Therapeutic Milieu

Individual’s environment within hospital or mental

facility is designed to be socially therapeutic
 MILIEU THERAPY
Introduction
• Milieu is the French word for “middle” – in
English translation, the word milieu means
“surroundings, or environment.”
• Milieu therapy is the treatment of mental
disorder or maladjustment by making substantial
changes in a patient's immediate life
circumstances and environment in a way that will
enhance the effectiveness of other forms of
therapy
 Definition

• A scientific structuring of the environment in

order to effect behavioral changes and to
improve the psychological health and
functioning of the individual (Skinner, 1979
 Basic assumptions:
Skinner outlined seven basic assumptions on which a
therapeutic community is based
1. The health in each individual is to be realized and
encouraged to grow
2. Every interaction is an opportunity for therapeutic
intervention
3. The client owns his or her own environment
4. Each client owns his or her behaviour
5. Peer pressure is a useful and a powerful tool
6. Inappropriate behaviors are dealt with as they occur
7. Restrictions and punishment are to be avoided
 Goals of milieu therapy:
 Manipulate the environment
 Client is expected to learn adaptive coping,
interaction and relationship skills that can be
generalized to other aspects of his or her life
 Achieving client autonomy
 Principles of milieu therapy
• To promote a fundamental respect for individuals
(both clients and staff).

• To use opportunities for communication between

client and staff for maximum therapeutic benefit.

• To encourage clients to act at a level equal to their

ability and to enhance their self
esteem( autonomy is reinforced)

• To promote socialization.

• To provide opportunities for clients to be part of

unit management
Characteristics of milieu therapy:
• Distribution of power
• Open communication
• Structured interactions
• Work- related activities.
• Community and family involvement in the
treatment process
• Adaptation of the environment to meet
developmental needs.
 Progressive levels of responsibility
according to client’s self care capacity
• Level I: Displays a destructive behavior to self,
others, or the environment.
• Level II: Does not display destructive behavior
• Level III: Attends All Therapeutic Activities
• Level IV: Takes an active role in assisting other
clients to gain level changes
 Programs within the milieu
• Client government
– Structured meeting
– Clients have inputs into all unit activities.
– May make decisions related to privileges for other clients.
– Discussion of the problems of everyday living
– Usually meets once per week.
• Work related activities:
– Work therapy
– Monetary reward
– Client should choose the type of work.
– Offer a variety of activities
 Advantages:
• The patient learns to make decisions which
improves his self confidence
• Milieu includes safe physical surroundings
• Safe space, a non punitive atmosphere,
which minimize the environmental stress
• Patient develops harmonious relationships
with other members of the community.
• Develops leadership skills.
• Becomes socio centric
 Disadvantages
• Role blurring between staff and patient.
• Group responsibility can easily become nobody’s
responsibility.
• Individual needs and concerns may not be met.
• Patient may find the transition to community
difficult.
• Milieu therapy is limited to only hospitalized
patients.
• Conflict resolution is needed as part of the staff’s
skills.
• Low client- to- staff ratio.