By: MARTIN R. INFANTE

President, SELF

December 2006

EDITOR’S NOTE: The following is an excerpt of the paper Martin presented at the 23rd World Federation of Therapeutic Communities (WFTC) conference held in New York on September 1-5, 2006. It discusses the challenges TC’s face regarding the preservation of Professional Integrity in the work place. Martin is the Vice-Chairman of the Standards & Goals Committee of the WFTC Executive Council.

Professional Integrity

…In today’s world of drug rehabilitation and treatment, there exist numerous modes of intervention that have been developed over time and have provided hope to thousands of drug users worldwide. Perhaps the most important challenge that centers face is how to sustain professional integrity in the administration of their rehab program.As with many other TC programs worldwide, we at SELF have become accustomed to training residents to run the program and eventually hiring those who demonstrate the requisite willingness and potential to become staff. As it has been said that the “addict knows the addict best”, he/she would be the best teacher and role model. We do know that TCs around the world have practiced this for years and, for all practical purposes, it has worked well for some time.

However, we take this opportunity to note and share some of the counterproductive experiences we have had when recovering addicts were left alone to run the TC program over long periods of time without proper supervision and external evaluation:

1) Recovering addicts tend to base decisions on their own experience. This worked just fine with many cases, but not for those where professional intervention was required, particularly for clients with special needs that needed to be addressed in special ways.

2) At times, I have observed that when recovering addicts mirror their own negative attitudes with other residents, they can react more intensely than necessary. In the same manner, when they encounter situations that trigger their people-pleaser attitude, they can become unduly sympathetic. Without continuing guidance and proper supervision, they tend to lose their objectivity.

3) Giving a newly recovering addict too much responsibility too soon often results in their wanting to change tried and tested systems and do things their own way. When not carefully guarded, this could lead to a very real danger of abuse of authority.

Program Culture Changes

Given these observations, three years ago we began changing the way we do things at SELF. We embarked on a purposeful reexamination of the very ground of our organization and processes — our Culture. We tasked ourselves to examine and challenge the way we had been doing things over the last 12 years. The goal was to instill a refreshed culture with ways of doing things that are life-giving to all concerned. The target was to ensure that our leaders and role models became bearers of this new culture and ultimately lead in its propagation. To this end, we reorganized the program administration, assigning our most trained professional to head the program. We then instituted a clinical department composed of professionals who would handle case management while a complement of ex-addicts staffed the behavioral modification program. For this to work effectively, however, we got both departments to work closely together through daily conferences.

As a result, a new mindset has been incorporated that has dramatically minimized internal crises in our facility and organization in general.

Three Way Test

In order to sustain this attempt towards professional integrity and ensure that we continually provide the fertile ground on which members of our TC community could sink roots and grow, we searched for and succeeded in identifying and establishing three guiding principles that would serve as benchmarks. We established that any practice or tool of the house had to be: 1) Respectful, 2) Logical, and 3) Practical.

 

Respectful — The first criterion was Respect. The TC seeks to promote the full realization of each individual’s potential based on the belief in the infinite worth of each human being. Any practice or procedure that violates this tenet and that shows disrespect for a person has no place in the TC. Through my years of experience, I have learned about the different obscure ways in which residents have been treated by their community. Under the pretense of providing discipline when it was due, many were maltreated to teach a lesson and often­times, residents suffered not only from physical abuse but also from emotional shame and embarrassment.

The problem was that since some of these practices have proven to be effective in teaching residents never to do it again, they have gained acceptability. One tends to wonder whether residents, in cases like these, actually pick up a learning insight or merely hide their resentment. Thus, at SELF we continually remind ourselves to always give concerns and consequences respectfully. Treating people with respect should always be at the core of every program.

In essence, even if you have an effective approach that is logical and practical, if you want to develop character, you must model respect. When living up to the motto “strict yet caring”, it is important that one remains strict but not abusive.

 

Logical — Practices must proceed from a coherent understanding of the rehabilitation process. This means that they must conform to each other and hang together. Each practice or procedure must be logically connected with all the rest. It is also important that everything that is done in the program must have a logical connection or relation to what needs to be learned in standing up against relapse. When giving learning experiences to residents, it is important to ensure that the learning experience is related to the failure. Conversely, when providing understanding to the resident, in living up once again to the motto “strict yet caring”, it is important that one is caring but not enabling.

Practical — Finally, we arrive at the question of practicality. Mere conformity with theory is not enough. It is also necessary that any proposed practice or procedure must meet the test of application in the real world. It is not enough to simply formulate practices and procedures that are theoretically sound. These must actually achieve the intended effect. Moreover, all procedures and practices must also be employable in the world beyond the TC.

Today, with this ongoing process of reviving the TC culture at SELF, we feel we are on the road to providing both our residents and staff the fertile ground we all need to discover and to grow.