The therapeutic milieu: changing themes and theories.

Since its development close to 40 years ago in England, the therapeutic milieu, or therapeutic community, has undergone significant alteration and corruption by the emphasis on community care, increased use of pharmacotherapy, quick staff turnover, and lack of psychoanalytically trained staff. The hallmarks of milieu therapy, however, such as patients' participation in decision-making, collective responsibility for ward events, a multidisciplinary staff, and a belief in the rehabilitative potential of the environment, remain a part of many modern inpatient settings. The author believes that milieu therapy remains a viable treatment modality, and he offers guidelines for optimizing its potential.