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Chapter 12Chapter 12MILIEU THERAPY—MILIEU THERAPY—

THE THERAPEUTIC COMMUNITTHE THERAPEUTIC COMMUNIT

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Milieu therapy, or therapeuticcommunity, is defned as

“a scientifc structuring o theenvironment to eect behavioralchanges and to improve the

 psychological health and unctioning o

the individual” Within the therapeutic community setting,

the client is expected to learn adaptivecoping, interaction, and relationship skills

that can be generalized to other aspectso his or her lie.

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asic !ssumptions o "ilieuasic !ssumptions o "ilieu

 #herapy#herapy

 #he health in each individual is to berealized and encouraged to gro$.

%very interaction is an opportunity or

therapeutic intervention. #he client o$ns his or her o$n environment. %ach client o$ns his or her o$n behavior. &eer pressure is a useul and po$erul tool.

'nappropriate behaviors are dealt $ith asthey occur.

(estrictions and punishment are to beavoided.

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Goals of milieu

therapy"anipulate the environment so that allaspects o client)s hospital experienceare considered therapeutic.

Client is expected to learn adaptivecoping, interaction and relationshipskills that can be generalized to otheraspects o his or her lie.

!chieving client autonomy

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Conditions #hat &romote aConditions #hat &romote a #herapeutic Community #herapeutic Community asic physiological needs are ulflled. #he physical acilities are conducive to

achievement o the goals o therapy. ! democratic orm o sel*government

exists. (esponsibilities are assigned according to

client capabilities. ! structured program o social and $ork*

related activities is scheduled as part o thetreatment program.

Community and amily are included in theprogram o therapy in an e+ort to acilitate

discharge rom treatment.

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 #he &rogram o #herapeutic #he &rogram o #herapeuticCommunityCommunity Care is directed by an interdisciplinary team.

! comprehensive treatment plan isormulated by the team.

 #eam members o all disciplines sign theplan and meet regularly to update the planas needed.

isciplines may include psychiatry,

psychology, nursing, social $ork,occupational therapy, recreational therapy,art therapy, music therapy, dietetics, andthe chaplain)s service.

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Chara!teristi!s of milieu therapy

 #he concept o milieu therapy developed rom a desire to

counteract the negative, regressive e+ects o institutionalization-reduced ability to think and act i"#epe"#e"tly, an adoption oinstitutional values and attitudes, and loss o commitments in theoutside $orld.

$e%eral strate&ies have been developed to counter these

negative e+ects. #hey include-istribution o po$er

/pen communication

0tructured interactions

Work* related activities.

Community and amily involvement in the treatment process

!daptation o the environment to meet developmental needs.

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Pro&ressi%e le%els of respo"si'ilitya!!or#i"& to !lie"t(s self !are !apa!ity

Le%el I isplays a destructive behavior to sel, others, orthe environment.

isoriented to time, place and person.

nable to unction in group therapy.%xhibits poor personal hygiene.

Le%el II oes not display destructive behavior.

no$s the current time, date and place.

!ttends at least one therapeutic group daily.

!ttempts to maintain good personal hygiene

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Le%el III- !ttends !ll #herapeutic !ctivities.

&articipates actively in the Community "eetings and serveson at least one client committee.

evelops a sel*directed behavior plans to change orresolve a personal problem.

no$s the names o all medications and the times they areto be taken.

&articipates in a amily session.

Le%el I*- #akes an active role in assisting other clients togain level changes.

emonstrates $illingness to serve as an o3cer on theclient committee.

!ssumes a leadership role in the community, acts as apositive role model, and ensures that other clients areprompt in their attendance o regularly scheduled activitiesand group meetings.

'nitiates discussions $ith the mental health teamconcerning discharge planning.

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te"!hoo