Common Milieu Therapy Techniques

By Michael Puskar|Updated August 2, 2022
CheckedMedically Reviewed By Laura Angers, NCC, LPC

While treatments exist for people experiencing paranoia, paranoia symptoms can be complicated to address. For most people, milieu therapy can help relieve symptoms, but because they're likely to return at some point, it's essential to learn how to manage them.

What is the milieu treatment? Learn about this therapy

Do You Feel Like You're Paranoid More Often Than Most People?

The medically reviewed Encyclopedia of Mental Health suggests that Paranoid Personality Disorder is the most challenging mental health condition to understand and treat. It's difficult to address specifically because the paranoia symptoms themselves often block any potential advantage of treatment and make individuals with it war of a treatment setting. If the patient can't trust the therapies and medications necessary to help them, they may refuse to cooperate and avoid treatment. However, there are some treatments for paranoia, like milieu therapy, that have shown promise. If a mental health professional like an online therapist can build trust with the patient, it becomes possible for treatments to have a lasting effect. Although these treatments usually allow the patient to cope with their symptoms, it's important to know that it's rarely possible to eliminate them completely.

Nonetheless, many people successfully treat paranoia with the help of a therapist and through medication. If you're affected by paranoia, know that seeking help is the first and most essential step to getting better and improving your mental health and learning new life skills to manage your paranoia.

Milieu Therapy To Treat Paranoia

Psychotherapy is the most effective treatment for paranoia symptoms, and there are many types of psychotherapy, including milieu therapy, that a patient might try. However, the key is to build trust with a therapist and others involved so the patient has a supportive environment and is open to treatment methods for these mental health challenges. That said, building and keeping the trust of a paranoia patient while still offering constructive advice can be a fine line for a therapist to walk in individual therapy sessions. Because of the nature of paranoia symptoms, therapy as a paranoia treatment relies heavily on the patient and sometimes does not last long. As soon as the patient feels that they cannot trust the therapist, they will likely stop going to therapy, and treatment will end. For this reason, many people living with Paranoid Personality Disorder go in and out of treatment over the course of many years.

Cognitive Therapy

Cognitive therapy is a specific form of psychotherapy in which negative thoughts about one’s self and the world are challenged and reshaped, so the patient can develop a more positive outlook. The idea is that, with a conscious effort to change negative thoughts to positive ones, behavior can be modified and any residual mental health issues (such as stress) can be addressed. Cognitive therapy requires a strong foundation of trust between the therapist and the patient because the therapist must challenge the patient’s paranoid thoughts. If the patient does not completely trust the therapist, the patient could believe that the therapist is against them, essentially siding with the issues they're paranoid about.

Group Therapy

Group therapy is a psychotherapy method where people with the same symptoms of psychosis (not to be confused with schizophrenia patients) meet in a group session and share a positive peer influence with one another in a structured environment with open communication. Each member of the group shares their feelings and experiences with others and, in turn, these individuals know they're not alone. Also, group therapy can be useful for learning coping skills that have helped others in the same situation create positive change.

When it comes to paranoia treatment, the biggest hurdle with group therapy is that group members are often suspicious of one another and the leading therapist. While building trust with a therapist can happen over time, building trust with a group of other individuals experiencing symptoms of paranoia can prove difficult. This is especially true because many patients do not stick with therapy, so the group dynamic is constantly changing. Support groups also work well for this kind of treatment, but have similar downfalls for patients with these mental health issues. 

Milieu Therapy

Milieu therapy is a type of psychotherapy in which the patient's environment is controlled to prevent self-destructive behavior. This is often used on an in-patient basis, but contemporary milieu therapy can also be applied to out-patient treatment from outpatient clinics with some in-home visits or scheduled therapy sessions. A patient's environment and interactions at home, work, and in certain activities are controlled or manipulated to help suppress or cope with paranoia symptoms. This could take many forms, but therapeutic milieu techniques are usually aimed at making sure that the patient does not become self-destructive or elicit violent behavior when they're trying to function in their day-to-day life. These techniques help the patient practice positive change and learn new coping skills so they do not need to be in the right environment to take control of this behavioral condition. 

Self-Esteem Boosting

In 2011, one study researched the effects of negative beliefs about the self on paranoia symptoms. It found that subjects who had negative feelings about themselves had more negative symptoms. When these views about self became more positive, their symptoms decreased. Because of this research, many therapists focus on self-esteem boosting exercises during the first six weeks of psychiatric treatment. Boosting your sense or self or purpose can reduce symptoms and help make other therapies more effective. It can also help to build trust between the therapist and the patient.

Supportive Psychotherapy

It can be very beneficial for patients to undergo simple, supportive psychotherapy. In this type of therapy, counselors are supportive of the patient and help them work through their symptoms or problems. Instead of challenging paranoid delusions, the session is instead focused on ways to cope with situations that arise. This could be a good way to start therapy sessions for people experiencing paranoia symptoms. It allows the therapist to build a rapport with the patient and also builds upon trust. Once trust is established, it's easier for the therapist to then try other methods.

Coping Skills

For over a century, therapy, including milieu therapy, has helped people living with paranoia, from trauma or otherwise, by teaching them a variety of coping skills. These skills might include relaxation routines, such as meditation or visualization, or ways to reduce stress or anxiety and ground oneself when paranoid thoughts arise.

The goal of learning coping skills is to function in society despite the difficulties presented by the illness. In general, it's a good idea for a therapist to teach coping skills in addition to any other treatments that are used. Because there's no cure or effective long-term treatments for Paranoid Personality Disorder, coping skills can help people living with this illness to function as normally as possible.


When it comes to treatment, medications have not been proven to successfully treat Paranoid Personality Disorder. Unfortunately, there's little research on this topic because many patients are convinced that the drugs will harm them. However, some medications have shown the ability to treat multiple symptoms, while others may simply help patients cope with their symptoms by reducing anxiety and certain behaviors. However, medications are not an appropriate course of treatment for children, which is important to note if a younger person you know is struggling. Please consult with your doctor or primary care physician about your diagnosis before considering any medication management options.


Phenothiazines are a type of antipsychotic that's typically used when other antipsychotics are ineffective. The scientific community has conducted peer reviewed studies but still does not well understand the exact mechanism of how these medications work, although it's assumed that they block dopamine in the brain. There are many different phenothiazines available in the U.S. market. These include: prochlorperazine, chlorpromazine, fluphenazine, perphenazine, trifluoperazine, and thioridazine. Compazine, Compro, Procomp, Promapar, Thorazine, Permitil, Prolixin, Stelazine, and Mellaril are some of the brand names you might hear. Just be sure to discuss a possible interaction between drugs with your primary care doctor before starting any of these medications.

One medically reviewed study from 1981 showed some promising effects of phenothiazines in treating Paranoid Personality Disorder. The results were found to be most effective for those experiencing premorbid Schizophrenia paranoia symptoms, but the effects of the medications were found to be less effective among those who do not experience paranoia symptoms. Therefore, psychiatrists sometimes attempt to use these medications on clients with extreme paranoia or schizophrenia.


Pimozide is an antipsychotic medication that's frequently used to treat Tourette syndrome. Research from 1993 suggests that this medication could also be used to treat paranoia. In the study, a patient was essentially cured of paranoia symptoms using low dose pimozide. This paranoia treatment may be an option when other treatments fail, but it's not common and its effectiveness has been disputed.

Anti-Anxiety Medications

Anti-anxiety medications will not directly treat paranoia, but they are often prescribed to patients experiencing symptoms of paranoia to help control extreme anxiety. Anxiety symptoms can make it very difficult for the patient to function in according to societal rules. Anti-anxiety medications in high enough doses can sometimes help control these symptoms, so patients can find ways to function in everyday settings. The medications may allow them to hold a job, travel around their communities, attend social events, or have functioning family relationships.

Antipsychotic Medications

Antipsychotic medications, in addition to treatments like milieu therapy sessions, are often used to treat paranoia. These medications do not treat the paranoia itself, but instead, they treat the symptoms that come along with the paranoid delusions. Antipsychotics can often help relieve some of the more severe symptoms that keep a patient from being able to function. These medications are most frequently given to patients when their symptoms could cause harm to themselves or others. They're largely sedative in nature, which helps calm what could otherwise be harmful impulsive behaviors, and they're most frequently used as a form of behavior modification. However, many patients become convinced that the medication is harming them in some way and refuse to take it.

Do You Feel Like You're Paranoid More Often Than Most People?

The Potential Of Hospital Admission

In severe cases of Paranoid Personality Disorder, the patient may need to be hospitalized. This becomes required when other treatments, like milieu therapy, fail or when the patient refuses to cooperate with needed treatments developed by their doctors. Hospitalization is usually used as a last resort. Unlike in times past, hospital admissions today are typically temporary and only last as long as the worst of the symptoms. Once the disorder stabilizes to a non-harmful point, the nurses will release the client. However, there are some severe cases in which symptoms of paranoia never subside. In these cases, people may find themselves in long-term care facilities with mental health nursing units. Although this is very rare, most paranoia patients could find themselves in and out of hospitals throughout their lives.

Moving Forward With Milieu Therapy

If you're living with paranoia symptoms or if you know someone who is, it's important to seek psychiatric treatment right away. A licensed psychologist can help diagnose paranoia and determine if it's a stand-alone disorder or a sign of a more serious mental health condition.

As with any mental health disorder, seeking help is the first step toward getting better. Anyone who struggles with paranoia will likely benefit from treatment in the form of milieu therapy. If your symptoms are severe enough that you rarely leave the house, being able to connect to a counselor online who can help you could be life changing. Studies show that online counseling can improve your mental health as well as traditional face-to-face therapy. One such study from Palo Alto University found that video-based cognitive behavior therapy effectively treats depression and anxiety. According to the research, approximately 73% of study participants saw an improvement of symptoms after six weeks, and the data suggests a “decelerated decrease in symptoms over time.”

If you need help with psychosis or mental health issues such as stress, consider contacting a therapist at BetterHelp to get started. BetterHelp is an online counseling platform that connects those in need of professional direction or advice with affordable and remote care, making it a more accessible reality for people to get help on their own terms. Every therapist is fully licensed. In the next section, you can read some reviews to see how others have greatly benefited from using BetterHelp's services.

“Have you ever felt like no one really understands? I have for a while. It’s been a short time, but Allyson seems to 100% get it. She helps me feel like I’m not crazy and is helping me work on my self-esteem, but strength and more things that will help me be a better, stronger happier human going forward. Plus, she’s patient; she will talk when I’m up for it. That’s hard to find. No pressure. Couldn’t be happier with ending up with her!”

“Jennifer is so kind and understanding. She listens without judgement and has helped me develop my self-esteem and self-love. She is absolutely wonderful, and I would recommend her to anyone and everyone!”


Paranoia is often a challenging disorder with many components to treat, but it's possible to get help. If you're struggling with paranoia, things will get better when you start working with a qualified mental health professional. Take the first step today.

Frequently Asked Questions: Milieu Therapy

What are examples of milieu therapy?

Examples of milieu therapy could include weight-loss groups, behavioral treatment centers for various disorders, alcohol rehab facilities, or a peer group setting, such as Alcoholics Anonymous. The setting can vary greatly as it's based more on the therapeutic environment for the people who are assembled for a collective goal. Having this therapeutic community can be a beneficial way to make mental health progress.

What are the 5 elements of a therapeutic milieu?

The milieu therapy approach has multiple elements, including supportive and therapeutic relationships, daily routine and structure, continuous exploration of life events, socialization, focus on self-care, and a supportive physical space. All of these are considered to be strengths or benefits of milieu therapy.

What is the primary goal of milieu therapy?

In short, the goal of milieu therapy is meeting your needs. Staff members or mental health outreach employees put your needs before anything else in milieu therapy. While this may seem obvious from a mental health perspective, it's not always true. So having this goal for milieu therapy set from the beginning makes a big difference in the overall outcome. 

Not only can the team members be positive role models for change in milieu therapy programs, but they often have a pulse of new treatment programs and opportunities that the patient can try. In addition, Milieu therapy is deemed a positive for bringing down conflict behaviors for those people experiencing a mental illness.

What are the stages of milieu therapy?

According to, here are the stages that are part of milieu therapy and the treatment goals of milieu therapy: 
  1. You do some self-destructive behavior, hurt someone else, or damage your environment in some way. You're disoriented, unable to participate in group therapy and don't take care of your hygiene.
  2. You're not destructive. You're oriented as to time, place, and person. You attend at least one therapy session per day. You try to take care of your hygiene.
  3. You go to all your scheduled milieu therapy sessions and begin to take responsibility when it comes to meeting your own goals.
  4. You're actively engaged in helping other patients progress through the first three levels and giving them feedback, using peer pressure in a positive way.

What is the importance of milieu?

More than anything, milieu therapy is about providing a safe, secure and home-like environment to allow adults to feel their maximum amount of personal safety to the space and to each other. Milieu therapy is intentionally set up in a way that mimics a health home environment. Not only does this make the individual feel more comfortable on the whole, milieu therapy allows them to make mental health treatment progress in an environment as similar as possible to the space where the challenges usually occur.   

What does milieu mean in healthcare?

With respect to healthcare, milieu therapy is likely to mean a hospital unit, in-patient facility, or other place which has staff members, a treatment team, and a treatment environment. 

What is bibliotherapy used for?

It can be an integral part of group therapy, milieu therapy, or a group setting, as it allows a group of people to explore their thoughts, emotions, and reactions to a piece of written text, whether that is a book, poem, or play. It can be a starting point for a more in-depth conversation with mental health professionals where each person dives deeper into thinking.

What does milieu mean in psychology?

On the whole, milieu therapy means "the environment in general." In a psychology or psychiatry context, milieu therapy means a focus on the nearby social setting for an individual. This could refer to the atmosphere in a home, neighborhood, school, workplace, etc. It's widely understood that these environments have a profound impact on the personality of a person.

What is bibliotherapy and examples?

It uses literature to help a person improve their life and mental health challenges through relevant information, support, and guidance. These could take the shape of books, stories, or other written content. Lessons learned through bibliotherapy could include life skills, self confidence, or relationship skills.

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