What's therapeutic about the therapeutic milieu?

While the milieu of an inpatient facility is considered a treatment modality, extant literature focuses on the staff's role in creating the milieu rather than the patient's perception of it. Not since Goffman's Asylums (1961) has there been an in-depth examination of the phenomenal world of the hospitalized psychiatric patient. In this study, eight inpatients (ages 23 to 58) on the acute psychiatric unit of a metropolitan general hospital participated in phenomenological interviews about their experience of the environment. The essential meaning of the hospital was refuge from self-destructiveness. Prominent aspects of patients' experience within the place of refuge were three interrelated themes (like me/not like me, possibilities/no possibilities, and connection/disconnection). Universally, patients perceived peer-administered "therapy" as the most beneficial aspect of their hospitalization. They expressed longing for a deeper connection with staff and more intensive insight-oriented therapies. Although their needs for safety, structure, and medication were met, patients were not gaining greater understanding of their dysfunctional patterns of behavior. Renewed emphasis must be placed on the nurse-patient relationship and the therapeutic alliance.