The space for therapy

I was interested to read the letter from Hugo Maximillian Metcalfe in the April issue of The Psychologist. He raises an interesting question: Why do we think that the standard arrangement of the individual therapy room is recommended?

There are a number of answers to this question, none of which is research-based, which he seems to suggest is required for justification. One is that the therapy room needs to be as user-friendly to the client as possible – comfortable decor, chairs, paintings, hangings, etc., so that it might be as close as possible to a living, rather than a clinical, environment. This may reduce anxiety and also communicate to the client that they have some value. And we also facilitate the free flow of dialogue and the sharing of experience. The provision of tissues communicates that the therapist is understanding that there may be distress and allows it.

I played about with his suggestions: How would it be for me if I was met with a panel with chairs in a line – surely reminiscent of an anxiety-provoking interview panel? Do we all meet our friends in this way and why not? Possibly, because it is uncomfortable. There is a reasonable space of intimacy that may be right for all people. Placing a chair at one corner of the room and sitting in the furthest corner may be right for a very small minority, also sitting very close may be right for some people with personality issues. But it should also be recognised that the client's choice of seating may communicate something about their difficulties: too close, or too near, the need to please the therapist or not, may say something about them.

Freud, famously, decided on the couch because he was disturbed by direct eye contact and he then discovered transference. So there was a value, but the needs of the therapist also came into this.

However, I'm aware that Hugo is speaking from his adult individual therapy experiences. He will find that there is a rich literature, if he investigates, about the impact of the room environment in relation to child psychotherapy and group psychotherapy. In groups, for example, there have been many explorations outside of the clinical setting: large groups of up to 50 members in inner-city estates in London; therapeutic communities, such as the one at Grendon Prison. There have also been therapy walking groups formed, for
example in Yorkshire, where the agenda is on walking, talking and then participating, in the hills, in a psychotherapy group experience. No walls, no physical boundaries.

So, I think that the question that Hugo raises is valuable and interesting. Perhaps we can research this, although to my mind the variables are too complex in relation to particular client needs, and the difficulties are mind-boggling in their complexity. Perhaps we could, though, use our own experiences of what we find is a comfortable space in which to divulge to others our innermost and possible shameful private experiences? Would this be an office-type environment, a factory environment, or something else? And, the relationship probably needs to be right for us to be able to do this.

Terry Birchmore
Browney, Co. Durham