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This paper seeks to provide a history and a prehistory of the therapeutic community movement, and a series of questions still debated in the field.

The paper discusses the factors which favour the creation of therapeutic communities, drawing on Winnicott's views on democracy and the history of therapeutic community innovations. Some key factors are identified and their implications discussed.

The paper suggests that the therapeutic community impulse takes root where a number of individuals, with what Winnicott has called the “democratic tendency”, come together in response to a community's need for psychological care and support, and this can happen anywhere.

The paper offers a history and a prehistory of the therapeutic community movement, and draws out some of the implications for the future development of therapeutic communities and the nurturing of the therapeutic community impulse.

The developing generic market has huge advantages of availability and affordability of therapy. The question of whether a therapeutic equivalent substitute under an unfamiliar name may cause confusion that leads to medical errors has not been sufficiently studied. This paper seeks to answer this question.

The study was triggered following sporadic reports according to which patients mistakenly consider therapeutic equivalents as unrelated medications rather than substitutes. Family physicians and pharmacists in one of eight districts of Clalit, Israel's largest healthcare provider were surveyed. The survey's questions recall episodes of medication uncertainty, confusion, misidentification, and medication mistakes associated with switching from one therapeutic equivalent to another. A total of 66 physicians and 63 pharmacists responded to the surveys (61 percent and 45 percent, respectively).

The results recall uncertainty, confusion, misidentification, and mainly cases of medication mistakes in which patients consumed both therapeutic equivalents simultaneously as was reported by 81 percent of physicians and 70 percent of pharmacists.

There are two limitations in this work, the first is the study type, which is recall survey; the second is the response rate which is not unusual among health care professionals. However, the high face‐validity and the consistency of the findings in both physicians and pharmacists surveyed indicates high validity of the study conclusions.

A practical implication is unique medication error of consuming both therapeutic equivalents simultaneously. The authors wish to raise awareness of the potential of such error, which may be difficult to disclose as each of the therapeutic equivalents is apparently the intended medication but consuming them simultaneously results practically in doubling the intended dose. Given the forecast for generic market growth, awareness is not enough and worldwide regulatory cooperation should be made otherwise these types of medication errors will inevitably emerge.

The study is original as a literature search revealed no studies evaluating potential medication mistakes attributed to a switch between therapeutic equivalents.

Therapeutic landscapes can be beneficial for patients recovering from cognitive and behavioural impairments. The therapeutic garden in the Royal Talbot rehabilitation centre (RTRC) located in Kew, Melbourne is a precedent for its nature design outdoor spaces and horticultural therapy (HT) program for patients with cognitive impairments due to brain and spinal cord injuries. There have been no studies into the physical design of the RTRC therapeutic garden.

This case study unveils the critical design themes, and dominant physical elements of the RTRC therapeutic garden through site observation and analysis over the course of two months, a semi-structured interview with a key staff, and graphical representations using integrated photography and collaborative digital tools of AutoCAD and Adobe Photoshop.

Seven critical design themes are identified for the RTRC garden: (1) space layout and organization, (2) physical and visual access, (3) pathway and facility, (4) multisensory vegetation, (5) amenity, wayfinding and seasonal interest, (6) cognitive stimulation, (7) utility and HT. Qualitative and quantitative data analysed in visual and descriptive format reveal multisensory vegetation, amenity, wayfinding and seasonal interest, and utility and HT are the top three most pivotal critical design themes in the RTRC therapeutic garden.

The findings of this case study can be used to impart knowledge about the design of therapeutic landscape settings for cognitive impairments to design professionals and the public.

There is no case study has been conducted for this precedent of therapeutic garden in the Royal Talbot rehabilitation centre that targets for cognitive impairment patients. With the increasing awareness in medical and healthcare environments, this case study would help to inject mutual understanding, generate knowledge and design awareness among design professionals and public, and to cultivate more good quality healthcare settings.

To assess the quality of anticoagulation control at an out‐patient clinic and to investigate patterns of deviation from therapeutic ranges.

Records for 36,157 clinic visits (2,050 patients) were studied. The quality of anticoagulation control was assessed by comparing the measurement of pro‐thrombin time recorded at each clinic visit, expressed as an international normalised ratio (INR), with the target therapeutic range for that patient, also recorded at the time of the clinic visit. Each INR measurement was classified according to the relevant patient's therapeutic range and the signed difference between the INR measurement and the centre of the therapeutic range was calculated. For each patient the percentage of their INR measurements that lay within their therapeutic range was calculated.

Of the measurements, 52.3 per cent were within the relevant therapeutic range. The proportion of individual patients' INR measurements within range varied greatly (median 52 per cent, inter‐quartile range 40‐65 per cent). The quality of anticoagulation control, as measured by the proportion of patients within their therapeutic range, changed little with patient follow‐up time.

The quality of anticoagulation control reported is comparable with that at other centres. The vast majority of patients spend periods outside the therapeutic range for their condition. There may be considerable room for improvement.

The Road to Wellville is a useful allegory to describe the consequences a therapeutic approach to Public Administration can have on citizen participation. A therapeutic approach assumes that the citizens in an administrative state, are sick, and therefore need intervention by the government to heal them, regardless of whether we want it or not. In The Road to Wellville, Kellogg, though well intentioned, relied on alternative, unconventional therapies to try to cure health problems. This paper uses The Road to Wellville to illustrate how public organizations that adopt a therapeutic approach can broadly undermine legitimacy

This study aims to describe Italian and UK therapeutic community developments during 1960–2021.

Historical review and personal experience.

After significant divergence in the nature of “therapeutic communities”, mostly based on the different sociopolitical contexts in the two countries, areas of formal rapprochement have been emerging in the past 20 years.

The details of how therapeutic communities developed in Italy, particularly in the wake of Law 180, deserves investigation and comparison to the UK and other countries.

The recent collaborative work in quality, training and research could support the future use of therapeutic communities and enabling environments.

The underlying principle of “relational practice”, which underlies the therapeutic community approach, could have wider implication in public services beyond mental health.

Much has been written about the progressive intentions of Italian mental health with Law 180, but not with a specific focus on therapeutic communities – which were an important initial impetus for Basaglia and his equipé.

This study aims to investigate whether the influence of group cohesion on the outcomes depended on the levels of the therapeutic alliance.

Sixteen individuals with a substance use disorder who were undergoing treatment in a therapeutic community responded to therapeutic alliance, group cohesion, craving and outcomes measures after every therapeutic small group session for a period of six weeks. Data analysis was performed using hierarchical linear modeling.

Results indicate that the effect of group cohesion is stronger when there is a high therapeutic alliance between resident and therapist.

Even on group interventions, to enhance group cohesion effects on outcomes, therapists must foster higher therapeutic alliance levels. The findings point out the importance of studying the effect of common factors on outcomes.

The purpose of this paper is to provide an overview of a Learning Programme designed around the animation film-making process, contextualising abstract concepts to address the cognitive limitations of children with foetal alcohol spectrum disorders (FASD).

Animation production is tactile, multimodal and multisensory which allows for wide application alongside traditional learning tools, targeting multiple learning pathways with its visual, auditory and kinaesthetic approach. Individuals with FASD require information to be explained in a concrete way to enable them to process and understand. Most information can be drawn, providing a visual to assist the individual, but we must also consider abstract concepts which require further explanation or a series of drawings to display the concepts development. Animation, however, allows us the opportunity to make abstract concepts concrete, contextualising the concept in a visualisation of the child’s story, narrated with their voice and designed to represent their world, in a film produced entirely by them, therefore allowing opportunity for a therapeutic approach to learning through storytelling. This learning tool is designed to be implemented in a specifically designed therapeutic learning environment to enhance the benefits of participation from both educational and therapeutic perspectives.

A review of relevant literature highlights a significant connection between animation, the learning needs of those with FASD and the need for a therapeutic learning environment. This is a proof of concept study, demonstrating the value and potential of animation film making in this new area of practical application. The study closely considers the learning environment from a therapeutic perspective and aims not only to develop a learning tool but to also define the optimum therapeutic learning environment. The study is therefore untested at this stage.

Phase 2 of this ongoing research study seeks to explore additional benefits of participation and engagement with the process in an educational and therapeutic context. Considerations of the therapeutic learning environment will be further explored to determine the optimum setting to support the ongoing learning of this pedagogically bereft (Carpenter, 2011) population. Phase 2 also aims to clarify therapeutic benefits as additional outcomes of participation in this programme.

The proposed learning tool and therapeutic learning environment outlined in this paper is an original contribution to knowledge and if found to be successful, could offer significant opportunities for a therapeutic approach to education for this population and others.

The purpose of this paper is to explore the social climate of therapeutic wings and mainstream wings within one prison, to identify positive areas of social climate that can be built upon and areas for improvement.

In total, 1,054 social climate questionnaires (the Essen Climate Evaluation Schema – EssenCES) were sent to prisoner-facing staff and all prisoners within an English Category B prison holding indeterminate sentenced prisoners. Perceptions of social climate on therapeutic wings and mainstream wings and perceptions of social climate between staff and prisoners were compared.

The results showed that the therapeutic wings felt safer, there were better staff-prisoner relationships and there was better peer support among prisoners than people on the mainstream wings. Also, prisoners felt safer than staff, staff rated the overall social climate as more positive than prisoners and staff felt that they supported prisoners, but prisoners did not feel the same.

The main limitation is that the EssenCES measure does not explain the participants’ ratings of the social climate.

There is a need to transfer the principles and values of therapeutic wings to mainstream wings. In addition, there is significant room for improvement in the social climate of this prison.

This is the first study to compare the social climate of therapeutic and mainstream wings within one single prison. The research has a valuable contribution to the development of positive social climates conducive to better clinical outcomes.

A better therapeutic alliance at the beginning of treatment for addictive behaviours has been found to prevent dropout. The purpose of this paper is to evaluate how the development of therapeutic alliance dimensions was associated with the dropout prevention.

A total of 23 participants presented a substance use disorder related to heroin or cocaine and were in three distinct treatment phases of a therapeutic community. Each participant filled in the therapeutic alliance measures once a week after mini-groups. A naturalistic prospective research design was used to collate 198 repeated alliance measures.

Participants who presented stable bond development at higher levels tended to stay in treatment, whereas those who developed stable bonds at lower levels tended to drop out. The goals and tasks dimension increased significantly across the phases and was not associated with dropout.

To prevent dropout, therapists should pay special attention to residents who manifest difficulties in establishing stable and secure bonds and not overestimate the impact of the goals and tasks alliance dimension, as it is not a failsafe indicator of treatment retention.

The alliance dimensions were differentiated (bond, goals and tasks) and studied throughout the treatment, pointing out the importance of therapeutic relationship dynamic variables to prevent dropout.