Milieu therapy

Milieu therapy can be defined as the type of treatment in which the patient's social environment is manipulated for his benefit. The total environment or milieu is regarded as the medium of therapy, all interactions and activities regarded as potentially therapeutic.

In the hospital environment, medications are only one part of the therapeutic regimen. Other therapies offered to patients include psychiatric consultation, and group or individual psychotherapy. Psychiatric consultation provides an opportunity for patients to speak directly with doctors, who monitor symptoms and create or adjust treatment plans accordingly. During group therapy, therapists help patients to help each other with reality testing and interpersonal problems they may have. The highly structured schedule of hospital life provides another avenue of therapy; termed "milieu" therapy in which benign and beneficial order is imposed upon patients who cannot generate this order themselves (such as making sure patients eat and sleep on a regular schedule). Milieu therapy can take place both in hospital and after a patient leaves the hospital, a therapeutic community residence offering continuing milieu therapy may be available, so that patients can live in a well-controlled environment all the time. Though expensive, this type of therapy can be exceptionally valuable and can mean the difference between re-current active phase psychosis and a normal life.

It aims to include patients in decision-making and in managing activities and routines in the institutions which they attend.

Goals of milieu therapy:

• Manipulate the environment so that all aspects of client’s hospital experience are considered therapeutic.

• 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

Factors which contribute to a favourable milieu:

Size of the group of patients in a unit: group size seem to be important greater satisfaction was found when the groups were around 17.

Balance between individual and group activities and therapy sessions. Individual therapy should be given priority over group sessions.

Group activities should be lead confidently and should be task orientated. The task should be well-defined and structured.

How does it work?

Every interaction is an opportunity for therapeutic intervention: within this structured setting, it is virtually impossible to avoid interpersonal interaction. The ideal situation exists for clients to improve communication and development relationship skills. Learning occurs from immediate feedback of personal perceptions.

The client owns his or her own environment: client makes decisions and solves problems related to government of the unit. In this way personal needs for autonomy as well as needs that pertains to the group as a whole are fulfilled.

Each client owns his or her behaviour: Each individual within the therapeutic community is expected to take responsibility for his or her own behaviour.

Peer pressure is a useful and a powerful tool: Behavioral group norms are established through peer pressure. Feedback is direct and frequent, so that behaving in a manner acceptable to the other members of the community becomes essential.

Inappropriate behaviours are dealt with as they occur: Individuals examine the significance of their behaviour, look at how it affects other people, and discuss more appropriate ways of behaving in certain situations.

Restrictions and punishment are to be avoided: Destructive behaviours can usually be controlled with group discussion.

What would you include or exclude from these two hospital environments as a part of a new milieu therapy scheme? Justify your answer

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Explain how milieu therapy can be helpful to schizophrenic patients.

Evaluation of Milieu Therapy