When assistance is not given: Disaffiliative responses to therapeutic community clients’ implicit requests

Abstract

Therapeutic Communities (TCs) are residential rehabilitation services for people with diagnoses of mental illness (Campling, 2001). TCs are programmat-ically removed from hospitals; they are set up in home-like settings; and they host a relatively small number of clients. Clients are expected to be actively involved in the practical management of the house by sharing responsibilities with the staff (such as cooking, cleaning, and the like) hierarchical demarcation between staff and clients is expected to be reduced compared to more traditional mental health institutions (Campling, 2001). TC clients also enjoy more freedom than in more traditional mental health institutions (e.g. hospital wards), particularly by being allowed to exit the TC unaccompanied, having a job, taking part in free-time activities, and entertaining relationships outside the TC. This is unlike psychiatric hospitals, particularly forensic-care hospitals, where patients have little free movement (Bone & Marchant, Chapter 23, this volume; Dobbinson, Chapter 22, this volume).