Treatment of Severe Psychological Disorders in a Therapeutic

Community

Presented byDavid Tansey, Ph.D.September 25, 2003

Copyright © 2003 Hanbleceya, USA

Hanbleceya History

HistoryFounded by Moira P. Fitzpatrick, Ph.D. In 1979

Hanbleceya means “quest for vision”

Originally a residential program treating primarily people diagnosed with schizophrenia

VisionProvide a model of comprehensive, integrative

services for the seriously mentally ill and individuals in need of in-depth and diverse forms of treatment

Intensive outpatient services

Inpatient hospitalization

Partial hospitalization

Residential treatment

Semi-independent living, and independent living homes

Mission

Provide comprehensive outpatient services for the seriously mentally ill within a therapeutic community

Provide a haven for recovery in a safe, loving, and supportive community atmosphere

Create the space for the celebration of each individual's life and foster hope for recovery

Discovering the skills and developing the tools to take charge of one’s life

Mission (Continued)

Make a positive difference in the lives patients, families, the mental health system, and the community of San Diego

Committed to the discovery and dissemination of information

A Values - Oriented Community

Community culture patterned after Native American beliefs and spirituality

A sense of community, the development of a work ethic, and a desire to excel

The belief that each person is responsible for his or her own recovery

Each member’s recovery is a concern for all other members

We Believe...

Healing work is greatly enhanced in an environment of safety and hope

Each individual entering treatment in earnest can learn balance and thereby create a quality life

We Believe…(Continued)

Treatment is facilitated, and recovery made more possible, in a safe and loving environment where each individual’s life is celebrated

People can learn to be responsible for their lives and recovery

Project WIN

Project WIN Opened in 1993

Work Incentive NetworkThe staff expanded on the theme of the

1992 California Alliance for the Mentally Ill (CAMI) conference which described these needs as primary

Project WIN (Continued)

A place to live An job or education Hope for recovery

What We Do and How We Do It

Services Provided

Group treatment and therapyIndividual psychotherapySemi-independent living supervisionWork developmentLeadership developmentMedication monitoringStaff development

Groups

A loving and safe, and structured environment to allow Support Feedback Direct communication

Groups (Continued)

Groups provide opportunities for Confrontation Acknowledgment

Group - Weekly Time Structures

Time management skills Appointment books given to all clients

“Confession”AcknowledgmentSupport for structure

Group - Process

Self-discoveryAppreciationConfrontationDirect feedback regarding

effectiveness of thinking and perception

Group - Trauma and Recovery

A safe and structured environment to address issues of early trauma and abuse

Group - Men’s and Women’s

Structured environment to address issues of gender importance when necessary

Group - Treatment

Provides a structured and trusting environment to address issues in depth

Closed group where each member comes to know the issues of every other member

Close bonds form

Group - Bioenergetics

Provides a safe and structured environment to do body work

Attends to the affect raised by the work

Group - Addictions

• Addresses issues specific to dual-diagnosis clients

• Encourages adjunctive use of twelve-step programs

Group - Work DevelopmentPromotes the belief that recovery

requires a person be gainfully occupied in the world

Group - Peer LedCommunity members meet without staff

three times during the weekTime managementEducational topics of their choosingSenior members encouraged to take new

members “under their wing”Promotes independence and decision

making between peers

Group - Community MeetingAllows for confrontation in a safe

structured environmentEncourages acknowledgementFacilitates meditationProvides a forum for sharing issues of

personal and community importance

Group - Leadership

Provides senior members an opportunity to develop leadership skills

Facilitates the consolidation of living skills learned in individual and group therapy

Individual TherapyProvides a safe connection and environment

to explore issues at a deeper levelSeveral modalities are used to promote

effective behavior and understanding of self Cognitive-behavioral Psychodynamic Jungian Family systems Behavioral

Semi-independent Living Program

Provides support in housingPromotes responsible behaviorAssists people in handling real life

situationsOffers people direct, real time

feedback

Semi-independent Living Program (Continued)

Weekly house meetings address: Cooperative living Household maintenance Budgeting Meal planning, shopping and meal

preparation Conflict resolution

Work Development Program

Promotes the development of a work ethicVocational developmentEducational assessment and support

Work Development Program (Continued)

Weekly Work Development Groups address Resume and interview preparation Job placement assistance Conflict resolution in the workplace Support in attending school or vocational

training

Leadership Development

Encourages senior members to take an active role in the direction of their community

Leadership Group meets with the DirectorMembers of the group

Nominated by current members Acknowledged for their growth Held to high standards of conduct

Leadership Development (Continued)

Members of the Leadership Group Take a lead in confronting peers Pass on therapeutic endeavors that have been

helpful Perpetuate the community culture Participate as peer counselors

Medication Monitoring

Use of medication Clears thinking

• Facilitate the ability to take in and make use of information

Balances mood Essential to a client’s ability to function in the

program and in the community

Staff Development

Individual supervisionGroup supervisionCase conferencesCountertransference groupStaff trainingStaff play days

Staff Development (Continued)

Ensures ethical practice and high professional standards

Empowers therapistClarifies staff communication and avoids

splittingStrengthens treatment teamAssists in preventing burnout

Specific Aspects

What We Do - Specific Aspects

ConfrontationDealing ProcessPeer SupportLeadership Group

Community ActivitiesTouchingMeditation

Confrontation Awareness

• Problems in thinking and perception through contrast with the realities of others in the community

• Focus on something overlooked or cognitively distorted while accepting the person

• Reaction to the past rather than response to the present

Confrontation (Continued) Acknowledgement

• Appreciation and support for achievement

Integrity• Learn to be responsible and take

responsibility

Dealing Process

Identify dysfunctional behaviorIdentify thoughts and feelingsRecognize significanceAsk how others were impactedIdentify new options

Dealing Process (Continued)

Commit to using new optionsRemake agreement to follow the rulesAsk if others believe “dealing” is completeAcknowledge self for dealing and be

acknowledged

Peer Support

Promotes life in a loving, safe situation where others are there to confront, support and acknowledge

Mutual social support as part of community social structure where social interaction is required both in person and by telephone

Leadership Group

Be responsive to issues in the community and participate in their resolution

A direct bridge between clients and administration

Community ActivitiesHoliday celebration

Community building and outreach Active participation in the event open to family

members, friends and outside professionals

Member celebrations Acknowledgement of personal milestones in life by the

entire community

Outings Community building among members and staff with

active interaction by all in playful, social behaviors

TouchingHolding

Recapitulative, healing event Contributes to the experience of a safe, loving

environment where the traumas of the past are not reproduced

Subject to defined boundaries and guidelines Everyone involved must consent

Strokes Contributes to soothing agitation and to support in a

safe, loving environment Everyone involved must consent

Meditation

Encourages focus in the moment and teaches self-soothing as useful, practical, and to be taken into the world

Reduces stimulation and agitationPromotes grounding

Measures of Success

Measures of Success

Stable on medicationsFewer hospitalizations

of shorter durationFunction in work or

school

Think and feel at the same time

No acting outBehave responsibly

In Housing

ChoresBudgetMeal planningFood shopping and preparationGood relationships with neighbors

In Social Situations

Plan social interactionsMeet social obligationsBehave appropriately

In Community

Provide medication supportEngage in community tasks

In Confrontation

Confront discountsConfront maladaptive behavior

In Integrity

Confess discountsAdmit maladaptive behaviorTake responsibility for change

In Stress Reduction

Develop a range of coping strategies from which to choose

When faced with a problem get support from the person most able to help

Use effective options to resolve problemsSelf soothe

In Learning Signs of Imbalance

Detect internal warning signsLearn “Red flag” behaviors

In Using the Dealing Process

Use this systematic way of looking at dysfunctional behavior and distorted thinking that invites the observations and feedback of peers

In Staff DevelopmentHealth

Mind

• Maintain stability

• Avoid burnout

• Grow personally Body

• Exercise, rest, and recreation

In Staff Development (Continued)

Professional functioning Work effectively with clients Work effectively as part of a team Grow professionally Maintain tenure Enjoy work

Maintain integrity

Hope for Recovery

Summary

Basic to the treatment of severe psychological disorders at Hanbleceya USA is a community culture where individuals are supported on their healing journey and expected to similarly support others

Summary (Continued)

Individuals whose behavior is maladaptive, whose thinking is unclear or whose perceptions are inaccurate can expect to be confronted by others with how they are effected, with clearer thinking and with alternate perceptions

Summary (Continued)

Individuals who are nonassertive or aggressive, passive or irresponsible can expect to be confronted by others who are assertive and effective

Summary (Continued)

The culture of love, safety and structure supports the use of new options to replace old practices that have not worked effectively and provides hope for recovery