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October 1969

Milieu Therapeutic Process

Author Affiliations

New Haven, Conn
From the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. Dr. Almond is now at the Stanford University School of Medicine, Stanford, Calif.

Arch Gen Psychiatry. 1969;21(4):431-442. doi:10.1001/archpsyc.1969.01740220047005

T HE VALUE experience of patients, the treatment ideologies of therapists, and the cultures of treatment services are being recognized increasingly as critical aspects of therapeutic process.1-4 Although most discussions of values have concerned individual treatment, it is now universally accepted that the value systems of psychiatric inpatient services also have powerful effects upon patient course.5.6 This is especially true of therapeutic communities, where treatment occurs on a small group or ward level, and where group and unit norms are recognized as a critical component of the hospital experience.7,8

The topic of induced value change in psychiatric units has received little theoretical analysis and even less empirical investigation. Research has been hampered by the difficulty in knowing what values to examine, by the fact that the value system of most hospitals are implicit, and by the lack of reliable and valid instruments for measuring value change in

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