Psychiatric Quarterly [psaq] ph163-psaq-454353 November 26, 2002 12:27 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 74, No. 2, Summer 2003 (
Principles and Practice
in Clinical Settings
Paula G. Panzer, M.D. and Sandra L. Bloom, M.D.
The ﬁve papers in this collection of articles represent a collaborative
effort to bring the wisdom of social psychiatry and its concern with
context and meaning back into a more central position in the ongoing
conversation about what it takes to bring about real change. For several
decades, the knowledge about what it means to be part of a therapeutic
milieu has been marginalized. The words “therapeutic milieu” are still
batted around, usually on treatment plans, but an increasingly smaller
number of people actually know what a rigorous and demanding prac-
tice it is to create and maintain a truly “therapeutic” milieu. Many of
the concepts referred to in these articles are not new. The tenets of good
milieu management stretch back more than a century, even back to the
Moral Treatment ﬁrst practiced in the 18th century. Systems theory
gave birth to the community psychiatry movement of the 1960’s. The
notion of nonviolence, even if not practiced, has been around for a very
long time. What is new is the burgeoning knowledge we have gained in
the last twenty-ﬁve years about the frequency of exposure to violence
and the impact of trauma on children, adolescents, and adults.
Model pulls old and new together into a coherent
conceptual framework that strikes a chord of deep resonance in staff
and clients, children and adults. The articles in this issue speak to that
chord, and are the product of three groups working interdependently.
Bloom and Bills are at Community Works
in Philadelphia, and are
part of the team who created the model. Abramovitz and Madsen are
leaders in the Jewish Board of Family and Children’s Services’ Center
for Trauma Program Innovation, implementing the Sanctuary model
in clinical settings. Rivard’s evaluation of the Sanctuary model comes
2003 Human Sciences Press, Inc.