Moreno’s approach to community work finds seamless congruence with Hardcastle, Powers, and Wencour (2011) description of social work—“social work practice is about using the community and using naturally occurring and socially constructed networks within the social environment to provide social support” (p. 3). Moreno’s early work with immigrants, refugees, sex workers, inmates, and the underlying philosophy of his methods of sociometry, psychodrama, and group psychotherapy pivots on the foundational concept of using the resources within the group or community to provide support. He described each community or group member as a therapeutic agent and worked to restructure the group or community process to cultivate mutual aid between members.
Macrosocial work practice has evolved to include three primary domains—the community, organizational management, and policy (Austin, Anthony, Knee, & Mathias, 2016). It has been proposed that the primary goal of community social workers is to utilize social networks within communities to connect community members to organizational or community resources (Rodriguez & Ferreira, 2018). An argument could be made that all community work is based on the engagement, assessment, intervention, and evaluation of social networks within the community. Social workers intervene on the individual level by connecting individuals or families to social networks or agencies within the community who can meet their needs or enhance their living conditions. De Robertis (2003) notes that one of the most essential tasks of community social workers is to (re)establish connections of people to the community or society, and to (re)establish connections of the community to society. Community organizing has been described as a process by which a community discerns its goals or needs, prioritizes them, commits to working toward them, accesses related internal or external resources, takes action, and in doing so cultivates collaboration and mutuality within a community (Ross & Lappin, 1967).
Social workers utilize individual (micro), group (mezzo), and community (macro) interventions in clinical practice. It is worth noting that every individual and group intervention take place within the context of community (often multiple overlapping communities). Person-in-environment means that the client must be conceptualized within their social and community contexts. Even casework interventions and referrals have an element of community practice as a referral is essentially the facilitated connection between a client and a community resource (Hardcastle et al., 2011). Many agencies actually contain multiple (formal or informally recognized) communities or social networks within the organizational structure (a community of staff, a community of patients, a community of alumni, a community of volunteers, etc.).
A community is simply defined as a unified group of people, usually with a shared history, identity, goal, or interest. Communities are often categorized into five different types, based on either interest, location, action, practice, or circumstance. There are, of course, many different types of specific communities including neighborhoods, national communities, ethnic communities, religious communities, political communities, professional communities, educational communities, organizational communities, treatment communities, and recreational communities, among others. Social workers engage with all of these types of communities to bring about change. In some cases, the entire community is actively engaged at once, but in most cases the social worker is engaging with a subgroup of a community. For example, it may be logistically impossible the convene a group of the entire Pennsylvania medical community, but a subgroup of the community may respond to a call to meet and information, decisions, and calls to action can be distributed back to the entire community.
While clinical and group work are connected to community work , social work with communities is a uniquely different arena of practice (Austin et al., 2016). The goals of community work, though sometimes similar, differ in nature from the goals of clinical or group work. Though the goals in each social work arena may overlap, the means (interventions, practice skills, tools, etc.) used to work toward these goals have much more differentiation between clinical social work, social group work , and social community work. Perhaps the most obvious difference between these three levels of social work practice is the size of the client. In individual work, the client is an individual; in group work, the client is a group; in community work, the client is the community or organization. Another major factor distinguishing community work from group work and clinical work is that it is not typically framed as therapy. Though it is not psychotherapy or treatment, community work is often therapeutic and healing. The specific use of community as therapy, such as the therapeutic community , will be discussed shortly. Regardless of the community context, it can be helpful to revisit Yalom’s therapeutic factors of group psychotherapy in the framework of community.
Yalom and Leszcz (2005) propose these eleven factors for a therapeutic group experience—instillation of hope
, imparting information, altruism
, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness
, catharsis , and existential factors. When the community-as-a-whole is approached as its own group, each of these eleven elements can be considered. In a similar fashion, these therapeutic factors also become relevant to the development of a therapeutic society . The synthesis of these curative factors provides a sense of connection, purpose, meaning, healing of past wounds, and future orientation for groups, communities, and society.
2.1 Therapeutic Communities
The concept of therapeutic communities (TCs) has emerged in various points in time, mostly connected to religious/spiritual sects, educational groups, or mental health advocates (De Leon, 2000). The most common types of contemporary therapeutic communities are specifically for psychiatric patients or folks recovering from addiction . Therapeutic communities for psychiatric patients were organized by psychiatrists while the TCs for addiction developed in opposition to psychiatry and medicine (Ayyagari, 2014). Main (1946) and Jones (1953) are generally considered as the founders and pioneers of the modern therapeutic community , originating from their work in the UK in the mid-twentieth century. In the therapeutic community perspective, treatment is not located in the provision of therapy by staff, but instead, in the therapeutic effects of involvement in healthy community life (Jones, 1953). The community itself is seen as the doctor (Rapoport, 2013). Main, in his 1946 manuscript first utilizing the term therapeutic community , states that, “the fact must be faced that radical individual psychotherapy is not a practicable proposition for the huge numbers of patients confronting the psychiatric world today” (p.67). The therapeutic communities were major advocates of group therapy due to its congruence with the TC philosophy (Bloom, 2013).Therapeutic communities were based on the following assumptions: Patients should be co-responsible for their own treatment; patients have the ability to help each other; the community should be led democratically; treatment should be voluntary (as often as possible); physical restraint should be avoided whenever possible; psychological therapies were preferred to physical treatments (Almond, 1974; Bloom, 2013; Cumming & Cumming, 1962; Wilmer, 1981). Maxwell Jones’ therapeutic community in England included the use of theater and drama by 1943, later integrating psychodrama when Jones became aware of Moreno’s work around 1949 (Bloom, 2013; Casson, 2000; Jones, 1949, 1953).
Moreno’s Beacon Hill Sanitarium , later renamed Moreno Sanitarium , was founded in 1936 in Beacon, New York, and resembled the structure of a therapeutic community in terms of the democratic and equal nature of role relationships between participants (Moreno, 2014). Robert Landy describes it to have “represented Moreno’s notion of an integrated community, an early exemplar of a therapeutic milieu, where all staff and patients, family and visitors were encouraged to engage with one another openly and equitably” (2008, p. 53). Another connection between Moreno and the emergence of the therapeutic community model in psychiatry comes from Bierer (1960), who was a close friend of Moreno and pioneer of the TC movement (Moreno, 2014). Like other fields, scholars of the therapeutic community movement rarely make mention of Moreno’s work, even though it predated Main and Jones by a decade or two. It is likely that Moreno’s resistance to operating within mainstream psychiatry also contributed to the absence of reference to his ideas.
-focused therapeutic community movement emerged in 1958 with the founding of Synanon by Charles Dederich in Santa Monica, California. One of the primary supporters of Synanon and the therapeutic community model, who served as their director of research, was Lewis Yablonsky —a prominent psychodramatist, sociology professor, and close colleague of Jacob Moreno (Yablonsky, 1962, 1965, 1976, 2002). Yablonsky notes that Dederich was an admirer of Moreno’s work and that psychodrama techniques become an embedded part of nearly every Synanon group (Moreno, 2014). Synanon experienced early success and integrated philosophies and approaches from Alcoholics Anonymous , the Human Potential Movement , encounter groups and psychodrama (Janzen, 2000; Yablonsky, 1989, 2002). In 1963, Daytop Village was founded in New York, its leaders motivated by Synanon’s model. Daytop and Synanon were the most influential and well-known therapeutic communities in the addiction industry. The addiction-focused therapeutic community structure draws inspiration from Alcoholics Anonymous in that they elevate ex-addicts to the status of co-therapists or peer supports with a large emphasis on mutual aid (Yablonsky, 1989). While the TCs created by the social psychiatrists used pharmaceutical interventions and maintained equal status between all community members, the addiction TCs rejected pharmaceutical treatments and developed hierarchies within the community structure. Synanon and Daytop Village communities were recreated around the world and helped tens of thousands of former criminals or addicts. Yablonsky writes that the Synanon project “facilitates the realization of a true total therapeutic community , a live demonstration of Moreno’s concept of the total therapeutic community , where everyone is a therapist (and at the same time a patient) to everyone else” (1976, pp. 151–152). In its later years, Synanon and its members became associated with intense catharsis , violence, abuse, coercion, cults, and crime—including putting a rattlesnake into the mailbox of a lawyer (Janzen, 2000).
Therapeutic communities became widely implemented and have demonstrated successful outcomes (De Leon, 2010; Vanderplasschen et al., 2013). At the same time, many TCs, particularly in the addiction field, developed poor reputations for their use of confrontation, humiliation, shaming members, and the intense emotional nature of community meetings. The philosophy of “tough love” and “break them down to build them back up” became guiding forces as TCs began implementing what they called “attack therapy” and excessive confrontation (Ayyagari, 2014; Polcin, 2003; White & Miller, 2007; Yablonsky, 1976). Lieberman, Yalom, and Miles (1973) major research study on encounter groups , which included 17 encounter groups with different leadership styles and approaches, found the Synanon groups to have the biggest dropout rates (38%). Many became concerned with the ways in which these TCs were harming and re-traumatizing community members more than helping them (Ayyagari, 2014; White & Miller, 2007). Cadiz and colleagues (2011) write that “many of the basic philosophies of a traditional therapeutic community conflict with philosophies about how to treat trauma and what a survivor needs to recover” (p. 133). The high rates of trauma underlying addictive disorders make some practices of the therapeutic community especially inappropriate or even unethical (Ayyagari, 2014; IDHS, 2005). As the field of trauma therapy quickly evolved in the past few decades, The Sanctuary Model for trauma-informed therapeutic communities and systems developed.
2.2 The Sanctuary Model as Trauma-Informed Therapeutic Community
The Sanctuary Model emerged from Sandra Bloom and colleagues’ work between 1985 and 1991 in a suburban Philadelphia inpatient psychiatric hospital (Bloom, 2013). The Sanctuary Model is essentially a trauma-informed and democratic therapeutic community approach developed with attention to the importance of attachment, neurobiology of trauma, and community life (Bloom, 1997, 2008). After years of refinement and implementation around the world, it has become well respected as a trauma-informed philosophy for treatment centers, organizations, systems, cities, and society (Bloom, 2012, 2013). The sanctuary approach is centered around seven commitments: (1) nonviolence; (2) emotional intelligence; (3) social learning; (4) open communication; (5) democracy ; (6) social responsibility; and (7) growth and change (Bloom & Farragher, 2013). Each of these seven commitments is regarded as essential and interconnected elements of a system’s operating framework which guide the formal and informal relationships between staff, patients, and administration.
The Sanctuary Model offers “a compass for recovery” called “S.E.L.F.” which is an acronym for Safety, Emotions, Loss, and Future (Bloom, 2013). These four simple concepts represent major areas in one’s life that can be disrupted by trauma and adversity, as well as the four domains in which sanctuary programs base their treatment plans, organizational changes, community dialogues, and decision-making process (Bloom & Farragher, 2013). The S.E.L.F. compass is operationalized through the regular use of safety plans, treatment planning, psychoeducational groups, structured team meetings, and community meetings (Bloom, 2008). Bloom writes that, “ultimately in the Sanctuary Model, the purpose of our shared assumptions, goals, practice, and vision is to create what Maxwell Jones, a half-century ago, described as a ‘living-learning environment’ within which healing, growth, and creative expression can occur” (Jones, 1968; as cited by Bloom, 2008, p. 16). In addition to her inspiration from Jones’ early therapeutic community philosophy, it is interesting to note Bloom’s positive regard for psychodrama evidenced in regular references to how helpful it had been in her psychiatric treatment programs (Bloom, 2000, 2013; Bloom & Farragher, 2013)—she even wrote the foreword for a textbook focused on the clinical uses of drama in therapy with children (Weber & Haen, 2005). Similar to Moreno, Bloom’s writing transcended clinical contexts and also considered the objective of a healthy society.