Changing encounters with the other : a focus group study on the process of change in a therapeutic community

Democratic Therapeutic Communities (TCs) are long-term group programs that address severely ingrained clinical populations. These psychodynamically informed social environments can facilitate improvement in people suffering from personality pathology. However, the TCs’ working principle is not well documented, which threatens its continued existence. To gain further insight into how TCs work, this study explores former TC residents’ perspectives on their treatment, its outcome, and the process of change they underwent. Four steps that might explain this process were identified through focus group interviews (using qualitative analyses) with 24 former residents of a Belgian democratic TC: (1) I encounter a safe, caring and challenging Other, (2) I unfold my particular way of interacting with the Other, (3) I am confronted with the Otherness in me, and (4) I live an Other life. This fourth step refers to the reported treatment outcome that consists of three main changes: (a) residents became more resilient and capable of coping with their problems, (b) residents became more involved in pleasant social relations, and (c) residents developed the capacity to make choices in their own lives. We recommend a reappraisal of social psychiatry, emphasizing the social aspect of human life, psychopathology and its treatment. Limitations of the study and suggestions for further research are discussed.