Milieu Therapy

Benefits of Milieu Therapy


The history of milieu therapy extends back to the late 1700’s, and its use was so effective that it is still in use today for many disorders.



The word “milieu” when translated from its French origin means surroundings or environment.  The idea behind this form of treatment was to integrate humanity into the therapy of psychiatric care, which in the early days was a frightening experience utilizing chains, beatings, electroshock, spinning and immobilizations.  As recently as the 1900’s, lobotomies were being performed on individuals with various types of mental conditions.


Needless to say, these types of “treatment” were under scrutiny as moral treatment of patients with psychiatric problems.  Hundreds of thousands of people were murdered in attempts by psychiatrists to treat them.  A small percentage of psychiatrists recognized as early as the 1700’s there were better and more successful methods of treating people with mental issues by using kindness, gentleness and humanitarianism to treat a variety of disorders in children, women and men.  It was called milieu (or mileux) therapy.


How it works

Changing the environment in a way that ensures every aspect of the hospital experience is therapeutic is the major goal of this form of treatment.  Making these changes to an individual’s current life situation as well as the environment is found to improve the value of all other therapy that person is undergoing.  By enhancing these aspects of treatment, the patient’s mental health improves, as does their ability to function in everyday life.


By integrating a therapeutic community that includes groups of individuals, people grow familiar and accustomed to their environment.  Located within a hospital, the atmosphere exhibits anything but what is normally encountered in such an institution.  Staff and patients alike are encouraged to wear traditional street clothing to bolster an everyday feel.  The length of stay within this environment will vary according to the place, the patients and the type of disorder being treated.


Milieu has been used extensively in the areas of autism, personality disorders and those with behavioral issues.  The focus of the therapy in all types of disorders is to offset negativity, reverse the deterioration of patients often seen in cases of institutionalization, increase the patient’s independence in both thought and actions as well as to link them positively to society.  To reach these goals, there are certain strategies adopted and practiced during therapy:


  • Open communication
  • Structured interactions
  • Involvement of family and friends
  • Activities that relate to the individual’s work and life
  • Changing the environment to meet each person’s developmental needs
  • Equal distribution of power


Throughout therapy, progress is gauged by the professional staff, and the levels of responsibility assigned to patients adjusted according to positive steps forward.


How it helps

Being a member of an environment that is safe and secure where all one’s basic needs are met is a comforting and satisfying situation.  Far removed from the shame their condition provokes in social settings, the patient begins to relax and become more open to further therapy.


In addition, patients feel that their humanity is validated within a group that reaffirms their value and individuality.  Interacting with other group members in milieu therapy is guided through rules and consequences set forth early in the group’s formation so everyone understands and agrees to abide.  Open communication is strongly encouraged, with patients opening up in a safe place with supporting professional staff.  Improving the confidence and esteem of patients is accomplished through praise, support, reassurance and positive attention.


Because the group functions as a unit, each member of the group has a vote in activities as well as decision making actions that will affect other members of the group.  This promotes responsibility and self-confidence, and begins to prepare the members for life outside of the therapeutic atmosphere.  Operating as a unit means accepting responsibility on all levels, so work activities are integrated into the therapy as well.  This provides not only some form of monetary reward but feelings of accomplishment for the patient.


Behind the scenes

There is much more to milieu therapy than just running a group.  Behind the scenes, a full team of professionals that include psychiatrists, clinical nurses, social workers, occupational therapists, mental health technicians, recreational therapists (including music and art), dieticians and chaplains oversee and interact with different aspect of the group.  Of course, each type of mental disorder requires its own specialized teams, so the combinations will vary accordingly.



When the group interaction is successful (which is more often than not), a patient can walk away with an improved sense of being.  Over the period of time prescribed within the unit, leadership skills, social skills, self-confidence, self-esteem, relationship building skills and a more at peace attitude should have been instilled in the patient.



In some situations, becoming accustomed to a regimented safe haven and then joining the real world can be a difficult adjustment for the patient.  In addition, an individual must be hospitalized in order to be eligible to join milieu therapy.


The overview of milieu therapy is much more positive than previous treatment beliefs and processes from previous days.  Though it seems to be simple common sense in retrospect to realize that all any individual wants is to be treated humanely, it has taken the medical world over 200 years to integrate it into treatment of mental disorders.