Table of ContentsView AllTable of ContentsMilieu Therapy for Mental HealthWho Can Benefit from Milieu Therapy?Benefits vs. DrawbacksEnrolling in a Milieu Therapy ProgramLife After Milieu TherapyFrequently Asked Questions

Table of ContentsView All

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Table of Contents

Milieu Therapy for Mental Health

Who Can Benefit from Milieu Therapy?

Benefits vs. Drawbacks

Enrolling in a Milieu Therapy Program

Life After Milieu Therapy

Frequently Asked Questions

Milieu therapy is a type of therapy that changes or creates an environment to support patients' goals.It can be used in an individual or group setting and is effective for learning coping skills, addiction treatment, and building relationships.

This article explains the history, goals, benefits, and drawbacks of milieu therapy and how to get started with the approach.

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Mature adult therapist listens to mid adult male client

Milieu therapy focuses on changing a patient’s surroundings, especially the social and physical elements, to promote healthier emotions and behaviors. Examples of milieu therapy include a children’s therapy office that looks like a playroom, an addiction treatment facility with enrichment activities, and a staff lounge where workers can share their concerns.

History

In the 1700s, the French physician Dr. Philippe Pinel noticed patients in inpatient mental health facilities were less violent when permitted to move around. The Quakers brought the idea of letting patients move around to the United States, but it became less common in the 1800s and early 1900s.

Goals and Environment

Milieu therapy’s goal is to make all aspects of a patient’s environment therapeutic, including relationships with staff and other patients, their schedule, and diet. In milieu therapy, every patient interaction could be an opportunity for growth. Patients within a therapeutic milieu are expected to learn or re-learn skills that prepare them for independent living.

Milieu therapy focuses on developing skills like:

Pillars of Milieu TherapyPillars of milieu therapy include:Containment:Providing physical safety for patients via food, shelter, and supervision without harsh punishmentSupport:Supporting patients and their progress with the goal of increasing self-esteemStructure:Providing structure and a daily routineInvolvement:Encouraging patients to be active within the facility and its eventsValidation:Validating the patients' decision-making without judgmentRead more:What Is a Support Group?

Pillars of Milieu Therapy

Pillars of milieu therapy include:Containment:Providing physical safety for patients via food, shelter, and supervision without harsh punishmentSupport:Supporting patients and their progress with the goal of increasing self-esteemStructure:Providing structure and a daily routineInvolvement:Encouraging patients to be active within the facility and its eventsValidation:Validating the patients' decision-making without judgmentRead more:What Is a Support Group?

Pillars of milieu therapy include:

Read more:What Is a Support Group?

Milieu therapy can be applied to most treatment settings, including:

It can also help with:

The benefits of milieu therapy include:

Drawbacks of milieu therapy (for both patients and providers) include:

A therapeutic milieu can be applied to most environments. When searching for a facility or therapy that acknowledges the need for environmental support, you might consider researching:

One pillar of of milieu therapy is teaching coping skills via relationship building and life skills training.Life after milieu therapy might include follow-up visits and continued individual and group therapy. It might also include adjusting to life without certain relationships, including those with therapists and other staff.It’s important for patients to prepare for life after milieu therapy through training and expressing any doubts to therapists within the program.

Summary

Milieu therapy is based on the premise that a person’s environment can affect how they heal. A children’s treatment facility decorated with childlike themes or an addiction treatment center with life skills training are two examples of therapeutic milieu. Therapeutic milieu can include everything from relationships with others in a facility to a structured environment with a set schedule and enrichment activities.

Milieu therapy can be applied to group, individual, inpatient, and outpatient settings. Before enrolling in a milieu therapy program, it might be important to ask about group requirements, structure, scheduling, and life after treatment.

A Word from Verywell

Learn MoreWhat Is Family Therapy?

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Milieu therapy can be applied to multiple mental health conditions occurring at once (dual diagnosis). If you’re seeking milieu therapy for a dual diagnosis, try to find facilities that have services for multiple conditions and where a supportive, personalized milieu is encouraged.Learn MoreWhat Is Comorbidity?

Milieu therapy can be applied to multiple mental health conditions occurring at once (dual diagnosis). If you’re seeking milieu therapy for a dual diagnosis, try to find facilities that have services for multiple conditions and where a supportive, personalized milieu is encouraged.

Learn MoreWhat Is Comorbidity?

16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychological Association.Milieu therapy.Borge L, Røssberg JI, Sverdrup S.Cognitive milieu therapy and physical activity: Experiences of mastery and learning among patients with dual diagnosis.Journal of Psychiatric and Mental Health Nursing. 2013;20(10):932-942. doi:10.1111/jpm.12090LeCuyer EA.Milieu therapy for short stay units: A transformed practice theory.Archives of Psychiatric Nursing. 1992;6(2):108-116. doi:10.1016/0883-9417(92)90006-5White NF.The descent of milieu therapy.Canadian Psychiatric Association Journal. 1972;17(1):41-50. doi:10.1177/070674377201700108Stephens T.The lonely ones: Selfhood and society in Harry Stack Sullivan’s psychiatric thought.Dissertations, Theses, and Masters Projects. Published online July 3, 2018. doi:10.21220/s2-wpg1-ba68Smith Y, Spitzmueller MC.Worker perspectives on contemporary milieu therapy: A cross-site ethnographic study.Social Work Research. 2016;40(2):105-116. doi:10.1093/swr/svw003The Sonia Shankman Orthogenic School.The six components of modern milieu therapy.American Psychological Association.A therapeutic milieu.Norton K.Re-thinking acute psychiatric inpatient care.Int J Soc Psychiatry. 2004;50(3):274-284. doi:DOI: 10.1177/0020764004043146Bhat S, Rentala S, Bevinahalli Nanjegowda R, Belsiyal Chellappan X.Effectiveness of milieu therapy in reducing conflicts and containment rates among schizophrenia patients.invest educ enferm. 2020;38(1). doi:10.17533%2Fudea.iee.v38n1e06Bachmann L, Michaelsen RA, Vatne S.Feeling “overloaded” and “shortcomings”: Milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. JMDH. 2016;9:285-296. doi:10.2147/JMDH.S106310Vaglum P, Friis S, Karterud S.Why are the results of milieu therapy for schizophrenic patients contradictory? An analysis based on four empirical studies.Yale J Biol Med. 1985;58(4):349-361. PMCID: PMC2589909Leach D, Kranzler HR.An interpersonal model of addiction relapse.Addictive Disorders & Their Treatment. 2013;12(4):183-192. doi:10.1097/ADT.0b013e31826ac408McMorris BJ, Beckman KJ, Shea G, Baumgartner J, Eggert RC.Applying restorative practices toMinneapolis public schools students recommended for possible expulsion. Minneapolis, MN: University of Minnesota, Healthy Youth Development, Prevention Research Center.Glowa-Kollisch S, Kaba F, Waters A, Leung Y, Ford E, Venters H.From punishment to treatment: the “clinical alternative to punitive segregation” (CAPS) program in New York City jails.IJERPH. 2016;13(2):182. doi:10.3390/ijerph13020182Substance Abuse and Mental Health Services Administration.Substance use disorder treatment forpeople with co-occurring disorders. Washington, DC: Substance Abuse and Mental Health Services Administration.

16 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychological Association.Milieu therapy.Borge L, Røssberg JI, Sverdrup S.Cognitive milieu therapy and physical activity: Experiences of mastery and learning among patients with dual diagnosis.Journal of Psychiatric and Mental Health Nursing. 2013;20(10):932-942. doi:10.1111/jpm.12090LeCuyer EA.Milieu therapy for short stay units: A transformed practice theory.Archives of Psychiatric Nursing. 1992;6(2):108-116. doi:10.1016/0883-9417(92)90006-5White NF.The descent of milieu therapy.Canadian Psychiatric Association Journal. 1972;17(1):41-50. doi:10.1177/070674377201700108Stephens T.The lonely ones: Selfhood and society in Harry Stack Sullivan’s psychiatric thought.Dissertations, Theses, and Masters Projects. Published online July 3, 2018. doi:10.21220/s2-wpg1-ba68Smith Y, Spitzmueller MC.Worker perspectives on contemporary milieu therapy: A cross-site ethnographic study.Social Work Research. 2016;40(2):105-116. doi:10.1093/swr/svw003The Sonia Shankman Orthogenic School.The six components of modern milieu therapy.American Psychological Association.A therapeutic milieu.Norton K.Re-thinking acute psychiatric inpatient care.Int J Soc Psychiatry. 2004;50(3):274-284. doi:DOI: 10.1177/0020764004043146Bhat S, Rentala S, Bevinahalli Nanjegowda R, Belsiyal Chellappan X.Effectiveness of milieu therapy in reducing conflicts and containment rates among schizophrenia patients.invest educ enferm. 2020;38(1). doi:10.17533%2Fudea.iee.v38n1e06Bachmann L, Michaelsen RA, Vatne S.Feeling “overloaded” and “shortcomings”: Milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. JMDH. 2016;9:285-296. doi:10.2147/JMDH.S106310Vaglum P, Friis S, Karterud S.Why are the results of milieu therapy for schizophrenic patients contradictory? An analysis based on four empirical studies.Yale J Biol Med. 1985;58(4):349-361. PMCID: PMC2589909Leach D, Kranzler HR.An interpersonal model of addiction relapse.Addictive Disorders & Their Treatment. 2013;12(4):183-192. doi:10.1097/ADT.0b013e31826ac408McMorris BJ, Beckman KJ, Shea G, Baumgartner J, Eggert RC.Applying restorative practices toMinneapolis public schools students recommended for possible expulsion. Minneapolis, MN: University of Minnesota, Healthy Youth Development, Prevention Research Center.Glowa-Kollisch S, Kaba F, Waters A, Leung Y, Ford E, Venters H.From punishment to treatment: the “clinical alternative to punitive segregation” (CAPS) program in New York City jails.IJERPH. 2016;13(2):182. doi:10.3390/ijerph13020182Substance Abuse and Mental Health Services Administration.Substance use disorder treatment forpeople with co-occurring disorders. Washington, DC: Substance Abuse and Mental Health Services Administration.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychological Association.Milieu therapy.Borge L, Røssberg JI, Sverdrup S.Cognitive milieu therapy and physical activity: Experiences of mastery and learning among patients with dual diagnosis.Journal of Psychiatric and Mental Health Nursing. 2013;20(10):932-942. doi:10.1111/jpm.12090LeCuyer EA.Milieu therapy for short stay units: A transformed practice theory.Archives of Psychiatric Nursing. 1992;6(2):108-116. doi:10.1016/0883-9417(92)90006-5White NF.The descent of milieu therapy.Canadian Psychiatric Association Journal. 1972;17(1):41-50. doi:10.1177/070674377201700108Stephens T.The lonely ones: Selfhood and society in Harry Stack Sullivan’s psychiatric thought.Dissertations, Theses, and Masters Projects. Published online July 3, 2018. doi:10.21220/s2-wpg1-ba68Smith Y, Spitzmueller MC.Worker perspectives on contemporary milieu therapy: A cross-site ethnographic study.Social Work Research. 2016;40(2):105-116. doi:10.1093/swr/svw003The Sonia Shankman Orthogenic School.The six components of modern milieu therapy.American Psychological Association.A therapeutic milieu.Norton K.Re-thinking acute psychiatric inpatient care.Int J Soc Psychiatry. 2004;50(3):274-284. doi:DOI: 10.1177/0020764004043146Bhat S, Rentala S, Bevinahalli Nanjegowda R, Belsiyal Chellappan X.Effectiveness of milieu therapy in reducing conflicts and containment rates among schizophrenia patients.invest educ enferm. 2020;38(1). doi:10.17533%2Fudea.iee.v38n1e06Bachmann L, Michaelsen RA, Vatne S.Feeling “overloaded” and “shortcomings”: Milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. JMDH. 2016;9:285-296. doi:10.2147/JMDH.S106310Vaglum P, Friis S, Karterud S.Why are the results of milieu therapy for schizophrenic patients contradictory? An analysis based on four empirical studies.Yale J Biol Med. 1985;58(4):349-361. PMCID: PMC2589909Leach D, Kranzler HR.An interpersonal model of addiction relapse.Addictive Disorders & Their Treatment. 2013;12(4):183-192. doi:10.1097/ADT.0b013e31826ac408McMorris BJ, Beckman KJ, Shea G, Baumgartner J, Eggert RC.Applying restorative practices toMinneapolis public schools students recommended for possible expulsion. Minneapolis, MN: University of Minnesota, Healthy Youth Development, Prevention Research Center.Glowa-Kollisch S, Kaba F, Waters A, Leung Y, Ford E, Venters H.From punishment to treatment: the “clinical alternative to punitive segregation” (CAPS) program in New York City jails.IJERPH. 2016;13(2):182. doi:10.3390/ijerph13020182Substance Abuse and Mental Health Services Administration.Substance use disorder treatment forpeople with co-occurring disorders. Washington, DC: Substance Abuse and Mental Health Services Administration.

American Psychological Association.Milieu therapy.

Borge L, Røssberg JI, Sverdrup S.Cognitive milieu therapy and physical activity: Experiences of mastery and learning among patients with dual diagnosis.Journal of Psychiatric and Mental Health Nursing. 2013;20(10):932-942. doi:10.1111/jpm.12090

LeCuyer EA.Milieu therapy for short stay units: A transformed practice theory.Archives of Psychiatric Nursing. 1992;6(2):108-116. doi:10.1016/0883-9417(92)90006-5

White NF.The descent of milieu therapy.Canadian Psychiatric Association Journal. 1972;17(1):41-50. doi:10.1177/070674377201700108

Stephens T.The lonely ones: Selfhood and society in Harry Stack Sullivan’s psychiatric thought.Dissertations, Theses, and Masters Projects. Published online July 3, 2018. doi:10.21220/s2-wpg1-ba68

Smith Y, Spitzmueller MC.Worker perspectives on contemporary milieu therapy: A cross-site ethnographic study.Social Work Research. 2016;40(2):105-116. doi:10.1093/swr/svw003

The Sonia Shankman Orthogenic School.The six components of modern milieu therapy.

American Psychological Association.A therapeutic milieu.

Norton K.Re-thinking acute psychiatric inpatient care.Int J Soc Psychiatry. 2004;50(3):274-284. doi:DOI: 10.1177/0020764004043146

Bhat S, Rentala S, Bevinahalli Nanjegowda R, Belsiyal Chellappan X.Effectiveness of milieu therapy in reducing conflicts and containment rates among schizophrenia patients.invest educ enferm. 2020;38(1). doi:10.17533%2Fudea.iee.v38n1e06

Bachmann L, Michaelsen RA, Vatne S.Feeling “overloaded” and “shortcomings”: Milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. JMDH. 2016;9:285-296. doi:10.2147/JMDH.S106310

Vaglum P, Friis S, Karterud S.Why are the results of milieu therapy for schizophrenic patients contradictory? An analysis based on four empirical studies.Yale J Biol Med. 1985;58(4):349-361. PMCID: PMC2589909

Leach D, Kranzler HR.An interpersonal model of addiction relapse.Addictive Disorders & Their Treatment. 2013;12(4):183-192. doi:10.1097/ADT.0b013e31826ac408

McMorris BJ, Beckman KJ, Shea G, Baumgartner J, Eggert RC.Applying restorative practices to

Minneapolis public schools students recommended for possible expulsion. Minneapolis, MN: University of Minnesota, Healthy Youth Development, Prevention Research Center.

Glowa-Kollisch S, Kaba F, Waters A, Leung Y, Ford E, Venters H.From punishment to treatment: the “clinical alternative to punitive segregation” (CAPS) program in New York City jails.IJERPH. 2016;13(2):182. doi:10.3390/ijerph13020182

Substance Abuse and Mental Health Services Administration.Substance use disorder treatment for

people with co-occurring disorders. Washington, DC: Substance Abuse and Mental Health Services Administration.

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