Where the Change Is: Everyday Interaction Rituals of Therapeutic Communities
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WHERE THE CHANGE IS: EVERYDAY INTERACTION RITUALS OF THERAPEUTIC COMMUNITIES Jenelle M. Clarke, BA (Hons), BA (Hons), MA Thesis submitted to the University of Nottingham for the degree of Doctor of Philosophy March, 2015 Words: 99,995 ABSTRACT 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, 1 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. 2 ACKNOWLEDGEMENTS A doctoral study exploring every day interactions rituals is ultimately itself part of a ritual: the ritual of doing a PhD and of writing a thesis. I am sincerely grateful and indebted to a number of organisations and individuals who helped me throughout the ritual of this doctorate. Firstly, I would like to thank my academic supervisors, Professor Nick Manning (University of Nottingham) and Dr Gary Winship (University of Nottingham). I would also like to thank Professor Ruth McDonald (University of Warwick) who supervised the first two years of this research. I thank you all for your unwavering support, expertise, engaging supervision conversations, helping me find the core of this thesis and teaching me so much more than just how to do a PhD. Secondly, I thank the Economic and Social Research Council (ESRC) and the Institute of Mental Health (IMH) for funding this study. My thanks also to the ESRC Doctoral Training Centre and especially Professor Peter Bartlett and Professor Alison Pilnick for their support. I thirdly thank those within the School of Sociology and Social Policy. Dr Amal Treacher Kabesh for always going above and beyond a convenor’s role. Dr Melanie Jordan for walking me through ethics and always taking the time to talk. Alison Haigh for exceptional administrative support. My fellow PhD colleagues Anisa, James, Steven, Philip, Hakan and Michaela, in the School of Education, for countless conversations, moral support and exchange of ideas. You all have expanded my perspective and I cannot imagine doing this without you. Fourthly, I wish to thank Christ Church Deal (CCD) Therapeutic Community. Your experiences and stories of change over the past 13 years inspired this study, particularly Yvonne H. I thank you all for helping me get here, especially the support of Sarah C, Catriona B, Jenny B, Margaret G, Natalie L, Helen G and Kathryn P. My thanks also to Wendy I for providing much needed opportunities to talk. In particular I thank Dr Peter Holmes, Dr Susan Williams and Dr Ruth Brown for your expertise, friendship, guidance and encouragement over many years. 3 I fifthly thank my husband, Dr Simon Clarke. You took a leap with me over three years ago and for that I am beyond grateful. I thank you for your wonderful cooking, listening ear, walks through the Nature Reserve, study music, critical feedback, for being a sounding board as I worked to find the words for this thesis, and above all, for reminding me it is ‘perfect weather to fly’. Lastly, I thank the two host organisations and all of the participants in this study. You opened your doors to me and shared your lives with me. I came because I wanted to understand how you made your changes, but you have changed me in the process as well. Through sharing life in TCs with you, I gained a deeper awareness of the complexities involved in community life, learned to value the extra-ordinary of the ordinary and expanded my conceptions of what change means. For everything, thank you. 4 TABLE OF CONTENTS ABSTRACT ................................................................................................................ 1 ACKNOWLEDGEMENTS .......................................................................................... 3 CHAPTER 1. WHERE THE CHANGE IS – INTRODUCTION .................................. 10 1.1 THE RESEARCH STUDY ..................................................................................... 12 1.2 AIMS AND OBJECTIVES ..................................................................................... 13 1.3 A THEORETICAL JOURNEY OF TRANSFORMATION ................................................ 15 1.4 EVERYDAY SOCIAL INTERACTIONS (RITUALS), TCS AND PERSONAL CHANGE ........ 19 1.4.1 Everyday Interactions Rituals ................................................................. 19 1.4.2 Therapeutic Communities ....................................................................... 22 1.4.3 Personal Change .................................................................................... 23 1.4.4. A Note on Terminology .......................................................................... 24 1.5 OVERVIEW OF CHAPTERS ................................................................................. 25 CHAPTER 2. THERAPEUTIC COMMUNITIES, PERSONAL CHANGE AND SOCIAL SUPPORT .................................................................................................. 27 INTRODUCTION .................................................................................................. 27 2.1 THERAPEUTIC COMMUNITIES (TCS) ................................................................... 28 2.1.2 Research within TCs .............................................................................. 34 2.1.3 Limitation of TC Research ...................................................................... 40 2.2 PERSONAL CHANGE ......................................................................................... 42 2.2.1 Conceptions of the ‘Self’: an interactionist perspective ........................... 42 2.2.2 Self Transformations and Personal Change ........................................... 44 2.2.3 Limitations of Symbolic Interactionism in Relation to Personal Change . 47 2.3 POWER WITHIN TCS ......................................................................................... 49 2.4 THE IMPORTANCE OF SOCIAL SUPPORT ............................................................. 53 2.4.1 Limitations of Social Support .................................................................. 56 SUMMARY ............................................................................................................ 58 CHAPTER 3: INTERACTION RITUAL CHAIN THEORY ........................................ 60 INTRODUCTION .................................................................................................