Milieu Therapy in Residential and Inpatient Settings

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Abstract Residential and inpatient settings are service sites when emotional, mental, and behavioral problems are severe enough to require 24‐hr treatment environments before clientele can return to less‐restrictive settings. The structure of staff and client responsibilities is the core of any residential program. Traditional inpatient wards are organized like medical hospitals for the physically ill, where staff administer psychosocial and biomedical treatments as more‐or‐less discrete entities. Here, the unit‐wide program provides supportive care. Treatment is in rather than by or through the unit‐wide program. Milieu therapy, in contrast, means treatment by the environment. Therapeutic community and social learning approaches to milieu therapy have emerged as the most promising alternatives. In both, an overriding set of principles and procedures is followed by all clinical personnel with all clientele. For milieu therapy units, treatment is by and through their psychosocial programs. Evidence clearly supports social learning programs and particular therapeutic community approaches as replacements for traditional practices.