What is inside the “black box”? Therapeutic community residents’ perspectives on each treatment phase

Abstract

Although the Therapeutic Communities (TCs) have been considered a useful drug addiction treatment resource, much remains to be understood about the process of change in this treatment. The TC residents’ perspectives on their change can contribute towards an understanding of this process of change. This study aims to describe residents’ perspectives on change through each of the three treatment phases. We used a longitudinal and prospective research design with 25 residents from the three treatment phases. All residents filled in the Helpful Aspects of Therapy sheet after their weekly therapies; those who ended the treatment phase were interviewed using the Change Interview. A total of 427 documents were analyzed using grounded theory data procedures. According to residents’ views, the study results suggest that their agency was the core factor in the change, while treatment tasks and healing relationships established the context for change. During each phase, contextual factors acquired particular features, with the common factor being conduciveness to action by the residents themselves. Such agency enabled the residents to appropriate treatment resources across three phases. By the end of the treatment, residents had made major changes to the way in which they relate to themselves and others and could envisage a new life in which drugs had no place. Based on the results of the study, we suggest that clinicians should monitor and support the agency of the residents. We also propose that further studies focus on residents’ perspectives about the events that limited their mobilization for change as agents.