Treatment of Severe Psychological
Disorders in a Therapeutic
Community
Presented by
David Tansey, Ph.D.
September 25, 2003
Copyright © 2003 Hanbleceya, USA
Hanbleceya History
History
 Founded by Moira P. Fitzpatrick, Ph.D. In 1979
 Hanbleceya means “quest for vision”
 Originally a residential program treating primarily
people diagnosed with schizophrenia
Vision
 Provide a model of comprehensive, integrative
services for the seriously mentally ill and
individuals in need of in-depth and diverse forms
of treatment

Intensive outpatient services

Inpatient hospitalization

Partial hospitalization

Residential treatment

Semi-independent living, and independent living homes
Mission
 Provide comprehensive outpatient services for the
seriously mentally ill within a therapeutic community
 Provide a haven for recovery in a safe, loving, and
supportive community atmosphere
 Create the space for the celebration of each individual's life
and foster hope for recovery
 Discovering the skills and developing the tools to take
charge of one’s life
Mission (Continued)
 Make a positive difference in the lives patients,
families, the mental health system, and the
community of San Diego
 Committed to the discovery and dissemination of
information
A Values - Oriented Community
 Community culture patterned after Native
American beliefs and spirituality
 A sense of community, the development of
a work ethic, and a desire to excel
 The belief that each person is responsible
for his or her own recovery
 Each member’s recovery is a concern for all
other members
We Believe...
 Healing work is greatly enhanced in an
environment of safety and hope
 Each individual entering treatment in earnest can
learn balance and thereby create a quality life
We Believe…(Continued)
 Treatment is facilitated, and recovery made more
possible, in a safe and loving environment where
each individual’s life is celebrated
 People can learn to be responsible for their lives
and recovery
Project WIN
Project WIN Opened in 1993
 Work Incentive Network
 The staff expanded on the theme of the
1992 California Alliance for the Mentally Ill
(CAMI) conference which described these
needs as primary
Project WIN (Continued)
A place to live
 An job or education
 Hope for recovery

What We Do and How We Do It
Services Provided







Group treatment and therapy
Individual psychotherapy
Semi-independent living supervision
Work development
Leadership development
Medication monitoring
Staff development
Groups
 A loving and safe, and structured
environment to allow



Support
Feedback
Direct communication
Groups (Continued)
 Groups provide opportunities for


Confrontation
Acknowledgment
Group - Weekly Time Structures
 Time management skills

Appointment books given to all clients
 “Confession”
 Acknowledgment
 Support for structure
Group - Process
 Self-discovery
 Appreciation
 Confrontation
 Direct feedback regarding
effectiveness of thinking and
perception
Group - Trauma and Recovery
 A safe and structured environment to
address issues of early trauma and
abuse
Group - Men’s and Women’s
 Structured environment to address
issues of gender importance when
necessary
Group - Treatment
 Provides a structured and trusting
environment to address issues in depth
 Closed group where each member
comes to know the issues of every
other member
 Close bonds form
Group - Bioenergetics
 Provides a safe and structured
environment to do body work
 Attends to the affect raised by the work
Group - Addictions
• Addresses issues specific to dualdiagnosis clients
• Encourages adjunctive use of
twelve-step programs
Group - Work Development
 Promotes the belief that recovery
requires a person be gainfully occupied
in the world
Group - Peer Led
 Community members meet without staff
three times during the week
 Time management
 Educational topics of their choosing
 Senior members encouraged to take new
members “under their wing”
 Promotes independence and decision
making between peers
Group - Community Meeting
 Allows for confrontation in a safe
structured environment
 Encourages acknowledgement
 Facilitates meditation
 Provides a forum for sharing issues of
personal and community importance
Group - Leadership
 Provides senior members an
opportunity to develop leadership skills
 Facilitates the consolidation of living
skills learned in individual and group
therapy
Individual Therapy
 Provides a safe connection and environment
to explore issues at a deeper level
 Several modalities are used to promote
effective behavior and understanding of self





Cognitive-behavioral
Psychodynamic
Jungian
Family systems
Behavioral
Semi-independent Living
Program
 Provides support in housing
 Promotes responsible behavior
 Assists people in handling real life
situations
 Offers people direct, real time
feedback
Semi-independent Living
Program (Continued)
 Weekly house meetings address:





Cooperative living
Household maintenance
Budgeting
Meal planning, shopping and meal
preparation
Conflict resolution
Work Development Program
 Promotes the development of a work ethic
 Vocational development
 Educational assessment and support
Work Development Program
(Continued)
 Weekly Work Development Groups
address




Resume and interview preparation
Job placement assistance
Conflict resolution in the workplace
Support in attending school or vocational
training
Leadership Development
 Encourages senior members to take an
active role in the direction of their
community
 Leadership Group meets with the Director
 Members of the group



Nominated by current members
Acknowledged for their growth
Held to high standards of conduct
Leadership Development
(Continued)
 Members of the Leadership Group




Take a lead in confronting peers
Pass on therapeutic endeavors that have been
helpful
Perpetuate the community culture
Participate as peer counselors
Medication Monitoring
 Use of medication

Clears thinking
• Facilitate the ability to take in and make use of
information


Balances mood
Essential to a client’s ability to function in the
program and in the community
Staff Development






Individual supervision
Group supervision
Case conferences
Countertransference group
Staff training
Staff play days
Staff Development (Continued)
 Ensures ethical practice and high
professional standards
 Empowers therapist
 Clarifies staff communication and avoids
splitting
 Strengthens treatment team
 Assists in preventing burnout
Specific Aspects
What We Do - Specific Aspects




Confrontation
Dealing Process
Peer Support
Leadership Group
 Community Activities
 Touching
 Meditation
Confrontation

Awareness
• Problems in thinking and perception through
contrast with the realities of others in the
community
• Focus on something overlooked or
cognitively distorted while accepting the
person
• Reaction to the past rather than response to
the present
Confrontation (Continued)

Acknowledgement
• Appreciation and support for
achievement

Integrity
• Learn to be responsible and take
responsibility
Dealing Process





Identify dysfunctional behavior
Identify thoughts and feelings
Recognize significance
Ask how others were impacted
Identify new options
Dealing Process (Continued)




Commit to using new options
Remake agreement to follow the rules
Ask if others believe “dealing” is complete
Acknowledge self for dealing and be
acknowledged
Peer Support
 Promotes life in a loving, safe situation
where others are there to confront, support
and acknowledge
 Mutual social support as part of community
social structure where social interaction is
required both in person and by telephone
Leadership Group
 Be responsive to issues in the
community and participate in their
resolution
 A direct bridge between clients and
administration
Community Activities
 Holiday celebration


Community building and outreach
Active participation in the event open to family
members, friends and outside professionals
 Member celebrations

Acknowledgement of personal milestones in life by the
entire community
 Outings

Community building among members and staff with
active interaction by all in playful, social behaviors
Touching
 Holding




Recapitulative, healing event
Contributes to the experience of a safe, loving
environment where the traumas of the past are not
reproduced
Subject to defined boundaries and guidelines
Everyone involved must consent
 Strokes


Contributes to soothing agitation and to support in a
safe, loving environment
Everyone involved must consent
Meditation
 Encourages focus in the moment and
teaches self-soothing as useful, practical,
and to be taken into the world
 Reduces stimulation and agitation
 Promotes grounding
Measures of Success
Measures of Success
 Stable on medications
 Fewer hospitalizations
of shorter duration
 Function in work or
school
 Think and feel at the
same time
 No acting out
 Behave responsibly
In Housing





Chores
Budget
Meal planning
Food shopping and preparation
Good relationships with neighbors
In Social Situations
 Plan social interactions
 Meet social obligations
 Behave appropriately
In Community
 Provide medication support
 Engage in community tasks
In Confrontation
 Confront discounts
 Confront maladaptive behavior
In Integrity
 Confess discounts
 Admit maladaptive behavior
 Take responsibility for change
In Stress Reduction
 Develop a range of coping strategies from
which to choose
 When faced with a problem get support
from the person most able to help
 Use effective options to resolve problems
 Self soothe
In Learning Signs of Imbalance
 Detect internal warning signs
 Learn “Red flag” behaviors
In Using the Dealing Process
 Use this systematic way of looking at
dysfunctional behavior and distorted
thinking that invites the observations and
feedback of peers
In Staff Development
 Health


Mind
• Maintain stability
• Avoid burnout
• Grow personally
Body
• Exercise, rest, and recreation
In Staff Development (Continued)
 Professional functioning





Work effectively with clients
Work effectively as part of a team
Grow professionally
Maintain tenure
Enjoy work
 Maintain integrity
Hope for Recovery
Summary
 Basic to the treatment of severe
psychological disorders at Hanbleceya USA
is a community culture where individuals
are supported on their healing journey and
expected to similarly support others
Summary (Continued)
 Individuals whose behavior is maladaptive,
whose thinking is unclear or whose
perceptions are inaccurate can expect to be
confronted by others with how they are
effected, with clearer thinking and with
alternate perceptions
Summary (Continued)
 Individuals who are nonassertive or
aggressive, passive or irresponsible can
expect to be confronted by others who are
assertive and effective
Summary (Continued)
 The culture of love, safety and structure
supports the use of new options to replace
old practices that have not worked
effectively and provides hope for recovery