Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth

Background and Goals: The role of milieu therapy on inpatient treatment has become more prominent due to the changing landscape of hospital care, with shorter length of stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual psychotherapy with the psychiatrist or therapist, and more milieu and group based treatment that emphasizes acute stabilization. Methods: The authors share some of the core domains that provide the basic framework for milieu treatment within an acute care setting when working with adolescents and transitional age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer practical ideas for implementation in clinical practice. Discussion: The therapeutic milieu and collaboration of an interdisciplinary team has a significant impact on hospital treatment. Considerations for milieu therapy implementation in an inpatient unit include developmentally informed concepts related to milieu treatment of adolescents and TAY patients in a hospital setting.

Milieu approaches and other adaptations of therapeutic community method: past and future

Purpose The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments. Design/methodology/approach Milieu treatment is defined and differentiated from TC “proper”. Literature is reviewed covering attempts to use TC methods in inpatient wards, across hospitals, and more recently in the criminal justice system and more widely through the enabling environments initiative. Findings It is unclear whether TC milieu treatments proved helpful in acute ward environments in their heyday in the 1950s, 1960s and 1970s, in particular those involving people suffering from acute psychosis, and the changing landscape of psychiatric provision may make further investigation difficult. The reasons for this, and for the difficulties reaching a firm conclusion, are outlined. In contrast, TC milieu interventions appear to be demonstrating usefulness more recently in less mixed populations without the implementation of full TC “proper”. Research limitations/implications Much of the research is old and the methodology poor, which limits the conclusions that can be drawn. Practical implications Recent innovations pick up in a more accessible way principles of therapeutic communities that can inform and improve care in a variety of contexts. They are sufficiently well defined to lend themselves to research, which should now be a priority. Originality/value After a gap in developments in the field, recent innovations are reintroducing elements of TC functioning to new contexts including criminal justice settings, inpatient wards, homeless shelters and city communities.

Cultural Mediations in the Therapeutic Process with Border Lines Adolescents

Psychopathology of bounding is a central feature in Border Line Adolescents. This feature is underlying both their violent acting and their reluctance to engage in a therapeutic relation. In a milieu treatment, cultural mediations appear as one of the best way to overcome this difficulty because they put the focus on pleasurable activities rather than on the relation itself. It allows the therapeutic staff to find a way out of the paradox where relation which is the main therapeutic solution is at the same time the main psychopathological problem.