The necessary adaptation of a public Therapeutic Community to new needs of the treatment process.

 
In this presentation I propose to reflect on the experience of the last 25 years of clinical work carried out at CT do Restelo and its necessary adaptations over time. The characteristics of the population of residents were changing (ages, type of consumption, usage patterns, their health phisical and mental status, social problems, family relationships) and with this the community had to adapt, seeking to provide an adequate response from the technical and theoretical point of view, learning from the empirical experience of daily challenges posed over time. This evolution meant a lot of experience gained, a mandatory ability to listen to the needs of the population and the proposing institutions, to rethink the model, to create within it, more individualized responses to specific cases for whom the general program created to respond basically to heroin addicts did not gave an answer. Supervision was essential for thinking outside the box, and from this came changes that remain to this day, such as the introduction of a new phase of the program to respond to the need to reduce the waiting time for candidates for admission.
The introduction of alcoholics into general programs forces us to make profound changes and a different dynamic between the group's elements. Also the "new dependencies" (like gambling for example) have been challenging.
The staff (multidisciplinary and transdisciplinary team) was also restructured and reinvented, within a broader scenario where the country's socio-economic changes prevented its renewal by not hiring colleagues who were retiring, thus imposing permanent efforts compensation so as not to reduce the quality of services provided. This process and work dynamics will also be subject to reflection.
The idea of ​​the need for a village (community) to raise a child can be adapted to the need for many patients of a home, with a method of treatment and a model of healthy community relationships that allow individual emotional and psychological growth to occur. so that it is possible to build the responsibility and autonomy inherent to what is expected of an adult.
The general objectives of the program in which Treatment equals Individual and lifestyle change, may be the same over time, but the nuances of with whom, in what way and through whom this process should be done have been suffering. changes. This presentation will focus on all of this.