Nidotherapy: Changing Environment To Heal

The nidoterapia ( nidotherapy ) is a therapeutic method that has as main objective to change the environment in which people live with schizophrenia and other serious mental disorders.

It is applied in combination or in parallel with other interventions. Rather than focusing on direct treatment with the patient, the goal is to help him identify the need for change and strive for it.

Nest therapy  is not aimed at changing the person, but at creating a better adaptation between them and the context in which they live. As a result, the individual improves not thanks to the direct treatment received, but to the establishment of a more harmonious relationship with the surrounding environment.

If environmental factors or a person’s context have a significant bearing on the onset of the disease and relapses, it is the therapist’s job to work with the individual to identify these factors and reduce the risk of relapse.

Theoretical basis of nest therapy

This therapy was proposed by psychiatrist Peter Tyrer who, in his 40 years of profession, has published 38 books, was editor for the British Journal of Psychiatry and developed nest therapy as a form of environmental intervention. The basis of this approach is linked to the Darwinian concept of evolution.

The adaptation of an individual to his context guarantees his survival, therefore adapting the environment to the organism will allow us to obtain positive changes at the behavioral level.

Although the environment and the context have always been considered important in the context of psychological disorders, interventions are rarely carried out in this perspective. Prioritizing the environment favors changes that would otherwise not be possible. Environmental problems often become the cause of major relapses in mental illness.

Successful environmental interventions require a sensitive conscience and a special ability to balance the patient’s needs with those of others.

Principles of nest therapy

The basic principles of nest therapy are:

• Collateral setting: considering the environment from the patient’s point of view.

• Formulation of realistic environmental goals.

• Establishing clear goals for environmental change.

• Social Function Improvement: Focusing on function rather than symptoms.

• Personal adaptation and control: allowing the patient to participate appropriately and take responsibility for the program.

• Broader context integration and arbitrage.

• Include others, even external parties, in solving difficult aspects of environmental change.

Synchronization with other therapies and stockbrokers

Nest therapy can work in parallel, and cumulatively, with other existing therapies, however it must maintain a certain independence from these.

Helping the patient to focus on changes in their surroundings can improve their adaptation to the context. This could result in better effectiveness of the other treatments.

The goals set during nest therapy usually involve many people, social workers, psychologists, occupational therapists or creative therapists.

Duration and phases of nest therapy

According to the author’s experience, the formal intervention tends to last 10 sessions. Nest therapy adopts a five-step model.

Phase I. Identify the limits of nest therapy

Nidotherapy is generally used after the patient has undergone treatment for a long time and has obtained what is possible from previous interventions. At other times, it is used following a long battle between therapists and patients who oppose it.

The therapist should be able to define to the patient which phenomena are due to his disorder and which are determined by the environment, in order to reduce conflict and increase his cooperation.

Phase II. Complete environmental analysis

First of all, all the wishes of the patient must be noted, even the most demanding or hardly achievable ones.

It is then up to the therapist to carry out his own analysis, with or without the patient, taking into account that often the two analyzes are not at all similar. Once completed, an agreement must be reached on the objectives to be achieved and, if there are differences of opinion, seek a mediator.

Phase III. Tracing a common path

Phase II will take many hours, but if done successfully it will make the next phases leaner. The different elements of the path in common are identified and planned in each intervention.

Many of the changes have to be thought through carefully and have to happen gradually. It is important to set appropriate time targets so as to avoid future disappointments.

Phase IV. Monitor progress

While the acquisition of objectives can take a considerable amount of time, these must always be clear and transparent in all proceedings.

It is essential to monitor all progress, for this purpose a quarterly evaluation is recommended. However, it is highly unlikely that all objectives will be met satisfactorily.

Phase V. Reposition the nest therapy

Sometimes goals that were thought to be appropriate turn out to be unattainable over time. When this happens, it is necessary to go back and chart a new path with different goals, sometimes less ambitious, sometimes more.

In this phase the patient’s task is very important and it is essential that he honestly accept what is established.

Conclusions

There is a need for further research into the efficacy of this therapy, its benefits and possible risks. At the same time, people with mental health disorders, health professionals, as well as our political representatives should start considering this new method as an experimental therapy.

Nest therapy is a complex approach that is still under development. At the moment, it is the only treatment for mental disorders that involves a systematic and prolonged environmental intervention. Therapists must be able to accept patients for who they are and not as they would like them to be.