How is change at the level of affect regulation achieved in a drug-free therapeutic community? A systematic single case study on a person suffering from severe addiction

Aim: Psychodynamic conceptualizations consider addiction as a solution away from the psychic realm and the social bond to deal with overwhelming arousal. Ambulant psychotherapy has shown low levels of effectiveness for this population. In contrast, outcome studies in drug free Therapeutic Communities (TC’s) have proven to be effective in providing a drug free changed lifestyle, but the treatment process in these self-help group programs stays misunderstood. In this systematic single case study we investigate how the disruptive affect regulation in a TC resident is restricted by the interventions of the peer community and led towards more verbalized ways of dealing with arousal. Methods: The Clinical Diagnostic Interview and the Inventory of Interpersonal Problems-32 have been administered both at the beginning and the end of the treatment process. Besides this, every two weeks the first author conducted a short interview on the resident’s TC experiences. Fluctuations in subjective well-being and affect regulation were linked to TC interventions using thematic analysis on the clinical material. Results: The results illustrate how interventions at the level of the peer community succeed in restricting dysfunctional patterns of affect regulation, what allows the person to deal with subjective issues of his traumatic childhood. Discussion: The changing process in a TC resident indicates that interventions aimed at restricting dysfunctional patterns of affect regulation are a necessary condition to make people suffering from addiction responsive to ‘psychotherapeutic’ treatment. The TC program will be discussed within a psychodynamic conceptual framework. Strengths and limitations of the study will be considered