Therapeutic Communities, Old and New

Abstract

The author attempts to clarify two largely different uses of term, Therapeutic Community (TC). By "old" TC he describes a movement which originated in psychiatry in the United Kingdom at the end of World War II. This was an attempt to establish a democratic system in hospitals where the domination of the doctors was replaced by open communication of content and feeling, information sharing, shared decision making, and problem solving shared as far as possible with all patients and staff. Daily meetings of all patients and staff formed the nucleus of this process. In recent years developments in the areas of systems theory, learning theory, and organization development have contributed to a better understanding of social organization and change. The "new" TCs derive from the more recent developments in the treatment of substance abuse. Central to this movement is Synanon and its many modification which use the clients' peer group to solve their own problems, largely eliminating mental health professionals. Linked with these "new" TCs is the development of Asklepieion units in prisons, which use Synanon "games" along with transactional analysis. An attempt is made to distinguish the methodologies used in TCs, "old" and "new".

The Development of the Therapeutic Community in Correctional Establishments: A Comparative Retrospective Account of the ‘DEMOCRATIC’ Maxwell Jones TC and the Hierarchical Concept-Based TC in Prison

“…Several authors (Broekaert et al, 2000;De Leon, 2000;Jones, 1984Jones, & 1979Kennard, 1998;Sugarman, 1984;Wilson, 1978;Zimmer & Widmer, 1981; see also Lees, Manning & Rawlings, 1999) have stressed the existence of fundamental similarities and have remarked upon the growing relations between both TC-'traditions'. Jones (1979, p. 147) has written: 'It could be said that all the therapeutic communities described, both 'old' and 'new', have certain trends in common.…”

“…In later years, after the concept-based TC developed independently from Synanon and expressed its obligations to existentialism and the humanistic psychology, Jones actively tried to connect both traditions and became one of the most prominent advocates for integration (Jones, 1979(Jones, , 1984(Jones, & 1984b. He was an enthusiastic supporter of developments at Asklepieion, despite its reliance upon the confrontational techniques (the 'game', which was often harsh and 'violent') of Synanon (Gates and Bourdette, 1975).…”

“…Jones has, in addition, written several accounts (published in American addiction journals) in which he comments on the possible integration (Jones, 1979(Jones, , 1984(Jones, & 1984b. Today, the principle of social learning is fully accepted in the concept-based TC.…”

“…Yet, even there, a constant struggle between two opposing goals (treatment vs. imprisonment) has been and continues to be, a central characteristic (Cullen, 1997;Rawlings, 1999;Roberts, 1997). Several prisons were also changed towards more open systems in other European countries, including the Netherlands (Van der Hoeven Clinic, Utrecht), Denmark (Herstedvester) and Switzerland (Champdollon Prison, Geneva) (Genders & Players 1995;Jones, 1979).…”

The Third Generation of Therapeutic Communities: The Early Development of the TC for Addictions in Europe

“…In the course of time, this has become less psychoanalytic in nature and based more on individual interaction in a group setting -what has been termed 'social learning'. The democratic TC infl uenced psychiatric hospitals in the United Kingdom, the rest of Europe and the United States [7] .…”