The implementation of therapeutic community principles in acute care psychiatric hospital settings: An empirical analysis and recommendations to clinicians
✍ Scribed by James T. Hansen; Christopher Slevin
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 470 KB
- Volume
- 52
- Category
- Article
- ISSN
- 0021-9762
No coin nor oath required. For personal study only.
✦ Synopsis
We applied therapeutic community principles to a contemporary acute care psychiatric treatment program and investigated the effects upon milieu treatment variables using the Ward Atmosphere Scale (WAS) as a measure. Significant differences were found between experimental and control units on several scales of the WAS following the introduction of program changes. These differences indicated that the introduction of therapeutic community principles in treatment programming enhanced milieu factors that are conducive to patient recovery. 0 1996 John Wiley & Sons, Inc.
In the 1940s Maxwell Jones established a psychiatric treatment environment that was radically different from the authoritariankustodial approach to patient care prevalent at that time (Jones, 1953). Recognizing that the milieu could serve as a healing force in the treatment of psychiatric patients, Jones established a therapeutic community, which emphasized open communication, patient involvement in treatment planning and decision making, and open discussions of interpersonal conflicts.
The conditions of the current hospital psychiatric treatment environment are very different from the treatment environment where the therapeutic community concept was first established, particularly in terms of the shortened length of hospital stay and the emphasis on pharmacological rather than psychotherapeutic methods of treatment (Kahn & White, 1989; Murray & Baier, 1993; Watson, 1992). However, even with these changes, an admixture of psychopharmacological treatment and therapeutic community principles has been advocated as an effective, realistic, and desirable treatment modality in today's hospital environment (Oldham & Russakof, 1987; Watson, 1992).
The authors introduced the principles of the traditional therapeutic community to an acute care psychiatric inpatient unit that primarily provided medication and custodial care to patients. The introduction of these principles was guided by Rapoport's (1960) outline of the fundamental elements of the therapeutic community. These elements are democratization, permissiveness, reality confrontation, and communalism. Democratization refers to patient involvement in decision making. Permissiveness means that the emphasis in the therapeutic community is on tolerance for, not suppression of, abnormal behavior. With reality confrontation, patients are made aware of their behavior and open communication about their behavior is encouraged. Communalism means that a community atmosphere is fostered and milieu participants are encouraged to voice their feelings and work out their problems openly.
Although other researchers have explored the effects of implementing a therapeutic community on psychiatric units, these studies have not taken place in these times of very short hospital stay, and they were methodologically limited by a lack of a control or comparison unit (e.g., Ingstad & Gotestam, 1979; Schless, Grant, Westlake, & Verhaest, 1983). The present study took place in a contemporary acute care unit (i.e., the average length of patient stay in the study was eight days) and has overcome the methodological limitations of previous studies by utilizing a comparison unit.
It was hypothesized that the introduction of therapeutic community principles in unit programming would have a beneficial therapeutic effect on the milieu, as reflected in the