Milieu therapy

RENU JOSHI
ASSISTANT PROFESSOR
SANTOSH MEDICAL COLLEGE
Milieu therapy
 The milieu therapy in that the word milieu is the French for “Middle”.
 The English translation of the word is SURROUNDINGS OR
ENVIRONMENT.
 In psychiatry, therapy involving the milieu or environment , may be
called milieu therapy.
 The therapeutic milieu is an environment that is structured and
maintained as an ideal, dynamic settings in which to work, with client.
 The milieu therapy include safe physical surrounding, all the
treatment team members, and other client.
GOALS

• Changes maladaptive behavior into adaptive behavior

• Promotes early recovery
• Minimizes prolongation of hospital stay.
•To re-socialize the client.
• To promote self- confidence
OBJECTIVES

• To use patients social environment to provide a therapeutic

experience for him.
• To enable the patient to be active participant in his own care and
become involved in daily activities of his community.
• To help patients solve problems, plan activities and develop the
necessary rules and regulation for the community.
PRINCIPLES OF MILIEU THERAPY
• To promote a fundamental respect for individual.(staff and client)
• To use the opportunities for communication between client and staff
for maximum therapeutic benefit.
• To encourage client to cut at a level equal to their ability and to
enhance their self-esteem.
• To promote socialization.
• To provide the opportunities for clients to be part of unit
management.
• Individuals are held responsible for own action
• Client is expected to learn adaptive coping, interaction and
relationship skill that can be generalized to other aspects of his or her
life.
• Achieving client autonomy.
• Peer pressure is utilized to reinforce rules and regulations.
• Team approach is used.
• Group discussions and temporary seclusions are favored approaches
for acting out behaviour.
CHARACTERISTICS OF MILIEU
THERAPY
1) DISRTIBUTION OF POWER
2) OPEN COMMUNICATION
3) STRUCTURED INTERACTION
4) WORK RELETED ACTIVITY
5) COMMUNICATION AND FAMILY INVOLMENT IN TRETMENT
6) ADAPTATION OF THE ENVIRONMENT TO MEET DEVELOPMENTAL
NEEDS
1. DISRIBUTION OF POWER

• The milieu therapy approach involves ‘flattening’ the control

hierarchy so all participants have a voice in decision making.

• This process may include the whole population of the treatment unit,
or a governing council may take the final decision based on input from
various smaller groups of clients and staff members.
2) OPEN COMMUNICATION.
• In the therapy, treatment decisions are often made by the client
themselves , who therefore need information to make effective
decision.

• It is not necessary to communicate personal information but clients

and staff need to be aware of individual treatment goals to ensure
everyone is working towards the same goals.
3) STRUCTURED INTERACTION

• It’s a interaction approach is that all staff members approach the

client in a consistent manner, acknowledging specific diagnostic areas,
therapy shortening treatment time
4) WORK- RELATED ACTIVITIES

• Frist, clients need to choose the type of work they wish to perform.

• Second, work activity should be geared towards developing skills

that will be useful in actual job situation.

• Thirds, a variety of activities provide the opportunities to test

different areas for future job interest.
5) COMMUNITY AND FAMILY INVOLVEMENT IN THE
TRETMENT PROCESS
• Clients are kept in their usual environment, for example a day treatment
centre, or halfway house, and continue most of their routine activities
while receiving treatment.

6) ADAPTATION OF THE ENVIRONMENT TO MEET THE

DEVELOPMENTAL NEED
• To develop his full potential an individual must have an environment
adapted to his current need.
• Adapting the environment to meet these multiple needs is challenging
due to the extension of milieu therapy to all age group and the inclusion
of family members with individuals of varying ages within the treatment
milieu.
COMPONENTS OF MILIEU THERAPY

1) MAINTAIN SELF ENVIRONMENT

2) THE TRUST RELATIONSHIP
3) BUILDING SELF- ESTEEM
4) LIMIT SETTING
1) MAINTAINING SAFE ENVIRONMENT:
Dispose of all needles safely and out of reach of client.
 Do not allow smoking.
 Restrict or monitor the use of matches and lighters.
 Keep away sharp instrument from patient.
 Identify potential weapons e.g. mop handles, hammers.
 Do not leave medicines unattended or unlocked.
 Be aware of items that are harmful if ingested, e.g. mercury in monometer.
2) THE TRUST RELETIONSHIP

One of the key to therapeutic environment is the establishment of

trust.
Trust is the foundation of therapeutic relationship, and limit settings
and consistency are its building blocks.
3) BUILDING SELF-ESTEEM
Set and maintain limits.
Accepts the clients as a person.
Be non-judgmental at all times.
Structures the clients time and activities.
Initially provide the client with task, responsibility and activities.
Allow the client to make his own decisions whenever possible
4) LIMIT SETTINGS
• State the expectation or limits as clearly, directly and simply as
possible.
• The consequence that will follow the clients exceeding the limits also
must be clearly stated at the outset.
• The consequence should immediately follow the clients exceeding's
the limits and must be the consistent, both over time and among staff
Advantages of milieu therapy

1. Its create different type and attitude and behaviour of client because the
environment like home.
2. Patient learn the making decisions which improve his self confidence.
3. Its develop a leadership skill.
4. It becomes the sociocentric.
5. Its help to learns the live and think collectively with the members of the
community.
DISADVANTAGES OF MILIEU
THERAPY
• Role blurring between staff and patient.
• Milieu therapy is limited to only hospitalise patient.
• Requires continuous open communication among all staff and clients.
• Group responsibility can easily becomes nobody’s responsibility.
• Low client-to-staff ratio.