The environment in which a person receives services is as important as the services being provided. We must be sensitive to the culture of our treatment environments to ensure that they are therapeutic and feel safe for the person receiving services. The Joint Commission includes in its standards, language that services be provided in a therapeutic milieu. Do we understand what the term means?
Milieu therapy was coined by Bruno Bettelheim in 1948 and is more often used in relation to institutional treatment centers. Arguably the term can be applied to any health and human service setting, inpatient or outpatient. The relational training section of The Mandt System addresses this expectation and informs service providers of what must be in place to provide an environment in which healing/recovery can occur.
A therapeutic milieu provides a safe and trusting environment which allows the person receiving services to engage in their treatment and recovery effort. Often service providers complain that individuals in their service system are resistant and non-compliant with their individualized plan. This is less likely to occur if the individual themselves is instrumental in the development of the plan. To engage in that activity, the individual receiving services must feel safe and trust those involved in the provision of services. When an individual does not feel safe, their behavior will demonstrate that they do not feel safe. Part of the staff’s responsibility is to help the individual feel that with them and in that environment, the person receiving services is safe.
To enable trust to occur, individuals receiving services must be able to anticipate that they are going to be treated with respect and dignity and in a manner that is supportive of them. Individuals receiving services will be observing and testing the environment and staff to determine if they are safe with them and in the treatment environment. An important way of conveying trust is by the staff’s demonstration of respect, dignity and support to each other on a consistent basis. When the person receiving services perceive that the staff members do not trust each other, they will question why they should trust the staff.
It is important to recognize that each interaction with another person holds the potential for social learning and personal growth because an individual’s psychological difficulties are inevitably expressed in the context of human relationships. It is a strengths-based approach that focuses on teaching problem solving skills which can be applied to future events rather than using punishment to change behavior. This can be challenging when most service providers grow up with the notion that when someone does something wrong they should be punished, an attitude that accompanied them into their work environment.
It necessitates a change in attitude, the adoption of positive behavior supports and a movement away from control or punishment to shape the behavior of service recipients. These are perhaps the biggest barriers service providers face in developing a healing and therapeutic environment. It is challenging because it necessitates first looking at ourselves and other service providers to ensure that we are treating each other, as well as individuals being served, in a supportive, respectful and dignified manner.
However it is worth the work, because by doing so service providers actually model the behaviors they expect service recipients to exhibit.
Aaryce Hayes – COO & Faculty
