Therapeutic Community: Past. Present. And Moving Forward

Dr. Perfas provides an intriguing account of the history, dispersion, and evolution of the therapeutic community (TC). His discussion of the TC’s transformations, which he refers to as hybridization, is insightful. He cautions, however, practitioners of the perils of the TC culture beginning to drift farther and farther from its fundamental principles as it is adopted and adapted in different settings. The delineation of the TC’s practice principles provides guidelines for keeping the TC true to its substance while variations of its form are taking place. The issues involved in integrating evidence-based practices into the TC are discussed while underscoring the importance of keeping the fidelity to TC practice. His description of a bi-modal TC comprised of a social system and a treatment model, offers a fresh perspective for understanding the workings of the TC and designing outcome studies. Grounding the TC on psychological theories is an important step for moving the TC forward into the future. He explains how the principles of attachment theory can enrich the theoretical base of the TC model and reinforce its relevance in the treatment of addictive disorders.