Therapeutic community

1. Introduction

Version followed: the therapeutic community (TC) family as a whole. The shared definition and UK typology follow the Consortium of Therapeutic Communities (TCTC) pages "How TCs Work" and "Core Values" (the ten values agreed in the 2008 Community of Communities consultation). The concept-based addiction lineage follows the NIDA Research Report Therapeutic Communities (NIH Pub. No. 15-4877, revised July 2015) and the six essential elements measured by Dye et al. (2009). The democratic lineage follows Campling (2001), Griffiths & Hinshelwood (1995) and Rawlings & Haigh (2017). Planned environment therapy follows Franklin (1944) and Diamond (2009). This tab is the family overview. Full democratic TC procedures are in 092 Democratic therapeutic community. The concept-based model in detail, and the account of harms in the Synanon lineage, are in 093 Concept-based therapeutic communities.

Everything tagged [source] was checked against the pages listed under Sources. Further reading (not drawn on): De Leon's books (1997, 2000), Jones (1953, 1968), Main (1946), Rapoport (1960) and the current Community of Communities standards document. Claims that rest on them are tagged [uncertain].

What it is. A TC is not a single therapy. It is a way of organising a whole living or day setting so that the community itself is the main agent of change. The TCTC describes TCs as "structured, psychologically informed environments" in which relationships, daily structure and activities are deliberately designed to support health and well-being [source: TCTC How TCs Work]. A team delivers it, and so do the members. A single clinician cannot.

Core shared idea: community as method. NIDA defines "community as method" as the defining approach of TCs: taking part in a mutual-help community drives individual change. Every activity and interaction is a chance for personal change, and members share responsibility for each other's recovery [source: NIDA 2015]. The phrase comes from De Leon (1997) [source: Vanderplasschen et al. 2013; De Leon not drawn on]. The democratic tradition names the same idea "living–learning": daily life and formal therapy form one process, and the community's life is examined openly [source: Campling 2001]. Main called its hallmark "a culture of enquiry" [source: Griffiths & Hinshelwood 1995].

The main lineages (UK typology from TCTC; US addiction typology from NIDA):

• Democratic (social-psychiatry) TCs. These grew from wartime army psychiatry at Northfield, Main's Cassel Hospital and Maxwell Jones's Henderson Hospital [source: Campling 2001; Griffiths & Hinshelwood 1995]. They are used for personality disorder and complex needs in NHS day and residential units, and for serious offenders in prison. The first custodial democratic TC opened at HMP Grendon in 1962 [source: TCTC How TCs Work]. Change works through flattened hierarchy, shared decisions and open examination of relationships. Detail: 092.
• Concept-based (hierarchical) addiction TCs. These began outside mainstream mental health care, and often in reaction to it, with Synanon, a self-supporting community of ex-addicts founded in 1958 in Santa Monica, California [source: Vanderplasschen et al. 2013; NIDA 2015]. The Daytop and Phoenix House lineage spread the model, which De Leon later systematised [uncertain here: not in the sources for this tab; see 093]. It is drug-free and residential. It aims at "right living" (honesty, responsibility, hard work, willingness to learn) through a peer hierarchy, work roles, stages, rewards and sanctions [source: NIDA 2015]. It has been adopted in more than 65 countries [source: NIDA 2015]. Detail and harm account: 093.
• Modern variants. Prison TCs, of both the UK democratic and the US concept-based types. Modified TCs for co-occurring disorders, homelessness, women and adolescents. Day and "mini" TCs. Therapeutic homes and schools for children in the planned environment therapy tradition. Social-therapy housing for long-term psychosis. Learning-disability and faith-based communities [source: TCTC How TCs Work; NIDA 2015; Rawlings & Haigh 2017; Diamond 2009].

Where the lineages differ. Democratic TCs ask members to live "as themselves" without a visible status ladder. Concept-based TCs use a graded hierarchy and ask newcomers to "act as if" [source: Rawlings & Haigh 2017]. Both treat the community as the method, use peers as agents of change, make work part of therapy, and examine behaviour in public groups [source: NIDA 2015; Campling 2001; Rawlings & Haigh 2017].

2. Framework

No TC uses a session-count protocol. Treatment is membership of a programme that has a beginning, a middle and an end. The phase names below are a cross-lineage map [synthesis]. Each row gives what each lineage's sources describe.

Formats [source: TCTC How TCs Work; NIDA 2015; Dye et al. 2009]

• Residential TC. Members live in. This is the traditional format for both lineages.
• Day TC. Three or more days a week. Mini TC. Fewer than three days a week (TCTC terms). NHS example: two full days a week for 12 months [source: Spring House].
• Concept-based modified formats. Short-term residential, outpatient-only, or mixed residential and outpatient [source: Dye et al. 2009; NIDA 2015].
• In-prison TCs. Ideally housed apart from the general prison population [source: NIDA 2015; PSO 2400].

Duration

• Concept-based: historically 18–24 months, now often 3, 6 or 12 months because of funding and insurance limits [source: NIDA 2015]. Usually around 6–12 months in European studies [source: Vanderplasschen et al. 2013].
• Democratic: time-limited, never open-ended in UK personality-disorder TCs [source: TCTC]. About 18 months is described as optimal in prison [source: Rawlings & Haigh 2017]. 12 months in one NHS day TC [source: Spring House].

Phases (cross-lineage map)

Criteria for moving between phases. Concept-based TCs tie progression to tenure, role and stage. Senior residents take more responsibility and act as models for junior ones [source: Dye et al. 2009; NIDA 2015]. Democratic TCs decide progression and departure through the community, using reviews, votes and staff veto with reasons [source: PSO 2400; TCTC]. Stage-by-stage criteria for each lineage are in 092 and 093.

3. Guiding principles

These principles are shared by the whole family. Where only one lineage holds a principle, it is marked.

• Community as method. The community, not a single therapist, is the agent of change. Practical meaning: route problems back into the community's structures instead of solving them privately [source: NIDA 2015; Campling 2001].
• Living–learning. Everyday events are the material of therapy. Practical meaning: what happened in the kitchen or on the wing belongs in the next group [source: Campling 2001; NIDA 2015 "every activity and interaction"].
• Peers as agents of change. Members help, challenge and model for one other. In the TC model this is "clients as therapists" [source: Dye et al. 2009]. Practical meaning: let peers give feedback first, and add staff comments after.
• Work as therapy. Running the place is part of the treatment [source: Dye et al. 2009; NIDA 2015; Rawlings & Haigh 2017]. Practical meaning: treat task failures as therapeutic material, not just a management problem.
• Public examination of behaviour. Behaviour and its effect on others are discussed openly. Democratic TCs call this "reality confrontation". Concept-based TCs use peer "pull-ups" and affirmations [source: Campling 2001; NIDA 2015]. Practical meaning: name the impact on others, specifically and in the group, and never as humiliation (see 5).
• Structure and containment. Both lineages depend on a predictable daily structure and clear limits. Concept-based TCs use a highly regulated routine with explicit expectations, rewards and sanctions [source: NIDA 2015]. Democratic TCs combine a small set of fixed core rules with a constitution the community owns [source: PSO 2400]. Practical meaning: know which rules are fixed and which the community can change.
• Authority: shared or graded (the main point of divergence). Democratic TCs flatten the hierarchy and share decisions. Concept-based TCs use a graded peer hierarchy based on tenure and role [source: Rawlings & Haigh 2017; Dye et al. 2009]. Practical meaning: before working in or referring to a TC, find out which form of authority it uses and explain it to the client.
• The ten TC core values (Community of Communities consultation, 2008, agreed by members of over 100 TCs across sectors). The values are attachment, containment, respect, communication, interdependence, relationships, participation, process, balance and responsibility [source: TCTC Core Values]. Practical meaning: use them as a checklist for whether a setting is working as a TC. How democratic TCs apply them is in 092.
• Behaviour is communication. The TCTC states that "all behaviour has meaning" [source: TCTC Core Values]. The children's tradition reads behaviour as a symptom of underlying need [source: Diamond 2009]. Practical meaning: ask what a behaviour communicates before deciding how to respond.
• Staff are the key factor and need support. Franklin wrote that "the staff are the most important factor" [source: Franklin 1944]. TCs depend on supervision, staff groups and consultation [source: Diamond 2009; PSO 2400; TCTC]. Practical meaning: protect staff reflective time first when resources are cut.
• Keep the idea alive. Main warned that organisations can become possessed by an idea [paraphrase; source: Griffiths & Hinshelwood 1995]. Franklin warned against rigid discipline and against treating custodial care as therapy [source: Franklin 1944]. Practical meaning: review routines regularly and drop rituals that no longer serve a purpose.

4. Intervention inventory

In a TC the "interventions" are mostly structures, and the way staff and members behave inside them. This inventory covers the structures shared across the family and how each lineage runs them. It also covers the modern variants and the tasks of a clinician who refers to or works alongside a TC. Step-by-step procedures for each structure are in 092 (democratic) and 093 (concept-based, including encounter groups and their risks). They are not repeated here. Example language is illustrative. Steps beyond the sources are marked [synthesis].

4.1 Matching a client to the right kind of TC

• Purpose: the lineages ask very different things of a member. A poor match leads to early dropout or harm [synthesis].
• Steps:
  • Identify the main problem. Substance dependence points to a concept-based or modified addiction TC. Personality disorder or complex relational needs point to an NHS democratic or day TC. Serious offending in custody points to a prison TC. Severe emotional deprivation in a child points to a therapeutic school or home [source: TCTC How TCs Work; NIDA 2015].
  • Ask the programme which model it uses: shared or graded authority, how confrontation works, rules and sanctions, length, and whether it is residential, day or mini [source: TCTC; Rawlings & Haigh 2017; synthesis for the checklist].
  • Check co-occurring needs. Severe mental illness, homelessness, motherhood or adolescence may need a modified TC [source: NIDA 2015]. Ask whether the programme accepts prescribed or substitution medication [synthesis; methadone use in TC treatment is reported in Vanderplasschen et al. 2013].
  • Check quality markers. Is it a Community of Communities member, or accredited? For a prison TC, is the model accredited? [source: TCTC; PSO 2400; Rawlings & Haigh 2017].
• Example language (illustrative): "This programme runs on a ladder. You start with few privileges and earn more by taking on jobs. The other one makes decisions together in a big meeting. Which of those sounds more workable for you?"
• Watch for: a referral driven only by bed availability or by court pressure. It's working when the client can describe the model they are going to in their own words [synthesis].

4.2 Entry: engagement, assessment, preparation and selection

• Purpose: make entry an informed choice and begin attachment to the community. In UK TCs it also lets existing members share in admission [source: TCTC].
• Steps: referral (self-referral in some TCs), then assessment, preparation and selection. Existing members vote on admission at a case conference or admissions panel [source: TCTC How TCs Work]. Concept-based TCs start with an orientation or induction stage instead [source: Dye et al. 2009]. Democratic procedures in detail (preparation group, joining visit, vote) are in 092. Concept-based induction is in 093.
• Watch for: consent under pressure. Ask what the person wants for themselves [synthesis].

4.3 The whole-community meeting

• Purpose: the forum where the community reviews its life, makes decisions and examines behaviour. It appears in every lineage [source: Campling 2001; NIDA 2015; Dye et al. 2009].
• How the lineages differ:
  • Democratic: a resident-chaired meeting of all members, patients and staff. It decides community business and discusses incidents, with staff veto with reasons [source: Campling 2001; PSO 2400]. See 092.
  • Concept-based: morning and evening house meetings within a regulated routine [source: NIDA 2015]. See 093.
  • Children's TCs: forms suited to development, such as circle time, where children sort worries into ones they can and cannot do something about [source: Diamond 2009].
• Example language (illustrative): "Before we move on to the rota, what has the house not talked about this week?"
• Watch for: meetings that turn into ritual with no real business (see 5) [source: Griffiths & Hinshelwood 1995].

4.4 Peer roles, peer feedback and role modelling

• Purpose: peers act as therapists and models. This is "clients as therapists" [source: Dye et al. 2009].
• How the lineages differ:
  • Concept-based: senior residents take on responsibilities and model behaviour for juniors. Members give "pull-ups" (specific feedback on conduct) and affirmations [source: Dye et al. 2009; NIDA 2015]. Graduates and ex-offenders often join the staff [source: NIDA 2015]. See 093.
  • Democratic: elected roles such as chair and secretary. Feedback is given in public discussion, not through pull-ups [source: Rawlings & Haigh 2017; Spring House]. See 092.
• Steps (any TC) [synthesis]: give newcomers a named peer guide. Make feedback specific to behaviour and its effect. Pair every challenge with acknowledgement of what the person does well.
• Example language (illustrative), peer to peer: "When you walked out of the kitchen, the rest of us had to finish. I'd rather you told us you were struggling."
• Watch for: feedback that turns into status games or bullying.

4.5 Work as therapy and communal tasks

• Purpose: responsibility, self-reliance and a live arena where patterns show up [source: NIDA 2015; Dye et al. 2009; Rawlings & Haigh 2017].
• How the lineages differ: concept-based TCs assign job functions that are graded within the hierarchy. Prison TC members work during incarceration [source: NIDA 2015]. Democratic TCs share cooking, cleaning, gardening and policy work, and members are elected to manage them [source: Rawlings & Haigh 2017; Griffiths & Hinshelwood 1995]. Children's and planned-environment communities use work, building and contact with animals [source: Franklin 1944].
• Watch for: staff doing the work to avoid conflict [source: Griffiths & Hinshelwood 1995], or work used as punishment (see 5).

4.6 Group therapy inside the community

• Purpose: focused work on each person's patterns, alongside community life.
• How the lineages differ:
  • Democratic: small psychotherapy groups with fixed membership, several times a week. They link behaviour on the unit to history and offending [source: Rawlings & Haigh 2017; PSO 2400]. See 092.
  • Concept-based: traditional TCs relied on confrontational group therapy [source: Dye et al. 2009]. Current programmes add seminars, individual counselling, CBT and motivational interviewing [source: NIDA 2015]. Encounter groups as now practised, and their harmful history, are in 093.
  • Children's TCs: a treatment team from group living, psychotherapy, education and family support, with individual child psychotherapy where needed [source: Diamond 2009].
• Watch for: any group that uses humiliation as a technique. See 093's Harm account.

4.7 Stage progression, privileges and sanctions

• Purpose: link responsibility and freedom to growth.
• How the lineages differ: concept-based TCs move members through stages (assimilation, behavioural treatment and personal development, re-entry), with rewards such as praise and higher status and disciplinary sanctions for rule-breaking [source: NIDA 2015; Dye et al. 2009]. Democratic TCs have no status ladder. Breaches go to the community, and leaving can be decided by community vote with staff veto [source: Rawlings & Haigh 2017; PSO 2400].
• Steps (any TC) [synthesis]: publish the stage or review criteria in writing. Make sanctions proportionate and time-limited, and explain them. Check that no sanction involves humiliation, sleep or food deprivation, or loss of contact with family as punishment (see 093 Harm account).

4.8 Staff reflective structures

• Purpose: keep staff thinking. Staff reactions carry information about the community [source: Diamond 2009; Griffiths & Hinshelwood 1995].
• Steps: clear job descriptions and supervision [source: TCTC]. Regular staff meetings, individual supervision and a staff sensitivity or dynamics group (prison TCs) [source: PSO 2400]. Team meetings, reflective space and consultation with a psychotherapist (children's TCs), with horizontal team structures as "anchors" against dependency on a single worker [source: Diamond 2009].
• Example language (illustrative): "Half the team wants to discharge him and half wants to protect him. What is he getting each of us to hold?"

4.9 Re-entry and aftercare

• Purpose: carry the gains into life outside.
• Steps: concept-based: help with employment, education or training, then aftercare (individual and family counselling) and strong encouragement to keep attending self-help groups [source: NIDA 2015]. Democratic: ending work, a transition programme and follow-up groups. In prison, an End of Therapy Report and case conference [source: Spring House; PSO 2400]. See 092 and 093 for detail.
• Clinician task [synthesis]: if you will see the client after the TC, agree the handover before the leaving date and ask for the TC's ending summary.

4.10 Prison therapeutic communities

• Purpose: treatment for offenders inside custody. The two lineages run different prison models.
• UK democratic prison TCs: HMP Grendon, the first custodial TC (1962), plus Dovegate, Gartree and others [source: TCTC; Rawlings & Haigh 2017]. The Democratic TC Core Model was accredited in 2004 and is delivered under Accredited Manuals, with annual review and Community of Communities membership [source: PSO 2400]. Reaccreditation every 5 years, Community of Communities audit every 2 years. TC Plus is an adapted version for people with intellectual disabilities [source: Rawlings & Haigh 2017]. Detail: 092.
• US concept-based in-prison TCs: residential drug treatment units, ideally housed apart from the general prison population. Participants work and spend about 4–5 hours each weekday in treatment. Staff often include ex-offenders as role models. Aftercare in the community after release is a core part of the model [source: NIDA 2015]. Named programmes include Amity, Delaware KEY/Crest, Forever Free, a modified TC for people with mental illness and substance use (MICA), and the Pennsylvania DOC TC [source: CrimeSolutions].
• Related planned environments: Psychologically Informed Planned Environments (PIPEs) in the Offender Personality Disorder Pathway support people and prepare them for treatment. They are not treatments themselves [source: Rawlings & Haigh 2017].
• Clinician task [synthesis]: at referral, separate the person's own motivation from parole considerations. On release, link the person to community aftercare at once.

4.11 Modified therapeutic communities

• Purpose: keep community as method while adapting to populations and settings the classic TC served poorly [source: NIDA 2015; Vanderplasschen et al. 2013].
• Variants as published [source: NIDA 2015]:
  • Co-occurring severe mental illness: integrated mental-health care, dual-recovery education and medication monitoring.
  • Homelessness: shorter sessions, more hands-on staff involvement, and supportive housing as aftercare.
  • Women: gender-responsive services, child care, parenting goals, trauma treatment (for example Seeking Safety), and less emphasis on confrontation.
  • Adolescents: family involvement, peer influence, life skills, motivational enhancement, trauma-informed care and expressive or body-based activities.
  • Format changes: short-term residential, outpatient-only and mixed programmes. Outpatient-only TCs showed much lower adherence to the essential elements [source: Dye et al. 2009].
• Watch for: a programme that keeps the TC name but none of its elements. Ask which essential elements it actually runs [source: Dye et al. 2009; synthesis for the check].

4.12 Children's therapeutic communities and planned environment therapy

• Purpose: an organised daily life that gives "protection and stimulation", for children and young people whose development has been disrupted [source: Franklin 1944].
• Origins: Marjorie Franklin, a founder member of the Planned Environment Therapy Trust, described the Q Camps, including one for young men with W. David Wills and one for boys aged 11–15 led by Arthur Barron. Residents and staff shared the government of the community [source: Franklin 1944]. Later children's TCs influenced by this work include the Mulberry Bush School, Peper Harow and the Cotswold Community [source: Whitwell note to Franklin 1944]. The PETT archive is now managed by the Mulberry Bush Organisation [source: Whitwell note].
• Practices described at the Mulberry Bush (ages 5–12; founded by Barbara Dockar-Drysdale, who had consultations with Winnicott) [source: Diamond 2009]:
  • Children live "as a group", in a "society in miniature" where they learn cooperation and conflict resolution.
  • "Primary provision": a managed, localised regression within a consistent attachment to one adult, sometimes through a chosen "special thing" such as a particular food.
  • Behaviour is read as communication of need. Staff survive testing without withdrawing, and work through entanglement in supervision.
  • A treatment team links group living, education, psychotherapy and family support.
• Watch for: Franklin's own list of misuses. Trying to analyse through the environment. Rigid discipline and fixed punishments. Unsuitable placements. Confusing custodial care with therapy [source: Franklin 1944].

4.13 Quality standards and the boundary of the term "TC"

• Purpose: know what makes a setting a TC, and how to check it.
• Steps:
  • UK: the Royal College of Psychiatrists' Community of Communities quality network sets the standards by which TCs are judged. Some TCs are accredited [source: TCTC How TCs Work]. Its ten core values are listed in section 3 [source: TCTC Core Values]. The current standards document is not drawn on here [uncertain].
  • Related but different settings: Enabling Environments, Therapeutic Environments, PIPEs and intentional communities have some, but not all, of a TC's elements [source: TCTC How TCs Work; Rawlings & Haigh 2017].
  • Concept-based fidelity: the six essential elements measured by the SEEQ survey are TC perspective, hierarchy, clients as therapists, work as therapy, programme components (meetings, rituals, stages) and disciplinary actions [source: Dye et al. 2009]. De Leon's full model is not drawn on here [uncertain]. See 093.
  • Applying TC principles on ordinary wards: Haigh's five qualities (attachment, containment, communication, inclusion, agency) turned into ward practices [source: Haigh 2002]. These are derived applications, not TCs [synthesis].

4.14 Working alongside a TC as an outside clinician [synthesis]

• Purpose: support the client without undermining the community's method.
• Steps:
  • Before entry: prepare the client for public feedback and the loss of private confidences. In democratic TCs, information is shared with the community [source: Campling 2001].
  • During: agree with the TC whether any outside therapy continues. Avoid becoming a private channel that draws material away from the community.
  • Crises: follow the TC's crisis arrangements and standard risk-assessment practice. Your own duty of care stays in place.
  • After: take the handover and help the client use what they learned in ordinary relationships.
• Example language (illustrative): "That sounds important. Have you taken it to your group? What do you imagine would happen if you did?"

5. Handling problems

This section covers problems common to the whole family. Problems specific to democratic TCs (splitting, malignant regression, vote-outs, crisis meetings) are in 092. Problems specific to concept-based TCs, and how confrontation can turn into abuse, are in 093.

• Wrong model for the person. For example, someone with severe trauma placed in a highly confrontational hierarchy, or someone who needs firm external structure placed in a loosely held day TC. Response: re-assess fit early, using 4.1. Move the person to a modified or different TC rather than labelling them resistant [synthesis; modified TCs from NIDA 2015].
• Confrontation turning into humiliation. Public feedback is shared by every lineage, and so is the risk that it slides into attack, ritual shaming or group bullying. Response: stop it, name what is happening in the group, and restore feedback about behaviour and its effect. Treat humiliation used as a technique, head-shaving, signs, sleep or food restriction, or coerced confessions as red flags, never as treatment. The history and how to recognise these practices are in 093's Harm account [source: Rawlings & Haigh 2017 on the difference between the models; synthesis for the response].
• Model drift and dilution. A programme keeps the name but drops the elements. Outpatient-only and short programmes keep fewer of them [source: Dye et al. 2009]. Response: audit against the essential elements or the Community of Communities standards, and say openly which elements are missing [source: Dye et al. 2009; TCTC; synthesis].
• Ritual and rigidity. Meetings become routine, rules multiply, and discipline hardens [source: Griffiths & Hinshelwood 1995; Franklin 1944]. Response: review each structure's purpose with members at least yearly, and ask "what do we do only because we always have?" [synthesis].
• Custodial care mistaken for therapy. This is Franklin's warning, and it applies to prison TCs and secure children's settings [source: Franklin 1944]. Response: keep the TC's therapeutic structures (groups, meetings, staff reflection) protected from the host institution's routines. Raise it with the host institution when they are eroded [synthesis].
• Early dropout. Most dropout happens in the early months [source: PSO 2400 on returns within 6 months]. Response: front-load attachment work: peer guides, early roles, and quick follow-up of missed days [source: Spring House; synthesis].
• Coerced or externally motivated entry (court, parole, family). Response: explore the person's own goals at assessment. Revisit motivation openly in the community, and use motivational interviewing where the programme includes it [source: NIDA 2015 on MI; synthesis].
• Overwhelm on joining. Response: a gradual induction or preparation phase, a named peer guide, and explicit permission to pace disclosure [source: Spring House; Dye et al. 2009 on induction; synthesis].
• Co-occurring mental illness and medication in a drug-free setting. Response: choose or ask for a modified TC with integrated mental-health care and medication monitoring. Never let a drug-free ethos override prescribed treatment [source: NIDA 2015; synthesis].
• Self-harm and suicide risk. Response: use standard individual risk assessment and safety planning, and lethal-means counselling (safe storage or removal), alongside the community's crisis structures. Treat a rise across the community as a community event for the staff group [synthesis; democratic crisis meetings in 092].
• Staff entanglement, splitting and burnout. Response: supervision, staff groups and outside consultation. Use horizontal team structures rather than one worker holding everything [source: Diamond 2009; PSO 2400].
• Boundary violations by staff, or by senior peers in hierarchical TCs. Response: a flattened or peer-run structure never removes professional boundaries. Sexual, financial or exploitative relationships go to safeguarding and the regulator [synthesis].
• Re-entry failure. Response: plan aftercare before discharge, and connect the person to community aftercare at once after leaving a prison TC [source: NIDA 2015; synthesis].
• Outsiders misreading the model. Managers see shared decisions as chaos. Referrers see confrontation as harshness. Response: give clear written information on the model, its core rules, how risk is managed and who holds final authority [synthesis].

Sources

Sources:

• NIDA Research Report: Therapeutic Communities (NIH Pub. No. 15-4877, revised July 2015), Council of Europe copy
• NIDA: How is treatment provided in a therapeutic community?
• Dye MH, Ducharme LJ, Johnson JA, Knudsen HK, Roman PM (2009) Modified therapeutic communities and adherence to traditional elements. J Psychoactive Drugs 41(3):275–283
• Vanderplasschen W et al. (2013) Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. Scientific World Journal
• TCTC: How TCs Work
• TCTC: Core Values (Community of Communities, 2008)
• Franklin ME (1944/1945) The use and misuse of planned environmental therapy (John Whitwell archive)
• Diamond J (2009) The Mulberry Bush as a therapeutic community. Therapeutic Communities 30(2) (John Whitwell archive)
• CrimeSolutions: Incarceration-based therapeutic communities for adults

Sources:

• PSO 2400 Democratic Therapeutic Communities (HM Prison Service, 2004)
• Rawlings B, Haigh R (2017) Therapeutic communities and planned environments for serious offenders in English prisons. BJPsych Advances 23(5)
• Campling P (2001) Therapeutic communities. Advances in Psychiatric Treatment 7(5):365–372
• Haigh R (2002) Acute wards: problems and solutions. Psychiatric Bulletin 26(10):380–382
• Griffiths P, Hinshelwood RD (1995) A culture of enquiry: life within a hall of mirrors (Psychomedia)
• Mersey Care NHS FT: What is Spring House? (patient guide)

Further reading (not drawn on) [uncertain]:

• De Leon G (ed.) (1997) Community as Method: Therapeutic Communities for Special Populations and Special Settings. Praeger.
• De Leon G (2000) The Therapeutic Community: Theory, Model, and Method. Springer.
• Jones M (1953) The Therapeutic Community: A New Treatment Method in Psychiatry. Basic Books.
• Main TF (1946) The hospital as a therapeutic institution. Bulletin of the Menninger Clinic 10.
• Rapoport RN (1960) Community as Doctor. Tavistock.
• Royal College of Psychiatrists, Community of Communities service standards for therapeutic communities (current edition).

Pages tried but not usable: the RCPsych Community of Communities "Who we are" page (only navigation text came back) and the NIDA reference-list page.