3.1 Milieu Therapy

Question 1

Milieu (Environmental) Therapy (Therapeutic Community)

Answer 1

• Scientific structuring of environment to effect behavioral change and improve physiological health and functioning of an individual.
• Expected to learn adaptive coping and interaction/relationship skills to be generalized to other aspects of life

Question 2

Milieu Therapy

Answer 2

Beginning
- In patient care used to provide sufficient time to implement programs that helped social rehabilitation. It emphasized individual autonomy.

Current trend
- Now we are more focused on acute care hospitalizations that last 2-3 days. We focus on short term approaches to care or outpatient treatments.

Question 3

Assumptions of Milieu Therapy

Answer 3

Skinner
- Operant conditioning as a method of learning
- Consequences of a response determine the probability of it being repeated
- Behavior that is rewarded will likely be repeated and behavior that is punished will occur less frequently

Question 4

ASSUMPTIONS OF SKINNNER ON THERAPEUTIC COMMUNITY

Question 5

1. The health of each individual is to be realized and encouraged to grow

Answer 5

• All people have strengths and limitations
• The health aspects are identified and used as a foundation for growth

Question 6

2. Every action is an opportunity for therapeutic intervention

Answer 6

• The structured setting makes it impossible to avoid interpersonal interactions which makes it the ideal situation for clients to improve communication and relationship skills
• Learning happens from immediate feedback of personal perceptions

Question 7

3. The client owns their environment

Answer 7

• Clients should have the opportunity to problem solve in their unit to provide personal autonomy and needs for the group

Question 8

4. Each client has their own behavior

Answer 8

• Each client takes responsibility for their own actions

Question 9

5. Peer Pressure is a useful and powerful tool

Answer 9

• Behavior group norms are established through peer pressure
• Feedback is direct and frequent, making it essential to behave properly

Question 10

6. Inappropriate behavior is dealt with as they occur

Answer 10

• Individuals examine the significance of their behavior, how it affects others, and discuss appropriate ways of behaving in certain circumstances

Question 11

7. Restrictions and punishments are to be avoided

Answer 11

• If an individual requires external control, use temporary isolation instead of lengthy restrictions or harsh consequences.

Question 12

CONDITIONS OF THERAPEUTIC COMMUNITY

Answer 12

Structure
- Structure that promotes goals of treatment. This includes schedules and group therapy sessions. Individuals should also know who to go to for help (concerns, medications)

Involvement
- Environment should encourage involvement. (Common dining areas, group seating arrangements, community meetings)

Support
- Should be supportive and not punitive. Nurses provide emotional support, reinforce expectations, redirection for patients who are struggling. Support means creating a sense that patients are involved in their treatment and empowered to decision make their direction of care

Validation
- Active, empathetic listening to patients perceptions and concerns. Promoting autonomy

Containment
- Environment is contained to create sense of safety and security. Suicidal patients resist self-destruction through locked doors and lack of access to self-harm methods.

Question 13

IDT Team (Interdisciplinary Team)

Answer 13

• Nurses and admitting psychiatrist preform initial assessments
• IDT Team determines comprehensive treatment plans

MEMBERS OF THE TEAM
- Social Work – Individual, group, family therapy
- Occupational Therapy
- Art Therapy
- Music Therapy
- Dieticians
- Chaplain services
- Psychiatry/Psychology

NURSES
- Management of therapeutic milieu on a 24 hour basis
- Ensure physiological needs are met (physical status assessments)

Question 14

Nurses Role in Milieu Community

Answer 14

• Medication Administration
• Establishing Trust (orienting patient to new environment, rights/responsibilities in the unit, structured activities for personal growth, limit/restrictions to maintain safety)
• Setting Limits on unacceptable behavior. Consistency in carrying out consequences for violations is essential for learning.
• Client Education. Assessment of clients readiness for learning.

EDUCATION EXAMPLES
- Information about medical diagnosis
- Side effects of medication
- Importance of taking medications
- Stress management