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Patient Value Change in Milieu Therapy

Richard Almond, MD; Kenneth Keniston, PhD; Sandra Boltax, MD
Arch Gen Psychiatry. 1969;20(3):339-351. doi:10.1001/archpsyc.1969.01740150083012.
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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


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