Therapeutic communities in Poland

A therapeutic community is a place where the socially marginalized live under the supervision of a  staff, for an extended period and where reintegration is pursued via programs consisting of a mixture of labour, group and individual therapy and other activities stressing social skills and personal growth. Therapeutic communities – also referred to hereafter as centers – have existed for more than 27 years in Poland, and today there are 149 centers with 2,784 beds in locations all across the country.  Most of the centers are run by the humanitarian non-governmental organization (NGO) Monar, but the national government and the Catholic church also run therapeutic communities.

Monar helps socially marginalized children, adolescents and adults: the homeless, poor, drug- or alcohol-dependent, elderly, and prisoners. Depending on the group, the content and the length of the programs of reintegration vary, but all programs share general characteristics of the therapeutic community method. The following short description of the therapeutic communities primarily focuses on communities for drug addicted children and young people.

Location, size and staff
The therapeutic communities are typically located in rural areas. Centers for children and young people are, however, normally situated in suburbs of cities in order to be near schools. The number of clients in each community typically ranges between 20 and 70 plus staff consisting of a therapeutic team (psychologists and social workers) and workshop and sports instructors. The staff includes “program graduates”, former drug users who have completed the program successfully.  Program graduates make up 40 per cent of the total staff employed by Monar.

The members of the therapeutic teams are obliged to stay current in their fields, and they are required to hold special certificates entitling them to work with drug dependent people. Every center employs a psychiatrist and a therapist. Administrative and maintenance tasks are, however, carried out by clients themselves in the centers, as an integral part of the rehabilitation process.

Activities, stages and principles
Before entering a therapeutic community the child or young person must agree to total abstinence, including tobacco cessation, and – if needed – pre-admission detoxification. The point of departure in the programs for young drug abusers is the assumption that drug abuse is a symptom of the crisis of adolescence and personal disorders, and that change can take place when adolescents are offered a nurturing, therapeutic and secure environment. In this connection two types of groups are central: the peer group and the therapy group. The clients run day-to-day and therapeutic events in the program, and they meet regularly to work together in peer groups. They play primary roles in clinical decision making, housekeeping, program planning and decisions on new admissions to the program. In the therapy groups, the staff serve as friends, role models and guardians to the clients.

The day-to-day events consist of work (house keeping duties, maintenance, gardening, farming etc.), education, and active forms of leisure. Every client implements an individual rehabilitation program under supervision of a selected staff member who is his or her “case-manager”. The therapy is conducted both in groups and individually. The therapeutic process is divided into stages which enable the clients to control the process and see the results of the therapy. The three basic stages are newcomer, housekeeper and resident. In centers for children and young people on a program of 7-12 months there are seven stages which are named: observer, newcomer, housekeeper, organizer, warden, master, and resident.  The sevenfold division makes each stage shorter, and since the achievements of every stage are precisely defined, it is easier to measure results and advance.

All the activities in therapeutic communities are based on a few principles which are written down and posted in a prominent place. In general the six basic principles are: 1. strict abstinence from any psychoactive and pharmacological substances (except for medical prescription cases for somatic reasons), 2. ban on aggression, 3. submission to the therapeutic group, 4. active participation in the life at the center, 5. openness and trustworthy behavior, and 6. giving up sexual relationships.

Following is a typical schedule for a client in a Polish therapeutic
community for children:

  7:00   Rise and shine
  7:15   Morning exercises
  7:45   Shower
  8:00   Breakfast
  8:45   Planning meeting
  9:00   Work, obligatory activities
11:00   Second breakfast
11:45   Work, obligatory activities
14:00   Lunch
16:00   Leisure activities, group or individual therapy
18:00   Group meeting
20:00   Dinner
21:00   Leisure activities, group or individual therapy
22:00   Bedtime
23:00   Lights out
               

Results
As part of an evaluation of drug treatment in a number of European countries, an American publication*) reported in 2003 on attitudes of staff members and clients at a Monar therapeutic community for adolescents. In one focus group staff members were asked to list the three most successful features of the community method, and they identified the following:
-   The peer group setting of the therapeutic communities;
-   The emphasis of universal values such as love and community;
-   Clear, gradual, and structured treatment stages.
In another focus group seven clients were given the same task, and they highlighted these features:
-   A caring environment with a friendly spirit;
-   Encouragement to pursue new interests and challenges;
-   A peer group for “sharing our problems with others like us”.

In 1993, the Monar therapeutic community for young people in Gdansk contacted the 309 clients of the center since its inception in 1983. Of the 262 who answered, 82% were drug-free. In 2001 the center carried out a similar survey. Of the 663 persons contacted, 463 reported on their use of drugs, and 79% of these were drug-free.

*) “Promising Practices in Drug Treatment: Findings from Europe” by Danya International Inc.     Published by the U.S.s Department of State, Bureau for International Narcotics and Law     Enforcement Affairs, May 2003