Patient Value Change in Milieu Therapy

OBSERVERS and practitioners of psychotherapy have frequently emphasized the role of patient values and value changes in the process of treatment. A series of descriptive and anthropological studies during the past two decades have demonstrated the existence of ward or hospital "cultures" in a variety of settings. These institutional value systems, it has been argued, strongly affect the attitudes of patients, and exert great power over patient behavior and prognosis.^1-5 Recognition of such cultures has led both to a more sophisticated examination of the psychiatric hospital as a complex organization, and to a more self-conscious use of the hospital community as a major therapeutic instrument.

At the same time, a small number of investigators have begun to examine the specific effects of therapeutic values on the values and attitudes of patients. Most formal studies have examined value phenomena during individual