Therapeutic community

Therapeutic community is a term applied to a participative, group-based approach to long-term mental illness and/or drug addiction that includes group psychotherapy as well as practical activities, and which may or may not be residential with the clients and therapists living together.

The term may have first been used in the 1940s by Harry Stack Sullivan, but the modern community was pioneered by Tom Main, Maxwell Jones, R. D. Laing and the Philadelphia Association, David Cooper and Villa 21 and Joshua Bierer, and gained some reputation for success in rehabilitation and patient satisfaction in Britain and abroad. The availability of the treatment on the National Health Service has recently been threatened because of changes in funding systems. In Britain, 'democratic analytic' therapeutic communities specialise in the treatment of moderate to severe personality disorders and complex emotional and interpersonal problems. The evolution of therapeutic communities in the United States followed a different path with hierarchically arranged communities (or concept houses) specialising in the treatment of drug and alcohol dependence.

History
Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill 1958; Rapoport 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al. 1957, Stanton and Schwartz 1954) and the sociopolitical influences that permeated the psychiatric world towards the end of and following the second World War, the concept of the therapeutic community and its attenuated form - the therapeutic milieu - caught on and dominated the field of inpatient psychiatry throughout the 1960’s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other's mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. 'TC's have often eschewed or limited medication in favour of psychoanalytically-derived group-based insight therapies.