Communication, Organization, and Conduct in the "Therapeutic Milieu"

In the past several years, many psychiatric establishments have come to express an ideology often referred to as the "therapeutic milieu." While the distinctions between such a credo and an ethic of "custody" are well understood, the differences between the two types of arrangements in terms of organizational structure are less clear. In general, however, the former tends to take the shape of a bureaucracy, while the latter more closely approximates a diffuse and flattened authority system. Such a trend appears to be related to changing relationships between hospitals and the larger community as well as to increased autonomy on the part of the clients such institutions serve. Within the debureaucratized milieu, however, important processes of change seem to take place which importantly affect the content and functions of communication channels, the processes of decision making with respect both to clinical and administrative matters, the attitudes that staff have toward themselves and toward patients, the strategies which staff employ to articulate appropriate conduct for the clients, and the meaning of the institution for both patients and staff. This paper attempts to describe the historical forces shaping recent innovations in hospital administration, to set forth the organizational features of the "therapeutic milieu," and to trace the interpersonal consequences of the debureaucratized establishment. [ABSTRACT FROM AUTHOR]