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

Abstract

The term "milieu therapy" (MT) is commonly used in mental health literatures. However, because MT has historically encompassed a wide range of practices, it has invited the criticism that it is simply an attractive theoretical packaging of the time clients spend between other specified interventions, such as individual and group therapies. Some have suggested that, because of its conceptual ambiguity, MT should be abandoned altogether. Despite these challenges, MT endures as a common approach to social work practice in a range of clinical settings. This article describes a study that used ethnography to investigate the perspectives of workers from two mental health organizations that claim to provide MT. By analyzing four themes common to both sites, this article brings exploratory empirical findings to bear on the question of what constitutes MT in contemporary mental health organizations. Participants reported that (a) everything in the physical and social milieu has the potential to affect therapeutic change; (b) the milieu itself functions as a therapeutic agent; (c) the milieu provides a context for modeling and practicing desired behaviors; and (d) MT is a principlebased ethos, rather than a set of specific interventions. Implications of these findings for social work research, practice, and funding are discussed.

Being recognised as a whole person: A qualitative study of inpatient experience in mental health

“…Inpatient treatment may include medication, individual therapy, group therapy and milieu therapy as integral parts of the intervention strategy. There is only a limited empirical understanding of the mechanisms and processes by which inpatient treatment aids recovery of hospitalised mental health patients in distress (Smith & Spitzmueller, 2016;Thomas, Shattell, & Martin, 2002). Existing studies of established principles of inpatient care, such as genuine respect, collaboration, and promoting patient autonomy, tend to be implemented to only a limited extent (Oeye, Bjelland, Skorpen, & Anderssen, 2009;Oute, 2018;Stomski, Morrison, Whitely, & Brennan, 2017;Waldemar, Arnfred, Petersen, & Korsbek, 2016).…”

“Sense” and sensitivity: Informal apprenticeship among youth care workers in a residential treatment center for children

“…They also physically restrained clients whose behavior they deemed imminently dangerous. As described elsewhere (Smith & Spitzmueller, ), workers understood this entire range of work tasks as “clinical” in nature, even though only some of them resembled group or dyadic psychotherapy.…”

Rather a Competent Practitioner than a Compassionate Healer: Patients’ Satisfaction with Interactions in Psychiatric Inpatient Care

“…Psychiatric inpatient care (PIC) commonly includes pharmacological interventions and counseling, together with different types of behavioral and milieu therapies (Smith & Spitzmueller, 2016;Thomas et al, 2002). On their course to recovery, patients tend to express a need for support and encouragement in their progress (Gunasekara et al, 2014), highlighting the importance of staffs' ability to help and strengthen patients in their recovery.…”