N.39 - Building a therapeutic community. A case of therapeutic engineering

Community therapy. Focusing on the foreign body. Effects on patients and caregivers

Abstract

Therapeutic communities are now and have for several decades been used for a wide array of disorders that range from substance abuse to personality disorders, and from subacute to chronic psychosis. These disorders are often intertwined and causes an overly dense diagnostic framework.

It is possible to observe two different perspectives which converge into the therapeutic  community system and allow us to pinpoint two pivotal factors of treatment. The first one, which we could define as individual, privileges the protective and facilitating function of the setting, which tends to be seen as a third element, between patient and caregiver, and therefore such that it can permit a one-to-one relationship that would otherwise be made difficult by the intensity of the transference From another standpoint (1), however, collective and group factors must be stressed, insisting on the overall therapeutic value of the community setting, understood not only as humane but also as a cultural mechanism capable of offering an affective but, so to speak, structured and orderly, reception. From this second perspective, we could say, to put it very simply, that “it is the group that treats”; while from the individual perspective, it could be said that “the therapist treats with the help of the group”.

Having in his mind these two clinical work perspectives in the therapeutic community, the author analyses in depth the issue of “foreign body”, definable as “a traumatic identification with the mind and body of another with which there has been a highly involving and meaningful relationship, and which includes repeated traumatic features to a more or less heightened extent”.

The community should set itself the goal of driving a sort of wedge between the foreign body and the patient-subject in such a way that the two are able to launch a dialogue, a dialectic and stop ignoring each other through destructive dissociation.

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