Milieu Therapy

• The concept of milieu therapy, originally developed by Sullivan, involved

clients’ interactions with one another; i.e., practicing interpersonal relationship
skills, giving one another feedback about behavior, and working cooperatively
as a group to solve day-to-day problems.

• In this type of therapy, the therapist provides a corrective interpersonal rela-

tionship for the client. As Sullivan coined, the therapist here plays a role of a
participant observer in which the therapist plays as a participant in creating an
interpersonal relationship and creating a therapeutic atmosphere, at the same
time the therapist observes the progress of the relationship that he/she had
with his/her client.

• Sullivan and later Jones observed that interactions among clients in a safe,
therapeutic setting provided great benefits to clients.

• Milieu therapy is one of the primary modes of treatment in the acute hospital
setting. Although in today’s healthcare environment, inpatient hospital stays
are often too short for clients to develop meaningful relationships with an-
other. Therefore, the concept sometimes of milieu therapy receives little atten-
tion because for it to be effective, the client has to be immersed in a facility for
a long period of time so that positive characters will be developed. However,
the management of milieu or environment is still a primary role for the nurse in
providing safety and protection for all clients and promoting social interac-
tions.

• Milieu therapy, meaning the total environment and its effect on the client’s
treatment. Individual and group interactions focused on trust, self-disclosure
by clients to staff and one another, and active participation in groups.

• Effective milieu therapy required long lengths of stay because clients with
more stable conditions helped to provide structure and support for newly ad-
mitted clients with more acute conditions. That’s why this kind of therapy is
still used nowadays, but it is not getting enough attention for the reason that
this one requires longer lengths of stay.

• A therapeutic milieu is a 24-hour environment designed to provide a secure

retreat for individuals whose capacities for coping with reality have deterio-
 rated.

• The therapeutic milieu gives them opportunities to acquire adaptive coping

skills (with the help of the therapist who acts as the participant observer and
at the same time with the help of the clients who are already stable in their
condition). By offering source, comfortable physical facilities for sleeping, din-
ing, bathing and engaging in recreational, occupational, social, psychiatric
and medical therapies, the therapeutic milieu does many advantages.

• In this kind of therapy, what the therapists primarily do is that they create a
stable environment (Stable- to allow the client to function appropriately and in
a socially acceptable manner). So the will be taught adaptive and social skills
which they may imbibe and then integrate in their own personality so that by
the time that they will be discharged, they will be able to use them in integrat-
ing with their community.

• A therapeutic milieu is a “safe space,” a non-punitive atmosphere in which

caring is a basic factor. In this environment, confrontation may be a positive
therapeutic tool that can be tolerated by the client.

• Nurses and treatment team members should be aware of their own roles in
this environment, maintaining stability and safety, but minimizing authoritarian
behavior.

• Clients (at the same time therapists)  are expected to assume responsibility
for themselves within the structure of the milieu as much as possible. So it’s
like simulating the outside environment where in different people play different
roles and in the roles that they play, there are expectations and conse-
quences but here in milieu therapy it is much more controlled compared to the
outside world which is the reality but it’s just like simulation the real world and
bringing it here in the milieu therapy in a less constrictive and less stressful
environment so that their adaptive and social skills will be honed. By the time
that the client is ready to be integrated to the community then they can look
back on what they’ve learned in the facility where they have been admitted.

• In here, you are putting your client in an environment where everything is con-
trolled where everything as much as possible is structured and stable. 
COMPONENTS OF A THERAPEUTIC MILIEU

1. Maintaining safe environment

• The nursing staff should follow the facility’s policies with regards to prevention
of routine safety hazards and supplement these policies as necessary.

• A nurse or SN assigned in mental facilities should make sure that you follow
the policies, rules and regulations set by the facility to prevent injury and
maintain safety to the client. So you can do that by: 

◦ disposing all needles safely and keep them out of reach of the client 

◦ restrict or monitor the use of matches and lighters 

◦ Do not allow smoking because it may lead to fire

◦ Remove mouthwash, after shave lotions, and any substances that may
be suspected to abused 

◦ Keep sharp objects out of reach of clients as well or anything that can
be used to harm themselves  or others so that can include a simple pen
because they can be really creative and resourceful on how to make
that pen an object or a weapon that can potentially harm themselves
and other clients. 

◦ Keep away knives and dental floss because they can use it for suicide.