Beyond the “black box” of the Therapeutic Community: A qualitative psychoanalytic study Virginie Debaere Promotor: Prof. dr. Stijn Vanheule Proefschrift ingediend tot het behalen van de academische graad van Doctor in de Psychologie 2014 Table of contents CHAPTER 1 General introduction ..................................................................................... 1 The Therapeutic Community: An outcast in today’s (mental) health care field .................... 3 The roots of the TC: In search for an answer to an unsatisfying treatment offer ................. 5 The TCs’ growing need for qualitative process research ....................................................... 7 A qualitative psychoanalytic study ....................................................................................... 11 Psychoanalysts’ long-lasting struggle with addiction ...................................................... 12 Why Lacanian theory? ...................................................................................................... 13 Identity formation and drive regulation: not without the Other ..................................... 14 Substance addiction as a ‘successful’ disconnection from the Other .............................. 15 Research question ................................................................................................................ 18 Overview of the next chapters ............................................................................................. 18 References ............................................................................................................................ 20 CHAPTER 2 Beyond the ‘‘black box’’ of the Therapeutic Community for substance abusers: A participant observation study on the treatment process 29 Introduction .......................................................................................................................... 31 Method ................................................................................................................................. 34 Participant observation in a TC ........................................................................................ 34 The analytic process ......................................................................................................... 35 Findings................................................................................................................................. 36 ‘Addicted people don’t feel’ (1) ........................................................................................ 36 The TC is both a frustrating and a holding environment (A) ............................................ 37 The drowned emotional life awakens (2) ......................................................................... 41 TC tools to transform affective tension into words (B) .................................................... 42 The mentalizing ability develops (3) ................................................................................. 46 Discussion ............................................................................................................................. 47 References ............................................................................................................................ 51 CHAPTER 3 Joining others on the rocky road towards a sustained drug-free life: A study on the process of change in a drug-free Therapeutic Community by means of two empirical single cases .............................................................................. 57 Introduction .......................................................................................................................... 59 Lacanian Theory ................................................................................................................... 61 A Lacanian perspective on substance addiction .................................................................. 62 Method ................................................................................................................................. 64 Participants....................................................................................................................... 64 Data-gathering ................................................................................................................. 64 Data-analysis .................................................................................................................... 66 Case descriptions .................................................................................................................. 66 Simon ................................................................................................................................ 66 Andrew ............................................................................................................................. 67 Findings................................................................................................................................. 67 The Other is “dead” .......................................................................................................... 68 The Other “awakens” ....................................................................................................... 69 The subject “awakens” ..................................................................................................... 71 Discussion ............................................................................................................................. 77 References ............................................................................................................................ 81 CHAPTER 4 Changing encounters with the Other: A focus group study on the process of change in a Therapeutic Community ................................................ 87 Introduction .......................................................................................................................... 89 Method ................................................................................................................................. 91 Setting and sample characteristics................................................................................... 91 Focus group data collection and qualitative analyses ..................................................... 91 Findings................................................................................................................................. 94 1. I encounter a safe, caring and challenging Other ........................................................ 95 2. I unfold my particular way of interacting with the Other ............................................ 96 3. I am confronted with the Otherness in me ................................................................... 97 4. I live an Other life ......................................................................................................... 98 Discussion ........................................................................................................................... 100 References .......................................................................................................................... 105 CHAPTER 5 Identity change in a drug-free Therapeutic Community: A qualitative study with former residents ...................................................................... 111 Introduction ........................................................................................................................ 113 Method ............................................................................................................................... 114 Sampling ......................................................................................................................... 114 Study participants ........................................................................................................... 114 Data collection .................................................................................................................... 115 Qualitative data-analysis .................................................................................................... 115 Findings............................................................................................................................... 117 Life before the TC ............................................................................................................ 117 Life in the TC ................................................................................................................... 119 Life after the TC .............................................................................................................. 122 Discussion ........................................................................................................................... 124 References .......................................................................................................................... 126 CHAPTER 6 General discussion ..................................................................................... 129 Main study findings ............................................................................................................ 131 Interrelatedness of the main study findings ...................................................................... 135 Disconnection from the Other .......................................................................................