Understanding personal change through storytelling in a therapeutic community

Purpose: This article explores the potential for personal and community transformation through storytelling within a therapeutic community through the analysis of one narrative case study. Design/Methodology: The article uses a narrative research design to describe and theorise the individual narrative of a TC client member, “Emily”, who self-identified areas of therapeutic change. Emily’s story is a single case of personal and community transformation. Analysis focussed on story of her weight loss to understand her changing role to her self and the community. Findings: Emily’s story reveals the social complexities underpinning individual transformations within a community context. This complexity is particularly evident as Emily experienced visible weight loss but identified that the meaningful change is her changed relationship with herself and others. Using theories on symbolic interactionism, analysis of Emily’s narrative indicates the TC played a role in facilitating personal change and that through sharing her story with the wider TC, the community shifted its perspective on food and weight loss. Value: The article expands the discussion on how storytelling practices within a TC contribute to therapeutic change. It is argued that community relationships play a key role in facilitating a changed relationship with self and others, and that stories themselves play an active role in shaping community meanings

The case for ‘fluid’ hierarchies in therapeutic communities

Purpose: Democratic therapeutic communities, use a ‘flattened hierarchy’ model whereby staff and clients are considered to have an equal voice, sharing administrative and some therapeutic responsibility. Using the sociological framework of interaction ritual chain theory, this paper explains how TC client members negotiated and enforced community expectations through an analysis of power within everyday interactions outside of structured therapy. Design: The study used narrative ethnography, consisting of participant observation with two democratic communities, narrative interviews with 21 client members, and semi-structured interviews with seven staff members. Findings: Findings indicate social interactions could empower clients to recognise their personal agency and to support one another. However, these dynamics could be destructive when members were excluded or marginalised. Some clients used their interactions at times to consolidate power amongst dominant members. Practical implications: It is argued that the flattened hierarchy approach theoretically guiding TC principles does not operate as a flattened model in practice. Rather, a fluid hierarchy, whereby clients shift and change social positions, seems more suited to explaining how the power structure worked within the communities, including amongst the client group. Recognising the hierarchy as ‘fluid’ may open dialogues within TCs as to whether, and how, members experience exclusion. Originality/value: Explorations of power have not specifically focused on power dynamics between clients. Moreover, this is one of the first papers to look at power dynamics outside of structured therapy

Where the change is: everyday interaction rituals of therapeutic communities

This thesis has been concerned with how everyday social interactions facilitate personal change in the lives of therapeutic community (TC) client members. TCs are planned social environments that aim to provide a safe setting whereby troubling relational patterns can be explored through confronting past trauma and dysfunctional interpersonal dynamics. All aspects of community life, particularly everyday social encounters, such as smoking breaks and meal times, are potentially therapeutic. Whilst there are have been numerous studies focusing on treatment effectiveness and clinical outcomes, there have been relatively few studies that explore how interactions during these potentially therapeutic informal periods facilitate personal change. Thus, everyday social encounters are not only underrepresented in the literature in terms of mechanisms of personal change, they remain poorly understood in practice. Therefore, this research specifically investigates how everyday interactions support personal change by: examining the mechanisms of interaction rituals outside of structured therapy; questioning the function of peer-to-peer interactions; exploring how social interactions reflect TC values; studying the influence of power and social control that may exist; and looking to understand client members’ definitions of change. The study used a narrative ethnographic approach within two adult-democratic TCs, one residential and one a day community, for individuals with a diagnosis of personality disorder. Specific methods of data collection included over 700-hours of participant observation, in-depth interviews with clients and staff members and document analysis. Drawing on Interaction Ritual (IR) theory, this study explores the role of emotions, feelings of inclusion and how power is used during everyday interactions. One of the key findings is that transforming negative emotions into positive long-term feeling occurs through the process of inclusion and solidarity. Crucially, community members will tolerate high levels of negative emotions if they feel included in the TC. Both communities had an overall rhythm to community life that provided the emotional tone and pace of each day. Importantly, solidarity and emotional rhythmic entrainment, the process by which individuals become in synch with one another, were crucial for establishing and maintaining inclusion and producing positive change outcomes. Where solidarity and entrainment are broken, communities will invoke restoration rituals to establish connection with the entire community in order continue working towards positive change. Additionally, interaction rituals highlight dynamics of power, authority, and social control within communities, particularly between client members. Several clients reported increased feelings of confidence and tolerance towards themselves and others as a result of participating in community life. There are two main contributions of this research for IR theory and TCs. Firstly, IR theory has not been applied widely to the field of mental health. The thesis suggests clarifying the use of emotions to include an analysis of how negative emotions are sustained in successful interaction rituals. Secondly, for TCs, this research highlights the significance of times spent outside of structured therapy. Exploring personal transformations through the lens of interactions, rather than individuals, provides a multi-layered explanation of how change occurs

Becoming active in the micro-politics of healthcare re-organisation:The identity work and political activation of doctors, nurses and managers

The changing organisation and governance of healthcare work represents a persistent focus of micro-politics. Whilst there is a developed literature describing the micro-politics struggles that occur amongst health occupations, there is little understanding about how actors become politically aware and active. Framed by research on political activation and the concept of identity work, the paper reports on a narrative interview study with 65 people, specifically doctors, nurses and managers, working in the English healthcare system. The narratives show that healthcare workers become increasingly aware of and engaged in micro-political activities through incremental stages based on their accumulating experiences. These stages are opportunities for identity work as actors make sense of their experiences of micro-politics, their occupational affiliations and their evolving sense of self. This identity work is shaped by actors changing views about the morality of playing politics, the emotional implications of their engagement, and the deepening political commitments. The study shows that political socialisation and activation can vary between occupations and rather than assuming political affiliations are given or acquired the papers highlights the reflective agency of healthcare actors

The case for ‘fluid’ hierarchies in therapeutic communities

Purpose: Democratic therapeutic communities, use a ‘flattened hierarchy’ model whereby staff and clients are considered to have an equal voice, sharing administrative and some therapeutic responsibility. Using the sociological framework of interaction ritual chain theory, this paper explains how TC client members negotiated and enforced community expectations through an analysis of power within everyday interactions outside of structured therapy. Design: The study used narrative ethnography, consisting of participant observation with two democratic communities, narrative interviews with 21 client members, and semi-structured interviews with seven staff members. Findings: Findings indicate social interactions could empower clients to recognise their personal agency and to support one another. However, these dynamics could be destructive when members were excluded or marginalised. Some clients used their interactions at times to consolidate power amongst dominant members. Practical implications: It is argued that the flattened hierarchy approach theoretically guiding TC principles does not operate as a flattened model in practice. Rather, a fluid hierarchy, whereby clients shift and change social positions, seems more suited to explaining how the power structure worked within the communities, including amongst the client group. Recognising the hierarchy as ‘fluid’ may open dialogues within TCs as to whether, and how, members experience exclusion. Originality/value: Explorations of power have not specifically focused on power dynamics between clients. Moreover, this is one of the first papers to look at power dynamics outside of structured therapy

Where the change is: everyday interaction rituals of therapeutic communities

This thesis has been concerned with how everyday social interactions facilitate personal change in the lives of therapeutic community (TC) client members. TCs are planned social environments that aim to provide a safe setting whereby troubling relational patterns can be explored through confronting past trauma and dysfunctional interpersonal dynamics. All aspects of community life, particularly everyday social encounters, such as smoking breaks and meal times, are potentially therapeutic. Whilst there are have been numerous studies focusing on treatment effectiveness and clinical outcomes, there have been relatively few studies that explore how interactions during these potentially therapeutic informal periods facilitate personal change. Thus, everyday social encounters are not only underrepresented in the literature in terms of mechanisms of personal change, they remain poorly understood in practice. Therefore, this research specifically investigates how everyday interactions support personal change by: examining the mechanisms of interaction rituals outside of structured therapy; questioning the function of peer-to-peer interactions; exploring how social interactions reflect TC values; studying the influence of power and social control that may exist; and looking to understand client members’ definitions of change. The study used a narrative ethnographic approach within two adult-democratic TCs, one residential and one a day community, for individuals with a diagnosis of personality disorder. Specific methods of data collection included over 700-hours of participant observation, in-depth interviews with clients and staff members and document analysis. Drawing on Interaction Ritual (IR) theory, this study explores the role of emotions, feelings of inclusion and how power is used during everyday interactions. One of the key findings is that transforming negative emotions into positive long-term feeling occurs through the process of inclusion and solidarity. Crucially, community members will tolerate high levels of negative emotions if they feel included in the TC. Both communities had an overall rhythm to community life that provided the emotional tone and pace of each day. Importantly, solidarity and emotional rhythmic entrainment, the process by which individuals become in synch with one another, were crucial for establishing and maintaining inclusion and producing positive change outcomes. Where solidarity and entrainment are broken, communities will invoke restoration rituals to establish connection with the entire community in order continue working towards positive change. Additionally, interaction rituals highlight dynamics of power, authority, and social control within communities, particularly between client members. Several clients reported increased feelings of confidence and tolerance towards themselves and others as a result of participating in community life. There are two main contributions of this research for IR theory and TCs. Firstly, IR theory has not been applied widely to the field of mental health. The thesis suggests clarifying the use of emotions to include an analysis of how negative emotions are sustained in successful interaction rituals. Secondly, for TCs, this research highlights the significance of times spent outside of structured therapy. Exploring personal transformations through the lens of interactions, rather than individuals, provides a multi-layered explanation of how change occurs

The transformative role of interaction rituals within therapeutic communities

Mental health settings are fraught with emotion as clients address difficult life experiences and relational patterns. Clients spend a substantial amount of time together outside of structured therapy, but little is known about how these moments are potentially therapeutic, especially as sites of emotional change. We draw on interaction ritual chain theory to explore how negative emotions in situations outside of formal therapy can be transformed into positive emotions and facilitate personal change. The research is based upon a narrative ethnography of two therapeutic communities for individuals with a diagnosis of personality disorder. Despite the presence of negative transient emotions in these rituals, clients experienced positive feelings of solidarity and belonging, and the majority of clients reported increased feelings of confidence and positive change. Conversely, dynamics between clients showed clients were not always supportive of one another and at times, could exclude others, resulting in isolation and alienation. We argue interactions that generate feelings of inclusion or exclusion over time area key component in whether clients gain positive or negative emotional feeling and experience personal change

The challenge of inclusive coproduction: the importance of situated rituals and emotional inclusivity in the coproduction of health research projects

Previous studies highlight that coproduced research initiatives are influenced by how individuals interact together, and that group inclusivity amongst diverse members is crucial. However, it not fully understood how inclusivity is sustained over time, particularly through routine encounters. Our study examines how coproduction occurs through routine and ritualistic patterns of everyday practices which have the potential to facilitate sustainable and inclusive research initiatives. Using ethnographic data with four applied health research projects, we explored how everyday rituals generate and sustain inclusivity. Informed by interactional ritual change theory, we identify two types of interlinked inclusivity: relational, individuals routinely engaging together, and emotional, the feeling of being included. The process of producing and maintaining both types requires ongoing reflexivity from members. Groups with sustained inclusivity build interpersonal momentum through situated practices that enable them to mitigate external pressures and internal disagreements. Where groups experience a breakdown in inclusivity, they also experience a loss of momentum that makes them vulnerable to disintegration and collapse. Building and sustaining inclusivity are worked out through everyday interactions and operate as a feedback loop that sustains the cohesiveness of the network and supports coproduction of knowledge

Hurting and healing in therapeutic environments: how can we understand the role of the relational context?

It has long been recognized that relationships are key to good mental health service delivery and yet the quality of the relational context remains poorly understood. This article brings together three studies that utilize very different methodologies to explore the various ways in which a process of therapeutic change can be aided or prevented by relational factors. All three studies took place within the context of therapeutic communities. The first study uses narrative ethnography and interaction ritual theory to explain how the mechanisms of everyday encounters in two therapeutic communities transform negative feeling into a sense of belonging and positive emotions such as confidence. The second study uses grounded theory to explore how the relational setting and the altered context of the researcher in a therapeutic faith community environment induces either a positive or negative quality of relationships. The final study uses a novel autoethnographic methodology to inform understanding of the relational experience of mental health treatment by comparing and contrasting multiple perspectives of different treatment environments. The paper concludes by identifying the expression and containment of affect in a congruent environment, belonging and hope, and fluid hierarchies of relational structures as key aspects of the relational context informing change