Therapeutic Communities: History, Effectiveness and Prospects

By Lipton, Douglas S. | Corrections Today, October 1998 | Go to article overview

Therapeutic Communities: History, Effectiveness and Prospects


Lipton, Douglas S., Corrections Today


50 Years After Its First Appearance, the TC Has Evolved Into a Successful Treatment Model

Seven out of every 10 men and eight out of every 10 women in the criminal justice system are drug users - persons who used illicit drugs with some regularity prior to entering the criminal justice system. The Federal Drug Use Forecasting system data show that the use of all drugs except cocaine has increased since 1989, and cocaine remains at the same level. Accordingly, the 1990s have seen major increases in arrests of drug users, followed by pressure for funds to expand correctional capacity to treat those inmates with serious drug problems. Interestingly, with this increase has come increased public support for programs aimed at treating drug users and curbing drug-related crime. There is a genuine public and government concern that without treatment, most drug-involved offenders will resume their criminal activities and drug use after release and inevitably will return to criminal justice system custody.

The 1994 Crime Bill included, for the first time, a substantial sum provided for treatment of inmates in state and local correctional systems. The Residential Substance Abuse Treatment for State Prisoners Formula Grant Program (abbreviated RSAT) legislation created an opportunity for states to apply for funds to establish residential substance abuse programs beginning in 1996. In conjunction with this legislation, Congress has authorized spending $270 million for the first five years of the program, the largest sum ever for the development and enhancement of substance abuse treatment programs in state and local correctional facilities.

Largely because of research showing that prison-based therapeutic community programs can significantly reduce recidivism and drug relapse, RSAT legislation encourages the development of this residential treatment model, in addition to other viable treatment approaches, including cognitive skills training, behavioral programming, vocational methods and even 12-step programming.

Therapeutic Communities

Historically, the term "therapeutic community" (TC) has been used for several different forms of treatment - sanctuaries, residential group homes and even special schools - and for several different conditions, including mental illness, drug abuse and alcoholism. For example, the British TC emerged primarily as a process for treating military veterans as they returned from WWII with serious neurotic conditions from their experiences in combat and as prisoners of war. The term was coined when Thomas Main pioneered a therapeutic model combining community therapy with ongoing psychoanalytic psychotherapy in 1946. This was a modification of therapeutic work developed about the same time by Maxwell Jones and several others. By 1954, TC ideas were influencing wards in British psychiatric hospitals.

At about the same time, the use of tranquilizers began to emerge as the dominant "treatment" for institutionalized, mentally disordered persons. Drastic reductions in psychiatric beds and other confinement beds occurred as facilities closed down. In the 1950s and 1960s, the TC movement shifted toward other milieus, notably corrections, and TC principles began to guide offender programs in the United Kingdom. Grendon Prison was built in 1959 specifically with a number of wings within which TCs would experimentally operate to provide treatment for psychologically disturbed offenders.

The British prison TCs operate within these principles:

* enfranchisement and empowerment, "wherein every community member has a direct say in every aspect of how the wing is run" (including the power to vote someone out for a rule breach);

* a philosophy of tolerance to allow members to make mistakes, and to accept themselves "with all their warts" and support each other "regardless of their warts";

* encouragement of individual and especially collective responsibility and accountability;

* continuous, direct and candid presentation of interpretations of one another's behavior to counteract any tendency to distort, deny or withdraw from interpersonal difficulties or rule breaking; and

* peer group influence, used to control and modify inimical prison cultural values with an important role for "community elders" - members who have successfully completed the transition themselves and who now play a supportive role. …

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