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The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions.

The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits.

The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.

Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper.

The PhD summary study contributes to the existing literature on TC treatment.

Over nearly six decades in prison, therapeutic communities (TCs) have waxed and waned in California. While there have been dramatic and demonstrable sucess with some of the most intractable populations in California prisons, the TC model has met substantial challenges, both bureaucratic and political. The paper aims to discuss this issue.

This is a six-decade review of in-prison TCs in California based both on the research literature and from personal experience over 30 years providing both in-prison and community based TCs in California.

Despite well-documented success reducing the recidivism of violent offenders in California prisons (which is now the bulk of the population), the government has ignored the success of well implemented in-prison TCs, and has implemented a CBT model which has recently been documented to have been ineffective in reducing recidivism. The State is now at a crossroads.

Documented research findings of success do not necessarily result in the implementation of the model.

There is evidence that violent felons are amenable to treatment.

Public concern over the return of violent felons from prison can be ameliorated by the evidence of the effectiveness of TC treatment in prison.

There is no other publication which captures the narrative of the TC in California prisons over six decades.

This paper aims to describe the impact of the COVID-19 pandemic on a prison-based therapeutic community (TC).

The paper takes the form of a case study where the authors reflect on their current practice, using the findings of research on social isolation and the overarching TC principles to explore the effect of the pandemic on the TC at HMP Grendon. The authors consider how the residents and staff adjusted to the change as the parameters changed when the social distancing rules were imposed and how they adapted to the prolonged break to therapy. Sections in the paper were written by a resident and an operational member of staff. The authors conclude with their thoughts on how to manage the consequences the lockdown has brought and start to think about what returning to “normality” might mean.

The paper describes the adjustments made by the residents and staff as the UK Government imposed the lockdown. The authors, including a resident and an operational member of staff comment on the psychological and practical impact these adjustments had. The thought is given to the idea of “recovery”, returning to “normality” and how this study can be best managed once restrictions are lifted.

At the time of writing, there are no confirmed cases of COVID-19 at HMP Grendon. The measures and commitment from all staff and residents in the prison to keep the prison environment safe may in part account for this. This paper explores the effects of lockdown on the emotional environment in a TC and highlights the consequences that social isolation can have on any individual. To the authors’ knowledge, there is currently no research undertaken on the impact of lockdown/social isolation on a TC. This research would be useful, as the authors postulate from reflections on current practice that the effects of the lockdown will be greater in a social therapy environment.

HMP Grendon started in 1962, as this time there have been no significant events that have meant the suspension of therapy for such a sustained period. It is, therefore, important that the impact of such is considered and reflected upon.

The purpose of this paper is to present a case study of a programme aimed at raising standards of care and levels of professionalism in private, drug-free therapeutic communities (TCs) in Santa Catarina, Brazil.

The paper describes the Reviver intervention in detail and draws on subjective insights collected during its implementation.

Over 100 TCs applied to the Reviver project, of which 83 qualified to participate. The large majority of TCs were found to combine community-as-method, religious worship and abstinence in their treatment model.

The paper highlights the significant role religious organisations have in the treating substance dependency in Brazil and raises ethical and practical questions regarding the incorporation of religious TCs into mainstream public mental health provision.

The paper outlines the qualification process, control systems and monitoring procedures employed by the Reviver project.

The paper attends to the gap in English language publications regarding TCs in Brazil and raises important questions regarding the role of religion, faith and spirituality in the treatment of substance dependency.

The purpose of this paper is to present a previously unpublished letter from children’s therapeutic community pioneer David Wills to his younger colleague in the field, Robert Laslett, which attempts to define and summarise a lifetime’s understanding of the essence of a therapeutic environment. This raises concepts and issues of relevance to current theory and practice in therapeutic environments.

The authors contextualise the 1977 letter from David Wills before presenting it verbatim, with clarifying annotations relating to people and events. They then analyse and discuss the fundamental arguments presented in the letter, with relevance to current thinking and practice.

The approach presented by David Wills to his younger colleague is deeply challenging to current concepts and understandings of therapeutic environments and the role in the therapeutic task of subjectivity and “attitude of mind”. The view is taken that this presents “a great question for wide debate, right now”.

Very little historical/analytical research has taken place into the experiences, thinking and practice of those who have built the diverse fields of therapeutic communities and environments, not least because history disturbs and challenges the present. This paper opens a small window on the vast resources which are available, and indicates something of the rich potential for debate and practical challenge Experts by Experience pose to living and, hopefully, learning practitioners to day.

Questions are raised: the debate they engender should eventuate into clearer, better grounded, more radical, and more effective practice.

This letter challenges assumptions about the role and nature of the “therapeutic attitude” and the place of subjectivity, with profound implications for the therapeutic enterprise itself, and the organisation of therapeutic environments, as well as policy, assessment and regulation regimes.

The use of previously unpublished archive material opens living questions to examination from a different perspective, widening the debate to include voices of expertise and experience which are generally, consciously or unconsciously, excluded from it. Presenting the letter in its whole, and not excerpted as supporting evidence, allows the voice of expertise by experience to contribute directly to discussion and debate; unbalancing and enriching it.

Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help Ourselves (WHOS) organization. Supported reduction of OST and stabilization services for those remaining on OST are offered to this population and continue to break down barriers of discrimination in offering the same services to all drug using populations. The paper aims to discuss these issues.

A number of research projects have been undertaken with the WHOS Opioid Treatment Program (OTP) TC services profiling clients accessing the services; looking at health benefits whilst in the programs; looking at retention and completion rates and conducting an evaluation post-treatment for one of the two programs currently being offered.

The excerpts from the research findings are presented identifying the complexity of individuals accessing WHOS services; highlighting the benefits for individuals on OST and assessing the effectiveness of the TC model for the client groups.

Working with multiple complex needs clients on OST in a residential TC environment offers many challenges and opportunity to work with an array of issues that present before during and after the residential stay. Provision of a history and overview of the WHOS OTP TC services and recent enhancements to these programs highlight a continuum of care for the individual on OST.

The Therapeutic Communities (TCs) movement tends to become from a revolutionary answer to the problem of addiction to another mainstream therapeutic proposal. The author considers that the crisis in 1968 in the seminal TC of Daytop was a pivotal event of this transition. This study aims to evaluate the impact of this historical crisis on the course of the TCs movement, assuming that, to enter into a constructive dialogue that can lead to the overcoming of today’s deadlocks of the movement, an awareness of the history is needed.

The present paper is a perspective/opinion paper and starts with a brief review of the origins of the first TCs for addicts. Emphasis is placed on their inevitable, according to the author, confrontation with the political and scientific status quo of that time. Then, it focuses on the period of the crisis in Daytop TC. The author interprets the events under a whole new scope, based on conversations he personally had with pioneers of that time, on his longstanding experience on the field, and the available literature.

The author attempts a historical and sociological analysis of the course of TCs and the Daytop TC. He concludes with a dispute of the prevailing idea that the Daytop crisis was a product of the confrontation between personal ambitions. He maintains that the collision that took place in Daytop TC was a confrontation between two antipodal perspectives over the notion of therapy. In any case, the subsequent estrangement of the movement from the groundbreaking attributes of the first TCs did not prove to be in the best interests of addicts; it was rather dictated by the need of the leaders of TCs to rescue their professional career.

The present paper attempts to offer a different view from the conventional reading of TCs’ history and their present situation for today’s predicaments of this proposal to be understood and possibly overcome.

Even though there is much information available with regard to the development of the therapeutic community (TC) for addictions in Europe, little is known about the particular situation in Denmark.The paper aims to discuss this issue.

In order to address this dearth, the methodology of the following historical account is largely based on an interview and personal contacts with Hanne Holm Hage-Ali, current director of TC Opbygningsgården and star witness of the development of TC in Denmark.

In 1971, the Freetown “Christiania”, Copenhagen, where TC Opbygningsgården started up, was based on communal, anarchic and hippie ideas and values. In the beginning, TC Opbygningsgården was not well accepted by TC pioneers promoting the classic hierarchical TC, as it was seen as a social experiment with anti-authoritarian roots. Later, in its turn, it became influenced by TCs Veksthuset and Phoenix House Haga, Norway, which were part of the common European TC movement. At this moment, TC Opbygningsgården functions as a well-accepted member of the European Federation of Therapeutic Communities.

The interview revealed information that it is line with current trends in and challenges for TC throughout Europe, as outlined in a recent EMCDDA study: TC in Europe can be considered as “children of the late sixties”; TCs are embedded in the anti-psychiatric movement, existentialism and the promotion of alternative community living; European TC leaders had different origins and professional background; and the TC never belonged to one religion or ideology. The common human value system always transcended the different visions.

This paper aims at addressing the dearth in knowledge on the development of TCs in Denmark.

Eric Broekaert passed away shortly after the XVIth European Working group on Drug-Oriented Research (EWODOR)-conference in Rome on 28 September 2016. He was one of the great TC pioneers in Europe, who founded the first TC for addictions in Belgium (De Kiem) and co-founded the European Federation of Therapeutic Communities and EWODOR. He was a respected Professor of “Orthopedagogics” at Ghent University and a Member of the Editorial Collective of Therapeutic Communities: the International Journal of Therapeutic Communities. The paper aims to discuss the overview of the career of Eric Broekaert.

In this obituary, the authors provide an overview of his career, major achievements and theoretical, methodological and integrative ideas, clustered around four typologies: university professor and scholar; manager and source of inspiration; TC pioneer and believer, and integrative thinker.

Besides his obvious merits as a TC researcher and advocate, one of his major theoretical contributions has been the introduction of the holistic, integrative approach and the idea that diverse types of interventions, as well as methodological approaches can alternatively go together.

He regarded TCs as the ultimate integration of various educational and therapeutic approaches to promote growth and quality of life among severely disadvantaged populations, such as drug addicts and children and adults with emotional and behavioural disorders.

Training in therapeutic community and related approaches has not been widely available, and there is debate about the form this should take. This has had a negative impact on the field. The paper aims to discuss this issue.

The authors consider the history of training in democratic therapeutic community methods in the UK in particular, and trace some of the reasons for its lack of development.

With the expansion of TC methodology into new areas, such as therapeutic and enabling environments, the ability to provide training in DTC approaches and techniques is increasingly important. The developing evidence base, and the increasing detail in which the method has been described, make dedicated TC training increasingly important.

Training in therapeutic community methods, and enabling and therapeutic environment approaches, provides a grounding in technique and theory that would otherwise be impossible to acquire for most workers, and can lead to a general increase in the level of competence and confidence in the way these environments operate.