Identity change in a drug-free Therapeutic Community: a Lacanian interpretation of former residents’ perspectives on treatment process and outcome

Abstract

Purpose In drug-free Therapeutic Communities (TCs), people with addictions live together in order to achieve recovery in terms of a modified drug-free lifestyle. Central to the TC approach is the assumption that this shift is only achievable when “identity change” has taken place. However, this claim has rarely been addressed in TC research. Further insight into the nature and realization of such identity change might help to understand how this community approach contributes to long-term recovery. The paper aims to discuss these issues. Design/methodology/approach The present qualitative interview study explores the perspectives of ten former TC residents on their treatment and their process of change. To organize the interview data, Lacanian psychoanalytic theory on identity formation/change is used as a framework. Findings The common thread in the participants’ process of change is presented in three parts: their life before, in and after the TC. The substeps within these parts are illustrated with several quotes. Originality/value The findings highlight the value of innovative qualitative research designs to address the many challenges to addiction treatment research. A Lacanian reading of the data makes it possible to describe the subjective logic of the process of change in the TC, focusing on how substance (mis)use functions as an attempted solution in dealing with identity issues. By linking crucial TC ingredients such as the TC law and TC tools to the process of the identity change, a new reading of this long-term group approach is achieved.

What works to change identity? A rapid evidence assessment of interventions

“…Other interventions were based on different identity theories or single factors hypothesized to make a difference through unspecified theoretical pathways. These comprised: Lacanian Identity change (Debaere et al., 2017), Dynamic Systems Model of Role Identity (Foster & Shah, 2016), Labelling Theory (Hayes, 2010), Self‐determination Theory (McPherson et al., 2018), Cognitive Evaluation Theory (Oliver et al., 2016), nature as promoting psychological health (Husk et al, 2016), couple identity (Ahmad & Reid, 2016), mastery through transformative activity (Eichas et al., 2010), Community as Method (Goethals et al., 2017), self‐efficacy (Graziano et al., 2014) and generative activity (O'Sullivan et al., 2018).…”

“…Interviews with eight women engaged in the Prostitute Rehabilitation Program, indicated that the creation of a shared social identity among participants acted as a means of informal social control (Oselin, 2009). Similarly, interviews with 10 former residents of a therapeutic community for people with drug or alcohol problems, indicated that it was through acceptance of, and adherence to, the rules of the therapeutic community (TC law), a common set of standards for behavior, that they felt a sense of community and belonging, which encouraged hope for, and persistence in attempts to, change (Debaere et al., 2017). O'Sullivan et al.…”

“…Marsh (2011) indicated that this awareness and acceptance of their problematic and harmful behaviors strengthened participants' commitment to a new, more prosocial, way of being. Similarly, former residents of a therapeutic community for people with drug and alcohol problems indicated that change in self‐view was predicated on being able to see oneself clearly, describing a process of moving from a deceptive self‐view, to a more realistic view of the self, which was associated with increased self‐acceptance and self‐worth (Debaere et al., 2017).…”

“…Most commonly this was attributed to the development of new social identities, facilitated by interventions that brought similar others together to work collaboratively on personally or socially meaningful activities with a focus on helping others, and which provided opportunities to demonstrate a commitment to the shared values and behaviors of the group (Barker et al., 2014; Finn et al., 2009; Husk et al, 2016; Kitchell et al., 2000; Marsh, 2011; Ng et al 2018; Oselin, 2009; Ross, 2014; Vangeli & West, 2012). Three studies indicated that social control played a role in encouraging people to conform to new identities (Debaere et al., 2017; O'Sullivan et al., 2018; Oselin, 2009), while two suggested that such connections helped by generating a sense of belonging and social acceptance (Corsten et al., 2015; McPherson et al., 2018). Bringing people facing similar problems or with similar aims together also, in some cases, facilitated access to social, psychological, and emotional resources, which were thought to help maintain identity change, providing a buffer against threats to identity (Barker et al., 2014) and opportunities and encouragement to act in line with, and demonstrate commitment to, the new identity (Husk et al, 2016; McPherson et al., 2018; Oselin, 2009).…”

“…Theory and research in this area commonly implicates other people, and more specifically, social interaction, as key to this process. De Leon (2000) describes the community itself as the therapeutic method of change, suggesting that this works in a number of ways, including (but not confined to): (i) being surrounded by and working with others who are similarly looking to change, which increases and maintains individual receptivity to identity change, (ii) taking on different social roles in the community, which offers a chance for learning and role identity change, and (iii) others provide feedback which deconstructs deceptive self‐images and help build alternative imagined selves that are incompatible with the problem behavior (e.g., Debaere et al, 2017).…”