A SEMINAR PRESENTATION

ON
THERAPEUTIC MILIEU; A VITAL TOOL IN ENHANCING AN
EFFECTIVE TREATMENT/MANAGEMENT OF MENTAL
DISORDERS.

PRESENTED BY:
IBOK, INI-OBONG ENO

SUBMITTED TO:
SCHOOL OF PSYCHIATRIC NURSING,
EKET, AKWA IBOM STATE

APRIL, 2022
 A SEMINAR PRESENTATION

ON
THERAPEUTIC MILIEU; A VITAL TOOL IN ENHANCING AN
EFFECTIVE TREATMENT/MANAGEMENT OF MENTAL OF
DISORDERS.

PRESENTED BY:
IBOK, INI-OBONG ENO

SUBMITTED TO:
SCHOOL OF PSYCHIATRIC NURSING,
EKET, AKWA IBOM STATE

IN PARTIAL FULFILMENT OF THE COURSE REQUIREMENTS FOR

INTRODUCTION TO SEMINAR

APRIL, 2022
 TABLE OF CONTENT

Title page

Chapter one

Introduction

Objectives of the seminar presentation

Definition of Terms

Chapter Two

Literature review

Historical review

Components of Milieu Therapy

Benefits of Milieu Therapy

Disadvantages of Milieu Therapy

Theoretical review

The Integrative Milieu Model

Integrative Milieu Day treatment

Therapeutic Milieu As A Vital Tool in Enhancing An Effective Treatment/Management of Mental

Disorder.

Principles of Milieu Therapy

Milieu Therapy in Management of Schizophrenia

Psychophysiology of Milieu Therapy

Importance of of Milieu Therapy in Management of certain mental Disorders

Milieu Therapy Location types

Characteristics of Milieu Therapist.

Role of a Nurse in Milieu Therapy

Chapter Three

Summary
Conclusion

Recommendation

References.
INTRODUCTION

In the past, mental illness was shrouded in mystery and apprehension. Today, however, the

mental health sector has made tremendous progress in understanding and, especially, the

ability to offer effective treatments. Moreover, these improvements and advancements helped

in erasing the stigma tied to mental illnesses. The psychiatric mental health Nurse provides,

structures, and manages a therapeutic atmosphere in partnership with the client and other

health team members, according to the American Nurses Association's 2000 scope and

criteria of psychiatric mental health nursing practice (Baldessarini, 2014). The therapeutic

milieu is an inpatient unit, Nursing units, or other Nursing practice setting's distinct Nurse-

created, Nurse-led healing culture and atmosphere. The treatment environment is often

discussed in nursing. The therapeutic milieu, on the other hand, is more than just the

setting(Lecuyer, 2019).

It is a healing culture rich in therapeutic interpersonal relationships and cooperative

attentiveness to patients. In addition, its physical features are soothing and provide for

optimum safety and Comfort (Bhat et al, 2020). The word milieu comes from the French

term milieu, which means “middle.” The word's English meaning is surroundings or

environment. In a therapeutic context, it refers to the overall environment and interactions of

the environment. A therapeutic milieu is defined as a scientific structuring of the environment

to affect behavioral changes and improve the individual's psychological health and

functioning (Lecuyer, 2019). The history of Milieu therapy dates back to the 1700s; Dr.

Philippe Pinel found that Paris asylum inmates were less violent when they were free to move

around.(Hoffman, 2020) .The medical model and early Freudian methods gained popularity
in the 19th and early 20th centuries, and hospitals became places where patients prepared for

treatment, emphasizing intrapsychic elements(Hoffman, 2020).

As a result of this trend, many hospitals have become more regressive and controlling.

Sullivan and Menninger reported that patients did not behave psychotically when certain

people dealt with them. In 1953, probably the best-known early milieu approach was the

therapeutic community, developed by Maxwell Jones, who insisted upon fostering a social-

democratic culture. During late 70s, Gunderson (1978) in Hoffman,(2020) identified five

processes needed for a milieu to be therapeutic: containment, support, structure, involvement,

and validation .Furthermore, the discovery of various new classes of psychotropic resulted in

a change in psychiatric treatment toward symptom management. (Baldessarini, 2014). At

present, milieu for psychiatric care is identified under the standard implementation practice

for any psychiatric setting. The milieu of a psychiatric hospital plays a fundamental role in a

patient's treatment, yet it is one of the most neglected health-care aspects(Baldessarini, 2014).

Poor milieu management in psychiatric hospitals affects the patient's social environment and,

ultimately, mental health. Lack of conducive milieu in psychiatric settings can leave a

detrimental effect, such as feelings of self-harm and violence and providing an unsafe and

uncomfortable milieu(Bhat et al, 2020). According to the American Nurses Association, it is

the mental health nurse's responsibility to provide, organize, and maintain a therapeutic

milieu with the patient and health-care team members (Kane et al, 2012). The therapeutic

milieu is better explained as creating a structured environment designed for teaching

psychosocial skills and

limiting disruptive and maladaptive behavior of patients. A significant challenge for inpatient

psychiatric care is maintaining a therapeutic milieu that facilitates patient recovery, safety,

and good interpersonal relationship (Ergun, 2017). Pieces of evidence from the West depict
that milieu therapy interventions were beneficial for depressive patients who positively

impacted clinical outcomes (Caesar & Manty, 2015).

Objectives of the Seminar Presentation

At the end of this seminar presentation, the students should be able to;

 Define Therapeutic Milieu

 Briefly discuss the historical perspective of Therapeutic milieu

  States the benefits and disadvantages of Milieu Therapy

 Briefly discuss the Integrative Milieu Model by McCready

 State the importance of Milieu Therapy in Management of certain mental Disorders

 Discuss the Role of a Nurse in Milieu Therapy.

Definition of Terms

 Therapeutic; the branch of medicine concerned with the treatment of disease and the

action of remedial agents.

 Milieu; the physical or social setting in which something occurs or develops :

environment.
  Therapeutic milieu;: Milieu therapy is a safe, structured, group treatment method for

mental health issues. It involves using everyday activities and a conditioned

environment to help people with interaction in community settings.

 Vital; Extremely important : crucial.

 Tool: something that helps you to do a particular activity.

 Enhancing: To intensify, increase, or further improve the quality, value, or extent of.

 Effective: successful in producing a desired or intended result.

 Treatment; medical care given to a patient for an illness or injury.

 Management: The process of dealing with or controlling things or people.

 Mental Disorders: A mental disorder is characterized by a clinically significant

disturbance in an individual's cognition, emotional regulation, or behaviour(Hoffman,

2020).

2.0 Literature review

2.1 Historical review;

Late 1700 s: Pinel (in France) coined the term “moral treatment” to describe his new

approach to psychiatric care, which included removing chains, using attitudes, and setting

examples of appropriate behavior and humanitarianism. Early 1800s: Tuke (in

England) established the York retreat based on atmosphere, much like a prison. 1930:

Sullivan began to experiment again with varying the treatment milieu by selecting the staff

members who were sympathetic and interacted well with the patient. 1939: Menninger and
others developed prescribed attitudes based on psychoanalytical principles that determined

staff interaction patterns. 1940: the predominant service patterns was the medical intervention

pattern in which staff, including nurses, served as the physicians agents in providing care.

1946: Main ‘coined the term “therapeutic community” to describe the approach of

resocialization of neurotic individuals through social interactions. 1948: Bettelheim’ coined

the term Milieu therapy to describe his use of the total environment for treatment of disturbed

children. 1953: Max Well Jones used the therapeutic community approach in two

experimental units for the treatment of antisocial personality disorders in which the social

environment was seen as the primary treatment modality. 1990: the development of milieu

therapy based on research to identify the milieu structure most effective for specific treatment

groups. Future: Better integration of hospital and community psychiatry will provide for

more efficient and more effective care for the mentally ill in the community (Hoffman,

2020).

2.2 Components of milieu therapy

The right environment for milieu therapy is based on five components. These components

are:

Support: Milieu therapy thrives in a lenient environment rather than a strict one. People

receiving treatment are given time to adapt to the environment comfortably. To help with the

process, caregivers offer support with an individualized approach. This also contributes to

fast progress.

Structure: Environments have regular, predictable routines that help in building trust.

Consistency also provides learning opportunities that contribute to health improvement.

Validation: A milieu therapy environment is warm and welcoming. It's a safe space for those

who might feel vulnerable. Protection encourages members to explore new habits that help

them develop new life skills.

Involvement: These are often regular routines that encourage socialization. Where necessary,

therapists can help members learn new methods to reciprocate and develop friendships.

Containment: Milieu therapy environments have various limiting rules. These rules are

consistent and communicated clearly to people enrolled in the therapy treatment (Armiyadi,

2020).

2.3 Benefits of milieu therapy

The popularity and success of milieu therapy in treating mental health issues is proof of its

many benefits.

Development of a sense of security: Patients feel safe, both emotionally and physically,

during and after treatment, which enhances their overall well-being.

Acquisition of New Coping Skills: The environment is conducive and creates an opportunity

for people to learn new coping skills and practice them. People feel encouraged to adopt

healthy behavior and practice it while still undergoing treatment.

Monitoring of patient behavior: During treatment, patients get direct feedback from their

caregivers, therapists, other personnel, and even others in their community. These individuals

not just motivate a patient’s progress but also monitor it.

Modification of behaviours: Milieu therapy provides a supportive environment for patients

to try and experiment with new behaviors without the fear of failure. The therapists and

community that they work with during their therapy also offer constructive feedback that

further increases the support.

Behavioral responsibility: Milieu therapy also offers patients the freedom from the existing

norms that may otherwise hinder their treatment and its progress. The safe and encouraging

environment also allows patients undergoing the therapy to take responsibility for their

behavior (Bhat et al, 2020).

2.4 Disadvantages of milieu therapy

 Role blurring between staff and patient.

 Group responsibility can easily become nobody’s responsibility.

 Individual needs and concerns may not be met.

 Patient may find the transition to community difficult.

 Milieu therapy is limited to only hospitalized patients.

 Conflict resolution is needed as part of the staff’s skills.

 Low client- to- staff ratio.

 Requires continuous open communication among all staff and clients(Caesar& Manthy,

2015).

2.5 Theoretical review

The integrative milieu model by Kevin f. mccready

The integrative milieu model, developed by Kevin F. McCready(1957-2004) in 1990, is an

alternative treatment regime to the medical model of psychiatry for treating people suffering

from psychological distress. A central part of the anti-psychiatry movement, being a close

friend of Peter Breggin and a board member of the International Center for the Study of

Psychiatry and Psychology, McCready based his model on the idea that human psychological

suffering is not caused by a physiological disease or a chemical imbalance, but by a

compromise to a person's humanity. He believed that the biomedical model of psychiatry was

a compromise to a person's humanity, stripping its patients from elements he considers to be

a necessary and natural part of human life experience. This model of treatment combined

elements from psychodynamic theories, particularly the theories of Carl G. Jung, humanism,

and existentialism (Baldessarini, 2014).

The integrative milieu model's approach is one which attempts to create a new community for

its participants to interact within. This community is based on four main ideas;

 The milieu must be a therapeutic container which allows an intensive exploration of the

personal and collective psyche. It must therefore have a structure which maintains

continuity and a sense of security.

 The professionals who work to maintain the structure of the container must be flexible to

allow for the expected and the unexpected expression of self which comes in such an

environment.

 The integration of all aspects of the human experience must be not only allowed to be

expressed and explored, but must be encouraged to be expressed and explored. This

means that all aspects of humanity must be made part of the integrative milieu, including

such things as play, art, music, discussion, and intimacy (Bhat, 2020).

 A respect for the human being's sense of self-direction. All patients within the milieu are

expected to behave in a responsible, respectful manner. McCready believed that the

expectations which are part of a community's fundamental philosophy play a significant

role in the corresponding behavior of those who are part of the community (Baldessarini,

2014).

INTEGRATIVE MILIEU DAY TREATMENT

McCready developed a day treatment program based on the integrative milieu model. It is a

continuous program, with open enrollment. Most group therapy situations have a beginning
phase, during which all clients who are participating in the group begin and an ending phase,

until which all group members are encouraged to maintain regular attendance; and all group

members complete their treatment at that time. However, in a continuous program, new group

members may join the group at any time and group members complete their treatment and

terminate therapy at any time they are ready, which means there is a staggered enrollment.

The schedule of the program was intentionally set up in such a manner that one started the

day light, gradually went deeper, and finally returned to a lighter level before the end of the

day. The groups were set up to run for fifty minutes each. All groups would have one

therapist moderating. The groups would include not only traditional psychodynamically-

oriented psychotherapy groups, but also groups designed for artistic expression, recreation,

discussion of dreams, discussion of specific topics selected by the group, and general

community goal and feedback groups (Behat, 2017). All clients enrolled in the integrative

milieu also receive individual psychotherapy from one of the staff psychotherapists. This

therapy is psychodynamic in orientation, but adheres to the principles of the integrative

milieu model.

2.5 Therapeutic milieu as a vita Tool in Enhancing an effective treatment/management

of mental Disorders

Milieu therapy can effectively treat a wide range of mental health conditions. Studies have

shown efficacy in treating schizophrenia and other psychotic disorders, among other

behavioral or psychological conditions, including: Depression and generalized anxiety

disorder (Ergun, Isik, &Dikec, 2017). Milieu therapy is a method for treating mental health

conditions using a person’s surroundings to encourage healthier ways of thinking and

behaving. This treatment approach may be known as milieu therapy (MT) because those in

the program are immersed in a small, structured community focused on helping them develop
skills and behaviors that’ll enable them to live healthier lives in a larger society(Blickford,

2012).

Some of its earliest proponents Trusted Source described MT as a living-learning

environment. MT has been around in various forms for over a century. Though its particulars

continue to evolve, its primary method has remained consistent: People are surrounded by a

safe, structured community in which their daily activities and interactions are the means of

receiving therapy. This treatment approach might take place in a full-time, residential setting,

but it can also take place in a meeting or peer group setting, such as Alcoholics Anonymous.

In milieu therapy, you spend a significant amount of time in a home-like environment,

interacting with other people as you conduct ordinary activities throughout the day. You may

attend group or individual therapy sessions as part of your schedule.

You’ll establish your treatment goals and make decisions for yourself, as well as participate in

making decisions for the community. As challenges arise in the course of your day, you learn

new ways of responding from your peers and counselors.

2.6 Principles of milieu therapy

Interdisciplinary Treatment teams;. most people in MT program receive care from

people in different healthcare professions . When treatment are made up of professionals

from different disciplines, patients get the benefit of a variety of skill sets and perspectives.

Some studies Trusted Source have shown that interdisciplinary teams help the treatment team

develop better goals for their patients. These teams help foster a good learning climate and a

sense of equality between clients and staff members.

Mutual respect: One of the most powerful aspects of this treatment approach is the idea that

everyone in the program — therapists and patients alike — deserves respect. Most MT

programs intentionally focus on creating supportive, caring environments in which people

can talk about their experiences with each other as they move through the day. MT settings

don’t operate with a traditional hierarchy where therapists have most of the decision-making

authority and participants have little control over their environment

Individual responsibility: In milieu therapy, power is distributed in a more egalitarian way.

This shared authority approach allows everyone in the program to have a greater sense of

agency and responsibility. That’s because the end goal is for everyone in the program to

emerge with more confidence in their ability to handle stressors in the larger society.

Activities as opportunities

With this treatment approach, patients have daily responsibilities that contribute to the

functioning of their environment. Many programs allow people to choose the work they do

every day so they feel comfortable and productive. The idea is that these activities and

responsibilities will become opportunities to look at, talk about, and change ways of thinking

and acting that aren’t healthy.

Peer communication as therapy: In Milieu therapy, group dynamics play an important role

in shaping behaviors. Researchers Trusted Source have defined the power of group dynamics

by its ability to help group members understand how their behaviors affect other people.

As people work, play, and interact with each other, opportunities and conflicts naturally arise,

and people can learn new ways to cope with and respond to them. MT can be used to treat

almost any psychological or behavioral condition. An MT ethos is often part of the treatment

approach at addiction rehabilitation facilities, in weight loss groups, and in residential and

outpatient clinics that treat behavior disorders. Some researchers have concluded that MT is a

good way to create a therapeutic foundation for individuals with eating disorders. In these

therapeutic settings, patients have examples of effective skills, which allows them to learn

new skills and helps them develop feelings of trust and hope. There’s also some evidence that
MT can help reduce symptoms and increase relaxation in people who have schizophrenia

(Ergun, 2017).

2.7 Milieu therapy in management of schizophrenia: Studies have shown that milieu

therapy helps reduce violent behavior in people with schizophrenia. Milieu therapy is

essential because it gives a holistic approach to mental health treatment. Unlike other mental

health interventions, milieu therapy incorporates activities like bathing, eating, and waking up

(Bhat, 2020). In these therapeutic settings, patients have examples of effective skills, which

allows them to learn new skills and helps them develop feelings of trust and hope. There's

also some evidence that MT can help reduce symptoms and increase relaxation in people who

have schizophrenia. (Armiyadi, 2021.) In the past decade, the medical community has begun

to reframe its ideas about what the clinician-client relationship should look like in treatment

for schizophrenia and move toward a shared decision-making model. While the effects of

shared decision-making can be profoundly positive, such a model is limited in efficacy when

applied solely to pharmacological interventions.

Milieu therapy for schizophrenia, however, is a participatory approach that goes beyond

pharmacological decision-making to create true emotional and behavioral change and foster

lasting wellness. Milieu therapy for schizophrenia is a shared decision-making model where

clinicians and patients work together to make decisions about a treatment program. The

despair of untreated schizophrenia isn’t confined to that which comes in the midst or wake of

disorienting psychosis. It is not fleeting or limited to acute symptomatologies. Rather, it

permeates the lived experiences of those struggling with the illness and their family members,

who so often stand helplessly by as their loved one suffers, unable to find the entryway to

healing. “Untreated schizophrenia,” doesn’t necessarily mean that someone isn’t in treatment.

Many people living with schizophrenia are being ostensibly treated, but in environments or

with methods that are limited in their efficacy or simply unsuccessful. The medication doesn’t
work, the therapy doesn’t help, your loved one doesn’t adhere to their doctor’s

guidelines—the causes of treatment failure are multiple and often overlapping. This in-

between space is where despair so often lies. Your loved one is brushing up against treatment

but not melding with it.

Recovery seems so close, yet further out of reach than ever. Historically, people have often

blamed those struggling with schizophrenia for treatment failure, particularly that which is

brought on by non-adherence. But what if the failure isn’t from loved one, but in how the

medical community has approached the clinician-client relationship? What if reorienting the

understanding of the roles of clinicians and clients can create breakthroughs in treatment for

schizophrenia? (Kane, 2014).

2.8 Psychophysiology of milieu therapy: Milieu therapy posits that a therapeutic

environment is an integral part of the therapeutic process and necessary for change. While it

can involve different types of traditionally structured therapies like group therapy, family

therapy, and individual therapy, it is not a specific, structured intervention on its own.

Practitioners and experts in the field instead see milieu therapy as a collection of beliefs

informed by the needs and abilities of the community, clients, and staff. It requires a

perspective that acknowledges the constant, ongoing nature of the treatment, as it is not

defined by start or end dates or individual moments. Milieu therapy harnesses several facets

of the environment and treatment perspective. It first establishes that an environment is

structured, safe, secure, and comfortable. The therapists have complete control of the

environment, so they can optimize it to promote desired positive changes. Every part of the

therapeutic environment is regulated.

In inpatient environments, the mental health team considers everything from the time clients

wake up in the morning to room decorations and makes each decision based on how it might

affect clients’ behavior. Therapists also use the necessary daily living activities to facilitate
change. Group dynamics are important factors in encouraging behavioral change and healthy

communication by increasing individual participants’ awareness of how their actions impact

others. When conflicts arise, the therapists provide opportunities for clients to learn new

coping mechanisms to deal with stressors more positively. For instance, therapists often see

mealtimes as opportunities for the clients to act out the strategies they’ve learned. When one

person is being hurtful or harmful to the others, rather than stepping in, the therapists

encourage the clients to communicate kindly, directly, and effectively to work out the issue or

dispute. Additionally, they let the social environment spur the clients to correct their

maladaptive behaviors. Where other methodologies might punish or limit negative behaviors

or selectively reinforce desired actions, milieu therapy lets the community encourage healthy

behaviors and actions (Bhat, 2020). The therapeutic milieu also represents a safe environment

in which “real-world” scenarios can occur and play out, so that clients learn how to handle

social interactions and conflicts that would have been overwhelming in a less consistent

environment. The environment encourages this by providing a “lounge” or other areas where

clients can chat, participate in informal groups, and play games. The competitive nature of a

game can be a helpful, low-stakes setting to work through differences. One of the functions

of the milieu is to help clients transfer their coping skills to social settings outside of the

therapeutic environment (Ergun, 2017).

2.9 Importance of milieu therapy in management of schizophrenia

Elimination of social stigma: By molding the environment to your needs and abilities and

collaborating with others as a team to encourage accountability, positive social interaction,

self-care, and a sense of agency. The flexibility and personalization of milieu therapy allows

you to work at a level that is appropriate for you while continuously expanding your skillset.

The ultimate goal is to give you the ability to live autonomously and harmoniously in both

practical and emotional terms.

Safe space: Milieu Therapy offers a safe space in which to cultivate positive coping

mechanisms and build a sense of community.

Comprehensive clinical care: Empirical evidence shows, milieu therapy as one of the most

effective modalities for treating schizophrenia, and by combining it with comprehensive

clinical care in a residential setting, you can begin your journey toward recovery with a

renewed sense of clarity and hope for the future.

Observation and Tracking of Influence of environment on emotional states and other

Schizophrenic symptomatology: Milieu therapy also gives you and your clinical team the

opportunity to observe psychotic phenomena and track the influence of environment on

emotional states and other schizophrenic symptomatology. This helps you gain the insight

you need to identify potential triggers and develop strategies to avoid or manage distressing

symptoms without relying solely, or even primarily, on antipsychotics. For example,

minimizing change, sidestepping chaotic situations, and surrounding yourself with calm,

respectful, kind people can diffuse even acute psychotic disturbances.

Importance of milieu therapy in management of depression

Self- Knowledge: This self-knowledge and ability to modulate your own psychiatric state

can be extraordinarily empowering.

Individualized care: Milieu therapy is for the patient and not for their problem; Patients are

encouraged to learn what their triggers are, communication skills, develop empathy, build

confidence and leadership skills.

Social and personal skills: Patients are also taught social and personal skills that can

motivate them to pull out of their current depression state and be useful throughout their life

too.
Social interaction: Since milieu therapy is conducted as a group activity with

personalized/individual sessions, it offers ample opportunities for patients with depression to

interact with others, participate in activities that can help them regain their confidence in life.

With ample socializing opportunities, patients with depression can discuss with others in their

group how their day was, their thoughts and feelings, etc. Individuals also get constructive

feedback from the therapists and other personnel that further motivates them to feel good

about themselves and their life. This can help patients with depression greatly (Bhat et al,

2020).

Milieu therapy in management of Aggression

Anger management classes often use Milieu Therapy. Participants are free to discuss their

feelings of rage with others who understand, and without being judged. They learn to

recognize when the anger starts to build and what to do to keep it within healthy boundaries.

They practice coping mechanisms in the group (Armiyadi, 2021).

Milieu therapy in management of Alcohol/Drug Addiction

Addiction rehabilitation treatment uses Milieu Therapy to help patients learn to recognize the

types of people, places, and situations that trigger their desire for drugs, alcohol, or whatever

they are addicted to. They can learn from the therapist and from peers in the group how to

avoid those people, places, and situations and how to cope or what better thoughts to think if

they don’t have the option to avoid them. They can also be taught behaviors to practice to

replace the unhealthy habits (Armiyadi, 2021).

2.10 Milieu therapy location types

Community based settings: Community based settings are becoming more popular and many

are led by a trained facilitator rather than a psychiatrist or psychologist. Weight Watchers and
Alcoholics Anonymous are examples of community-led meetings where Milieu Therapy is

practiced.

Residential treatment facility: Inpatient or residential treatment facilities may have

predetermined lengths of treatment, depending on their policies. For example, a hospital ward

might have a time limit that a patient can stay before being required to move to a

rehabilitation center, halfway house, or other community setting.

Halfway house: A halfway house is a residential facility designed to help people transition

into independent living. They were initially developed as drug-free living environments for

people who had completed residential treatment. These houses were meant to be “halfway”

points between the restrictive structure of rehab and the complete independence of home

(Armiyadi, 2021).

Characteristics of milieu therapist

 Shares problems within a context that will benefit others.

 Recognizes the risks involved in honest communication and works to minimize these

risks.

 Communicates an empathetic understanding of others problems.

 Is warm and supportive without excessive attachment.

 Accepts responsibilities for own actions and admits mistakes.

 Works to solve problems independently, asks for assistance when problems exceed own

scope or resources.

 Self- directed in selecting activities that contribute to organizational goals.

 Believes that others enjoy work and responsibility when given the opportunity to

participate in goal setting.

 Sees their contribution in terms of the whole, not only on the task.

 Works with others to achieve consensus in decision making.

 Shares information at the appropriate time and with the appropriate people.

 Acknowledges anxiety and uses resources to cope effectively.

 Seeks feedback about abilities and performance.

 Has a sense of self- worth and self- respect.

 Readily adapts to change.

 Functions comfortably in various roles, acts as either a leader or a follower as the

situation dictates.

 Accepts conflicts and confrontation as normal aspects of life and handles them

effectively.

 Believes that all people can change, grow and function more effectively (Blickford,

2012).

2.11 Role of a nurse in milieu therapy

Physical dimension: The physical aspects of the treatment environment include all concrete

features of the external world. These features include the organization, structure and

interaction of many spatial components. The study of this interrelationship, called proxemics,

is subdivided into three aspects: fixed feature space, semi fixed feature space and informal

space. A nurse participating in the design or renovation of the setting can greatly affect the

therapeutic physical environment. A nurses input concerning the number of activities and

interactions that occur in a dayroom can determine if the design is functional. Shower
curtains, lockers for personal items, bulletin boards to display personal art work and pictures,

and bed side lamps can be added at little costs.

Design features: Several design features can be used to promote orientation. Patterns in floor

coverings and furnishings may be used to identify personal space. These can serve as

orientation supports to assist confused individuals in identifying their special relationship to

others. Perceptual clarity is especially important for stairways to prevent accidents resulting

from confusion.

Nurse’s role: The nurse may interpret the needs of the client population for design experts

with knowledge of color, texture and lighting. All these factors combine to promote

perceptual clarity and orientation. The nurse is often responsible for making referrals,

encouraging client participation and coordinating the team members involved.

Social dimension: The social system of a treatment milieu includes the roles of individual

members, the organization of these roles into a social system based on leadership style,

communication patterns that develop, and staff/ client ratio. The function of the care giver is

to respond to the needs of the client who is seeking assistance. Although each of the care

giver roles described has separate functions, many of them overlap. The delegation of

specific functions is largely determined by the social structure and leadership style of the

treatment setting.

Nurse’s role: Intervening communication pattern effectively is the most significant role of a

nurse

Emotional dimension: The emotional atmosphere can be sensed almost immediately when

one enters a treatment setting

Nurse’s role: In the treatment setting all the group members can be motivated to work toward

the common goal of improved mental health (Hoffman, 2020).

Spiritual dimension: Although providing a specific place for worship is important, the entire

treatment environment can provide the background for meeting the spiritual needs. Important

in this assessment is the provision of quiet spaces and opportunities relating to nature and

other people.

Nurse’s role: The nurse must make sure that physical environment is structured to provide

both private places for contemplation and reflection and larger areas for group interaction

(Kane, 2014).

3.0 Summary

Milieu therapy has shown benefits for people with a wide variety of mental health and

behavioral disorders and is widely used in group counseling for various demographics. This

method uniquely harnesses the environment for therapeutic engagement that extends beyond

the scope of an individual therapy session.

3.1 Conclusion

Milieu therapy interventions are simple, safe, cost-effective which can be used in any

inpatient psychiatric setting. However, there are few experimental studies found on milieu

therapy. Nurses play a crucial role in the management of the therapeutic milieu who carry the

responsibility for ensuring that clients basic needs are fulfilled; assessing physical and
psychosocial status, administering medications, ensuring safety, helping the client to develop

trusting relationships, setting limiting on unacceptable behaviors, structuring ward activities

for the clients, educating patients and caregivers, and ultimately, helping the patients within

the limits of their capability, to become productive members of the society.

3.2 Recommendations

The followings are recommended;

 Government should provide well equipped Therapeutic milieu structures/centers in

Psychiatric hospitals in federal, state level and in the community.

 Rehabilitation centers and half-way home hospitals should be built in communities.

 Awareness and mental Health Education should be made available to general public on

the importance and effectiveness of milieu therapy.

 Trained and professional staffs should be employed in Therapeutic milieu centers,

Psychiatric hospitals and rehabilitation centers.

 Appropriate funds should be allocated to Therapeutic milieu centers and other mental

health homes for an effective management and maintenance.

 REFERENCES

Armiyadi, M. (2021). Milieu Therapy How to implement it in Aceh Mental Hospital

(2nd Ed). University of Chicago press. https://brage.inn.no-

muli/11250/132573.

Baldessarini, R. (2014).The impact of psychopharmacology on contemporary

psychiatry.(ebookedition).59:401-5.John Benjamins Publishing

Company.https://org/10.1007/978-1-4757-4806-2

Bhat S, Rentala S, Nanjegowda R, Chellappan X (2020). Effectiveness of Milieu

Therapy in Reducing Conflicts and Containment Rates Among

Schizophrenic Patients. Invest Educ Enferm Publishing Company.

https://10.17533/idea.iee.ve879eo6.com.
Bickford CJ, (2012). Psychiatric Mental Health Nursing: Scope and Standards of

Practice. Maryland Publishing company.htpps://google

scholar.1007/976-2.

Caesar LG. & Manty J. (2015).The Importance of a Psychiatric Milieu in Inpatient

Settings. (Ebook edition) . Minnesota Cappella university Press.

Enferm. 10.17533/udea.iee.v38n1e06.com

Ergun G, Isik I, Dikec G, (2017). Roles of psychiatry nurses within a therapeutic

environment of Psychiatric Clinics. (3rd edition). 31:248-55. John Benjamin

Publishing Company.

Hoffman , L. (2020). The Evaluation and Care of Severely Disturbed Children and their

Families( ebook edition). Springer Press. https: google scholar1111/ppc.

12725.

Kane C, Brackley M, Clement J, D'Antonio P, Haber J, Hamera E,(2012) Essential

psychiatric of Mental Health and Substance use Competences for the Registered

Nurse; 26:80-110. University of Chicago printing press. https://pubMed Scholar.

Kane CF, (2014).The scope and standards of practice for psychiatric mental health Nursing:

20:1. John Benjamin Publishing Company. https: pubMed Scholar.11275-2.

LeCuyer, E. (2019). Milieu therapy for short stay units: A transformed practice theory.

(3rd Edition) 6:108-16. Arch Maryland Press.

https:s.31:24855.PubMed.Google.Scholar.