milieu therapy


Summary: A treatment program based on manipulation of the patient's environment by the medical staff. The patient does not participate in planning the treatment regimen.

Top Publications

  1. Vatne S, Hoem E. Acknowledging communication: a milieu-therapeutic approach in mental health care. J Adv Nurs. 2008;61:690-8 pubmed publisher
    ..Gunderson's therapeutic processes in milieu therapy have come into use in a broad range of mental health contexts in many countries...
  2. Delaney K. Top 10 milieu interventions for inpatient child/adolescent treatment. J Child Adolesc Psychiatr Nurs. 2006;19:203-14 pubmed
    ..Each intervention includes a summary of the theory that supports its efficacy, a brief explanation of the intervention, and methods for applying the technique in clinical situations. ..
  3. Maffei C, Shea J, Stewart M. Measuring patient satisfaction. Psychiatr Serv. 2003;54:1411 pubmed
  4. Ad Dab bagh Y, Greenfield B, Milne Smith J, Freedman H. Inpatient treatment of severe disruptive behaviour disorders with risperidone and milieu therapy. Can J Psychiatry. 2000;45:376-82 pubmed
    To evaluate the therapeutic impact of adding risperidone to milieu therapy of latency-aged inpatients with severe disruptive disorders...
  5. Oeye C, Bjelland A, Skorpen A, Anderssen N. Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway. Issues Ment Health Nurs. 2009;30:151-8 pubmed publisher
    b>Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective...
  6. Mermolja E. [Raising the quality of life with milieu therapy]. Krankenpfl Soins Infirm. 2005;98:21-2 pubmed
  7. Zegers M, Schuengel C, van IJzendoorn M, Janssens J. Attachment representations of institutionalized adolescents and their professional caregivers: predicting the development of therapeutic relationships. Am J Orthopsychiatry. 2006;76:325-34 pubmed
    ..Moreover, specific combinations of attachment representations of mentor and adolescent had different effects on adolescent hostility. ..
  8. Kennedy N, Paykel E. Treatment and response in refractory depression: results from a specialist affective disorders service. J Affect Disord. 2004;81:49-53 pubmed
    ..The study was retrospective. Treatment courses were sequential rather than random. Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms. ..
  9. Bjorgvinsson T, Wetterneck C, Powell D, Chasson G, Webb S, Hart J, et al. Treatment outcome for adolescent obsessive-compulsive disorder in a specialized hospital setting. J Psychiatr Pract. 2008;14:137-45 pubmed publisher
    ..Thus, inpatient treatment appears potentially efficacious, although future controlled trials with larger samples are needed. ..

More Information


  1. Greenstein D, Wolfe S, Gochman P, Rapoport J, Gogtay N. Remission status and cortical thickness in childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry. 2008;47:1133-40 pubmed publisher
    ..008). Our results provide neuroanatomic correlates of clinical remission in schizophrenia and evidence that response to treatment may be mediated by these cortical brain regions. ..
  2. Borge L, Angel O, Røssberg J. Learning through cognitive milieu therapy among inpatients with dual diagnosis: a qualitative study of interdisciplinary collaboration. Issues Ment Health Nurs. 2013;34:229-39 pubmed publisher
    ..was to explore the experiences of interdisciplinary collaboration among staff members, applying cognitive milieu therapy for inpatients with dual diagnosis. The study is based on 33 individual, qualitative interviews...
  3. Becker T, Kösters M. Psychosocial interventions in people with severe mental illness: a Bleulerian perspective. Neuropsychobiology. 2012;66:70-5 pubmed publisher
    ..i) Current evidence suggests that therapeutic communities (and new forms of milieu therapy, e.g...
  4. Stokes J, Pogge D, Powell Lunder J, Ward A, Bilginer L, DeLuca V. The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population. J Pers Assess. 2003;81:11-9 pubmed
  5. Freitag C. [Empirically based early intervention programs for children with autistic disorders - a selective literature review]. Z Kinder Jugendpsychiatr Psychother. 2010;38:247-56 pubmed publisher
    ..In this review article based on a selective literature search, the relatively best empirically based early intervention programs will be discussed with a focus on the proven efficacy of these interventions. ..
  6. Ben Arush O, Wexler J, Zohar J. Intensive outpatient treatment for obsessive-compulsive spectrum disorders. Isr J Psychiatry Relat Sci. 2008;45:193-200 pubmed
    ..Working in the client's natural environment and making use of technology are particularly highlighted. ..
  7. Skorpen A, Anderssen N, Oye C, Bjelland A. Treatment regimes in a psychiatric hospital and apparent contradictions: report from field work in a lock-up ward illustrated with a constructed case. Int J Ment Health Nurs. 2009;18:409-16 pubmed publisher
    The medical approach dominates in Norwegian psychiatry, but mental health nurses and other ward staff hold that milieu therapy constitutes an additional and important treatment approach for psychiatric patients...
  8. Southard K, Jarrell A, Shattell M, McCoy T, Bartlett R, Judge C. Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?. J Psychosoc Nurs Ment Health Serv. 2012;50:28-34 pubmed publisher
    ..No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings. ..
  9. Hummelvoll J, Severinsson E. Coping with everyday reality: mental health professionals' reflections on the care provided in an acute psychiatric ward. Aust N Z J Ment Health Nurs. 2001;10:156-66 pubmed
    ..coping strategies, included five different methods the primary nursing system, concealing versus integrating, milieu therapy, seclusion and the medical orientated model...
  10. Eddy J, Chamberlain P. Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. J Consult Clin Psychol. 2000;68:857-863 pubmed publisher
    ..As hypothesized, family management skills and deviant peer association mediated the effect of treatment condition and accounted for 32% of the variance in subsequent antisocial behavior. ..
  11. Lorenc T, Petticrew M, Whitehead M, Neary D, Clayton S, Wright K, et al. Environmental interventions to reduce fear of crime: systematic review of effectiveness. Syst Rev. 2013;2:30 pubmed publisher
  12. Birkeland S. Psychopharmacological treatment and course in paranoid personality disorder: a case series. Int Clin Psychopharmacol. 2013;28:283-5 pubmed publisher
    ..Although the findings should be interpreted with caution, they support the notion of the disorder being a relatively chronic condition, although antipsychotics appeared to be safe and possibly had an effect in the short term. ..
  13. Delaney K. Time-out: an overused and misused milieu intervention. J Child Adolesc Psychiatr Nurs. 1999;12:53-60 pubmed
    ..Personal observations and published literature. The time-out is a useful tool, but only when employed with minded intent and understanding of how it is supposed to help the child. ..
  14. dos Santos M, Wolvaardt G. Integrated intervention for mental health co-morbidity in HIV-positive individuals: A public health assessment. Afr J AIDS Res. 2016;15:325-331 pubmed
  15. Scotti J. [Care and restraint, when the law questions nursing practice]. Soins Psychiatr. 2017;38:32-39 pubmed publisher
    ..A decision which was made as a result of a clarification of certain regulations which have proved controversial from the point of view of individual liberties. ..
  16. Pryor J. Nurses create a rehabilitative milieu. Rehabil Nurs. 2010;35:123-8 pubmed
    Despite the recognition of milieu therapy as a nursing intervention, nursing's contribution to the creation of inpatient environments that facilitate patient rehabilitation has been underresearched...
  17. Oeye C, Bjelland A, Skorpen A, Anderssen N. User participation when using milieu therapy in a psychiatric hospital in Norway: a mission impossible?. Nurs Inq. 2009;16:287-96 pubmed publisher
    ..b>Milieu therapy is a therapeutic tool to ensure user participation and re-socialization...
  18. Kaiser A, Roberts M. Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. J Speech Lang Hear Res. 2013;56:295-309 pubmed publisher
    ..Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments. ..
  19. Nesset M, Rossberg J, Almvik R, Friis S. Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study. Scand J Caring Sci. 2009;23:117-24 pubmed publisher
    The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction...
  20. Franco J, Davis B, Davis J. Increasing social interaction using prelinguistic milieu teaching with nonverbal school-age children with autism. Am J Speech Lang Pathol. 2013;22:489-502 pubmed publisher
  21. Riggs S, Garrett M, Arnold K, Colon E, Feldman E, Huangthaisong P, et al. Can Frontline Clinicians in Public Psychiatry Settings Provide Effective Psychotherapy For Psychosis?. Am J Psychother. 2016;70:301-328 pubmed
  22. Streeck Fischer A, Kepper Juckenack I, Kriege Obuch C, Schrader Mosbach H, von Eschwege K. ["Beware of coming too close to me"--development-oriented psychotherapy of a dangerous aggressive boy with early complex trauma experiences]. Prax Kinderpsychol Kinderpsychiatr. 2003;52:620-38 pubmed
    ..From this, it becomes clear how, through new experiences with regulating others, he gradually surfaces from a world of annihilation and destruction and learns to survive and to live. ..
  23. Thomas S, Shattell M, Martin T. What's therapeutic about the therapeutic milieu?. Arch Psychiatr Nurs. 2002;16:99-107 pubmed
    ..Renewed emphasis must be placed on the nurse-patient relationship and the therapeutic alliance. ..
  24. Melnick G, De Leon G. Clarifying the nature of therapeutic community treatment. The Survey of Essential Elements Questionnaire (SEEQ). J Subst Abuse Treat. 1999;16:307-13 pubmed
    ..Results were seen as validating the TC formulation from which the SEEQ items were drawn. Implications on the potential use of the SEEQ as a means of codifying TC treatment for research, training, and quality assurance are discussed. ..
  25. Smiley McDonald H, Leukefeld C. Incarcerated clients' perceptions of therapeutic change in substance abuse treatment: a 4-year case study. Int J Offender Ther Comp Criminol. 2005;49:574-89 pubmed
    ..Data that were collected over 5 years are presented. Implications, including how the program's interim therapeutic milieu eased the transition to a therapeutic community, are discussed. ..
  26. Teaford T, Shaw R, Reiss A, Lotspeich L. Pseudologia Fantastica associated with Pervasive Developmental Disorder. Psychiatry. 2002;65:165-71 pubmed
    ..Treatment implications are discussed along with a formulation of the psychological and cognitive functions of PF in a person with a PDD diagnosis. ..
  27. Bola J, Mosher L. Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project. J Nerv Ment Dis. 2003;191:219-29 pubmed
    ..In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications. ..
  28. Svendsen A, Lau M. [Focus group interview. A method of study and implementation]. Ugeskr Laeger. 2001;163:3227-30 pubmed
    ..The focus group interview is a valuable method of evaluating psycho- and milieu therapeutic treatment. Interviewing the staff served as triangulation and eased the implementation of the results remarkably. ..
  29. Wolfersdorf M, Lehle B. [Depression wards--1998 structure and process quality]. Psychiatr Prax. 2003;30 Suppl 2:S140-2 pubmed
    ..We describe the results of a survey about therapeutic standards in German and Swiss depression treatment units. ..
  30. Schunk M, Steinwachs K. [Structures and changes in the combined modality treatment concept at a gerontopsychiatric Europakanal Erlangen Day Care Clinic]. Psychiatr Prax. 2003;30 Suppl 2:S203-6 pubmed
    ..This is not only a question of cost-effectiveness, but also an ethical approach bearing in mind future trends towards an increasingly aging population where demand will increase for this type of provision. ..
  31. Ritchie E, Cassimatis E, Emanuel R, Milliken C, Gray S. The contributions of Kenneth Leslie Artiss, M.D. J Am Acad Psychoanal Dyn Psychiatry. 2003;31:663-73 pubmed
    ..Leslie Artiss (1913-2001) was an Army psychiatrist who did significant investigative work in schizophrenia and milieu therapy and whose broad scholarship led to decisively important and enduring contributions to operational psychiatry...
  32. Kupper Z, Tschacher W. Lack of concordance between subjective improvement and symptom change in psychotic episodes. Br J Clin Psychol. 2008;47:75-93 pubmed
    ..The treatment of psychosis should take a possible discordance between subjective and objective change into account. ..
  33. Ungvarski P, Trzcianowska H. Neurocognitive disorders seen in HIV disease. Issues Ment Health Nurs. 2000;21:51-70 pubmed
    ..Treatment strategies include pharmacologic interventions, alternative and complementary therapies, and milieu management. ..
  34. Altschuler E, Multari A, Hirstein W, Ramachandran V. Situational therapy for Wernicke's aphasia. Med Hypotheses. 2006;67:713-6 pubmed
    ..g., buying food, taking transport--and let the patients train and learn to use and hone their non-language communication means and skills for improved practical functioning. ..
  35. Boxer P, Terranova A. Effects of multiple maltreatment experiences among psychiatrically hospitalized youth. Child Abuse Negl. 2008;32:637-47 pubmed publisher
    ..Clinicians working in youth psychiatric populations should implement maltreatment-specific psychotherapy approaches for maltreated youth, even as adjunctive treatments in a therapeutic milieu. ..
  36. Mancil G, Conroy M, Haydon T. Effects of a modified milieu therapy intervention on the social communicative behaviors of young children with autism spectrum disorders. J Autism Dev Disord. 2009;39:149-63 pubmed publisher
    The purpose of the current study was to evaluate the effectiveness of combining milieu therapy and functional communication training (FCT)] to replace aberrant behavior with functional communicative skills in 3 male preschool or ..
  37. Quartesan R. The role of psychodynamic understanding in the treatment of the medication-refusing schizophrenic patient: a clinical report. J Am Acad Psychoanal Dyn Psychiatry. 2003;31:675-86 pubmed
    ..Rehabilitative work was important, not only to recover lost or lessened capacities, but also to modify the patient's feelings towards external and internal objects. ..
  38. Chemtob D, Levy A. Rationale and staff evaluation of using a "therapeutic milieu" for substance users within a tuberculosis ward. Subst Use Misuse. 2009;44:672-83 pubmed publisher
    ..However, using Therapeutic Milieu in TB ward hospitalization, as a "window of opportunity," remains the first step in a longer journey for rehabilitation. The study's limitations are noted. ..
  39. Nativ G, Treves I. "Whose groups are these anyway?" on staff and patients' needs and their impact on the milieu. Psychiatr Danub. 2009;21 Suppl 1:61-6 pubmed
    ..Some vignettes will be presented which demonstrate these different needs, of staff and patients, and the way they were explored in the staff's group supervision meetings. ..
  40. Gabbard G, Coyne L, Allen J, Spohn H, Colson D, Vary M. Evaluation of intensive inpatient treatment of patients with severe personality disorders. Psychiatr Serv. 2000;51:893-8 pubmed
    ..These results suggest that patients with severe personality disorders benefit from intensive inpatient treatment. We found no evidence that hospitalization of such patients is associated with regression or deterioration of function. ..
  41. Fey M, Yoder P, Warren S, Bredin Oja S. Is more better? Milieu communication teaching in toddlers with intellectual disabilities. J Speech Lang Hear Res. 2013;56:679-93 pubmed publisher
    ..49 to .65). More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects. ..
  42. Schepker R. [Adolescent psychiatry addiction centers--necessary and effective? Treatment follow-up of adolescent psychiatric treatment and rehabilitation for adolescent drug addicts]. Prax Kinderpsychol Kinderpsychiatr. 2002;51:721-35 pubmed
    ..Both settings have their own right in the system because comorbid patients need highly individualized therapy, and rehab patients need programs able to address school-based, family-related, and gender-specific issues. ..
  43. Reggentin H, Dettbarn Reggentin J. [Group homes for patients with dementia: the possibility of social interaction]. Pflege Z. 2004;57:181-4 pubmed
  44. Baer J, Hall J, Holm K, Lewitter Koehler S. Challenges in developing an inpatient psychiatric program for patients with AIDS and ARC. Hosp Community Psychiatry. 1987;38:1299-303 pubmed
    ..Other issues relating to infection control, ethical concerns, needs of friends and family, and disposition planning are also discussed. ..
  45. Geanellos R. The milieu and milieu therapy in adolescent mental health nursing. Int J Psychiatr Nurs Res. 2000;5:638-48 pubmed
    The milieu is a well discussed concept in the mental health nursing literature; so too is milieu therapy. Nevertheless, despite evidently clear understandings of the milieu's significance, and of its therapeutic potential, little ..
  46. Szanton S, Thorpe R, Boyd C, Tanner E, Leff B, AGREE E, et al. Community aging in place, advancing better living for elders: a bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. J Am Geriatr Soc. 2011;59:2314-20 pubmed publisher
    ..The CAPABLE intervention was acceptable to participants and feasible to provide and showed promising results, suggesting that this multicomponent intervention to reduce disability should be evaluated in a larger trial. ..
  47. Schjødt T, Middelboe T, Mortensen E, Gjerris A. Ward atmosphere in acute psychiatric inpatient care: differences and similarities between patient and staff perceptions. Nord J Psychiatry. 2003;57:215-20 pubmed
    ..From an overall point of view, the findings suggest a basic agreement between patients and staff regarding the valuation of the treatment environment as well as the general preferences concerning the ward milieu. ..
  48. Kibel H. Interpretive work in milieu groups. Int J Group Psychother. 2003;53:303-29 pubmed
    ..The combination of working with displaced material followed by a question or statement that is framed in terms of that theme has an interpretative function. ..
  49. Ellila H, Valimaki M, Warne T, Sourander A. Ideology of nursing care in child psychiatric inpatient treatment. Nurs Ethics. 2007;14:583-96 pubmed
    ..The majority of the wards were guided by two or more approaches. Nursing models, theories and codes of ethics were almost totally ignored in the ward managers' ideological descriptions. ..
  50. Courey T. Mental health needs of children and adolescents at camp: are they being assessed and treated appropriately by the camp nurse?. J Child Adolesc Psychiatr Nurs. 2006;19:215-23 pubmed
    ..It is paramount that mental health needs of children and adolescents at camp are addressed and managed appropriately by the camp nurse. Education of camp nurses and camp administrators is also a vital part of providing care. ..
  51. Ivezic S, Skocić P, Bagaric A, Oruc L. [Importance of an interpersonal approach and object relation theories for the organization of treatment at the psychiatric hospital]. Med Arh. 2004;58:241-3 pubmed as a therapeutic setting is presented through the theoretical framework of object relations and milieu therapy. From the point of view of psychodynamic approach the majority of hospitalized patients show the pathology of ..
  52. Beal D, Delaney K. Milieu management of a child with bipolar illness. J Child Adolesc Psychiatr Nurs. 2005;18:113-5 pubmed
    ..This case study presents such a child and the behavior patterns that resulted in seclusion and PRN medication. Also presented is the plan that staff derived which eventually helped this young boy regulate his behavior. ..
  53. Slevin E, McClelland A. Multisensory environments: are they therapeutic? A single-subject evaluation of the clinical effectiveness of a multisensory environment. J Clin Nurs. 1999;8:48-56 pubmed
    ..It is concluded that multisensory environments are therapeutic, in that they can promote relaxation, and they may also have a place in the care of people with learning disabilities who display challenging behaviours. ..