Therapeutic Community

The therapeutic community philosophy centered around the belief that if patients and staff worked together in a democratic environment, then psychiatric treatments would be more effective. Therapeutic Community arose about 40 years ago with an emphasis on community care, increased use of psychopharmicological drugs. What characterizes this theory is patient's participation in decision making, collective responsibility for the events on the ward, multidisciplinary staff, and belief in the rehabilitative potential of the environment. The milieu environment is a valuable treatment modality. The key players in the development of this type of care Maxell Jones, Adolph Meyer, August Aichhorn, Ernest Goffman, Alfred Stanton and Morris Schwartz and Milton Greenblatt. Some of the radical notions were that the patient's were worked with not worked on. The patient's surroundings and circumstances could be beneficial for their treatment. This normalized the lines that were previously drawn between the sane and the insane (Gutheil, 1985). Early communities formed with this theory in mind carefully selected patients often excluding the most severely psychotic people and the offered extended lengths of stays in order to provide prolonged observation and treatment.

"The term therapeutic community stands for a system of treatment; it has also been used as a battle cry, a charm, and a password" (Gutheil, p. 1280, 1985). There are three types of therapeutic communities according to Wilmer those of the left, right and center. The left viewpoint can be characterized by being disordered and chaotic while being ritualistic and repressive. The right perspective took the opinion of therapeutic communities as being practice with no empirical support or legitimate basis. Rather this position clung to a single psychological theory such as the psychoanalytic framework. A flexible and a non-authoritarian approach characterized the center perspective. The most common philosophy of therapeutic communities today leans towards the center viewpoint. Classic therapeutic community practices are limited group size, group voting, and decision making and patient government (Gutheil, 1985).