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Understanding the nature of the therapeutic milieu

Al Trieschman

I should like to find out, not only what milieu is and how it operates, but also how we can describe it, how we influence it, and by what actions of all involved it is, in turn, created or molded. At the moment I am convinced of only one thing for sure – we all have quite a way to go to achieve either of these tasks (Redl, 1966, p. 94).

These problems face us nearly a decade after Redl posed them and more than four decades after professional work with children began citing the child's living situation as a therapeutic influence. This chapter deals with these problems by presenting one kind of framework for understanding and utilizing a milieu as a therapeutic tool. Our notion is that the actions of adults with children and the adults' control of the environment can be coordinated to improve children's lives. Our framework is constructed for the adults who people a milieu: child-care workers, houseparents, counselors, nurses, social workers, group workers, psychologists, and psychiatrists. It is meant for all the adults who deal with children, or plan for children's living situations, whether they deal directly or supervise or advise those who do deal directly. Our major concern is the 23 hours outside the psychotherapy session-because that is when and where most of the milieu is.

Unfortunately we fall far short of complete answers to Redl's questions. Our look at the milieu is like a sea chart and some word pictures. It is unable to capture fully either the beauty or the turbulence of the milieu's many moods, and is hardly adequate to guarantee you will be a good sailor in that sea. If you grasp some of the excitement and power of milieu treatment and feel better equipped to participate in it, we will have succeeded.

The word milieu is our first hurdle. It is troublesome to pronounce and awkward to spell. What is it? Without being profound, let us settle on what we are talking about. We are describing a group living situation for children, specifically for children with emotional problems, children who must live away from home and whose lives are full of crises. We are focusing on events that occur and processes that exist in such a setting. Moreover, we are thinking in terms of people using these events and processes as an effective tool to help children.


Redl, Fritz. 1966. When we deal with children. New York: Free Press.

Trieschman, A. E., (1969) Understanding the nature of the therapeutic milieu. The other 23 hours – Child care work with emotionally disturbed children in a therapeutic milieu. New York: Aldine de Gruyter. pp. 1-2

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