Use of the environment or residential settings as a training ground for patients to participate in social, interpersonal and functional skills and to test their ability to deal with problems commonly encountered in the community.
The therapeutic environment of the inpatient wards is called the Therapeutic Milieu.
Formal milieu therapy depends on attention to the social structure of the ward and depends on an adequate number of well-trained staff.
Interactions between staff, patients and formal social organisations are tools regularly used in milieu therapy.
Nowadays, trends are shifting away from an emphasis on milieu therapy due to shorter hospital stays and a shift in the hospital’s focus to diagnosis, rehabilitation, and psycho-educational activities.
There are three components in milieu therapy –
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Structure
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Flexibility
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Ward community
1. Structure –
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The structure of the ward should contain regular structured activities and help with personal hygiene and self-care.
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Milieu therapy avoids intense probing and anxiety-provoking psychotherapeutic interventions.
2. Flexibility –
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The milieu should be flexible enough to respond to the engaging needs and individuals with regard to the length of stay, the extent of restrictions, contact with family, group involvement and activity levels.
For example, with improvement in the symptoms, efforts may be initiated to increase the patient’s socialisation with other patients, and engage in the patient’s participation in the ward.
3. Ward community –
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The patients, as individuals and as a group, are components of the ward community.
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They are also used as therapeutic agents in the therapeutic milieu.
For example use of more organised and improved patient can act as models. -
The patients are encouraged as a group to make decisions about the daily activities of the ward and to help change the maladaptive behaviour of patients through open feedback.
Side effects of milieu therapy –
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Exaggeration/exacerbation of psychotic symptoms or delay in recovery if premature, harsh confrontation with staff and other patients, or too much pressure for recovery.
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Dependence on ward – a structured and tolerant atmosphere may promote dependence, making it difficult to return to the community.
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Overstimulation and disorganisation can be caused if excessive demand is placed for participation in any activity.
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Less ill patients may take advantage of sicker patients unless the interactions are monitored carefully.
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Staff may retain patients in the ward milieu for longer than is desirable. Staff believe that they understand the patient better than anyone else.
Objectives of my leave therapy –
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The major therapeutic objective of milieu therapy is the maintenance of the achieved status in the rehabilitation program.
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It attempts to provide the patient with the necessary social, psychosocial and performance skills to overcome frustration, deal effectively with new or risky social situations, cope with rejection and remain independent.
