Day programs and some psychiatric hospital wards were largely based on a treatment strategy for providing services called milieu therapy. Milieu, a French term that literally means "environment," refers in this case to the physical, social, and cultural setting of the program. Milieu therapy is a technique based on the idea that every aspect of a treatment setting or environment can be used to help achieve therapeutic or rehabilitation goals or results. Milieu therapy can be a very powerful tool for shaping behavior, encouraging self-awareness, and increasing self-confidence. In everyday terms, milieu therapy uses phenomena such as peer pressure, social support, public recognition, and social mores to help improve participants' social functioning, self-confidence, and ability to check their perceptions of reality. Some examples of the implementation of milieu therapy strategies are structuring a day around work tasks, community meetings, and skills training groups; ensuring that the physical environment is comfortable, inviting, and clean; and planning a recreational event that will encourage high levels of participation and interaction between people. Each of these tasks helps to shape the environment in order to make it conducive to achieving the goals of the individuals receiving services.
Milieu therapy—the use of the whole physical, social, and cultural environment in the therapeutic process. In milieu therapy the environment is the essential treatment component.
Milieu therapy had its roots in inpatient treatment, where all aspects of the patient's life were under the control of treatment professionals. For persons with disorienting conditions (e.g., acute psychosis), various aspects of their surroundings and environmental cues can be very important. We have all experienced these environmental effects. Messy, hectic environments accompanied by loud noise tend to make people either anxious or withdrawn. Peaceful, calm environments accompanied by soft music tend to make people relaxed. For persons with severe mental illness, attention to all aspects of the milieu is critical because these effects can be greatly magnified.
Gunderson (1978), described five basic elements of successful treatment that were helped by milieu therapy: containment, support, structure, involvement, and validation. As you review these terms in the list that follows consider what it might feel like if each of these elements were absent. Then consider how important it is to an individual's sense of well being to help restore these elements.
1. Containment: A sense of being controlled by the environment
2. Support: A sense of being supported or affirmed by the environment
3. Structure: An ordered environment, where who, what, and where are predictable
4. Involvement: Participation and belonging to the social environment
5. Validation: Affirmation of the individual in the environment.
The benefits of these therapeutic effects for persons with severe mental illness were first observed in inpatient settings, but they are equally beneficial and important for persons in the community programs where milieu strategies are employed.
Washburn and Conrad (1979) suggest that a sixth important treatment element of milieu therapy is negotiation. Negotiation refers to the process a consumer goes through with treatment staff to determine treatment goals and plans. As PsyR has developed, so has the emphasis on consumer choice and involvement, making negotiation a very important skill. Numerous other benefits of milieu therapy have also been suggested by practitioners and researchers. Milieu therapy can be a powerful tool for reducing anxiety, improving self-awareness, and shaping and maintaining behavior.
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