Therapeutic Community ( Milieu Therapy)

Sullivan envisioned the goal of treatment as the establishment of satisfying interpersonal relationships. The therapist provides a corrective interpersonal relationship for the client. Sullivan coined the term participant observer for the therapist’s role, meaning that the therapist both participates in and observes the progress of the relationship.
Credit is also given to Sullivan for the developing the first therapeutic community or milieu therapy with young men with schizophrenia in 1929 (although that term was not used extensively until Maxwell Jones published The Therapeutic Community in 1953). In the concept of therapeutic or milieu therapy, the interaction among clients is seen as beneficial, and treatment emphasizes the role of this client-to-client interaction. Until this time, it was believed that the interaction between the client and psychiatrist was the one essential component to the client’s treatment. Sullivan and later Jones observed that interactions among clients in safe, therapeutic setting provided great benefits to clients. The concept of milieu therapy, originally developed by Sullivan, involved clients’ interactions with one another; i.e., practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems.
Milieu therapy was one of the primary modes of treatment in the acute hospital setting. In today’s health care environment, however, inpatient hospital stays are often too short for clients to develop meaningful relationships with one another. Therefore the concept of milieu therapy receives little attention. Management of the milieu or environment is still a primary role for the nurse in terms of providing safety and protection for all the clients and promoting social interaction.

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