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Frequently Asked Questions and Misconceptions

1. I have heard TCs are anti-psychiatry and are run by hippies, is that true? 

…TCs did get themselves a bad name in the 1960s for being part of the antipsychiatry movement, they often attracted people who were opposed to the use of medication for mental illness and wanted to adopt more radical approaches to caring for people and allowing freedom of expression. Modern TCs are mostly staffed by fully qualified doctors, nurses, psychologists, and other mental health professionals, as well as social therapists, trainees and others. It may be true that they are more independent-minded and less willing to be told what to do without thinking about it, than staff in more structured roles. But if they did not believe in a high order of team work, and respecting people for themselves, they would not survive for long.

2. Therapeutic Communities are cults?

…This is not the case, all TCs only accept people who choose to come to them and coercion is not used at any point, people always have the right to leave the TC at any time. Nearly all TCs now have professional visitors’ days, they allow others in to discuss how they are practicing, and many of them publish articles in scientific and academic journals to describe and evaluate their work.  The Community of Communities sets standards for TCs and some are accredited by the Royal College of Psychiatrists.

3. Is there any evidence to show that they work?

…TCs have been undertaking and publishing qualitative and descriptive work since before the Second World War, and ATC is in the 29th year of publishing the ‘International Journal of Therapeutic Communities’. However, modern requirements of ‘evidence based practice’ now demand experimental quantitative designs to gain recognition, and these are fraught with problems in systems as complex as TCs. However, there is a substantial body of other types of outcome research showing positive results, and high quality randomised trials are being planned.

4. People undergo ritual humiliation when they join, and then a new member has to tell everybody else all their most intimate secrets

…TCs do have rituals, and some are concerned with joining, but if their intention was to humiliate – or if humiliation was inadvertently allowed to happen – they would not meet standards required of staff sensitivity, training or supervision. Members often do reveal painful and intimate details about their lives, but only when they have established enough trust to be able to do so safely. However, some of the original ‘Concept TC’ practices were very confrontative and possibly humiliating, but these were large American TCs for treating addicts, and modern practice has moved on a long way.

5. If the TC tolerates all sorts of behaviour, are they violent places?

…In most TCs, there is a ‘no harm to others’ rule in place – and it is very unusual for it to be broken. All forms of self-harm are also strongly discouraged and people for whom it has been a problem usually do it much less when in a TC. Rigorous research has shown that prison TCs have much lower occurrence of violent incidents than other prison wings. Any unacceptable behaviour is soon challenged by somebody’s peers, and learning about ‘boundaries’ of what is respectful to others is often a major part of the work.

6. Are TCs all residential?

…Many TCs are still residential but is becoming less so in the NHS. Tighter economic times have meant that many TCs now operate a Day TC model (meeting for three or more days per week), or even a Mini TC model (meeting for less than three days per week). Although this might not be safe enough for some who do need the full intensity of a residential programme, it has the advantage of being better integrated into somebody’s ‘normal life’.

7. It’s an ‘easy option’ for people – being mollycoddled and just sitting in groups all day

…people who have been in TCs would strongly disagree! Common things said about being in a therapeutic community are ‘There’s no place to hide’; ‘I go home utterly exhausted every day and just collapse’ and ‘It’s the hardest thing I’ve ever done’. If TCs were physical activities instead of emotional and mental, it would be the equivalent of being in a gym for several hours every day. And physical activities, such as playful team sport, horticulture, and walks, are often part of the programmes, although less so for the day programmes in urban areas which do not have access to the space for them.

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