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Milieu therapy is not new as a psychotherapeutic technique. It is no more than the application of psychoanalytical concepts to the specific task of creating a setting for emotionally disturbed children who are in need of residential treatment. At the Orthogenic School, which functions as a therapeutic milieu, the total frame of reference is one of psychoanalytic concepts in action, and has a therapeutic value which is greater than that of individual psychotherapeutic sessions. Nor is the idea of creating a psychoanalytic milieu for emotionally disturbed children a new one. Anna Freud considered it, though not without scepticism, when she spoke of the need for a milieu which would be suited to child analysis, (5) and Aichhorn reported favorably on his experience in an institutional setting which had a therapeutic value in itself. (1)
Our own clinical observations, too, have shown that structural changes in the personality result only where therapy is directed at the total individual. This differs in no way, of course, from original psychoanalytical concepts of personality, and warrants restatement here only because of recent emphasis on attempts to achieve therapeutic goals by applying special techniques to isolated functions of the total personality.
It is recognized that certain types of children cannot be treated with any success while they continue to live with their parents. This is true of any family setting which fails to offer a child the most basic conditions for normal personality development, namely the experience of instinctual gratification within a consistent frame of interpersonal relations.
In psychotherapy, no matter what the form, there is no other tool but the one to one relationship between patient and therapist; but while this is adequate for adults, it puts grave limitations on the treatment of children which must be considered. In view of the emotional and cultural dependency of children both during and after psychotherapy, one must therefore eval