Milieu therapy is the treatment of mental disorder or maladjustment by making substantial changes in a patient's immediate life circumstances and environment in a way that will enhance the effectiveness of other forms of therapy.

1. MIILIEU THERAPY/THERAPEUTIC
COMMUNITY
PRESENTED BY:-
MS. NEHA SHARMA

2. INTRODUCTION

3. MEANING

4.  A scientific structuring of the environment in order to
effect behavioural changes and to improve the
psychological health and functioning of the individual
(Skinner, 1979
DEFINITION

5. TYPES:-
Genuine therapeutic
community of
Democratic/Analytic
Therapeutic milieu of
institutional
Social therapy or
concept –based therapy

6. GOALS

7. CONT….
 Change maladaptive behaviour
into adaptive behaviour.
 Provides conducive environment
(free and favourable climate) in
which the client can talk and be
aware about his feelings, impulses
and behaviour.

8. CONT….
 Promotes early recovery.
 To make the clients to
understand how their
behaviour will be effected,
with the behaviour of
others.

9. CONT….
 To enable the client to
actively participate in his
living activities and will be
actively involved in community
Activities.
 Staff members will help the
client to to take their own
decisions

10. CONT….
 To improve the self-esteem.
 To promote group and social
interaction.
 The client is expected to learn
adaptive or coping techniques

11. CONT….
 To promote self confidence.
 To manipulate the
Environment.
 To resocialise the client

12. FUNCTIONS OF MILIEU THERAPY

13. CONT….
 1. Shelters clients physically from what they perceive as painful,
terrifying stressors.
 2. Protects clients physically from discharges of their own and
others’ maladaptive behaviours.
 3. Provides pleasant, attractive, sensory stimulation to clients.
 4. Educates clients and their families about adaptive, effective
coping

14. CHARACTERISTICS OF MILIEU THERAPY:
 Several strategies have been developed to counter these negative
effects. They include
 Basic physiological needs are fulfilled.
 The physical facilities are conducive to achievement of the goals
of therapy.
 Distribution of power/A democratic form of self-government
exists.
 Responsibilities are assigned according to clients capabilities.

15. CONT….
 Open communication
 Structured interactions
 Work- related activities.
 Community and family involvement in the treatment process
 Adaptation of the environment to meet developmental needs.

16. PRINCIPLES:-
 DEMOCRATIZATION.
 PERMISSIVENESS.

17. CONT….
 COMMUNALISM.
o REALITY CONFRONTATION.
o GROUP ACTIVITY.

18. CONT….
 DECISION-MAKING.
 PATTERN OF ATTENTION.

19. BASIC ASSUMPTIONS
 Skinner outlined seven basic assumptions on which a therapeutic
community is based:
 The health in each individual is to be realized and encouraged
to grow.
 Every interaction is an opportunity for therapeutic
intervention.
 The client owns his or her own environment

20. CONT….
 Each client owns his or her behaviour.
 Peer pressure is a useful and a powerful tool.
 Inappropriate behaviours are dealt with as they occur.
 Restrictions and punishment are to be avoided.

21. KEY PARAMETERS IN SETTING –UP
THERAPEUTIC COMMUNITY
 SIZE OF THE UNIT:-20-30members

22. DURATION OF TREARMENT

23. PHASES OF TREATMENT FOR THE
INDIVIDUAL
STARTING
TREATMENT
MIDDLE PHASE
ENDING
TREATMENT

24. COMPONENTS OF THERAPEUTIC
COMMUNITY.
DAILY
COMMUNITY
MEETINGS
PATIENT
GOVERNMENT
OR WARD
COUNCIL
FORMAL
TRAINING, IT
PROVIDES
LIVING
LEARNING
OPPORTUNITIES
STAFF
MEETINGS OR
REVIEW:-

25.  Free and effective communications, interaction.
 Shared responsibilities and active involvement in
community activities.
 Understanding of roles/responsibilities, abilities,
limitations authorities.
 Manipulation of environment to fulfil their needs and
demands.
ELEMENTS OF THERAPEUTIC COMMUNITY:-

26. TYPES OF STAFF INVOLVED IN THERAPEUTIC COMMUNITY:-
 Psychiatrist.
 Psychiatric clinical nurse.
 Clinical psychologist.
 Medico-social worker.
 Technical staff and
 Support personnel.

27. CONT….
 Mental health technician.
 Occupational therapist.
 Art therapist.
 Music therapist.
 Psycho-dramatist.
 Dietician.
 Chaplin.

28. THE THERAPEUTIC TOPICS FOR CLIENT EDUCATION:-
 Ways to increase self-esteem.
 Stress management techniques.
 Anxiety reduction programmes.
 Normal stages of grieving and
behaviour associated with
each stage.
 Assertiveness techniques

29. CONT….
 Relaxation techniques.
 Effects of substance abuse.
 Problem solving techniques
and skills.
 Thought stopping/thought
switching techniques.
 Sex education.

30. CONT….
 Effective parenting technique
 Medical diagnosis.
o Therapies and follow-up care.

31. INDICATIONS:-
 Dependence syndromes.
 Depressive disorders.
 Neurosis.
 Somatoform disorders.
 Personality disorders

32. CONT….
 Self harming nature.
 Drug abuse.
 Violent offenders.
 Schizophrenia.
 Enduring mental illness

33. CONTRAINDICATIONS:-
 Severe depression.
 Acute attacks of mania.
 Paranoid delusions and
paranoid personality.

34.  Initiates good interpersonal relationships among
residents and staff members.
 Residents will gain self confidence.
 Learns to understand themselves and understands others.
 Decides themselves related to their issues and help others
to solve their problems.
 Relearns socialization skills.
ADVANTAGES OF THERAPEUTIC COMMUNITY:-

35. CONT….
 Promotes collective thinking and participates in social activities.
 Participates in formulation of rules and regulations of
community by actively involving in community meetings.
 Residents learn adoptive acceptable behaviour in the therapeutic
environment.
 To improve self-esteem.
 Minimizes hospital stay and disability.

36. CONT….
 To foster therapeutic environment.
 Provides opportunities to participate in community as well as
hospital administration.
 Residents will become less dependent and passive.
 Enhances interaction among the residents.

37. CONT….
 Every individual in the community (staff and residents) will be
fully aware of their roles, limitations and responsibilities.
 Residents and staff members will be involving in decision making
process actively.
 Staff will be able to provide the required information to the
residents about job oppurtunities, half-way homes, and self help
groups.
 It creates positive attitude and inculcates conduxcive approach to
live happily among residents, as it creates homely atmosphere.

38. CONT….
 Client becomes less dependent and passive.
 Resident also involved in making decisions related to war
management and involved in caring other residents.
 Client will be able to learn adaptive, acceptable behaviour.
 Residents will be able to control their negative emotions, e.g.
Hostility, anger.

39. DISADVANTAGES:-
 As it is a group responsibility,
there is a chance nobody will
feel a sense of responsibility.
 Individual’s needs and
concerns may not be met.
 Client may find the
transition and difficulty to
survive within the community.
 Role confusion may be felt
for both staff and residents.

40. ROLE OF NURSE:-

41. ASSIGNMENT
Make the Assignment on Role of Nurse in Milieu Therapy.

44. RESEARCH ABSTRACT
Effectiveness of Milieu Therapy in reducing conflicts and containment rates among
schizophrenia patients
 Objectives: To evaluate effectiveness of Milieu Therapy in reduction of conflict and
containment rates among schizophrenia patients.
 Methods: This study utilized quasi experimental non-equivalent control group pre-
post design. One hundred schizophrenia patients admitted in acute psychiatric
wards were non-randomly assigned to either of the experimental (n=50) or control
group (n=50). The experimental group received both milieu therapy and routine
hospital treatment. The Milieu Therapy intervention Included environmental
modification and structuring ward activities, establishing effective interaction with
patient, and teaching caregivers on managing conflict behavior of patient. The
control group received only routine treatment in the hospital. Outcome measures on
conflict and containment rates were evaluated for both the groups at baseline and at
2nd, 3rd and 15th day. The Patient-Staff Conflict Checklist Shift Report (PCC-SR)
was used to collect information about rates of conflict and containment.
 Results: Compared with control group, the experimental group participants showed
decrease in aggressive behavior, self-harm behavior and general rule breaking
behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p < 0.004, η2=0.04;
F=11.92, p < 0.001, η2=0.11; F=6.94, p < 0.001, η2=0.06) over seven days interval.
 Conclusions: The present study findings provided evidence for the effectiveness of
integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors
among schizophrenia patients. Milieu therapy should be considered as an integral
part of psychiatric care settings in these patients.

45. REFERENCES:
 TOWENSEND C. MARY, MENTAL HEALTH
NURSING,8TH EDN,PUBLISHED BY JAYPEE
PUBLICATIONS.
 WWW.PSYCHOTHERAPIES. COM.
 SREEVANI R, GUIDE TO MENTAL HEALTH AND
PSYCHIATRIC NURSING, PUBLISHED BY
JAYPEE PUBLICATIONS.