Restricted accessOtherFirst published online 1998-09
Therapeutic environment of secure units: a feasibility study of the interactions between people working and accessing a secure unit for people with learning disabilities
The present feasibility study aimed to develop a reliable and valid measure to assess the types of therapeutic interactions between people working and accessing a secure unit for people with a learning disability. Seventeen health professionals participated in ascertaining support for the face and construct validity of the items and therapeutic approaches of the Therapeutic Interaction Measure (TIM) developed. Twenty-seven staff and eight clients participated in the direct observation of therapeutic interactions. The TIM was found to be reliable and valid in terms of face validity and construct validity of the overall items contained in the measure. There was some clinical but not statistical support for the construct of the nine therapeutic approaches in the TIM of being supportive, empathic, showing pro-social modelling, collaborative teaching, positive control, challenging, diffusing, promoting personal growth and self-awareness. Five alternative reliable factors were identified. These were described as understanding and dealing with difficult behaviour, socialisation, practical care, active listening and facilitating. There was no support for the external validity of the TIM relating to external measures of the treatment environment and client perceptions of their quality of care. The external and predictive validity of the TIM to monitor the process of therapeutic progress in secure units for people with a learning disability warrants further investigation. The use of TIM as a measure of the therapeutic interactions at a relationship level between staff and clients is discussed. A descriptive model of the therapeutic use of security is proposed in terms of the physical, organizational and the relationship level of therapeutic interactions.
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References
1.
Balbernie R.1989Looking at what professional carers do the therapeutic context and conditions of changeMaladjustment and Therapeutic Education, 7(1) 4-14
2.
Beker J., Feuerstein R.1991The modifying environment and other environment perspectives in group care. a conceptual contrast and integrationResidential Treatment for Children and Youth8(3): 21-37
3.
Beutler L.E.1991Have all won and must all have prizes? Revisiting Luborsky et al's verdictJournal of Consulting and Clinical Psychology , 59(2) 226-232
4.
Blotcky M.J., Dimperio T.L., Blotcky A.D., Looney J.G.1987A systems model for residential treatment of childrenResidential Treatment for Children and Youth5(1). 55-66
5.
Cronbach L.J.1951Coefficient alpha and the internal structure of testsPsychometnka16. 297-334
6.
Crowne D., Marlowe D.1964The Approval Motive Wiley, New YorkWiley
7.
8.
Glancy Report1974Revised Report of the Working Party on Security in NHS Psychiatric Hospitals. DHSS report
9.
Goffman E.1961Asylums Penguin, Harmondsworth
10.
Grencarage L.M., Norcross J.C.1990Where are the commonalties among therapeutic common factors ? Professional Psychology: Research and Practice5372-378
11.
Hall J.N.1990Towards a psychology of caring. British Journal Of Clinical Psychology29. 129-144
12.
Health of the Nation A Consultative Document for Health in England1991 Cm 1523. HMSO, London
13.
Karasu T.1986The specificity versus nonspecificity dilemma towards identifying therapeutic change agentsAmerican Journal of Psychiatry143687-695
14.
Lambert M.J.1989The individual therapists contribution to psychotherapy process and outcome. Clinical Psychology Review9: 469-485
15.
Luborsky L.Mclellan A.T., Woody G.E., O'Brien C P., Auerbach A.1985Therapist success and its determinantsArchives of General Psychiatry42602-611
16.
Mansell Report1993Services for people with a learning disability and challenging behaviour or mental health needs report of a project group. HMSO, London
17.
Mental Health Act1983HMSO, London
18.
Miller L.1993Who are the best psychotherapists? Qualities of the effective practitioner Psychotherapy in Private Practice12(1): 1-18
Moos R.H.1989Ward Atmosphere Scale Manual, 2nd Ed Consulting Psychologists Press, Palo Alto, CA
21.
Norton K.1992Personality disordered individuals the Henderson Hospital model of treatment. Criminal Behaviour and Mental Health2: 180-191
22.
Oakes P.1998 Unpublished. PhD thesis QUEST, University of Portsmouth
23.
O'Brien J.1980The principal of normalisation a foundation for effective services In Gardner J, Long L, Nichols R, Iagulli D (Eds). Program Issues in Developmental Disabilities A Resource Manual for Surveyers and Reviewers, Paul H Brooks, Baltimore
24.
Orlowska D., McGill P., Mansell J1991Staff-staff and staff-resident interactions in a community based home for people with moderate and severe mental handicaps. Mental Handicap Research4(1) 3-19
25.
Paton X., Stirling E.1974Frequency and type of dydadic nurse-patient verbal interactions in the mentally subnormal. International Journal of Nursing Studies11135-145
26.
Perry S., Frances A., Clarkin J.1985A DSM-III Casebook of Differential TherapeuticsBrunner/Mazel , New York
27.
Pettipher C., Mansell J.1993Engagement in meaningful activity in day centres. Mental Handicap Research6(3): 263-274
28.
Reed J.L.1991Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. Steering Committee The Reports of the Service Advisory Groups an overview. Department of Health and Home Office, London
29.
Rice M.E., Harris G.T., Cormier C.A.1992An evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behaviour16(4). 399-412
30.
Rogers C.R.1975Empathic: an unappreciated way of beingThe Counselling Psychologist22-10
31.
Rose J., Mullan E., Fletcher B.C.1994An examination of the relationship between staff behaviour and stress levels in residential careMental Handicap Research7(4) 313-327
32.
Rose M.1986The design of atmosphere ego nurture and psychic change in residential treatment. Journal of Adolescence9. 49-62
33.
Seligman L.1990Selecting Effective Treatments. a Comprehensive, Systematic Guide to Treating Adult Mental DisordersJossey-Bass Publishers , San Francisco
34.
Sexton T.L., Whiston S.C.1991A review of the empirical basis for counselling. implications for practice and training. Counsellor Education and Supervision30: 330-354
35.
Smith M.L., Glass G.V., Miller T.I.1980The Benefits of PsychotherapyJohn Hopkms University Press, Baltimore
36.
Wagenberg J E A, Tremonti G.W., Hesselink A.L., Koning R.F.1988The follow-up project on psychotherapeutic communities: design and preliminary results. International Journal of Therapeutic Communities9(3): 129-152
37.
Whiteley J.S., Collis M.1987The therapeutic factors in group psychotherapy applied to the therapeutic community InternationalJournal of Therapeutic Communities821-32
38.
Whitwell J.1988The residential treatment of unintegrated children: implications for therapeutic communitiesThe International Journal of Therapeutic Communities10(2)
39.
Wolfensberger W.1983PASSING Normalisation Criteria and Rating Manual, 2nd Ed. Canadian National Institute on Mental Retardation, Toronto
40.
World Health Organisation1981Development of Indicators for Monitoring Progress Towards Health for All by the Year 2000World Health Organisation, Geneva
41.
Appleby L., Joseph P.1991Management of personality disorders. International Review of Psychiatry359-70
42.
Bateman A.1996Day hospital treatment for borderline patients. In: Cordess C, Cox M (Eds). Forensic Psychotherapy Crime, Psychodynamics and the Offender Patient Volume II: Mainly Practice. Jessica Kingsley, London
43.
Benoit B.1992Promoting the rehabilitative potential of community residential facilities. Psychosocial Rehabilitation Journal15(3): 109-113
44.
Coady N.F.1991The association between client and therapist interpersonal processes and outcomes in psychodynamic psychotherapyResearch on Social Work Practice1(2) 122-138
45.
Coady N.F.1991The association between complex types of therapist interventions and outcome in dynamic psychotherapyResearch on Social Work Practice1(3) 257-277
46.
Conte H.R., Ratto R., Clutz K., Karasu T.B.1995Determinants of outpatient satisfaction with therapistsJournal of Psychotherapy Practice and Research4(1). 43-51
47.
Cox M.1996Supportive and interpretive psychotherapy in diverse contexts . In: Cordess C, Cox M (Eds) Forensic Psychotherapy Crime, Psychodynamics and the Offender Patient. Volume II Mainly PracticeJessica Kmgsley, London
48.
Davis W 1989The prevention of assault on professional helpers In Hollin C R, Howells K (Eds) Clinical Approaches to Violence . John Wiley & Sons, Oxford
49.
Dolan R.T., Arnkoff D.B., Glass C.R.1993Client attachment style and the psychotherapists interpersonal stance. Psychotherapy30(3): 408-412
50.
Dnnkwater J., Gudjonsson G.1989 In Hollin C R, Howells K (Eds) Clinical Approaches to Violence. John Wiley & Sons, Oxford
51.
Emerson E., Felce D., McGill P., Mansel J.1994Introduction. In. Emerson E, McGill P, Mansell J (Eds). Severe Learning Disability and Challenging Behaviours: designing high quality servicesChapman & Hill, London
52.
Emerson E., Hastmg R., McGill P.1994Values, attitudes and service ideology In: Emerson E, McGill P, Mansell J (Eds) Severe Learning Disability and Challenging Behaviours: designing high quality services. Chapman & Hall, London
53.
Gentry M.R., Ostapiuk E.B.1989 In. Hollin C R, Howells K (Eds). Clinical Approaches to Violence. John Wiley & Sons, Oxford
54.
Hesch J.B.1992Fostering the development of compassion in young children . Pastoral Psychology41(1): 31-37
55.
Hile M.G., Walbran B.B.1991Observing staff-resident interactions what staff do, what residents receiveMental Retardation29(1): 35-41
56.
Hilton M.1996The psychologist. In. Cordess C, Cox M (Eds). Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient. Volume II Mainly Practice. Jessica Kingsley, London
57.
Jenkinson J.1991An Investigation of Worker Characteristics in the Provision of Services to Clients with an Intellectual DisabilityPaper Presented at the 26th Conference of the Australian Psychological Society , Adelaide
58.
Jones D.1996Purchasing and providing Forensic psychotherapy in the market place. In: Cordess C, Cox M, (Eds) Forensic Psychotherapy Crime, Psychodynamics and the Offender Patient. Volume II: Mainly Practice. Jessica Kingsley, London
59.
Juul K.D., Linton T.1978European approaches to the treatment of behaviour disordered childrenBehavioural Disorders3(4) 232-249
60.
Killu K.1994The role of direct-care staff. Behavioural Interventions9(3) 169-176
61.
Kottler J.A.1990The Complete Therapist. Jossey. Bass , San Francisco
62.
Lambert M.J., Shapiro D.A., Bergin A.E.1986The Effectiveness of psychotherapy. In Garfield S L, Bergin A E (Eds) Handbook of Psychotherapy and Behaviour Change (3rd Ed). John Wiley, New York, pp 157-211
63.
van denLangenberg S., Dekker J J M1989What is 'therapeutic' in the therapeutic community? International Journal of Therapeutic Communities10(2): 81-90
64.
Lazarus A.A., Lazarus C.N.1991Multimodal Life History Inventory. Research Press, Champaign, Illinois
65.
Lewis P., Perkins D.1996Collaborative strategies for sex offenders in secure settings . In: Cordess C, Cox M (Eds) Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient Volume II: Mainly PracticeJessica Kingsley, London
66.
Luborsky L.1976Helping alliances in psychotherapy. In Claghorn J L (Ed) Successful Psychotherapy . Brunner/Mazel, New York
67.
Mansell J., McGill P., Emerson E.1994Conceptualising service provision. In: Emerson E, McGill P, Mansell J (Eds) Severe Learning Disability and Challenging Behaviours Designing High Quality Services. Chapman & Hall, London
68.
Merrylees S., Gates B.1997Leading a normal life. In: Gates B, Beacock C (Eds) Dimensions of Learning DisabilityBaillière Tmdall, London
69.
Millard D., Oakley H.1993Psychotherapeutic communities. the contemporary practice . In (Eds). Psychotherapeutic Communities. Routledge, London
70.
Miller R.K., Maier G.J., van Rybroek G.J., Weidermann J.1989Treating patients 'doing time'. a forensic perspectiveHospital and Community Psychiatry, 40(9) 960-962
Najavitz L.M., Strupp H.M.1994Differences in the effectiveness of psychodynamic therapists: a process-outcome study. Psychotherapy, 31(1): 114-123
73.
Norton K.1996The personality-disordered forensic patient and the therapeutic community In: Cordess C, Cox M (Eds) Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient Volume II Mainly PracticeJessica Kingsley, London
74.
O'Brien J., Tyne A.1981The Principle of Normalisation: a foundation for effective services. Campaign for the Mentally Handicapped, London
75.
Perkins D.1996The cognitive-behavioural approach. In Cordess C, Cox M (Eds) Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient Volume I. Mainly PracticeJessica Kmgsley, London
76.
Ricks D.F.1974Supershrink: methods of a therapist judged successful on the basis of adult outcomes of adolescent patients. In Ricks D F, Roff M, Thomas A (Eds) Life History Research in Psychopathology . University of Minneapolis Press, Minneapolis
77.
Robmson S.1987A Study of Some Aspects of the Role and Education of the Nurse in Relation to the Prevention and Management of Violent Behaviour by Mentally-ill PatientsHMSO, London
78.
Rush R.G., Hall J.C., Griffin H.C.1986Abuse-provoking characteristics of institutionalised mentally retarded individualsAmerican Journal of Mental Deficiency90: 618-624
79.
Scheffer J.H.1996The setting: general conditions In Cordess C, Cox M (Eds). Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient. Volume II: Mainly PracticeJessica Kingsley, London
80.
Schneider K.J.1992Therapists' personal maturity and therapeutic success how strong is the link? Psychotherapy-Patient8(3-4) 71-91
81.
Sinason V.1996From abused to abuser In. Cordess C, Cox M (Eds). Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient. Volume II: Mainly PracticeJessica Kingsley, London
82.
Warren F.1994What do we mean by a 'therapeutic community' for offenders ? Therapeutic Communities, 15(4) 312-318
83.
West A.1996The risks of burnout. In: Cordess C, Cox M (Eds). Forensic Psychotherapy. Crime, Psychodynamics and the Offender Patient. Volume II: Mainly Practice. Jessica Kmgsley, London
84.
Whiteley J.S.1970The response of psychopaths to a therapeutic communityBritish Journal of Psychiatry116.517-529
85.
Whiteley J.S.1986Sociotherapy and psychotherapy in the treatment of personality disorder discussion paperJournal of the Royal Society of Medicine79721-725
86.
Whiteley J.S.1996The antisocial personality disorder: strategies for psychotherapy . In: Cordess C, Cox M (Eds) Forensic Psychotherapy Crime, Psychodynamics and the Offender Patient Volume II: Mainly PracticeJessica Kingsley, London
87.
Yalom I.D., Lieberman M.A.1987A study of encounter group casualties. Archives of General Psychiatry47427-439
