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.For many professionals, on-going training is via an apprenticeship model.Training isthereby integrated with clinical work.This integration is effected via the use ofpre-groups and after-groups; staff meetings immediately before, and immediately fol-lowing, the various therapy and activity groups.In pre-groups, relevant clinical andgroup dynamic aspects are rehearsed prior to the group activity in question.This theninfluences the mode of co-therapist functioning, all group activity being led byco-therapists rather than a single therapist.After-groups are strategically placed toreview what went on during the group, particularly with reference to any goals identi-fied in the pre-group.Also in the after-group there are opportunities to debrief if therehave been disturbing or other untoward matters, and to develop an open exchange ofviews, particularly in relation to the co-therapists counter-transferences.It is also possi-ble to begin to identify the effects of interpersonal splitting deriving from the interactionwith clients.A common example is where some staff feel sympathetic to a resident smaterial discussed in a community meeting, and others are irritated, bored, or feel nega-tive about it.Discussion of this difference often leads to a new level of understandingabout how the resident feels and behaves.Training opportunities for others in TCsTherapeutic communities are also a valuable training resource for a wide range of pro-fessionals, where a knowledge of small group and large group processes, psychoanalyticideas, psychotherapy techniques, systems theory, institutional dynamics, user empow-erment, crisis management (non-physical and non-chemical), social therapy, or milieutherapy can significantly enhance services.Indeed, they are an ideal place for unimodaltrainings to be tried out, balanced, and compared with each other.This is an environ-ment where the differences can be continually monitored and used to enrich the prac-tice of all those participating.For example, simple techniques such as writing contractsare not done as part of many therapies but, in TC groups, practitioners can observe howthey work, when they are appropriate, and what effect they have.This can help practitio-ners develop the flexibility and breadth and that is a hallmark of a mature clinician. 172 | KINGSLEY NORTON AND REX HAIGHMost TCs welcome day visitors and trainees on longer placements, as staff and mem-bers themselves gain benefit by having to explain how they work (without jargon orcomplex psychological language) and from regularly responding to questions, criticism,and scrutiny from those outside.TC placements are highly valued by trainees doing ageneral or specialized mental health training, and the relevance of this for dynamic psy-chotherapy training of specialist registrars has been described by Norton and Fainman1994.ConclusionsThe essence of an effective therapeutic community is integration both internally andexternally.Internally, this is of its constituent treatment elements, psychotherapy andsociotherapy.Externally it involves integration with services, systems, and structureswhich relate to it in various ways, including training, supervision, clinical governance,and referral networks.Internally, the treatment elements may derive from a single theory or single profes-sional group.Typically, however, TCs embrace more than one explanatory model andstaff teams are multidisciplinary.With such complexity comes the need to pursue inte-gration to guarantee a coordination and harmonization of therapeutic goals.A thera-peutic community may be usefully construed as both a modality and method.Often the TC s clientele has been marginalized or never enjoyed a settled or secureposition in society or attachment within the family.As a result many reach adulthoodwith unintegrated personalities and a sense of social and interpersonal dislocation.Forthem the TC represents an externally provided set of stabilizing and integrating influ-ences.Through regularly encountering such structuring of time and place anintrapsychic integration (or individualization) of the person can sometimes beachieved.For this to be successful some support before and early on during treatment isrequired to make the successful transition from the set of external systems into the TC,whether it is a residential or day facility.Making an attachment to an unfamiliar environment which demands a high level ofcommitment, but which offers consequent rich rewards of real belonging, asks much ofneophyte members.They are frequently puzzled by the explicit expectation to revealhealthy personal, interpersonal, and social functioning.Many resort to former means ofself-destructive and maladjusted coping as a defence.There is support, however, for fullintegration, a sign of acceptance of TC mores.For those who complete their therapeutic course in a TC, something of the structuredenvironment is internalized.But this is accompanied by a great sense of impending lossclose to discharge the more integrated the personality, the more powerful the con-scious experience of the loss.Re-integration into wider society, or perhaps integrationfor the first time, represents a painful rebirthing process for which external support is THE THERAPEUTIC COMMUNITY | 173often required.For this to occur, attention has to be paid to the complex set ofsupraordinate systems in which the system of the TC is situated.Placed as they are cur-rently, TCs fulfil an integrative function for a variety of marginalized and alienated sec-tions of society. This page intentionally left blank Chapter 11Supportive psychotherapy as anintegrative psychotherapySusie Van Marle and Jeremy HolmesDefinitions and meaningsSupportive psychotherapy is not easy to define
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