MILIEU THERAPY

INTRODUCTION

The word milieu is French for "middle." The English translation of the word is
"surroundings, or environment." In psychiatry, therapy involving the milieu, or environment,
may be called milieu therapy, therapeutic community, or therapeutic environment.

MILIEU THERAPY

A scientific structuring of the environment in order to effect behavioural changes and to improve
the psychological health and functioning of the individual (Skinner, 1979).

CONCEPT OF MILIEU THERAPY

A therapeutic milieu is a 24 hour environment designed to provide a secure retreat for

individuals whose capacities for coping with reality have deteriorated. The therapeutic milieu
gives them opportunities to acquire adaptive coping skills. By offering secure, comfortable
physical facilities for sleeping, dinning, bathing, and engaging in recreational, occupational,
social, psychiatric and medical therapies.

GOAL

The goal of milieu therapy is to manipulate the environment so that all aspects of the client's
hospital experience are considered therapeutic. Within this therapeutic community setting the
client is expected to learn adaptive coping, interaction, and relationship skills that can be
generalized to other aspects of his or her life.

FUNCTIONS OF MILIEU THERAPY

1. Shelters clients physically from what they perceive as painful, terrifying stressors.

2. Protects clients physically from discharges of their own and others maladaptive behaviours

3. Supports the physiological existence of clients.

4. Provides pleasant, attractive, sensory stimulation to clients.

5. Educates clients and their families about adaptive, effective coping.

CHARACTERISTICS OF A THERAPEUTIC MILIEU/ELEMENTS OF MILIEU
THERAPY

1. INDIVIDUAL TREATMENT PROGRAM

A therapeutic milieu is tailored to the client's individual needs without infringing on the
needs and rights of other clients. A definite structure, schedule, overall guidelines and
social controls are set forth to provide organization and predictability.
2. SELF-GOVERANCE
To avoid the cultivation of dependence and regression, the clients are encouraged to
participate in decision making regarding milieu issues. Structured community meetings
client-team meetings and client-team committee meetings held at regular scheduled
intervals to help the client to find opportunities to develop decision making skills.
3. PROGRESSIVE LEVELS OF RESPONSIBILITY
Clients are expected to assume a responsible role in the maintenance of the environment.
The degree of responsibility expected of clients is depending upon their capabilities. This
approach is a form of behaviour modification in that it rewards and reinforces adaptive
behaviour.
4. A VARIETY OF MEANINGFUL ACTIVITIES
To minimize social withdrawal and regression, therapeutic milicu must provide cach
client with an individual activity schedule. Such activities may include structured
exercise classes, jogging, training, arts, crafts, relaxation training and stress management
classes and occupational therapies.
5. LINKS WITH THE CLIENT'S FAMILY
Therapeutic milieu provides opportunities for clients to re-enter the mainstream of
family life at their own pace. Links with the family is accomplished in several ways.
Family visits and family counselling are carried out.
6. LINKS WITH COMMUNITY
Activities occurring outside the structured milieu such as shopping, trips, picnics,
camping trips. attending movies and plays serve to link clients to community
7. EFFECTIVE WORKING RELATIONSHIPS AMONG MENTAL HEALTH TEAM
MEMBERS
 Interpersonal conflict occasionally occurs in any group of people. When mental health
team members can engage in effective conflicts resolution, they are more likely to trust
other and to act an interact as a mental health team.
8. HUMANISTIC MENTAL HEALTH TEAM MEMBERS
They should possess;
 Optimistic attitudes toward people in general
 The ability to inspire hopefulness in clients.
 Creativity in working toward more effective ways of involving clients in the
environment
 Lack of fear or prejudice
 Ability to set limits
 Willingness to share control and decision making

COMPONENTS OF A THERAPEUTIC MILIEU

Comfortable, secure physical facilities, the mental health team and the therapeutic milieu
program are the three essential components of a therapeutic milieu.

MILIEU THERAPY APPROACH

It is a group therapy approach that uses a total living experience- recreational,

occupational, psychosocial, psychiatric, nursing, plus mental health team-client relationships-to
accomplish therapeutic objectives, which includes:

 Correct or re-define their perceptions of stressors

 Correct maladaptive coping behavioural patterns
 Develop adaptive coping behavioural patterns
 Acquire interpersonal and stress management skills in order to conduct themselves more
effectively in the environment and strengthen or correct their coping abilities.

ROLE OF NURSE IN MILIEU THERAPY

 Use nursing process to provide comprehensive care

 Provide direct client care
 Manages the day to day care of individual clients
 Assists the client for re-entry into the community
 Administer medication and give medication teaching
 Provides psychosocial care
 Uses informal group interventions such as community meetings
 Conduct brief on the spot counselling with clients and families.
 Set limits to deal with behaviours destructive to the self, others or the environment
 Help the clients use their time productively for leisure an work
 Involves withdrawn patients in the milieu
 Encourages client who have low self esteem to value themselves
 Serve as the role model
 Provide mental health teaching.
 Encourages clients to help and support each other individually and as a group
 Assists to understand each other's feelings
 Conduct community meetings
 Participate freely in milieu activities.