The social climate of a unit is an important feature in treatment outcomes (Moos 1974). The Essen Climate Evaluation Schema (EssenCES; Schalast et al 2008) has been developed specifically for forensic settings but research in secure settings for women has been limited.

To compare staff and patient perception of social climate and it's relationship to therapeutic alliance, motivation to change and level of disturbance across levels of security within a women's secure care pathway.

To assess the implications for therapeutic milieu and service development.

Questionnaire survey of staff and patients in 2 medium and 2 low secure units using; EssenCES (Shalast et al 2008); California Psychotherapy Alliance Scale (Mormar et al 1986); and Patient Motivation Inventory (PMI; Gudjonsson et al 2007).

Comparisons are made across levels of security, treatment programme, therapeutic alliance, patient motivation and disturbed behaviour.

Social climate varied between levels of security and was also found to co vary with perceived therapeutic alliance and patient motivation to change. Differences between staff and patient ratings along with treatment implications are discussed.

Measuring the social climate in a secure women's service is an important part of a wider assessment of the therapeutic milieu that has practical implications for the ongoing development of therapy services.