if helps us learn to deal with our feelings, a skill we will need
for life.
 Acting as if can help us feel comfortable with valuable new behaviors.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Act as if and soon you will become.

 Act as if and have a great day!
 Act as if and you can do anything!

Concept: It All Comes Out in the Wash

1. Define the Concept: "What the concept means to me...."'

a. Write the concept on a board or poster.

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b. Ask members of the group to describe what the concept means to them.

Definitions may include:

 Today's actions will affect your future.

 Though it may seem we have gotten away with negative behavior, it
usually catches up with us.
 Eventually the truth always comes out.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why do we teach this concept in the TC?

We teach this concept in the TC to help members understand that all of their
personal actions, positive and negative, affect them in the future. Because
dishonesty is so much a part of the street lifestyle, this concept helps us look at
the consequences of dishonesty. The concept teaches residents that they never
really get away with dishonesty because it always catches up with them. If they
kept “guilt” in treatment, it eventually comes out, whether in treatment or
after, and always has negative consequences. It is another way of looking at the
opposite concept of “honesty” and its importance in recovery.

This concept also regards how effort or hard work pays off and, also, how
wasted time and poor work results in little accomplishment. In treatment,
members can work hard on their personal growth and come out with the skills
that will make their future lives happy, productive, and drug free. Likewise,
they can do as little as possible in treatment, avoiding hard work in difficult
areas, and go back to the real world without the skills needed for a stable
recovery.

In what ways do what we do in the TC can "come out in the wash"?

 Guilt (being dishonest, breaking rules, etc.)- can make members leave
treatment and lead to a range of consequences from disciplinary
actions in treatment (if they're lucky) to a return to drug use (guilt can
literally kill).

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  Groups - working in groups gives people emotional and coping skills,
social skills to understand and deal with other people, and personal
growth through self-awareness and an increase in self-esteem.
 Seminars - helps members develop the knowledge, attitudes and values
needed for recovery. Speaking in seminar helps them develop
communication skills, self-esteem, and the persona of a drug free
person.
 Job Functions - work habits and skills developed on the job function in
the TC give members the ability to successfully hold a job in the larger
community.
 Relationships - working at relationships with peers, staff and family
while in the TC can help members develop the skills they need to make
healthy relationships if they look at the personal issues they have with
them.

Though people who "slide" through treatment by holding on to guilt and doing
as little as possible may think they are "getting over"; they aren't. They are very
likely to relapse or have other serious problems in recovery. All these activities
in treatment are designed to help members develop the skills and personal
growth needed for a fulfilling, stable recovery. Bypassing these activities,
members only shortchange themselves.

Can you share some experiences with this concept?

(Open this up to group discussion.)

What are some other ways it "all comes out in the wash", outside of
treatment?

Some examples:

Cheating in college may allow one to obtain a degree, but that person bypasses
knowledge necessary to perform well in his/her field. Studying hard in school
gives one the knowledge and skills needed to excel on the job.

Hard training in any sports results in better performance. Cheating, via steroid
drugs, may ultimately weaken the body, inhibit performance, and disqualify
athletes in competitions.

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Using mind-altering drugs may initially make people feel good, but, ultimately,
they make people feel worse.

If we don't do the difficult job of parenting, we may find our children

disrespectful, mistrustful, and distant from us.

If we don't give time and energy to our friendships and intimate relationships,
we may find that they deteriorate. If we are dishonest in our relationships, we
will not be trusted and will very likely lose them.

What moral lesson is taught by this concept?

This concept teaches us that our actions always have consequences, though
they may not be immediately apparent. Positive actions are followed by
positive outcomes and negative actions are followed by negative outcomes.

This concept goes against the values of the street which uphold dishonesty and
"getting over".

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 All actions have consequences.

 Guilt will kill.
 Hard work pays off.
 You never really "get over".
 You sow the seeds of future outcomes in the present.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Remember that any hard work and effort that is put into treatment will
pay off many times over.

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  If you're not working the program, you are only fooling yourself. It's
your life, your program, and your recovery. You determine where you
want your life to go.
 There is no "magic pill". The only way to a better life is doing real work
in the program.

Concept: What Goes Around Comes Around

1. Define the concept: "What the concept means to me....""

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to them.

Definitions may include:

 You get back what you give.

 Treat others as you wish to be treated.
 Our actions affect others and ultimately ourselves.
 What you plant is what you reap.

2. Explore the concept: Questions for Discussion

Ask residents these or other questions about the concept.

How does "what goes around comes around"?

Because our actions influence those around us, we tend to get back what we
give. When we behave in a positive manner towards others, they usually
respond in kind and vice versa. It is human nature to seek pleasure and avoid
pain, therefore, we gravitate to people and experiences that make us feel good
and turn away from those that don't.

Why do we teach this concept in the TC?

This concept teaches residents that there are consequences for their actions
and that there is mutuality (we respond in kind to others) in human
relationships. Most come to the TC either unaware of or unwilling to accept

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responsibility for the power of their own actions and their ability to influence
their environment.

This concept is empowering in that it shows residents how they can affect their
environment and what happens to them. If they are willing to behave toward
others the way they want to be treated and engage in behaviors conducive to
recovery, they will be able to achieve a positive, satisfying lifestyle. Again,
positive behavior results in positive outcomes; negative behavior results in
negative outcomes.

In what ways have you found this concept to apply to your life?
(Open this up to group discussion.)
Some examples of real-life applications of the concept:

"People who live by the sword, die by the sword". Violence begets violence.

People who are kind, giving and loving tend to be loved and cared for in return.
Those who shun others or are manipulative and unkind tend to have few real
friends; instead, they are likely to have acquaintances who will exploit them as
well.

What about situations where it seems that people get away with negative
behavior or people who are honest and caring have bad things happen to
them? Is the concept sometimes not valid?

Sometimes bad things do happen to good people and good things happen to
bad people. It is often a matter of luck or factors we have no control over, like
accidents and death. However, overwhelmingly, we do have control over our
destinies, and our behavior does matter. Overall, this concept is valid.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 There are consequences for our behavior.

 There is mutuality in human relationships.
 You get what you give.

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  We have control over our environment and our destinies.
 There is such a thing as “Karma.”

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Remember the golden rule: Treat others as you, yourself, would like to
be treated.
 Recognize your power and use it wisely.
 When things don't go as you would like, rather than blame others or
circumstances out of your control, think about what you might do
differently.
 Think about all the things you might change in your life by changing
your behavior.
 You can begin to influence the outcome of your future life by doing the
right thing now.

Concept: To Be Aware Is To Be Alive

1. Define the Concept: "What the concept means to me...

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.

Definitions may include:

 Recovery requires a new understanding and view of the world.

 Recovery requires us to be knowledgeable and actively take care of
ourselves.
 We cannot be passive and uneducated in recovery.
 Recovery or positive change is a dynamic process while keeping the
status quo is static

2. Explore the Concept: Questions for Discussion

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Ask residents these or other questions about the concept.

What do we mean by "aware"? What do we mean by "alive"?

To have your awareness "raised" means to be educated or informed - to become

knowledgeable about something you were not aware of before. A good part of
treatment involves members becoming "aware" of, or educated about,
themselves, their addiction, and recovery, and in touched with reality and the
environment around them.

"Alive" in this concept refers to recovery. If members do not raise their

awareness or allow themselves not to be careful about their behavior, they can
relapse. Being "alive" and in a good place in recovery also means being “alive" in
the fullest as a human being. In drug addiction, people are not totally "alive" in
that they are trying to escape life and are anesthetized from their experiences
and reality. In recovery, people are in touched with their feelings, know
themselves, and are in tuned with people around them and their environment.

What do we need to be "aware" of?

Ourselves:
Who are we? What do we like? What do we need? What are we afraid of? How
did we get here? How can we keep from getting here again? What are our
weaknesses and strengths?

Addiction and Recovery:

How and why do we get addicted? What is addiction? How does treatment
work? What is recovery and how do we achieve it? How do we prevent relapse?

People around us and our environment:

Who in our environment helps or hinders us? How can we best get along with
those around us? Where do we fit in our environment? Is our role in the
environment healthy or unhealthy? How do we feel in our community? What in
our environment brings out the best in us? The worst?

These are only some examples. Many more may be generated by the group.

How do we become aware?

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One of the major goals of this community is to raise awareness and to keep it
raised. By virtue of living in this community, most members will have their
awareness raised to some extent, whether they want it or not. If they actively
participate in the process and want to pursue personal growth and recovery, the
structure and activity of this community will give them the knowledge and skills
they need to be successful in recovery.

Almost every TC program activity raises awareness (Ask members to explain

how.):

 Morning Meeting - should raise our awareness of each other and

ourselves. Also, awareness of, “Who are the people in our community?
Who's feeling good and having a good time, and who's not?” Raising
questions like, “How do we do in morning meeting? Do we feel better
as a result? Can we have a good time?”

 Job Functions - allows for exploration of many issues concerning self

and others - how we deal with stress and authority, assessment of
personal strengths and weaknesses, interpersonal skills (includes
understanding others and getting along with others), who we are in the
community (Where do we fit in? What role do we play?), vocational and
educational skills, where we may function well in the community after
treatment.

 Seminar - learning about addiction, treatment and recovery; how we

present ourselves to others, self-confidence, communication and
critical thinking skills.

 House Meeting - raises our awareness about our fellow members, who
are doing well and those who are not, how we stand in the community,
consequences for the variety of behaviors in the community, problems
in the community we need to work on?

 Encounter or Concern Groups - raises our awareness of our own

recovery issues and those of fellow members, gives us perspective in
understanding our own behavior and that of others, gives us knowledge
of choices we have and problem-solving strategies.

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The TC gives us constant feedback about our behavior, who we are and where
we need to go, in these activities and in every other aspect of its operation.

If ignorance is bliss, is awareness agony?

Awareness can be painful, since some feedbacks that members get about
themselves are not flattering and suggest that change is needed. However,
personal growth and positive change are often facilitated by addressing painful
issues. Discomfort can be part of a healthy process.

Becoming aware of ourselves and our personal circumstances allows us to

realistically assess our lives and illuminates choices we are capable of making.
Ignorance may seem like bliss, but ignorance gives us no control over our lives
and does not protect us from the consequences of our behavior.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Recovery requires that we become "aware" and educated about

ourselves, addiction, recovery and other people.
 All TC activities are geared to increase our awareness in ways that are
important to recovery.
 Awareness, although sometimes painful, is the first step to personal
growth.
 Awareness opens up your choices and gives you control over your life.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Be aware and change your life.

 Open up your mind and look at all your choices.
 Be aware and be alive!
 Awareness can also be bliss

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Concept: No Free Lunch

1. Define the Concept: "What the concept means to me..."

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.

Definitions may include:

- Nothing worthwhile in life comes without cost.

- We need to work for the things we want.
- No one will hand us the things we need.

Ask residents these or other questions about the concept.

2. Why is this an important concept in the TC?

This concept is important because it addresses a critical problem most members

have when they come in that will potentially hinder their recovery - their
unwillingness, or sometimes inability, to earn the things they need in life. Most
have had unhealthy, immature dependencies on other people for the things
they needed in life. This stifled their growth and development, impairing their
ability to be on their own. Many have become accustomed to getting their
needs met by criminal activity. Members need to learn new ways to take care of
themselves if they are to be successful in recovery.

How do we live the "no free lunch" concept in the TC?

Since everyone works from day one in the TC, all members earn their keep. In
teaching them to work and be responsible for a job, members learn the skills
they will need to be self-sufficient on the outside. This will keep them from
having to develop unhealthy dependencies on others or engage in crime.

Members are also taught to be responsible for other things here, their rooms
and belongings, their behavior and for their brothers and sisters. In managing
the responsibilities they are given in the TC, members develop the maturity to

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handle their lives independently on the outside. Privileges in the TC, like in the
outside world, are bestowed on those who earn them.

Is depending on others always a bad thing?

Members need to understand that we all need other people, especially in

recovery. However, healthy, mature relationships require a mutuality, or give
and take, and interdependence (people depending on each other). One person
should not do all the giving and the other all the taking. This gives one person a
lot of power and leaves the other helpless, often beholden to rules that are not
in his/her best interest. The dependent person usually feels more and more
incompetent and his self-esteem deteriorates.

In recovery, people need mutually supportive friendships. Yet they need to be

independent enough to provide for their own needs financially and to remove
themselves from personal relationships that threaten their self-esteem and
recovery.

Does this concept only apply to the TC?

This concept also applies to the outside world, although at times it may appear
to members that some people always manage to get a "free lunch". They
should understand that when something is given, there is always a cost,
whether it is immediately apparent or not. That cost may be their self-esteem,
control of their behavior, or keeping their independence. Examples:

- Public or government assistance may erode people's self-esteem,

sense of competence, and subject them to the control of caseworkers.
- Living with and depending on parents as an adult or with a controlling,
insecure significant other, can likewise, erode people's self-esteem,
their sense of competence and subject them to the control of others,
which may not be in their best interests.
- Crime may seem to pay off without consequences, but will sabotage
recovery and will eventually result in sanctions.

How else does this concept help us in recovery?

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Members should appreciate that there is pride and security in earning your own
way. They can feel proud of their accomplishments when they have worked
hard to achieve them. No one can take away their personal achievements - they
are theirs and theirs alone.

Self-sufficiency and the ability to earn your way allow people self
determination, which means that they are able to decide what to do in their
lives, because they do not have to depend on others. This is important because
to be successful in recovery, recovery and all that it entails, must be a priority.
Members need to understand that they are responsible for their own recovery
and their recovery is not always the priority of, or understood by, others.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

- The "no free lunch" concept addresses our need to earn what we need
and become self-sufficient.
- Earning our own way increases our self-esteem and gives us self-
determination.
- Depending on others or engaging in crime will threaten our recovery.
- Our jobs and other responsibilities in the TC help us become self-
sufficient.
- We get good feelings from accomplishment based on hard work and
privileges earned.
- Healthy relationships involve mutuality (give and take) and
interdependence (each depending on the other at times).

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 We can feel good about the things we've worked hard for and earned.
 We can be in control of our own lives when we're able to work and be
responsible for ourselves.
 Self-sufficiency makes us feel good about ourselves.

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Concept: Hang Tough

1. Define the Concept: "What the concept means to me...""

a. Write the concept on a board or poster.

b. Ask members of the group to describe what the concept means to
them.

Definitions may include:

- "When the going gets tough, the tough gets going."

- We need to work the hardest when things get difficult.
- We need to stay with it, no matter what.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why is the "hang tough" concept important for us?

Before members came to treatment, when the going got tough, they got high.
As a result, they became less able to cope with life and discomfort. The inability
to tolerate unpleasant feelings leads many to act out their feelings, without
considering the consequences.

In order to be successful in recovery, members need to learn to deal with the

positive and negative aspects of life. They must resist their first inclination when
experiencing stress and pain, which is to run or act out in a self-defeating
manner. Part of what they need to do while in treatment is to learn new ways of
coping with discomfort and to think about the consequences of their behavior.

What do we do when we "hang tough"?

Members have to do what is in their best interest (stay in treatment, do their

jobs, etc.) and stand firm in the face of uncomfortable feelings. They need to
resist the urge to react in old ways, by running away or acting out. In so doing,
they are developing emotional strength and increasing their tolerance for
frustration and pain.

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Residents need to understand that they cannot deny their feelings but need to
cope with them constructively by processing them with peers and in group. In
this way, they appropriately vent their feelings and increase their self-awareness.
They also develop the ability to understand the sources of stress and learn
effective strategies to deal with it.

How do we become "tough"?

The Serenity Prayer is a good guide to approaching the stresses in life:

Grant me the serenity to accept the things I cannot change; Courage to change
the things I can; and the wisdom to know the difference.

"Accepting the things we cannot change" - There are some things we have no
control over that may arouse anger or sadness in us. We need to release and
explore those feelings by talking about them. After we do that, we may be able
to change our attitudes about the problem and accept our lack of control in the
situation, which will bring us to a peaceful place on the issue.

"Courage to change the things I can" - There are many problems we can change
by changing our own behavior and attitude about them. We often need to reach
out to others to help us embark on change, as change is often scary. Other
people can give us the emotional support we need to change, as well as help on
how to change.

"The wisdom to know the difference" - We need feedback from others to look at
situations objectively and to decide on what we are capable of changing and that
which we must accept.

Other strategies: prayer, meditation, exercise, humor, helping others.

What will "hanging tough" do for us?

"Hanging tough" will make members stronger because it increases their

tolerance for discomfort and their ability to process it in a positive way. It helps
develop patience, a foreign quality among drug users.

It will also help them achieve important goals that might have otherwise been
undermined by impulsiveness and the inability to deal with frustration.

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“Hanging tough" gives members important life skills for successful recovery after
treatment - maturity, emotional strength and the ability to feel good without
drugs.

Can people give examples of instances when "hanging tough" helped them?

(Open this to group discussion.)

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 "Hang Tough" addresses our impulsiveness and inability to deal with pain.
- An important part of treatment is learning to cope with negative feelings
and stress in a positive manner.
- "Hanging tough" makes us stronger, helps us achieve important goals and
gives us skills for success after treatment.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

- Hang tough and grow strong!

- Our old ways of being tough were really weakness; hang tough here and
get really tough.
- Hang tough and hang in there!
- Let's all help each other hang tough!

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Concept: Don't Look Outside Yourself

1. Define the concept: "What the concept means to me....""

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

- Don't constantly compare yourself to others.

- To understand your life, you need to look at yourself.

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

How does this concept apply in the TC?

Many residents may have seen themselves as victims of prejudice or favoritism in

the past and therefore are overly sensitive to any perceived injustice. They may
project some of those feelings onto peers who receive privileges or status that
they do not. Many also have difficulty accepting authority and quickly reject it as
being unfair. These can become excuses for their own shortcomings if they don't
look at the situation more objectively.

Decisions regarding privileges, sanctions and status are made carefully by staff
by considering many factors. No two residents are entirely alike and different
issues come into play for everyone regarding status, privilege and the like. A
related concept: "Different strokes for different folks".

Doing well in treatment and receiving the privileges and status that goes with it,
can only be accomplished if members look at their own behavior and modify it
accordingly.

In what other ways can we "look outside ourselves"?

Whenever people look to others to avoid things they need to do themselves, they
are "looking outside themselves". Some may not feel worthwhile if they are not
involved in a sexual relationship or look to others to help them meet their

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material, social or emotional needs. This leaves them vulnerable since their well-
being is dependent on others.

Should we never "look outside ourselves"? What about when there is real
injustice?

There is real injustice at times, in the TC and outside world. Sometimes we are
powerless to change it and must simply accept it. Other times we may be able to
challenge it in a constructive manner. The TC helps members learn the difference
and helps them also accept that life is not always fair. They also learn socially
appropriate ways to challenge what they see as unjust (groups, going through
the structure to see authority figures), a skill they will need to be successful in the
outside world.

How can this concept help us in recovery?

This concept makes people always look at how they can be in control of their
destinies. They may not be able to control other people or situations, but can
always control their own behavior and attitude. By making it a habit to always
look at how we can influence a situation by changing our own behavior makes us
proactive (to actively attempt to influence events before they occur) and inner-
directed (see our own actions as effective), rather than reactive (to respond to
events after their occurrence) and outer-directed (to see ourselves as controlled
by external factors). We are more likely to have events unfold in our favor when
we look at how our behavior and attitude can influence the situation.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

- When we "look outside ourselves" we blame others for our shortcomings

or look to others to do things for us that we should do ourselves, and
avoid doing the work we need to do on ourselves.
- In the TC, as in the real world, there are "different strokes for different
folks".
- We need to learn how to challenge injustice in a socially appropriate
manner and must also accept that sometimes life is unfair.
- When we "look inside ourselves" we have better control of the outcome
of events.
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b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

- Power comes from within.

- Let's all look at how we can improve our lives by looking at ourselves.
- Spend your time wisely and look at how you can make things better.
- You have a lot of control in your life if you recognize it.

Concept: It's Better to Understand Than to Be Understood

1. Define the concept: "What the concept means to me...."

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

- It does more for our personal growth to understand the world than insist
that others understand us.
- Understanding others helps us get along in life.
- To demand that others understand us doesn't help us change.

2. Explore the concept: Questions for Discussion

Ask residents these or other about the concept.

Why do we teach this concept in the TC?

This concept asks that members accept responsibility for their behavior and its
influence over events. When people understand others and their environment,
they are capable of appropriately adapting their behavior to be effective.

When members insist that others understand them, which most initially do, they
are resisting the notion of change, and asking that others accommodate them as
they are.

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When members understand how others see and react to them, they get the
feedback they need to engage in the personal change that will allow them to
successfully interact with others.

What do we need to "understand"?

Members need to "understand" themselves and their behavior, how others see
them and how their behavior affects others. When they develop this
awareness, they can change their behavior so they will get the response they
want from their environment. Residents often don't realize how they have
caused their own unhappiness by their behavior.

Members need to understand other people, their motives and behavior. This
helps them get along better with others. It also helps them understand when
they have provoked behavior in others and when the behavior of others may be
motivated by their own personal issues.

Members develop this "understanding" in groups and in honestly relating with

their peers.

Why is it a tendency for us to want to be "understood"?

Members may fear that others have an unfavorable opinion of them and want to
explain themselves so they "look good." In many instances, however, they are
offering rationalizations and excuses for poor behavior. This also keeps them
from considering negative feedback that they are getting about themselves.

Although it is a natural tendency to want to look good and avoid pain, it does not
help people change.

How can we better "understand"?

Members need to resist the inclination to defend themselves, instead learn to

listen to what other people say. Once they have honestly listened and carefully
considered the information they have received, then they may decide whether to
accept it or not. It is important to be open to the process.

In the TC, residents are constantly getting a lot of information. From seminar to
encounter groups, they are getting information about themselves, their peers
and the community. If they are receptive, it will help them change their lives.
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How can this concept help us after treatment?

This concept can help members refrain from impulsively reacting to situations
and to skillfully assess people and environments before acting. This will help
them act in a manner more likely to bring positive results.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 Understanding ourselves, others and our environment gives us the

insight we need to change.
 Asking that others understand us often prevents us from receiving
feedback about ourselves that will help us change.
 The TC gives us information that will help us change.
 Living by this concept can help us think before we act and to act more
wisely.

b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Seek to understand and open up your world.

 Understand others and understand yourself
 “No man is an island.”

Concept: You Get Back What You Put In

1. Define the concept: "What the concept means to me...."

a. Write the concept on a board or poster.

b. Ask members of the group what the concept means to them.

Definitions may include:

 The harder you work the more you benefit.

 Effort brings reward.
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  If you don't work, you won't accomplish anything.
 You enjoy the fruits of your labor

2. Explore the Concept: Questions for Discussion

Ask residents these or other questions about the concept.

Why do we teach this concept in the TC?

This treatment process is not one that works unless those involved are active in it
- it is not a treatment that one passively "receives." The more effort one puts into
it, the more the treatment process will help the individual.

Most members have not worked hard at anything before coming to the TC,
except perhaps at the activities involved in drugging. They need to appreciate
the benefits of hard work and need to develop the fortitude and patience to work
hard at something, particularly when the payoff is not immediate.

How does this concept apply to life?

This concept applies to any endeavor in life, in treatment and out. In jobs, school,
relationships or anything else we want to do well in, we need to recognize that
the outcome is directly related to the effort we put in.

This concept teaches us how powerful our actions are and that we can be in
control of our lives. We can have whatever we want, if we are willing to work
hard for it. We simply have to make the choice to do it.

Can you share experiences where you found this concept to apply in your life?

(Open this up to group discussion.)

What about situations where individuals seem to "beat the system" and get
ahead without paying their dues?

There may be instances where individuals reap rewards through dishonesty or

manipulation and not through hard work. However, there are always
repercussions for benefits or status obtained this way.

Examples - Ask residents what might happen in the following situations:

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1. Someone gets a job through personal connections or cheating on a test and
doesn't have the knowledge and skills needed for the job.

 The person may eventually lose the job.

 The person may keep the job but will be disliked and disrespected by
coworkers.
 The person is likely to feel uncomfortable in the job.
 The person's self-esteem deteriorates as he/she sees him/herself as a
fraud and as less capable than others.

2. A peer in treatment holds guilt he never admits to, routinely breaks rules and
deviates on trips out of the facility. Yet he always gets promoted and even
graduates.

 The person relapses.

 The person has big "holes" in his recovery. He has problems on the job,
with friends and intimate relationships.
 The person doesn't feel the same joy his peers do at graduation, feels
guilty and like an impostor. His self-esteem is low.

3. A friend gets a job in sales. When she finds the product difficult to sell, she
begins making false claims and guarantees about it. She beats all her coworkers
in sales and is promoted.

 Customers complain and she is fired.

 Her company's reputation suffers and business is drastically reduced.
She and others are laid off.
 She is arrested for fraud and on other charges.

3. Closure

a. Summarize the discussion. Ask residents for help. Highlight key points.
Write them or abbreviated phrases on the board. For example:

 In treatment and in life, we need to put effort into the things we want.
 The harder we work, the better the outcome.
 Advantage obtained through dishonesty or manipulation is usually short-
lived.

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b. Comment on noteworthy contributions.

c. Close on an inspirational note, for example:

 Whatever you "put in" today will pay off tomorrow.

 The harder you're working now, the better your recovery will be.
 Though you may not see it now, every effort you're making now will
improve your future.

Seminar Games

Objective: The objective of seminar games is to gather the community and

have fun, while also helping members learn something. Seminar games are
particularly appropriate on the weekend or other "down time," when a
lighthearted and upbeat tone in the community is desired. Having residents
learn to laugh and have fun through positive activities is an important recovery
task.

1. Spelling Bee

Two teams can be assembled out of the group. Members should all stand in lines
on either side of the room. The leader should call out spelling words, taking turns
between sides. Words should become progressively harder. The leader may tell
the groups to assemble themselves with their best spellers last. When members
misspell a word, they should sit down. The team whose members are all sitting
first loses.

2. Image Breakers

As the name suggests, this game attempts to get members to put their images
down with humor. This game is also called a "Grab Bag." Members must pick
slips out of a bag, which instruct them to perform a particular task. These tasks
may include:

- acting like an animal or inanimate object

- singing a song
- saying a silly poem or tongue-twister
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- imitating a movie star or other performer
- answering yes to every question asked by the members of the group
- telling a ghost story
- making at least three people laugh
- dancing a jig
- walking across the room on the knees
- giving a one minute talk about elephants (or other subject)
- saying five times rapidly, "Three big blobs of a black bug’s blood."
- Saying five times rapidly, "Truly rural."

There must always be care in image breaking games that members not be
ridiculed or humiliated. The goal is to help members laugh at themselves, let go
of their need to "look good," and have fun.

3. Going to the Store

This is a memory game. The first person states what he/she is going to buy at the
store, for example, eggs. The next person adds something to the list, such as
milk. Members continue taking turns by stating what they will be buying at the
store, each adding another item, e.g., I will be buying eggs, milk, and bread at the
store. Members should take turns until no one can remember all the items on the
list.

4. Song Game

The leader should give each member a number as they enter the seminar room.
The leader will then call a number; the member with that number will get up and
sing a song. The leader will continue to call numbers as time permits.

5. Trivial Pursuit

The cards of trivia questions from this board game can be used without the
board. The game can be played in two or more teams. Each team should select a
category and the leader can call out the question. The team can collectively
come up with the answer. The leader, or a designee, can keep score. The team
with the most correct answers wins.

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6. Charades

Charades is a guessing game in which one or more players act out a word or
group of words without using the word itself. The words can be an expression,
the title of a book or a movie, or the name of a person, place or thing. These
words can be written on slips of paper, which are then randomly selected by the
player.

Charades can be played with one person acting out in front of the whole group,
or in teams. In team playing, teams can play at the same time or they may take
turns. Each team should begin with the same number of slips. Each player can
take as long as necessary to act out the charade until he/she gets a correct guess,
with the time recorded. Or, each player can get a time limit (three minutes is
enough). Either way, the team that wins has the most correct guesses in the
least amount of time.

These are varieties of charades games:

a.) The Game

Divide the group into teams, each with a captain. Pass out slips of paper and
pencils. Team members should write on the slip the names of TV shows, movies,
books, songs, etc. (one category can be selected or they can be varied) they feel
are difficult to act out. The captains should each collect them and put them in a
container. The captains then trade containers. Now the two teams race to see
which can act out and guess all the words on the slips of paper the fastest. Again,
the teams can take turns or play at the same time.

b.) Where am I?

In this game, all of the answers are places. The following can be used:

1. in a submarine
2. on a roof
3. in a gold mine
4. on a parade
5. in a jewelry store
6. in a bank
7. in a zoo
8. in a printing shop
9. in a lighthouse
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10. in a theater
11. on a train
12. in a cafe
13. in a museum
14. in a library
15. in a fire station
16. on shipboard
17. up an apple tree
18. in a kitchen
19. in a courtyard
20. in a hospital
21. on a picnic
22. in the desert
23. on a space ship
24. in an aquarium
25. in a closet
26. in a shoe shop
27. in a taxi
28. behind a ticket booth
29. in a canoe
30. on a mountaintop
31. on a plane
32. on a bus
33. in the jungle
34. at a football game
35. on a roller coaster
36. in a pet shop
37. in a gymnasium
38. in a garden
39. in church
40. in a final examination
41. in a fashion show
42. on an iceberg
43. at a switchboard
44. in an office
45. in a supermarket
46. on a farm
47. in a band
48. in a chorus line
49. in jail
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50. on the moon

c.) Open It
In this game, the players act out the opening of something, such as the objects
listed below:

1. package of flower seeds

2. safety pin
3. wallet
4. candy bar
5. can of paint
6. Chinese fortune cookie
7. watermelon
8. photo album
9. bottle of ketchup
10. walnut
11. "Dear John (or Jean)" letter
12. jar of glue
13. umbrella
14. box of crackers
15. package of cough drops
16. woman's purse
17. can of shoe polish
18. safe
19. jar of vitamins
20. package of butter
21. cupboard
22. box of stationary
23. jar of peanut butter
24. tool box
25. first aid kit
26. filing cabinet
27. package of cheese
28. sewing kit
29. doctor's bag
30. box of laundry soap
31. make-up kit
32. Pandora's box
33. Jack-in-the-box
34. package of panty hose
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35. birthday present
36. telegram with bad news
37. can of sardines
38. jeweler’s box with a diamond bracelet in it
39. music box
40. banana
41. alligator's mouth
42. "forbidden book"
43. vampire's coffin
44. refrigerator
45. the window of a burning building
46. overcrowded closet
47. the door to the lion cage
48. pill box
49. poison ring
50. compact

d.) It Takes Two

Pairs of players act out these skits. The audience needs to guess who the
characters are and what they are doing.

1. Barber as he tries to cut the hair of a wriggling child

2. Doctor and patient
3. Mailman and the recipient of mail
4. Grocery clerk and customer
5. Cowboy roping a wild horse
6. Carpenter and assistant
7. Taxi driver and passenger
8. Dancer and awkward partner
9. Swimming instructor and student
10. Pedestrian asking directions from policemen
11. Sprinter and track coach
12. Lion tamer and ferocious lion
13. Parent teaches child to cook
14. Pianist and singer
15. Bank teller and customer
16. Person tries to escape determined bee
17. Tightrope walker and spectator
18. Baseball pitcher and catcher
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19. Boss dictates letter to secretary
20. Parent tries to sooth crying baby
21. Driving teacher and student driver
22. Fisherman tries to catch fish
23. Play director shows actor how to act
24. Person tries to teach dog how to shake hands
25. Parent tries to get baby to eat strained rhubarb

7. Strange Speeches

Topics for silly speeches can be written on slips of paper and randomly drawn by
players. Players should be limited to three minutes each to make their speech.
Speech topics may include:

1. My Cold Trip to the North Pole

2. What I Think About Spaghetti
3. How to Stand on Your Head
4. Famous Cowboys of the East
5. Washing Dishes Can Be Fun
6. Fun With Taxidermy
7. How to Blow Soap Bubbles
8. Why I Like to Climb Trees
9. Why I Don't Like to Climb Trees
10. Build Your Own Airplane
11. How to Make a Cabbage Salad
12. The Funniest Story I Ever Heard
13. What I Did on My Last Birthday
14. What I Did Last Summer
15. Keep an Elephant For a Pet
16. The Men in My Life
17. The Women in My Life
18. How to be Very Popular
19. I Fought Monsters in Transylvania
20. King Kong is My Best Friend
21. How to Carry Peanut Butter in Your Pocket
22. Strange Facts About Alligators
23. What We Can Learn From Babies
24. Karate is Really a Safe Sport
25. Insects Don't Bite, You Just Think They Do
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8. Thought for the Day

Divide the group into two or more teams. Have the teams form lines in front of a
chalkboard or some paper posted on a wall. Give the first player in each line a
piece of chalk or a marker.

At a signal, the first player of each team runs to the board, writes down a word,
returns to the line, and passes the chalk or marker to the second person, without
talking.

The second player then runs to the board and places a word either before or after
the first player's word. Each player does the same thing, until each player has
had a turn. The team must come up with a complete sentence in order to win.
Words cannot be written in between words already on the board.

Whatever sentences the teams come up with are their thoughts for the day.

9. Art Relay

This game is played much like the Thought for the Day, except that a picture is
drawn on the board. The leader should tell the teams what the picture should be.
At a signal, the first person of each team begins the picture. Each player takes a
ten-second turn at drawing the picture. (Someone should be designated to keep
time.) When the time is called, the first person runs back and the second player
runs up and adds to the picture.

The game continues until all team members have had a chance to contribute to
the picture. The team with the most "complete" picture wins.

10. The Mystery Voice

Have half of the audience go to the back of the room. Select a seated person to
be the first "guesser." The "guesser" should put his/her head down on the table
with their eyes closed. One of the players in the back of the room should come
behind the "guesser" and sing a song. When and if the “guesser" guesses the
song (this should be limited to two or three minutes), he or she goes to the back
of the room and the "singer" sits down. Players continue to take turns being
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"singers" and "guessers." Leaders may wish to have singers draw names of songs
out of a hat to make this game really funny. Singers can disguise their voices to
make the guessing difficult.

If there are no desks or tables in the room, blindfolds may be used on the
“guessers."

11. Rumor

Divide the group into two or more equal lines or teams. The first player in each
line is the team captain. They get together and make up a message for both
teams. It might be a proverb* such as "A bird in the hand is worth two in the
bush,” or it may be a line from a movie, or an original sentence.

They write two copies of the message, fold the papers and give one to the last
player on each team, who can't look at it. Then the captains go back to the head
of their team lines.

At a signal, each captain whispers the message to the next person on line who
whispers it to the third person. The message is whispered from player to player
until the last person in line gets the message.

When both teams are finished, the last player of each team says aloud the
message he/she has heard. Then they open up the slips of paper and read what
the original message was. They are usually quite different. The team that gets
the message correct (or more correct) wins.

Now the last player becomes the captain and the two new captains decide on
another message. The game is played over and over again until everyone has
had a chance to make up a message, and to prove that rumors can't be believed.

*A list of proverbs is listed below.

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12. Actions Speak Louder

Three or four players are asked to leave the room while the group decides on a
scene that one person, say John, will act out. The scene may be something like,
"Horseback Ride in a Chinese Restaurant,” or "Murder in an
Amusement Park,” or "Party in a Haunted House." It should be complex enough
so the act lasts a couple of minutes.

The first player, Jane, is then called in and watches John act out the scene.

Then the second player, William, is called in. William watches Jane repeat (or
try to repeat) the actions John performed in the scene.

The third player, Raymond, then comes in and watches William's version of
Jane's performance.

When the fourth player, Angelo, is brought in, he watches Raymond's

translation of the action, and must guess what he's doing.

The results usually prove that actions do not always speak louder than words.

13. Who's Missing?

One player is designated as "It" and goes out of the room. While "It" is gone,
another player leaves the room through a different door or hides. All the other
players change places.

Now "It" is called back into the room. "It" must look around and see how quickly
he/she can figure out who is missing. After "It" finds out, the missing person
becomes "It" and a new person hides.

How long it takes "It" to guess who's missing should be timed with a watch or
clock with a second hand. Whoever figures out who's missing in the shortest
period of time wins.

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14. Indian Chief

The players sit in a circle. One player is asked to leave the room. While he/she is
out, another player is chosen to be Indian Chief. Then the person who left the
room returns.

The Indian Chief makes all kinds of motions, such as slapping knees, raising arms,
shaking head, etc. The other players watch and do what the Chief does. When
the Chief changes his motions, so do the other players. However, the players try
not to look directly at the Chief, as the person who left the room has to try and
guess who the Indian Chief is.

After the guesser discovers who the Indian Chief is, another person is selected as
guesser. When the guesser leaves the room a new Indian Chief is chosen.

15. I Took a Trip

The group sits in a circle. The leader says to each person, "I took a trip. What did
I take along?" The players may name various objects, e.g., a toothbrush, my dog,
a peanut butter sandwich, etc.

After each player has named an object, the leader asks another question. The
leader should try to come up with a funny question, since players have to try not
to laugh. The players must use the same response to the new question that they
gave to the first question.

For example, the leader may ask, "What did I travel on? The answers would be, "
a toothbrush,” “my dog," or "a peanut butter sandwich." Since anyone who
laughs is out of the game, the leader should try to come up with questions which
will make the responses to the first question sound absurd.

After everyone has had a chance to answer the question, the leader should come
up with another question. Players who laugh should leave the circle. The player
who laughs last wins.

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Proverbs, Sayings and Maxims

A barking dog never bites.

A bird in the hand is worth two in the bush.
Absence makes the heart grow fonder.
A cat can look at a king.
A cat has nine lives.
Actions speak louder than words.
A fool and his money are soon parted.
A friend in need is a friend indeed.
All's fair in love and war.
All's well that ends well.
All that glitters is not gold.
All things come to those who wait.
All work and no play makes Jack a dull boy.
A man's (woman's) home is his castle.
A miss is as good as a mile.
An apple a day keeps the doctor away.
Any port in a storm.
A penny saved is a penny earned.
April showers bring May flowers.
A rolling stone gathers no moss.
A squeaky wheel gets the most grease.
A stitch in time saves nine.
As ye sow, so shall ye reap.
A watched pot never boils.
A word to the wise is sufficient.
Bad news travels fast.
Beauty is in the eye of the beholder.
Beauty is only skin deep.
Beggars can't be choosers.
Be it ever so humble, there's no place like home.
Better late than never; better still, never late.
Better safe than sorry.
Better to bow than to break.
Birds of a feather flock together.
Blood is thicker than water.
Brevity is the soul of wit.
Business before pleasure.
Cast not your pearls before swine.
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Charity begins at home.
Children should be seen and not heard.
Cleanliness is next to godliness.
Clothes make the man (woman).
Cold hand, warm heart.
Crime does not pay.
Curiosity killed the cat.
Dead men tell no tales.
Don't count your chickens before they're hatched.
Don't cross your bridges until you come to them.
Don't cry over spilt milk.
Don't give up the ship.
Don't put all your eggs in one basket.
Don't put off for tomorrow what you can do today.
Do unto others as you would have them do unto you.
Early to bed and early to rise, makes a man (woman) healthy, wealthy and wise.
Easier said than done.
East, west, home's best.
Easy come, easy go.
Every cloud has a silver lining.
Every dog has his day.
Experience is the best teacher.
Faint heart ne'er won fair lady.
Familiarity breeds contempt.
Fifty million Frenchmen can't be wrong.
Fools rush in where angels fear to tread.
Forewarned is forearmed.
For want of a nail, a shoe was lost.
Give a man enough rope and he'll hang himself.
Great oaks from little acorns grow.
Half a loaf is better than none.
Handsome is as handsome does.
Haste makes waste.
He also serves who only stands and waits.
Heaven helps those who help themselves.
He travels fastest who travels alone.
He who hesitates is lost.
He who laughs last laughs best.
Home is where the heart is.
Home is where you hang your hat.
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Honesty is the best policy.
If at first you don't succeed, try, try again.
If the shoe fits, wear it.
If wishes were horses, beggars would ride.
It is always darkest before the dawn.
It is an ill wind that blows no man good.
It is always better to light one candle than to curse the darkness.
It's all in a day's work.
It takes two to make a quarrel.
It takes two to tango.
Jack of all trades, master of none.
Keep a civil tongue in your head.
Laugh and the world laughs with you; cry and you cry alone.
Laugh before breakfast, cry before dinner.
Leave well enough alone.
Let him who is without sin cast the first stone.
Let sleeping dogs lie.
Like father (mother), like son (daughter).
Little strokes fell great oaks.
Look before you leap.
Lost time is never found again.
Love thy neighbor as thyself.
Make hay while the sun shines.
Man (woman) cannot live by bread alone.
Many hands make light work.
Marry in haste, repent at leisure.
Misery loves company.
Monkey see, monkey do.
Music hath charms to soothe the savage beast.
Necessity is the mother of invention.
Neither a borrower or a lender be.
No man (woman) can serve two masters.
No man (woman)is an island.
No man (woman) is a prophet in his own country.
Nothing ventured, nothing gained.
One hand washes the other.
One man's meat is another man's poison.
Out of sight, out of mind.
Out of the frying pan, into the fire.
People who live in glass houses shouldn't throw stones.
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Possession is nine-tenths of the law.
Practice makes perfect.
Practice what you preach.
Rome wasn't built in a day.
Seeing is believing.
Seek and ye shall find.
Silence is golden.
Still waters run deep.
Strike while the iron is hot.
The child is the father to the man (woman).
The devil finds work for idle hands.
The early bird catches the worm.
The fat is in the fire.
The grass is always greener on the other side of the fence.
The love of money is the root of all evil.
The morning is wiser than the evening.
The pen is mightier than the sword.
The pot calls the kettle black.
The proof of the pudding is in the eating.
There is an exception to every rule.
There is many slip twixt the cup and the lip.
There is a method in his madness.
There is nothing new under the sun.
There's no fool like an old fool.
There's no place like home.
There's safety in numbers.
The road to hell is paved with good intentions.
The thought is father to the deed.
The truth will out.
Time and tide wait for no man (woman).
Time heals all wounds.
Time is money.
'Tis better to have loved and lost than to never have loved at all.
To err is human, to forgive, divine.
Tomorrow is another day.
Too many cooks spoil the broth.
Turnabout is fair play.
Turn the other cheek.
Two heads are better than one.
Variety is the spice of life.
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Virtue is its own reward.
We are all in the gutter, but some of us are looking at the stars.
Where there's smoke there's fire.
While there's life, there's hope.
You can lead a horse to water, but you can't make him drink.
You cannot make an omelet without breaking eggs.
You can't have your cake and eat it too.
You can't judge a book by its cover.
You can't make a silken purse out of a sow's ear.
You can't take it with you.
You can't teach an old dog new tricks.
You made your bed, now lie in it.
You must learn to crawl before you can run.

References
Barry, Sheila Anne, Super-Colossal Book of Puzzles, Tricks and Games,
Sterling Publishing, Inc., 1978.

Mock Speaking Seminar

Objective: The objective of the Mock Speaking Seminar is to help members learn to
“tell their story” of addiction and recovery. Testimonial is a powerful self-help tool;
it instills hope in and boosts the morale of an audience in recovery. It has a similar
effect on the speaker himself, as he compares where he has been and where he is
now. The self-disclosure of recovering addicts humanizes addiction for a general
audience in the community and can encourage the use of treatment services. Mock
Speaking develops confidence and public speaking skills.

Format:

Three members should be selected by the seminar leader to speak at the assembled
seminar. They will be simulating a public speaking forum. One will serve as the
moderator and two will tell their stories. Of these, one should be a more senior
member (9 mos. or more) and one can be a bit more junior (6 mos. – 9 mos.).
Selected members should have enough time in program to be able to discuss their
experience with recovery.

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The seminar leader should tell the members who the audience is, i.e., senior citizens,
Rotary Club, high school students, etc.

I. Opening - The moderator opens the forum and provides the following (5
min.):

1. Greeting of the audience.

2. Introduction of self and speakers.
3. Brief description of program.
4. Let audience know that question and answer period will follow
presentations.
5. Ask members to speak, one at a time.

II. Basic Format for Giving Testimonials (15 min. each):

1. Introduction of self, how old you are, what program you’re in, how long
you’ve been in treatment.
2. How you got involved with drugs, how old you were, what drugs you
used, how long you used.
3. How you became drug dependent, how you knew you were drug
dependent, how your life and family became affected by drug use.
4. What made you come to treatment?
5. What treatment is like, what you have learned and changed as a result
of being in treatment.

DO NOT TELL WAR STORIES!

Do not go into details about drug-taking or criminal escapades. These sessions

are not to be a glorification of your drugging days. When you discuss your drug
use, you should convey its seriousness. The point you want to make to your
audience is how drugs created a crisis in your life and the hope that there is in
recovery. You should aim at inspiring the people in the audience to get help for
themselves or people they know. To members of the program, your message
should be one of hope and an encouragement to stay in treatment. Your success
in recovery is an example for others.

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III. Questions and Answers – After each member has told their story, the
moderator should open the discussion up for questions. The audience should
ask questions they think the members of the community would be interested
in. (15 min.)

IV. Constructive Criticism – The moderator should ask members to give the
speakers constructive criticism, i.e., how they might have made points more
effectively. (10 min.)

Pro and Con Seminar

Objective: The objective of the Pro and Con Seminar is to help members
broaden their perspectives by examining viewpoints different than their own. By
defending a position they do not agree with, they may be able to see the merits
of an opposing point of view and develop the capacity for empathy (being able to
put themselves in someone else's shoes). These exercises also point to the
inherent weakness of any extreme position and the advantages of compromise.
The abilities encouraged by the Pro and Con Seminar can help members become
more effective socially.

Format:

The Pro and Con Seminar is a debate of a controversial subject.

A controversial topic should be selected by the staff. A current story in the news
can be used if the community is familiar enough with the details to sustain a 45-
minute discussion.

The group should be divided in half, with one group on one side of the room and
the other on the other side. Each group should be assigned a position on the
subject, pro or con. Halfway through the discussion, the groups may be
switched.

One group should be selected by the leader to make the first statement in
support of its position. The opposing group will then have a turn to address the
statement with the opposing viewpoint. The teams will take turns throughout,
each rebutting the other's statements. There should be a point–by–point debate
of the issues at hand between the two sides, not a disjointed expression of

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opinions. Members should be instructed to raise their hands to speak so the
conversation is orderly.

The leader should attempt to facilitate the discussion so that it stays focused,
lively, and constructive. He/she may clarify points of view, ask members to
address points made by the opposing team, and keep the conversation on track.
Although the discussion should be a stimulating debate, it should not become an
argument in which people become angry or aggressive.

The last five or ten minutes can be used to process the debate. The leader should
help the group reflect on their experience. He or she may ask:

1. Did you learn anything you didn't know?

2. Do you feel any differently about your position on this subject? Why or why
not?

3. Did you learn anything about yourself?

4. What do you understand about people who feel differently on this subject
than you? Where are they coming from?

Possible Topics for Pro and Con Seminars:

a. Abortion
b. Euthanasia
c. Free Will vs. Determinism (people are in control of their destinies vs. being
limited by fate, God's will, biology, etc.)
d. Gay Rights, e.g., gay marriages
e. Free Speech, e.g., KKK, Nazis, Skinheads
f. Reproductive Rights of Mentally Handicapped
g. Gun Control
h. Privacy Rights of President and Other Elected Officials
i. Drug and HIV Testing by Employers
j. Capital Punishment
k. Personality and Behavior: Nature or Nurture? (genes and biology or
upbringing)
l. Prayer in Public Schools
m. Legalization of Marijuana (Drugs)
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n. Privacy Rights of Celebrities vs. Freedom of the Press
o. Jobs are gender-related (Gender determines what job one can have/do)
p. Religion versus spirituality
q. Evolution versus creation
r. Extra-terrestrial beings (Beings other than human beings in the universe)

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 Morning Meeting Sign-up Sheet
Date:______________________________________________
Facilitator: Coordinators, Chief Expediters, or Staff
1. Philosophy (all):Led by:___________________________
2. Word of the Day: by:______________________________
3. Public Announcements:
by____________________________________________
by____________________________________________
by____________________________________________
4. Community Pull-ups:
by____________________ by _____________________
by____________________ by _____________________
by____________________ by _____________________
by ___________________ by _____________________
by ___________________ by _____________________
5. Public Affirmations:
by ___________________ by _____________________
by ___________________ by _____________________
by ___________________ by _____________________
by ___________________ by _____________________
by ___________________ by _____________________
6. Concept of the Day by _____________________________
7. News-Weather, Sports, Horoscopes, Upbeat Headlines:
by ___________________ by _____________________
by ___________________ by _____________________
8. Skit or Joke: by:____________________________________
9. Song: by _________________________________________

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 TC RULES

Cardinal Rules:
1. No physical violence or threats of physical violence
2. No drugs or alcoholic beverages
3. No Sex or Sexual Acting-out
4. No Stealing

Example of Basic House Rules:

1. Treat fellow clients and staff with respect.
2. Be honest, in word and behavior.
3. Accept authority and follow directions.
4. Be on time to all activities.
5. Adhere to dress code and facility standards of cleanliness.
6. No weapons of any kind or anything that can be used as a weapon
allowed.
7. Gang affiliation must be checked at the door; gang activity is strictly
prohibited.
8. Friendships between clients are encouraged; no sexual relationships are
permitted.
9. Respect the belongings of others.
10. Do not lend or borrow.
11. No smoking or tobacco products are allowed on premises.
12. Staff permission is needed to leave facility.
13. All residents must sign out/in in the log when leaving and returning to
the facility
14. All residents must leave the facility by the designated front door only.
15. Staff permission is needed to make or receive phone calls.
16. Only those personal possessions on the approved property list will be
permitted in the facility. Other personal items must have counselor
approval, including gifts.

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 Group Rules and Objectives

Rules for all groups:

o Respect fellow group members and their safety
o Let others speak, one at a time
o Speak for yourself and let others speak for themselves
o Stay in the group at all times
o Stay in seat, unless asked by facilitator to move
o Listen to the feedback of others, even if you don’t agree
o Hold all said in group in confidence
o All in the group are equal
o Uphold personal dignity
o When necessary to express disapproval, it should be of behavior, not the
person

The Goals of Encounter or Concern Group are to:

 Solve problems related to life in the community
• Learn about ourselves and others through feedback and discussion, and
looking at “here and now issues”
• Raise awareness on how our behavior affects ourselves and others.
• Find helpful ways to resolve differences with others.
• Understand why we behave the way we do and how our feelings, thoughts
and behaviors influence each other
• Commit to small behavior changes that will help us work on personal goals
• Develop relationship skills
• Learn how to deal with stress and other problems in an effective way

Participating in encounter group will help you:

 Express your feelings effectively
 Solve problems constructively
 Practice honesty
 Give and receive difficult and positive feedback
 Practice assertiveness
 Learn the truth about yourself and others
 Think clearly about your goals
 Improve communication skills
 Learn how to have successful relationships

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 The TC Philosophy

I am here because there is no refuge,

finally, from myself. Until I confront myself

in the eyes and hearts of others, I am running.

Until I suffer them to share my secrets,

I have no safety from them. Afraid to be known,

I can know neither myself nor any other;

I will be alone.

Where else but in our common ground,

can I find such a mirror?

Here, together, I can at last appear clearly

to myself—not as the giant of my dreams,

nor the dwarf of my fears, but as a person,

part of the whole, with my share in its purpose.

In this ground, I can take root and grow,

not alone anymore, as in death,

but alive—to myself and to others.

Richard Beauvais

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 References

Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ:

Prentice Hall.

Campling, P. & Haigh, R. (Eds.) (1999). Therapeutic Communities: Past,

Present and Future. London: Jessica Kingsley Publishers.

De Leon, G. (2000). The Therapeutic Community: Theory Model and

Method,. New York, NY: Springer Publishing.

Jones, M. (1968). Beyond the Therapeutic Community: Social Learning and

Social Psychiatry. New Haven, CT: Yale University.

Perfas, F.B. (2012). Deconstructing the Therapeutic Community. New York:

Hexagram Publishing.

Perfas, F.B. (2014). Therapeutic Community: Past. Present. And Moving

Forward. New York: Hexagram Publishing.

Rawlings, B. & Yates, R. (Eds.) (2001). Therapeutic Communities for the

Treatment of Drug Users. London: Jessica Kingsley Publishers.

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