In Britain, 'democratic analytic' therapeutic communities have tended to specialise in the treatment of moderate to severe personality disorders and complex emotional and interpersonal problems.
Examples are the Little Commonwealth school run by Homer Lane, the Q camps initiated by Marjorie Franklin, and Finchden Manor, founded by George Lyward.
[5][2] The Q camps were based on Planned Environmental Therapy, which focused on normally functioning parts of a patient's personality and use them to deal with difficult social situations.
[6] Lyward’s work at Finchden Manor and its predecessor, provided from 1930 to 1973 what he called a ‘type of hospitality’[7] for emotionally troubled boys and young men of high intelligence.
[10][11] The term was coined by Thomas Main in his 1946 paper, "The hospital as a therapeutic institution",[12][13] and subsequently developed by others including Maxwell Jones, R. D. Laing at the Philadelphia Association, David Cooper at Villa 21, and Joshua Bierer.
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 1960s.
The first development of therapeutic community in a large institution took place at Claybury Hospital under the guidance of Denis Martin and John Pippard.
No psychotropic medication or one to one therapy sessions were available and so all the work of the DTC was pursued, on the one hand, in small or larger therapy groups or work groups and community meetings, which could be called (by the residents) day or night; and on the other hand, in the unstructured time in between these more formal spaces, in which belonging in and membership of a living community could become in itself a healing experience.
Researchers at the University of Oxford and King's College London studied one of these national Democratic Therapeutic Community services over four years and found external policy 'steering' by officials eroded the community's democratic model of care, which in turn destabilised its well established approach to clinical risk management (this had been jointly developed by clients and staff).
The most recent exponent, the North Cumbria model, uses a dedicated out of hours website moderated by service users according to therapeutic community principles.
The use of 'starter' groups as a preparation for entry into therapeutic communities has lowered attrition rates and they now represent a cost-effective model still aimed at producing durable personal and intergenerational effects; this is at odds with the current trend towards the defensive needs of service providers, rather than service users, for less intensive treatments and management of pathways to control risk.
[citation needed] Modified therapeutic communities are currently used for substance abuse treatment in correctional facilities of several U.S. states including Pennsylvania,[19] Washington,[20] Colorado,[21] Texas,[22] Delaware,[23] and New York.
[1] As an intervention model for drug-using offenders with co-occurring mental health disorders, therapeutic communities may help people reduce drug use and subsequent criminal activity.