What does it mean to be a Therapeutic Community?

I work as a Forensic Psychologist in Training in a therapeutic residential children’s home in Nottinghamshire. This home operates differently than most residential children’s homes because it is a Therapeutic Community, otherwise known as a TC.

 

In my experience, when I speak to professionals about being a TC, I am met with a blank or confused look. The term Therapeutic Community is alien to some, especially in children and young people’s services. The definition is particularly difficult to convey to others so I provide the following description of a TC, in my own words.

To me, a TC is an environment where the staff and young people are treated equally as ‘community members’. In this environment, we openly talk about the things that bother and concern us and support others who may struggle to express their thoughts, feelings and life experiences. We all contribute to the running of our home and we make small and big decisions about it collectively. We all include each other and share meals, and enjoy recreation time together to build memories and to develop therapeutic relationships with one another. Everything in the community is up for discussion, whether this is the home décor or increased independence.

TC’s are nothing new, they have been around since WW2 in varying forms and settings. The core TC principles and ideas are the same but they have been implemented in different ways, and have, over time, developed a growing evidence base. Modern day TC’s are regulated by the ‘Community of Communities Project’ which is designed to support and enable TC’s to reach best practice. I am so proud to work in a TC and to have a central role in starting and guiding our home’s journey. I have written this blog, through my lens, to explain what it means to be a children’s home TC and why I am so grateful to work in one.

 

A supportive network

One thing that particularly strikes me as a quality that can flourish in a TC is the development of a supportive network and atmosphere between community members in the home. We live and work in an environment where everyone is welcoming and friendly to those within the organisation and those outside coming to visit. Community members do not change often and many of the people who are working there now have been there since the beginning. This can be quite rare in the childcare industry. Those who become a community member at a later stage must have qualities that complement the community. New members are supported when they join and they become well integrated in a short space of time. Community members communicate regularly with each other and offer words of support and guidance during stressful or unsettled periods that naturally occur when working with children in care who have many complex needs. This atmosphere is a crucial part of our TC and in my view, it provides a positive environment to live and work in. This atmosphere is something that is felt within the home and when on group activities. We share a bond and a collective understanding on the work of the TC.

 

Our TC Culture

When setting up a new service the questions that inevitably get asked are, who are we? and what do we want to become? It took some time for us to ponder these questions throughout the first year as a developing TC. I think we had to accept not knowing this from the start. What I have learnt is that no TC culture is the same and it is made up of all the community members within the home. This makes the TC a unique and special experience. For example, if we implemented the exact same model in a different children’s home it would feel different and may not work. The environment should always be catered to the community members working and living in the TC.

My theoretical foundation throughout my career has been Compassion Focused Therapy and Cognitive Behavioural Therapy. These approaches seemed to complement the presentation of the young people residing in the home. They also provided a method in which we could apply TC culture and principles. A lot of what we do is centred around how our thoughts, feelings and behaviour affect one another. We use structured groups as an opportunity to discuss this. We have a token scheme which we use to positively reinforce desired behaviour and reduce the likelihood of undesired behaviour. Young people are rewarded with tokens that they can save up and spend on a wide range of activities or items chosen by them, for them. We negotiate these tokens at the end of the day as a community. We run psycho-educational group programmes for the young people. Suggestions of groups and the content is obtained from the young people residing in the TC. Groups that have ran so far include; self-esteem, a girls group, dealing with decisions, and communication skills. These groups are informed by cognitive behavioural approaches (as well as others), tailored to the young people who reside in the TC.

The way in which our TC is Compassion Focused relates to how we communicate with those inside and outside of the community. We completely avoid using blaming and judgemental terms that, in my experience, I often hear from external sources or see written in documentation about the young people. This judgemental language, in my opinion, is often heard by the young people (either in the past experiences before coming into the care system and within it), and they internalise and remember these experiences. They grow up, blaming themselves for their past abuse, and their resultant emotional and behavioural difficulties. This type of language is quite frankly wrong and damaging. It shows that the young person is not being understood and that they are the behaviour they present with. We are all much more than our behaviour and too often people forget that all behaviour is communication. When a young person resides in our TC we use non-judgemental and compassionate language to emphasise that what has happened to them is not their fault. The use of this type language develops shared understanding and shows that we care about the young people. It can help build trust, the compassion they have for themselves and, help them to form truly therapeutic relationships. The compassion focused approach we take in our TC is consolidated through training workshops and how we communicate as professionals in team meetings, handovers, and external meetings.

 

Seeing the results

In my opinion, the highs vastly outweigh the lows when working in a TC. The TC environment is challenging because community members thoughts, feelings, and behaviours are openly discussed. This can be difficult to work through, contain, and to make sense of. It is a highly emotive environment that sometimes borders on the edge of chaos. However, the environment and the community provides safety for all. We are able to work through particular difficulties as a whole community, adding a layer of support and guidance. We all identify small and big results over time and they are rewarded. Sometimes, we can be stuck working reactively to things and we forget the bigger picture. However, in our TC, we give time to think about the recent past and the progress that has been made. I came into the dining area last week to find a staff member listening to a young person who was reflecting on her risk of going missing. Now, this may seem a small change but it is a stark contrast to how she was able to articulate her thoughts regarding safety when she first arrived. These realisations for staff are the reason we do what we do and reinvigorate us with the primary task. In my view, the primary task is to support the young person throughout their adolescence by meeting their therapeutic needs and building their life skills.

 

Concluding Thoughts

In essence, creating and developing a TC is something that has been quite freeing and fulfilling. We live in a world where the status quo is not challenged enough. Being a TC provides a platform in order to do this. It is a different way of thinking. The culture is constantly questioning what you and others in the industry are doing. Why does this work? Have you tried this? What about this idea? We all need to question what works and developing a TC feels right for a residential children’s home. I ask the reader, why wouldn’t you want to work in an environment where young people are treated equally, respected, and given numerous opportunities to share their thoughts and feelings about the running of the environment in which they reside?

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