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Health Differences Across the Lifespan 2 Study Guide setting, the patient is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life. Skinner outlined seven basic assumptions on which a therapeutic community is based: 1. The health in each individual is to be realized and encouraged to grow: All individuals are considered to have strengths as well as limitations. These healthy aspects of theindividual are identified and serve as a foundation for growth in the personality and in the ability to function more adaptively and productively in all aspects of life. 2. Every interaction is an opportunity for therapeutic intervention: Within this structured setting, it is virtually impossible to avoid interpersonal interaction. The ideal situation exists for clients to improve communication and develop relationship skills. Learning occurs from immediate feedback of personal perceptions. 3. The patient owns his or her own environment: The patient makes decisions and solves problems related to government of the unit. In this way, personal needs for autonomy, as well as needs that pertain to the group as a whole, are fulfilled. 4. Each patient owns his or her behavior: Each individual within the therapeuticcommunity is expected to take responsibility for his or her ownbehavior. 5. Peer pressure is a useful and a powerful tool: Behavioral group norms areestablished through peer pressure. Feedback is direct and frequent, so that behaving in a manner acceptable to the other members of the community becomesessential. 6. Inappropriate behaviors are dealt with as they occur: Individuals examine thesignificance of their behavior, look at how it affects other people, and discuss more appropriate ways of behaving in certain situations. 7. Restrictions and punishment are to be avoided: Destructive behaviors can usually be controlled with group discussion. However, if an individual requires external controls, temporary isolation is preferred over lengthy restriction or other harsh punishment. Goals of milieu therapy: • Manipulate the environment so that all aspects of patient’s hospital experienceare considered therapeutic. • The patient is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life. • Achieve patient autonomy. Principles of milieu therapy: • To promote a fundamental respect for individuals (both patients andstaff). • To use opportunities for communication between the patient and staff for maximum therapeutic benefit. • To encourage patients to act at a level equal to their ability and to enhance theirself-esteem (autonomy is reinforced). • To promote socialization.

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