치료공동체 프로그램의 효과성에 관한 연구 = (A) Study on the Effectiveness of Therapeutic Community Program

다국어 초록 (Multilingual Abstract)

The purpose of this study is to evaluate the effectiveness of Korean Therapeutic Community program (TC, hereafter).
Many countries have suffered from drug problems since ancient times. At first, doctors prescribed only medicine for drug addicts. But it has been unsuccessful or often creates new other drug problems. So, a kind of self-help approach has evolved outside of mainstream psychiatry, psychology, and medicine : Therapeutic Community.
Therapeutic Community has proven to be a powerful approach to treatment for substance abuse and its related problems.
Korea has many drug addicts and they were mainly imprisoned. There are many alcoholics also. Since the IMF economic crisis in 1997, many people have lost their jobs and become homeless. Most homeless people are alcoholics. But, alcohol is not perceived as harmful and is not regarded as a drug. There were no treatment system except hospitalization for alcoholics in Korea. So, drug addicts and alcoholics were confined behind the closed doors of jails or hospitals.
In the early 1980s, many adolescents began to use different kinds of drugs and chemical substances, like inhaling adhesives or taking stimulants like barbiturates. By the 1990s adolescent drug addicts received the attention of many doctors and social workers. At first, these adolescent drug users were treated in hospital. Doctors healed them through psychiatry and psychology. But they couldn't completely discard the temptation of using drugs. Stealing or using violence to get money for drugs obviously creates great problems within their families, schools, or in society generally.
So, social workers began to approach them from the view of social welfare. They gave them personal or group counseling. But it took a lot of time and was too costly to provide these services for many clients. Moreover, it was not effective enough for clients who had severe addiction problems.
In 2001, a child guidance center administered the Daytop TC program to the children clients. The staff trained in the United States for three to four months under the supervision of the staff members of Daytop, started the TC program from September 2001. Altering the children's behavior considerably, it was proven to be a successful program. Therefore, other facilities are going to employ the TC program one by one.
In this study, two facilities administering the TC program and two facilities not administering the TC program were chosen to verify the effectiveness of the TC program.
Two are probation institutions for adolescents. One of them administered the TC program and the other did not.
Another two are facilities for adults. One is a shelter for homeless people, and the other is a national mental hospital.
There was 38 adolescent clients and 7 staff in the TC program, and 54 clients and 9 staff in the No TC program.
The adult group consisted of 22 clients and 6 staff in the TC program, and 30 clients with 12 staff in the No TC program.
The effectiveness of administering the TC program was tested by COPES (Community-Oriented Programs Environment Scale), and the data was analyzed by the Statistics Program SPSS 10.0.
COPES consists of three dimensions (Relationship, Personal Growth, and System Maintenance Dimensions) and 10 items( Involvement, Support, Spontaneity , Autonomy, Practical Orientation, Personal Problem Orientation, Anger & Aggression, Order & Organization, Program Clarity, Staff Control).
The result of administering the TC program was effective both for adolescents and adults. By statistical analysis, the total mean of the raw scores was proven to be significant.
But, for the adolescents, except for the Involvement, Spontaneity, Autonomy, Practical Orientation and Staff Control, the individual scores were not statistically significant. The former three items, Involvement, Spontaneity, Autonomy, are considered components which can be improved at the early stages of the administration of a TC program. But these results indicate that using only the TC program, is not enough because most of the juvenile adolescents come from the disfunctional families and they have many emotional problems, They are in need of additional programs to deal with their internal problems.
For the adults, not only were the mean scores of the TC administered program higher than the No TC program, but nearly all of the results were statistically significant.
Only the item 'Anger and Aggression' was not signifiant. That is because in Korea, adults, particularly men, are not allowed to express their emotions. This is Korean culture. But the men in homeless shelters have no family, no job, nor any kind of support. They have a lot of anger, but they have no way to express it. Adults also need programs to deal with their personal problems.
As mentioned in the study by Kim, Bo-Ai (A Study on the application and effectiveness of Therapeutic Community program for juvenile delinquents : Focusing on the change of personality and behavior, 2002) the role of staff in the TC program is very important. The effectiveness of a TC program is up to the degree of an agreement between the staff and clients about their therapeutic environment.
The standard scores of staff and clients for the 4 facilities were plotted on the graphs. Some of them are coincident and some are not. It does not mean that they are satisfied with their therapeutic environment. It explains that the therapeutic environment of TC programs in Korea should be improved more.

목차 (Table of Contents)

• 목차
• Ⅰ. 서론 = 1
• A. 문제 제기 = 1
• B. 연구의 목적 = 3
• C. 연구의 제한점 = 3
• Ⅱ. 이론적 배경 = 4
• A. 치료공동체의 이론적 개념 = 4
• 1. 치료공동체 (Therapeutic Community ; TC )의 개념 = 4
• 2. 치료공동체의 기원 = 7
• 3. 치료공동체의 관점들 = 8
• 4. 치료모델의 요소들 = 13
• 5. 치료공동체에서 사용하는 도구들 = 21
• 6. 변화의 과정 = 26
• B. 우리나라에서의 치료공동체의 적용 현황 = 28
• 1. ㄱ 아동상담소 = 29
• 2. ㄴ 청소년 근로복지관 = 29
• 3. ㄷ 노숙자 쉼터 = 30
• C. 치료공동체프로그램 평가에 관한 선행연구 = 31
• Ⅲ. 연구방법 = 33
• A. 연구 절차 = 33
• B. 연구대상 = 33
• C. 연구문제 = 36
• D. 측정도구 = 36
• 1. 사회환경척도(Social Cl imate Scale)란 = 37
• 2. 사회환경척도의 측정영역 (Dimensions) = 38
• 3. 치료공동체프로그램 사회환경척도의 하위 영역들 = 39
• E. 분석방법 = 40
• Ⅳ. 연구결과 분석 및 논의 = 41
• A. 청소년시설의 치료공동체프로그램 적용효과성 검증 = 42
• B. 성인시설의 치료공동체프로그램 적용효과성 검증 = 45
• C. 표준점수에 의한 스텝과 클라이언트의 치료환경에 대한 견해비교 = 48
• Ⅴ. 결론 = 53
• A. 결과 요약 = 53
• B. 연구의 함의 = 55
• C. 향후 연구를 위한 제언 = 56
• 참고문헌 = 57
• 부록 = 60
• ABSTRACT = 68