Therapeutic Communities: the International Journal for Therapeutic and Supportive Organizations

Published by Emerald
Print ISSN: 0964-1866
Publications
The present study investigated crime rates in areas surrounding 42 Oxford Houses and 42 control houses in a large city in the Northwestern United States. A city-run Global Information Systems' (GIS) website was used to gather crime data including assault, arson, burglary, larceny, robbery, sexual assault, homicide, and vehicle theft over a calendar year. Findings indicated that there were no significant differences between the crime rates around Oxford Houses and the control houses. These results suggest that well-managed and governed recovery homes pose minimal risks to neighbors in terms of criminal behavior.
 
The work of members of the Religious Society of Friends, also known as Quakers, in therapeutic environments has often been commented on but not discussed in detail. While several of the pioneers of planned environment therapy, therapeutic education and therapeutic communities have discussed their Quaker faith in the context of their work, very little of the practical role of Quaker governors and trustees for therapeutic environments has been written about. This paper aims to explore some of the reasons why therapeutic environment work and Quaker principles are compatible, and how Quakers and non-Quakers have been able to work together to establish and maintain effective social-based methods of therapy and management.
 
Describes the services offered by Dingleton, a therapeutic community and a community psychiatric service. The author discusses the evolution of Dingleton's therapeutic community values since their introduction in the 1960s by Maxwell Jones. This service is discussed as it relates to 4 criteria for therapeutic communities: democratization, permissiveness, communalism, and reality confrontation. As Dingleton is dispersed into the community, lost opportunities for social learning are identified, and lessons that have been learned are described. These may be relevant to other services as they develop community care in the 1990s. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Presents a summary of the guiding principles of the Clinique la Chavannerie, a therapeutic institution for patients suffering from anorexia nervosa. The therapeutic approach of the clinic is firmly psychoanalytic, with daily small and large group sessions and daily staff groups. Particular emphasis is given to the links between the psychotherapeutic and administrative functions of the clinic. It is recognized that only a small percentage of anorexic patients can benefit from this approach, but the author argues that for these patients the clinic's approach is preferable to those that are eclectic or collude with the patient's defenses. (Dutch & French abstracts) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Describes the 1st 3 mo of outreach nursing (ON) at Cassel Hospital in Richmond, England. The central ON work was in the form of meetings offered to groups of patients, but nurses also undertook work with individual patients. The early outreach experience was evaluated against 4 criteria for psychosocial nursing: (1) work with an identified primary nurse, (2) mutual support among the patient group, (3) the use of structured time and space, and (4) the use of shared practical tasks to support patients' functioning and to enable difficulties to become known and available for understanding. ON was valuable to patients and continues to be recognizable as psychosocial nursing. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Describes the present certification procedure for Holland's therapeutic communities and the process of accreditation for hospitals. The history of the Association of Therapeutic Communities in Holland is reviewed, including the development of basic values (e.g., democratization, reality-confrontation) into hard criteria. The benefits and drawbacks of Holland's accreditation procedure are then considered. It is asserted that the important step forward is the development of a quality control system for therapeutic communities. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Attachment theory was developed in the 1940s and 1950s in reaction to 2 assumptions that were commonly accepted at the time in psychoanalytic thinking. The 1st concerned the nature of the attachment between infants and their mothers; the 2nd concerned the importance of the environment as a cause of psychopathology. J. Bowlby (1990), the originator of the theory, argued that the main parental function is to serve as a secure base for the child. This essay discusses outcomes of severe failures in fulfilling this function. By means of a clinical example involving a female adolescent client, the challenges and advantages of fulfilling this function in a therapeutic community for adolescents with severe emotional disturbances are described. The clinical significance of the model of the therapeutic community for adolescents is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Investigated therapeutic methods used in 3 traditional healing centers (THCs) for the treatment of schizophrenia (SCZ) in Malawi, Central Africa. The integrative therapy of 51 SCZ patients in the 3 THCs is described in terms of therapy setting (organization, environment, culture, and family), follow-up, and comparative data. The key therapeutic structures of the THCs are discussed with the help of an analytic framework based on affect logic practiced at the Soteria healing center in Switzerland. In addition, concepts of the therapeutic community and current psychiatric practice are included in the comparison. The enormous support of family, community members, and community-centered lifestyle appears to be an important part of successful African therapies. If the Soteria concept could be enriched by the milieu of the village community that is familiar to the patient, an ideal concept of the treatment of SCZ could be reached. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Presents a pilot project initiated in a residential school for disturbed boys to understand better what attracted staff to the school, why they left, and whether staff brought particular personality characteristics to their work. 11 staff members participated in the study. The Defence Mechanism Test was used together with an interview based on a psychodynamic frame of reference to determine the emotional profiles and defense mechanisms of the Ss. Predictions about length of stay were made on the 6 1st-yr Ss who participated in the study. The predictions proved to be largely accurate. As a result of the study, the school substantially altered its staff selection procedure. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Reports findings from the 1st step of an action research approach examining factors associated with who drops-out of treatment. In this instance the focus is restricted to the pre-intake, assessment meeting non-attender at a unique center offering a variety of short-term groups. Socio-demographic information, in addition to that available from the referral document, was collected by means of an in-house designed questionnaire, along with a measure of clients' treatment expectations (T.E.Q.), whether favorable to small group psychotherapy or behavior therapy, for all referrals during a 6-mo period. Non-attenders completed this and a semi-structured interview focused on their reasons for not keeping the appointment. The most frequent reason given for non-attendance was categorized as obstructing conceptions, incorporating clients fears and anxieties, followed by child care responsibilities. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Suggests that the armed services rely on the development of well-defined group structures of different sizes and at different levels to sustain the morale of individuals. Selection methods identify those who cannot easily fit into groups and accept the primacy of group loyalties. Such recruits tend to be rejected. The cohesion of the nuclear operational group, small enough for each member to feel a strong personal connection with all the others, is heavily relied on to sustain morale and individual integration in combat. Individual factors that might increase anxiety and reduce effectiveness are controlled and lessened by factors that are functions of group processes. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Analyzes 2 levels of organizational management of forensic treatment. The 1st level consists of case management of individual treatment programs, and the 2nd level consists of institutional management, including internal and external security. Quality of treatment is based on their interdependence. The following topics are discussed: (1) the institutional goals of forensic psychiatry, (2) the treatment principles of the Van der Hoeven Kliniek, a forensics clinic in the Netherlands, (3) the organizational aspects of case management, and (4) institutional management. In the final section, the discussion of individual and institutional management aspects is generalized to social policy problems at the national level. (0 ref) (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
This discussion of group and individual aspects of residential treatment begins with an examination of the historical development of residential care and the concept of the therapeutic milieu in the US. The historical review then turns to a consideration of some of the more recent advances made in the understanding of theories about treatment. Given the evolvement of contemporary theories, the paper discusses a number of selected difficulties which remain embedded in current discussions about group care, including: the sometimes conflicting assumptions of a medical model of treatment vs milieu therapy; efforts to define an appropriate psychological model to adequately describe milieu therapy or the therapeutic community; and the potentially inherent conflict between the assumptions of individual psychotherapy and milieu therapy, when both are provided within the context of residential group care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Suggests that the admission to the Cassel Hospital of a whole family is useful when they can neither separate nor stay together with the help of outpatient interventions. Failures of home-making and family living may result from the parents' difficulties in achieving the psychological separateness and adequate symbolic functioning, which enable the physical, emotional, and social needs of all family members to be met in 1 space. The therapeutic inpatient setting, which is symbolically invested by the staff, holds the patients as their conflicts around separation–individuation are evoked by the ordinary rhythm of life: duty rotas, rotations, staff turnover, admissions, and discharges. When combined with psychodynamically informed psychotherapy and nursing, such real experiences have therapeutic potential for the parents and developmental potential for the children. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Describes the history of Conolly Psychotherapeutic Community and the way in which it worked during the time that Harold Bourne was consultant, from 1973 to 1989. The paper explores the psychodynamics within the community and the effect of these forces as experienced by both staff and patients. It stresses the benefit of long term residential containment for borderline patients, thus allowing regressive states to be worked through in a place of safety. It examines various aspects of work with this patient group in a community setting, and concludes with some observations on the events which led to the closure of the unit in 1991. Two clinical examples are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Describes the process of developing a close key working relationship with a very withdrawn man (aged 30 yrs) suffering from chronic schizophrenia. The key worker built a relationship with the S and developed a program to address his low self-esteem, socially withdrawn behavior, passivity and underactivity, poor verbal and nonverbal communication skills, indecisiveness, lack of confidence and initiative in interaction, and poor living skills. The S became able to trust and relate to his key worker and began to participate in small activity groups. Next some recognition of the therapeutic community came to light, and the S was prepared to take part in social events in the ward. The S also spontaneously began to share tasks in his activity groups. The S eventually became much more interactive in groups outside the hospital in a day center. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Discusses the Program for Traumatic Stress Recovery. A program description follows a discussion of both the trauma model and the inpatient therapeutic community. Information about treatment outcomes is presented, along with a discussion about the role of the therapeutic community in achieving positive treatment gains. Initial outcome studies suggest that the efficacy of the program appears to be substantial in both symptom reduction and goal attainment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Discusses the recent changes to the UK's National Health Service (NHS), designed to make the NHS more efficient, relevant, and responsive to the actual needs of the population. The article focuses on how these changes have impinged on staff's clinical work at a British hospital, in particular to complicate the examination of staff's countertransference reactions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Researched the need for psychiatric care of Finnish prisoners. The study was part of the Health Survey of Finnish Prisoners and dealt with a representative sample of 903 Finnish prisoners (aged 15–74 yrs). Data collection consisted of questionnaires, interviews, clinical examinations, and gathering register information. The study found that 50% of prisoners were in need of some form of psychiatric care. More than 33% of all prisoners had an impaired working capacity arising from their mental disturbance, and 20% of prisoners with psychiatric disorders were unable to work. (Dutch & Finnish abstracts) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Explored the concept of "transference to the institution" and its effect on treatment in a group of inpatients at the Cassel Hospital. Responses to different elements of inpatient life were related to previous, especially family, experience and their effect on treatment discussed. The group sustained its investigative function reasonably well, but, in addition, became an institution and assumed a therapeutic function for its members. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Describes a group of 13 severely disabled patients (aged 26–59 yrs) with schizophrenia, who made the difficult transition from being hospital inpatients to being residents of a community hostel. A daily community meeting was used to help patients prepare for the move. Major issues communicated in the meetings pertained to denial, anger, anxiety, optimism and hope, the nature of a hospital vs a home, relinquishing the role of the patient, loss and sadness, and disseminating information. All the patients moved without difficulty on the appointed day; however, 1 patient had to be readmitted 5 mo later due to disruptive behavior and a worsening of symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Reports errors in the original article by L. A. Moffett and C. Flagg ( Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 1993[Sum], Vol 14[2], 103–218). The titles of Figures 1 and 3 were transposed. After the last paragraph on page 113, this should appear: "Figure 5 illustrates these ideal–real discrepancies. Each point on the vertical axis represents a difference of one point between the real and ideal mean scores on the WAS scales. For example, the residents' ideal level of personal problem orientation was the same as what they perceived the real level to be (an ideal–real discrepancy of essentially zero). In contrast the staff's ideal level of personal problem orientation was about one scale point higher than what they perceived the real level to be." (The following abstract of this article originally appeared in PA, Vol 81:7191.) Used the Ward Atmosphere Scale to assess on 5 occasions the social climate perceptions of 57 personality-disordered, substance-dependent men and 15 staff members in a therapeutic community (TC) program. Patients described the program as very involved and self-disclosing, practical, having clear rules, argumentative, spontaneous… (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
It is argued that despite the rhetoric of patient empowerment, the present political and ideological climate of individualism works against the realization of empowerment. Empowerment of the most vulnerable members of society is a yardstick of its commitment to equality and democracy; it must be allied to the concept of emancipation and equality. A number of specific factors militate against patients having an influence over the treatment they receive. These include the reluctance of professionals to be disempowered; ideological attacks on the achievements of collectivism; and the rise of individualistic, prescriptive forms of psychological treatment. An ideology of patient empowerment exists, but in a body politic that is incapable of facilitating it. The challenge of social reparation may be far greater than the challenge of economic recovery. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
In the threatening purchasing restrictions of the National Health Service there are windows of opportunity for therapeutic communities, for the Therapeutic Community (TC) model has some positive selling points. TC is an outstanding example of patient advocacy, and it can influence the education of purchasers. The change into a day unit of the Winterbourne Unit is described; it evolved rapidly to deal with external power bases. Members of the Trust's Board of Directors are welcomed as day visitors and are impressed by the TC climate; so far each has left impressed by the TC climate and seemingly proud that their Trust should include such an eloquent example of patient advocacy. A true TC ethos is its strongest selling point. Within a cared for and controlled mini- society, members have needed and deserved developmental moments. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Identifies essential characteristics that have been clustered together under the umbrella term "therapeutic community" (TC). Seven levels are described, from any collective situation through to a full TC. Challenges that residential TCs that were developed in the 1960s and 1970s have had to face in the 1990s are also examined. These include economic recession, community care, and the new professional ideologies of individualized care, measurable competencies, and the human rights critique of psychotherapy. Examples of innovative forms of TC are presented, and suggestions are made for using TC know-how in the current climate of service provision. It is argued that psychotherapists and health professionals should take issue with 1-dimensional ideologies that fail to address the complexities of human need. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Replies to S. Whiteley (see record 1996-15557-001) which comments on G. T. Harris, M. E. Rice, and C. A. Cormier (see record 1995-30848-001), citing conflicting interpretation of the impact of therapeutic communities (TC) and the recidivism rates of psychopaths. It is suggested that TC treatment should be eschewed for all psychopaths as it is difficult to determine which are the creative psychopaths. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Discusses the Department of Forensic and Social Psychiatry (DFSP) of the University Psychiatric Hospital in Ljubljana, Slovenia, which is an open institution organized as a therapeutic community (TC) and has a psychotherapeutic and rehabilitative orientation. The DFSP offers treatment for psychotic offenders, prisoners, and people with socially accentuated psychiatric disorders. The article describes the development of the TC ward over the past 27 yrs and its current functioning. Some preliminary figures on treatment episodes and readmissions during 1992 and 1993 are presented. The TC practices both medical and sociotherapeutic activity. The DFSP's success is attributed not only to the atmosphere of the TC, but to a less severely disordered patient group, the small number and homogeneity of the Slovenian people, and the sociocultural tendencies of the population to self-aggressiveness rather than to violence. (Dutch & Slovenian abstracts) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
A model of therapeutic and rehabilitative intervention has been developed for severely disturbed psychiatric patients in the first assisted Therapeutic Community of the Mental Health Department in Syracuse, Italy, following the epistemological bases of Gestalt Psychotherapy. The model includes definitions—the nature of a therapeutic community, and its means of intervention—and proposes a methodology. The methodological model follows the phases of an "Evolutionary Contact Cycle" experienced by the patients from their admission to their discharge, made up of 6 phases: Confluence, Introjection, Projection, Retroflection, Contact and Post Contact. Gestaltic community therapy and the elements of difference with the 1st model of community proposed by M. Jones (1968) are analysed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Conducted a large, cross-sectional survey of psychiatric disorder and treatment needs of sentenced prisoners in the UK and assessed the suitability and efficacy of therapeutic community (TC) treatment within prison. Following an interview and case note assessment of 1,769 men and 294 women, TC treatment was considered suitable for 5% of male Ss and 8% of female Ss. The most common diagnoses were substance abuse (77%) and personality disorder (47%). Results suggest that there is a need to expand TC treatment for offenders with mental disorders, both inside and outside prison. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Examined data from 237 records drawn from a series of 380 staff-consultation group meetings in mental health day centers. This is the 2nd of 2 papers on external staff consultancy. Part 1 (see record 1993-43024-001) described a model of developing staff competence referred to as educated intuition. In the current study, material was recorded using a modification of the Group Therapy Interaction Chronogram (M. Cox, 1978). A framework for analysis is presented, which illustrates the application and demystification of educated intuition. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Examines certain of T. Main's (1946, 1967, 1983) contributions to therapeutic community theory and practice using Henderson Hospital as an example. Main's concept of a "culture of enquiry" is amplified. Culture and structure are described in their interaction and in their combined effect to produce therapeutic change. Ways in which a therapeutic culture can be lost in the short- and long-term are discussed. It is argued that the responsibility for preserving a "culture of enquiry" rests, mainly, with the staff. Through meeting in group settings, staff, like resident members of the community, are exposed to regressive pulls into immature modes of expression and resolution of personal and interpersonal conflict. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Evaluated a small Finnish prison that was opened in 1991 with the aim of rehabilitating prisoners using modified therapeutic community principles. The organizational functioning of this prison was assessed by questionnaires which examined functioning in terms of 19 subprocesses including external milieu and guarding; care, interaction, and rehabilitation; team work and administration; and organizational entity. The state of each subprocess (from poor to excellent) was assessed by 26 prisoners and 23 staff members, using a visual analog scale. In general, prisoners were more critical than staff members, particularly when assessing care and the staff's team work and professional skills. However, prisoners rated the organizational functioning at a moderate level and assessed the relations between prisoners and their everyday rehabilitation positively. (Dutch & Finnish abstracts) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Reviews the current treatment philosophy and programs at Grendon prison, and summarizes the recent reconviction studies that add to earlier research in establishing the efficacy of this regime. Grendon is the only prison in England devoting all its resources to a therapeutic purpose. It has long been subject to the doubting scrutiny of both professional colleagues and the wider criminal justice system. At best, it is considered an unproven but worthy flagship, and at worst, it is regarded as an expensive and largely ineffectual token of care within the resource-impoverished and punitive prison service. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Indicates that family planning clinics in the 1950s allowed women and men to ask for help, often for the 1st time, with difficulties in sexual intercourse, infertility, and non-ejaculation. T. Main, working with M. Balint, met with the doctors in groups. They focused on "the moment of truth" in the consultation, which occurred around genital examination, and on the doctor–patient relationship and what it conveyed about the problem. Most of the training was on a basic level, offering understanding but not psychoanalysis. Clinical examples are presented for illustration. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Demonstrates the value of working with individuals who have had disrupted and unhappy experiences in relation to others using the working relationship as a therapeutic tool. Work of patients and nurses within the "Patients' Pantry" workgroup at the Cassel Hospital is highlighted. In the context of this therapeutic setting, the Patients' Pantry is considered symbolically in terms of a potential space in which individuals have the opportunity to demonstrate their creativity within a circumscribed, relatively reliable system. Examples of work with 3 patients (aged 24–36 yrs) demonstrate how the clinical problems and difficulties encountered are thrown into relief, so that they become difficult to deny and thereby more available to the process of introspection and of change and growth. (Dutch abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Purpose: The present study explored the effects of length of stay in an Oxford House (a sober living environment) with the number of days attended school/vocational training and days worked in the past 90 days with 292 women and 604 men. Design/methodology/approach: This paper presents quantitative data. Findings: Results indicated that number of days residing in these recovery homes was related to number of days attending school/vocational training and days worked. Originality/value: The present study suggested that in addition to staying abstinent from alcohol and drugs, Oxford House residents may gain useful life skills through vocational education, training, and employment. This is an area of further exploration for the substance abuse recovery community.
 
This paper presents a perspective on the staff and patient experiences of the introduction of Community Meetings into the Rampton Hospital DSPD Peaks Unit, a high-secure setting designed to accommodate "some of the most dangerous people in society" (Home Office, 2004); nevertheless a client group who have often lived through deeply traumatic experiences in childhood and young adulthood. The bi-weekly Ward Community Meetings, which are intended to integrate aspects of Therapeutic Community living into the highly restricted, institutionalised life of the DSPD Unit, were introduced in late 2004 by Claire Moore, Principal Forensic Psychologist in the Peaks. Since then, they have become an accepted feature of life on the Unit but one which nevertheless seems to induce strong feelings in patients and staff at all levels, making the maintenance of a therapeutic environment an ongoing process of negotiation and the epicentre of institutional conflict. In this paper, Claire reflects on her personal experience of introducing, implementing and defending the Meetings - as well as the strong therapeutic ethos behind them - and, based on his ethnographic fieldwork in the Peaks, Mark Freestone presents a sociological contextualisation of this therapeutic ideal within a 'totally' institutionalised environment, with particular attention to the maintenance of a particular power/knowledge apparatus within the Unit.
 
Purpose – The current study focused on five female offenders who completed the only female‐specific therapeutic community (TC) for drug addiction in the UK prison system. The aim of the study was to investigate the effect that such residency had on individuals' emotional management skills compared to when they were active drug users. Design/methodology/approach – The study was based on a qualitative design, and interpretative phenomenological analysis (IPA) was used to produce idiographic results. Findings – Results suggested that before TC residency all participants displayed problematic emotional management skills. However, during TC residency individuals witnessed elements of emotional healing and increased emotion connection. Additionally improvements were noted in emotional consideration, emotional communication, outward emotional displays and self‐worth. Originality/value – Further developments in TC treatment are suggested concerning treatment length and further development of individuals' independent emotional management strategies.
 
Purpose As the clamour within the drug treatment field in the UK – and throughout much of Europe – increases, leading agencies are arguing for a review of the current legislation and a change in focus away from criminal justice and towards a more public health understanding of addiction. Therapeutic communities have found themselves united with many drug users-led campaigns to argue for a wholesale restructuring of the legislative, policy and funding arrangements which recognises the role of recovery-oriented interventions within the mix. Given these on-going debates, it is perhaps useful to understand how the current arrangements were established [1]. Design/methodology/approach In 1850s, the sale of opium – like alcohol – was largely unregulated. It was widely used, in a variety of preparations, by all classes for medical and non-medical purposes. A pennyworth of opium was as likely (perhaps more likely) as a pound of potatoes to find its way into the weekly shopping basket. Findings By the 1920s, the Fu Manchu novels of Sax Rohmer – with their tales of innocent English virgins being seduced into crime and sexual perversion by an evil Chinese genius who lurked within the opium dens of Edwardian Britain – had redefined opium as a drug of the outside, the deadly, an agent in the enslavement of innocence. Originality/value This dramatic change was largely brought about by the introduction of an array of new medications and a move away from traditional “herbal” remedies. This change was accelerated by the experiences of the First World War and underpinned by the print media and laid the foundations of the legislation and policy of the present day.
 
Purpose This paper aims to reflect upon the findings of a fast-track study carried out in April 2020, by the Brazilian Federation of Therapeutic Communities, focused on the impact of the first measures taken by the Brazilian therapeutic communities (TCs) in response to COVID-19. Design/methodology/approach An electronic survey was disseminated to TCs in the different regions of Brazil through online platforms. A total of 144 TCs responses were used in the final analysis. The survey collected the following information: suspected and confirmed cases of COVID-19 (only one case of COVID-19 was confirmed), changes in treatment protocols, the impact in admissions and daily activities and the safety measures adopted to stop or reduce the transmission between residents, families and staff. Findings The survey successfully collected general data regarding interruptions (82.6% of TCs interrupted admissions, 100% of TCs interrupted volunteer’s activities, 94% of TCs interrupted family visits and 93% of TCs interrupted external activities). Research limitations/implications The caveat of this study is the fact that there were tight deadlines for the TCs to generate their responses and the limited availability of staff to answer long surveys. Because of this, the study could not explore other important qualitative data. The results were shared in Brazil and Latin America with the staff of TCs, the national Federations of Therapeutic Communities and government agencies linked with them, in all Latin America. Originality/value This research aims to contribute to the adoption of developed prophylaxis and prevention protocols in response to COVID-19.
 
Purpose COVID-19 pandemic is affecting the well-being and the psychological resilience of different populations, particularly in the addiction field. This study aims to assess anxiety and its severity among patients and staff from different types of addiction services in Israel during this emergency. Design/methodology/approach The study was conducted during the period from March–July 2020. Participants included patients and staff ( N = 282) from three different types of addiction services, were administered the State-Trait Anxiety Inventory, the multi-dimensional scale of perceived social support and demographic variables. In addition, a logistic regression model was applied to identify predictors of state anxiety by using statistical package for the social sciences software. Findings The results show that therapeutic communities clients reported more social support compared to other subjects. State anxiety has a positive strong correlation with trait anxiety both among patients and staff, and it was found as a crucial predictor of state anxiety in the regression equation. There is no statistically significant correlation between state anxiety and social support, gender or education among clients and staff as one. The state anxiety remains relatively stable and characterizes most people, staff and patients, men and women, medical staff members and other professionals. Research limitations/implications The current study has some contributions to the addiction field by understanding the psychological distress of a vulnerable population: substance users in treatment settings. The study population relied on convenient samples and future studies should be planned using a cross-sectional design and should take into account substance use measures. The findings are reinforcing the assumption that state anxiety was likely to increase during the coronavirus pandemic. Practical implications Adequate services should be planned to avoid relapse or mental deterioration of people who use drugs during health emergencies. Originality/value The research points out the unique and real difficulties of SUD clients, as well as the complexity and risks in their staff members’ works. The authors also saw that staff members need attention and maintenance; they are in the front line.
 
Purpose The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience. Design/methodology/approach A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors. Findings There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment. Research limitations/implications The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work. Originality/value This study describes a novel way that a TC has adapted to the COVID-19 pandemic.
 
Purpose As Clinical Psychologists working in a tertiary Intellectual Disability (ID) service in the UK, this paper aims to address the impact of Covid-19 – and the subsequent transition out of Covid-19 restrictions – on individuals with an ID, and the clinicians working alongside them. Additionally, the paper reflects upon how Covid-19 has shaped and manipulated therapeutic communities and environments. Design/methodology/approach This paper is reflective in nature and reviews current evidence associated with how people with an ID experienced the impact of Covid-19. Clinicians reflect upon their shared experience in line with this evidence. Findings This paper highlights perpetuating inequalities and injustices on people with an ID as a result of Covid-19. Further, it is indicated that that there should be consideration of how people with an intellectual disability experience transitions back to their day-to-day environments and encourages clinicians to widely consider how to shape therapeutic communities and environments. Originality/value Multiple themes have been addressed in this paper, and the reflections add to an understanding of how those individuals specifically working in, or using intellectual disability services, have experienced the Covid-19 pandemic, though a critical lens.
 
Purpose The purpose of this paper is twofold: to reflect upon what the global therapeutic community (TC) movement has learnt from coronavirus and to consider how TCs will continue to adapt and evolve in a post-pandemic climate. Design/methodology/approach This is a viewpoint paper based on the authors’ participation in an international learning event whereby speakers from TCs from around the world spoke about how they adapted their services to overcome adversity. Findings The findings are usefully thought out as shelter, creativity, reintegration and employment, technology and roots. Based on the material discussed in the learning event, it would seem that the global TC movement has engaged in a process of looking to the past to move forward by drawing upon founding principles and prescriptions of the TC tradition, rooted in humanistic and indeed humanitarian responses to staff, client and sociocultural needs. Originality/value According to the author, this paper is one of the first attempts to capture how TCs from across the globe have responded to the threat of coronavirus.
 
Purpose Eric Broekaert passed away shortly after the XVIth European Working group on Drug-Oriented Research (EWODOR)-conference in Rome on 28 September 2016. He was one of the great TC pioneers in Europe, who founded the first TC for addictions in Belgium (De Kiem) and co-founded the European Federation of Therapeutic Communities and EWODOR. He was a respected Professor of “Orthopedagogics” at Ghent University and a Member of the Editorial Collective of Therapeutic Communities: the International Journal of Therapeutic Communities . The paper aims to discuss the overview of the career of Eric Broekaert. Design/methodology/approach In this obituary, the authors provide an overview of his career, major achievements and theoretical, methodological and integrative ideas, clustered around four typologies: university professor and scholar; manager and source of inspiration; TC pioneer and believer, and integrative thinker. Findings Besides his obvious merits as a TC researcher and advocate, one of his major theoretical contributions has been the introduction of the holistic, integrative approach and the idea that diverse types of interventions, as well as methodological approaches can alternatively go together. Originality/value He regarded TCs as the ultimate integration of various educational and therapeutic approaches to promote growth and quality of life among severely disadvantaged populations, such as drug addicts and children and adults with emotional and behavioural disorders.
 
Purpose This study aims to describe Italian and UK therapeutic community developments during 1960–2021. Design/methodology/approach Historical review and personal experience. Findings After significant divergence in the nature of “therapeutic communities”, mostly based on the different sociopolitical contexts in the two countries, areas of formal rapprochement have been emerging in the past 20 years. Research limitations/implications The details of how therapeutic communities developed in Italy, particularly in the wake of Law 180, deserves investigation and comparison to the UK and other countries. Practical implications The recent collaborative work in quality, training and research could support the future use of therapeutic communities and enabling environments. Social implications The underlying principle of “relational practice”, which underlies the therapeutic community approach, could have wider implication in public services beyond mental health. Originality/value Much has been written about the progressive intentions of Italian mental health with Law 180, but not with a specific focus on therapeutic communities – which were an important initial impetus for Basaglia and his equipé.
 
Purpose – The purpose of this paper is to summarize research conducted in long-term residential rehabilitation centers, including therapeutic communities (TCs), in order to further clarify the effectiveness of this treatment approach and to evaluate the quality of TC research conducted in the period 2000-2013. Design/methodology/approach – The composite search engine UQ database Summon were used to find articles with “Therapeutic Community” as title words, and the search was limited to adult participants, peer-reviewed articles, published between January 2000 and June 2013 in the English language. The review was conducted using Cochrane Collaboration methods and reported under the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. Findings – In total, 25 studies met inclusion criteria for the review and represented data from n =5,923 participants in the USA, Australia, Spain, England, and Belgium. Evidence supports the TC approach for a diverse range of individuals who misuse a range of substances. Several studies reported a relationship between retention and outcomes however dropout from treatment is a widespread issue. A paucity of research using multiple time points precludes any firm conclusions regarding the optimal length of treatment in a TC. There is a lack of research on the interplay between individual and community-level factors on client well-being, retention, and longer term outcomes. Research limitations/implications – This review highlights the need for TC research that includes multiple time points and follow-up assessments, and measures of change in theoretically meaningful constructs alongside standard measures of demographics, substance use, and psychiatric symptoms. Practical implications – The reporting format of TC research should be better standardized in order to create a better basis for research comparison. More standardized reporting would also allow for effect size analysis, and create a more efficacious evidence base. Originality/value – This updates the systematic review body of research.
 
Top-cited authors
Rex Haigh
  • Royal College of Psychiatrists
Grant T Harris
  • Queen's University
Marnie Rice
  • McMaster University
Michael Savic
  • Monash University (Australia)
David Best
  • University of Derby