The Value of Therapeutic Communities in the Treatment of Personality Disorder: A Suitable Place for Treatment?

Abstract

In the United Kingdom, a government program investigating the links between offending and personality disorder has stimulated renewed interest in the treatment of personality disorders. One psychosocial treatment option for patients with personality disorders is the therapeutic community (TC). In 2000, the authors conducted a small qualitative study with a sample of psychiatrists which suggested that TCs were not well understood and that the status of evidence on efficacy might be partly responsible for low referral numbers. This article reviews the evidence for the efficacy and cost-effectiveness of TCs as a treatment for personality disorders and considers which types of disorders are amenable to TC treatment. We conclude that there is a strong case for more rigorous evaluation and that some of the difficulties anticipated in applying randomized clinical trial (RCT) methodology to the study of TCs could be overcome.