Democratic TC — MRCPsych Paper B MCQ

Correct answer: D — Members and staff share decisions and responsibilities within a relatively flat hierarchy

The correct answer is D. A democratic therapeutic community uses the social environment and group relationships as the therapeutic medium. Members participate with staff in community meetings, day-to-day decisions and shared responsibilities; hierarchy is deliberately reduced, and mutual feedback helps members understand the interpersonal effects of their behaviour. A token economy is a staff-directed behavioural reinforcement system and is not the defining democratic principle. Individually delivered formulation-based therapy may occur alongside other interventions but does not characterise a therapeutic community. A day hospital is a service setting rather than a treatment model and could be either democratic or clinician led. A crisis house primarily provides short-term community-based crisis support and is likewise not defined by shared governance.

Reference: Royal College of Psychiatrists, Community of Communities: 10th Edition Service Standards for Therapeutic Communities, Core Standards 1.3–1.10, 2024. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/therapeutic-communities-c-of-c/cofc-10th-edition-service-standards-for-therapeutic-communities.pdf?sfvrsn=fafe84ad_3