What Is Milieu Therapy And Why Is It Used?
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?
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 receiving psychiatric treatment within their home community.
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 environment's structure 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
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 because it requires staff members to respect patients and encourage them to treat each other respectfully. Even when the patient behaves 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.
This can be one of the downsides of milieu therapy, but if the interaction training is well-structured enough to deal with individual differences, it's less of a problem.
Meeting Your Needs Is The Primary Goal
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 institution's needs.
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 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 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.
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.
- You do some self-destructive behavior, 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.
- 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.
- You go to all your scheduled therapy sessions and begin to take charge of meeting your own goals.
- 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 therapy type makes solving problems more relaxed, natural, and ultimately, doable.
The physical environment is structured to provide maximum personal safety for each person in the environment.
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 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. 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 it fits with your schedule.
You can find counselors to help you deal with whatever environment you find and whatever situations you face. You can talk to a licensed counselor through ReGain.us to learn skills to improve your mental health and relationships and set you on a better life course.
Frequently Asked Questions (FAQs)
What is milieu therapy used for?
Medically-reviewed milieu therapy is often used in an inpatient setting and support groups and family therapy. The therapeutic community and structured environment used in milieu therapy can treat nearly any medically-reviewed psychological or behavioral condition. Treatment goals include controlling negative behaviors and engaging in social learning in a group setting, sometimes referred to as the “therapy family.” This type of therapy is used in the United States and many other countries.
How does milieu therapy work?
Milieu therapy operates under the belief that all aspects of a person’s experience can be medically reviewed and therapeutic. There are six main components to this type of health care: supportive and therapeutic relationships; daily routine and structure; continuous exploration of life events; socialization and open communication in a group setting; a focus on self-care; and a supportive treatment environment. Milieu therapy works by encouraging people to take responsibility for themselves and others in the therapeutic environment. It can be used in an inpatient setting or family therapy.
What is milieu therapy in mental health nursing?
Nurses have an important role in milieu therapy. They can be agents of change for clients’ behavior and treatment goals, and they can also manipulate the dynamic therapeutic community in which clients live. Nurses are also expected to confront discrepancies in client behavior and act as role models for interpersonal skills in the milieu therapy family or therapy group. Finally, nurses are medically-reviewed leaders in milieu therapy that can display diverse functional skills throughout the therapeutic community.
What is meant by therapeutic milieu?
The therapeutic milieu refers to the nurse-created and led healing culture and atmosphere in an inpatient setting. A therapeutic milieu is an environment that includes all treatment team members, safe physical surroundings, and clients. It is created and maintained as a dynamic setting where providers can work with clients to better their mental health and learn new handling problems. Every aspect of the milieu is medically reviewed to ensure that it is therapeutic.
Who invented milieu therapy?
Milieu therapy was invented in the early 1900s by P. Pinel, who revolutionized the treatment of mental health disorders by advocating for the kind and humane treatment of psychiatric patients. It may have started in Germany, but it wasn’t long before milieu therapy made its way to the United States as well. Respect and compassion were important parts of milieu therapy, which was revolutionary at the time.
What do you mean by milieu?
“Milieu” is a French word meaning “middle,” which is typically translated to mean the environment surrounding a patient or therapy group here in the United States. According to Merriam-Webster, the definition of milieu is “the physical or social setting in which something occurs or develops: environment.” In a medical dictionary, the milieu is defined as “In psychiatry, the social setting of the mental patient, for example, the family setting or a hospital unit.” Therefore, the term “milieu” can also be used in the family therapy setting to refer to the environment in which the family lives and interacts.
What is the milieu in psychology?
The APA Dictionary of Psychology defines milieu first as the environment in general and second as the social environment, affecting the individual's adjustment and personality. In the Psychology Dictionary, it is noted that milieu refers to the individual's immediate social setting.
What constitutes a therapeutic relationship?
A therapeutic relationship is a medically-reviewed relationship between the client and the healthcare provider. The therapeutic relationship begins the first time the client and provider meet. It continues to develop throughout the course of treatment as both parties learn new things about each other.
What does a behavioral therapist do?
A behavioral therapist provides health care by helping clients form healthier thought processes and behavioral patterns in a medically reviewed manner. The techniques that behavioral therapists use are based on behaviorism, which states that all behaviors are learned. Behavioral therapists help their clients learn new, constructive behaviors.
This type of therapist's most common techniques includes positive reinforcement of healthy behaviors, aversion therapy, systematic desensitization, and operant conditioning. It’s not unlikely for behavioral therapists to use psychoanalysis techniques as well. Behavioral therapy has been proven to be highly effective in treating a wide range of mental health disorders.
What are the criteria for a mental disorder?
To be diagnosed with a mental disorder, a person must meet the criteria put forward by the Diagnostic and Statistical Manual of Mental Disorders (DSM). These criteria are different for each mental illness. Mental illnesses are notoriously difficult to diagnose because they present in a slightly different way for each individual. No two cases are the same, and no two treatment goals are the same.
How do you maintain a therapeutic environment?
You can maintain a therapeutic environment by reducing or even eliminating all environmental stressors, providing positive distractions for clients, enabling social support in a group setting, and giving clients a sense of control over their treatment and lives. A therapeutic environment also relies on medically-reviewed limits and boundaries, rules for clients, and consistency in health care.