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Title: Staff and service users' evaluations of therapeutic principles at a High Secure Learning Disability Therapeutic Community (LDTC)
Author: Capone, Georgina
ISNI:       0000 0004 6424 9622
Awarding Body: University of Lincoln
Current Institution: University of Lincoln
Date of Award: 2017
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Background: Growing evidence has been provided on the efficacy of Democratic Therapeutic Community (DTC) treatment in forensic LD populations (known as learning disability therapeutic communities, LDTC) in the form of reduced violence, personality pathology and interpersonal difficulties. Recently, the LDTC model has been introduced within a high secure setting at one of three high secure hospitals in the U.K., for males with a dual diagnosis of mild LD and PD, and produced equally successful results. While a number of outcome studies exist, on-going difficulties have remained in regard to applying a post-positivist approach to research design of Therapeutic Communities (TCs) as the approach fails to capture its matrix of interrelated treatment components. Consequently, there has been a call for investigation of processes within DTCs to identify important treatment mechanisms that support therapeutic change. While Haigh (2013) has updated the theoretical background on DTCs via formulating ‘quintessential principles’ within a given therapeutic environment the principles have not been empirically validated within a TC setting. Study aims: To explore service user and staff members’ evaluations of the quintessence principles as outlined by Haigh (2013) and identify whether any further important principles exist within the social climate of the LDTC that were not captured by current TC theory. Design: A single case study design was employed, with the ‘case’ being defined as the LDTC based at one of three high secure hospitals in the U.K. A qualitative approach was employed within the case study to enable initial analysis of TC members’ experience of therapeutic principles, any additional principles and to also permit identification of any shared experiences. The results of the qualitative analysis were used to develop a set of statements that can be used by future research to determine the importance of existing TC principles and additional elements identified in qualitative findings to TC members. Method: A qualitative approach was employed to enable analysis of TC members’ experience and evaluation of therapeutic principles in addition to identification of shared experiences. Data were collected via semi-structured interviews with 12 participants (6 staff members and 6 service users). The interview transcripts were initially analysed via deductive content analysis (Mayring, 2001) in order to identify whether Haigh’s (2013) quintessence principles were evident in the LDTC. Inductive thematic analysis (Braun & Clarke, 2006) was then performed on remaining data, which also involved completion of saliency analysis (Buetow, 2010) in the final stage to justify selection of themes and ensure identification of codes that did not recur but remained important to the research questions posed. Results: The deductive content analysis identified all five quintessence principles were experienced in the LDTC environment by staff and service users. Some limits to the principle of ‘agency’ were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional themes were identified via inductive thematic analysis and a saliency analysis indicated the following themes as both important and recurrent; security and risk, responsivity, trust, more physical freedom. Further themes that were identified as important but not recurrent within the saliency analysis included: staff fit with LDTC, moving on, being reflective. The theme of security and risk was specifically related to the context of the LDTC functioning in a high secure environment and ‘trust’ was understood to fall within Haigh’s (2013) conceptualization of the containment quintessence principle. While the remaining themes may not primarily contribute to the experience of secondary emotional development outlined by Haigh’s (2013) five quintessence principles they remain important considerations within therapeutic environments in light of their role in facilitating enactment of TC principles within secure environments, such as the LDTC. Conclusions: This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The single case study provides empirical evidence for the quintessence principles in a novel TC setting along with further elements in the environment that help support implementation of quintessence principles. Fundamentally, the study suggests important recommendations for future research.
Supervisor: Braham, Louise ; Schroder, Thomas ; Moghaddam, Nima ; Clarke, Simon Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: C800 Psychology