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.
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.
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.
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.