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This study aims to describe Italian and UK therapeutic community developments during 1960–2021.

Historical review and personal experience.

After significant divergence in the nature of “therapeutic communities”, mostly based on the different sociopolitical contexts in the two countries, areas of formal rapprochement have been emerging in the past 20 years.

The details of how therapeutic communities developed in Italy, particularly in the wake of Law 180, deserves investigation and comparison to the UK and other countries.

The recent collaborative work in quality, training and research could support the future use of therapeutic communities and enabling environments.

The underlying principle of “relational practice”, which underlies the therapeutic community approach, could have wider implication in public services beyond mental health.

Much has been written about the progressive intentions of Italian mental health with Law 180, but not with a specific focus on therapeutic communities – which were an important initial impetus for Basaglia and his equipé.

This paper aims to describe a method of training for practitioners in democratic Therapeutic Communities (TCs) which has been used in several settings across the world over the past 25 years: the “Living-Learning Experience” (LLE) workshop. It goes on to consider the cross-cultural implications of the work.

Drawing on the experience of running exactly the same programme in different countries and cultures, the paper examines the cross-cultural adaptability and describes necessary adaptations for local circumstances. It also contains original ethnographic research in UK and Italy; further study is planned for other countries.

The workshops are readily transferable to different cultures and are appreciated for their democratic and relational way of working.

The ethnographic study examines the workshops in some depth, in UK and Italy, and could usefully be replicated in other countries. No quantitative, outcome or follow-up studies have yet been done, and this paper could contribute to the design of useful quantitative studies.

The paper demonstrates that the LLE is a useful experiential learning tool in widely different settings. It could be developed in different ways, such as for developing relational practice or establishing therapeutic environments in different settings.

The workshops' acceptance in widely different cultures indicates that the open and non-didactic format addresses essential and fundamental qualities required for therapeutic engagement and human relatedness.

This is the first description of the principles of democratic TCs being applied across different international settings. Its value extends beyond the TC field, to the use of democratic and relational principles' applicability in therapeutic pedagogy and training.

The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments.

Milieu treatment is defined and differentiated from TC “proper”. Literature is reviewed covering attempts to use TC methods in inpatient wards, across hospitals, and more recently in the criminal justice system and more widely through the enabling environments initiative.

It is unclear whether TC milieu treatments proved helpful in acute ward environments in their heyday in the 1950s, 1960s and 1970s, in particular those involving people suffering from acute psychosis, and the changing landscape of psychiatric provision may make further investigation difficult. The reasons for this, and for the difficulties reaching a firm conclusion, are outlined. In contrast, TC milieu interventions appear to be demonstrating usefulness more recently in less mixed populations without the implementation of full TC “proper”.

Much of the research is old and the methodology poor, which limits the conclusions that can be drawn.

Recent innovations pick up in a more accessible way principles of therapeutic communities that can inform and improve care in a variety of contexts. They are sufficiently well defined to lend themselves to research, which should now be a priority.

After a gap in developments in the field, recent innovations are reintroducing elements of TC functioning to new contexts including criminal justice settings, inpatient wards, homeless shelters and city communities.

The purpose of this paper is to describe the role of the expert by experience, and its benefits and challenges.

Review of the relevant literature and a case study has been performed.

The role of the expert by experience is fluid and complex. Staff need to understand the ambiguities of the role.

Experts by experience (XBXs) play an important role in TC practice. They need support and supervision. Staff need to learn about the complexities and fluidity of the role, and to be aware of its transitional position between service user and staff member.

XBXs challenge the binary notion of staff and service user. The role calls for a different relational rather than procedural conceptualisation.

This is the first description of the lived experience of an expert by experience, working in a therapeutic community setting, with the analysis of the helpful and unhelpful aspects of the role.

The purpose of this paper is to collaborate across disciplines to agree a better map of human development.

This paper used an iterative process of consultation with professionals and specialists in relevant disciplines, and service users, continually refining the diagram and text until a “good enough” consensus was reached to produce a diagrammatic form and explanatory text.

The process revealed a strong commitment across many disciplines to find a common contextual framework within which specialist understandings could be accommodated. The consultation process and iterative development of the diagram and text was marked by widespread interest and many detailed discussions. The substance of this paper is the result of that process.

The model places research in different specialist fields onto a single “map of the territory”. It can encourage collaboration across disciplines when they are studying similar areas from different perspectives. It indicates the value of collaborative rather than competitive research enterprises.

Too often, professionals involved in fields concerning human development become focussed within narrow frameworks of specialisation. The model supports better understanding of how different elements relating to developmental life interrelate. This can facilitate the basis upon which a wide range of training, education and research programmes can be formulated.

The model proposes greater use of a “whole-person/whole-life” perspective, which should allow greater integration between disparate approaches, and less experience of fragmentation. For a wide range of public sector activities, the quality of relational activity should be central to effective organisational and human outcomes. Without a unifying context, the understanding required to support relational work is weak: this model ad-dresses that deficit.

This work is entirely original. It should be of value to all those interested in working in holistic ways; to policy makers wishing to avoid duplication, waste and ineffective interventions; and to researchers interested in working across disciplinary boundaries. Most importantly, it is for staff involved in health, justice, social care and education services at all levels. Their effectiveness relies on relational, as well as procedural working, and this model will support confidence in the primacy of these activities.

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.

A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.

The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.

This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

The purpose of this paper is to demonstrate the training value of a residential “enabling environments” (LLEE) workshop in relation to the Royal College of Psychiatrists’ (RCPsych) ten specified standards, as rated by workshop participants.

A 34 question yes/no/na questionnaire was drawn up, derived from the ten value-based standards and criteria which need to be met for the enabling environment (EE) award by the RCPsych’s Centre for Quality Improvement (Table AI). It was administered after six residential workshops, in Italy and UK, to 99 participants. Results were analysed for each of the six workshops, and for each of the ten standards, to show the degree to which participants recognised whether the standards were met.

High rates of positive responses were recorded with little variation across the six workshops sampled. Some standards and criteria showed higher levels of positive responses, and some showed slightly higher scores for “not applicable”.

Experiential Living-Learning Experience (LLE) workshops provide a valid training experience for those developing or working in EEs.

Value-based standards can only be fully understood by direct experience of them, as verbal or written explanations fail to convey the psychological impact of the experience.

The questionnaire and its translation is the original work of AL. RH is the founder of LLE training workshops and the EE award.

The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).

Literature review shows comparison of TC and group-analytic concepts with illustrative case material.

Findings reveal many similarities between TCs and GA, but also significant divergences, particularly in practice.

This paper provides theoretical basis for TC practice, and highlights the need for greater theorising of TC practice.

This paper highlights the importance of group-based treatment approaches in mental health.

This is the first paper to review the relevant literature and compare theory and practice in TCs and GA, highlighting their common roots in the Northfields Experiments in the Second World War.