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How do individuals change in a TC? A focus group study with former residents Virginie Debaere 14th EFTC Conference

Department of Psychoanalysis and Clinical Consulting . How do individuals change in a TC? A focus group study with former residents Virginie Debaere 14th EFTC Conference Prague, 17-20 September 2013. ‘ democratic ’ drug-free /concept TC’s long-term n on- medicalized

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How do individuals change in a TC? A focus group study with former residents Virginie Debaere 14th EFTC Conference

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  1. Department of PsychoanalysisandClinical Consulting How do individuals change in a TC? A focus groupstudywithformerresidentsVirginie Debaere14th EFTC Conference Prague, 17-20 September 2013

  2. ‘democratic’drug-free /concept • TC’s • long-term • non-medicalized • community-based • responsibility • additionalvalue of TCs ? democracyhierarchy professionalismself-help psychoanalysisbehaviorism

  3. setting 1 democratic TC De Evenaar • “serious neuroses, borderline & narcissistic PDs, psychoses in remission & serious developmental disorders” • +/- 13 months; no re-entry house

  4. setting 2 drug-free TC Trempoline • addiction • +/- 18 monthsto 2 years; Induction / Primary Treatment / Re-Entry

  5. FOCUS GROUP INTERVIEWS • Study 1 : withformerresidents of the democraticTC De Evenaar • Study 2 : withformerresidents of the drug-free TC Trempoline • (1) Did you change because of the TC treatment? • If so, in what way? •  OUTCOME • How did your stay in the TC contribute to this change? •  PROCESS

  6. DATA ANALYSIS • Verbatimtranscription of audio recordings • Identificationof alloutcome & process accounts • A seperatecoding procedure foroutcomeandforprocess

  7. How do I feel ? • How do I deal withtroubleand discomfort ? • 2.1 I don’t, I get overwhelmed • 2.2. Withpsychotropics • 2.3 ‘With’ the mind • 2.3.1 I dramatizeandblamemyself 2.3.2 I reflect • … • (3) How do I interactwithpeople ? • 3.1 I withdrawfrom the other • 3.1.1 I don’treact / I somatize / I ignore • 3.1.2. I run away … • 3.2 I approach the other • 3.2.1. I act out • 3.2.2. I askfor help • … • (4) What do I desireand go for in life ?

  8. How do I feel ? • How do I deal withtroubleand discomfort ? • 2.1 I don’t, I get overwhelmed • 2.2. Withpsychotropics • 2.3 ‘With’ the mind • 2.3.1 I dramatizeandblamemyself2.3.2 I reflect • … • (3) How do I interactwithpeople? • 3.1 I withdrawfrom the other • 3.1.1 I don’treact / I somatize / I ignore • 3.1.2. I run away … • 3.2 I approach the other • 3.2.1. I act out • 3.2.2. I askfor help • … • (4) What do I desireand go for in life?

  9. FINDINGS • I encounter a safe, caringandchallengingOther • I unfoldmyparticular way of interactingwith the Other • I amconfrontedwith the Otherness in me • I live anOther life • 4.1 I am more resilientand I copewithtroubles • 4.2 I am more involved in pleasantsocial relations • 4.3 I choose life process outcome

  10. I encountera safe, caringandchallengingOther(1/2) • safe andcaring • staff members are “authentic,patient, engaged, on equalfootingwith the group: • “They laugh with us at lunch, they play along (…)” (Angie) • residents start to feeling at home and being part of something bigger than themselves : • “The feeling that you exist ... was pretty new to me, to belong to something (…) • Being able to tell someone what you have experienced during the day ... It was so great.“ (Ida)

  11. I encountera safe, caringandchallengingOther(2/2) • challenging • socialpressuretoparticipate : • “I always felt, not only by the group, but also by the socio therapists, • that you are expected to take part in all activities.” (Angie) • expected to take responsibility : • “They expect that you make your own therapy. • Nobody is going to tell you that you have to do this or that; • with hindsight, it is up to you to make the choices.” (Bastian)

  12. I encountera safe, caringandchallengingOther ~ in the drug-free TC loving, respecting I have been loved for who I am; I have found in Trempoline what I have never have had in my life, even though I had parents who were very present (…) I have been recognized for who I am, for my efforts every day … “ (Daniel) frustrating and confronting “They are telling you all the time what is not working for you while at he same time you are appreciated and respected for what you are doing …” (Daniel) “They have shouted at me! but at the same time they have always supported me, when I didn’t go well, they have always been there for me” (Jacob)

  13. 2. I unfoldmyparticular way of interactingwith the other (1/2) “I used to be the joke of the wing, I fought with the staff to challenge their boundaries … I used to be the tough guy.” (Tim) “I used to a hot-headed person and I felt offended by anything … angry at once.” (Louise) “I used to be very well-behaved, I was amiable, (…) I was a nodder(…) I bottled up everything and in the end I always saw myself as the black sheep.” (Hank)

  14. 2. I unfoldmyparticular way of interactingwith the other (2/2) • a way to defend themselves against displeasurable feelings and thoughts • “I was so convinced that whatever I said was underpinned in a rational way … I had conclusive arguments (…). Yet, they [the mind games] were ridiculous, but they had been my only support, and they were a way to fend off othersaround me - rather than saying that I felt worthless, it was coming down to saying that maybe you are worthless.” • “ … my anger, my being misunderstood, my troubles and being unable to tolerate emotions.” • (Tim)

  15. 2. I unfoldmyparticular way of interactingwith the other ~ in the drug-free TC “I usedtobe a veryintroverted person, I never spoke a word, I never stood up formyself” (Anne) “How I thoughtthatothers had toperceive me was VERY important (…) I always had tobe on top andbeautiful. (…) I remember the first Encounter Group, that I saidtomyself: I won’t do that!Theylookedsouglywhentheyexpressedthemselves … as red as a tomatoos…! “ (Diana) “I usedtobesomeonewhosaid‘YES’ when he ment ‘NO’ “ (Mauro)

  16. 3. I amconfrontedwith the Otherness in me (1/2) repeat the interpersonal style  become aware of it .. as an ACTIVE participant “ Would the person that takes the last cup of coffee be so gentle to make a new coffeepot?’ Someone answered: ‘No. I drink one cup of coffee a day and you maybe twenty; I don’t think so that I’m gonna make coffee for you over and over again.’ I freaked out ! (…).” “ I loved rules, they at least make things clear (…) Woe betide if someone broke the rules, it was a ‘lack of respect.’ I couldn’t bear if someone was allowed to do something while the other person wasn’t. ‘Everyone is equal in the eyes of the law’ was a typical sentence of mine. One day, Steven [a staff member] answered: ‘Seven persons, seven laws. Everyone is different and everyone is treated in another way.’ I couldn’t understand it, I got so angry! “(Tim)

  17. 3. I amconfrontedwith the Otherness in me (2/2) • confrontations a tough process good in the long run • “That girl … she was such a ‘knew-it-all’ … • She made me so furious that I smashed the cooking-pots from the fire! • It had frightened me a lot, my own behavior”. • Later, Louise has been able to start talking about “how come that I always reacted that way and how I felt about it”(Louise) • residents discover it themselves: • “If they just explain it to you over and over again, well, that doesn’t work. • It’s up to you to discover things little by little. Then it becomes less possible to run away from it, to act as if it isn’t there … your reality”. (Emily) • painful process: • “I didn’t know I had so many emotions (…). • There are even moments that I don’t remember because I was so bad (…) in pain, sad. • The positive surplus only came up at the end of my stay “ (Louise)

  18. 3. I amconfrontedwith the Otherness in me ~ in the drug-free TC According toyourparticulardifficulties, youwillalwaysget intotroublebecause of the samerules until… untilyoufindyour solution” (James) “Sometimes, peopleknowvery well howthey are expectedtobehave within a certain TC job function. But theydon’t , becausethey want to keep the image of ‘being a cool guy’ or the image of ‘I don’tlikeyou’ … “ (Diana) “They ‘wearyou out’ (…) Theywantedtobringwhoyoureally are to the surface. Theywanted me toexplode... They have been ableto break something open that was sostuck-youhave tobeabletoaskwhatyou want, to say whatyou feel - I was notableto do thatanymore. Withthat‘plonge’, they have been ableto break me [=image] completely, sothatit was forced open” (Anne)

  19. I encounter a safe, caringandchallengingOther • I unfoldmyparticular way of interactingwith the Other • I amconfrontedwith the Otherness in me • I live anOther life • 4.1 I am more resilientand I copewithtroubles • 4.2 I am more involved in pleasantsocial relations • 4.3 I choose life process outcome

  20. 4. I live anOther life 4.1. I am more resilient and I cope with troubles in a mentalized way before the TC easily overwhelmed: “I crashed completely, I stayed in bed, I didn’t take care of myself.” (Nathalia) “For anything that was wrong, I blamed myself and I dramatized the situation”(Sylver) after the TC more resilient & reflect about problems: “Even when bad things happen, when someone hurt my feelings, I can deal with it” (Sylver) “There are things that happen automatically nowadays, for example, now, I reflect about a difficult situation” (Bastian)

  21. 4. I live anOther life 4.1. I am more resilient and I cope with troubles in a mentalized way ~ drug-free TC • before the TC • DRUGS ! • “I was anaesthetized all the time … ” (Mauro) • after the TC • experience less problems: • “Things are more easy … “(Diana) • “I don’t have moments that I feel really really bad” (Daniel) • reflect & talk about problems: • “Today, when I want to do something, I reflect about the pros and cons, about wheter I will be able to do it … “ (Jacob)

  22. 4. I live anOther life 4.2. I am more involved in pleasantsocialrelationships before the TC almost no social contact: “When someone said something to me or laughed at me, I never responded, I always piped down.” (Elisabeth) isolated + wearing a mask “You stay strong on the outside, I didn’t want to let it show. I kept it very hidden, nobody knew about it” (Nathalia) after the TC more involved in pleasant social relations “I have found an apartment and I have got to know several new friends. A whole new world has opened up (…) It’s great!” (Hank) “At school, in the sports club .. I talk much more with people (…)” (Nathalia)

  23. 4. I live anOther life 4.2. I am more involved in pleasantsocialrelationships ~ drug-free TC before the TC “I had nothing to do with people … to be with people did not interest me at all I stayed at my place, locked up like a RRRAT !” (Chris) “Heroine is something that you do not share with anyone” (Mauro) after the TC “Today, when I go to a restaurant with friends.. I’m pleased to put 100 euro on the table, It pleases me to share my money with my friends” (Chris) I have friends, peoplethat I cancount on, no matter what(Daniel)

  24. 4. I live anOther life 4.3. I chooselife before the TC in the grip of a paralyzing indecisiveness: “I didn’t know what to do with my life, I did many little jobs … I was so stuck” (Hank) determined by others: “It was kind of like: I am lived by the other… everything is decided for me“ (Darian) unable to pursue a goal: “When things came closer and started to be real, I cancelled everything because I was too scared.” (Nathalia)

  25. 4. I choose life 4.3. I chooselife • after the TC • able to stand up: • “I used to do anything that was the best for my foster family … I never took care of myself (…) Now I stand up, I say things like: ‘No, it has been enough.’ (…) They see it themselves how hard that I have changed. (…) Now, it’s my life. (…) Whether they like it or not (…) it won’t determine my life anymore”. (Louise) • make your own choices: • “I get up, I go to my job and two weeks later I come home • and in that week I do whatever I like to do. Yes, it fits me.” (Walter) • accept who they are: • “I have started to accept my homosexuality, for myself and for the outside world” (Bastian)

  26. 4. I choose life ~ drug-free TC “I used to live like a mussel … everywhere they put me, it was OK Now, it’s nothing like that. Now, I do the things for myself, I am energetic. I am alive. I used to be dead” (Mauro) “I did not change 90% … I changed 100 % ” (Anne)

  27. TO CONCLUDE • OUTCOME • globalimprovement in psychicandinterpersonalfunctioning • RECOVERY • empowerment • connectednesswithpeople • meaningful life • PROCESS • Importance of the environmentalandinterpersonal context • in-depththerapeuticprocesses • 1 to 2 years = short-term treatment ! 

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