A New Therapeutic Community: Development of a Compassion‐Focussed and Contextual Behavioural Environment

Abstract

Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self-identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change. However, the 'therapeutic communities' that have developed since the Second World War have been under-researched. We suggest that the concept of community, as a change process, should be revisited within mainstream scientific research. This paper briefly reviews the historical development of therapeutic communities and critically evaluates their current theory, practice and outcomes in a systematic review. Attention is drawn to recent research on the nature of evolved emotion regulation systems, the way these are entrained by social relationships, the importance of affiliative emotions in the regulation of threat and the role of fear of affiliative emotions in psychopathology. We draw on concepts from compassion-focussed therapy, social learning theory and functional analytical psychotherapy to consider how members of a therapeutic community can be aware of each other's acts of courage and respond using compassion. Living in structured and affiliative-orientated communities that are guided by scientific models of affect and self-regulation offers potential therapeutic advantages over individual outpatient therapy for certain client groups. This conclusion should be investigated further. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message:• Current therapeutic community practice is not sufficiently evidence based and may not be maximizing the potential therapeutic value of a community.• Compassion-focussed therapy and social learning theory offer new approaches for a therapeutic environment, involving an understanding of the role, nature and complexities of compassionate and affiliative relationships from staff and members, behavioural change guided by learning theory, a clear formulation based on threat-derived safety strategies, goal setting and positive reinforcement.

Outcomes for residential or inpatient intensive treatment of obsessive–compulsive disorder: A systematic review and meta-analysis

“…Little is known about how to optimize the therapeutic milieu to enhance outcome in a residential setting with a cognitive behavioral approach. Veale, Gilbert, Wheatley, and Naismith (2014) argue for an environment where residents learn and practice compassion focused approaches to others so that the culture supports being motivated and attentive to each other's needs, being empathic, respectful, sympathetic, kind, accepting, non-judgmental and tolerant of each other's distress. In such an environment, members would positively reinforce acts of courage in one another for efforts at exposure.…”

Outcome of Intensive Cognitive Behaviour Therapy in a Residential Setting for People with Severe Obsessive Compulsive Disorder: A Large Open Case Series

“…Treating adults with OCD in an inpatient or residential setting (without nursing staff) has the advantage of being able to provide CBT more intensively than for outpatients. There are also potential advantages in developing a therapeutic environment in which there are opportunities for staff and residents to positively reinforce acts of courage by compassion in doing exposure and behavioural experiments "in the moment" (Veale, Gilbert, Wheatley and Naismith, 2014). Another potential advantage is the removal from a family environment where there may be high levels of expressed emotion or criticism.…”

Schizophrenia: An Exploration of an Acceptance, Mindfulness, and Compassion‐based Group Intervention

“…This result could be explained by the higher levels of dysfunctional emotional regulation strategies that have been associated with psychosis (Livingstone, Harper, & Gillanders, 2009). This result could also be understood regarding the fear of experiencing affiliative emotions (widely studied in psychopathology; for a review, see Veale, Gilbert, Wheatley, & Naismith, 2014) as the intervention (specially being in a group setting) could have elicited difficult internal events that activated experiential avoidance strategies. However, the participant reported increased "observing" on the mindfulness questionnaire.…”