The Design of the Psychologists' Offices: A Qualitative Evaluation of Environment-Function Fit

Psychologists’ offices have been largely absent from contemporary theoretical and methodological discussions of therapeutic environments. Research on environmental stressors, healing environments, psychiatric facilities, and the transactions between a psychologist and client during a therapy session suggest that psychologists’ offices are significant for the psychologists who work there daily and the clients who visit them. To address the gap in the literature, we examined the relationship between psychologists and their office environments in an exploratory, qualitative study using interviews and projective measures. Projective measures included cognitive mapping exercises and photographs taken of the psychologist’s and client's views of each office. We interviewed 10 licensed psychologists about how they perceived—and how they believed their clients perceived—their office environments. Content analyses of the interviews revealed that the environmental responses psychologists used in their office designs met the needs imposed by therapeutic transactions. In addition, environmental responses helped psychologists adapt difficult spaces to the ongoing needs of therapy. Implications include design recommendations for psychologists and designers. The training of psychologists also should give greater consideration to office design. Sensitivity to office design could differentiate psychologists from their competitors. This is especially important in contemporary healthcare, where healing designs offer a competitive advantage. Researchers have investigated the therapeutic value of institutional healthcare environments such as hospitals and Alzheimer’s facilities in fostering positive medical outcomes and recovery from stress (McCormick and Shepley 2003). Several researchers have discussed the lack of research about psychologists’ offices (Anthony 1998; Anthony and Watkins 2002a; Anthony and Watkins 2002b). Experimental research lacks external validity because actual psychologists, psychologists’ offices, and clientele have not been used (Miwa and Hanyu 2006). As such, psychologists’ offices have been largely absent from contemporary theoretical and methodological discussions of therapeutic environments. Psychologists recognize that their clients suffer from stressors related to mental illness and daily routines. Clients also suffer stress from making a life transition involving discomfort and disclosure of private information within an unfamiliar setting (Demick and Andreoletti 1995; McLoughlin 1995; Spivack 1984). Consequently, how, if at all, do psychologists believe that their office designs contribute to the therapeutic process? How do psychologists compensate for the inadequacies of their therapeutic environments? Answers to these questions could guide future research on and design of psychologists’ offices. Environments for the treatment of mental illness When an imbalance exists between the demand posed by a stressor and a person’s perceived resources to adaptively respond to the stressor, stress occurs (Stokols 1979; Stokols et al. 2000). A stressor might overwhelm a person’s physical and psychological resources and, as a result, cause a person to feel incompetent (Stokols et al. 2000). Evans and McCoy (1998) identify negative, stressful experiences resulting from the relationship between physical environments and a person’s psychology. These concepts include 6/21/11 10:04 AM The Design of Psychologists' Offices: A Qualitative Evaluation of Environment-Function Fit Page 2 of 31 http://info.aia. org/nwsltr_print. cfm? pagename=aah_jrnl_20071101_watkins overstimulation resulting from crowding and ambiguous spatial configurations. Researchers and designers have long expressed interest in creating healthcare environments that mitigate stress. Healing gardens, views of nature, and legible building plans and signage have been well documented as design features that contribute to positive psychological and physiological health (Evans and McCoy 1998; Ulrich 1999; Ulrich et al. 2003). Researchers have extensively investigated institutions such as psychiatric facilities and their possible negative effects on mental health. Their research reveals that the design of a psychiatric facility can reinforce rigid social programs and patterns of behavior among patients and staff (Bechtel 1997; Goffman 1961; Schefflen 1965; Stevenson 2000). Consequently, the design of an institution reflects its philosophy of care (Bechtel 1997; Stevenson 2000; Williams 1994). For instance, in the 19th century, Thomas Kirkbride designed mental hospitals for the humane treatment of patients. His designs required one room for each patient, double-loaded main corridors, wards terminating with sunlit bays, and access to natural settings (Good et al. 1965; Sachs 1999). Critics warn that the physical designs of many mental institutions exacerbate patients’ conditions. Fortress-like facades reinforce the larger community’s stigma of the mentally ill (Ittelson et al. 1970; Stevenson 2000). Commons areas equipped with fixed seating inhibit social interaction (Osmond 1957; Sommer 1969). Spaces efficient for staff, such as radial plans and long corridors lined with easy-to-clean surfaces, convey a sense of sterility and distort patients’ already disturbed perceptions with illusions and glare (Ittelson et al. 1970; Spivack 1984). Ironically, the design of mental institutions can undermine the competence of the patient, thereby worsening the patient’s illness (Moos 1973; Timko et al. 2000). Similarly, a psychologist’s office both communicates and facilitates communication. People imbue the environment with psychosymbolic meaning formed through interactions with the environment (Lawrence and Low 1990). Likewise, office features and psychologist-client transactions have psychosymbolic importance. Obvious symbolic cues include artwork, desks, and diplomas (Pressly and Heesacker 2001). Less obvious forms of communication include those physical features that reflect the psychologist-client transaction and those integral to treatment and diagnosis. In general, the therapeutic setting should be a holding environment; psychologists and their offices should provide comfortable and secure environments within which clients feel free to communicate sensitive information (Saari 2002; Winnicott 1986). Clients and psychologists communicate through transference relationships (Wachtel and Messer 1997; Saari 2002). Horvath and Lubrosky (1993) state that a transference “implies that emotions and thoughts associated with the unresolved relationships with significant others are bound to be displaced (transferred) onto the relationship with the therapist” (p. 562). Transferences are imbued with feelings that the client and psychologist hold for each other and for inanimate objects (Winnicott 1953). From positive transferences, the psychologist and client develop a “working alliance” to relieve the client of distress (Pipes and Davenport 1999; Horvath and Lubrosky 1993). Saari’s (2002) concept of interpsychic space is the nonverbal, spatial expression of positive and negative transferences through proxemics and personal space. For Stern (1997), an interpersonal field opens a context for disclosure between a psychologist and a client. Similarly, Satir (1964), Shefflen (1973), and Sommer (1969) have all demonstrated that in mental health settings, clients communicate psychological states nonverbally with seating arrangements and the manipulation of nonfixed physical features. Psychologists can influence transferences through their intentional manipulations of space. For instance, Henry Stack Sullivan sat 6/21/11 10:04 AM The Design of Psychologists' Offices: A Qualitative Evaluation of Environment-Function Fit Page 3 of 31 http://info.aia. org/nwsltr_print. cfm? pagename=aah_jrnl_20071101_watkins across a desk from his schizophrenic clients because such an arrangement focused their attention on therapy (Goodman 1962). Psychologists record transferences with the physical manipulation of their therapeutic environments. In the process, psychologists use space to treat and diagnose clients. Klein (1949) used play therapy with children so that transferences between psychologist and client were expressed through toys. Lowenfield adapted Klein’s play therapy to trays of sand. Play with sand trays enabled a healing connection with natural elements, while helping the psychologist reach a diagnosis (Mitchell and Friedman 1994). Peled and Ayalon (1988) analyzed attachments to home as part of family therapy. As is the case with other therapeutic environments, psychologists’ offices must also alleviate and adapt to stressors. Psychologists’ offices should convey holding environments within which psychologist-client transactions are accommodated. Also, they should empower psychologists to perform transactions necessary for maintaining a holding environment. Therefore, they should provide psychologists with the resources necessary to adapt to the ongoing needs of therapy. Environment-function fit A traditional measure of compatibility between an environment and the activities performed within is environment-function fit (Alexander 1970; Sherrod and Cohen 1982). A derivation of environment-function fit, person-environment congruency measures the relationships between a person’s perceptions and the demands exerted by a sociophysical environment (Lawton 1989). Researchers have applied personenvironment congruency to measure fit between the elderly and nursing home facilities and the mentally ill and psychiatric facilities (Kristoff 1996; Lawton 1989; Moos 1973; Timko et al. 2000). Lawton theorized that congruency occurred when a demand fell into a person’s perceived competency to meet that demand. If so, either a person’s perceived control or actual control over the demand increased. The built environment is a resource that people use to exert control over demands and increase competency (Alexander 1970