Why does the Milieu Matter in Addiction Treatment?

The “milieu” is defined as a person’s social environment. One’s general surroundings. In addiction treatment, we use the term to describe the space between clinical activities (individual therapy, group therapy, psychoeducation, etc.) when clients have an opportunity to interact with one another, as well as with the staff. At Sanford Outpatient Center, this means that the times before, between or after group therapy are prime milieu times. People are still milling about, filling up coffee or introducing themselves to one another. 


Milieu in Outpatient Therapy

I originally became interested in this term when I had a supervisor tell me to never, ever discount the therapeutic effects of spending time in the milieu. In my role as a clinical therapist at Sanford Outpatient Center, that simple advice has always stayed with me. I can see the vital role of the milieu as individuals transition through our outpatient programming. I am inspired to share why environment matters, because it is one of the most influential parts of the staff and client experience.  


milieu is a safe friendly place

Spending time in a safe space.


Commitment to the Group

To start, group therapy is a big commitment. There is a lot of emotional processing, psychoeducation, discussion, laughter, and everything in between. Facilitators know that if we don’t give at least one break, everyone will start to sag, and the once-lively discussion will taper out.



And nobody wants that awkward silence. Bueller? Bueller…? I now recognize that breaks serve a larger purpose than just re-energizing.



The Milieu and Positive Treatment Outcomes

On a recent day at Sanford, I let one of our 3-hour groups out for a 10-minute break at the halfway mark. I went to fill up my water (hydration station!) and get my things in order for the rest of the session.  As I did this, I overheard two individuals who were sitting in the group room during break having a deep, personal discussion.



One of our clients was giving amazing advice and support to another. Outside of group time. Phrases such as “When I went through that…” and “It is so hard…”. I quietly sneaked away into the office to allow “magic” to happen. Group cohesion is the fairy dust that allows groups to relax into deeper, more honest, and more fruitful conversations. However, even though it can be encouraged in group, this is a prime example of why it often multiplies in the milieu. 


Hospitality in the Milieu

milieu Sanford outpatient break room

The hydration station and center of hospitality – Sanford Outpatient Center


At other times, the milieu at the Outpatient Center has been focused around hospitality and eating together. Most folks find themselves sitting around the table in the middle of the Outpatient Center drinking coffee or tea until group rolls around. There have been cookies, muffins, cupcakes, and even leftover catered food on that table. Boxes of pizza to celebrate someone’s completion of our 18-session program. The list goes on. This might be my favorite part about the milieu.


Who doesn’t love sharing food with people? I think we would all be hard-pressed to find another social binding agent so consistently successful as food. 


I can’t tell you how many times another staff member, a group of clients or I have started a lively conversation about something small and inconsequential. Movies, music, Grand Rapids news, weather – you name it. There is something so valuable about being able to relax into a “real” conversation when in treatment. It reminds everyone involved that there is so much humanity in this process. If I am grabbing a snack out the fridge and a client is getting coffee – you can bet I will strike up a conversation about how their day went. 


The author (second from right) with Outpatient staff creating the real life milieu – Halloween 2019.


Together with Therapeutic Modalities …

As a clinical social worker, I am passionate about therapeutic modalities. Dedicated to  evidence-based treatment, and diligence in building a comprehensive recovery program. I want my clients to feel supported, advocated for, and informed on changing their lives for the better. Most of the time this happens in evidence-based interventions in individual and group therapy.


But in the past few months, I have been grateful to notice that sometimes the best purpose of treatment is simply holding a safe space for individuals to spend their time in.


A conversation or a quick wave between therapy sessions can be all that is needed to convey a positive message. Whether it is between peers in recovery or staff and client, I am proud to say that the message in the milieu at Sanford Outpatient Center is “come and hang out, we can work on this together”. 



Ali Kitchin grew up outside of San Francisco, but most of her extended family lives in Michigan, so she’s glad to call Grand Rapids home these days. Ali has a bachelor’s degree in social work and a master's from Baylor University. She was a clinical manager at Sanford Outpatient Center and worked for Sanford from 2018 to 2023. In her free time, Ali loves to run (when weather permits), read science fiction novels, or be outside with her dog, Pepper!