Regaining Autonomy
Institutions regularly strip survivors of certain basic rights, including their ability to make general decisions for themselves. Psychiatric hospitals often have enforced bedtimes, requiring patients to stay in their rooms after a certain time. Certain cults may force members to eat meals with the group for socialization, dictating what time of day each meal is had. Survivors in prison might be “subject to involuntary confinement and, potentially, servitude,” stripping away fundamental freedoms (Hill et al., 2016).
The structure and organization of institutions often takes away survivors’ ability to decide how to go about their day, making it difficult to organize daily tasks on their own. Survivors may struggle with certain rules that were enforced with their IOD, such as aforementioned regulations on when to sleep, when to eat, when to work, and more. This is often one of the hardest things that people who are suffering from institutional syndrome deal with—the newfound lack of structure and stability that comes with freedom. Regaining Autonomy is about restructuring one’s life in a way that benefits them and provides much-needed stability in periods of transition.
One of the key issues of institutionalization is the inability to function outside of an IOD’s facility due to a dependence on the structure of the institution. Regaining Autonomy aims to return feelings of independence and safety to survivors. Autonomy-primed people show less “self-handicapping” than others, opening survivors up to new opportunities to combat learned helplessness (Hodgkins et al., 2006). Feeling assured in one’s own decisions allows them to adjust to their new freedoms and find their own preferred routines.
Regaining Autonomy is perhaps the most important principle of Institution Therapy. IODs often have a unique, near total power over survivors’ mindset and perspective, not unlike the relationship between an enmeshed parent and child. According to schema therapy’s Domain of Impaired Autonomy and Performance, such relationships can lead to dependence on others, a strong fear of harm, excessive enmeshment in one’s relationships, and feelings of failure. It’s also been shown that impaired autonomy and performance positively relate to depression (Renner et al., 2012). As such, autonomy and independence are extremely important to address in the recovery of institutional trauma survivors, especially those who have had these stripped from them long-term. Not addressing these values can result in survivors going back to old negative behaviors for stability, sometimes resulting in a return to one’s IOD after they have already been freed.
Another key aspect of Regaining Autonomy is the creation of a safe space. Safe scene work is a popular trauma therapy technique, and it is especially helpful for survivors who were/are forced to remain in unsafe environments like IODs. One’s safe space can be a physical room or a mental world and should relate to the five senses of sight, touch, hearing, smell, and taste. Survivors can do this by incorporating soft or rough textures, music and white noise, essential oils and other grounding scents, pieces of candy or snacks, or more. In being able to choose every aspect of one’s safe space, feelings of safety and autonomy work together to create an adaptive coping mechanism that can be used anytime. (If a survivor creates a physical safe space, it is also recommended that they create a mental safe scene to access at all times.)
Example Regaining Autonomy affirmations include:
- I am in control of myself and my body.
- I can decide to do whatever I think is best for me.
- I will choose to do the things that make me happy.
- I am safe and secure in my safe scene.
Example Regaining Autonomy exercises include Creating a Safe Scene and Creating a Daily Schedule. (Daily schedules will be unique to each survivor, but example features may include self-determined times for meals, self-care activities, sleep and rest, etc. In the days after being freed from an IOD, if a survivor is struggling to make a schedule, it might be beneficial to model their schedule after the IOD’s until they can come up with their own structure.)
Disclaimer
The Five R’s of Institution Therapy serve as overarching umbrella categories under which different skills and techniques may fall. Example techniques are provided in each principle section, but this paper is not a complete list of all possible treatment methods that fall under Institution Therapy. Any skills taught in trauma therapy will be helpful in Institution Therapy and can be freely applied with the administer’s discretion.