Finding and setting up a new office as I return to private practice has meant thinking about the impact of space and design and décor. Oh, there’s a part of me that thinks it shouldn’t matter. After all, while working in large community agencies, my clients and I coped with crowded waiting rooms, institutional grade furniture, pea green walls and nothing that indicated my personality on the desk of whatever office I was assigned that day.
People did improve. Some improved a lot. But I have to wonder if positive outcomes of treatment might have been sooner or more frequent or more dramatic if the setting had been other than it was.
Now that I have the option to create my own space, I’m interested in what I can do to use the external structure of the office to support the internal work. No surprise to me: Research indicates that the setting does make a difference, for client and therapist alike.
A depressing room does little to lift the mood of either. Shabby and anonymous settings convey to our clients that people with mental illness don’t count and those who work with them don’t count either. In contrast, thoughtfully setting an attractive therapeutic environment conveys respect for both of us and sets a positive tone for the work we do together.
Guidelines For Creating a Treatment-Supportive Office
Surroundings always have an impact on the mood, energy, and self-esteem of the people in them. Although the basics of creating treatment-supportive space are common sense – keep it clean and inviting – researchers have found some more specific parameters for us to think about as we construct our space.
Consider the following variables when setting up your therapy office:
Color: Interior designers, architects and marketing directors can point to a wealth of literature on the effects of color on people’s mood. We need to pay attention. People’s affect and level of activity are affected by the colors around them.
Blue tones are calming while red tones are activating. Muted tones quiet people while bright colors perk them up. Think about the needs of the clients you are serving and paint the walls accordingly.
If you are seeing a wide range of diagnoses, look for mid range colors – soft shades of purple or middle greens. Do stay away from colors that remind people of public institutions and hospitals (pinky beige and soupy green). Such colors are practical as they are cheap and easy to maintain but people who have been in such institutions may unconsciously react negatively.
Lighting: As with color, intensity of light matters. Soft lighting can be comforting; too soft and it can induce sleepiness. Bright lights can either overwhelm or energize. Make sure you can adjust the lighting as needed for different clients.
Fluorescent bulbs emit a flicker that can trigger migraines, tics, seizures or even aggression in some individuals. People with traumatic brain injury, a seizure disorder or autism may be especially reactive.
Although CFLs (Compact Fluorescent Bulbs) are more energy efficient, they also have an imperceptible flicker that can be disturbing. The most therapeutic light is sunlight. If you can do so without sacrificing privacy, turn off the lights and open your window shades during sun lit days.
When you must use artificial light, bear in mind that old fashioned incandescent bulbs are the least stimulating to the nervous system of light-sensitive clients.
Furniture: People come in different sizes so your furniture should too. It’s infantilizing for a petite person to be in a tall chair with feet swinging. It’s embarrassing for a plus-sized person to be unable to sit back in a chair that is too narrow. It can be threatening for a slight person to be so engulfed by an overstuffed chair that he can’t get out of it easily.
You want people to be comfortable but you also want them to be alert and thinking. Equip your office with chairs of varying heights that let people keep their feet on the floor and that provide good support.
Although cartoonists inevitably put a couch in a therapist’s office, think carefully about who you are serving before you do. Many survivors of sexual abuse find it uncomfortable to talk about their experience while sitting on a couch if a couch or bed was the scene of their abuse.
A rocking chair or upholstered chair may be more conducive to feeling safe. Furthermore, people can relax without lying down. Hypnosis and mindful meditation exercises can be done while people sit comfortably.
Of course, if your style of therapy includes a couch, you’ll need to have one. But do consider carefully whether you want it to look like furniture that could be in anyone’s living room or if it would be preferable to go with what people culturally think a therapist’s formal couch should look like.
Furniture placement: The aesthetics of furniture placement is not as important as our clients’ sense of safety. Those who are suffering from schizophrenia or who are trauma survivors may feel threatened unless the door is in their line of sight and there is a clear path to it. Some need to have their back to the wall to ensure that no one can get behind them. Some need the door to be left slightly ajar or open.
Placement also includes where you sit in relation to your clients. Your training may influence this placement. Freud sat where his clients could not see him in order to prevent the possibility of a patient responding to his nonverbal cues. Alfred Adler (a colleague of Freud) believed it was important to set a tone of equality and collaboration by sitting face to face with his patients. Decades later, Carl Rogers did the same.
Some clients become anxious if the therapist is between them and the door. Sometimes, it’s a matter of our own safety to make sure we are not in their way if they are compelled to bolt.
To personalize or not to personalize: What you include in your surroundings is your clients’ window into your personality. Freud is said to have had an office cluttered with art work and memorabilia. One writer described it as a museum that created a “frame” for treatment that made a space for necessary regression.
On the other hand, there are therapists who believe that an office that is barren of all things personal to the therapist keeps the client focused on his or her own issues, not on speculations about the therapist’s private life. A middle ground is decorating with some attractive but neutral artwork and some personal mementos that don’t invite too much conversation about them.
It is generally suggested that we not put photos of our happy family or our wonderful vacations on our desk. It can put the life of the therapist too much in contrast with the unhappy reality of many clients’ lives.
Since some of my clients are people with intellectual disability who also lack impulse control, I keep my room free of “chuckables”, i.e., things that if thrown could cause injury to people or the walls. The same is true when seeing families with children who have anger and impulse control issues. As much as I love my collection of paperweights, I keep them out of the office for safety’s sake.
There is, of course, no “one size fits all” design for maximizing treatment effectiveness. But those of us in private practice do have the underlying message of our environment in our control. We can set a positive context for treatment by consciously and carefully considering the design variables and their effect on the people we serve.