Milieu Therapy: A Therapeutic Loophole

Abstract

topic. The confusion over, and ultimate demise of, milieu therapy source. Literature review goal. To chronicle the conceptual problems and other events leading to the decline in the use of milieu therapy. conclusion. Inpatient nurses would do best to leave the concept of milieu therapy behind and focus on clarifying how specific nursing interventions are operationalized and tied to patient outcomes.

Worker Perspectives on Contemporary Milieu Therapy: A Cross-Site Ethnographic Study

“…Significantly, in neither site did workers view MT as a euphemistic catch-all term for nontherapeutic activities between discrete interventions such as case management or psychotherapy. These findings challenge Delaney's (1997) argument that MT denotes no particular set of beliefs and operates as a convenient "catch-all" for "any and all" nontherapeutic activities involving clients. Instead, the workers who participated in this study reported a consistent, shared rationale for their approach to practice, and one that resonates strongly with historical formulations of MT.…”

“…Workers' common assertion that the milieu was an environment in which "everything is clinical," along with their belief that the challenges of everyday living provided continuous opportunities for growth, echoed the influential assertion of Trieschman and colleagues (1969) therapeutic use of "the other 23 hours" of clients' days. These findings counter Delaney's (1997) charge that MT is little more than a euphemism for the time clients spend between formal therapeutic interventions, and suggest that her criticism may misinterpret the emphasis that MT places on the therapeutic potential of everyday activities in the milieu. Workers framed a range of quotidian activities, including dining, bathing, homework, playing pool, and waking up, as opportunities to promote positive change in the lives of clients.…”

“…Writing in the field of psychiatric nursing, Kathleen Delaney (1997) has argued strongly that MT be abandoned because the practice "lacks a sound conceptual definition" on which the "scientific community" can agree (p. 19). She charged that, without consensus on an operational definition, MT "has become a therapeutic loophole, a catch-all term that indiscriminately serves as a rationale for the therapeutic intent of any and all inpatient nursing activities" (p. 19).…”

“…T he term "milieu therapy" (MT) is commonly used in clinical literatures, often without a clear or operational definition ( Delaney, 1997;Wilmer, 1981). Generally speaking, MT refers to the treatment of people in intentionally designed physical and interactional environments, where commonplace interactions around a range of everyday events provide opportunities to promote positive change.…”

“…Critics have cited a lack of conceptual clarity as cause for skepticism about the validity of MT as a specifiable, researchable, and reimbursable intervention for people with mental illness ( Delaney, 1997;Mahoney et al, 2009). Attempts to define MT are further complicated by the fact that it is used by a wide range of helping professions and in an array of settings.…”