What Is Milieu Therapy And Why Is It Used?

Updated March 17, 2020

Medically Reviewed By: Melinda Santa

Milieu therapy is becoming more popular and important to mental health treatment as more people are being treated in their community rather than as inpatients in hospitals. Few people outside the mental health professions are aware of the name 'milieu therapy.' If you're in treatment for a mental condition, you may be familiar with it on an intuitive level. Finding out exactly what it is and why it's used can help you or your loved one get the most benefit from it.

What Is Milieu Therapy?

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Milieu therapy is a type of psychotherapy that seeks to control your environment to keep you safe, improve your ability to learn new mental health skills, and encourage attitudes like respect and positivity.

This therapy has been used in psychiatric hospitals, psychiatric wards in general hospitals, and group living situations for many years. In recent years, it's been adapted to assist people who are receiving psychiatric treatment within their home community as well.

Key Components Of Milieu Therapy

Milieu therapy is a very specific type of therapy that's carefully planned to provide the most benefit for the patient. It relies on several key components. The structure of the environment is typically well-ordered and complex enough to take your normal daily activities and interactions into account.

Power Is Distributed More Evenly

In treatment centers and hospitals that don't use milieu therapy, the power structure tends to put staff above patients in all or most respects. Certain patients may have more power, too, and some may not have a say in their treatment at all.

In milieu therapy, though, the power is as evenly distributed as possible. Each person can make decisions for themselves and be heard on group decisions.

Autonomy Is Encouraged

You're not only allowed to make your own decisions, but you're also encouraged to think for yourself and do things on your own. By encouraging autonomy, the staff prepares you for life outside the psychiatric institution or your structured environment.

Everyone Is Respected

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Long ago, people with mental conditions weren't respected even in the hospitals and treatment centers that were supposed to be helping them become mentally healthier. Those institutions didn't acknowledge each person's strengths. Neither did it recognize that the limitations they did have didn't make them less deserving of respect.

Milieu therapy is different in that it requires staff members to respect patients at all times and to encourage patients to treat each other with respect. Even when the patient is behaving inappropriately, the staff takes their needs into account while remembering that they deserve respect simply because they're human.

Building Trust Is Valued

In milieu therapy, the goal isn't to place you in a subservient position that requires you to put staff above you. Instead, you and the staff build trust in each other through appropriate behavior and open communications.

Interactions Are Structured For Consistency

When you're in milieu therapy, you might notice that the staff seems to have similar answers to similar questions. That's because the staff is trained to interact with you in specific ways. Rather than just 'winging it,' they already know what responses are usually going to help you the most.

Although structured interactions provide a secure environment, they aren't always specific enough to your needs to be very helpful. This can be one of the downsides of milieu therapy, but if the interaction training is well-structured enough to deal with individual difference, it's less of a problem.

Meeting Your Needs Is The Primary Goal

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Staff members or mental health outreach workers put your needs first. It may seem obvious that mental health professionals should be focused on meeting your needs. The truth is that that isn't always true. If you're in an institution or going to a mental health treatment center that doesn't practice true milieu therapy, they may be more focused on the needs of the institution.

You Choose And Do Work To Meet Your Own Goals

A part of milieu therapy is interacting with your environment in productive ways. That may mean doing simple housekeeping chores while an inpatient or having a paying job in your community. Either way, you have a say in what job you do and what goals you want to pursue.

Ideally, Treatment Happens In Your Home Community

In the past, people were admitted to psychiatric hospitals and psych wards regardless of whether they were in crisis or not. These days, though, fewer people are admitted to hospitals and more people are treated in community mental health centers or hospital day programs. This gives the mental health professionals less control over your environment. However, they can still provide support and offer many of the other benefits of milieu therapy outside of the institution.

Structured Physical Environment

During any time that you spend in an institutional setting, your physical environment will be carefully structured for milieu therapy. This therapeutic model uses three different types of space:

  • Fixed feature space - the design of the building structure and all unmovable features of it.
  • Semi-fixed feature space -the objects like furniture and other moveable physical objects.
  • Informal space - interpersonal space that includes the physical distance between people who are interacting socially.

Family Interactions Encouraged

In the old days of psychiatric treatment, family members were discouraged from visiting or spending much time with the patient. Milieu therapy recognizes your family's importance in your life and their place in your natural milieu. By encouraging you and your family to spend time together during the treatment process, they again prepare you for life in your community.

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Four Levels Of Responsibility

In milieu therapy, you take on increasing responsibility for your care as your mental condition improves. If you're in a hospital or day hospital program, staff members expect you to take you to become more responsible as you progress through these four levels.

  1. You do some behavior that is self-destructive, hurts someone else, or damages your environment in some way. You're disoriented, unable to participate in group therapy and don't take care of your hygiene.
  2. You're not destructive. You're oriented as to time, place, and person. You do to at least one therapy session per day. You try to take care of your hygiene.
  3. You go to all your scheduled therapy sessions and begin to take charge of meeting your own goals.
  4. You're actively engaged in helping other patients progress through the first three levels.

Why Is Milieu Therapy Used?

Milieu therapy benefits both you and the staff who are there to help you. By building an environment where everyone feels respected and valued, this type of therapy makes solving problems more relaxed, natural, and ultimately, doable.

Provides A Safe, Secure, Homelike Environment

The physical environment is structured to provide the maximum personal safety for each person in the environment. Because the system is well-ordered, you feel secure in knowing how things will go, that your needs will be listened to and addressed and that you'll be respected as a human person.

The environment is structured in a way that's as close to a healthy home environment as possible. This not only makes you feel more comfortable, but it also gives you many opportunities to work out your usual problems in the type of environment where they usually occur.

Acknowledges Your Human Rights In An Institutional Setting

It's common to feel different from others when you have a mental condition. Milieu therapy recognizes that you are indeed an individual with your strengths and limitations, but that so is everyone. Even if you're in a psychiatric hospital or day program, you always have human rights. Staff is trained to show you respect and encourage you and others in the program to treat each other the same way.

Brings Value To Each Interaction With Staff

When milieu therapy is used, you can potentially benefit from every interaction with staff members. Although not all staff is trained in therapy, the structured interactions are designed to give you something valuable you can learn, experience, or accomplish.

Promotes Open Communication

Milieu therapy works best when you feel comfortable communicating openly in group therapy sessions and, in fact, in all your daily interactions. This can only happen when the other components of milieu therapy succeed in helping you feel safe, secure, comfortable, and respected. The benefit here is that the more open you can be during treatment, the more effectively you can address the problems that brought you into therapy.

Getting help for a mental condition doesn't mean you need to give up your human dignity or personal control. If you or a loved one needs help resolving problems and becoming mentally healthier, therapy is available wherever you are, whenever fits with your schedule.

You can find counselors to help you deal with whatever environment you find yourself in and whatever situations you face. You can talk to a licensed counselor through Regain.us to learn skills that can improve your mental health and relationships and set you on a better life course.


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