The Therapeutic Community Program at Riggs: Patient Government



by Aaron Beatty

Spencer Biel, PsyD is the Associate Director of the Therapeutic Community Program at the Austen Riggs Center“The values embedded in the Therapeutic Community are human values,” says Associate Director of the Therapeutic Community Program (TCP) Spencer Biel, PsyD, “that recognize and honor the dignity of every person and take seriously not only the struggles patients are bringing to us with, but also their capacities and the ways they can contribute meaningfully to relationships, to communities and to life.”

One of the ways patients can contribute in a meaningful way during their treatment at Riggs is by participating in the elected patient government. Biel explains, “There’s an honest, genuine way in which patients are sharing in the running of this place, the way this community looks and feels and operates.” 

The patient government at Riggs is organized according to a variety of tasks that collectively help support fundamental aspects of living in the Riggs community. Patients may run for and be elected to eight-week terms in a number of positions in the patient government in areas such as:

  • Community Meeting (CM) Chairperson: A central elected role, the Chair helps to organize and run the five-times-weekly CMs. CM has many tasks including information sharing, problem solving and decision-making and is a primary reflective space for the community. 
  • Patient Activities: The Community Events Board (CEB) manages a budget and works on finding ways for patients to spend time together less formally, get to know one another and have fun. 
  • Task Group: Patients can meet with an elected group of peers and two staff consultants, and can refer one another to this group, to consider relationships between individual, interpersonal, and group functioning.  This group is often mobilized in the context of troublesome behavior, with an effort to “unpack it and think both about how the behavior impacted others and potentially stemmed from and expressed social pressures.” 
  • Sponsors: New patients receive support from patient sponsors to help orient them and make the transition into life and treatment at Riggs smoother.
  • Transitions Representative: This person notifies the patient community of comings, goings and changes in levels of care to “mark the changes, celebrate progress while also recognizing that all change is disruptive, and support people who are grappling with changes associated with intensifying struggles” says Biel. 
  • Work Program: There are paid work positions patients may apply for in numerous parts of the Riggs community (Nursery School, library, etc.), and patients help to identify work opportunities and manage the processes involved.

The Community Events Board at Austen Riggs facilitates the development of recreational events for the patient community.There are a number of other committees and positions available for patients to get involved with – from helping to run a patient library at the Inn, to participating on the Food Committee, to taking up issues concerning the physical facilities of Riggs. 

“The effectiveness is clear to me regularly,” remarks Biel. “Patients are working to face and bear experiences that are often unclear and overwhelming. In order to be able to tolerate and learn from this process, it requires that they also engage in ways they feel capable, confident, proud and skilled.”  There is a balance to it – focusing too much on one side or the other fails to recognize the complexity of people and the degree to which functioning is related to context. Biel sees a common drift in treatment settings or hospitals to label patients as sick and troubled and to label the professional staff as healthy and rational. He remarks, “To try to organize the world that way deprives and disadvantages everybody – we [staff] make just as big messes as the patients do.” 

There are many ways for patients to contribute, have a voice, have an impact and shape not only their time at Riggs, but also shape the community overall. While not the only one, patient government is a primary vehicle for patients to be empowered and involved in a way that transcends their patient role. 

Biel notes that staff members are involved in supporting and working with patients in their patient government roles, stating “It’s often my experience that I’m not supporting but rather working alongside patients, trying to offer my mind and my thinking as a resource to them as they use their own.” At its best, Biel sees the Therapeutic Community as a space where patients and staff are “in this partnership mode where we’re leaning on each other, bouncing ideas off one another.” 

In Biel’s eyes, the Therapeutic Community is “unique and precious and needs to be nourished, thought about and struggled with.”  Biel comments on the core tenets of partnership, recognizing struggles and strengths in our patients and the real way in which we work together to keep the community functioning and each other safe as follows: “I feel strongly about preserving and bolstering these principles while also recognizing that communities are dynamic systems that are enlivened and sustained by curiosity, questioning, and a willingness to take chances and try new things.” 

Read more about the Therapeutic Community: 


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