Identifying the Need for Insitutuion Therapy
Institution Therapy was created with people suffering from institutional syndrome in mind, but in the process of developing the Five R’s, the creator realized that it would be beneficial for all those who have experienced institutional trauma. Institutional trauma is defined here as any form of maltreatment or neglect suffered under the perpetration of identified members of an Institution of Distress (IOD). Such identified members include healthcare workers, prison guards and police officers, teachers and school administrators, and even family members. It is important to note that sometimes, individual workers are not the cause of trauma, but rather the entire system itself is designed to traumatize individuals who are forced into it. This is especially seen in long-term hospitals and prisons.
There have been attempts to alleviate the trauma caused by correctional institutions. Prison-based therapy programs, however, show little benefit in alleviating trauma symptoms or helping people after they’ve been released. Trauma symptoms showed less improvement with therapy than depression, anxiety, and other mental health concerns. Truly beneficial programs utilized realistic expectations, harm reduction strategies, restorative justice, and support from loved ones (Sered et al., 2021). As such, the Five R’s of Institution Therapy include Relapse Prevention to target harm reduction strategies and Rebuilding Community to discuss restorative justice and finding support from loved ones.
Deinstitutionalization necessitates programs that care for the psychological and physical needs of survivors. Being released from an IOD comes with its own challenges, such as finding stable housing, a source of income, and accessible healthcare. In a study on the effectiveness of trauma-informed interventions in a deinstitutionalization program, it was shown that trauma-informed interventions “decreased negative behaviors, increased socialization, and emotional felt safety” (Hunsley et al., 2021). Those who instructed others (specifically caregivers) in trauma-informed interventions to better care for the survivors in their lives were not psychologists but volunteers, illustrating that interventions such as Institution Therapy can be administered by non-professionals. Institution Therapy specifically has been designed as an accessible choice for survivors who may not be able see professionals or survivors who may not be able to speak about their institutional abuse.
Survivors of organized, institutional abuse often deal with a level of conditioning unseen in other forms of abuse. Examples of such conditioning are seen in cult members, survivors of transgenerational organized violence, sexually exploited children, and more. They may view the abuses they suffered as “necessary evils,” be told that they are “in training,” or generally believe that they are meant to be abused for a purpose (Salter 2014, p. 153, 149). Many survivors also face disbelief and criticism after opening up about their trauma for being too ‘unrealistic’ or ‘hysterical,’ retraumatizing them and reinforcing these views. This often prevents survivors from reaching out for fear of having their trauma further compounded. As such, treatment of institutional trauma requires the targeted deconditioning of negatively-affecting beliefs and self-separation from the distorted worldview taught by the IOD. Institution Therapy supports this through the principles of Rehumanization and Regaining Autonomy.
Institutional abusers make use of targeting and entrapment to choose their victims and further traumatize them. For example, children with disabilities or those who are already being abused are often sought out by institutional abusers. These children “[suffer] a great deal of harm” from the institutions that are meant to help them (Gallagher 2000). In this way, IODs may disproportionately affect at-risk populations due to unchangeable aspects of survivors’ lives, such as their disability, race, sexual identity, etc. In cases such as these, it is important for survivors to be taught the concept of Radical Understanding, a combined approach of dialectical-behavioral therapy and Institution Therapy. This concept, as well as the rest of the Five R’s, aim to strengthen survivors’ emotional expression and self-compassion, easing the effect of institutional trauma on their lives.