Simple core statements of the therapeutic community as a treatment modality are given, including a "living-learning situation" and "culture of enquiry." Applications are described in work with children and adolescents, chronic and acute psychoses, offenders, and learning disabilities. In each area the evolution of different therapeutic community models is outlined. In work with young people the work of Homer Lane and David Wills is highlighted. For long term psychosis services, the early influence of "moral treatment" is linked to the revitalisation of asylums and the creation of community based facilities; acute psychosis services have been have been run as therapeutic communities in both hospital wards and as alternatives to hospitalisation. Applications in prison are illustrated through an account of Grendon prison. The paper also outlines the geographical spread of therapeutic communities across many countries.

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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.

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Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty-five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.