Therapeutic environment of secure units: a feasibility study of the interactions between people working and accessing a secure unit for people with learning disabilities

Abstract

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.