A sociotherapeutic milieu in inpatient treatment or coaching
Lecture given at the 4th European Conference on Traumatic Stress in Paris
Nico van Tol, Paris, May 1995
part 3

During creation of a clinical sociotherapeutical environment, which is a continuos process, we have to consider the following prerequisites.

• The participants experience the clinical setting as significant
   
• Internal participants are defined to be the clients, the therapists and the supporting services
   
• External participants are defined as the people being a part of the social network of the clients, the insurance companies, the primary healthcare and the government and related authorities
   
• Agreement about the aim and meaning of the social system
   
• Agreement on how decisions are made and the definition of the limitations of responsibilities and activities
   
• Ensuring sufficient energy for the participants so the goals can be reached
   
• Agreement on the limits and identity of the system with respect to surrounding systems

An essential part of sociotherapy is to create the possibility for exchange and negotiation which is the reason why communication is very important.
Communication may be redefined to contact and interaction.
Contact can be described as the extend to which people are open or secluded to information exchange with other persons in their environment.
Interaction can be described as the extend to which people adapt to other people and their environment and the extend to which they are able to influence their own life.

The skills necessary to obtain contact are preceding the skills necessary to interact whith others. Without contact it is impossible to interact. If persons are too open for contact, stimuli, there is a possibility they will be invaded or even they will become chaotic or psychotic.
When people seclude contact with others they might isolate them selves.
Too much adaption might lead to helpless following without the ability to influence.
When people try to influence too much it might result in dominant behaviour.

When actions based on sociotherapeutical principles are executed, the most important factor is to show the clients the way how to obtain contact and how to interact.
The predominant factor to achieve this, although it sounds like a paradox, is contact with the therapist. When clients acquire the ability to obtain contact and interaction it can be tried to increase the social skills.
Practice and experimentation is of great importance and a clinical setting can be the appropriate environment to achieve this.

Sociotherapy is directed towards the executive functions of the ego, among which are the ratio, sensorial observation and physical properties. Hence, sociotherapy is focussing on the way how people may open up to others, isolate them self from others, adapt them selves and influence others.

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