Why are the results of milieu therapy for schizophrenic patients contradictory? An analysis based on four empirical studies.

The results of milieu therapy with psychotic patients have been highly conflicting because of unrecognized differences among the wards investigated. Our own research indicates that for psychotic patients in short- and intermediate-term wards: A beneficial milieu has a low perceived level of anger and aggression and a high level of support, practical orientation, and order and organization. Confronting group therapy is detrimental and individually oriented milieu therapy beneficial. Community groups may become anti-therapeutic pseudo-groups. Extensive use of confrontational groups may contribute to a detrimental ward atmosphere. A high mean age of patients may contribute to a favorable low level of aggression. A high percentage of psychotic patients, a high number of patients, and a high staff turnover may lead to a detrimental atmosphere. On this basis we tried to change the milieu on a 26-bed therapeutic community ward which proved to have pseudo-groups and a detrimental ward atmosphere. The amount of compulsory group activities was reduced, the groups made more task-oriented, the amount of individually oriented milieu therapy increased, and the number of beds reduced. At re-evaluation the ward atmosphere had improved considerably.