An Exploration Into the Processes of Change in a Non-Residential "Fusion" Therapeutic Community

Therapeutic communities (TCs) have been a longstanding intervention for individuals with complex mental health needs; however, there remains a lack of research into how UK-based TCs work to support their members. Modifications to TCs include the merging of "concept" and "democratic" TC practices, producing a "fusion" model. The aim of this study was to explore processes of change that occur within a community-based, non-residential "fusion" TC across two community sites. This was done through exploring lived experiences of active members and graduates of an established and a newer TC site. Eleven participants took part in online or face-to-face interviews. Interviews were analyzed using interpretative phenomenological analysis. Three themes emerged from the analysis: (1) Exploring the Authentic Self: Encouraged and Supported in Showing Emotional Vulnerability Within the TC (subthemes: "Nowhere to Hide": Sharing With Others and Looking Back to Move Forward: Reflecting On Change and Self-Discovery); (2) Developing a Sense of Community: Learning to Navigate Relationships Within the TC (subthemes: "They seem to fit": Building Connection With Others and Unravelling the Clashes: Holding Space to Manage and Tolerate Conflict); and (3) "Me to We": The Lasting Benefits of the TC Co-Production Experience. Staff were integral in supporting change identified across all three themes. The findings highlight processes that could be implemented into existing TCs to support change for members and evolve the community structure. The study provides insights into how TC practice could be informed to accommodate the growing diversity of TC members and support staff development.