Elien Neimeijer

123 Valk, Kuiper, Van der Helm, Maas, & Stams, 2016). Perceived repression seems to be dependent of various determinants, many of which depend on the quality of the relation- ship between clients and sociotherapists. This implies that staff, in multidisciplinary col- laboration, have a key role in detecting, preventing, or diminishing repression. Because of the persistent character of repression once it is institutionalised, it is difficult for pro- fessionals to break this vicious circle. Prevention of repression seems therefore a better option. To prevent repression, the organisational culture, ethical values, and awareness of repression must be institutionalised at all levels of the secure forensic setting and in- corporated into everyday decision-making and acting (De Valk, 2019). In research and practice different opinions are held on the proportionality of the use of coercive measures. The general attitude in the Netherlands is that coercive meas- ures are considered undesirable, and should only ever be used as a last resort. This is in line with national legislation such as the Dutch Care and Coercion Act (in Dutch: Wet Zorg en Dwang), that has been in effect since 2020. The core principle of this legislation is: involuntary care is not applied, unless there are no less intrusive options available (Ministry of Health, Welfare and Sport, 2020). This fundamental precept implies that there must be good alternatives in situations when immediate harm for clients or others is likely. In particular, when individuals with MID-BIF are admitted to a secure forensic setting where ‘involuntariness’ is integrated in admission and treatment because of be- haviour that can lead to harm and danger for themselves or for others. The findings presented in this dissertation underpin the importance of group climate and work climate factors related to client and sociotherapist behaviour. In chapter 5 it was for example argued that if sociotherapists experience more positive team function- ing, less repression was perceived by clients. Also, in earlier group climate research it was proposed that it is possible to offer clients a therapeutic group climate without work- ing solely from structure and control but based on relational care (Schubert, Mulvey, Loughran, & Losoya, 2012; Van der Helm & Vandevelde, 2018). Sociotherapists and other multidisciplinary team members should therefore be encouraged to find the right balance in their dual-role relationship with clients (‘firm but fair’; Hachtel et al., 2019). In clinical practice, this is less obvious than it seems. Clinical Implications Dealing with this highly context-dependent target group places high demands on so-