Caring for the Whole Person: Milieu Therapy at the O-School
From the smiling receptionist and the living room filled with antiques to the bright classrooms and the cook serving home-style meals, there is no mistaking: you have entered a place that feels like a family.
Foundation of Milieu Therapy at the O-School
The implementation of milieu therapy, a treatment concept that has evolved throughout the 20th century, was one of the most significant and enduring contributions of Dr. Bruno Bettelheim, the O-School’s director from 1944 until 1973.
The life-changing impact of the external setting was proven to Dr. Bettelheim as a young man while he was imprisoned in a Nazi concentration camp. There, he saw first-hand how people could become de-humanized by their environment. Why, he asked, couldn’t the opposite also be true?
Bettelheim’s study of his fellow prisoners — together with his later study of psychoanalysis, Dr. Freud’s “ego” based theories, and his work in the 1940s with Anna Freud at the O-School — led to his innovations in milieu therapy as a methodology for caring for children who did not fit elsewhere. This comprehensive milieu treatment model—in an evolved form—is still in operation today.
The Origins of Milieu Therapy
a super-humanizing environment that promoted the individual
and gratified their interpersonal and practical needs, they could assist
the challenged in becoming competent, confident and capable individuals.”
Although he did not originate the concept, Dr. Bettelheim’s early creation of a full milieu model at the O-School has resulted in his close association with this treatment approach. His innovations in milieu therapy, carried forward by succeeding School Directors Dr. Jacqui Sanders and Dr. Bertram Cohler, garnered worldwide recognition.
Bettelheim’s adaptation of milieu treatment concepts was based on work originated by other psychotherapists in the 1930s, including:
- August Aichhorn (1878-1949)
- Harry Stack Sullivan (1892-1949)
- Anna Freud (1895-1982)
- Joseph Noshpitz (1922-1997)
Over the years, milieu therapy has been broadly documented. Books about the work at the School include:
- A Home for the Heart – By Bruno Bettelheim
- Truant from Life – By Bruno Bettelheim
- The Sonia Shankman Orthogenic School: Psychodynamic Milieu Therapy in an Education Residential Setting – By Jacqui Sanders
- A Greenhouse for the Mind – By Jacqui Sanders
Despite the continued success of the O-School’s application of milieu therapy, for some in the mental health field, the treatment model may be perceived as outdated. Other approaches — models of care that claim to provide quicker fixes, easier billing units, and shorter durations — are preferred by some residential treatment centers and special education programs.
The O-School’s position is steadfast: milieu therapy remains highly effective in helping children who have not benefitted from other treatment approaches. For the majority of students, attending the O-School is the end of repeated hospitalizations and the beginning of developing new skills, accomplishments and relationships that enable each child to live a full and successful life. Learn More >
Evolution of Milieu at the School
Through its 100 year history, several changes in the School’s administration and clinical focus have naturally occurred. Today, an evolved milieu blends with advanced psychodynamic and relational therapy practices, and the School continues to build on its reputation as a highly desired treatment and educational center.
Highlights of the O-School milieu of the 21st Century:
Increased Family Involvement: In the remote past, families were rarely included in their child’s treatment, resulting in uneven growth between the student and home. Today, the O-School has a therapeutic culture that actively encourages and benefits from the family’s involvement.
Approach to Medications: Current medications can target more specific areas or actions of the brain, causing fewer unwanted side effects. Thus, safer and better researched medications at appropriate doses now play a larger role in helping O-School students use and benefit from the therapeutic milieu.
As seen in the School’s mission statement, the O-School remains dedicated to its past, while also looking forward to the future:
The Orthogenic School provides a comfortable and nurturing, family-like residential setting and is staffed by a talented and devoted multidisciplinary team of professionals. The School distinguishes itself by providing highly refined and individualized attention to the unique needs of each of the children who pass through its “Yellow Door” entrance.
Working in collaboration with our families, we offer a safe haven and a path to hope as the students move toward becoming happy, productive, and independent young adults.”