What Is Milieu Therapy And Why Is It Used?
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?
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.
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.
Takeaway
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.
Frequently asked questions (FAQs)
What is milieu therapy used for?
Medically-reviewed milieu therapy is often used in an inpatient setting, as well as 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 may 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 often used in the United States and many other countries.
How does milieu therapy work?
Milieu therapy generally operates under the belief that all aspects of a person’s experience can be medically reviewed and therapeutic. There are typically 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 normally 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 usually 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 normally 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 generally 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 usually refers to the nurse-created and led healing culture and atmosphere in an inpatient setting. A therapeutic milieu is an environment that normally includes all treatment team members, safe physical surroundings, and clients. It is generally 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 tends to be 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 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 “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 generally refers to the individual's immediate social setting.
What constitutes a therapeutic relationship?
A therapeutic relationship is normally a medically-reviewed relationship between the client and the healthcare provider. The therapeutic relationship usually begins the first time the client and provider meet. It often 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 often 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 usually based on behaviorism, which states that all behaviors are learned. Behavioral therapists often help their clients learn new, constructive behaviors.
What are the criteria for a mental disorder?
To be diagnosed with a mental disorder, a person usually must meet the criteria put forward by the Diagnostic and Statistical Manual of Mental Disorders (DSM). These criteria tend to be different for each mental illness.
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.
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