Nidotherapy: Healing in a Different Environment

23 January, 2020
Although the influence of the environment on psychological disorders has always been taken into account, nidotherapy is so far the only systematic and time-controlled environmental intervention for persistent mental disorders.

The term “nidotherapy” refers to a modern therapeutic method. Its main objective is to modify the environment of those suffering from schizophrenia and other serious mental disorders.

Professionals apply this therapy in combination with other kinds of intervention. Instead of focusing on direct interventions only with the patient, the goal is to help them identify the need for change. This, as a consequence, would motivate them to fight for a change in their environment.

The purpose of nidotherapy isn’t to change the individual but to make the relationship between them and their environment more comfortable. Evidently, this would give an overall improvement in the subject’s life. However, this isn’t the direct result of treatment. Instead, it comes from giving rise to a more harmonious relationship between the person and what surrounds them.

In fact, a person’s environment has significant weight in the occurrence of diseases and relapses. That being said, nidotherapists work alongside with schizophrenics to be able to identify these factors and try to reduce the number and severity of relapses.

The theoretical foundation of nidotherapy

Psychiatrist Peter Tyrer is the founder of this therapy. In his now 40 years of profession, he has published 38 books, has been editor of The British Journal of Psychiatry and developed nidotherapy as a form of environmental intervention. Its theoretical foundation is closely linked to the Darwinian concept of evolution.

The adaptation of an organism to its environment assures its prosperity. That being said, if we get the environment to adapt to the organism in a similar way, it’ll be possible to obtain positive changes in behavior.

Moreover, mental health professionals have always taken environmental conditions into account in the evaluation and treatment of people with mental disorders. Nonetheless, researchers rarely ever follow a consistent intervention strategy.

Giving primary importance to the environment allows changes that couldn’t be achieved otherwise. Environmental problems frequently become the main reason for mental illness relapses.

In order to achieve success in environmental interventions, it’s necessary to balance out the needs of the patient with those of others.

A woman covering her face with her hands.

Principles of nidotherapy

The main principles of nidotherapy are:

  • Collateral placement, which refers to considering the environment from the patient’s point of view.
  • Formulation of realistic environmental goals.
  • Setting specific goals related to environmental change.
  • Improvement of social functions. In other words, focusing on functions rather than symptoms.
  • Adaptation and personal control. Basically, allowing the patient to participate appropriately and assume responsibility for the program.
  • Broader integration of the environment and arbitration.
  • Involving others – including independent arbitrators – in the process of resolving difficult aspects of environmental change.

Synchronization with other therapies and change agents

Nidotherapy can work in parallel to the application of other existing therapies. Nonetheless, it must be independent of them at the same time.

Helping the patient focus on environmental changes could improve adaptation to their environment.

The goals proposed during nidotherapy often involve many team members, social workers, psychologists, occupational therapists, creative therapists, or community agents.

Nidotherapy: Duration and phases

Formal interventions usually last according to the author’s experience. This therapeutic model adopts five phases.

Phase I. Identifying the limits of nidotherapy

Nidotherapy is usually implemented after the patient has been treated extensively and has obtained all the possible gain from the available interventions. Other times, it’s implemented after a long battle between therapists to perform interventions and patients resisting them.

If the therapist gets the patient to differentiate between the phenomena given by the disorder and that given by the environment, there’s a decrease in the possibility of conflict decreases and an increase in the possibility of collaboration with other types of interventions.

Phase II. Full environmental analysis

All the patient’s wishes must be taken into account, no matter how implausible they might be.

First off, the therapist carries out their own environmental analysis. After that, it’s the patient’s turn. It can be done with or without the patient. We must note that both environmental analyses are most likely going to be different from each other. Once completed, the therapist and patient must reach an agreement regarding the goals. If there happen to be any differences, they must resort to the arbitrator/mediator.

Phase III. Implementation of a common path

This phase usually takes many hours to complete. However, if done successfully, the following phases can be negotiated quickly. The different elements of this common path must be identified and planned in each intervention.

Many of these changes must be carefully thought out. And not only that, but it’s important that they happen gradually. It’s essential to set appropriate timeframes for these changes in order to avoid future disappointment.

Phase IV. Progress monitoring

It can take a while to reach the set goals. Despite that, though, the patient must keep them in mind at all times and the procedures to achieve them must be transparent.

It’s important to give feedback on the progress made. Many therapists recommend giving feedback every three months. Nevertheless, it’s highly unlikely that all objectives will be successfully reached.

Phase V. Adapting nidotherapy

Sometimes the goals set at the beginning turn out to be quite implausible. When this happens, it’s necessary to go back and draw a new path with different objectives – they could be less ambitious or even more so depending on the case.

In this task, the role of the patient is very important, as well as an honest acceptance of the decision.

A therapist filling out a patient's clinical history before carrying out nidotherapy.

Conclusions

In brief, there needs to be more research on this topic to be able to fully comprehend its efficacy, benefits, and possible risks. Meanwhile, people with mental health problems, health professionals, managers, and policymakers should see this new therapy from an experimental approach.

Overall, nidotherapy is a complex process that’s still under development. Thus far, it’s the only systematic and time-controlled environmental intervention for persistent mental disorders. Therapists must be trained to accept patients for what they are and not for what they would like them to be.

  • Tyrer, P., Sensky, T., & Mitchard S (2003). The principles of nidotherapy in the treatment of persistent mental and personality disorders. Psychotherapy and Psychosomatics, 72, 350-356