The Placebo & The Therapeutic Milieu

The question was raised, what is the difference between a good example of architecture (well designed etc) and the architectural placebo?

The architectural placebo will not work without it's corresponding therapeutic setting, or milieu. This setting includes the caregivers for a patient, the disease/disorder of that patient, the history of that patient and the events leading up to being in this place. Using the example of a tablet placebo, for it to work there needs to be:

1. the need for it to work - eg. the disease/disorder being treated
2. the therapeutic setting - eg. the experience of the patient beforehand such as visiting the doctor
3. the belief both of the person administering it and the person using the placebo

The architectural placebo requires some shaping of a person's experience before entering the building, the entrance, the setting etc.

'Therapeutic milieu'

Milieu = from Old French, midst, from mi middle (from Latin medius) + lieu place, from Latin locus — more at mid, stall. The English translation of the word is surroundings or environment.
Milieu therapy = scientific planning of an environment for therapeutic purposes. Much like the architectural placebo...

The goal of milieu therapy is to manipulate the environment so that all aspects of the patient’s experience are therapeutic

See these links for more information:
http://nursingplanet.com/pn/milieu_therapy.html

The environment must be flexible and able to be adapted to patient's current needs. Patients who are regressed or who are overwhelmed need more structure and support while others need more autonomy and responsibility. Ideally there is a form of stepwise increase in responsibility.

Progressive levels of responsibility according to client’s self care capacity (according to the psychiatric nursing website listed above):

Level I: Displays a destructive behavior to self, others, or the environment.
Level II: Does not display destructive behavior.

• Knows the current time, date and place.
• Attends at least one therapeutic group daily.
• Attempts to maintain good personal hygiene 

Level III: Attends All Therapeutic Activities.

• Participates actively in the Community Meetings etc.
• Develops a self-directed behavior plan to change or resolve a personal problem.
• Knows the names of all medications and the times they are to be taken.

Level IV: Takes an active role in assisting other clients to gain level changes.

One approach to differing levels is to divide the clients into small groups according to their developmental needs. More regressed clients focus on physical and safety needs, and more advanced individuals concentrate on social, esteem and self- actualizing needs. The building spaces should support this.