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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.

There has been growing attention given to the concept of social climate as an element of prison practice. Research has indicated that more positive social climates can improve safety, psychological well-being, quality of life and contribute towards reduced reoffending. The purpose of this paper is to consider how the more positive social climates found in democratic therapeutic communities are constructed and how these practices can be replicated in other settings.

This paper adopts a reflective practice approach. The intention is to look back at the concept of social climate in prisons and in particular within a prison-based democratic therapeutic community (DTC); draw upon research and theory in order to critically evaluate the nature and effectiveness of that social climate, and; draw wider lessons about the nurturing and maintenance of social climates that may have broader relevance in prisons.

It is concluded that understanding and managing social climate is an essential aspect of improving the safety and effectiveness of prisons. Developing practices that enhance social climate requires looking beyond mainstream prison practices, towards niches such as specialist units and prisons, including DTCs and other therapeutic communities, and psychologically informed environments, as well as looking at practices in other settings including forensic mental health. Taking this wider perspective can be source of ideas and practice that could inform a profound culture change.

The paper offers an attempt to understand the distinct practices that create a more positive social climate in DTCs and consider how elements of this could be exported to other prisons. This has implications for both penal theory and practice.

The aim of this research is to gain an insight into the attitudes that therapists, both qualified and trainee, have towards the use of artificial intelligence (AI)/machine therapy in therapeutic practice. The paper also aims to gain an insight into attitudes towards machine therapy and the potential of developing a therapeutic alliance with a machine therapist.

A short questionnaire was developed to gauge therapists and trainee therapists’ attitudes towards machine therapy. The questionnaire included a scenario for participants to read and then respond to questions on the therapeutic alliance using questions based upon those asked on the working alliance short inventory scale. At the end of the questionnaire, there was also the opportunity for participants to respond to an open-ended question.

It is evident from the responses that there is a clear reservation about the use of AI technology within the therapeutic setting. In spite of this reticence, many participants recognised the potential and are open to the possibilities this technology can bring. It was notable that the therapists largest concern was about the potential to create a strong bond with a machine therapist.

This paper presents findings on therapists’ attitudes towards AI use within therapeutic practice and machine therapy. Whilst limited in scope, it provides a yardstick for considering the way that attitudes towards these emerging technologies might change in the future.

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.

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 present results achieved by the first, and to date only, Democratic Therapeutic Communities (DTC) quality improvement program developed in Italy, in the past 10 years, named “Visiting DTC Project.” Process of bottom-up identification, definition and evaluation of good practices of TCs for adult users with long term severe mental disorders will be described. In addition, a five-phase clinical care pathway will be presented for the same user category, developed by the “Visiting DTC Project” to comply with Italian National Health Service accreditation standards for TCs.

“Visiting DTC Project” involved 40 Italian TCs, since 2012 until 2020, in an action research on good practices developed throw a democratic and bottom-up methodology. Project’s methodology is the “Democratic Peer-to-peer Accreditation,” a kind of professional scientific quality accreditation and continuous improvement process for community mental health services. Scientific model for the definition of service standards and principles of treatment is the British “Democratic Therapeutic Community,” which the “Visiting DTC Project” is organizationally inspired by.

In the eighth annual cycle of the program for TC with adult users of mental health services a significantly effective good practice procedure (GPP), with good practical efficacy, was finally identified (for the first time after eight years), but still no best practice. GPP with the title “Multi-family Community Meeting” is the Good Practice of the year 2020. No Best Practice has yet been identified. An integrated clinical care pathway for Adult DTCs Users in five phases is also presented. This care pathway organizes advanced standards of Community Group Quality in a map, to support the description and planning of the five phases of the user’s clinical work in DTC treatment.

Cooperation with local community services, organizations and networks, as well as a therapeutic environment based on informal coexistence and cooperation between TC members, are thus, together with care of family relationships, the main characteristics of the Italian experience of implementing and developing the Italian DTC treatment model. These characteristics make it clear how fragile Italian DTCs are at this moment. They are still in an early stage of development. All the most applied and effective best practice procedures are dependent on a wide and dense network of relationships, formal and informal, which cross the therapeutic environment and interconnect TC members with all other stakeholders.

This study aims to raise awareness of the importance of the sociological aspects of therapeutic community work, including clarity about the nature of the task, the power of informal interactions between participants and the relevance of leadership.

Applying insights from historical research to present-day practice.

The Northfield experiments offer a number of insights into present-day practice of therapeutic communities and enabling environments. These include clarity about the task, the relevance of participant interactions outside of specifically therapeutic work and the importance of leadership.

The therapeutic community/enabling environments approach has relevance to a wider sector of society than solely the therapeutic. More attention needs to be paid to leadership issues in the therapeutic community movement, as well as the therapeutic power of the mutual support networks amongst those receiving care.

Through the lens of the Northfield experiments, this paper offers a broadening of the sociological nature of therapeutic community practice, arguing that the purpose is to enable greater social adaptability, thereby enhancing relationships and deepening our awareness of ourselves. Implicit in this perspective is the recognition of the power of non-formal interrelationships in the service as well as the importance of leadership. It is also suggested that our experience in this way of working has a value in other organisations such as work places or schools. However, to achieve this, we need to adapt our language appropriately.

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.

Recent ethnographic research has examined the forces that shape the working lives of prison managers, in particular, the growth of managerialism, pushing in from the outside and the deeply rooted local cultures that exist within. The purpose of this paper is to reconsider the interplay of these forces in the context of a therapeutic community (TC) prison.

This paper draws upon ethnographic research conducted in two prisons and expands this using an autoethnographic approach to examine the experience of governing a TC prison.

The original study described how the dynamic interaction of globalised change and local culture created gave rise to “prison managerialism”. This notion reflects the negotiation between the global managerialism and local occupational culture. This concept is equally relevant in a TC prison, albeit it exists in an altered form reflecting the distinct characteristics of the local culture.

The approach builds upon an ethnographic study, expanding this through autoethnography. This inevitably limits the scope and perspective as it is looking at a specific context. It nevertheless highlights the distinctive challenges of managing a TC prison.

The work has implications for the management of TC prisons in practice, including human resource management such as recruitment, selection, appraisal and development of those managers.

The paper applies and revisits a recent in-depth study of prison managers, re-imagining and revising this to reflect the distinct context of managing a TC prison.