What Is Milieu Therapy And Why Is It Used?

Medically reviewed by Majesty Purvis, LCMHC
Updated April 8, 2024by Regain Editorial Team

Milieu therapy is a type of therapy in which the environment is often very controlled to provide the maximum benefit to patients. Patients tend to move through four levels of responsibility as they progress through this form of treatment. A few common components of milieu therapy can include evenly distributed power, encouraged autonomy, mutual respect and trust, consistent interactions, a focus on patients’ needs, a structured physical environment, and encouraged interaction with family. Milieu therapy often takes place in psychiatric hospitals, but can also be used in home environments. Another way to receive treatment from your home environment may be online therapy.

What is milieu therapy?

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Milieu therapy is a type of psychotherapy that generally controls your environment to keep you safe, improve your ability to learn new mental health skills, and encourage attitudes like respect and positivity. "Milieu” refers to a person’s social environment, and the goal of the approach is to provide a “therapeutic milieu” where a person can grow and adapt.

This therapy has often 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 receiving psychiatric treatment within their home community.

Key components of milieu therapy

Milieu therapy is a very specific type of therapy that's usually carefully planned to provide the most benefit for the patient. It typically relies on several key components. The environment's structure is generally 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 usually as evenly distributed as possible. In general, each person can make decisions for themselves and be heard on group decisions.

Autonomy is encouraged

In milieu therapy, you may not only be allowed to make your own decisions, but you're often also encouraged to think for yourself and do things on your own. By encouraging autonomy, the staff can prepare you for life outside the psychiatric institution or your structured environment.

Everyone is respected


Long ago, people with mental conditions weren't always respected, even in the hospitals and treatment centers that were supposed to be helping them become mentally healthier. Those institutions didn't always acknowledge each person's strengths. Nor did they always recognize that the limitations patients had didn't make them less deserving of respect.

Milieu therapy can be very different because it usually requires staff to respect patients and encourage them to treat each other respectfully. Even when the patient behaves inappropriately, the staff typically 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 usually to place you in a subservient position that requires you to put staff above you. Instead, you and the staff may build trust in each other through appropriate behavior and open communication.

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 usually trained to interact with you in specific ways. Rather than just 'winging it,' they often already know what responses are usually going to help you the most.

This can be one of the downsides of milieu therapy, but if the interaction training is well-structured enough to accommodate individual differences, it's usually less of a problem.

Meeting your needs is the primary goal

Staff workers or mental health outreach workers tend to put your needs first in milieu therapy. It may seem obvious that mental health professionals should be focused on meeting your needs. The truth is that isn't always the case. 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 institution's needs than individual patients’ needs.

You choose and do work to meet your own goals

A common part of milieu therapy can be interacting with your environment in productive ways. That may mean doing simple housekeeping chores or having a paying job in your community. Either way, you usually 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 often admitted to psychiatric hospitals and psych wards regardless of whether they were in crisis or not. These days, though, fewer people tend to be admitted to hospitals, and more people tend to be treated in community mental health centers or hospital day programs. This can give mental health professionals less control over their environment. However, they can still provide support and offer many other benefits of milieu therapy outside the institution.

Structured physical environment

During any time you spend in an institutional setting, your physical environment will usually be carefully structured for milieu therapy. This therapeutic model typically 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 can include the physical distance between people who are interacting socially.

Family interactions encouraged

In the old days of psychiatric treatment, families were frequently discouraged from visiting or spending much time with the patient. Milieu therapy tends to recognize 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 can prepare you for life in your community.

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Four levels of responsibility

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

  • You may do some self-destructive behavior, hurt someone else, or damage your environment in some way. You may be disoriented, unable to participate in group therapy, and don't take care of your hygiene.
  • You're generally not destructive. You're usually oriented as to time, place, and person. You typically go to at least one therapy session per day. You normally try to take care of your hygiene.
  • You tend to go to all your scheduled therapy sessions and begin to take charge of meeting your own goals.
  • You’re usually actively engaged in helping other patients progress through the first three levels.

Why is milieu therapy used?

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

The physical environment may be structured to provide maximum personal safety for each person in the environment. 

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

Acknowledges your human rights in an institutional setting

It can be common to feel different from others when you have a mental condition. Milieu therapy usually recognizes that you are indeed an individual with strengths and limitations. Even if you're in a psychiatric hospital or day program, you always have human rights. Staff is generally 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 may be trained in therapy, the structured interactions are generally designed to give you something valuable you can learn, experience, or accomplish.

Promotes open communication

Milieu therapy tends to work best when you feel comfortable communicating openly in group therapy sessions and all your daily interactions. The benefit here can be that the more open you are during treatment, the more effectively you can address the problems that brought you into therapy.

Another option: Online therapy

Getting help for a mental condition doesn't necessarily 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 may be available wherever you are, whenever it fits with your schedule, through an online therapy platform.

Online therapy can be as effective as traditional in-person therapy, according to this study. If you feel you’d benefit from working with a licensed therapist online, please don’t hesitate to reach out for professional support.


In milieu therapy, the environment is usually controlled and medically reviewed to help patients progress and improve. As patients move through four levels of responsibility, they can benefit from advantages like open communication, valuable staff interactions, and an acknowledgment of their inherent human rights. Milieu therapy can take place at home or in institutional settings. If you’re interested in getting the mental health help you deserve from the comfort of your home, you may wish to consider joining an online therapy platform.

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