Developing a measure to assess clinicians' ability to reflect on key staff-patient dynamics in forensic settings

Adam Polnay*, Helen Walker, Chris Gallacher

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective Practice Groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This project aimed to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties.

Methodology: A multi-professional sample of 80 clinicians were recruited, completing TRACE and Attitudes to Personality Disorder Questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test-retest reliability. TRACE was cross-validated against the APDQ.

Findings: EFA found five factors underlying the 20 TRACE items: “awareness of common responses” “discussing and normalising feelings”; “utilising feelings”; “wish to care”; “awareness of complicated affects”. This factor-structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α=0.66, 95% CI=0.55-0.76) demonstrated borderline acceptability. TRACE demonstrated good test-retest
reliability (ICC=0.94, 95% CI=0.78-0.98) and face-validity. TRACE indicated a slight negative correlation with APDQ. A larger dataset is needed to substantiate these preliminary findings.

Practical implications: Early indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice.
Originality: The TRACE was a distinctive measure that filled a methodological gap in the literature.
Original languageEnglish
Article numberJFP-07-2021-0041.R3
JournalJournal of Forensic Practice
Early online date30 Nov 2021
Publication statusE-pub ahead of print - 30 Nov 2021


  • reflective practice
  • staff-patient dynamics
  • secure-settings
  • countertransference
  • factor analysis
  • measurement tool


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