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“De Kiem” Therapeutic programme for drugusers and their social environment. “De Kiem” started since 1976, as the first therapeutic community in Belgium dealing with drugaddiction. One of the founders was Prof. Dr. Eric Broekaert; honory president of the European Federation of Therapeutic Communities. Nowadays “De Kiem” is active within the drugcare in Flanders as a multi-modality programme. “De Kiem” is a non-profit, non-governmental organisation, which operates financed by the Belgian Ministry of Social Welfare. It’s basic objective is to provide in a wide range of services to people experiencing problems related to the use of drugs, alcohol or medication and their social environment. The residential part of the programme includes an induction-unit, a therapeutic community, a mother-and-child unit and a re-entry unit. The ambulatory part includes all intakes, outpatient treatment, groups with parents and groups in prison. “De Kiem” is also involved in prevention activities and edits it’s own magazine. Targetgroup The residential programme aims at adolescents and adults (man and woman) till approximately 40 years, addicted to illegal drugs, alcohol or medication. This programme has a special interest for woman. The mother-and-child unit “De Tipi” aims at addicted woman with young children (till 6 years), pregnant woman or woman who recently had a baby. All programmes have integrated support programmes for parents, partners and other family-members. Affiliations “De Kiem” is a member of the European Federation of Therapeutic Communities (EFTC), the Belgian Federation of Therapeutic Communities (B.F.T.C.), The Flemish Federation of Treatment-centres for Drugcare (V.V.B.V.) and the Association for Alcohol and other Drugproblems (V.A.D.).
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THE ENCOUNTER GROUP METHOD: RENEWING ACCENTS AND GUIDELINES IN TODAY’S IMPLEMENTATION. Bracke, R. & Calle, D.
Rudy Bracke Clinical Director of the Drugfree Therapeutic Program “De Kiem” Introduction In spring 2006 the Belgian Federation of Therapeutic Communities (B.F.T.C.) held a symposium to exchange the evolution of encounter group methods. Belgium counts 7 drug free therapeutic communities; non-governmental organisations financed by the Belgian Ministry of Social Welfare. All of them are member of the B.F.T.C. and most of them are member of the European Federation (E.F.T.C.). As clinical director of “De Kiem” we were involved in specific drug care in Belgium from the early beginning. “De Kiem” is a multi-modality program for youngsters and adults (man and woman) addicted to illegal drugs, alcohol or medication, with a special interest for woman, family and cultural differences. The residential part of the program includes an induction-unit, a therapeutic community, a mother-and-child unit and a re-entry unit. The ambulatory part includes an intake-unit, outpatient treatment (in Ghent and soon in Ronse alsoo) , groups with parents, groups in prison and regional prevention. Within the residential program we were able to build up a 30 years experience in encounter groups. Despite many other engagements in the induction unit and in re-entry, we manage to stay involved on a weekly basis in the leading of encounter groups in the T.C. and also in the training and supervision in this matter. The Therapeutic Community as model of treatment has undergone an evolution. There is the change in population and the search for differentiation. The T.C. tries to anticipate the question of the clients and tries to make the internal life of the residents more flexible. The European Federation of Therapeutic Communities sponsored a conference in De Haan, Belgium in June 1991, in order to find an answer to the question “What cannot be changed in the T.C.?”. The conference conclusions gathered by Broekaert, Kooyman and Ottenberg where inspiring. It was striking however that nothing was said about the encounter group method. Did the encounter method, as a therapeutic means, survive these changes or did changes occur within the method? Is the encounter still equally adequate and so no changes have to be made? Is the method too rigid, too hard and so not very popular to get into the public eye and does it in this way discredit the image of the T.C. as model of treatment? In 1996 we tried to give and answer to these questions, in an article called “The encounter: the heart of the therapeutic society”. This article was published in “The New Therapeutic Community”, a book that was created under the inspiration of my good friend Eric Broekaert, on the occasion of the 20th anniversary of “De Kiem”. In the article we tried to establish the effect of T.C.-evolution on the encounter. In the encounter groups nowadays, the focus is moved from mutual and harsh confrontation towards balanced and respectful dialogue. Attention should be devoted to an atmosphere of safety and trust. We were eager to know if this evolution could be established by objective parameters. In 2000 the literally transcribed proceedings of two similar encounter groups, held at a 20-year interval (1980 – 2000) were systematically analysed by the Department of Special Education of the University of Ghent. The text segments were coded into several categories, and than the ‘old’ and the ‘new’ encounter where compared. The findings of this analysis support the evolution in encounter group methods. The communication is relatively more balanced in the ‘new’ encounter as compared to with the ‘old’ encounter and the associated behaviour in the ‘new’ encounter is found to be more supportive. The symposium of the Belgian Federation in 2006 focused on exchange about the encounter groups methods in an attempt to consolidate the existing experience and to train young team members. Due to the symposium we tried to state explicitly the atmosphere within the encounter and the purpose of the encounter. We also tried to render shape to a number of renewing accents and guidelines in the methodology. On this occasion encounter groups where also video-taped and a questionnaire was send to all members, on the today’s implementation of encounter groups within Belgian T.C.’s. Most T.C.’s have two encounter groups a week, during approximately 90 minutes, in a circle and on chairs, with two staff members present. The larger T.C.’s split up the community into separate groups (10 to 14 residents). There are clear differences in the way the encounter is lead and staff roles are divided and in the focus within the encounter. Differences also appear in the intensity in witch residents and staff members are trained, in the way the encounter is registrated and in the number of confrontations during the group. We can talk some more about those differences in the discussion later on. In this contribution we would like to throw a light on the following accents: - the climate in the T.C. defines the atmosphere and the content of the encounter - the one who starts the confrontation is the one who is working - the accent in the confrontation is on the feelings and thoughts of who is confronting and not on the behaviour of who is confronted - it is important to define and express thoughts and feelings in right explicit terms, aiming them to the other, step by step - negative behaviour should be tackled in structure rather than in the encounter - invest on a regularly basis in learning encounters and seminars (for residents and staff members) - take care of a clear division of staff roles while taking part in the encounter The climate of the T.C. nowadays The atmosphere and the content of the encounter is undoubtedly influenced by the climate of the T.C. in which it takes place. We would like to define the T.C. nowadays (or the ‘new T.C.’, as we called it in our book) as a warm and safe community where someone who has used drugs for many years will be encouraged and stimulated in a clean way to achieve new insights and to work on new perspectives. A place where someone can give a new direction to life, where someone will be supported in new challenges, gaining new experiences on which can be built. The challenge here is to create a climate which is as optimal as possible to enable personal growth. The climate of the T.C. is characterized among others by respect and unconditional positive regard, by safety and by responsibility. These characteristics will be equally important within the encounter group. In the T.C. nowadays recognition and respect is shown for new residents with specific needs and habits, for minorities and cultural differences within the community. Respect is shown for those residents bearing mayor responsibilities and doing well in structure, for well-intentioned feedback on the floor (informal or formal) or in groups and for the staff members who take time and distance to consult so that all interventions should be righteous and adequate. In order to allow residents to grow, a clear organisation of the group of residents will ensure an atmosphere of safety. There can be no violence or threats, no drug use or no excessive acting out. Through a chain of responsibilities everyone is involved on his or her level. Within the hierarchical structure all tasks and the different positions are well-defined. Daily life is structured by a clear planning of day and week, so everyone always knows what is expected. In the T.C. each resident bears the personal responsibility to learn new behaviour, new insights and attitudes. One is supposed to be open for others, to be willing to take in feedback and to accept it. One is also supposed to give feedback to the others. The concept of the "responsible concern" focuses on every resident of the community. Every resident is responsible for what he knows, sees and feels. This means that when he observes a fellow-resident making a mistake, he has to react.
The climate of the encounter The encounter should take place in the same atmosphere as the T.C. nowadays. To safeguard the right atmosphere, we tried to describe some conditions that should be taken care of: the encounter should offer safety and point out responsibility; it should offer support, it should make things clear and every confrontation should be ended in the right way. Later on in this workshop we will show you some images to illustrate the atmosphere and methodology of the encounter group. In the encounter someone should feel free and secure to speak up and to express feelings and thoughts. Every (young) resident is given time and space to built up its presence in the group: I am (see me, I’m here), I need (recognise my specific needs), I’m entitled (I’m entitled to an opinion, to respect, to an answer, to my feelings…). By stimulating him who confronts, a certain safety is created in the beginning for the one confronted. The focus is on the other, he gets time to think and time to abandon his defences and furthermore, he is not obliged to give an answer. Later in the group you can return to the confronted when he is ready for it and even if not. Do not underestimate here the importance of the group. By encouraging the one who confronts, they will indirectly put pressure on the confronted. If this shows no results in the group, then remember there are yet other groups and that rejection and hostility can be deadly for the trust and the safety in the group. In the encounter someone has the responsibility to speak up for oneself and to express opinions and feelings about the relation of the indicted (towards you, towards others or himself). The one who starts the confrontation is the one who’s working. Stimulate him to say what he feels, so that he will also feel what he says. In the encounter someone also has the responsibility to listen and to take in and the responsibility to accept and to reply. It is in choosing the right terms to reply that someone reflects real acceptance of the confrontation: for instance “you’re right, I’m sorry, I understand you better now, I can feel what you feel…” The encounter is a supportive environment in which someone feels stimulated and encouraged to express feelings and thoughts. Other residents will get enough time and space to take position, when a confrontation goes wrong and when the confronted person (the indicted) does not want to co-operate and reply, the one who started the confrontation will be supported by the recognition of other group members (and staff members): “you did well, you did what you had to do, we heard you…” In the encounter time is taken to make things clear. Everyone is helped to elucidate his opinion and to deepen his emotions. The more someone takes time to choose the right (explicit) words to express a feeling or a point of view, the more someone will also feel it and feel recognised. It isn’t always “I am angry”, maybe it’s “I’m hurt, you made a fool of me…”. Furthermore, the confronted will get time to be open for confrontation. Those doing well in the encounter group will be confirmed and encouraged to further take the right course in other groups to come. Lastly, every confrontation is ended in the right way. Often a confrontation goes on different directions before coming to an end. Therefore it is important to check in the end, if the one who started the confrontation is satisfied and feels himself supported. Is the one who was confronted satisfied? Encourage that residents reach out in the group by hugging each other to prove to one another that there is nothing more in between them. In this way participants can hug after each individual encounter or at the end of the entire encounter session.
The purpose of the encounter group In a personal way, we would like to describe the purpose of the encounter group as follows: The purpose of the encounter group is to learn to take responsibility for it’s own life by taking the opportunity to manifest oneself, to express one’s thoughts and feelings towards others and by feedback of those other group members, to augment self-knowledge and self-esteem, and by this, to make new choices in life. Or, in other words… - to learn to take responsibility for it’s own life; ‘to take the opportunity within this unique forum’ - to learn how to acknowledge, handle and express emotion - to learn to give and to ask for support, respect and trust - to learn to listen to the others, to take in and to be open for change
Initiation of the encounter group method It is the responsibility of staff members to initiate the encounter method to all new members of the community and to safe hold it through time. They should watch over both method and climate of the encounter group. To do so, we developed a specific group, every two weeks, where the encounter is initiated. Every new member of the community participates, in a three months period, in a package of groups where all therapeutic group techniques are initiated: for instance training of voice and respiration, bio-energetic exercises, dynamic meditations, practice of confidence, endurance or other attitudes… and of course, of the encounter techniques. Within the initiation encounter the new residents are stimulated to follow instructions, to put their mind open for what’s new (new thoughts, tensions, feelings…), to give the best of oneself in the knowledge that nothing or nobody is perfect and to stay in the ‘here and now’ and focus. All participants, including the proceeding staff member, are sitting down in a circle (on chairs), facing one another. The staff member (or a group member) starts with a short briefing about the purpose of the initiation group: this is to get to know and to practise the encounter method in the best possible way, to learn to write encounter slips, to practise the technique of building up a confrontation, the attitude to take in a confrontation and the ability to feel and to sympathise with an other who’s confronted and, at last, to learn to give feedback to an other group member. In this way the involvement of all new residents is installed and stimulated. Once started, the encounter group develops in the following order: A group member explains with what and to whom he wants to work, the staff asks who (other than the one confronted!) wants to take in the confrontation, the confronter learns to formulate the essence of his confrontation and is than helped to build up his confrontation, with the stimulus of other group members and staff. The confronted learns to take in. In fact, it is easier to take in a confrontation about someone else than about oneself. In a next step the confronted and the group members are asked how they experienced the confrontation and at last the confronter is asked how he feels, if he feels satisfied and if there are any questions… Despite the initiation and practice in the encounter method it will be necessary that some residents will be helped in advance, before the group is started. We help them to formulate their confrontation and to show them how they can build it up. Residents with a restricted use of language, insight or intelligence will be helped in this way to accomplish a good result in the encounter group.
Methodology Let us try to render shape to a number of renewing accents and guidelines within the methodology and to point out a number of do’s and don’ts. Set up the group with all participants sitting down in a circle (on chairs), facing one another. Once the group is started, everyone can take the floor. As everyone is equal within the encounter, there is no prescribed order in which confrontations should take place. Often confrontations towards staff members are taken first, to facilitate the leading of the encounter further on. At first, the staff member will not interfere the confrontation, so it can evolve spontaneously, even if the confrontation appears to go wrong. Only in second instance, the staff will interfere when the confronter gets stuck in his words or feelings or in an endless discussion. To confront someone means to speak up in a direct way, without beating about the brush. Feel the tensions in your body , build them up en let them out, without acting out or excessive shouting. To confront someone means to bring out your thoughts, if needed with power, because you believe in them. That will build your self-esteem. Let go your feelings towards the other in an ‘refined’ way, with well-chosen words. There are clear differences in the way the encounter is lead in our country. The importance of these subtle differences for the climate of the encounter and the growing process of all participants is often underestimated. Therefore we would like to put in contrast some do’s and don’ts. They can serve as guidelines for those leading an encounter. The staff (and older group members) should take guard of the fact that the confronter must always look at who sits in front of him and what he or she can handle or take. The confronter should not shout too loud or speak too quick and acting out is not allowed. Take guard of the fact that the focus is on what’s bothering the confronter (his feelings) and what he is thinking (his thoughts) and not on the behaviour of the confronted. An important pitfall is that group members talk and rationalise too much, and beat about the brush using long sentences. Stimulate them to build up and let go their emotions using short and powerful words. Support the one who is working through encouragement and don’t take over the confrontation, an other important pitfall. Don’t bring up your own items and frustrations! The staff should help group members to explain an opinion or a feeling by asking short questions and by refining and rephrasing things; they should not draw everything to themselves by asking too many questions, and in this way, let feelings ebb away. At last, don’t try to change negative behaviour in the encounter, it should be dealt with in structure! The tasks of the staff members is to divide the group (usually on the basis of encounter slips) and to pre-discuss confrontations so that certain pitfalls can be evaded. Chose a clear role, before going in to the group with several staff members: who leads; who takes in staff confrontations and who goes in as a participant? In leading the encounter group it is the task of staff members to ensure a climate of safety, responsibility and support, to make things clear and to end confrontations in the right way. After the encounter the staff will always evaluate and keep record of all confrontations. And last but not least, sufficient training for residents and staff (through seminars, initiation groups and on the job counselling) on the climate and methodology of the encounter group will make it far more easy to lead the group.
Conclusion The encounter group method remains an essential element within the therapeutic community, when implemented in an appropriate way, with necessary care . The encounter group is a unique forum, offering a lot of opportunities. It is typical for the therapeutic community and often not known or misunderstood by relief care or society. Let us take care of it’s quality by exchanging our experiences and refining the methodology.
References Bracke, R. (1996) De encounter, het hart van de therapeutische gemeenschap (The encounter, the hart of the therapeutic community). In E. Broekaert, R. Bracke, D. Calle, A. Cogo, G. van der Straten, & H. Bradt (Eds.), De nieuwe therapeutische gemeenschap (pp. 65-70). Leuven: Garant. Bracke, R. & Calle, D. (1996) De organisatie van de therapeutische gemeenschap (The organisation of the therapeutic community). In E. Broekaert, R. Bracke, D. Calle, A. Cogo, G. van der Straten, & H. Bradt (Eds.), De nieuwe therapeutische gemeenschap (pp. 65-70). Leuven: Garant. Broekaert, E., Kooyman, M. & Ottenberg, D. (1998). The “new” drug-free Therapeutic Community: Challenging encounter of classic and open Therapeutic Communities. Journal of Substance Abuse Treatment, 15 (6), 595-597. Broekaert, E., Vandevelde, S., Schuyten, G., Erauw, K., Bracke, R. (2004). Evolution of encounter group methods in therapeutic communities for substance abusers. Addicitve Behaviours, 29 (2), 231-244.
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