What Is Milieu Therapy?

Milieu therapy is a type of therapy that changes or creates an environment to support patients' goals. It can be used in an individual or group setting and is effective for learning coping skills, addiction treatment, and building relationships.

This article explains the history, goals, benefits, and drawbacks of milieu therapy and how to get started with the approach.

Mature adult therapist listens to mid adult male client

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Milieu Therapy for Mental Health

Milieu therapy focuses on changing a patient's surroundings, especially the social and physical elements, to promote healthier emotions and behaviors. Examples of milieu therapy include a children's therapy office that looks like a playroom, an addiction treatment facility with enrichment activities, and a staff lounge where workers can share their concerns.

History

In the 1700s, the French physician Dr. Philippe Pinel noticed patients in inpatient mental health facilities were less violent when permitted to move around. The Quakers brought the idea of letting patients move around to the United States, but it became less common in the 1800s and early 1900s.

In the late 1920s, psychiatrist Harry Stack Sullivan observed that his patients with schizophrenia were not psychotic around some staff members. Sullivan then began experimenting with patients' relationships and living environments. The phrase "milieu therapy" was used by Dr. Mary White, one of Sullivan's students.

In the 1950s, child psychologists Fritz Redl and Bruno Bettelheim popularized the idea that children being treated in mental health facilities needed environments and relationships that supported well-being. The idea of a "therapeutic community" was developed by psychologist Maxwell Jones in 1953, and by the 1960s, most mental health care facilities in the US acknowledged that a patient's environment was a part of effective treatment.

Goals and Environment

Milieu therapy's goal is to make all aspects of a patient's environment therapeutic, including relationships with staff and other patients, their schedule, and diet. In milieu therapy, every patient interaction could be an opportunity for growth. Patients within a therapeutic milieu are expected to learn or re-learn skills that prepare them for independent living.

Milieu therapy focuses on developing skills like:

  • Personal hygiene
  • Creating and maintaining healthy boundaries with others
  • Money management
  • Time management
  • Organizational skills

Pillars of Milieu Therapy

Pillars of milieu therapy include:

  • Containment: Providing physical safety for patients via food, shelter, and supervision without harsh punishment
  • Support: Supporting patients and their progress with the goal of increasing self-esteem
  • Structure: Providing structure and a daily routine
  • Involvement: Encouraging patients to be active within the facility and its events
  • Validation: Validating the patients' decision-making without judgment


Read more: What Is a Support Group?


Who Can Benefit from Milieu Therapy?

Milieu therapy can be applied to most treatment settings, including:

  • Inpatient psychiatry for youth and adults
  • Addiction treatment
  • Senior care
  • Individual and group therapy
  • Workplaces (adding things like lounges to the environment where people can socialize and relax)

It can also help with:

  • Patients in need of a controlled environment, such as those in a 12-step program (mutual aid programs designed to help people overcome addictions)
  • Patients wanting to learn emotional coping skills without judgment
  • People in need of relationship healing or building skills
  • Patients with schizophrenia
  • Children in clinical settings
  • People who enjoy collaborative environments
  • Healthcare workers who want to feel more connected to patients

Benefits vs. Drawbacks

 The benefits of milieu therapy include:

  • Learning coping mechanisms that can be applied to everyday life
  • Developing social and life skills
  • The possibility of less conflict among schizophrenic patients
  • Fewer restrictions on patient movement
  • Health care workers and patients feeling more empowered to create change

Drawbacks of milieu therapy (for both patients and providers) include:

  • Feeling vulnerable
  • Feeling physically or emotionally hurt by patients
  • Group dynamics creating interpersonal conflict
  • Difficulty with professional boundaries

Enrolling in a Milieu Therapy Program

A therapeutic milieu can be applied to most environments. When searching for a facility or therapy that acknowledges the need for environmental support, you might consider researching:

  • How relationships between staff and patients are conducted
  • Facility structure and schedule
  • What activities are available
  • How staff turnover is managed
  • The number of patients per staff member
  • Group and individual therapy requirements and expectations
  • Goals and expectations for life after after the program

Life After Milieu Therapy

One pillar of of milieu therapy is teaching coping skills via relationship building and life skills training. Life after milieu therapy might include follow-up visits and continued individual and group therapy. It might also include adjusting to life without certain relationships, including those with therapists and other staff. It's important for patients to prepare for life after milieu therapy through training and expressing any doubts to therapists within the program.

Summary

Milieu therapy is based on the premise that a person's environment can affect how they heal. A children's treatment facility decorated with childlike themes or an addiction treatment center with life skills training are two examples of therapeutic milieu. Therapeutic milieu can include everything from relationships with others in a facility to a structured environment with a set schedule and enrichment activities.

Milieu therapy can be applied to group, individual, inpatient, and outpatient settings. Before enrolling in a milieu therapy program, it might be important to ask about group requirements, structure, scheduling, and life after treatment.

A Word from Verywell

We're all affected by our living environment and our relationships. In that sense, finding a treatment facility or office with the right therapeutic milieu for you could be one way to start a mental health journey. Within milieu therapy, a person can receive group support, learn coping and life skills, live or receive treatment with an organized schedule, heal relationship issues, and feel physically comfortable in their surroundings. We all deserve surroundings that support our well-being. Learning about the principles behind milieu therapy could be a significant way toward building such a world for yourself.

Frequently Asked Questions

  • How can family members stay involved during milieu therapy?

    Studies show social systems, including family, can be crucial for someone facing mental health challenges. Family therapy can be an important part of milieu therapy during treatment, including during residential stays. Family members can contribute to creating a therapeutic milieu at home by being supportive and refraining from overly harsh personal criticism of someone in recovery.

  • Which government programs use milieu therapy?

    Therapeutic milieu is a concept applied to several government programs. Public schools implementing programs to reduce bullying or truancy apply principles of milieu therapy, as do prison programs with rehabilitation services, exercise facilities, and skills training. The US Substance Abuse and Mental Health Services Administration (SAHMSA), which provides addiction treatment services and information to the public, supports milieu therapy practices by funding community centers and outreach programs.

  • Does milieu therapy work for multiple mental health conditions?

    Milieu therapy can be applied to multiple mental health conditions occurring at once (dual diagnosis). If you're seeking milieu therapy for a dual diagnosis, try to find facilities that have services for multiple conditions and where a supportive, personalized milieu is encouraged.


16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Neha Kashyap
Neha is a New York-based health journalist who has written for WebMD, ADDitude, HuffPost Life, and dailyRx News. Neha enjoys writing about mental health, elder care, innovative health care technologies, paying for health care, and simple measures that we all can take to work toward better health.