Therapeutic communities

Abstract

Abstract Two of the best-known pioneers of therapeutic communities, Tom Main and Maxwell Jones, defined them as follows: An attempt to use a hospital not as an organization run by doctors in the interests of their own greater technical efficiency, but as a community with the immediate aim of full participation of all its members in its daily life and the eventual aim of the resocialization of the neurotic individual for life in ordinary society. What distinguishes a therapeutic community from other comparable treatment centres is the way in which the institution's total resources, staff, patients, and their relatives, are self-consciously pooled in furthering treatment. That implies, above all, a change in the usual status of patients. Today therapeutic communities can be defined by a number of common features, but a word of warning. For reasons of historical coincidence, the term is used in the fields of mental health and addictions to refer to two somewhat different treatment models. In the addiction field they are also known as hierarchical, drug-free or concept-based therapeutic communities, or simply addiction therapeutic communities, in contrast to the more democratized programmes in mental health. The two models have similar goals but their methods differ, although there are signs of increasing rapprochement between them. This chapter deals mainly with therapeutic communities in mental health, but reference will also be made to addiction therapeutic communities and those in long-term care settings. It is worth noting that those admitted to a therapeutic community for treatment are usually referred to as residents, clients, or members, rather than as patients.