I’ll admit it: I just wrote my first sensationalised title. The truth is more complicated. I was already a little fucked up before I worked in rehab - but for sure the complex environment made that worse.
For six years, I worked as a Counsellor in the demanding world of rehabs called Therapeutic Communities (TCs). These places aren’t just rehabs; they’re micro-societies built on strict moral frameworks. Residents and staff alike commit to “basic living principles” — honesty, respect, punctuality, accountability — and every small action is scrutinised. Leave a cup on the bench, use disrespectful language, avoid confrontation, and you’ll receive consequences.
Why is it like this? Well it’s because of the philosophy. It doesn’t believe addiction is about substances, it’s about behaviours. As addiction develops over time a host of maladaptive behaviours arise. Treatment means stripping away “anti-social” habits and replacing them with “pro-social” ones. And the way to do that? There’s a mix, but confrontation is at the heart of it.
The Confrontation Culture
As a leading facilitator, I frequently ran groups with 20–40 residents, initiating verbal showdowns over micro-behaviours. The point was to achieve therapeutic outcomes by exposing maladaptive behaviour patterns, forcing accountability, and pushing people toward change. Sometimes it was a pivotal intervention. Sometimes it felt unproductive and empty.
True TC staff thrived in the intense environment. They relished the sparring, the dominance, the moral authority. I wasn’t that guy. My natural style as a therapeutic ‘Counsellor’ was softer — exploring subconscious dynamics, listening deeply, helping people connect dots, exploring their pain. But the role demanded constant vigilance and willingness to engage in conflict. Over time, as I was forced to be something I wasn’t, crucial parts of who I was eroded away.
Burnout by Design
The model itself sets up an impossible tension: addicts are defined by maladaptive behaviours, yet the community demands immaculate morality! - The clash guarantees endless conflict. For it to work, staff must enforce the framework relentlessly, bucking the residents resistance. Constant cultural self analysis and correction is the norm.
Add to that the unnaturalness of the role. You pour all your social energy into a community that isn’t truly yours. Boundaries keep relationships professional, so the emotional investment never comes back. You go home drained, with little left for real friendships or family.
Inside staff meetings, the contradictions multiplied. Decisions about residents were often clouded by personal biases, alliances, and unconscious motivations. What was called “clinical discussion” often devolved into gossip - one of the same behaviours we scolded the residents for! The place was usually absorbed with power struggles — between staff, between residents, between the ideals of the model and the reality of human behaviour, which whether it’s under the cloud of addiction or not, is very messy.
Additionally, the role turns you into a critical and detached observer. Outside of the general maladaptive behaviours, residents have ‘treatment issues’ which are the unique set of factors underpinning their addiction. For instance, low self esteem, loss and grief, shame, identity issues to name a few. Your role as a clinical staff member is to help clients identify these issues and ensure their growth across the program. Overtime the habit of doing this becomes a feature of your personality. You start to see Treatment issues in all areas of your life and you feel compelled to change them. A kind of friction arises in your general experience because you see issues everywhere, then feel frustration and hopelessness when your efforts don’t lead to change.
Rediscovering Myself
It’s been a year since I stepped away and I’ve spent most of my time in Ashrams. The contrast is stark. Ashrams focus on tolerance, patience, and self-responsibility. No confrontation groups, no moral sparring matches, no critical analysis. Just space to breathe, reflect, and be…
Instead of other people being your business, you make it about yourself. Your task is to look at yourself: How do I feel today, why can’t I accept this? What’s actually occurring inside me? What about my behaviour?! What inside me is impeding my peace?!
Its made me question: did I ever truly care about the cups on benches, gossip in corridors and other so called maladaptive addictive behaviours that weren’t literally using drugs?! Or was I convincing myself of their importance because the job demanded it?
The truth is, I cared about residents. I cared about their recovery. I could see how their addiction played out in non-obvious ways. I also did my job to the best of my ability and I was actually good at it. But living in a role that required constant vigilance, constant confrontation, constant moral policing and scrutinising — Overtime being like that it wore me down because it made me forget how to be.
What I Learned
Therapeutic Communities are unique and powerful. They really can transform lives. But they also demand a kind of relentless performance from staff: to embody moral perfection, to enforce rules, to confront endlessly. For some, that role fits. For me, it took a toll. I developed chronic pain, fatigue, bouts of depression diminished confidence and confusion.
And so, after six years, I walked away — I learnt so much from that experience. Despite it being difficult at times, and losing parts of myself, I’m still grateful for it being part of my life. My challenge now is to heal, rejuvenate and to find more authentic living in the next chapter.
