Care Counseling: Milieu Therapy

Milieu Therapy

There is power in numbers when impacting change, especially when one is surrounded by a group of supportive individuals in a physically and emotionally safe environment.

Check out Milieu Therapy—an approach where the social environment is incorporated as the therapy.

This approach uses a therapeutic-milieu consisting of a therapeutic community. An important foundation is within the environment itself for successful results. It should have the following elements—

Structure
Support
Safety
Respect
Routine
Consistent Expectations

Milieu-therapy incorporates daily living activities in an environment that supports shaping behaviors, grounded in values within the social setting. There is an emphasis on collective responsibility, self-expression, and immediate feedback.

Milieu therapy is commonly seen in substance-use-related settings such as residential programing, intensive outpatient programs, or group supports such as Alcoholics Anonymous to help change patterns of behavior and thinking patterns. Milieu therapy is similarly found in mental health settings and places that support well-being such as weight-loss clinics.

A multidisciplinary team may include but is not limited to mental health counselors, psychiatrists, medical doctors, nurses, nutritionists, drug and alcohol counselors, occupational therapists, behavioral specialists, art therapists, and peer leaders who are active in modeling and socializing values and behaviors within the milieu.

Since the environment is a supportive element of change, the important foundational elements noted above are essential as guiding-principles for establishing a therapeutic milieu. The facilitator or therapist’s role helps set the structure and model behaviors, while individuals work together within a community of peers to participate in their own treatment. Discussing topics such as confidentiality and behavioral expectations while also ensuring that these are consistently maintained is important to help each person feel safe and supported. Ideally, a therapeutic milieu will help others share to where they can be vulnerable with others to facilitate healing in a supportive space that is accepting without judgment.

While milieu therapy is in a group format, each person focuses on taking individual responsibility. Groups activities within the community help create opportunities to learn skills together and try out new skills together and work together during times of setback. These skills can then be transferred and applied in one’s own home and broader community-based settings.

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