Room layout in therapy

Before the start of a recent co-therapy session with my supervisor, she asked that I come with her to the room we had booked to 'make sure it was OK'.

We entered and, as I have done myself countless times before, we arranged the furniture. Moving surplus chairs to the side, arranging some chairs facing each other either side of a central table and placing a box of tissues to one side. As we sat in our chosen seats and surveyed our newly constructed landscape I asked her why we didn't place the chairs at the corners of the table facing in, or remove the table all together or even (the eternal contrarian) what would happen if we placed the chairs in a line.

She paused, looked at me puzzled and said, 'Well… this is just what we do.' But why?

I recall my first ever therapy session with a client, and my supervisor advising how I should 'set up' the room, with two chairs facing each other and the box of tissues within reach of the client or close enough that I could slide it across if need be. As a fresh trainee I did not question this, just added it into my model of what it meant to be a psychologist. But I wonder now why we engage in this ritual, it is not something that has been taught explicitly thus far in my training process nor does it seem to come from some body of research. It feels instead like some learned act of psychological feng-shui, seemingly acquired from observation of our peers. How is it that the act of rearranging chairs, tables and tissues into a set formation transforms the room into an effective therapeutic space?

Exploring this issue, it seems there is very little research examining the role or impact of environment or furniture within the therapy room, despite research acknowledging the impact that environments can have on our mood and sense of wellbeing (Jackson, 2018). I am conscious that much of the research concerning influences on the success of therapy refers to the therapeutic relationship between client and therapist, but why not the relationship we and our clients have with the environment in which therapy takes place?

I am aware, that given the current state of the NHS and the buildings and rooms usually available to us and our clients, significantly influencing the design and furniture choices for therapeutic spaces may be the reserve of the private therapist alone. For many of us, competition for rooms within the services we work is fierce and there is often no guarantee that we will have the same room each week. As Jackson (2018) states, psychologists, and perhaps trainees in particular, are often in a 'borrowed space'.

Yet perhaps the rooms or furniture we use do not matter to our clients in the creation of healing spaces. Perhaps successful therapy can take place in any manner of space. Although if this is the case, I cannot help but wonder why we arrange our rooms as we do and perhaps whether we fear that not doing so will somehow be detrimental to the therapeutic process. Furthermore, I wonder what would happen if we were to eschew these learned patterns of therapeutic interior design, assuming you don't already.

What if we were to let clients arrange the room to their own specifications? Do away with the furniture all together? Or perhaps more radically take our sessions out of the 'therapy room' entirely.

Hugo Maximillian Metcalfe
Trainee Psychologist at Large, Hertfordshire

References
Jackson, D. (2018). Aesthetics and the psychotherapist's office. Journal of Clinical Psychology, 74(2), 233–238.

Illustration: Tim Sanders