A sociotherapeutic milieu in inpatient treatment or coaching
Lecture given at the 4th European Conference on Traumatic Stress in Paris
Nico van Tol, Paris, May 1995
part 4

When we observe the extended, delayed consequences of organised violence we are able to identify ways how people react :

1. Avoidance of stress inductors, avoidance of negative confirmation and preventing positive confirmation. Avoidance might cause isolation of the client. Due to this behaviour normal social situations will be avoided.
    
2. Numbing expressed as a lack of interest in the environment and a lack of emotions, feelings. The client is avoiding contact and is not able to interact socially, shows a lack of energy and feels depressed, empty.
    
3. Intrusions and nightmares, with a predominant lack to adapt to reality. Next to that phenomenon we observe that people will follow helplessly without the willingness to influence this, as if the client lost the ability to influence his own free will. This causes feeling of invasi on,overwhelming.
    
4. Hyperarousel, the client experiences this to be a tempestuous level of energy resulting in a negative dominance, other people might be blamed for failures. Focussing to external factors inhibits the evaluation of the own responsibility in relation to other people.

These reactions can be linked to different type of personality. The interventions of the sociotherapists towards the reactions (avoidance, numbing, intrusions/nightmares and hyper arousal) will be tuned to the different types of personality.

Sociotherapists in Centrum '45 are focussing on the skills needed to obtain contact and interaction. The interventions of sociotherapists are (in general terms) directed to the following four types of personality:

1. detached personality: the sociotherapist should avoid isolation and support the client.
    
2. independent personality : the sociotherapist should deny challenges, build structures, point specifically to the rules applied, paying attention to that person in a friendly but determined way.
    
3. dependent personality : the sociotherapist should activate, stimulate, confront, neglect the over-reaction and offer possibilities and stimulate personal initiatives.
    
4. ambivalent personality: the sociotherapist should support, offer limited and defined contact and should stimulate personal choices.

The systematically approach to restore contact and improve interaction in a specifically designed environment is in fact the basis of sociotherapy. This process requires a lot of effort of the sociotherapist and it requires real participation of the client and it requires an institution offering the right possibilities.

The sociotherapeutical profession is limited to the activities in the clinical system. This is defined so-called 'direct sociotherapy'.

Forms of indirect sociotherapy:

1. Sociotherapy is not focussing on genetical/biological or psychopathological personality factors only. This is considered to be the professional expertise of biologists, physicians, psychiatrists and psychotherapists.
    
2. Sociotherapy is not focussing on employment, salary, social security, ethnical background. This is considered to be the responsibility of political and social authorities.
    
3. The sociotherapist is co-operating (supporting and advising) with other disciplines such as social work and relation therapy. This to address situational factors such as debts, housing, relation with partner and/or children etc.

Ladies and gentlemen, I hope this presentation gave you some insight in sociotherapy in Centrum '45 and the application to the treatment (cure - care?) of victims of WW2. The meaning of this presentation is that people who feel suppressed or denied might be helped by treatment based on equality between therapist and client and in that way restore the confidence of the client to attain the skills, to think and act more competent and more in harmony with himself and others. This is a tedious and time consuming process. This way of treatment is expensive and I hope it will be supported by a society with true interest in people who are seriously damaged and maltreated.

This lecture was given at the 4th European Conference on Traumatic Stress in Paris, May 1995.

@ Nico van Tol is Coordinator of the training 'Social Pedagogical Assistence' at the Hogeschool in Leiden.
He has been working as head of the sociotherapeutic staff of the clinic of Foundation Centrum '45 in Oegstgeest.
He is member of the board of the Association for the Development of Sociotherapy / Institute for Sociotherapy and editor of the Dutch publication on the professional code for sociotherapy. He is teacher and management trainer for Panta rhei.

@ Nico van Tol is Opleidingscoördinator Sociaal Pedagogische Hulpverlening aan de Hogeschool Leiden. Daarvoor was hij gedurende 10 jaar Hoofd Sociotherapie van de kliniek van Stichting Centrum '45 te Oegstgeest.
Hij is bestuurslid van de Vereniging ter Bevordering Sociotherapie / Instituut voor Sociotherapie, eindredacteur van Beroepsprofiel voor Sociotherapeuten en docent en begeleider van managementvraagstukken bij SPH onderwijs en Panta rhei.

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