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.