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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