Therapeutic Milieu | Overcoming Setbacks in a Group Setting

How a structured group setting can affect the outcome of treatment

'Group Therapy, meeting of support group with their counselor. Selective focus to young woman talking.'
Miodrag Gajic/Vetta/Getty Images

A therapeutic milieu is a structured group setting in which the existence of the group is a key force in the outcome of treatment. Using the combined elements of positive peer pressure, trust, safety and repetition, the therapeutic milieu provides an idealized setting for group members to work through their psychological issues. Many alcohol and drug rehab facilities rely on this type of setting as well as weight loss groups and those receiving therapy for behavioral disorders.

Some people feel that within the trusting therapeutic milieu of their therapy group, they are able to try out new coping skills without feeling self-conscious.

The More We Get Together: Group Cohesion

The term is often used to refer to inpatient settings in which clients learn healthy patterns of living through constant exposure to role models and strict expectations, but a therapeutic milieu can be developed with an outpatient group as well such as is the case with Alcoholics Anonymous which relies on participants to come to regularly scheduled meetings. The goal is to promote group cohesion and togetherness. Without regular interactions the positive peer pressure, trust and repetition that this technique relies on to work cannot develop properly.

The Big 4: Support, Structure, Repetition and Consistent Expectations

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. He must serve as role model, practicing the behaviors that are expected of the group. She must facilitate the group in developing a list of rules and expectations and dealing with infractions without coming across as an authority figure.

The therapist should guide the group towards self-management without allowing natural leaders to overshadow the participation of natural followers.

The Importance of Being Vulnerable

Although it takes time to achieve, a successful therapeutic milieu is a safe and trusting environment. Group members feel free to experiment with behavioral changes and discuss deep secrets without fear of judgment or reprisal. Members 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 structured group setting for treatment. Ongoing participation in the group is sometimes an essential part of maintaining the gains achieved in the group setting. When the group setting ends, many patients have significant setbacks as a result of losing the support, structure and familiarity of other group members.

It's important that this type of therapy teaches individual coping mechanisms in the group setting so that the transition to self-care or individual agency to follow the treatment techniques used within the group when the group setting is not available. Some people secure a buddy from the group to stay in touch with to help them cope with their own personal freedom after the group therapy setting changes. Some also struggle with becoming the "big brother or sister" in the group when certain members of the group leave. These challenges to therapeutic milieu can be overcome with foresight and proper preparation for both practitioners and patients.

Continue Reading