Developing the TC trainingcurriculum: what do we need in

a TC worker?

Training and Research SymposiumOctober 2010

An introduction to the TCPage 2

My story of training to be a TC worker...• In April, 1974, appointed to the Ley

Community in Oxford as a “GroupWorker”.

• First time the Ley, which had onlybeen established in 1971,hadappointed anyone who had notcome through the ranks as agraduate of the Ley or Alpha House,the first UK therapeutic community.

• Alpha House established three yearsearlier than the Ley by PsychiatristIan Christie and his psychologistwife, Jane Green, who had alsobeen “TC trained” by placingthemselves as residents in USprograms in late 1960s.

An introduction to the TCPage 3

• John McCabe, graduate of Phoenix Housein New York and Director of the LeyCommunity.

• Dr BertramMandlebrote andDr Peter Agulnik(on right) – werepsychiatrists from

the Littlemore Hospital who established the Ley Unit, initiallyas a therapeutic community within the hospital. The LeyCommunity was established in a beautiful house that hadonce belonged to potter Bernard Leach, on Cumnor Hill in1974 and re-establishing to Yarnton in 1979.

• Marvin seated next to Peter, Charlie Blatch on left.

An introduction to the TCPage 4

The training begins!Setting out– and thearrival at

AlphaHouse!

• After about three weeks, living in the girl’sdorm, had gone from hating it to loving it.

• Arrival of two friends from Australia, alarmedabout lack of contact - in the house andsearching for me!

• When nothing else was going to appeasethem, I was brought to see them, at whichpoint they grabbed me and tried to run for thefront door! I stayed!

An introduction to the TCPage 5

• Five weeks later Ihad moved throughall stages of theprogram.

• Been on the kitchencrew, an Expeditor,Assistant Manager,Department Head andHouse Coordinator.

• Shouted at inencounter groups -these were the earlydays of encounterswhen shouting toexpress pent up angerwas expected.

• AndperformedsomewonderfulImagebreakers!

An introduction to the TCPage 6

Other friends from Australia, bothfellow art teachers, had alsoarrived – and spent the weekendengaged with the residents in anart program. On Monday 24th June

1974, the PortsmouthNews did a story onthe Australian ArtTeacher who was“Kept out of Touch”while undertakingtraining in thisrelatively new methodof therapeuticcommunity treatmentfor people with drugaddiction.

I always knew the residentswould do wonderful art work!

An introduction to the TCPage 7

• Completed mythree months –with the sevenweeks followingmy period as aresident spent asa staff member.

• Others not sofortunate in thetraining!

• Marvin kept asresident for thewhole 3 months.

• The next staffmember “split”from training

Martin Evans (nowwith NSW Health) &David Kennard –relieved they werenot sent for training!

An introduction to the TCPage 8

• Sold on the idea of TCs, anddespite meandering back intothe arts for a short period oftime, have maintained myinvolvement in TCs for over 36years.

• I was lucky, because despite the sometimesdifficult experience of being a resident, AlphaHouse was enormous fun – and it worked!

• Both Alpha and the Ley provided tremendousopportunities for training with sound clinicaloversight provided by psychiatrists and trainedstaff.

An introduction to the TCPage 9

A 1974 Charlie Blatch (top) and Jane Green and Ian Christie, who I met up withlast year in The Hague, 35 years after Alpha House – TC people are stayers!

• Adaption of the classic on the jobtraining model.

• Certainly it could be seen assomewhat of an extreme form – moston the job training methods don’tinvolve the worker becoming a client.

• Nevertheless on the job training is amodel that has been used acrossmany work areas over a long periodof time – usually teamed with trainingthrough TaFE, universities and otherinstitutions or training organisations.

An introduction to the TCPage 10

• Both the Ley and Alpha House were established as units ofpsychiatric hospitals, the UK model was underpinned bysound clinical direction and governance.

• Peter Agulnik very involved in both clinical supervision andtraining.

• Opportunity to engage in psychotherapy training – includinggestalt therapy and encounter group training – both the theoryand the practice.

• Bertram Mandlebrote, Ian Christie and Peter Agulnik were allmembers of an innovative and creative group of psychiatristsin the 1960s and 1970s who were looking for a different wayof treating substance use and mental health problems.

• Ian Christie and Jane Green established Alpha House aftervisiting America and undertaking training by puttingthemselves into therapeutic communities as residents.

An introduction to the TCPage 11

George De Leon talks about three distinct issues which confrontTCs as they move closer to the mainstream in working withdiverse populations and complex issues -

1. The need to upgrade skills of clinicians.2. Broaden skills as general counsellors to work effectively with

problems in relation to chemical dependency.

• The third issue reflects the training needs resulting from thechanges to the composition of the TC.

3. As increasing numbers of professional staff come to work inthe TC, new concepts, language and methods are introduced.– The warning given by De Leon is that these staff members may

counter or even subvert the fundamental self-help features ofthe TC – is this warning justified?

An introduction to the TCPage 12

• De Leon - Need for professional staff to have both theoreticaland experiential training in “traditional” TCs to be effectivelyintegrated into the TC approach.

• TCA (Therapeutic Communities America) - establishedcriteria and procedures for evaluating counselling staff byformal training in theory and methods of the TC, whichcomplements and upgrades the experientially basedcompetencies of TC workers who have come throughprograms.

• De Leon makes the point that TC counsellors must also begrounded in the skills and knowledge of the generalistcounsellor to enhance their professional stature in the humanservices hierarchy.

An introduction to the TCPage 13

• Professional staff who come from outside the TCenvironment need to be trained in TC methods andthrough both theoretical and experiential training.

• Conversely, staff who have experiential training – iehave been through a program, and are referred to byDe Leon as “traditional” TC workers, need to gain theskills and knowledge of other counsellors in order toachieve the professional stature and credibilitynecessary to advance in the wider human servicesfield.

An introduction to the TCPage 14

The TC Curriculum, developed because Leaders in the therapeuticcommunity (TC) model of treatment identified a critical need forentry-level staff training in the basics of the TC model. 11 Modules:1.Introduction to the Therapeutic Community Curriculum2.The History and Evolution of the Therapeutic Community3.Treatment and Recovery—The TC View4.The Community-as-Method Approach5.The TC Social Structure and Physical Environment6.Peer Interpersonal Relationships7.Staff Roles and Rational Authority8.TC Treatment Methods9.Work as Therapy and Education10.Stages of the TC Program and the Phases of Treatment11.How Residents Change in a TC

An introduction to the TCPage 15

Australasian AOD Therapeutic CommunitiesStandards & Support Package• In 2009, the ATCA launched the Standards, developed

by Jill Rundle and distributed to members over thepast 12 months.

• These include a training package that picks up on allthe vital components of the US TC Curriculum, andplaces them within the Australasian context.

• Our objective was to ensure the integrity of the“Therapeutic Community” principle is maintained andwill continue to stand as a model of best practice in thetreatment of substance misuse and co-occurringdisorders.

An introduction to the TCPage 16

An introduction to the TCPage 17

Training Package

• The supporting training package wasdeveloped for the professional development ofmanagement and staff working within theTherapeutic Community (TC) sector.

• Includes an induction kit for staff entering theTC field.

An introduction to the TCPage 18

Questions and issues...• Are we there yet in our training programs?• What do we need in the TC worker?

• George De Leon, in Byron Bay in 2008, talked aboutCentres of Excellence along the lines of the “teachinghospital” model where TC staff could be trained – is thisa good idea?

• Should the ATCA, in partnership with some of itsmember groups be establishing teaching and trainingcentres?

• Or are we already well served by the sector throughminimum qualification requirements?