Where can therapeutic community ideals be realized? An examination of three treatment environments

Staff views about the actual and ideal treatment environment of three therapeutic milieus with psychoanalytic, biological, and rehabilitative orientations were assessed using the Community-Oriented Programs Environment Scale (COPES), real and ideal forms. COPES scores indicated that the staff of the three units shared many beliefs about the ideal milieu but that only staff of the rehabilitation unit felt the milieu had realized its ideals. Disparities between real and ideal COPES scores on the other two units were believed to reflect staffs' inability to resolve the conflicting demands of milieu therapy and other treatment approaches. The authors identify specific sources of conflict on the psychoanalytic and biological milieus and reasons for the greater compatibility of ideology and practice in the rehabilitation milieu.