MILIEU THERAPY

Mr. Sathish Rajamani M.Sc (N)

Lecturer, Annai Meenakshi College of Nursing, Coimbatore.

INTRODUCTION

Milieu therapy is a planned treatment environment in which every day events and
interactions are therapeutically designed for the purpose of enhancing social skills and building
confidence.

HISTORICAL PERSPECTIVES

Milieu Therapy (MT) has been in existence since the late 1800’s, when moral treatment
and therapeutic communities were key issues in the treatment of psychiatric problems. It has
been used as a viable treatment modality for kids for over fifty years in residential and in –
patient settings, and more recently in the partial hospitalization and day treatment settings.
August Aichorn, Bruno Bettelheim, Fritz Redi and David wineman were among the elderly
pioneers in using MT to treat impulsive children and ego impaired kids in residential and school
settings as early in the 1920’s.

PURPOSE OF MT

1) Enhance social skills

2) Build confidence
3) Provides a safe environment
4) Offers guidance and reinforcement
5) Set limits on disturbing and maladaptive behavior
6) Teaches psycho – social skills

GOALS OF MT

1) Manipulate the environment that all aspects of client’s hospital experience are
considered therapeutic.
2) Client is expected to learn adaptive coping interaction and relationship skills that
can be generalized to other aspects of his or her.
3) Achieving client autonomy

PRINCIPLES OF MT

1) To promote fundamental respect for individual (Both staff & client)

2) To use opportunities for communication between client and staff for maximum
therapeutic benefit

Sathish Rajamani | Milieu Therapy

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f 3) To encourage clients act a level equals their ability and to enhance their self –

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esteem
4) To promote socialization
5) Individuals are held responsibility for their own behavior
6) Peer pressure is utilized to reinforce rules and regulations
7) Team approach is used
8) Group discussion and temporary seclusions are favored approaches for acting out
behavior
9) The nurse function is to act in ways that consistently promote these goals

CHARACTERISTICS OF MT

An emphasis on group and social interaction

Rules and expectations mediated by peer pressure
Blurring the clients role through viewing of clients as responsible human beings
An emphasis on client’s rights through involvement in setting goals
An emphasis on interdisciplinary participation
Freedom of movement and informality of relationships with staff
Goal – oriented clear communication

ROLE OF NURSE IN MT

Traditionally psychiatric mental health nurses have assumed responsibility for managing
and coordinating milieu activities, the roles of nurses in therapeutic milieu includes,

Sathish Rajamani | Milieu Therapy

Physical and Safety Care
 Assess the client’s ability to perform activities of daily living
 Assess the client’s physical status for signs of physical illness or adverse reaction
to psychotropic medications
 Assess the client’s physiological reaction to detoxification from addictive agents
 Conducts periodic safety checks of the entire milieu

Medication Administration and Education

 Manages the medication administration
 Assist the client to assume responsibility for taking his/her own medication

Psycho – Social care

 Helps the client to eliminate the stressors within the milieu
 Encourages the client to identify his/her problems and conflicts
 Organizes informal group interventions such as community meetings and
structured or unstructured group therapy sessions
 Provide brief on the spot individual therapy

Mental Health Education

 Provides client and family teaching centering around psychotropic medications /
coping strategies
 Teaches relaxation techniques

Health Education
 Provides client teaching regarding physical health problems

GUIDELINES FOR NURSES WORKING IN THERAPEUTIC MILIEU FOR EFFECTIVE

PRACTICE

 Cultivate self – awareness through self evaluation and evaluation by supervisors

and peers
 Be sensitive to the needs of all peoples
 Communicate clearly and do not hesitate to seek clarification from others
 Always expect the unexpected despite the best efforts and plans
 Be clear at all times regarding one’s values, principles and beliefs regarding what
is and is not clinically appropriate for adequate client care

Sathish Rajamani | Milieu Therapy

REFERENCES

1. Psychiatric Mental Health Nursing, Barbara Schoen Johnson, 4th edn, Lippincott,
Philadelphia, 229-230.
2. Foundations of psychiatric Mental Health Nursing, Elizabeth M. Vacarolis, 3 rd edn,
W.B. Saunders company, Philadelphia, 58-60.
3. www.mentalhealth.com
4. www.focus-alternative.org
5. www.milieutherapy.com

Sathish Rajamani | Milieu Therapy