Milieu therapy involves structuring the patient's entire environment and social interactions as part of treatment. The therapeutic environment aims to help patients learn adaptive coping skills, social skills, and work towards autonomy. Key aspects of milieu therapy include distributing power equally, open communication, structured social activities and work, and adapting the environment to meet patient needs. Nurses play an important role by helping design the physical setting, coordinating the treatment team, and interpreting patient needs.

1. milieu therapy
MR. KULTHE VIKRANT R
M SC NURSING

2. INTRODUCTION.
The milieu therapy in that the word milieu is the French for “Middle”.
The English translation of the word is SURROUNDINGS OR ENVIRONMENT.
In psychiatry, therapy involving the milieu or environment , may be called
milieu therapy.
The therapeutic milieu is an environment that is structured and maintained
as an ideal, dynamic settings in which to work, with client. The milieu
therapy include safe physical surrounding, all the treatment team
members, and other client.

3. PURPOSES OF MILIEU THERAPY
• Correct the redefine perception of stressors.
• Correct the maladaptive behaviour.
• Develop adaptive coping.
• Acquire interpersonal and stress-management skill.
• Manipulate the environment so that all aspects of clients
hospital experiences are considered therapeutic.
• Client is expected to learn adaptive coping, interaction and
relationship skill that can be generalized to other aspects of his
or her life.
• Achieving client autonomy.

4. PRINCIPLES OF MILIEU THERAPY
• To promote a fundamental respect for individual.(staff and
client)
• To use the opportunities for communication between client
and staff for maximum therapeutic benefit.
• To encourage client to cut at a level equal to their ability and
to enhance their self-esteem.
• To promote socialization.
• To provide the opportunities for clients to be part of unit
management.
• Individuals are held responsible for own action.

5. • Client is expected to learn adaptive coping, interaction and
relationship skill that can be generalized to other aspects of
his or her life.
• Achieving client autonomy.
• Peer pressure is utilized to reinforce rules and regulations.
• Team approach is used.
• Group discussions and temporary seclusions are favored
approaches for acting out behaviour.
• The nurses, function is to act in way that consistently
promote these goals.

6. CHARACTERISTICS
OF MILIEU
THERAPY
DISRTIBUTION
OF POWER
OPEN
COMMUNICATION
SRTUCTURED
INTERACTION
WORK
RELETED
ACTIVITY
COMMUNICATION
AND FAMILY
INVOLMENT IN
TRETMENT
ADAPTATION OF
THE
ENVIRONMENT
TO MEET
DEVELOPMENTAL
NEEDS.

7. 1. DISRIBUTION OF POWER
• The milieu therapy approach involves ‘flattening’ the control
hierarchy so all participants have a voice in decision making.
• This process may include the whole population of the treatment unit,
or a governing council may take the final decision based on input
from various smaller groups of clients and staff members.

8. 2. OPEN COMMUNICATION.
• In the therapy, treatment decisions are often made by the client
themselves , who therefore need information to make effective
decision.
• It is not necessary to communicate personal information but clients
and staff need to be aware of individual treatment goals to ensure
everyone is working towards the same goals.

9. 3.STRUCTURED INTERACTION
• It’s a interaction approach is that all staff members
approach the client in a consistent manner,
acknowledging specific diagnostic areas, therapy
shortening treatment time.

10. 4.WORK- RELATED ACTIVITIES
• Frist, clients need to choose the type of work they wish to
perform.
• Second, work activity should be geared towards developing
skills that will be useful in actual job situation.
• Thirds, a variety of activities provide the opportunities to
test different areas for future job interest.

11. 5.COMMUNITY AND FAMILY
INVOLVEMENT IN THE TRETMENT
PROCESS
• Clients are kept in their usual environment, for example a
day treatment centre, or halfway house, and continue most
of their routine activities while receiving treatment.

12. 6. ADAPTATION OF THE
ENVIRONMENT TO MEET THE
DEVELOPMENTAL NEED
• To develop his full potential an individual must have an
environment adapted to his current need.
• Adapting the environment to meet these multiple needs is
challenging due to the extension of milieu therapy to all age
group and the inclusion of family members with individuals
of varying ages within the treatment milieu.

13. COMPONENTS
MAINTAIN SELF
ENVIRONMENT
THE TRUST
RELATIONSHIP
BUILDING SELF-
ESTEEM
LIMIT
SETTING

14. COMPONENTS OF MILIEU THERAPY
1) MAINTAINING SAFE ENVIRONMENT:
Dispose of all needles safely and out of reach of client.
 Do not allow smoking.
 Restrict or monitor the the use of matches and lighters.
 Keep away sharp instrument from patient.
 Identify potential weapons e.g. mop handles, hammers.
 Do not leave medicines unattended or unlocked.
 Be aware of items that are harmful if ingested, e.g. mercury in
monometer.

15. 2) THE TRUST RELETIONSHIP
One of the key to therapeutic environment is
the establishment of trust.
Trust is the foundation of therapeutic
relationship, and limit settings and consistency
are its building blocks.

16. 3) BUILDING SELF-ESTEEM
Set and maintain limits.
Accepts the clients as a person.
Be non-judgmental at all times.
Structures the clients time and activities.
Initially provide the client with task, responsibility and
activities.
Allow the client to make his own decisions whenever
possible.

17. 4) LIMIT SETTINGS
• State the expectation or limits as clearly, directly and
simply as possible.
• The consequence that will fallow the clients exceeding
the limits also must be clearly stated at the outset.
• The consequence should immediately follow the
clients exceeding's the limits and must be the
consistent, both over time and among staff

18. Advantages of milieu therapy
1. Its create different type and attitude and behaviour of
client because the environment like home.
2. Patient learn the making decisions which improve his self
confidence.
3. Its develop a leadership skill.
4. It becomes the sociocentric.
5. Its help to learns the live and think collectively with the
members of the community.

19. DISADVANTAGES OF MILIEU THERAPY
• Role blurring between staff and patient.
• Milieu therapy is limited to only hospitalise patient.
• Requires continuous open communication among all staff
and clients.
• Group responsibility can easily becomes nobody’s
responsibility.
• Low client-to-staff ratio.

20. ROLE OF NURSE IN MILIEU
THERAPY:
• A nurse participate in the design and or renovation of the
settings can greatly affect the therapeutic physical
environment.
• The nurse responsible for making the referrals, encouraging
clients participation.
• The coordinate all team member is involve in team
• The nurse may interpret the need of the client population for
design expert with knowledge of colour.