Why Choose a Therapeutic Community?
The services provided to those with Borderline Personality Disorder can often not provide the support these clients need. In some cases weekly therapy may be provided, but the gap between these sessions can often cause clients to feel alone. As those with BPD can struggle with both closeness and being alone, the time between therapy sessions can result in crisis; with clients engaging in both self-harm and suicidal behaviours. In this case in-patient treatment may be provided. However, this can result in a both a loss of control over their everyday lives and privacy, which can therefore lead to further distress. Although in-patient treatment in a psychiatric ward may provide some short-term benefits, in the long run staff do not have the opportunity to work with the client therapeutically and gain a full understanding of them. However, out-patient treatment is also not enough. When this is the case, therapeutic communities, which provide residential and day-care treatment, specifically for those with personality disorders may be considered.
How are Therapeutic Communities structured?
Therapeutic communities offer an intensive programme and vary in length from a daily residential programme to a weekly one-day session. This programme can further vary between lasting a number of weeks, months, years or indefinite period of time. In order for a therapeutic community programme to be effective clients are encouraged to attend on a regular basis, with lateness or non-attendance being challenged as part of the therapy. Within a therapeutic community, sessions are usually group-based although some may also be held on an individual basis as part of the programme. Group sessions usually consist of a small number of people and have an interpersonal and psychodynamic focus. Group sessions may also include friends and family members, depending on the needs of the client.
Therapeutic Community Availability
Despite the growing push for day treatment as opposed to day-care, for some people a residential therapeutic community may be the best option as it provides them with the support they need to manage their feelings in a safe environment and to learn from others who are experiencing similar emotions. The availability of therapeutic communities however, is rather limited. In the UK there are 28 such communities, 2 of these are found within prisons, 17 are voluntary agencies, with only the remaining 9 being run by the NHS.
Within a therapeutic community, the clients themselves take on many staff functions in regards to the day to day running of the community. This includes cooking, cleaning, administration, finances and new admissions into the community. This provides them with a valued and necessary role within the community.