Question

Explain the goals of therapeutic community/milieu therapy. (Include a list of all references used to support your answer)

Answer 1

The concept of therapeutic community was first developed by Maxwell Jones.Stuart and Sundeen defined therapeutic community as "a therapy in which patient's social environment would be used to provide a therapeutic experience for the patient by involving him as an active participant in his own care andthe daily problems of his community."

Objectives

• To use patients social environment to provide a therapeutic experience for him.
• To enable the patient to be an active participant in his own care and become involved in daily activities of his community.
• To help patients to solve problems,plan activities and to develop the necessary rules and regulations for the community.
• To increase their independence and gain control over many of their own personal activities.
• To enable the patients become aware of how their behavior affects others.

The main goals of Therapeutic community are

Maintaining safe environment

The nursing staff should follow the facilitys policies with regard to prevention of routine safety hazards and supplement these policies as necessary such as

• disposal of all needles safely and out of reach of clients
• .Restrict or monitor the use of matches and lighters.
• Do not allow smoking.
• Remove mouth wash,after shave lotions and so forth,if substance abuse is suspected.

Building self-esteem

Strategies to help build or enhance self esteem must be individualized and built on honesty and on the clients strengths.Some general suggestions are

• Set andmaintain limits.
• Accept the client as a person.
• Be non-judgemental at all times.
• Structure the clients time and activities.
• Have realistic expectations of the client and make them clear to the patient.
• Initially provide the client with tasks ,responsibilities and activities that can be easily
• Praise the client for his accomplishments however small,giving sincere appropriate feedback for meeting expectations,completing tasks ,fulfilling responsibilities and so on.
• Never flatter the client.
• Use confrontation judiciously and in a supportive manner;use it only when the client can tolerate it.

Limit setting

Setting and maintaing limits are integral to a trust relationship and to a therapeutic mileu.Before stating a limit explain the reasons for limit setting.Some basic guidelines for effectively using limits are

• State the expectations or the limit as clearly,directly and simply as possible.
• The consequence that will follow the clients exceeding the limit also must be clearly stated at the onset.
• The consequences should follow immediately follow the clients exceeding the limit and must be consistent ,both over time and among staff.
• Consequences are essential to setting and maintaining limits,theyare not an opportunity to be punitive to a client.

The main advantages are

• patient develops harmonious relationships with other members of the community.
• Gains self confidence.
• Develops leadership skills.
• Becomes socio-centric.
• Learns to live and think collectively with the members of the community.