Milieu is a French word that refers to the social environment of the individual. Milieu therapy is a type of treatment that involves changing this environment in the hope that it will encourage a client to develop new coping strategies. This treatment will usually involve a long term residential stay within a therapeutic community but it can involve adapting the home life to create a more supportive environment. The aim is to create the right environment where change can take place. This approach has been used for over a century in the treatment of psychiatric disorders and other behavioral problems.
Milieu therapy is based on the theory that the individual can rely on their own inner strengths to change undesirable behaviors. Autonomy and personal responsibility is a key element, but there is also the assumption that social interactions can benefit the individual.
Peer pressure is seen as powerful force that can compel people to adapt to the environment. The impact of peer pressure can be increased through regular feedback sessions within the group.
Milieu therapy works by manipulating the environment in order to benefit the client. This can involve living within a community where life is tightly structured. The interaction of those in the group is important because positive change occurs due to these client to client encounters. Clients are able to provide feedback to each other and solve problems together. The main role of the therapist is to focus on facilitating and observing, but client-staff encounters can also be therapeutic in nature.
In Milieu therapy, the client is expected to take responsibility for their own welfare as well as the welfare of others in the group. The individual learns to develop relationship skills as well as improve their adaptive coping strategies. There will usually be agreed upon rules and expectations that the group will work together to enforce. The goal is that everything within the client’s environment should be therapeutic.
A safe community is one where the client is able to develop and learn. The pressures of living in the outside world may mean that the individual finds it difficult to cope. This inability to deal with life can make it harder for positive change to occur. In Milieu therapy the environment stressors will be kept to a minimum and efforts will be made to eliminate those conditions that can trigger negative reactions from the individual. This removal of threats to the client creates the ideal therapeutic environment. Treatment in this controlled environment will give the client the opportunity to learn new coping mechanisms so that they will be able to better deal with the outside world. There is also a focus on predictability in routine so that the client can develop trust, and further increase the sense of being in a safe environment.
Most Milieu therapy programs will contain an educational component where clients learn about coping strategies. There can also be health promotional classes where the dangers of inappropriate behaviors can be explained. The knowledge can enhance the client’s ability to function well within the group.
Milieu therapy can produce a number of benefits for clients who take part in this type of program.
*The individual learns to take responsibility for their own behavior and the behavior of others in the group.
*The environment feels safe to the client and this makes it easier for them to share their problems and be open about themselves.
*Regular feedback from others in the group allows the client to see how their behavior impacts the community.
*During their time in such a therapeutic community, the individual will be taught new coping strategies that will make life easier to deal with back in the real world.
In a sense, many or most inpatient alcohol or drug addiction rehabilitation programs have milieu therapy as a component, though it may not be understood in those terms. The structured environment of, for example, a 28-day rehabilitation can be powerful in assisting those with alcohol or other addiction problems.
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