Veale David, Gilbert Paul, Wheatley Jon, Naismith Iona
Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK.
Mental Health Research Unit, Kingsway Hospital, Derby, UK.
Clin Psychol Psychother. 2015 Jul-Aug;22(4):285-303. doi: 10.1002/cpp.1897. Epub 2014 Apr 14.
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. 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.
社会关系和社区为一系列心理发展提供了背景和动力，从基因表达至核心自我认同的发展。这表明有必要思考在社区背景下发生的治疗性改变和过程，以及社区如何促成治疗性改变。然而，自第二次世界大战以来发展起来的“治疗性社区”一直未得到充分研究。我们认为，应在主流科学研究中重新审视作为一种改变过程的社区概念。本文简要回顾了治疗性社区的历史发展，并在系统综述中对其当前的理论、实践和成果进行了批判性评估。文章还关注了最近关于进化情绪调节系统本质的研究、这些系统如何被社会关系所带动、亲和情绪在威胁调节中的重要性以及对亲和情绪的恐惧在精神病理学中的作用。我们借鉴了以慈悲为中心的治疗、社会学习理论和功能分析心理治疗的概念，来思考治疗性社区的成员如何能够意识到彼此的勇气行为并以慈悲回应。对于某些特定客户群体而言，生活在以科学的情感和自我调节模型为指导的结构化且以亲和为导向的社区中，可能比个体门诊治疗具有潜在的治疗优势。这一结论应进一步研究。关键从业者信息 当前的治疗性社区实践缺乏充分的循证依据，可能未充分发挥社区的潜在治疗价值。以慈悲为中心的治疗和社会学习理论为治疗环境提供了新方法，包括理解员工和成员之间慈悲和亲和关系的作用、本质及复杂性，基于学习理论指导行为改变，基于威胁衍生的安全策略进行清晰的构想、设定目标和积极强化。
