Overcoming Setbacks in a Group Setting

Overcoming Setbacks in a Group Setting Phobias Treatment Print What Is a Therapeutic Milieu? By Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics. Learn about our editorial policy Lisa Fritscher Updated on February 23, 2020 Miodrag Gajic/Vetta/Getty Images More in Phobias Treatment Causes Symptoms and Diagnosis Types A therapeutic milieu is a structured environment that creates a safe, secure place for people who are in therapy. It is the therapeutic environment that supports the individual in their process toward recovery and wellness. This milieu involves not just the provision of safe physical surroundings, but also of supportive therapists and staff. In group therapy settings, it includes the social community consisting of others who are part of the group. Using the combined elements of positive peer influence, trust, safety, and repetition, the therapeutic milieu provides an idealized setting for people to work through their psychological difficulties. A therapeutic milieu can occur in a number of different settings such as in hospitals, outpatient clinics, inpatient clinics, rehabilitation facilities, private therapeutic practices, and at home. Some settings that utilize a therapeutic milieu include alcohol and drug rehab facilities, weight loss groups, and behavioral disorder treatment clinics.  Some people feel that within the trusting therapeutic milieu, they are able to try out new coping skills without feeling self-conscious. Components of a Therapeutic Milieu Some of the keys to a successful therapeutic milieu are support, structure, repetition, and consistent expectations. Therefore, the therapist’s role in developing a therapeutic milieu is both complicated and highly important. The therapist must serve as a role model, practicing the behaviors that are expected of the group. They also facilitate the development of a list of rules and expectations for dealing with infractions without coming across as an authority figure. A therapeutic milieu should provide: Support: Support comes in many forms, from creating a safe environment to establishing expectations, boundaries, and consistency.  The therapeutic milieu should be an environment where people are safe from both physical and emotional danger. Ideally, this environment should be homelike, providing as much privacy as is possible based on resources and the clients individual needs. Structure: The environment should provide routines and structure, such as scheduled daily activities, mealtimes, and free time. This provides a sense of safety but also allows people in treatment to test new behavior patterns. Consistency: In addition to creating routines, the milieu should provide consistency. Therapists and other personnel should have clear behavioral expectations.   Cohesion: In inpatient settings, people learn healthy patterns of living through constant exposure to role models and strict expectations. A therapeutic milieu can also be developed for outpatient groups. An example is Alcoholics Anonymous, where participants attend regularly scheduled meetings. The goal is to promote group cohesion and togetherness. In the absence of regular interactions, the positive peer pressure, trust, and repetition that this technique relies on cannot develop properly. The Importance of Being Vulnerable Although it takes time to achieve, a successful therapeutic milieu is a safe and trusting environment. People feel free to experiment with behavioral changes and discuss deep secrets without fear of judgment or reprisal. One benefit in a community or group setting is that people are also exposed to the struggles of others. This can build empathy and understanding, reduce the feeling of being alone, and help spark new ideas on how people can handle their own difficulties. Challenges to Therapeutic Milieu Whether treatment is short-term, a month or less, or long-term, up to 12 months, there are challenges to this type of treatment environment. Ongoing participation is often an essential part of maintaining the gains achieved while in this type of setting. It is important for people to also develop and rely on individual coping mechanisms to help them adjust when they are not in the treatment environment. When treatment ends or changes, people may experience significant setbacks as a result of losing the support, structure, and familiarity of the therapeutic environment. It may be helpful to stay in touch with others who have also been in treatment. This can help people cope with their own personal freedom after the therapy setting changes. Changes to the therapy environment, such as staff members leaving or new personnel being introduced, can also lead to struggles. These challenges to therapeutic milieu can be overcome with foresight and proper preparation for both practitioners and patients. What Is Psychoeducational Group Therapy?