Development of a Compassion Focused and Contextual Behavioural Environment and validation of the Therapeutic Environment Scales (TESS)

Aims: The aims of the current study were to (a) develop a scale sensitive enough to measure the inter-personal processes within a therapeutic environment, (b) to explore whether the new scale was sensitive enough to detect differences between settings including a community based on compassionate mind and contextual behaviourism. Method: The Therapeutic Environment Scales (TESS) were validated in three different settings with 81 participants. The settings included a specialist service for anxiety disorders, a specialist in-patient ward and a psychodynamic therapeutic community. Results: The new scale was found to be reliable and valid. Significant differences were found between the services on the dimensions of compassion, belongingness, feeling safe, positive reinforcement of members’ acts of courage, extinction and accommodation of unhelpful behaviours, inconsistency and high expressed emotion. These processes were over time associated with improved outcomes on the service for anxiety disorders. Clinical implications: The TESS offers a first step in exploring important interpersonal relationships in therapeutic environments and communities. An environment based on a compassionate mind and contextual behaviourism offers promise for the running of a therapeutic community.