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Milieu therapy is distinguished by the attempt to bring about therapeutic change by the manipulation of their environments. This mght be achieved through changes in their existing environments such as adjusting domestic routines, layout etc or by taking people into fresh environments such as therapeutic communities.
Milieu therapy and the treatment of children
Milieu Therapy is a form of psychiatric therapy for children. It has been in existence since the late 1800s when moral treatment and therapeutic communities were key issues in the treatment of psychiatric problems. It has been used as a viable treatment modality for kids for over fifty years in residential and inpatient settings and more recently in the partial hospitalization and day treatment settings. August Aichorn, Bruno Bettelheim, Fritz Redl and David Wineman were among the early pioneers in using Milieu Therapy to treat "impulse-ridden and ego-impaired" kids in residential and school settings as early as the 1920s. Their work collectively has taught us that Milieu Therapy can be a powerful therapeutic tool when individual dynamics and the social system can be combined in a planned and meaningful way to manage and change behavior and relationships.
Milieu Therapy is a planned treatment environment in which everyday events and interactions are therapeutically designed for the purpose of enhancing social skills and building confidence. Academics are woven into the daily routine using an integrative and interactive approach that incorporates learning styles and areas of interest.
The milieu, or "life space," provides a safe environment that is rich with social opportunities and immediate feedback from caring staff. The milieu is not static but it is flexible and features normalizing and developmental perspectives that use common structures intended to be familiar to all children, such as daily routines, consistent rules and activities. The therapy is planned in such a way that it is constantly supporting, guiding and reinforcing the child's ability to learn life tools, such as problem solving and coping skills, while at the same time offering a safe place for these skills to be practiced and integrated into the child's repertoire of strategies. The milieu takes into consideration the perspective of the child as well as the perspective of the milieu at large. A simple example of this is a "wrap-up group" at the end of the day, where kids first tell what they appreciate from that day, and what their high point and low point are. Metaphorically, this teaches kids that every day has its ups and downs, yet there is always something that can be appreciated. They could do a self-evaluation and get feedback (not criticism) from the other kids. This is a very powerful group and can give kids an opportunity to see how others view them in a non-threatening forum.
One of Milieu therapy's primary goals is to teach kids "how" to "fit in" socially and emotionally in their world without changing "who" they are. They learn new skills that help them to better understand themselves and their relationships. The milieu is not a static environment, but is flexible and incorporates the use of common structures familiar to all children, such as daily routines, predictable rules and activities.