In this chapter we hope to satisfy the puzzlement of many who come to nidotherapy either for the first time or after trying the approach in practice. There are some who do not share our enthusiasm and just think of nidotherapy as old wine in new bottles, or just plain common sense, unnecessarily bottled and packaged when it is more comfortable out in the open. Time after time we come back to the core aim of nidotherapy – to change the environment to make the best possible fit for the patient and not to attempt to change the person directly – and we do not know of any other strategies or treatments that have the same primary aim. But we appreciate there are bound to be many questions about this form of management. Some have been asked repeatedly in the academic settings where nidotherapy has been described but there must be many more. The answers that are given below may satisfy some of the concerns, and even if they do not always do so, they should in particular show that the treatment adds something beyond the procedures of normal practice.

Is nidotherapy a psychological treatment?

Yes. Although it is clearly specified as an intervention that changes the environment, it does this in collaboration with the patient. This collaboration is very rarely a straightforward exercise such as meeting the bank manager and arranging a loan for a specific purpose, as it does not just satisfy a specific, exact environmental need but involves a full analysis of all aspects of the environment and careful judgement of the options afterwards. The processes involved require psychological skills that overlap with other psychotherapies but which are used in a different way. Sometimes nidotherapy has to be given indirectly without much direct contract with the patient, but more often it involves the development of a relationship and rapport with someone who is not exactly sure of their environmental wishes and whose needs require refining and developing in the context of a trusting relationship. This process requires skills that constitute psychological therapy.