A good friend sent me a link to a recently published paper on the Psychiatric Times website – Strategies to Facilitate a Positive Therapeutic Encounter – which I have really enjoyed and definitely provoked some thoughts. Head over and have a look, it’s open access.
The article outlines all the ways that the physical space – not just of the room where counselling takes place, but including the waiting room – can be moderated to impact positively on therapy.
On first read I thought most of what the author, Stephanie Liddicoat, is saying was probably pretty obvious, although most therapy spaces don’t take her recommendations to the extremes she suggests.
She talks about providing confidentiality to clients in the waiting room, suggesting that actually having clients meet each other is to be avoided, so that individual waiting pods or shielding spaces should be used. I can’t imagine finding that in a practice in the UK, but then I do expect the waiting room to be well shielded from the front door, just as Liddicoat suggests. I used to expect that no building would place a waiting room in such a way that you can directly hear the content of other people’s sessions whilst you are waiting… but experience in the last couple of years has popped that bubble! Lots of practices rely on converted older buildings, and I’ve had the discomfort of waiting in a room and being able to hear nearby sessions, because the building conversion just hasn’t thought of these things. I’m lucky in my current practice in Brighton, which was custom-converted and I think avoids a lot of those issues. Hopefully with work like Liddicoat’s, more people will think about these things explicitly and practices will improve.
I have to admit her idea that art materials and sensory equipment should be out of immediate sight-line to avoid clutter doesn’t ring true with my experience. I do find clutter anxiety provoking, but if creative materials such as a pad of paper and a pot of pencils are in easy reach I find people are much more likely to use them spontaneously. I love it when someone grabs a pen or pencil and draws, scrawls or outlines something they can’t quite put into words. I don’t think I’d want to set up a room so people had to ask for drawing materials, rather than go with the moment and grab them – though I do have to work in plenty of contexts where materials aren’t even available.
A lot of Liddicoat’s statements about what counselling rooms ‘should’ look like or have is definitely more aspirational than possible, particularly the need for a boundaried landscape view from the window for the client to be able to focus on. How many of us really get to chose our therapy practice rooms to that extent? But I really appreciate the paper pointing out how beneficial that can be. From my own experience I think part of the benefit is that there’s a third ‘presence’. It can be really hard to sit opposite another person. Being alone with another person, the weight of the eye contact, the pressure can feel like too much. I’ve been in both chairs, and I’ve definitely experienced this. A beautiful landscape through the window, or in a painting, gives you a third ‘person’ in the room with you, almost – somewhere to let your eyes rest or your mind wander to when the contents of the room are too much.
I have to admit I love Liddicoat’s idea in Table 3 of her article, of having a really nice rug on the floor for people to engage with. Chairs are safe, but sometimes it is nice for other ways of sitting with each other to be possible, and sometimes playing with the way we are in the room can be beneficial.
I don’t know whether Liddicoat’s article is a bit more ground-breaking from the perspective of a Psychiatry practitioners, but from my position in humanistic therapy, a lot of what she says feels part of our practice. Fundamentally, the physical therapeutic space needs to be safe, egalitarian, and preferably contain more than just two chairs and four white walls so that when we are clients we have a way of moderating the emotional, psychological and physical intensity of being alone with another person whose attention is fixed on us. The article makes these things explicit and gives them the weight of academic research – hopefully that means that more of us get to experience counselling in better physical spaces.
Ruth Fillery-Travis 