Therapeutic Communities. Do they work?


It’s nearly two years now since I finished group therapy and sometimes I wonder just what, if anything, I learnt from my experiences there. If you’d asked me a few years ago whether I would ever have considered giving a year of my life to full time introspection I would have laughed and replied ”Of course not, I’m not that mad!” Indeed that’s what I said to the community manager during my first assessment. You see, I’d asked for a referral for counselling to help with my longstanding depression. I was expecting to receive the bog standard hour per fortnight with a psychologist, so I was quite angry to sit there 8 months later and be told I should give up my job, go on benefits for a year, and attend a centre 4 days per week. I was horrified that anyone should think I was that ill and I returned to work and forgot about therapy. A year later, after a winter spent feeling suicidal and wanting to murder my work colleagues, I capitulated and found myself back in the same office, pleading for a second chance.

And so began the strangest, most frustrating, yet often most rewarding year of my life. Sitting in a room with up to 16 strangers and being expected to talk about your feelings is absolutely terrifying at first, especially when you wouldn’t recognise a feeling if it smacked you round the head and said ”hello i’m angry, now fuck off.” It took me quite a few months to settle in and stop staring at the floor. At first the staff encouraged me to speak, then they cajoled me, and eventually they threatened me with eviction from the community. At some point, and I’m not sure how, I started to talk.

I loved the weekly art therapy sessions. A chance to be a child again and splash paint around. Even better, a chance to criticise other people’s work afterwards, albeit it ahem constructively. Art therapy always brought the bitch out in me. Actually group therapy in general brought the bitch out in me, and I started to see that I had a nasty bullying side to my nature. But slowly, over time, I began to care about those other people. I formed friendships in the smoking area, one of which has lasted since leaving the community, and become one of the best friendships I’ve ever had. I finally managed to eat in front of the other members (it took 6 months) and after a few relapses, learnt to control my urge to self harm.

But it wasn’t all a bed of roses. The protective wall of self reliance and extreme independence I’d carefully constructed over the years was  beginning to develop holes. Being alone and managing my feelings during the days off was increasingly difficult. I had no crisis support, no medication, no friends other than those in the community, and the weekends stretched longer and longer. There were some issues which I never managed to talk about in group, sexual abuse being the main one. The one time I managed to bring it up I received a negative response from the therapists and I clammed up again after that. There was a huge emphasis on staying in the present, and moving on from the past. That’s all well and good, but sometimes you just desperately need someone to say ”That’s awful and it shouldn’t have happened to you”. Instead we heard a lot of ”You only have yourself to blame” and whilst they may not have meant the abuse, that’s how my mind interpreted it.

In the latter months I began to feel the pressure of being seen to have succeeded. The therapists thought I had turned a corner because I stopped fighting and started being positive about life. The reality was that I felt a huge responsibility to the newer group members and didn’t want anyone to know how frightened I was of leaving. So I put a smile on my face, shut off the part of my mind which still mourned the past, and sailed out of the centre on my last day with huge plans to get a job and report back to the follow up group as the most successful member ever!

5 months later I walked out of my new job. A few months later I was in hospital following a suicide attempt. I had pleaded with my doctor for help from the CMHT but that request was blocked by the community therapists, who felt I should be encouraged to be responsible for myself. They failed to understand that after 20 years of mental illness I knew how to recognise the signs, and I knew the difference between a blip and a serious slide into depression. I’d stopped opening my mail and paying my bills. I was close to being evicted from my home, and couldn’t even get dressed most days, let alone wash my hair or eat properly. The worst of it was that after a year of learning coping strategies, I knew I was fully to blame. So I hated myself even more. The therapy had been a last resort for me. Lets face it, if a year of full time treatment from the NHS doesn’t fix you, what will? And they sure did rub it in every day how lucky you were to have a place there.

Before I started therapy I had managed to hold down a full time job for 6 years, albeit with a lot of sick leave. Now I sit at home, on benefits, becoming more and more isolated as the weeks go by. My confidence is shot to pieces. I feel guilty for not acheiving a happy life, for not being ‘fixed’. I have a new (to me) diagnosis of emotionally unstable personality traits, which comes with the knowledge that I’ll be left to get on with it on my own now. It turns out that the therapeutic community was specifically for people with personality disorders, yet that term wasn’t used once the entire time I was there. None of us had been told about our diagnosis. Imagine being a depressive and going somewhere where you are constantly told off for feeling low. That’s how it is when you have a PD, because suddenly you’re not allowed to have ‘real’ depression anymore. You’re just acting out or being non compliant. If they’d just been honest with me from the start, I could have worked with them to overcome this condition. Instead I spent months in a state of confusion, wondering why I was being blamed for being ill.

To sum up, when I think about the TC I often have very angry feelings. Their biggest failing was the follow up care once you leave. To go from 4 days per week to one hour per month is a big wrench and something they really should consider changing.

However, there are positives too. I have learnt how to articulate my feelings. I recognise the triggers for most of my mood swings and I know they won’t last for ever. I’m in contact with my family again for the first time in several years, and I’ve learnt not to judge them in such black and white terms. If I could start that year again I would put so much more into my time there. I would make myself speak up about the past and work through it, rather than shut it away. And lastly, I would have taken the issue of boundaries more seriously and not got drunk and slept with another group member a few months after finishing the programme. Oops. I’ll just blame that bit on being borderline lol.


4 Responses to “Therapeutic Communities. Do they work?”

  1. Alison Says:

    You wouldn’t believe how helpful I found your post. I am only in this current therapeutic community once a week and it’s really had such a knock on effect on me over the past 8 weeks.

    The hardest part which is what you described is being alone, for six days out of seven after the group ends I am alone and literally feel I have no one to talk to. I’ve left the group for at least the past four weeks feeling extremely vulnerable and whilst it’s all well and good people telling me I can call them or the crisis team it’s not so easy… I find myself being confronted with issues and events from the past which I am struggling like crazy to deal with.

    I was all ready today to open up but I never got the chance…

    Excuse my language (I hope it doesn’t offend!) but I am feeling extremely pissed off because of the fact I’ve been sent to this group for people with personality disorders when officially I don’t have an accurate diagnosis. Whilst I accept I stand a good chance of having BPD and have secretly known it for years I still feel cheated that no one is prepared to discuss this with me and they feel by throwing me into this group all my issues and problems will be solved.

    I was patronised to hell last year because I’d thoroughly researched Bipolar disorder and was convinced it was what I had, I suspected it was more but being labelled with something other than recurrent depression would mean I might find some answers to what had been wrong for so long…

    I’ve bounced from job to job and after a long time on and off sick leave from my council job I quit rather impulsively last August after coming back from two weeks in Sweden. At first my employers didn’t want to accept my resignation as only weeks earlier I’d been planning my return. It took several visits to occupational health to convince them I was making the right decision. I know I wasn’t but I just wanted them off my back…

    I like the boundaries bit since I thought in the first couple of weeks I was falling for one of the members but now I see he’s an arse… still I have developed a major crush on one of the psychologists which is not really helping…

    All I could feel this evening was if I have to spent one more weekend alone in this house, I’d shove my head into the gas oven but then I realised I don’t have a gas oven anymore…

  2. bippidee Says:

    Thanks for replying Alison. I’m so glad you found my post helpful. I’ve often wondered if I am bi-polar because I do have what I would describe as manic episodes. But I applied for my medical notes this year and the therapists at the TC state that I showed no signs of mental illness the entire time I was there. I’d have to disagree with that but once it’s in your notes, you can’t change them.
    At first I was quite pleased to receive the BPD diagnosis. I thought having the label would help me and must mean more than just the depressive tag. But it’s only resulted in me being left to cope on my own.
    Maybe you could bring up the BPD label in group next time. I’m sure there will be others there who feel the same way. I hate how we’re not told up front about it. You wouldn’t tell someone they had cancer then refuse to tell them where it was or how it would affect them.
    If I could offer one piece of advice it would be to find your voice and say how you feel. Don’t sit there waiting for a gap in the conversation or you’ll end up missing out and taking all those feelings home with you.
    Oh the dreaded crush on the psychologist. Mine was old enough to be my father and nothing to look at, but that didn’t stop me having dreams about him. I couldn’t look him in the face the next day. I think it happens to most of us though.
    Modern gas ovens don’t work btw. It’s a different kind of gas. My neighbour tried it and only resulted in blowing up his kitchen when he forgot to turn it off and lit a cig!
    Sounds like you need to plan some distractions for this weekend. I used to volunteer in a charity shop one afternoon a week just to give myself some routine. I don’t know if you’re up to that right now?
    take care xx

  3. Zoe Says:

    Just a quick one Bippidee to say I read what you have written about therapeutic communities with great interest. I can relate it to my experiences of group therapy and I also know a few people who have endured the full treatment. One has been going through hell and I have hardly known at times whether to encourage her to ‘hang in there’ or commiserate about how harsh an experience it can be.

    I think you write really well, and I will be back for more, having found your blog through Aethelread’s.

  4. yorkie Says:

    thanks zoe. nice to know people are reading my musings.

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