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«Veerle Soyez Redactiesecretariaat: Liesbet Bockaert – OOBC Jozef Guislainstraat 47, 9000 Gent – 09/264 64 67 Orthopedagogische Reeks Gent, Nummer ...»

-- [ Page 1 ] --

The influence of Social Networks

on Retention in and Success after

Therapeutic Community Treatment

Veerle Soyez

Redactiesecretariaat:

Liesbet Bockaert – OOBC

Jozef Guislainstraat 47, 9000 Gent – 09/264 64 67

Orthopedagogische Reeks Gent, Nummer 16, 2004

ISSN: 0779-1046

D/2004/6585/16

v.z.w. Consultatie- en Begeleidingsdiensten en Orthopedagogisch Observatie- en

Behandelingscentrum, Jozef Guislainstraat 47, 9000 Gent

Universiteit Gent, Vakgroep Orthopedagogiek, H. Dunantlaan 2, 9000 Gent Druk: Academia Press - Gent Alle rechten voorbehouden. Behoudens de uitdrukkelijk bij wet bepaalde uitzonderingen mag niets uit deze uitgave worden vermenigvuldigd, opgeslagen in een geautomatiseerd gegevensbestand of openbaar gemaakt, op welke wijze ook, zonder de uitdrukkelijke, voorafgaande en schriftelijke toestemming van de auteur en de uitgever.

No part of this book may be reproduced in any other form by print, photoprint, microfilm or any other means without written permission from the publisher.

The influence of Social Networks on Retention in and Success after Therapeutic Community Treatment Veerle Soyez Promotor Prof. Dr. E. Broekaert Co-promotor Prof. Dr. G. De Leon Proefschrift ingediend tot het behalen van de academische graad van Doctor in de Pedagogische Wetenschappen en in het openbaar verdedigd op dinsdag 11 mei 2004

Begeleidingscommissie:

Prof. Dr. E. Broekaert (promotor) – Universiteit Gent, Vakgroep Orthopedagogiek Prof. Dr. G. De Leon (co-promotor) – Center for Therapeutic Community Research, National Development and Research Institutes, Inc. New York, USA Prof. Dr. I. Mervielde – Universiteit Gent, Vakgroep Ontwikkelings-, Persoonlijkheids- en Sociale Psychologie

Examencommissie:

Prof. Dr. G. De Soete (voorzitter) – Universiteit Gent, Decaan Faculteit Psychologie en Pedagogische Wetenschappen Prof. Dr. C. Andries – Vrije Universiteit Brussel – Vakgroep Ontwikkelings- en Levenslooppsychologie Prof. Dr. E. Broekaert (promotor) – Universiteit Gent, Vakgroep Orthopedagogiek Prof. Dr. M. De Bie – Universiteit Gent, Universiteit Gent, Vakgroep Sociale Agogiek Prof. Dr. G. De Leon (co-promotor) – Center for Therapeutic Community Research, National Development and Research Institutes, Inc. New York, USA Prof. Dr. H. Grietens – Katholieke Universiteit Leuven, Centrum voor Orthopedagogiek Prof. Dr. I. Mervielde – Universiteit Gent, Vakgroep Ontwikkelings-, Persoonlijkheids- en Sociale Psychologie Ik meen dat verslavingen zich aan de kant van het lot en aan de andere kant, die van vrije wil, kunnen bevinden en dat ze zich daarin onderscheiden.

Wat ik maar schrijven met je lichaam noem, hoort aan de kant van de familie en de dood. Het is een behoudende verslaving. Ze belooft een lichamelijk, zintuigelijk plezier; eten, seks, ruiken, voelen, verzadidging. Dik of dun worden, tatoeages, kapsel en kleding, verleiding, seks, het zijn allemaal pogingen om te sleutelen aan het lot van de familie en dat van de dood. Behoudende verslavingen zijn, volgens mij, altijd een boodschap aan je familie.

Vriendschap, het voeden van de geest, de manier waarop je je leven gestalte geeft, liggen aan gene zijde. Het zijn verkozen verbintenissen en daarom verkozen betekenissen. Je bent er niet minder afhankelijk van, maar deze afhankelijkheid staat bloot aan een andere bedreiging dan de afhankelijkheid die je hebt door het lot van de familie en de dood.

De verslavingen die zich op het vlak van de vrije wil bevinden zijn destructief, geestelijk en ze beloven een invloed op het denken. Destructieve verslavingen zijn een boodschap aan de verkozen geliefden.

Ouders kunnen kinderen mishandelen en in de steek laten, maar daarmee kun je ze nog niet beroven van het lichaam dat je kreeg en de betekenis die daaraan gehecht is: je bent en blijft de dochter van die vader en moeder.

Op het terrein van de vrije wil sta je bloot aan dit gruwelijk gevaar: als je bij mij weggaat, verlies ik aan betekenis. Daarom noem ik verbintenissen het drama van de afhankelijkheid. Eigenlijk wil niemand dit. We hebben een dierlijk verlangen naar autonomie, maar als je wilt leven als een mens, dan zit je opgescheept met een noodzakelijk verlangen naar binding en betekenis. Het is je verlangen om menselijk te zijn.

Alleen dieren zijn autonoom, mensen niet.

(Connie Palmen: De Vriendschap, Amsterdam: Prometheus, 1995) Acknowledgements After several years of studying the social networks of others, the time has come to give my own network, both professional and personal, a moment’s thought. I would like to take advantage of this moment to thank a number of people without whose help and input this dissertation would never have been possible.

Above all I wish to thank the persons who participated in the study –therapeutic community residents and social network members-, who gave me their trust and were so kind to share their thoughts and feelings. Without your co-operation this study would never have existed. It was encouraging to find out during the follow-up study that some of you were doing so well. I wish you all the best.

Throughout the whole project, the collaboration with four therapeutic communities (De Kiem, De Sleutel, De Spiegel and Katarsis) has been of major importance. Warm thanks go to the directors, who offered me the opportunity to do this study in their setting, and to all staff members, who demonstrated throughout the study period a co-operation and openness which I will never forget.





Special thanks go to the family counsellors and to Johan, for all their time investment and support.

Hours have been spent in discussing and implementing data collection and interventions. Hilde, Annette, Krista, Kristel, Els, Kathy, Chris, Rita and Greet, I admire your enthusiasm and dedication for this difficult job! Thanks to you, I was able to put the complex clinical reality into perspective;

you have taught me so much. I hope that this study will be supportive in giving your work the appreciation it deserves.

Special gratitude goes to Professor Dr. Eric Broekaert, my supervisor, who was the one that introduced me to the world of therapeutic communities some years ago, and who has been a source of support and knowledge throughout this whole project. Thank you, Eric, for your trust and patience, for the inspiring and challenging discussions and, above all, for all the possibilities you gave me to do my own thing. I also owe many thanks to my co-supervisor, Professor Dr. George De Leon. It was a real honour for me to share thoughts with you. Thanks to your encouraging and constructive reflections this thesis was moulded and finally got the shape it has today.

Sincere thanks go to Prof. Dr. I. Mervielde, for critically reading parts of this thesis and for contributing valuable suggestions concerning the methodological and statistical part of this dissertation. Thanks are also due to Dr. Y. Rosseel, who worked with me on the statistics for several chapters of this dissertation. Yves, it was good to know there was someone there that could give me the necessary information when I needed it.

Thanks to all my colleagues, for the support, but even more for sharing all those nice personal moments. Your solidarity has been really encouraging. I was supposed to be the first one at our department finishing this big task. I succeeded - now it’s all your turn!

Sincere thanks to my parents, as they have always showed genuine interest in the things I choose to do, and supported me endlessly. Especially now, in this period I was finishing my dissertation, their help and encouragement – as well as the one I received from my parents-in-law and my sister - have been of invaluable worth. It is a good feeling knowing that you all are always there, even if you don’t live right around the corner. In particular, I want to thank my mother, who has been critically reviewing some parts of my dissertation and whose endless energy has always been a real example to me. Unfortunately, my grandfather has never known about me doing this project. I’ve always admired his wisdom and knowledge. I think he would have been proud of me.

Finally… John, better than anyone else, you know what this is all about. Besides being my personal computer consultant, you have been taking care of me in so many ways during this whole process.

You are my soul mate and friend, and I hope you’ll always be.

Pim and Lot, however young you still are, you have been my source of inspiration and motivation at many moments. Your openness and joy of living made me putting things into perspective at any time. You had to give up plenty of quality time… Next week we’re going to visit the zoo by train.

Promised!

–  –  –

Chapter 1

General introduction 5

1.1 Theoretical background of this dissertation

1.1.1 Dropout and retention

1.1.2 Success

1.1.3 Social networks and social support

1.2 Methodology

1.2.1 Purpose and aims of this dissertation

1.2.2 Background

1.2.3 Subjects and settings

1.2.4 Research design

References

–  –  –

2.2 The Therapeutic Community

2.2.1 European precursors

2.2.2 Synanon: the beginning

2.2.3 Organizational evolutions

2.2.4 The Synanon offspring

2.2.5 Humanistic psychology in Synanon and the first TCs

2.2.6 Humanistic psychology and the modern TC

2.3 Family therapy in the therapeutic community

2.3.1 The family in Synanon and the early TCs

2.3.2 Family therapy in the TC

2.3.3 Contextual therapy as current example

2.3.4 Humanistic psychology and contextual therapy

2.4 Discussion

2.5 Conclusion

References

Chapter 3 The implementation of contextual therapy in the therapeutic community for substance abusers: A case study 63

3.1 Introduction

3.1.1 The therapeutic community model

3.1.2 Contextual therapy

3.2 Contextual therapy in the therapeutic community: Laura’s Case

3.2.1 Context

3.2.2 Background

3.2.3 Treatment issues

3.2.4 Summary

3.3 Reflections

3.3.1 Integration

3.3.2 Critical issues

3.3.3 Conclusion

References

–  –  –

4.2 Methods

4.2.1 Sample

4.2.2 Instruments

4.2.3 Procedure

4.2.4 Data analysis

4.3 Results

4.4 Discussion

4.4.1 Factor Structure

4.4.2 Construct validity

4.4.3 Predictive validity

References

Chapter 5 The influence of social network involvement on retention in a therapeutic community 105

5.1 Introduction

5.1.1 The impact of social network support in substance abuse treatment

5.1.2 Studies on social networks and social support in therapeutic communities.............. 107

5.2 Methods

5.2.1 Intervention

5.2.2 Procedure

5.2.3 Measures

5.2.4 Client study sample

5.2.5 Network study sample

5.2.6 Data analyses

5.3 Results

5.3.1 Factors associated with participation in the SNI: Univariate analyses

5.3.2 Factors associated with participation in the SNI: Multivariate analyses

5.3.3 Factors associated with retention

5.3.4 The influence of social network intervention on retention

5.4 Discussion

References

Chapter 6 How do substance abusers and their significant others experience the reentry phase of therapeutic community treatment: A qualitative study 131

6.1 Introduction

6.1.1 The TC view of aftercare

6.1.2 Re-entry as a stage of the therapeutic community programme

6.2 Aims

6.3 Methods

6.3.1 Sample

6.3.2 Instruments

6.3.3 Procedure

6.3.4 Data analysis

6.4 Results

6.4.1 General results

6.4.2 The case of Matthew

6.5 Discussion

Acknowledgements

References

Chapter 7 The influence of social networks on success after therapeutic community treatment 151 7.1 Introduction

7.2 Methods

7.2.1 Procedure

7.2.2 Measures

7.2.3 Client study sample

7.2.4 Data-analysis

7.3 Results

7.3.1 What factors predict success after treatment?

7.3.2 Is there an improvement in the clients’ situation at follow-up?

7.3.3 Does a social network intervention added to standard family counselling affects improvement?

7.4 Discussion

References

–  –  –

8.2 Main findings

8.2.1 The position and nature of family counselling within the TC

8.2.2 The influence of a social network intervention on retention

8.2.3 The influence of a social network intervention on success

8.3 Clinical relevance of the study

8.4 Some methodological considerations: Limitations of the study

8.5 Future research

–  –  –

Preface Substance abuse is one of the major problems of the last decades; given the vast social and health costs that stem from untreated substance abuse disorders, effective clinical treatment is highly required. In recent years, treatment for substance abuse has become increasingly evidence-based, and many existing approaches are nowadays recognised as being effective. Yet, there is still room for improvement, as treatment dropout and relapse during and after treatment remain important problems for all modalities. Research has focused on different factors that may influence dropout and relapse, and social network characteristics are amongst them. The focus of previous studies on social ties, however, has mainly been on outpatient treatment rather than on residential.

Specifically in therapeutic communities (TCs) research on this topic is lacking.

The major purpose of this dissertation was therefore to examine the role of social networks characteristics, such as perceived and actual social support, as well as other important variables that influence retention and success, in a sample of TC residents. The diagram on pages 3 and 4 gives a systematic overview scheme of the different studies in this thesis.



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