The next therapeutic community: autocracy, and other notes toward integrating old and new therapeutic communities

Purpose - This paper aims to provide a comparison of "old" democratic therapeutic communities, and "new" therapeutic communities for drug abuse.Design methodology approach - The paper is a review of historical and cultural influences on therapeutic community development, with particular reference to leadership.Findings - Free from bias, cultural, psychological or ideological, the next therapeutic communities should integrate elements of both old and new therapeutic communities, in a development strategy which assimilates, socializes and finally prepares the individual for full participation in the larger community. Within this strategy, a rational authority model is not inherently flawed but can provide a structured stage for corrective experience leading toward personal autonomy. Regardless of its particular form, however, the efficacy of the next therapeutic community will relate directly to the extent to which they incorporate the essential of its modern and ancient prototypes, that of community and healer and teacher.Originality value - The two main types of therapeutic community have tended to operate and develop separately. The author calls the rigid separation into question and identifies key shared elements.