Caring for the Whole Person: Milieu Therapy at the O-School

The O-School’s long history of being a safe and welcoming place, offering highly effective care through modern milieu therapy is alive and well today. This spirit is visible from the moment you enter the Yellow Door.

From the smiling receptionist and the living room filled with antiques to the bright classrooms and cook serving home-style meals, there is no mistaking that you have entered a place that feels like family.

Foundation of Milieu Therapy at the O-School

Photo of Dr. Bruno Bettelheim — Dr. Bruno Bettelheim

Milieu therapy is a comprehensive approach that seeks to treat the whole person by understanding and working with the dynamics at play with each individual, including internal and external forces. Implementation of milieu therapy, a treatment concept that 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 firsthand how people could become dehumanized by their environment. Why, he asked, couldn’t the opposite also be true?

Dr. Bettelheim’s study of his fellow prisoners — together with his later study of psychoanalysis, Dr. Freud’s ego-based theories, and his own 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. An evolved form of his comprehensive milieu treatment model is still in operation today.

The Origins of Milieu Therapy

Although Dr. Bettelheim did not originate the milieu concept, his early creation of a full milieu model at the O-School 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.

Dr. 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 O-School include:

A Home for the Heart, by Dr. Bruno Bettelheim
Truants from Life, by Dr. Bruno Bettelheim
The Sonia Shankman Orthogenic School: Psychodynamic Milieu Therapy in an Education Setting, by Dr. Jacqui Sanders
A Greenhouse for the Mind, by Dr. Jacquelyn Seevak Sanders

Dr. Bettelheim believed that if a collective group sought to provide 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.

– Dr. Jacqui Sanders

Perspectives

In a time when the term ‘milieu’ is both overused and misused, preserving its integrity and core values are at the very heart of the O-School.

– Diana Kon, Ed.D., Executive Director

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 a 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 them to live full and successful lives. Learn More

Evolution of Milieu at the School

Throughout its 100-year history, several changes in the O-School's administration and clinical focus have naturally occurred. Today, an evolved milieu blends with advanced psychodynamic and relational therapy practices, and the O-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 include:

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.

Mission Statement

As seen in its mission statement, the O-School remains dedicated to its past, while also looking to the future:

Continuing nearly a century of tradition, the Sonia Shankman Orthogenic School at the University of Chicago remains committed to providing the highest quality of intensive therapeutic milieu treatment for children and adolescents struggling with severe emotional challenges.

The Orthogenic School provides a comfortable and nurturing 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.

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