Beyond the 'black box' of the therapeutic community for substance abusers: a participant observation study on the treatment process

Therapeutic Communities (TCs) for substance abusers are an effective recovery oriented treatment for residents who finish the program. Over the years, the TC approach has been challenged by changes in society and by new perspectives on treatment. Moreover, the therapeutic process that takes place in TCs is barely understood or documented, often referred to as the "black box" of TCs. In order to gain insight into this process, there is a growing demand for qualitative research. This article presents the findings from a participant observation study in a Belgian TC. The first author fully immersed herself amongst the residents of a TC peer group for three weeks. By interpreting naturalistic participant observation data through psychoanalytic theory on addiction and mentalization, the process of change is discussed. It is argued that the TC program challenges former substance abusers in terms of problems they have with affect regulation. This process is understood in terms of a growing ability to manage disturbing affective experiences in a more mentalized way. The frustrating and holding TC environment together with the TC tools provide the condition and techniques to make this process manifest. Limitations of the study and suggestions for future research are discussed