1 crisis management and change in the therapeutic community charalampos poulopoulos, phd director of...
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Crisis Management and Change in the Therapeutic Community
Charalampos Poulopoulos, PhD Director of KETHEA
ΚΕΤΗΕΑ Therapy Center for dependent Individuals
11th EFTC European Conference on Rehabilitation & Drug Policy
Ljubliana, 06-09 June 2007
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Critical Incidents in T.C.
• Drop-out
• use of violence
• use of drugs and relapse
• suicidal attempts or suicide
• death
• severe illnesses such as HIV/AIDS and
• extreme acting out behaviors
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T.C. as Family Representation
• interaction amongst members and staff• personal and community change• dynamic affected by overt reality and past
experiences • childhood experiences influential on the present• crisis brings experiences of the past• crisis provokes intense feelings and unexpected
behaviors • crisis puts under risk the treatment
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The psychoanalytic approach
• Early mourning may be provoked in adulthood
• Some introject loss, feeling guilt and anger towards themselves
• Others project loss and feel angry towards others
• In crisis early doubts about themselves and others are reactivated
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Consequences
• Withdraw from community life • Acting out behaviors • Dropout • Apathy• Loss of trust in the community system • Lack of ability in handling intense feelings• Fear about the future • Helplessness• Denial
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The question is
How members may learn to grow and mature through crises and loss?
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The Concept of Crisis
• Central to the person, the group and the therapeutic community
• Destabilization characterizes crisis
• Partial or total deconstruction of the system
• Under risk whole function
• Opportunity for change
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Personal level
• Loss is lived as a shock• Affects person’s mental stability • Puts under question attitudes and behaviors• Internal cohesion and cohesiveness are lost • Sense of loosing homeostasis • New attitudes, ideas and behaviors are needed • Mourning a necessary process for finding new balance • Fear, pain, anger and guilt confuse the vision • Diminish hope for the future • Lack of trust and development of paranoia
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Staff consequences
• Staff feel unable to handle the situation.
• Staff conflict
• Splitting
• Lack of communication
• Blaming one another
• Acting out behavior amongst staff members
• Burn out
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The question remains
Can we prevent crisis in a therapeutic community?
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Definitions of Crisis
Chinese: • Two parts: the first part means risk and the second
challenge
Ancient Greek:• Setting apart, making a choice and a decision
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The process of crisis• Painful • Experienced as a shock• Influences the psychological balance • Challenges attitudes and behaviours • Internal coherence is lost• People experience mourning • Desire to maintain what is lost • Fear of the unknown• Loss of the familiar psychosocial context • Fear that cost greater than benefit
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Prolonged crisis
• Therapeutic community may be led to regression and decomposition
• Great degree of latent paranoia• Members and staff seek for secret motives• Dishonesty, suspicion, fear and self-depreciation
prevail • Members often form negative alliances• Formation of subgroups • Completing tasks becomes a burden • Disorganization upset personal relationships
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Reproduction of Crisis• Unexpected incidents • Continuous failure and frustration• Extreme ‘acting out’ behaviours • Violence• Drug abuse• High rates of dropout • Relapse • Serious staff problems • Alienation and Splitting • Developmental and organisational problems
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Five stages of crisis intervention
• Immediate intervention at personal and group level
• Stabilization by using social networks• Facilitation of understanding by discussing the
event and expressing emotions. • Focus on problem solving and identifying
alternative solutions • Encouragement of self-reliance by developing
strategies
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Categories of Crisis
• Situational Crisis (unexpected, unwanted or accidental events)
• Developmental Crisis (transitional situations)
• Complex Crisis (relevant to the internal life and the external environment)
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Sources of crisis
• Members’ behaviour and attitudes
• Staff behaviour
• Organizational structure, methods of treatment and policy
• External environment
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Staff crisis
• Not experienced and/or committed • Does not develop therapeutic alliance • Operates in an autocratic or chaotic style • High turn over rates• Sickness leave • Burn out• Rotation • Splitting • Unresolved conflicts
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Staff Pathology• Extreme narcissism • Feelings of isolation • Aggressiveness• Suspicion• Arrogance • Abuse of power • Powerful defence mechanisms • Rationalization• Projection • Displacement
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System pathology
• Lack of recognition and justice
• Excessive or lack of control
• Conflicts
• Double binds and manipulation
• Staff experience anxiety and frustration• People feel used, dried-up, without energy
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Organizational & External Sources
• Habits,experiences, knowledge and methods no longer effective
• Responsibility placed on clients • Therapeutic community stops changing• Confusion and uncertainty in policy • Conflicts between policy and goals • Lack of balance between power and responsibility,
formal and informal structure.• Reduction of resources
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The question is
How to facilitate change in an organization that goes through a crisis situation or a pathological condition?
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Crisis intervention vs. Crisis management
• Crisis intervention refers to an intervention that applies to a person or a group during a destabilization time
• Crisis management includes several components of crisis intervention on members, staff and parents and the broader system
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Process of crisis
• stimuli that creates severe stress • person tries to respond the usual ways • efforts fail• person feels emotional distress • stress level increases • person feels emotionally blocked• blocking of emotions does not allow problem
solving and reinforces emotional distress
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Resolving crisis
• Understanding and becoming aware of the problem
• Be relieved from feelings
• Explore cognitively alternative solutions
• Develop new skills for coping with the problem
• Use social support networks
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Learning organization
• Humanitarian ideology• Respect for others• Equality, justice and honesty• Democracy • Communication on any hierarchical level • Members and staff participation in decision making • Transparency and control in power distribution• Adoption of code of ethics• Continuous education and supervision
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KETHEA THERAPY CENTER for DEPENDENT INDIVIDUALS 24 Sorvolou str, 11636 Athens, GreeceTel. ++ 30 210 9241993-6fax ++ 30 210 9241986E-mail: [email protected]
www.kethea.gr