Download Wilco van der Meer - European Federation of Therapeutic

Wilco van der Meer (L. Tiesinga, G. Jansen)
Verslavingszorg Noord Nederland - VNN
Addiction Care North Netherlands /
(University of Groningen - RUG)
The Therapeutic Community from an
Ethical Perspective
Therapeutic Communities - Contributers to Change
EFTC
11th European Conference on Rehabilitation and Drug
Policy
June, 2007
Contents
• Theoretical considerations
• Practical considerations
• Conclusion and questions
Theoretical underpinning of the TC (1)
• The TC is a normative living and treatment environment focused on
the “right living” (De Leon, 2000) - a perspective on a healthy personal
and social life.
• Is their a normative theory that supports the social practice of the TC?
• No
Theoretical underpinning of the TC (2)
• Sociological and (humanistic) psychological perspective (Broekaert et
al., 2000; De Leon, 2000)
• Psychopathology (Ravndal, 1994)
Perspective, concepts and conclusion
• Perspective “Ethics of Care”
• “Ethics of care?”: interdependence, vulnerability
• Vulnerability
• Trust
• Care
• Responsibility
• The ”ethics of care” perspective corresponds to the theoretical
language of the TC practice.
Vulnerability
Person “X” is vulnerable to person “Y” in respect to some important
need or interest “N” (Goodin, 1985).
• Dependent upon “Y” to secure or protect “N.”
• Existing relationship.
• Agreement.
• Particular causal history.
• Unique proximity and plight.
(Walker, 1998)
Responsibility
•
People frame their responsibilities and handle the moral
dilemmas that go with conflicting responsibilities of care for “self”
and “others” (Sevenhuijsen, 2000) – network
•
Assign, accept or deflect responsibilities.
•
•
Flexible, contestable.
Means of expression: relationships, values and identity
(Walker, 1998)
example: safety
•
Functions: manipulation, regulation, expression and definition.
Empirical ethical research
• Narrative of relationships.
• Narrative of values.
• Narrative of identity.
(Walker, 1998)
Features of a Narrative:
• Make sense of experience.
• Construct the self.
• Create and communicate meaning.
• Social (in character).
(Chase, 2003)
Model: “funnel between theory and practice”
Narrative
of
relationships
Narrative
of values
Narrative
of identity
Theory
responsibility
Deduction
Induction
Practice
Narrative
of
relationships
Narrative
of values
Narrative of
identity
Example
“The ultimate goal of the client is a drug-free life without juridical
contact. A clean life is narrated as a good and autonomous life. The
client should refrain from destructive and extreme behaviour, what is
connected to addiction, and make a move to a healthy life” (van der
Meer et al., 2007).
Drug-free TC - Contributer to change
• The TC is a social practice.
• Professionals handle and make (moral) choices in the context of
the social practice.
• Responsibility of the professional about the (moral) choices
towards the client, organization and society at large.
• Development of moral professionalism: The TC as a “case.”
• A language of interpretation (hermeneutics) besides a (social)
scientific and political voice of evidence based truth finding.
• A source of development of moral voices and moral theory.
Conclusions and questions
• Staff members express themselves in a moral voice.
• Ethical theory should be developed within the context of the TC?
• “Moral consideration” as a practical and theoretical strategy
References
• Chase, S. E. (1995). Taking Narrative Seriously. Consquences for
Method and Theory in Interview Studies. In Josselson, R. & Lieblich,
A. (eds.), Interpreting Experience. The Narrative Study of Lives
(pp.1-26). Thousand Oaks, London, New Delhi: SAGE Publications.
• De Leon, G. (2000). The therapeutic community. theory, model, and
method. New York: Springer Publishing Company.
• Goodin, R. (1985). Protecting the vulnerable. Chicago: University of
Chicago Press.
• Ravndal, E., & Vaglum, P. (1994). Why do drug abusers leave the
therapeutic community? Problems with attachment and identification
in a hierarchical therapeutic community. Nordic Journal of Psychiatry
Supplement, 47 (supplement 33), 1-56.
• van der Meer W. C., Tiesinga, L. J. & Jansen, G. J. (2006). The
Drugfree Therapeutic Community from an Ethical Perspective.
• Walker, M. U. (1998). Moral understandings. A feminist study in
ethics. New York London: Routledge.