A therapeutic community for personality disorder in a high secure intellectual disability service: inception and early experiences
| DOI | https://doi.org/10.1108/20441281211236553 |
| Date | 13 July 2012 |
| Published date | 13 July 2012 |
| Pages | 165-170 |
| Author | Jon Taylor,Sarah Trout,Janice Christopher,Alan Bland |
| Subject Matter | Education,Health & social care |
A therapeutic community for personality
disorder in a high secure intellectual
disability service: inception and early
experiences
Jon Taylor, Sarah Trout, Janice Christopher and Alan Bland
Abstract
Purpose – This paper seeks to explain the reasons for use of a therapeutic community for personality
disorder in a high secure intellectual disability service.
Design/methodology/approach – The paper describes the rationale for, and early experiences of,
a therapeutic community intervention for people with mild intellectual disability and personality disorder
in a high secure setting.
Findings – No empirical findings are reported. Evaluation is being undertaken and will be reported in
due course.
Originality/value – The therapeutic community approach has not been applied in forensic intellectual
disability before, and this paper therefore describes an original and, in many ways, radical intervention.
Keywords Learning disabilities, Personality disorder, Therapeutic community, United Kingdom,
Mental illness, Social problems, Occupational therapy, Intellectual disability
Paper type Conceptual paper
Introduction
A therapeutic community (TC) is an example of a ‘‘psychologically informed planned
environment’’ (Association of Therapeutic Communities). A central feature of a TC is the
notion that the community within which patients live provides a powerful influence on the
nature of their recovery. In his seminal work at the Henderson Hospital, Rappoport (1960)
identified four key features of a therapeutic recovery environment. Each community member
should share equally in the decision-making practices (democratisation), community
members should demonstrate tolerance of a wide range of behaviours (permissiveness) and
community functioning is characterised by the sharing of amenities and open
communication between members (communalism). Finally, patients should be confronted
with interpretations of their behaviour based on the experience of their behaviour by other
community members (reality confrontation). TC’s operationalise these principles by
organising the working day into formal group meetings (community meetings and
psychotherapy groups) and educational, occupational and leisure time. The behaviour of
community members in each of these contexts can be challenged and explored in both the
community meetings and the small groups.
TC’s have a good evidence base in mainstream forensic settings, with outcome research
suggesting that TC’s both reduce reoffending and improveemotional and social functioning
(Taylor, 2000; Birtchell et al., 2009). TC approaches have burgeoned in both public and
private sector UK prison settings (to around 400 prison spaces in 2010), with encouraging
evidence for their efficacy in those with personality disorders (Miller and Brown, 2010).
There is, however,very little description of such approaches in either mainstream intellectual
DOI 10.1108/20441281211236553 VOL. 6 NO. 4 2012, pp. 165-170, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 165
Jon Taylor, Sarah Trout,
Janice Christopher and
Alan Bland are all based at
the National High Secure
Learning Disability Service,
Rampton Hospital,
Retford, UK.
To continue reading
Request your trial