Therapeutic Communities, Family Therapy, and Humanistic Psychology: History and Current Examples
Identifieur interne : 000192 ( Istex/Corpus ); précédent : 000191; suivant : 000193Therapeutic Communities, Family Therapy, and Humanistic Psychology: History and Current Examples
Auteurs : Veerle Soyez ; Eric BroekaertSource :
- Journal of Humanistic Psychology [ 0022-1678 ] ; 2005-07.
Abstract
This article discusses the use of residential therapeutic communities (TCs) to help addicts recover. The European and American antecedents of the TC and the model’s further evolution and dispersion are described. The increasing openness of the TC toward the outside world and its changed attitude toward family involvement have played important roles in the evolution of the TC. In this context, the article also pays attention to the family approach in the early TC and the major family therapeutic schools that influenced the model, specifically contextual therapy. A renewed attention to its humanistic roots can preserve the TC from becoming just another substance abuse treatment modality. However, good functioning of the TC as humanistic organization also requires openness, professionalism, and scientific input. Those elements are as safeguards against destructive charismatic leadership and insularity.
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DOI: 10.1177/0022167805277105
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<meta-value> 10.1177/0022167805277105 ARTICLETherapeutic CommunitiesVeerle Soyez, Eric Broekaert THERAPEUTIC COMMUNITIES, FAMILY THERAPY, AND HUMANISTIC PSYCHOLOGY: HISTORY AND CURRENT EXAMPLES VEERLE SOYEZ (Ph.D.) is a research and teaching assistant at the Department of Orthopedagogics (Special Education) at Ghent University (Belgium).After finishing her master in orthopedagogics,she has followed an additional training in contextual therapy and recently completed her Ph.D. dissertation focusing on the involvement of social networks during therapeutic community treatment. ERIC BROEKAERT (Ph.D.) is a professor and head of the Department of Orthopedagogics (Special Education) at Ghent University (Belgium). He is considered as one of the leading experts in Europe concerning therapeu- tic community treatment. His research activities specifically focus on the historical aspects and the development of the therapeutic community movement (Synanon, pioneers, etc.). Summary This article discusses the use of residential therapeutic communi- ties (TCs) to help addicts recover.The European and American ante- cedents of the TC and the model's further evolution and dispersion are described. The increasing openness of the TC toward the outside world and its changed attitude toward family involvement have played important roles in the evolution of the TC.In this context,the article also pays attention to the family approach in the early TC and the major family therapeutic schools that influenced the model, spe- cifically contextual therapy. A renewed attention to its humanistic roots can preserve the TC from becoming just another substance abuse treatment modality. However, good functioning of the TC as humanistic organization also requires openness, professionalism, and scientific input. Those elements are as safeguards against destructive charismatic leadership and insularity. Keywords: therapeutic communities; substance abuse treatment; family therapy; contextual therapy 302 Journal of Humanistic Psychology, Vol. 45 No. 3, Summer 2005 302-332 DOI: 10.1177/0022167805277105 © 2005 Sage Publications INTRODUCTION Therapeutic communities (TCs) for addicts are widely used as a residential treatment modality for people with severe substance abuse problems. Being preceded by the European democratic TC and having its roots in Synanon, the TC underwent a number of important adaptations over the years resulting in the model it is nowadays. One of the most important changes is probably the increasing openness of TCs in dealing with the outside world and with the families of residents. Humanistic psychology has played an important role in the early history and the subsequent development of TCs as well as in the survival of the TC. Historically, the influence of Abraham Maslow's ideas and the implementation of humanistic-based ther- apies in the TC have been invaluable; more recently, the efforts to implement some new frameworks in the TC model, such as the family therapy model of Ivan Boszormenyi-Nagy that is based on the existential theories of Buber, have led to a renewed attention for these humanistic roots. This renewed attention can preserve the TC from becoming just another substance abuse treatment modality or fade away as a soulless mechanistic enterprise. On the other hand, it may not cover some inherent dangers: Only open- ness, professionalism, and scientific research are sufficient safe- guards for a too utopian romantic approach of the TC movement. This article tries to contribute to one of those goals, a more scien- tific approach of the TC model, by examining in detail some of its important historical and current issues and putting them into per- spective: The European antecedents, the history of Synanon, the dispersion of the TC model, the family approach in the early TC, the major family therapeutic schools that influenced the TC, and the position of contextual therapy are all described and discussed. THE THERAPEUTIC COMMUNITY The modern TC has a number of important precursors of which Synanon is the best known. However, some other independent Veerle Soyez, Eric Broekaert 303 AUTHORS' NOTE: Reprint requests: Veerle Soyez, Ma.Ed., Ghent University, De- partment of Orthopedagogics, Henri Dunantlaan 2, 9000 Gent, Belgium; e-mail: veerle.soyez@UGent.be. impulses that influenced the development of the TC model came from the European continent. The European TC for adults, referred to as the democratic TC, takes a prominent place here (Broekaert, Vanderplasschen, Temmerman, Ottenberg, & Kaplan, 2000). European Precursors The democratic TC is based on "milieu" or "environmental" therapy and developed since the 1940s in England. Wilfred Bion and John Rickman (Bion, 1960), on the one hand (first Northfield experiment), and Harold Bridger and Heinrich Foulkes (Foulkes, 1948),on the other (second Northfield experiment),took care of sol- diers suffering from neurosis through war events in an English army hospital at Northfield. They tried to innovate psychiatry by concentrating on the "here and now" and on group interaction and by stressing the importance of clients' social setting and the global approach of the organizational structures. The innovators were psychoanalytically formed and paid attention to the creation of a transitional space of experience, which allowed growth and development (Bridger, 1984). Almost simultaneously, in 1939, Maxwell Jones started his innovating work in the "Effort Syndrome Unit" at "Mill Hill Public School." He continued these efforts at the Belmont Industrial Neu- rosis Unit, the later Henderson Hospital (Jones, 1952). Jones, an archetypal charismatic innovator (Rapoport, 1970), strived for "more open communication, less rigid hierarchy of doctors, nurses and patients, and daily structured discussions of the whole unit and various subgroups" (Jones as cited in Manning, 1945, p. 271). Residents were given decision-making powers. The former hierar- chical structure of the psychiatric hospital became more horizon- tal. The staff roles and job descriptions changed (democracy). An atmosphere receptive to social learning was created; the group rather than the individual became the agent of change (com- munalism). Patients were seen as persons and were permitted to utter whatever emotions (permissiveness). They learned to test the borders of reality during social interaction with residents, staff, and the larger society (reality testing) (Rapoport, 1960). 304 Therapeutic Communities Synanon: The Beginning At first independently from the European achievements, the development of the American TC for substance abusers started in the early 1950s. The history and background of this drug-free or concept TC has been described intensively (e.g., De Leon, 2000; Rawlings & Yates, 2001). The American TC model originates from Synanon, which was founded by Charles (Chuck) Dederich in 1958 (Broekaert, 1999; Casriel, 1963; Endore, 1967; O'Brien, 1993; Yablonsky, 1965). Dederich was born in 1913 in Toledo as the first of three sons in a Republican Catholic family. His father--an alcoholic of German background--died when he was 4 years old, and his mother over- protected him. A few years after his father's death, Chuck reluc- tantly but undisputedly took the father position in the family. Later, he rebelled against his stepfather and started calling him- self a socialist, democrat, pro-labor, and atheist. After finishing high school, Dederich entered Notre Dame where he met his surro- gate father, a priest with whom he discussed philosophy, sociology, and religion: Freud, Thoreau, Lao Tse, Buddha, Plato, and Emer- son. These subjects together with some unconscious Jesuit doc- trine would form the basis of the later seminars at Synanon (Casriel, 1963). Dederich failed at Notre Dame and got a job at Gulf Oil.He hung out with a group of dedicated Communist Party members (Gerstel, 1982). After a second marriage failure in 1955, he started drinking heavily. Somewhat later he joined AA and went on a controlled LSD experiment at the University of California, Los Angeles (Aus- tin, 1971). While reading Emerson's essay on self-reliance, Dederich experienced a conversion and became aware that he had to rely on own thinking and trust (Garfield, 1978). He started to apply the AA principles and methods to drug addicts, an initiative that resulted in some tensions between him and the AA: "The alkies didn't like the addicts" (Bassin, 1977, p. 3). Dederich decided to split, together with his group of about 20 followers (some alco- holics but mostly drug addicts) from the parent organization, lay- ing the foundations of Synanon. The name Synanon goes back to a malapropism--uttered by Gray Thompson, a renowned malapropist--when saying symposium and seminar at the same time. Synanon was adopted as name of the organization, and only Veerle Soyez, Eric Broekaert 305 later members realized its routes were syn, meaning putting together, and anon, meaning the unknown (Janzen, 2001). The first aim of Synanon was to change the substance abuser from "dopefiend" or "emotional child" into a "self-developing per- son" aware of his or her own potentials (Casriel, 1963, p. 168). This required disciplined behavioral change and growth of self-aware- ness, which was expected to be reached through the interplay of two mechanisms. First there was "the game:" "a complete expres- sion of the full range of human emotions" (Garfield, 1978, p. 8). In the game, the normal dichotomies of life, such as good versus bad, were not supposed to exist;the game represented the transcenden- tal and metaphysical world where an "enthusiastic" (en = within, theos = God) search for unity or wholeness prevailed. However,this search was often characterized by irreverence (Garfield, 1978) as game members attacked each other's weaknesses, ostensibly to force the other to take responsibility for his or her own life. Although the organization forbade physical violence, considerable verbal violence was possible and psychological violence was not eliminated. The game could consequently be used as a mean for indoctrination, alienation, and personality change (Broekaert, Vandevelde, Schuyten, Erauw, & Bracke, 2003). Secondly, there was the structure of the Synanon organization where "act as if" and "the reality of every days' life" prevailed. The dichotomies of life were prominently present in this daily structure and were con- sidered to be essential for social interaction (Dederich, 1978). Because behavior changes should be seen as internal changes leading to the acceptance of responsibilities, public living in Synanon (the structural and organizational aspects of "self- development" and "awareness") always prevailed as a function of the game (Simon, 1978). Organizational Evolutions The start of Synanon is referred to as "Synanon as Therapeutic Community" (Synanon I: 1958-1968). The impulse for the creation of Synanon lay in the massive social movements that character- ized California after the Second World War (Kaplan & Broekaert, 2003). In those days, Synanon's philosophy and treatment concept were based on some early Christian values and Zen influences (Garfield, 1978; Glaser, 1977; Mowrer, 1976), the ideas of the Oxford Group (Moral Rearmament) (Lean,1985), Alcoholics Anon- 306 Therapeutic Communities ymous (Bassin, 1977), the Human Potential Movement (Janzen, 2001), Skinner's Walden Two, and the Utopian Community (Maillet, 1972). Gradually "Synanon as Social Movement" (Synanon II: 1969-1975) replaced this Synanon I. Through a close collaboration with sociologists, Synanon evolved as an expression of "anti-psychiatry" rather than psychiatry: The aim was not only to change the individual's behavior but also the social environment in which the individual lived (Kaplan & Broekaert, 2003). In 1967, Synanon "game clubs" were opened for nonaddicted outsiders or "squares" who could play the game in some outside locations.Some of those squares became "lifestylers" and joined the movement. Synanon was now operating as an "Alternative Lifestyle Utopian Community" (Richardson, 2000b). Reinsertion of addicts into soci- ety was replaced by lifelong commitment, and the function of the game started to change now, as the lives of the squares and lifestylers showed little resemblance to that of the first (ex-addict) Synanon members (Warner, 2002). Lifestylers brought in money and a start for business and wealth of the community. Newcomers got some basic "walking around money" that ranked in accordance to their position in the hierarchy (Ofshe, 1973). Synanon's Advertising Gifts and Pre- mium Business (ADGAP) was growing rapidly and attracted the direct attention of the Dederich family. From 1975 on, Synanon wanted to protect its tax exemption and aimed at operating as a "church" (often referred to as cult) (Mitchel, Mitchel, & Ofshe, 1980).The board followed the advice of attorney and vice president Dan Garrett who stressed that Synanon was a direct descent of the Oxford Group Movement (later: Moral Re-armament Movement) (Mitchel et al., 1980). This movement was initiated in 1908 by Frank Buchman, a Lutheran minister, who--after his spiritual conversion--inspired a "first century Christian fellowship:" "a voice against the organized and lifeless Christian Work and an attempt to get back to the beliefs and methods of the Apostles" (Lean,1985,p.97)."Synanon as Religion"(Synanon III:1975-1991) was born, but simultaneously the organization denied the dark face of its heritage: In his Christian attempts to fight communism, Buchman tried several times to reach Hitler. In 1936, returning from the Olympic Games, he stated in a press interview (published in the New York World-Telegram) with Tom Driberg--an anti- Moral Rearmement campaigning British journalist--: "I thank God for a man like Hitler,who built a ground line of defense against Veerle Soyez, Eric Broekaert 307 the anti-Christ of communism" (Driberg, 1964, p. 68). According to Lean (1985), this statement was not Buchman's, but it had turned up in the interview as a consequence of the editorial process. On the other hand, he stated, "It is however clear that Buchman said something to the effect that we could be grateful that Hitler had turned back communism in Germany" (p. 240). This incident undoubtedly illustrates Buchman's belief in authority and leader- ship, but it can be questioned if he would have approved Dederich absolute and uncontrolled leadership. Under the direct influence of Dederich, while using mechanisms such as the game (that offered knowledge of the most private aspects of one's life),the wire system (through which Dederich from his office could communi- cate whenever and to whomever he wanted), and the tapes (mes- sages from Dederich to the membership that were sent out repeat- edly), the minds of people were controlled and brainwashed (Janzen, 2001). Several strange experiments took place (Richard- son, 2000a; "Life at Synanon Is Swinging," 1977). For example, in 1977 all men older than 18 that were Synanon members for more than 5 years were requested to undergo vasectomy--Dederich remaining the only man without vasectomy--while pregnant woman were obliged to commit abortion because Synanon had the mission to take care of all children in the world. According to Mitchel et al. (1980), the ultimate demand came in late 1977 when virtually all Synanon couples--married or not--were required to "change partners." Synanon became criticized by the press and charged with com- plaints of child abuse and violence. Dederich denied but reacted bitterly. A rattlesnake put in his postbox attacked the attorney Paul Morantz, who once won a suit against the organization. Two members of Synanon's paramilitary organization "The Royal Marines" were arrested ("Synanon's Founder Is Arrested," 1978). Tapes were found with statements of Dederich calling for violence. He got arrested under the influence of alcohol, was diagnosed manic depressive, and was assigned to a hospital room suffering from heart problems (Mitchel et al., 1980). Dederich resigned from the Synanon board in 1987 and died 10 years later; Synanon dis- mantled as an organization in 1991 (Janzen, 2001). Regardless of its collapse, it had given birth to a stormy development of TCs all over the world. 308 Therapeutic Communities The Synanon Offspring In 1959, William B. (Bill) O'Brien, a Catholic priest, visited-- coincidentally together with the psychiatrist Dan Casriel-- a Synanon outpost at Green Farms Road in Westport, Connecticut. He was very much impressed by Synanon's achievements. O'Brien (1993) wrote, "We were among Synanon's biggest boosters" (p. 63). In 1964, O'Brien and Casriel broke with Synanon--in reaction to the lifelong commitment of Synanon members, the lack of profes- sionalism,the closeness toward the outside world,and the authori- tarian tendencies and uncontrolled charismatic leadership of Dederich (O'Brien, 1993)--and founded Daytop Village, the first drug-free hierarchical TC according to the Synanon model (Sugarman, 1974). Daytop wanted--even more than Synanon--to stress its impact on society: Village implies a wider scope of influ- ence than was implied by the Synanon notion of house (Casriel, 1963). In Synanon there were mixed feelings about this ongoing evolution: "But can New York's program, by stealing our ideas and seducing our people, can they really be proud of what they've done?" (Endore, 1967, p. 357). Whatever, the TC model rapidly spread over the United States. The Phoenix Houses (Mitch Rosenthal), Odyssey House (Judianne Densen-Gerber), Delancey Street Foundation (John Maher) (Hampden-Turner, 1976), Walden House (Alfonso Alcampora), and Eagleville Hospital (Don- ald Ottenberg) further developed the model but were all to a cer- tain degree indebted to Synanon. In Canada, L'Institut Portage (Peter Vamos) and in Europe Phoenix House Londen (Ian Christie) took leading positions in the further spreading of the movement. A decade later, the first Asian, African, Latin American, and Australian communities were set up. With the spread of the TC over the world, several adaptations were made to the long-term traditional model. A first important influence in this context came from the rapprochement between the European and the American TC model after a long period of independent development and contradictions (Ottenberg, 1978). At the end of the 1970s, Maxwell Jones (1979) stated, It could be said that all the therapeutic communities described, both "old" [i.e., European] and "new" [i.e., American], have certain trends in common. All subscribe to the power of the client peer group . . . all Veerle Soyez, Eric Broekaert 309 started as residential communities . . . all claim to espouse a demo- cratic social organization and democratic ideals . . . all avoid the extreme professionalism. (p. 147) In 1980, Jones reported finding even more similarities than differ- ences in the two approaches. He saw the therapeutic nature of the total environment (social learning) as the main power in the TC,an idea that contributed greatly to the fundamental concept of com- munity as method in the TC for addicts (De Leon, 2000). Since the 1980s, the TC model has been confronted with new challenges.The AIDS epidemic merged with an enormous increase of substance abuse, often associated with health problems and criminal behavior. Harm reduction for the individual and society was promoted as an alternative to specialized treatment (Inciardi, 1999). The TC reacted by expanding its methods to different tar- get groups, such as homeless, prisoners, adolescents, substance- abusing mothers and their children, and psychiatric and dual- diagnosed populations (De Leon, 1997). Gradually, the TC also showed interest in participating in an integrated systems approach--"interrelated clinical interventions and social services that are guided by a common social-psychological vision of the individual and of recovery" (De Leon, 1997, p. 268)--in which the most effective treatment is provided in reply to the client's needs (De Leon,1996). Inspired by new management thinking,new orga- nizational principles based on coordination and continuity of care were adopted by the substance abuse field as well (Broekaert & Vanderplasschen, 2003). Within this vision, TC treatment alter- nates other forms of treatment even if those don't start from a recovery point of view. Regardless of those important evolutions,the basic TC elements and treatment goals always remained unchanged. The TC aims at the development of a new social self and at the reconstruction of a lifestyle (De Leon & Beschner,1976);the primary treatment goal is to encourage personal growth (Kerr as cited in Kooyman, 1993). The therapeutic program in the TC is based on the use of a peer community to achieve change ("community as method"; De Leon, 2000) and on two basic pillars: regular encounter groups (cf., the Synanon game) and a hierarchic structure.The customs character- istic of the game were mainly adopted in the first TCs and are still preserved in some TCs today. The hard confrontations in the 310 Therapeutic Communities encounter strove to break the image of the addict.However,it often happened that not only the image was destroyed but that the per- son felt broken,devalued, humiliated,and without support.Conse- quently, many dropped out of treatment prematurely because they did not get time to experience the support and comprehension that made the therapy tolerable (Bracke as cited in Broekaert et al., 2003). Safety and trust are considered central elements; residents are not only taught to (re)invest trust in relationships and in the world, but they are also asked to have blind faith, or at least to "act as if" they have blind faith in the program (Broekaert, 2001). Act- ing as if is not just an exercise in conformity but an essential tool for psychological change (De Leon, 2000). On the other hand, resi- dents are required to show responsible concern: They assume per- sonal responsibility for the recovery of their peers. This vision embraces the idea that monitoring,challenging,and affirming oth- ers in their struggle to recover is also caring about them (De Leon, 2000) and also stresses the fact that learning in the TC takes place as social learning through social interaction (Kooyman, 1993). Confrontation (instead of acting-out behavior), positive peer pres- sure,and learning to express emotions are other important change agents in TC treatment (Kooyman, 1993). Those elements all together are supposed to form the basis to reach treatment goals, especially because they are supported by an extraordinary capac- ity to reconcile ideas and activities that are usually polarized (Hampden-Turner, 1976). However, in reality, the daily structure of the TC, the chain of commands, and the harsh confrontation groups have often been experienced as extremely male oriented and of limited use for residents with psychiatric problems or learn- ing disabilities. Modified TCs, for example, for women and dual- diagnosed clients, tried to offer an alternative for these subpopulations. Previous findings may indicate that in TC practice, the central humanistic starting points are not always as prominently present as they should be.However,the TC has genuine humanistic roots:a belief in the human potential to change and to overcome addiction, a deep respect for human values and direct honest encounter, and hope for a better world based on human understanding. These humanistic roots were already stressed in Synanon. Veerle Soyez, Eric Broekaert 311 Humanistic Psychology in Synanon and the First TCs From the beginning,Synanon has been presented as an example of humanistic organization by several authors: Casriel (1976) cofounder of Daytop Village stated, In retrospect it is evident that Synanon and Daytop, as well as the groups I was running, were part of something going on--not just with addicts--but with people. The human potential movement had begun. The National Training Laboratory was growing fast. Follow- ers of Maslow and Rogers had founded the Association for Humanis- tic Psychology. (p. 54) Durand-Dassier (1970) confirmed that the work of Carl Rogers can be considered as essential for the drug-free TC, as the authenticity and real acceptance of the other with his major problems can be seen as the heart of the TC approach. Gould (1975) added, "Maslow's work on self-actualization (1968) and Buckminister Fuller's formulations (1969) on the design and use of environments that allow innovative use of living space and resources have also been central to the growth of Synanon's lifestyle and value system" (p. 100). Abraham Maslow definitely played an important role in the development of Synanon. Dederich was fascinated by Maslow's work and met him in 1966 (Janzen, 2001). He considered the thoughts of Maslow as a modern version of the work of Emerson, the 19th-century American transcendentalist he loved so much. According to Emerson (1955), transcendentalism is idealism, where the belief in human possibilities is sustained by an all- inspiring divine source, the "Over-Soul" or "the Universal Mind." There is hierarchy in everything, but the highest realization of man is integrity.A man has to become integer,honest,creative,and permanently to develop his possibilities. This process of "self-reli- ance" can best be realized in an ideal state where the natural hier- archy is based on love (Emerson, 1940, 1955). Maslow developed parallel ideas: People move through a hierarchy of needs. Their body, security, social, and ego needs form the step-by-step basis of growth toward self-actualization, an ongoing process during which healthy personalities fully exploit their talents. The qualities and values they discover during this process (B-values) include integ- rity, honesty, and creativity. Episodes of self-actualization can result in peak experiences: moments of great happiness, insight, 312 Therapeutic Communities and blessing. The creation of a society where all people search for a maximum of self-actualization is called Eupsychia (Maslow, 1961, 1968). On the "By-Pass tapes," tape recordings of conversations between Dederich and community members, Dederich called self- actualization in an elected community as Synanon the basic assumption for the creation of a "Eupsychian society" (Janzen, 2001). After visiting Daytop, Maslow also praised Synanon as a uto- pian society (Maslow, 1971), and he described Daytop as a beauti- ful place that had lessons for everyone--not just for drug addicts (Maslow, 1971; O'Brien, 1993). He stated that the self- actualization of substance abusers can be compared to a violent process of wrestling through shyness and pain: When the ache is surpassed, the process to self-actualization becomes a very pleas- ant thing (Maslow, 1971). A few years earlier, Maslow called direct emotional confronta- tion (as used in the Synanon game and the later encounter groups) as a token of respect for existential being (Maslow,1967).One of his Ph.D. students, Simon, spent many years in Synanon and evalu- ated the game as the reaffirmation of B-values (Simon, 1978). It thus meets the meta-needs to pursue truth, to dispel dishonesties, to pursue goodness, to attack evil, to root out selfishness, to create beauty in the faces and lives of other people, to sense unity and wholeness, to transcendent dichotomies and live by higher stan- dard. (Simon, 1978, p. 18) At the same time, he situated the game within Eastern mystical concepts and considered "consciousness of unity within polarities" an ultimate goal, a vision that corresponds to Emerson's neo-ro- mantic belief in the Universal Mind. Transpersonal concepts pro- mote organizational change,and therefore the game "appears to be the type of self-corrective change mechanism that Rogers and some other authors have called for in organizations and large so- cial groupings" (Simon, 1978, p. 16; O'Hara & Wood, 2002). Indeed, Rogers basically seems to take the same position of Maslow here. He also joined Maslow in this vision that the criticism of others,the emotional reactions to one's behavior by others in the group, and huge confrontations during encounters are most probably seen by the residents as care and concern (Rogers,1970).Rogers confirmed Bassin's opinion that Veerle Soyez, Eric Broekaert 313 perhaps beneath the veneer of cursing, shouting, moralizing and judging was a supply of pure undiluted love and concern that none of the residents had ever experienced before. The shouting and screaming was interpreted in the phenomenological field of the street culture as the ultimate expression of concern for the well- being of a family member. (Bassin, 1977, p. 10) Unconditional love and acceptance is the condition to transcend di- chotomies and to achieve insight, responsibility,self-actualization, and self-reliance. Despite this clearly humanistic aspiration of Synanon, the gap between the ideology and the practice always existed--as has been illustrated by the attitude of its leader and by the abuses of the game as therapeutic tool. Humanistic Psychology and the Modern TC With the further spread of the TC over the world, new elements-- a lot of them humanistic in nature--were added to the model and enriched the treatment approach, such as psychodrama, transactional analysis, New Identity Process, bonding therapy, bio-energetic groups, reality therapy, and Pesso psychotherapy (Kooyman, 1993). Although the essence of those approaches is to realize behavioral change, this has little to do with a Skinnerian or mechanistic view (Bratter, Collabolleta, Fossbender, Pennachia, & Rubel as cited in Broekaert et al., 2000). The behavioral approach in the TC is theoretically strongly opposed to the idea of punish- ment and mechanistic influencing. The learning experiences and encounters used in TCs are supposed to promote behavioral change within a value-oriented context and are considered to be tokens of mutual "responsible concern" (Broekaert et al., 2000). Within the same perspective, Casriel (1976) considered the TC a global method that involved "the re-education of what I call 'Trian- gular Men'. The ABC's are man's Affect, Behavior and Cognition" (p. 5). In Europe, Mario Picchi and Juan Corelli largely contributed to elaboration of a "Christian humanism" and to the humanistic input in the TC model by developing "Progetto Uomo" (Project Man), a philosophy putting the human being in the center of his own history (Picchi, 1994) and stressing the importance of mental, psychological,and spiritual growth (Correli & Briggs,1989).Progetto 314 Therapeutic Communities Uomo strongly influenced TC work in Italian- and Spanish- speaking countries in Europe and Latin America (Picchi, 1994). FAMILY THERAPY IN THE THERAPEUTIC COMMUNITY Parallel to the general evolutions in the TC model, some changes in the way TCs looked at family involvement and family treatment occurred. This evolution in turn cannot be separated from the general development of family therapy for substance abusers. Literature on families of substance abusers was published as early as the 1950s (Stanton, Todd, & Associates, 1982). Over the years it was given evidence that the family could not only play a functional role in the development of substance abuse problems but could also be important in the rehabilitation of the substance abuser: It was shown that the involvement of the family in treat- ment was a way to improve retention. In contrast to the alcoholism field, which already experimented with family and marital ther- apy techniques since the 1950s, family approaches weren't intro- duced in treatment facilities for drug abusers before the late 1960s or even the early 1970s (Coleman & Davis, 1978; Kaufman & Kaufmann, 1992; Liddle & Dakof, 1995; Stanton, 1979). But even then,family therapy had to continue fighting for a place within the treatment facilities. This was especially the case in the TC, where the vision on family involvement was guided by the habits of Synanon for a long time. The Family in Synanon and the Early TCs Synanon saw its members as part of an extended family that lived apart from the outside world (Yablonsky, 1965). The family of origin was not considered important for the substance abuser's recovery process and was even labeled as part of the problem of substance abuse. Whether or not the personal background of Dederich influenced this vision is never described in the literature, but he was particularly critical toward parents of substance abus- ers, whom he referred to (both male and female) as "mother- lovers." According to Dederich, mothers often gave their Veerle Soyez, Eric Broekaert 315 substance-abusing children a kind of unconditional love, keeping them away from any initiative to change their behavior (Janzen, 2001). Dederich also used a self-described "father-principle" on which he fell back to put women in an inferior position. This princi- ple suggested that substance abusers "were people who had too strong a dose of mother love . . . and had never been properly house- broken by [their] father" (Janzen, 2001, p. 123), and it emphasized the punishment of "bad behavior,"which mothers were not thought to be adept at. The tendency to separate the substance abuser from his family was taken over by the first Synanon-based therapeutic communi- ties. It was believed that the ethos of the TC and family involve- ment/therapy was not compatible because the TC saw family rela- tionships as destructive influences that needed to be avoided, whereas family therapy saw residential treatment as too divorced from the interpersonal pressures in the outside world (Stanton, 1979; Ziegler-Discroll, 1977). Usually members of the community were addressed as "family" and relatives of the resident as "my family" (Ames, 1976). In 1967, Daytop Village opened some ambu- latory outreach centers for younger substance abusers, and paral- lel to this evolution, family involvement obtained a structural place in the TC (Kooyman, 1993; Lakoff, 1984). The real shift how- ever came in the beginning of the 1970s when it was realized that "treating drug abusers apart from their families was an exercise in futility" (Dell Orto, 1974, p. 441). The TCs learned that the partici- pation of family members in treatment could prevent them from activities undermining the efforts of treatment staff (O'Brien, 1983). The family of origin was no longer seen as the enemy of the staff in most TCs and became involved in treatment from the moment of intake (De Leon & Beschner, 1976), although there was no real family therapy yet. The first efforts to implement family therapy elements in the TC came from Pauline Kaufmann, an adherent of Minuchin, in Phoe- nix House New York. She started with multifamily groups for ado- lescents in day care (Kaufman, 1992b; Kaufmann, 1979). In most residential TCs however, there were only conversation groups for relatives; the residents were not involved in those groups and were almost exclusively in contact with peers and staff members until reentry. Possible tension between families and residents was sup- posed to be detrimental to treatment;stabilization of the client and maturation of the family were preliminary conditions for a mutual 316 Therapeutic Communities encounter. Family meetings got a central place during reentry phase to prepare graduation (Kalajian, 1979). It was not until the end of the 1970s before residents became widely involved in family therapy, together with their relatives, from an early stage of treatment (Broekaert, 1985; Kaufman & Kaufmann, 1992; Kaufmann, 1979). Individual family therapists and TC programs started to cooperate, and family therapy was no longer promoted as an alternative to inpatient treatment, but it was seen as a way to support the family (Kooyman, 1993). As a result, family counseling and family therapy became more widely accepted in the TCs, and family groups became less rigid (Kooyman, 1993). Even today, many residential traditional TCs (mainly in the United States) don't provide regular family treatment (Coleman & Davis, 1978; De Leon, 1995). If family treatment is offered, it is mostly seen as an extra service but seldom as a necessary, integra- tive aspect of TC treatment,especially in the residential programs. Family Therapy in the TC1 The rapprochement between family therapists and the TC in the 1970s led to the introduction of family therapy techniques that were compatible with the TC model: It was tried to mold the famil- ial approaches to fit within the existent programs (Stanton, 1979). Group treatment for parents in which the substance abuser was commonly not engaged was the most reported approach for resi- dential TCs (Dell Orto, 1974; Kaufman, 1992b; Kooyman, 1993; Ziegler-Discroll, 1977). Often the content of such parent groups was of an educational nature (Stanton, 1979), although multiple family therapy (MFT) groups (Kaufman, 1992b) were also very popular. Kaufman (1992b) described the different roots of MFT and referred to the "ward or town meeting concept of both the psy- chiatric and Synanon modes of the TC" (p. 81) and to group tech- niques such as the encounter. He also stated that "the setting which most readily lends itself to the establishment and continu- ance of a successful MFT group is a residential TC" (p. 82). Although most of the applied techniques were based on certain basic principles, there was--and still is--a wide diversity of family treatment approaches used in the TC (Stanton, 1979). In a large survey, Coleman and Davis (1978) found that the ideas of Virginia Satir revealed to be the most influencing on family therapists Veerle Soyez, Eric Broekaert 317 working in the substance abuse field (including TCs), followed by those of Jay Haley and Salvador Minuchin. More than a decade later, Satir's work was still mentioned as historically highly influ- ential for this field, together with the contributions of Murray Bowen (Todd, 1991). Both Satir and Bowen didn't write anything directly focused on substance abuse, but their ideas had become important ingredients of psychoeducational programs for families in substance abuse treatment because of the fact that they were easy to use and understand. Although all basic approaches to family therapy can be applied to family therapy with substance abusers (Kaufman, 1992a), none of those approaches provided a readymade model in the beginning. This changed in the early 1980s when Stanton et al. (1982) pub- lished their influential work, The Family Therapy of Drug Abuse and Addiction. For several years, their model has been the most important for treating substance abusers and their family. The Stanton and Todd approach had both structural and strategical roots,together with some influences from other sources (Stanton et al., 1982; Todd, 1991). The idea behind the model is to examine the family interactions to find out how the substance abuse maintains the family system and how the family system maintains the substance abuse (Stanton et al., 1982). Although developed for ambulatory treatment, Stanton imple- mented his own structural-strategic approach in a TC setting (Stanton, 1985). However, there are only a limited number of other sources that report on implementation of this model in the TC. Cancrini and his colleagues (Cancrini, Cingolani, Compagnoni, Constantini, & Mazzoni, 1988) probably gave an explanation for this.Starting from the premise that the families of substance abus- ers can't be seen as homogeneous systems, they made a typology of heroin addicts and their families and concluded that the family therapy model of Stanton and Todd was most useful for substance abusers suffering from an actual neurosis (Type B) in combination with a self-help group for the parents. A TC program parallel with some family therapy sessions is considered to be most useful for substance abusers with a transitional drug addiction (Type C) in which psychotic and neurotic components interact in a complex way. According to the authors, the family therapy that fits the best here is the paradoxical strategy used in the original approach from the Milan School (Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1978).Also,some other researchers came to the conclusion that the 318 Therapeutic Communities substance-abusing population can be divided into important subpopulations that require a less problem-oriented and change- focused approach (Todd, 1991), such as the solution-based or brief family therapy approach (de Shazer, 1988) or the narrative family therapy approach (White, 1986). In the TC, very few of those approaches were fully implemented (Coleman & Davis, 1978). Due to the fact that family members' need for treatment or therapy usually doesn't arise until all parties involved are confronted with the underlying issues of the problem, the possibilities for real therapy are limited. It needs intensive family counseling before therapy can actually start, and very often those efforts are considered to be too time consuming or even too expensive. Contextual Therapy as Current Example During the past two decades, most existing models underwent some changes (e.g., Todd & Selekman, 1991)--basically under influence of other approaches--but above all it became clear that there are different ways in putting all the different approaches together depending on the therapist's own emphasis or back- ground (Kaufman, 1992b; Todd, 1991). Specifically for the TC model, it is also important that the approach that is used fits with the prevailing (humanistic) philosophy in the TC.To the authors,it seems therefore preferable that the approach that we will use to exemplify family therapy also be based on a humanistic ideology. One theory that is currently popular in a number of TCs2 and that strives to integrate ideas of several approaches while at the same time being humanistic in nature is the contextual vision of the Hungarian psychiatrist Ivan Boszormenyi-Nagy. In his theory, Boszormenyi-Nagy wants to integrate the significant premises of all approaches to psychotherapy and augment them with con- structs related to relational justice (Boszormenyi-Nagy & Krasner, 1986; Boszormenyi-Nagy & Ulrich, 1981). In this way, it should not be seen as a whole new family therapy theory but rather a way of thinking. Although Boszormenyi-Nagy almost never directly speaks about substance abuse himself,he was the consultant of Stanton in the beginning of the 1970s, who was then working in the Univer- sity of Pennsylvania psychiatry service at Philadelphia General Hospital. "Certain facets of this experience had a lasting impact on Veerle Soyez, Eric Broekaert 319 the work that emerged later" (Stanton et al., 1982, p. xii). Later, contextual theory--to a limited extent--adapted to the substance- abusing population by some other authors (Bernal, Rodriguez, & Diamond, 1990; Florez-Ortiz & Bernal, 1989; Hoet, 1993). Within the contextual approach, context points to the situation in which everyone interrelates in a dynamic balance of give and take--this is the relational reality. Accountability and fairness are the most influencing forces within this relational reality,which can be subdivided into four omnipresent dimensions--facts, psychol- ogy, transactions, and merited trust--that constantly intersect and entwine. Each dimension explains human behavior from one particular point of view and operates at the same time together with the other three (Boszormenyi-Nagy & Krasner, 1986). The fourth dimension (dimension of merited trust or the ethical dimen- sion) is the cornerstone of contextual therapy. It focuses on respons- ible,trustworthy action in relationships (Boszormenyi-Nagy,1987). Humanistic Psychology and Contextual Therapy Virginia Satir is one of the key figures in the development of family therapy and has always been very influential in the field.At the same time, she was well known as an outstanding humanistic therapist, who implemented those ideas in her work with families, and was even president of the Association of Humanistic Psychol- ogy (AHP). Although Satir did not directly influence Boszormenyi- Nagy (he never directly refers to her in his work), they had the same mentor: Kalman Gyarfas, a relational-oriented Hungarian psychiatrist (Boszormenyi-Nagy & Krasner, 1986; Van Rhijn & Meulink-Korf, 1997), and they regularly met in the late 1950s dur- ing Nagy's quest for "finding the specific helping moment" in treat- ing psychiatric patients (Van Rhijn & Meulink-Korf, 1997). Nagy has a thorough philosophical background and a deep knowledge of existentialism and psychodynamic theory. Develop- ing contextual therapy, he was well aware of the theoretical works of Hegel and other existentialists such as Heidegger, Jaspers, and Sartre (Boszormenyi-Nagy & Krasner, 1986; Duccomun-Nagy & Schwoeri, 2003) and had a deep interest for the psychodynamic vision of Sigmund Freud. Although he never openly criticized Freud, Nagy wrote in 1974 in a letter to Maurice Friedman, "Freud fought against his humanistic personal urges through his scient- ism and he abhorred Ferenczi's relational emphasis on therapeutic 320 Therapeutic Communities methods" (Friedman, 1992, p. 170). It isn't surprising therefore that the first theory concepts of contextual therapy were based on the more relational-oriented, theoretical framework of Fairbairn and his object-relation theory (Boszormenyi-Nagy & Krasner, 1986). Gradually, Nagy assigned a greater role to the dynamics of justice in relationships based on the ideas of Martin Buber. He mainly fell back on Buber in relation to his theory about dialogue: "The relational humanism of Martin Buber, introduces the dialec- tic view of man as being unthinkable without his being party to a dialogue with another" (Boszormenyi-Nagy, 1987, p. 140). Indi- rectly, Nagy also referred to Buber being an adherent of Chassidism, a mystic religious and social movement of East Euro- pean Judaism. Buber believed that every human being could actively contribute to fair relations between people, which he considered in turn as a real contribution to justice. Another important influence on the development of Nagy's the- oretical framework came from Maxwell Jones (Boszormenyi-Nagy, 1987), mentioned earlier as one of the pioneers of the democratic TC, who had experiences in working with families of patients in residential treatment. Jones had started involving his patients' relatives in the TC discussion groups. Initially this was done on a rather modest scale by introducing family members into existing patient treatment groups. Later on, he also initiated family groups where two or more families came together under staff supervision (Jones, 1982). In 1958, Nagy invited Jones for a brief visit to the Eastern Pennsylvania Psychiatric Institute (EPPI), of which he was director. Following the visit, adaptations were made at EPPI, and several procedures followed the same lines as those of Jones's TC. A lot of these innovations were later abolished for various rea- sons. However, the weekly meetings between staff members, patients, and their family members were retained (Van Rhijn & Meulink-Korf, 1997). It was felt that "the real hope for progress came from the involvement of close relatives in weekly therapeutic community meetings" (Boszormenyi-Nagy, 1987, p. XVI). DISCUSSION The TC model underwent a number of important changes over the years,and in this context there is often referred to the "new TC" (Broekaert, Kooyman, & Ottenberg, 1998). The general adapta- Veerle Soyez, Eric Broekaert 321 tions as well as the introduction of family therapy found a ratio- nale in the changing social reality and the increasing internation- alization of the TC movement accompanied with the foundation of organizations such as the World Federation of Therapeutic Com- munities (WFTC). The rapprochement between the democratic TC and the Synanon-based TC also offered new insights. This rap- prochement certainly led to a renewed attention for the human- ist(ic) roots of the TC (Picchi, 1994). However, the impetus for most changes was the introduction of professionals in the TC:They were already involved in establishing the break with Synanon, but their influence became significantly visible at the moment the TC was countering some major challenges in the 1980s.Professionals were primarily supposed to form a guarantee against charismatic lead- ership. The negative experiences with Dederich in Synanon, but also the excesses of for example Lars Bremberg in Daytop Sweden and John Maher in Delancey Street, initiated a discussion on char- ismatic leadership and on the personal background (excessive drinking) of those leaders. During the Second World Conference of Therapeutic Communities in 1978, this discussion was reopened when the French delegation revolted against uncontrolled hierarchic social systems (Ottenberg, 1978). Charismatic leadership can be seen as a heteromorphic situa- tion of group consciousness, where there is a self-transcendent individual in a self-assertive collective (O'Hara & Wood, 2002). "At their democratic best, such groups encourage their individual members to voluntary offer their best efforts to the group. . . . At their worst, these groups can be extremely aggressive and violent, taking the form of . . . cults" (O'Hara & Wood, 2002, p. 113). The dif- ference between a community and a cult can be found in the aims, the contract (what is offered to members and expected in return), and the way control is exercised: Cult communities aim to estab- lish an ideal lifestyle in which members are promised a complete and lasting solution to life's problems in return for complete accep- tance of the cult's practices and philosophy. Leadership is not openly discussed (Kennard, 1998). At the end of his life--even before Synanon evolved into a cult-- also Maslow started to reconsider his vision about Synanon. Situ- ating Synanon within his critics toward "Esalen" and reconsider- ing the Eupsychia, he stated that his thoughts were sometimes misused. "But the misuses are all old philosophies and issues: romanticism, pro and con; anti-intellectual, anti-scientific dan- 322 Therapeutic Communities gers" (Lowry, 1979, p. 1186). Maslow became increasingly critical toward Synanon's hierachical governing structure, and he con- trasted Daytop's open structure with Dederich's society. Indeed, charismatic leadership mostly goes together with an isolation and withdrawal from the outside world due to extreme solidarity within the group of residents (O'Hara & Wood, 2002) or internal conflicts (Barrett-Lennard, 1994). Residents of such poorly functioning communities usually mention unconditional acceptance and openness as important characteristics, but in fact they are often involved in power manipulation or conflict. Such was, for example, the case in the discrepancy between the utopian vision of the Synanon game and its actual effect on many who par- ticipated in it.At the same time,residents' family members experi- ence the community as closed to them and fearful of strangers (O'Hara & Wood, 2002). A well-functioning community on the other hand satisfies the growth or actualization needs of its own members and is an open system in interface with other systems (Barrett-Lennard, 1994). In the case of Delancey Street for exam- ple, it is exactly the openness to the outside world (Hampden- Turner, 1976) accompanied with the influence of professionals, that has contributed to the survival of this TC. Recently a revitalized search for spirituality was introduced in some TCs, either in traditional religions (Duglosz, 2002) or in postmodernism (Kaplan, 1993). Initiators stated that people are tuning in to the fact that they have a metaphysical or spiritual part of their being and are seeking some way to fulfill this need. Prac- tices as yoga, tai chi, and various meditation techniques were introduced in the TC. Others gave themselves to poetry, art, music, or charitable causes that are spiritually enhancing in that they have to do with nonmaterial goals and principles (Hurst, 2000). Although spirituality per se has no necessary link with charis- matic leadership,the danger of falling back into the old mistakes is latently present here. Attachment to the community, the power of "community as method" (De Leon, 1997) is an absolute prerequi- site for change. However, this group power will only be effective if staff members have profound knowledge of the theoretical back- ground of group processes and not simply apply some techniques in the hope to reach self-transcendent group consciousness. In gen- eral, it is important that all staff members, professionals or ex- addicts, receive intensive training focusing on the TC's background, basic components, and changing agents. Veerle Soyez, Eric Broekaert 323 When professionals started working in the TC, they were not only concerned with charismatic leadership, but they were also involved in the introduction of some new therapeutic approaches in the TC, such as motivational interviewing (Miller & Rollnick, 1991) and relapse prevention (Marlatt & Gordon, 1985), as well as social network and family interventions. Indeed, the introduction of family involvement in the TC is almost exclusively the work of professionals. Already in the late 1970s it was recorded that very few former addicts were working as family therapists (Coleman & Davis,1978).This has possibly to do with the fact that ex-addict lay therapists tend to identify more with the residents than with the family members. They feel inclined to go along with the resident's story--often characterized by a marked lack of justice or hostility to the parents--and take a neutral or even anti- or unilateral posi- tion. This unilateral position is never beneficial to the resident as the therapeutic process is largely undermined if the resident feels that a staff member is prejudiced in favor of one of his or her parents (Boszormenyi-Nagy & Krasner, 1986; Kaufman, 1992b). However, family issues don't uniquely occur within family therapy--as all evolutions relating to the family have a deep impact on how the client functions in the peer community (Soyez, Tatrai, Bracke, & Broekaert, 2004). It is exactly in such situations that the use of contextual theory and therapy in TC settings can prove its utility. Opening up the important humanistic, clinical context of TCs to additional sources, particularly those that are in accord with the naturally systemic and contextual aspects of its therapeutic milieu method, holds a potential to improve this modality. For too long, TC work has been shackled by the narrow- ness of its theory and by the insularity of its influences. However, real improvement is only possible if there is a full integration of the new source within the TC setting. In the case of contextual theory, the common humanistic roots per se are not a guarantee for integration (Soyez et al., 2004). Yet it has already been shown in the past that family therapy when well implemented within the TC can introduce a major shift in the global approach of the TC and can contribute to a more sup- portive and unifying form of therapy (Stanton, 1985). On the other hand, such integration also has its costs. Most visible in this con- text are the loyalty conflicts. A child owes one's life to one's parents and therefore usually feels existential loyalty toward them (Boszormenyi-Nagy & Spark, 1973). Relationships between resi- 324 Therapeutic Communities dents are not existential; residents even don't choose in the begin- ning to live with those specific people. The only choice they make is to start a drug-free life. Gradually, an "in-group feeling" (Boszormenyi-Nagy & Spark, 1973), a feeling of safety and a sense of belonging, can evolve, which is the seed from which loyalty can grow (O'Hara & Wood, 2002). Only if everyone involved in the TC (all staff members and all residents) is taking those loyalty issues into account and if a climate is created in which this openly expressed loyalty is acceptable,such loyalty conflicts can be solved. If not, dropout from treatment becomes a real danger. Possibilities to be loyal toward the group as well as to the out- side world in turn initiate the growth of trust in the community. As mentioned before, trust invested in the relationships in the peer community forms an important basis and resource for the reestab- lishment of family relationships.In this context, trust is the source from which the therapeutic bond to the TC can be transferred over to the family of origin. Contextual therapy, with its fourth dimen- sion focused on trust, can be of invaluable worth here. As the TC gradually took a more open position toward the out- side world--and family therapy,with its emphasis on support, uni- fication, and respect (Stanton, 1985) gained importance--the hard and confrontational aspects also became an issue of discussion. As a result, learning experiences such as wearing signs and shaving heads were excluded in almost all programs,the TC became a more female-friendly environment, and encounter groups developed to meetings characterized by more dialogue and respect (Broekaert et al., 2003). Especially in the "new TC" this tendency to more dia- logue is prominently present. It is of primary importance that all change agents in the TC are embedded into an atmosphere of safety and acceptance (Broekaert, 2001). If not, indoctrination and faulty application of confrontational methods within the community can surface at any moment. Buber (1956/1958) already illustrated the importance of dia- logue as an educational tool: "All real living is meeting" (p. 25). Institutions that are characterized by dialogue and relation allow room for growth and exploration (Smith, 2000). It is important in this framework to consider the TC not only as a therapeutic setting but also as an educational one. In fact, the TC can be seen as the highest "educational" realization of humanistic psychology (Broekaert, 1993). Veerle Soyez, Eric Broekaert 325 Compared to Synanon and the first generation of concept TCs, the "new TC,"characterized by a number of elements that probably are all safeguards against charismatic leadership (a well-trained staff team that is composed of a mix of professionals and ex-addict lay therapists, the introduction of more dialogue, the modification of the model to specific subpopulations, the implementation of new techniques and approaches, a proper and professional insertion of family therapy, and the introduction of research), is hopefully better positioned to build on the humanistic roots it maybe had before it fell off the wagon. CONCLUSION In the authors' view, the TC has been able to give an answer to the different challenges it was confronted with over the years thanks to its unique human concept (Broekaert, van der Straten, D'Oosterlinck, & Kooyman, 1999). In the 1960s and 1970s, large numbers of people were involved in the human potential move- ment and human potential groups, but they were only a partial success (O'Hara & Wood, 2002). In this framework, Synanon and the original TC have probably sometimes been oversold as human- istic organizations. Maybe the human potential movement isn't that strong anymore today because the society and its people have changed; and maybe the TC movement is dead (Kennard, 1998), but the TC still exists.And only a renewed attention for its human- istic roots can preserve the TC from becoming just another sub- stance abuse treatment modality to stimulate treatment retention and success (and thus cost-effectiveness). The growing respect for families and women, the introduction of more dialogue,and a more open position to the outside world in general have all contributed to this renewed humanistic input. However, we have to keep in mind that belief in human possibilities certainly is the inevitable motor of evolution and growth, but it needs permanent challenge by transparency, scientific research, and discussion. After all, pro- tection against charismatic leadership is only possible if there is sufficient dialogue in the community and sufficient openness between the community and the outside world,which can be estab- lished by the introduction of new therapeutic approaches, the implementation of family involvement, participation in integrated treatment, and participation in scientific research projects. 326 Therapeutic Communities NOTES 1. It is beyond the scope of this article to give a complete overview of family therapy for substance abusers. Only some issues of importance for the history of the therapeutic community (TC) are highlighted here. 2. 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</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<back><notes><p>1. It is beyond the scope of this article to give a complete overview of family therapy for substance abusers. Only some issues of importance for the history of the therapeutic community (TC) are highlighted here.</p>
<p>2. Studying family involvement and family therapy in four therapeutic communities in Flanders (Belgium), the authors were confronted with the fact that the contextual therapy approach seems to have a strong impact on family counseling activities in the TC. All family counselors mentioned this theory as highly important for their work. See Soyez, Broekaert, and De Leon (2000).</p>
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<mods version="3.6"><titleInfo lang="en"><title>Therapeutic Communities, Family Therapy, and Humanistic Psychology: History and Current Examples</title>
</titleInfo>
<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Therapeutic Communities, Family Therapy, and Humanistic Psychology: History and Current Examples</title>
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<name type="personal"><namePart type="given">Veerle</namePart>
<namePart type="family">Soyez</namePart>
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<role><roleTerm type="text">author</roleTerm>
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<name type="personal"><namePart type="given">Eric</namePart>
<namePart type="family">Broekaert</namePart>
<affiliation>Department of Orthopedagogics (Special Education) at Ghent University (Belgium)</affiliation>
<affiliation>Department of Orthopedagogics (Special Education) at Ghent University (Belgium)</affiliation>
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<dateIssued encoding="w3cdtf">2005-07</dateIssued>
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<abstract lang="en">This article discusses the use of residential therapeutic communities (TCs) to help addicts recover. The European and American antecedents of the TC and the model’s further evolution and dispersion are described. The increasing openness of the TC toward the outside world and its changed attitude toward family involvement have played important roles in the evolution of the TC. In this context, the article also pays attention to the family approach in the early TC and the major family therapeutic schools that influenced the model, specifically contextual therapy. A renewed attention to its humanistic roots can preserve the TC from becoming just another substance abuse treatment modality. However, good functioning of the TC as humanistic organization also requires openness, professionalism, and scientific input. Those elements are as safeguards against destructive charismatic leadership and insularity.</abstract>
<subject><genre>keywords</genre>
<topic>therapeutic communities</topic>
<topic>substance abuse treatment</topic>
<topic>family therapy</topic>
<topic>contextual therapy</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Journal of Humanistic Psychology</title>
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<genre type="journal">journal</genre>
<identifier type="ISSN">0022-1678</identifier>
<identifier type="eISSN">1552-650X</identifier>
<identifier type="PublisherID">JHP</identifier>
<identifier type="PublisherID-hwp">spjhp</identifier>
<part><date>2005</date>
<detail type="volume"><caption>vol.</caption>
<number>45</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>3</number>
</detail>
<extent unit="pages"><start>302</start>
<end>332</end>
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<identifier type="DOI">10.1177/0022167805277105</identifier>
<identifier type="ArticleID">10.1177_0022167805277105</identifier>
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