Chapter 12

MILIEU THERAPY

THE THERAPEUTIC COMMUNITY

 Milieu

therapy, or therapeutic
community, is defined as
a scientific structuring of the
environment to effect behavioral
changes and to improve the
psychological health and functioning of
the individual
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.

Basic Assumptions of Milieu

Therapy
The

health in each individual is to be

realized and encouraged to grow.
Every interaction is an opportunity for
therapeutic intervention.
The client owns his or her own environment.
Each client owns his or her own behavior.
Peer pressure is a useful and powerful tool.
Inappropriate behaviors are dealt with as
they occur.
Restrictions and punishment are to be
avoided.

Goals of milieu
therapy:
Manipulate the environment so that all
aspects of clients 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

Conditions That Promote a

Therapeutic Community
Basic

physiological needs are fulfilled.

The physical facilities are conducive to
achievement of the goals of therapy.
A democratic form of self-government
exists.
Responsibilities are assigned according to
client capabilities.
A structured program of social and workrelated activities is scheduled as part of the
treatment program.
Community and family are included in the
program of therapy in an effort to facilitate
discharge from treatment.

The Program of Therapeutic

Community
Care

is directed by an interdisciplinary team.

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
the chaplains service.

Characteristics of milieu therapy:

The concept of milieu therapy developed from a desire to
counteract the negative, regressive effects of institutionalization:
reduced ability to think and actindependently, an adoption of
institutional values and attitudes, and loss of commitments in the
outside world.
Several strategieshave been developed to counter these
negative effects. They include:
Distribution
Open

communication

Structured
Work-

of power

interactions

related activities.

Community
Adaptation

and family involvement in the treatment process

of the environment to meet developmental needs.

Progressive levels of responsibility

according to clients self care capacity:
Level I:Displays a destructive behavior to self, others, or
the environment.
Disoriented
Unable

to time, place and person.

to function in group therapy.

Exhibits

poor personal hygiene.

Level II:Does not display destructive behavior.

Knows

the current time, date and place.

Attends

at least one therapeutic group daily.

Attempts

to maintain good personal hygiene

Level III: Attends All Therapeutic Activities.

Participates actively in the Community Meetings and serves
on at least one client committee.
Develops a self-directed behavior plans to change or
resolve a personal problem.
Knows the names of all medications and the times they are
to be taken.
Participates in a family session.
Level IV: Takes an active role in assisting other clients to
gain level changes.
Demonstrates willingness to serve as an officer on the
client committee.
Assumes a leadership role in the community, acts as a
positive role model, and ensures that other clients are
prompt in their attendance of regularly scheduled activities
and group meetings.
Initiates discussions with the mental health team
concerning discharge planning.

tenchoo