Therapeutic Communities

Although the model of drug misuse treatment called the “therapeutic community” (TC) traces its American roots to Synanon, it has quite an ancient pedigree. At the dawn of the Christian era, Philo Judaeus wrote of com-munitae therapeutrides, the art of which was to “heal the souls which are under the mastery of terrible… incurable diseases of pleasures and appetites….”

Thus, it appears that the struggle with uncontrolled appetite was a challenge then, as it is now, and the ancients embraced similar principles to ensure spiritual health. These principles have been present in mutual help communities from early monastic splinter groups to the much later Methodist congregations that espoused a “return to first principles” and morphed into the early Oxford movement. They can be summarized as follows:

• Concern for the state of our soul and our physical survival
• Search for meaning: transcending truths
• Challenge and admonish with love
• Be invasive—accountable to the community
• Public disclosure of acts, fears, hopes, guilt
• Public expiation for wrongs done
• Banishment is possible—done with concern for survival
• Leadership by elders—by models

In the 17th and 18th centuries, religion-based mutual help societies emerged in Western Europe. [Page 936]Responding to the widespread overuse of alcohol, they launched temperance efforts in Europe that spread to America. Many of these early attempts at “appetite control” included temporary residential support and pledges of abstinence. Key principles embraced by these mutual help groups, including disclosure (confession), admonition, commitment, and conversion of others, spread and, by the 1800s, influenced development of the Oxford Groups.

The term therapeutic community, however, does not reemerge until World War II. At Northfield Hospital in England, a facility dedicated to the treatment of traumatized United Kingdom troops, two psychiatric innovators, Maxwell Jones and Tom Maine, sought to reapportion authority and decision making between staff and patients. They called their effort a “therapeutic community,” and “patients” in their psychiatric units became the active decision makers, taking on increasing responsibility for ward management. Early discussions among these pioneers resulted in five basic assumptions: (1) two-way communication at all levels; (2) decision making at all levels; (3) shared leadership; (4) consensus in decision making; and (5) social learning by social interaction with emphasis on the here and now. This horizontal, open system of communication was itself assumed to result in healing, eliminating the need for individualized treatment plans. This notion would later become doctrine in U.S. drug treatment TCs.

But the drug treatment TC was not introduced by any of the nurses or psychiatrists who, inspired by Jones, sought to develop similar models. It emerged in Venice Beach, California, in 1959, when an Alcoholics Anonymous member, Charles Dederich, began an organization called Synanon, embodying the mutual help principles of AA and characterized by hierarchical structure, a semi-open communication system, small-group encounters focusing on behavior change, and encouraging members or residents to become leaders. This clear progenitor of what later became known as TCs enjoyed early success working with heroin users, but it is best known for its slow decline into a controversial cult.

The next major residential community to utilize similar techniques for drug treatment was Daytop Village, established in New York in 1963. While adopting the treatment strategies of Synanon, this organization rejected that group's notion of becoming an alternative, Utopian community, referring to itself originally as a “humanizing community.”

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