Milieu Therapy

Milieu Therapy
“a scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual.”

The community environment itself serves as the primary tool of therapy

Goal of Milieu Therapy
to manipulate the environment so that all aspects of the client’s hospital experience are considered therapeutic.

Within the therapeutic community setting, the client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life.

Current Status of Milieu Therapy
– Milieu therapy blossomed during the 1960s, 1970s, and early 1980s, when psychiatric inpatient treatment provided sufficient time to implement programs of therapy aimed at social rehabilitation.
– Although strategies for milieu therapy are still used, they have been modified to conform to the current short-term approach to care and to outpatient treatment programs.

Basic Assumptions of Milieu Therapy
Skinner (1979) outlined seven basic assumptions on which a therapeutic community is based:
1. The health in each individual is to be realized and encouraged to grow.
2. Every interaction is an opportunity for therapeutic intervention.
3. The client owns his or her own environment.
4. Each client is responsible for his or her own behavior.
5. Peer pressure is a useful and powerful tool.
6. Inappropriate behaviors are dealt with as they occur.
7. Restrictions and punishment are to be avoided.

Conditions that Promote a Therapeutic Community
1. Basic physiological needs are fulfilled.
2. The physical facilities are conductive to achievement of the goals of therapy.
3. A democratic form of self-government exists.
4. Responsibilities are assigned according to client capabilities.
5. A structured program of social and work-related activities is scheduled as part of the treatment program.
6. Community and family are included in the program of therapy in an effort to facilitate discharge from treatment

Because the goals of milieu therapy relate to helping the client learn to generalize that which is learned to other aspects of his or her life, the conditions that promote a therapeutic community in the psychiatric setting are similar to the types of conditions that exist in real-life situations

The Program of Therapeutic Community
– Care is directed by an interdisciplinary team. (IDT)
– A comprehensive treatment plan is formulated by the
team.
– Team members of all disciplines sign the plan and
meet regularly to update the plan as needed.
– Disciplines may include psychiatry, psychology, nursing, social work, occupational therapy, recreational therapy, art therapy, music therapy, dietetics, and chaplain’s service.

The Role of the Nurse
– Through use of the nursing process, nurses manage the therapeutic environment on a 24-hour basis.
– Nurses have the responsibility for ensuring that the client’s physiological and psychological needs are met.
– Medication administration
– Development of a therapeutic one-to-one relationship with the client
– Encourage clients to improve communication and relationship skills
– Promote self-reliance, providing reality orientation
– Give feedback to clients about their behavior and verbalizations
– Setting limits on unacceptable behavior
– Client education

Nurses play a crucial role in the management of a therapeutic milieu. They are involved in the assessment, diagnosis, outcome identification, planning, implementation, and evaluation of all treatment programs.

Topics for Client Education
– Medication education
– Increasing self-esteem
– Anger management
– Management of anxiety
– Assertiveness
– Relaxation techniques
– Problem-solving
– Thought stopping
– Sex education, STDs, bloodborne pathogens
– Grief
– Nutrition
– Mental illness – client and family education
– Substance abuse – client and family education

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