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Democratic Therapeutic Community — MRCPsych Paper B MCQ

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ModeratePersonality DisordersDemocratic Therapeutic CommunityMRCPsych Paper B

A 30-year-old woman with borderline personality disorder enters a residential programme in which everyday interactions are used therapeutically. Residents and staff jointly review community rules, residents share responsibility for running the programme, and behaviour is discussed openly through mutual feedback. Authority is distributed as equitably as possible, although staff retain their professional responsibilities. Which therapeutic model is described?

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Correct answer: B — Democratic therapeutic community

This is a **democratic therapeutic community**. Its defining mechanisms include participative decision-making, shared responsibility, an equitable or relatively non-hierarchical structure, communal living and open mutual feedback about interpersonal behaviour. Everyday events become opportunities for social learning. A concept-based therapeutic community, traditionally associated with addiction treatment, is more hierarchical and commonly uses staged progression, status, privileges and sanctions. A token economy specifically modifies behaviour using contingent rewards rather than democratic community processes. A day hospital describes the setting or intensity of attendance, not this therapeutic model, and a crisis house provides short-term residential support during a crisis rather than a structured long-term therapeutic community.

Reference: National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management, CG78, full guideline, section 5.8, Therapeutic Communities. Published 2009; guideline last reviewed 30 July 2024. https://www.nice.org.uk/guidance/cg78/evidence/bpd-full-guideline-242147197