The difference between inpatient and outpatient programs regarding trait -anxiety, social support and state-anxiety in during the covid-19 pandemic in Israel

Purpose COVID-19 pandemic is affecting the well-being and the psychological resilience of different populations, particularly in the addiction field. This study aims to assess anxiety and its severity among patients and staff from different types of addiction services in Israel during this emergency. Design/methodology/approach The study was conducted during the period from March–July 2020. Participants included patients and staff (N = 282) from three different types of addiction services, were administered the State-Trait Anxiety Inventory, the multi-dimensional scale of perceived social support and demographic variables. In addition, a logistic regression model was applied to identify predictors of state anxiety by using statistical package for the social sciences software. Findings The results show that therapeutic communities clients reported more social support compared to other subjects. State anxiety has a positive strong correlation with trait anxiety both among patients and staff, and it was found as a crucial predictor of state anxiety in the regression equation. There is no statistically significant correlation between state anxiety and social support, gender or education among clients and staff as one. The state anxiety remains relatively stable and characterizes most people, staff and patients, men and women, medical staff members and other professionals. Research limitations/implications The current study has some contributions to the addiction field by understanding the psychological distress of a vulnerable population: substance users in treatment settings. The study population relied on convenient samples and future studies should be planned using a cross-sectional design and should take into account substance use measures. The findings are reinforcing the assumption that state anxiety was likely to increase during the coronavirus pandemic. Practical implications Adequate services should be planned to avoid relapse or mental deterioration of people who use drugs during health emergencies. Originality/value The research points out the unique and real difficulties of SUD clients, as well as the complexity and risks in their staff members’ works. The authors also saw that staff members need attention and maintenance; they are in the front line.

Good practices in Italian therapeutic communities. Outcomes 2020 of quality accreditation program “Visiting DTC Project”

Purpose This paper aims to present results achieved by the first, and to date only, Democratic Therapeutic Communities (DTC) quality improvement program developed in Italy, in the past 10 years, named “Visiting DTC Project.” Process of bottom-up identification, definition and evaluation of good practices of TCs for adult users with long term severe mental disorders will be described. In addition, a five-phase clinical care pathway will be presented for the same user category, developed by the “Visiting DTC Project” to comply with Italian National Health Service accreditation standards for TCs. Design/methodology/approach “Visiting DTC Project” involved 40 Italian TCs, since 2012 until 2020, in an action research on good practices developed throw a democratic and bottom-up methodology. Project’s methodology is the “Democratic Peer-to-peer Accreditation,” a kind of professional scientific quality accreditation and continuous improvement process for community mental health services. Scientific model for the definition of service standards and principles of treatment is the British “Democratic Therapeutic Community,” which the “Visiting DTC Project” is organizationally inspired by. Findings In the eighth annual cycle of the program for TC with adult users of mental health services a significantly effective good practice procedure (GPP), with good practical efficacy, was finally identified (for the first time after eight years), but still no best practice. GPP with the title “Multi-family Community Meeting” is the Good Practice of the year 2020. No Best Practice has yet been identified. An integrated clinical care pathway for Adult DTCs Users in five phases is also presented. This care pathway organizes advanced standards of Community Group Quality in a map, to support the description and planning of the five phases of the user’s clinical work in DTC treatment. Originality/value Cooperation with local community services, organizations and networks, as well as a therapeutic environment based on informal coexistence and cooperation between TC members, are thus, together with care of family relationships, the main characteristics of the Italian experience of implementing and developing the Italian DTC treatment model. These characteristics make it clear how fragile Italian DTCs are at this moment. They are still in an early stage of development. All the most applied and effective best practice procedures are dependent on a wide and dense network of relationships, formal and informal, which cross the therapeutic environment and interconnect TC members with all other stakeholders.

Emotional reactivity and difficulties in emotional regulation in drug users: a study in adolescents undergoing treatment in a therapeutic community

Purpose The purpose of this study is to investigate which emotions and difficulties in the emotional regulation of adolescents with illicit substance consumption. Design/methodology/approach In total, 41 adolescents undergoing treatment for the use of alcohol and drugs were recruited. The instruments used were the emotional rating scale and the difficulties in the regulation of emotions scale. Findings Emotional reactivity showed significant differences in the sadness dimension in relation to the number of cannabis cigarettes smoked daily and length of stay, and in the surprise dimension in relation to the number of cannabis cigarettes smoked daily. There was a significant correlation between happiness and age, surprise and number of siblings, sadness and school absenteeism and fear, school absenteeism and number of substances consumed. In regard to difficulties in emotional regulation, there were significant differences between the groups, in strategies regarding the gender of the participants and the number of substances consumed, in non-acceptance and impulses and in the number of substances consumed and in the awareness of the type and number of substances consumed. There was a significant correlation between strategies, non-acceptance, awareness and impulses and the number of substances consumed. Originality/value This study demonstrated that the emotional problems of adolescents admitted to a therapeutic community are predictors of illicit substance use.

Resident interactions when affirming and correcting peers in a therapeutic community for women

Purpose While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women. Design/methodology/approach The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model. Findings Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74). Originality/value While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.

An acute change? Does treatment within a therapeutic community for personality disorders affect local acute service use

Purpose The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project. Design/methodology/approach The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data. Findings The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance. Originality/value PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

Therapeutic community work with people who have sexually offended: responding to developments in research and practice

Purpose This paper aims to review the clinical approach adopted in prison-based therapeutic communities (TCs) for working with residents who have committed sexual offences. It reviews recent research and practice developments and explores the implications for TCs. Design/methodology/approach This paper describes a “think tank” review process which explores and reviews practice. This paper discusses the current approach adopted by TCs when working with those who have sexually offended and explores changes in clinical approach which could be considered in the light of current developments. Findings This paper explores the implications for TCs of the recent research and wider practice developments in interventions for those who have sexually offended. Practical implications This paper presents clinical options for working with those who deny their offence and undertaking victim empathy and offence disclosure work. It makes recommendations regarding staff training and support. It also discusses the strengths of the TC approach and how these can be built upon. Social implications This paper makes recommendations concerning how practice could be improved which promotes safety and public protection and enhances resident well-being. Originality/value There has been no recent review of TC clinical practice for working with those who have sexually offended.

What am I seen – who do I seem? Hidden discursive processes in the large group of a TC

Purpose The purpose of the paper is to present a possible way of discourse analysis of the meaning giving processes in a therapeutic community (TC). Design/methodology/approach Presentation of a research project, which aim is to analyse the attitudes towards the large group within the TC, is based on analysing the conceptual metaphors in semi-structured interviews. Findings The findings delineate a possible discourse, namely, the TC’s hidden discourse of working through the mirror-transference at the community level. Practical implications The paper proposes a possible content analysis method for better understanding the deep processes of the TC by examining the large group. Social implications The paper emphasizes the matrix of a TC as a mentalizing scene. Originality/value The use of linguistic methods in understanding the hidden community level mentalizing processes.

Taking the therapeutic community outside in the COVID-19 pandemic

Purpose The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience. Design/methodology/approach A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors. Findings There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment. Research limitations/implications The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work. Originality/value This study describes a novel way that a TC has adapted to the COVID-19 pandemic.

The complexity of the therapeutic experience within the therapeutic community based on an ex-patient’s account

Purpose The purpose of this paper is to explore the effectiveness of the therapeutic community and to look at the potential changes that some patients may experience following treatment at the therapeutic communities (TC). Design/methodology/approach A thematic analysis was conducted on an e-mail sent by an ex-patient of the TC. The text was reviewed multiple times and codes were generated. Based on the data found, three themes were identified. The e-mail was sent to the patient’s primary therapist, who was asked to provide an account of the e-mail. The therapist was sent six questions created by the authors of the paper; the responses were used to compare the two perspectives. Findings The main findings entailed the changes the patient went through after her treatment at the TC. The patient’s account described her inability to process the adversities she had been through at the time and therefore her inability to communicate them. However, the impact the service had on the patient, according to the e-mail was evident years later. The lack of a support network during treatment at the TC and evidence of one following treatment seemed to be the key factor in the patient’s improvement. Originality/value The authors confirm that the research presented in this paper is their original work. The authors hereby acknowledge that all material included in this piece of work, that has been published or written by another person has been referenced accordingly.