Soteria houses

Domain V · Systemic, relational, group & community · Loren Mosher, Luc Ciompi · 1971 · San Jose, California

What it is

Soteria is a service model, not a single psychotherapy. It is a small, home-like residential setting (or a ward with "Soteria elements") where people in an acute, usually early, psychotic episode are accompanied through the crisis by a stable team. The team uses intensive interpersonal presence,…

Format

• Format. Residential care, voluntary admission and a community setting.
• Version followed: Soteria Bern as its chief physician describes current practice (Gekle 2020: three phases, soft room, weekly treatment conference), set within Ciompi's eight Soteria principles (as summarised by Fabel et al. 2023) and the four-domain Soteria Fidelity Scale (Wolf et al. 2021).…

Who practises it, and how they are trained or regulated

• Scoring: 30–50 = ordinary clinical ward; 51–70 = ward with Soteria elements; 71–90 = Soteria. The scale calls for a majority of the patients to have psychosis. The International Working Group Soteria (which includes Ciompi) audits sites. No formal licence or certification for individual clinicians was found. Validation of the scale is still described as needed.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Tokenism, and peers without supervision.
• Plans that exist only on paper. Rehearse them with the network.
• Goals set by staff or family alone, and goals too big for the phase.
• Overload too early (a relapse trigger), and leaving without a bridging plan.
• Rotas that break continuity, and the person not knowing who their key persons are.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.