A Social Treatment: Mental Health Benefits of Milieu Therapy For People Living With Schizophrenia

On its most basic level, milieu therapy “manipulate[s] the environment so that all aspects of a client’s experience are considered therapeutic,” allowing you to learn and practice everything from maintaining a regular schedule to “adaptive coping, interaction, and relationship skills that can be generalized to other aspects of life.” This is achieved by working with both peers and staff as a therapeutic community based on the following principles:

• Creating a framework of respect for both clients and staff
• Using open communication as an opportunity for growth
• Promoting social participation
• Providing opportunities for leadership and management
• Holding you, as a client, accountable for your own behavior
• Harnessing the positive power of peer pressure to enforce rules

While this approach can be helpful for people living with a variety of psychiatric illnesses, it is particularly applicable if you’re struggling with schizophrenia, a condition that often drastically interferes with your ability to maintain both internal and external organization.

By molding the environment to your needs and abilities and collaborating with others as a team to encourage accountability, positive social interaction, self-care, and a sense of agency, you can regain your sense of order both within yourself and with the world around you. The flexibility and personalization of milieu therapy allows you to work at a level that is appropriate for you while continuously expanding your skillset. The ultimate goal is to give you the ability to live autonomously and harmoniously in both practical and emotional terms.

Milieu therapy also gives you and your clinical team the opportunity to observe psychotic phenomena and track the influence of environment on emotional states and other schizophrenic symptomatology. This helps you gain the insight you need to identify potential triggers and develop strategies to avoid or manage distressing symptoms without relying solely, or even primarily, on antipsychotics. For example, minimizing change, sidestepping chaotic situations, and surrounding yourself with calm, respectful, kind people can diffuse even acute psychotic disturbances. This self-knowledge and ability to modulate your own psychiatric state can be extraordinarily empowering.

Although clinicians and clients alike have witnessed the benefits of milieu therapy in its various incarnations for centuries, it is only in the past several decades that it has been studied as a discrete modality. Researchers have overwhelmingly found that milieu therapy can help you manage schizophrenic symptoms both in the short and long-term, while lowering reliance on psychotropic medications and creating a more positive view of the self.

According to Ciompi and Hoffman, “Comparative longitudinal research revealed at least similar, and partly probably better 2-year outcomes than with traditional methods, with much lower total doses of antipsychotics.” Although longer-term outcomes are harder to gauge due to methodological difficulties, the researchers observed “a number of cases with astonishingly favorable evolutions over decade-long periods.” They note:

Possible long-term advantages seem to be mainly located in the area of social adaptation and stigmatization at both subjective and objective levels, and in a less traumatic subjective impact of the psychotic experience. Feelings of personal value and identity, too seem better preserved, allowing for a better eventual integration of the psychotic experience into the personal life history.

This ability to fortify yourself emotionally, reframe the way you integrate residual symptoms, and nourish your sense of self are perhaps the most remarkable aspects of milieu therapy, phenomena which cannot be replicated through medication.

While milieu therapy has distinct benefits beyond those possible via medication alone and may decrease reliance on medication, its goal is not to supplant antipsychotics or other forms of intervention altogether. Instead, milieu therapy is one piece of the larger treatment puzzle, which should ideally include a wide variety of therapeutic modalities to create a comprehensive, personalized treatment picture.

Milieu therapy can act as the cornerstone of that comprehensive care, allowing you to more fully immerse yourself in and benefit from other forms of therapy, including pharmacological treatment. By working in concert with other evidence-based interventions, milieu therapy can help you form a strong foundation for growth, stability, and self-determination in an environment of respect, love, and kindness.