1. The Therapeutic Environment
Chapter 12
The Therapeutic Environment
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
List two situations that indicate a need for hospitalization.
Describe three types of clients treated in the inpatient therapeutic environment.
State two goals of the therapeutic environment.
Discuss five environmental factors that are assessed daily.
Copyright © 2013 by Elsevier Inc. All rights reserved.

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Learning Objectives
Explain the importance of setting limits on clients’ behaviors.
Identify three ways the therapeutic environment helps clients meet their needs for love and belonging.
Examine how care providers’ expectations influence clients’ behaviors.
List three techniques to improve client compliance.
Copyright © 2013 by Elsevier Inc. All rights reserved.

4. The Therapeutic Environment (p. 128)
In 1953, Maxwell Jones published a small book in England that described the value of the environment as a therapeutic tool.
This book later was published in the United States with the title The Therapeutic Community.
Therapeutic environment (milieu) describes certain settings or environments designed to help clients replace inappropriate behaviors with more effective personal and psychosocial skills.
Copyright © 2013 by Elsevier Inc. All rights reserved.

5. Use of the Inpatient Setting (p. 129)
Inpatient services are provided for three main groups of people:
Those who are experiencing crises
Crisis stabilization interventions are provided by placing clients in 1-day or 2-day treatment settings, where balance (homeostasis) can be reestablished.
Those with acute mental or emotional problems
Inpatient services are necessary when people cannot function sufficiently to satisfy their basic needs.
Those with chronic mental illness
The chronically troubled person may feel that life in the inpatient facility actually may be better than a lonely existence in the community.
What situations may indicate the need for hospitalization?
Describe types of clients treated in the inpatient therapeutic environment.
Discuss the role of mental health team members in humanizing the hospital environment.
Coping with the unknown—uncertainty can be overwhelming. Allow the client to take control by offering choices, explaining the unknown.
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6. Use of the Inpatient Setting cont’d. (p. 129)
Recidivism (repeated inpatient admissions)
Revolving door syndrome
Becomes a way of life for many chronically mentally troubled individuals
Frustrating aspect of inpatient mental health care for both clients and care providers
Primary reason for return to the inpatient environment is clients’ refusal to take their prescribed psychotropic medications (noncompliance).
Copyright © 2013 by Elsevier Inc. All rights reserved.

7. Goals of a Therapeutic Environment (p. 130)
Goals of a therapeutic environment (milieu) are to provide protection, support, and education.
Within the therapeutic environment:
Care providers assist clients in meeting their needs.
Clients can learn to replace their maladaptive behaviors with more effective actions
What are the goals of the therapeutic environment?
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8. The Therapeutic Environment and Client Needs (p. 131)
Maslow’s hierarchy of needs: Basic physical needs must be met before higher-level needs can be met.
Physiologic needs
To breathe, nourishment, hygiene, environment
Safety and security
Feeling of physical safety and the ability to feel secure with others
Love and belonging
Need to be accepted and find one’s place within a group
What environmental factors are assessed daily?
Copyright © 2013 by Elsevier Inc. All rights reserved.

9. The Therapeutic Environment and Client Needs cont’d. (p. 134)
Maslow’s hierarchy of needs
Self-esteem needs
You must love and respect yourself before others can love and respect you.
Self-actualization needs
Need to achieve one’s full potential
Explain the importance of setting limits on clients’ behaviors.
Identify ways that the therapeutic environment helps clients meet their needs for love and belonging.
Copyright © 2013 by Elsevier Inc. All rights reserved.

10. The Therapeutic Environment and Client Needs cont’d. (p. 131)
Maslow’s hierarchy of needs: Basic physical needs must be met before higher-level needs can be met.
Physiologic needs
To breathe, nourishment, hygiene, environment
Safety and security
Feeling of physical safety and the ability to feel secure with others
Love and belonging
Need to be accepted and find one’s place within a group
What environmental factors are assessed daily?
Copyright © 2013 by Elsevier Inc. All rights reserved.

11. The Therapeutic Environment and Client Needs cont’d. (p. 134)
Maslow’s hierarchy of needs
Self-esteem needs
You must love and respect yourself before others can love and respect you.
Self-actualization needs
Need to achieve one’s full potential
Explain the importance of setting limits on clients’ behaviors.
Identify ways that the therapeutic environment helps clients meet their needs for love and belonging.
Copyright © 2013 by Elsevier Inc. All rights reserved.

12. Variables of the Therapeutic Environment (p. 135)
Every staff member assists clients with activities of daily living and monitors each step made toward treatment goals.
Admission and discharge
Clients are expected to follow rules and engage in appropriate activities.
Make efforts to support the client in becoming familiar with the therapeutic environment.
The process of preparing for discharge begins upon admission.
How is the decision made to discharge the client?
Expectations of the provider as the therapeutic relationship ends:
client can use own resources to deal with difficult situations
client independent in therapy and compliant with meds
Expectations of the client:
being cured of the illness
having emotional support available from the care team
Discuss how both health care providers and clients may have unrealistic expectations at discharge.
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13. Variables of the Therapeutic Environment cont’d. (p. 136)
Compliance
Clients who follow prescribed treatments are said to be “in compliance.”
Noncompliance refers to not cooperating with the treatment plan.
Forty to eighty percent of clients do not comply with their prescribed therapeutic course.
Genuine concern is a powerful tool in helping clients with compliance.
How do care providers’ expectations influence clients’ behaviors?
How can care providers improve client compliance?
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Question 1
The nurse is taking care of a client with organic mental disorders. What type of impaired time concept should she expect from her client?
Difficulty understanding passage of time
Time passes quickly
Time passes slowly
Inability to tell time
Correct Answer: 1
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Question 2
The basic goals of a therapeutic environment include all of the following except:
To protect the client and others during periods of maladaptive behavior
To transition clients out of the facility as quickly as possible
To help individuals develop self-worth and confidence
To teach more effective adaptive skills
Correct Answer: 2
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Question 3
The health care provider realizes that his client needs to feel love and to have a sense of belonging while in a therapeutic setting. This goal is fulfilled in all of the following ways except:
Self-recognition
Client-parent relationship
Care provider–family relationship
Client-client relationship
Correct Answer: 1
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Question 4
The nurse realizes that in the therapeutic setting, she can help her client meet self-esteem needs through:
Acceptance
Explanation
Communication
Interactions
Correct Answer: 1
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Question 5
Vicki wants to help improve her client’s compliance with treatment. In order to do this, Vicki must:
Understand the unwillingness to follow the treatment plan
Socialize with the client
Focus on the negative behavior
Offer vague concern
Correct Answer: 1
Copyright © 2013 by Elsevier Inc. All rights reserved.