The Feeling of a Therapeutic Milieu

One of the most important ways that therapeutic boarding schools and residential treatment centers help struggling kids is through the therapeutic milieu. The mileau is the atmosphere or environment of the program. It includes the modes and schedules of individual and group therapy, as well as dormitory life and recreational activities. But more than the schedules, activities, and classes, the milieu is the feel of the program, the somewhat intangible culture of it. What are the people there like? What do they care about? How do they care for one another?

It is often difficult to characterize precisely a program's milieu and even more difficult to describe the importance of it. Many times, you have to feel it. That is difficult for parents to do, especially in short visits. Like visiting a foreign country, you often have to live there for awhile to really get a sense of the culture.

While it is difficult to get a handle on a particular program's milieu, you can get a feeling of its importance by watching the movie "Lars and the Real Girl." This 2007 film starring Ryan Gosling provides a moving, funny, and sweet immersion in a therapeutic milieu, even though it is never identified as such. This despite the decidedly off-beat and initially off-putting premise of the film.

The premise is that Lars, a troubled young man, deludes himself into thinking that a life-sized doll purchased on a pornographic web site is a real girl. Yet, Lars isn't interested in sex with the doll, whom he names Bianca. In fact, so chaste are Lars's intentions that he persuades his brother and sister-in-law to put Bianca up in the guest bedroom and look after her. When his brother takes Lars and Bianca to see the local doctor (played by Patricia Clarkson), she recommends that everyone, even Lars's co-workers and neighbors, play along with the delusion. The doctor slowly builds a relationship with Lars, attempting to discover the roots of his delusion.

While the sessions with the doctor look like therapy, the main therapeutic event is the interaction of the townspeople with Lars and Bianca. Despite initial doubts and some derision, the townspeople accept Bianca and Lars's obsession with her. More so than the therapy sessions, these sweet and loving encounters with his friends and neighbors buoy Lars in his troubles and set him on a path toward healing. You can get a sense of the passion that drives the caring for Lars in this scene with his sister-in-law, played by Emily Mortimer. http://www.youtube.com/watch?v=j9OxnHj43uE&feature=fvsr This clip gives you a sense of why the town is willing to help Lars, but only seeing the whole movie can show you how they do it.

The movie is a fable, of course, and the small town is a fabled setting. (Think "It's a Wonderful Life.") But the feeling of being supported and accepted as Lars is provides an approximate sense of what good programs are able to do with milieus--and why they can be so effective.