Therapeutic communities are not a ‘brand’ of therapy, with a manual and an uncomplicated evidence base. Rather, they are a treatment culture and structure into which other therapies are incorporated as intensive programmes of integrated sociotherapy. They have long and far-reaching historical roots, and share features with numerous psychological, social and educational approaches and movements (Box 19.1). Whichever specific therapies are integrated (Box 19.2), the predominant focus is the supportive and challenging network of relationships that exists between the members, both staff and service users. This is what Foulkes (1964), the founder of group analytic psychotherapy, termed the dynamic matrix.

The diffuse and complex nature of this core concept presents some difficulties for a mental health system that requires treatments to be managed with a degree of precision and predictability, to be measurable and auditable, and to be described in a straightforward, learnable way as in a manual. This is as true for the day-to-day hurly-burly of interpersonal interaction as it is for setting up a service, and it can cause therapeutic communities to be repeatedly pressured to ‘justify’ their therapeutic value.

However, new techniques, processes and guidelines are now available that help to deal with these necessary complexities, and this account will draw attention to them. It focuses on therapeutic communities for personality disorder, but it also considers their use for psychosis, addictions, offending behaviour, and emotional and conduct disorders in children and adolescents. Treatment cultures and structural features of different services are being increasingly recognised to be more alike than different (Haigh & Lees, 2008).