In group therapy settings, it includes the social community consisting of others who are part of the group. Using the combined elements of positive peer influence, trust, safety, and repetition, the therapeutic milieu provides an ideal setting for people to work toward their therapeutic goals. A therapeutic milieu can occur in a number of different settings such as in hospitals, outpatient clinics, inpatient clinics, rehabilitation facilities, private therapeutic practices, and at home. Some settings that utilize a therapeutic milieu include alcohol and drug rehab facilities, weight loss groups, and behavioral disorder treatment clinics. Some people feel that within the trusting therapeutic milieu, they are able to try out new coping skills without feeling self-conscious. The use of a therapeutic milieu is part of what is formally known as milieu therapy. This emerged in response to earlier approaches to community care which took a more custodial approach to treatment. People who were in inpatient or community care settings were provided basic care but rarely allowed to participate in their own treatment. Eventually, the idea of the therapeutic community emerged in which all dimensions of the individual’s environment have the potential to have therapeutic benefits.
Components of a Therapeutic Milieu
Some of the keys to a successful therapeutic milieu are support, structure, repetition, and consistent expectations. Therefore, the therapist’s role in developing a therapeutic milieu is both complicated and highly important. The therapist must serve as a role model, practicing the behaviors that are expected of the group. They also facilitate the development of a list of rules and expectations for dealing with infractions without coming across as an authority figure. A therapeutic milieu should provide:
Support
Support can come in many forms, from creating a safe environment to establishing expectations, boundaries, and consistency. The therapeutic milieu should be an environment where people are safe from both physical and emotional danger. Ideally, this environment should be homelike, providing as much privacy as is possible based on resources and the client’s individual needs. The therapeutic environment should also be a place where people feel safe to express themselves and participate without fear of rejection.
Structure
The environment should provide routines such as scheduled daily activities, mealtimes, and free time. This may also include staff-led social skill training, psychosocial education, group therapy, individual therapy, occupational training, recreation therapy, and art therapy. This provides a sense of safety but also allows people in treatment to test new behavior patterns while still having a sense of security and support. The therapeutic environment is beneficial because it allows people to solve problems and try out new behaviors through interactions with others that may include staff members, therapists, nurses, and other patients.
Consistency
In addition to creating routines, the milieu should provide consistency. Therapists and other personnel should have behavioral expectations that are clearly explained. This includes limits and boundaries that are consistently maintained. Having established norms that are consistent throughout the therapeutic environment helps people better understand what will be expected of them and what they can expect from others. While behavioral expectations are important, people should also be allowed to exercise as much of a sense of personal control as possible.
Cohesion
In inpatient settings, people learn healthy patterns of living through constant exposure to role models. The goal is to promote group cohesion and togetherness. In the absence of regular interactions, the positive peer pressure, trust, and repetition that this technique relies on cannot develop properly.
Vulnerability
Although it takes time to achieve, a successful therapeutic milieu is a safe and trusting environment. People feel free to experiment with behavioral changes and discuss deep secrets without fear of judgment or reprisal. One benefit in a community or group setting is that people are also exposed to the struggles of others. This can build empathy and understanding, reduce the feeling of being alone, and help spark new ideas on how people can handle their own difficulties.
Benefits of Milieu Therapy
Some of the benefits that a therapeutic milieu may provide include:
The ability to feel both physically and emotionally safeThe setting helps encourage people to take responsibility for their behaviorPeople can get feedback from therapists, other personnel, and others in the communityThe opportunity to learn and practice new coping skillsThe ability to try out new behaviors in a safe and supportive environment
Challenges to Therapeutic Milieu
Whether treatment is short-term, a month or less, or long-term, up to 12 months, there are challenges to this type of treatment environment. Ongoing participation is often an essential part of maintaining the gains achieved while in this type of setting. When treatment ends or changes, people may experience significant setbacks as a result of losing the support, structure, and familiarity of the therapeutic environment. It may be helpful to stay in touch with others who have also been in treatment. This can help people cope with their own personal freedom after the therapy setting changes. Changes to the therapy environment, such as staff members leaving or new personnel being introduced, can also lead to struggles. These challenges to therapeutic milieu can be overcome with foresight and proper preparation for both practitioners and patients.
