Therapeutic environments
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Therapeutic Environments. THE THERAPEUTIC ENVIRONMENT OR MILIEU. Physical: Psychological: Structure: Relationships:

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Therapeutic Environments

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Therapeutic Environments


THE THERAPEUTIC ENVIRONMENT OR MILIEU

  • Physical:

  • Psychological:

    • Structure:

    • Relationships:

      “The one practice that a CYW draws on consistently in their work is that of a therapeutic milieu or environment. An environment that fosters healthy relationship building, routine, consistency and structure is key to working with troubled children and youth.”


THE DIMENSIONS OF THE THERAPEUTIC ENVIRONMENT

  • Relationship Dimension

    • Foundation of work with youth

    • Relationship serves as a means of behavioural intervention

    • Builds assets in youth ( modeling etc.)

    • Direct impact on personal development (opportunity for LSIs, direct counseling etc.)

    • Encouragement is the cornerstone of an effective relationship

    • Encouragement reinforces effort as well as outcome

    • Staff to staff, staff to youth, youth to youth


THE DIMENSIONS OF THE THERAPEUTIC ENVIRONMENT

  • Personal Development Dimension

    • Encourages potential

    • An environment that supports growth

    • Awareness of and support to meet developmental tasks

    • Goal orientation

    • Strength based approach


THE DIMENSIONS OF THE THERAPEUTIC ENVIRONMENT

  • System Maintenance and Change Dimension

    • Appearance, order, routine and structure

    • Daily expectations

    • Staff vs. resident control

    • Responsiveness to change

    • Management of client movement – short -term placements

    • The issue of turnover! Burnout and its consequences.

  • The system of discipline

    • Emotional neutrality

    • Encouragement

    • Logical Consequences


  • DISCIPLINE WITHIN A THERAPEUTIC ENVIRONMENT

    • Emotional Neutrality

      • Easier said than done!

      • Depersonalizing behavior

      • Dealing with issues without engaging in power struggles

      • Conscientious effort to control both verbal and nonverbal behaviors when confronted with client misbehavior

      • Helping defuse client anger by forcing staff to depersonalize their interventions

      • Important to remember that client/staff conflict is almost always a lose-lose proposition for staff

      • Choosing your battles wisely!


    DISCIPLINE WITHIN A THERAPEUTIC ENVIRONMENT

    • Encouragement

      • Encouragement builds relationships, relationships effectively modify behavior.

      • Encouragement builds self worth.

      • Encouragement builds intrinsic motivation ( motivation that comes from within).

      • Encouragement assists in building resiliency.

      • Encouragement reinforces effort as well as success.


    DISCIPLINE WITHIN A THERAPEUTIC ENVIRONMENT

    • Logical Consequences

      • Behavior is followed by a consequence.

      • Logical consequences accomplish discipline without jeopardizing relationships.

      • Emotional neutrality ensures no judgment or anger involved

      • Logical consequences “make sense”.

      • Categories of consequences:

        • Natural

        • Logical

        • Punishment


    THE THERAPEUTIC AGENCY

    • If an agency aims toward the development of a therapeutic environment or milieu, it is necessary to:

      • Fully develop a system of logical consequences which address both positive and negative behaviors

      • Eliminate punishment

  • The way in which an agency structures the measures taken to correct misbehavior directly correlates with how therapeutic the environment is for children and youth.


  • This presentation was prepared and has been shared by Nancy Brown Brunton, Professor, CYW Program.


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