Therapeutic communities recently celebrated 40 years since the birth of the Association of Therapeutic Communities (ATC) with round table discussions held last month at the University of Nottingham. The focus for the event was ‘Re-birth in a time of austerity,’ specifically reflecting on the past 40 years and discussing what the future may hold for TCs when the ATC is re-launched in a new guise later this year.
The day covered several topics including leadership and charisma, research, management and organisation, publishing, staffing and education. Yet the big question on everyone’s mind was the future of TCs. As Nick Manning recently noted in his post, TCs have not made the impact that they perhaps could have done. With the closure of some TCs, the threat of closure for others and the continual challenges for NHS TCs, the future is looking uncertain at best.
During the celebratory event, the point was made near the end of the day that it is unlikely that TCs will ever truly fade away. Much like the performing arts and theatre, which continuously face hardships and funding crises, TCs will simply keep forming and reforming. I tend to agree with this argument, not least because TCs are about people and the quality of relationships.
Therapeutic communities aim to provide a safe environment whereby troubling relational patterns can be explored, often reprising the dynamics found in family relationships (Jones 1976). By using a variety of therapeutic approaches, an unhelpful social reality can be challenged, reconstructed and ultimately transformed. TCs employ interpretive techniques from both staff and user community members to help the latter learn a healthier way of relating in their own social world. Thus social interactions and relationships are at the core of the therapeutic work that occurs within TCs.
Middleton et al (2011) argue that supportive relationships during a therapeutic programme are valued most by service users and are the most influential in terms of recovery. Qualities such as feeling ‘safe’, ‘understood’ and ‘accepted’ are of paramount importance to people receiving care. Incidentally, these are also some of the core principles upon which TCs are based (Haigh 1999).
In determining where money should be spent however, funding commissioners are interested in value for money and whether or not a treatment is effective. Whilst there is research to demonstrate the effectiveness for specific therapeutic approaches such as cognitive behavioural therapy, Pilgrim et al (2009) writes that is the quality of relationships that ‘consistently predicts outcome, independent of the espoused model or condition being treated’ (244). This is good news for TCs who place such a high value on helping individuals establish a healthier sense of self-identity and social relationships. Yet it is hard to justify value for money when the relational approach favoured by TCs does not lend itself easily to the operationalised frameworks required by healthcare commissioners and funding bodies (Morant and Manning 2005). There are no simple solutions to these funding challenges facing TCs.
The future for TCs may look uncertain. However, the importance of relationships in the human experience will never be diminished. As individuals and relationships are at the heart of TCs, perhaps, in some form or another, they will never truly fade away. So the question then remains, what will the next 40 years bring?
ESRC PhD Student (Sociology)
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health and mental health. New York: Human Sciences Press.
Morant, N. and Manning, N. (2005). Principles and Practices in Therapeutic
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Middleton, H., Shaw, R., Collier, R., Purser, A. and Ferguson, B. (2011). The Dodo
Bird Verdict and the Elephant in the Room: a service-user led investigation of
crisis resolution and home treatment. Health Sociology Review, 20(2), 147-156.
Pilgrim, D., Rogers, A. and Bentall, R. (2009). The Centrality of Personal
Relationships in the Creation and Amelioration Mental Health Problems: the
current interdisciplinary case. Health: an interdisciplinary journal for the social
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