Psychosocial interventions

1. MILIEU
THERAPY
Sudipta Debnath

2. Overview
• Definition
• Goals
• Basic assumptions
• Conditions that promote
• Principles
• Indications contraindications
• Components
• Key parameters
• Advantages disadvantages
• Types
• Topics for education
• Nurses’ role

3. Meaning
• Milieu is the French word for “middle”.
• In English, milieu means “surroundings, or
environment.”
• The concept first developed by Maxwell Jones
in 1953.

4. Definition
• The total resource of the staff, the resident,
their relatives, and the institution are pooled for
the purpose of treatment
(Maxwell Jones, 1959)
• A scientific structuring of the environment in
order to effect behavioral changes and to
improve the psychological health and
functioning of the individual (Skinner, 1979).

5. Goals
1. Providing physically and psychologically safe
environment
2. Maximizing the highest level of psychological
functioning

6. 3. Identifying acute or chronic physical illness
that are affecting psychiatric symptoms
4. Promoting healthy coping behavior strategy
and symptoms management

7. 5. Helping to promote independence activities
of daily living
6.Educating clients and their families about
medications and other therapeutic modalities

8. Basic Assumptions – BF Skinner (1979)
1. The health of each individual is to be realized
and encouraged to grow.
2. Every interaction is an opportunity for
therapeutic intervention.
3. The client owns his or her own environment.
4. Each client owns his or her own behavior.
5. Peer pressure is a useful and powerful tool.
6. Inappropriate behaviors are dealt with as
they occur.
7. Restrictions and punishment are to be
avoided.

9. Conditions that Promote a Therapeutic
Community
1. Basic physiological needs are fulfilled.
2. The physical facilities are conductive to achieve the
goals of therapy.
3. A democratic form of self-government exists.
4. Unit responsibilities are assigned according to patient
capabilities.
5. A structured program of social and work-related
activities is scheduled as part of the treatment program.
6. Community and family are included in the program of
therapy in an effort to facilitate discharge from the
hospital.

10. PRINCIPLES..
1. Democratization: every
member has to share equally in
decision making
2. Permissiveness: every member
has to tolerate each others
behavior
3. Communalism: free and
effective communication &
sharing of amenities , to reduce
authoritativeness and isolation
4. Reality confrontation to
counteract denial, withdrawal or
distortion

11. Contd…
5. Group activity to solve problems
6. Decision making by residents to increase
their self confidence
7. Attention to be focused on their and others
need as well
8. Easy approach to interact with the hospital
staff without any inhibition
9. One-to-one contact to be developed
10.Nurse has to be consistent and continuous
assessment to be done

12. Indications
• Dependence syndrome
• Depressive disorders
• Neurosis
• Somatoform disorders
• Personality disorders
• Self harming nature
• Drug abuse
• Violent offenders
• Schizophrenia
• Chronic mental illness

13. Contraindications
• Severe depression
• Acute attacks of mania
• Paranoid delusion
• Paranoid personality

14. Characteristics / Elements
1. Individual treatment program
2. Self governance
3. Progressive level of responsibility
4. A variety of meaningful activities
5. Links with the client’s family
6. Links with the community
7. Effective working relationship among mental
health team members

16. Contd…
• Staff meetings/review
– To be held after each community meeting
– Patients are excluded
– Examine expenses, expectations and prejudices
• Living and learning opportunities
– Realistic learning experiences to be provided

17. Key parameters in setting up for
Milieu therapy
• Size of the unit
– 20-30 residents
• Duration of the treatment
– 9-18 months
– Divided into many phases
– For children and adolescents, up to 5 years
• Relations with the parent organizations and
wider community

21. Topics for client education
i. Ways to increase self esteem
ii. Ways to deal with anger properly
iii. Stress management techniques
iv. Problem solving skills
v. Thought- stopping/ thought- switching
techniques

22. vi. Essentials of good nutrition
vii. Assertive techniques
viii. Recognize signs of anxiety
ix. Relaxation techniques
x. Effects of substance in the body

23. xi. Sex education
xii. Medication

25. Disadvantages
• Role blurring between staff and patient
• Group responsibility can easily become no
ones responsibility
• Individuals needs and concerns may not be
met
• Patient may find the transition to community
difficult

26. NURSES’ ROLE
According to Jones

27. Authoritarian role
• Maintains trusting relationship
• The IDT works within the milieu in a
constructive and holistic manner in providing
productive & desirable effective treatment

28. Social role
• Nurse, encourages the residents to communicate
freely, actively & effectively to participate
• Provides moral support
• Maintains safe and conflict free environment
• Encourages residents to participate in decision
making
• Assists the patient to assume leadership roles by
role modeling, giving feedback
• Carries out supervisory roles
• Helps the patient to build self esteem

29. Therapeutic role
• Establishes therapeutic nurse patient relationship
• Uses confrontation judiciously in a supportive
manner
• Allows the pt to identify an alternative approach
to problem solving
• Pt’s abilities, strengths are constructively made to
influence their own environment
• Manipulates the environment to have therapeutic
effect

30. Assignment
Read about the phases of
Milieu therapy

31. CONCLUSION