Wilco van der Meer (L. Tiesinga, G. Jansen)

Verslavingszorg Noord Nederland - VNN

Addiction Care North Netherlands /

(University of Groningen - RUG)

The Therapeutic Community from an Ethical Perspective

Therapeutic Communities - Contributers to Change

EFTC11th European Conference on Rehabilitation and Drug

PolicyJune, 2007

Contents

• Theoretical considerations

• Practical considerations

• Conclusion and questions

Theoretical underpinning of the TC (1)

• The TC is a normative living and treatment environment focused on the “right living” (De Leon, 2000) - a perspective on a healthy personal and social life.

• Is their a normative theory that supports the social practice of the TC?

• No

Theoretical underpinning of the TC (2)

• Sociological and (humanistic) psychological perspective (Broekaert et al., 2000; De Leon, 2000)

• Psychopathology (Ravndal, 1994)

Perspective, concepts and conclusion

• Perspective “Ethics of Care”• “Ethics of care?”: interdependence, vulnerability

• Vulnerability• Trust• Care• Responsibility

• The ”ethics of care” perspective corresponds to the theoretical language of the TC practice.

Vulnerability

Person “X” is vulnerable to person “Y” in respect to some important need or interest “N” (Goodin, 1985).

• Dependent upon “Y” to secure or protect “N.”• Existing relationship.• Agreement.• Particular causal history.• Unique proximity and plight. (Walker, 1998)

Responsibility

• People frame their responsibilities and handle the moral dilemmas that go with conflicting responsibilities of care for “self” and “others” (Sevenhuijsen, 2000) – network

• Assign, accept or deflect responsibilities.

• Flexible, contestable.• Means of expression: relationships, values and identity

(Walker, 1998) example: safety

• Functions: manipulation, regulation, expression and definition.

Empirical ethical research

• Narrative of relationships.• Narrative of values.• Narrative of identity.

(Walker, 1998)

Features of a Narrative:• Make sense of experience.• Construct the self.• Create and communicate meaning.• Social (in character).

(Chase, 2003)

Model: “funnel between theory and practice”

Narrativeof

relationships

Narrativeof values

Narrativeof identity

responsibility

Theory

Practice

Narrativeof

relationships

Narrativeof values

Narrative of identity

Deduction Induction

Example

“The ultimate goal of the client is a drug-free life without juridical contact. A clean life is narrated as a good and autonomous life. The client should refrain from destructive and extreme behaviour, what is connected to addiction, and make a move to a healthy life” (van der Meer et al., 2007).

Drug-free TC - Contributer to change

• The TC is a social practice.• Professionals handle and make (moral) choices in the context of

the social practice.• Responsibility of the professional about the (moral) choices

towards the client, organization and society at large.

• Development of moral professionalism: The TC as a “case.”• A language of interpretation (hermeneutics) besides a (social)

scientific and political voice of evidence based truth finding.• A source of development of moral voices and moral theory.

Conclusions and questions

• Staff members express themselves in a moral voice.

• Ethical theory should be developed within the context of the TC?

• “Moral consideration” as a practical and theoretical strategy

References

• Chase, S. E. (1995). Taking Narrative Seriously. Consquences for Method and Theory in Interview Studies. In Josselson, R. & Lieblich, A. (eds.), Interpreting Experience. The Narrative Study of Lives (pp.1-26). Thousand Oaks, London, New Delhi: SAGE Publications.

• De Leon, G. (2000). The therapeutic community. theory, model, and method. New York: Springer Publishing Company.

• Goodin, R. (1985). Protecting the vulnerable. Chicago: University of Chicago Press.

• Ravndal, E., & Vaglum, P. (1994). Why do drug abusers leave the therapeutic community? Problems with attachment and identification in a hierarchical therapeutic community. Nordic Journal of Psychiatry Supplement, 47 (supplement 33), 1-56.

• van der Meer W. C., Tiesinga, L. J. & Jansen, G. J. (2006). The Drugfree Therapeutic Community from an Ethical Perspective.

• Walker, M. U. (1998). Moral understandings. A feminist study in ethics. New York London: Routledge.