Elien Neimeijer

48 the construct validity and reliability of the GCI for individuals with MID-BIF, based on confirmatory factor analysis (Neimeijer et al., 2019). These results are in line with other studies that used the GCI measure in other settings and for other target groups (Tonkin, 2015). The GCI consists of four subscales: support (α = .88), growth (α = .79 ), repres- sion (α = .64), and atmosphere (α = .76). Together, the 29 items measure overall Group Climate (α = .92). Responsivity of sociotherapists towards the needs of participants is an essential characteristic of the support subscale. Growth assesses learning opportunities, hope for the future, and comprehension of the benefit of staying on the ward. The perception of strictness and control, unfair and coincidental rules and a lack of flexibility on the living group encompass the repression subscale. Last, the atmosphere subscale assesses the degree to which participants treat and trust each other, feel safe and secure, and can find rest on the living group. The overall climate scale of the GCI includes all four dimensions and is bipolar. At the ‘positive end’ of the scale group climate should be regarded as open and therapeutic, whereas at the ‘negative end’ of the scale group climate should be re- garded as closed and repressive (Van der Helm et al., 2011). The four factors – support, growth, atmosphere, and repression - are evident in both a closed and an open group climate score. Aggressive incidents and coercive measures. Sociotherapists electronically register each aggressive incident committed by a client and use of coercive measures on the living group. Aggressive incidents and use of coercive measures were examined using inci- dent reports maximally three months before and after administering the Group Climate Instrument was completed. This interval was chosen to avoid accidental snapshots of the number of aggressive incidents and coercive measures and to ensure sufficient frequency of aggressive incidents and coercive measures. Three different types of aggressive inci- dents were distinguished: verbal aggression, physical aggression, and aggression against property. Examples of physical aggression are hitting, kicking, biting, and spitting. Exam- ples of verbal aggression are threatening, yelling, and scolding. Aggression against prop- erty refers to destroying furniture or kicking the door or wall. In the 58 participating living groups, in total 1,003 aggressive incidents had occurred in the study period, in which 161 participants were involved. The number of aggressive incidents per participant (as perpe- trator) varied from 0 to 53, with an average of 4.01 per participant ( SD = 7.33). A distinction between four different types of coercive measures was made: physical restraint (where one or more sociotherapists hold a client), seclusion in client’s own