Milieu Therapy

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

3) To encourage clients act a level equals their ability and to enhance their self ± 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 1) 2) 3) 4) 5) 6) 7) 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,

Medication administration

Physical and safety care

NURSES ROLE IN MT

Psycho social care

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Health education

Mental health education

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

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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, 3rd edn, W.B. Saunders company, Philadelphia, 58-60. 3. www.mentalhealth.com 4. www.focus-alternative.org 5. www.milieutherapy.com

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Sathish Rajamani | Milieu Therapy

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