‘Any room won’t do.’ Clinical psychologists’ understanding of the consulting room. An interview study

Abstract

In the social sciences, there is increasing interest in spatial practices and the meaning of places. The meaning of the psychotherapeutic room and its boundaries has traditionally been underlined in psychodynamic practice. In this study we investigated how clinical psychologists, working from different perspectives and with varying interventions and populations understand and use the consulting room. Five clinical psychologists were interviewed about how they perceive and use consulting rooms. The interviews were analysed using Interpretative Phenomenological Analysis. The participants understood the consulting room as a logistic unit but also as a welcoming place for relational encounters and sensed that spatial stability was important for their capacity to be fully attentive to their clients. Moreover, technological booking systems could hinder clinical work. The results were understood with respect to Winnicott’s theories of transitional space and holding. In sum, the importance of the room does not seem to be of concern exclusively to psychodynamic psychologists. On the contrary, it seems as if psychologists working with varying interventions and from different perspectives emphasise stable and personal consulting rooms that permit them to adapt to the needs of the clients, be attentive, and avoid disturbances.

Keywords:

• spatiality
• therapeutic space
• clinical psychology
• consulting room
• transitional space
• Winnicott

In the social sciences, there is increasing interest in the meaning of places (Blank & Rosen-Zvi, 2012). Human beings ascribe meaning to places and simultaneously places produce meaning (Domash, 2014; Larsen, 2012). Clinicians encounter their clients in consulting rooms, embedded in therapeutic landscapes, and in these rooms meaningful narratives evolve (Kehoe, Hassen, & Sandage, 2016). The meaning of places has been acknowledged in the theory of transitional objects and space, formulated by Winnicott (1969, 1974). Transitional spaces are characterised both by external reality and boundaries, and by individual and shared phantasies. The child’s play space, simultaneously concrete and imagined, is a paramount example of a transitional space; psychotherapy is another. In therapeutic spaces, characterised by openness and possibilities of shared experiences, the capacity to understand and handle emotions, and understand and accept oneself and others, is supported (Barreto, Giugliano, & Berry, 2015; BenEzer, 2012; Bronstein & Flanders, 1998; Freshwater, 2005).

Bondi and Fewell (2003) investigated spatial aspects of counselling, framed in the psychodynamic tradition. Their participants wanted to provide their clients a confidential and safe space. Predictable spatial boundaries, such as stable consulting rooms, communicated that the room was private which was perceived as important for supporting trust. Moreover, the consulting room should be protected from interruptions, and therefore the counsellors sensed that personal rooms were preferred over shared. It should also be noted that clients seem to appreciate homely environments (Larsen & Topor, 2017; Vaaler, Morken, & Linaker, 2005), which is possible with personal rooms. Price and Paley (2008) investigated spatial aspects of psychodynamic psychotherapy, as perceived by therapists. Their participants were subject both to external and internal pressure. External pressure could concern insufficient time between clients, not having an adequately planned consulting room, or having to borrow or book consulting rooms. Internal pressure could concern the tension that arose when not being able to hold the time frame since one needed to move between rooms. Moreover, inadequate therapeutic settings made it difficult to be attentive towards the client, and the participants underlined full attention as a prerequisite for clinical encounters. Unexpected external factors could be handled but too much external pressure became a negative influence. Price and Paley (2008) concluded that external pressure might cause stress and tension, which in turn affect the participants’ capacity to encounter and be attentive to their clients. They also acknowledged a lack of power among the therapists. The power of defining how rooms and buildings should be planned and used is located elsewhere. It should be noted that some stake holders, and also some researchers, assume that there is an optimal environment that influence clients in predictable and controllable ways. Accordingly, they strive to establish environments in which neither clients nor clinicians are permitted to influence the environment according to their needs or preferences (Punzi, in press). Such perspectives represent essentialist ideas that neglect questions of diversity and disability, as well as varying cultural backgrounds and contexts (Gergen 2016).

In psychodynamic practice, the transitional space and spatial boundaries, has traditionally been acknowledged; if boundaries are changed or transgressed, therapeutic reactions are seen as material for understanding (Borys, 1994). It is therefore not surprising that the psychodynamic therapists in the studies by Price and Paley (2008) and Bondi and Fewell (2003) emphasised the need for a stable, and most preferably personal, consulting room. Clinical practice is however changing. Long-term psychodynamic practice becomes less common while for example mindfulness interventions (Plank, 2014), neuropsychiatric assessment and treatment (Timimi & Leo, 2009), and cognitive behavioural interventions (Goldfried, 2016) achieve increasing attention. Clinical psychologists are educated in various perspectives and methods such as assessment, neuropsychological testing, psychodynamic practice, and cognitive psychology. Clinical psychologists might thus work with various interventions, rather than one specific method. Moreover, clinical practice is increasingly performed on premises adapted from the business sector, including the emphasis on efficiency, and logistics (Andersson Bäck & Linda, 2016; Gregory, 2011). Technical equipment is increasingly in focus and consulting rooms are less likely to be personal (Bondi & Fewell, 2003; Montalto, 2014). It thus seems important to understand how clinical psychologists perceive and use their consulting room. Accordingly, the aim of the present study was to investigate how clinical psychologists, working with various interventions and client populations, understand and use consulting rooms, personal as well as borrowed or booked. The following topics were investigated; What does the room mean for clinical work? What rooms are perceived as appropriate for clinical work? How is the room used?

Methodology

Participants

Five clinical psychologists, three women and two men, were interviewed by Elisabeth Punzi. Participants were recruited through the network of NN who is a researcher in clinical psychology, and a clinical psychologist. The participants are not dependent on, or involved in collaborations with the authors. The participants where thus approached through strategical sampling, a strategy that is in accordance with the Interpretative phenomenological analysis (IPA) that was used during the analysis (Robinson, 2014). To protect their privacy, the participants have been given assumed names. They worked in treatment units in the public health system in Gothenburg, the second largest city in Sweden.

Anita, 65 years, has been a clinical psychologist for 36 years. For the last 20 years she has worked in substance abuse treatment. She identifies as a psychodynamic psychologist and works with long and short-term psychotherapy, assessment, and treatment planning. The treatment unit in which she works is situated in an office building in the town centre, together with several other treatment units. She currently has her own consulting room but has previously shared or borrowed rooms.

Christina, 46 years, has been a clinical psychologist for 19 years. She works in the somatic care and sees clients with lifelong serious physical conditions. She identifies as an eclectic psychologist, mainly working with counselling. The treatment unit is situated at a large hospital. She currently has two consulting rooms; one in a non-restored building, the other in a part of the hospital that has been restored. She has previously worked in treatment units in which she had to borrow or book rooms.

Jenny, 47 years, has been a clinical psychologist for 12 years. She works with clients with Alzheimer’s disease or acquired neuropsychological dysfunctions. She identifies as an eclectic psychologist. She works with assessment, neuropsychological testing, long and short-term cognitive behavioural psychotherapy, and counselling. The treatment unit in which she works is situated at a regional hospital. Previously she has borrowed rooms from other clinicians but now has her own consulting room.

Robert, 48 years, has been a clinical psychologist for 16 years. He works in primary care, in an area characterised by considerable social difficulties and tensions. He identifies as a humanistic psychologist with a cognitive behavioural approach. He works with assessment, counselling, and short-term therapeutic contacts. The treatment unit is situated in a building hosting various units belonging to the public health and social care system. He has his own room, but has previously borrowed rooms.

John, 47 years, has been a clinical psychologist for 15 years. He has mainly encountered clients with psychosis. He identifies as a psychodynamic/eclectic psychologist, working with assessment, neuropsychological testing, and long-term psychotherapy. He is working in an office building similar to the one in which Anita works. Previously, he has borrowed rooms but currently he has his own.

Interview

Since the study concerned he participants understanding and use of consulting rooms it was considered important to provide them opportunity to describe their experiences with their own words. Therefore, interview questions were open and the participants were encouraged to tell their narratives about spatial aspects of clinical work (Hollway & Jefferson, 2008). This means that the participants were approached as storytellers and co-constructors of the interview rather than as respondents (Kvale, 1999; Potter & Hepburn, 2005). Each participant was first asked to describe what kinds of rooms they had worked in, and whether they had borrowed, shared, or had a personal room. The interview thereafter focused on the following topics; (I) rooms the participants preferred or found inadequate, (II) how rooms were used and decorated, (III) what the room meant for clinical work, (IV) reflections on clients’ perceptions of rooms. The interviewer followed the concerns of the participants and simultaneously made sure that these topics were captured. During the interview, the interviewer presented her understanding of what the participant had related and asked the participant to correct misunderstandings. The interviews lasted 35–50 min and were transcribed verbatim, including pauses and non-verbal material.

To understand the interview process and material, the position of the interviewer needs to be acknowledged (Parker, 2004). NN is a clinical psychologist who has worked with long- and short-term psychodynamic psychotherapy, counselling, assessment, and neuropsychological testing. Her clinical experiences might have contributed to understanding the participants’ perspectives. Simultaneously, there is a risk of false understanding (Potter & Hepburn, 2005). To counteract false understanding, the interviewer strived for a not-knowing mode and posed questions concerning the participants’ experiences. In some cases, the interviewer related own experience and asked whether the participant had alternative experiences or understandings.

Analysis

The interviews were analysed according to IPA with the aim to understand how the participants understand their experiences (Larkin, Watts, & Clifton, 2006). To achieve a holistic perception of each interview, the interviews were analysed case by case. In the first step, each interview was read in its entirety. In the second step, each statement in the interview was read with the aim to capture what it was all about. Codes were formulated for each statement. The third step was to scrutinise these codes, and group them together to reach a comprehensive understanding of how each participant understood and used their rooms. In the final step, three themes were formulated; The welcoming room, The logistic room, and The complexity of clinical work. During the final two steps the analysis was compared to the original transcripts. Thereby, it was assured that the themes were grounded in the participants’ narratives. The analysis was thus performed according to the hermeneutic circle; moving between the whole and the parts (Smith, Flowers, & Larkins, 2009). The findings from the interviews will be illustrated with quotations. In some cases quotations have been slightly changed in order to safeguard the participants’ privacy.

Results

The welcoming room

During the interviews, it came forth that the participants understood the room as representing continuity and safety. They wanted to provide clients a sense that someone is there for them, at a certain place, at a certain time. Stability was understood as contributing to recovery, since discontinuity could characterise the clients’ life history and current situation. Spatial stability was understood as especially important for clients with severe suffering such as psychotic or traumatic experiences. Anita said that psychologists should stand up for clients who are unable to stand up for themselves. She sensed that marginalised clients might become used to not having their basic needs fulfilled so they adapt to anything;

If I say to my clients that we have to see each other in the stairwell outside, they wouldn’t protest. They would adapt ‘cause they’re so used to the lowest level of attention or resources. Their adaption is sometimes taken as an indication that things are okey. But it’s not! To provide a room for those weakest client, to say – We will see each other in this room, twice a week at this time. That’s a prerequisite for recovery. It might take a very long time for them to trust this, but when such fundamental trust is reached we have come far.

The welcoming room was also connected to a sense of aesthetics. The participants expressed a need to like the room, and invite clients to a milieu that communicated that the clients are worthy. They reflected on whether questions of aesthetics were important for the clients. Simultaneously, they sensed that even if neither the room, nor its decoration, was directly important to the client, they participants themselves felt comfortable in a milieu they appreciated. This was in the service of their clients, since clinical practice takes place through a relationship. ‘One can fake a lot of things but one cannot fake a sense of comfort and presence’, John said. Christina used the following words;

It’s important to communicate that clients are worthy. Therefore the room should look nice. It makes a difference if they see that someone cares about this place. Of course, people and how we approach clients are most important but I think it’s respectful to show that we’ve made some efforts. It should be some orderliness and beauty. This is a relationship, and they should see that there’s another person who communicates; “You are welcome to me”.

When the participants spoke about the need to appreciate the milieu, they said that they wanted to show something of themselves and their taste, but not their private life. They did not expose their personal views on topics that could be overwhelming or provocative to the client. John expressed it with the following words;

I like to show my personal taste. Sometimes clients comment on things… and we talk about what they like and dislike, it might be a way to connect. But I wouldn’t expose pictures of my children. Maybe it’s nothing wrong with it but I try to think that this is a room for the client, not for me. If I have pictures of my children, the room becomes too centered on me. I want to be committed to the client. I would never expose something clients could take a position for or against. I don’t want to provoke reactions concerning a soccer team or an ideological question. Such questions might be important, but should be carefully discussed rather than provoked by something I’ve brought into the room.

Flowers and artwork were understood as important. Some participants expressed concern that they could not choose their artwork since there was a ‘committee for visual arts’¹ who decided about artworks. Jenny had explicitly disliked the artwork that had been chosen for her. She tried to ignore it but there was a nagging feeling of discomfort. Finally she managed to make the committee change it. Also Anita and Christina had been through discussions with the committee to have their rooms decorated with artwork they felt comfortable with. Christina said that she was interested in visual art and design and thought that many psychologists are, but the room is there for the clients. During the discussion with the art committee she described that she had said;

People come here because they suffer from serious physical and psychological problems. You have to respect that art needs to be accommodated. They have not asked for an art exhibition.

Anita said that it is impossible to predict how clients will react to artwork. She described how a client once had looked at a painting portraying a forest and a lake. When she made a comment about the beauty of the painting the client became upset and related that such a scenery invoked associations to criminal activities. It came forth that the client had been involved in criminal activities during his teenage years when he had abused illegal drugs. To him, openings in the forest were places where people who had been assaulted or even killed, were ‘dumped’. Thereafter, they could talk about the guilt the client felt for having been involved in criminal activities and also the fear that is an inherent part of a criminal lifestyle.

The participants also spoke about the architecture of treatment units, for example how windows and corridors were situated. Robert stressed the milieu as a whole. He dreamt of a treatment unit in the countryside; an old house with an open fire. ‘I think such a milieu would be healing in itself’ he said and continued; ‘It makes a difference if you overlook a parking place where criminal activities are going on or if you see trees and an open sky’. Spatial aspects could also be connected to security. In rare cases, clients might be hostile. If the consulting room was remote from other activities, for example in the end of a corridor, the participants could feel insecure. If the room was close to other clinicians, they felt calm even with somewhat hostile clients. If their colleagues had their personal consulting rooms they also knew where to get, and provide, support if needed.

The logistic room

For the participants, it was important to arrange the room in accordance with clients’ unique needs. Jenny arranged the room so that clients who had difficulties seeing knew where to sit, and were not blinded by the sun. The participants stressed that personal rooms supported attentiveness towards the clients. They could prepare the room without thinking about logistics and were thus relaxed and attentive to the clients’ needs and moods. Borrowing or booking rooms was connected to stressors such as having to plan for everything you might need in advance. Some treatment units had computerised systems for booking rooms. These systems could however create confusion. When there were difficulties with the Internet the participants did not know were they were supposed to meet their clients, and could not book the next session. Such system collapses created overwhelming stress and could lead to staff members opening closed doors in order to find an available room, with the result that sessions were disturbed. Jenny described the confusion with the following words;

When policy makers plan for how rooms should be borrowed or booked, they see utopia. They assume that everything will work according to the system. And if it did it would perhaps be fine. Bu it never does! We work with people, things happen, and change. If a client wants to come later the same day, I have to book another room ‘cause the room I’ve already booked for the morning is booked by someone else. It can take a lot of time. If I have my own room I say, Ok, you are welcome at two o’clock. I only have to pay attention to time instead of both time and space. And there’s another point. If I have my own room, the client is able to find me, if he or she is a little late for example. Otherwise they will have to go looking for me or I have to wait for them at the reception and they will feel very stressed. It creates unnecessary tension and lot of stress.

The participants also mentioned the 10 min in between clients. Sessions might be overwhelming and the participants needed to get themselves together. Anita could prepare herself for the next client through looking out of the window, at a specific tree, thinking about nothing. Christina took a cup of coffee and talked with a colleague about something other than work. With a room of one’s own, this important pause was protected. At worse, the pause was used to find the room for the next session, or look for materials that were to be used. This could mean that the participants were not only stressed and inattentive but also late for the next client. Jenny sensed that in the treatment unit in which she worked, superiors and decision makers were aware that clinicians needed personal rooms. Anita however described that decision makers had said that there was nothing problematic with sharing rooms and had called upon the staff to stop complaining since ‘it was only about booking a room’.

If booking or borrowing was done occasionally, for example during shorter contacts or neuropsychological testing, it was unproblematic. It was unnecessary for each psychologist to have test equipment, and a shared testing room was more effective. Those who carried out neuropsychological testing stressed the importance of a test room in which all equipment concerning tests and questionnaires is stored. It is not always possible to know in advance what tests will be needed and therefore it is hindering to borrow rooms for neuropsychological testing. Neuropsychological tests take several hours. It might be hard to book a room for such a long time. Moreover, if colleagues by accident open the door, time-limited tests become ruined.

According to the participants, stable rooms were important for a trustful clinical relationship to develop. Simultaneously, they underlined that both clients and clinicians were able to handle changes and unforeseen disturbances. Some participants even sensed that, if there was a basic stability, temporary changes could be beneficial for the therapeutic process since minor shortcomings or changes could support clients’ to encounter difficulties, and moreover, the clients’ reactions could be integrated in the treatment.

The complexity of clinical work

When John was asked to describe what the room means, he proclaimed; ‘It means everything’. He sensed that the room becomes an arena for emotional and relational processes. He also described that clients might discuss concrete details in the room, especially when they are about to terminate a longer contact. They might talk about the view, the armchair, or the artwork and what it meant. Anita sensed that it was hard to describe the importance the room since so many aspects needed to be taken into account. She compared the meaning of the consulting room to baking a cake;

You take eggs, sugar and butter… and other ingredients. You mix them in a specific way. When you’ve done that you have a cake. It consists of eggs and butter and everything but you’re never able to revise the process. You will never have eggs and flour again, because you’ve created something new… That’s how it is with clinical work. The room is an important ingredient. If there’s no room, there’s no cake. And I’m not talking about a room with four walls and a door, not just any room. Because just any room won’t do. It needs to be a therapeutic room. Reasonably nice and decorated… Stable, quiet… it’s also a room in time. It’s the same room… It’s a whole

The participants stressed the importance of having a personal room and simultaneously said that the importance of the room, and its decoration, should not be exaggerated. They did not strive for exclusive furniture or decoration, continuous restoration, spacious rooms or technical solutions. Christina said that it could even be counterproductive if the milieu was too designed or ‘exclusive’. She had previously worked in an elegantly designed treatment unit. Clients had sometimes said that they did not ‘fit’ in the environment or could feel inferior. Also Robert preferred a restrained approach to restorations and decorations, expressed in the following quote;

I don’t like the idea that we should rebuild things, and buy new furniture and everything. In one treatment unit I worked in, we moved to new locations and it was like – buy whatever you want. But simultaneously… there’s never enough money to hire professionals who work with the clients. I think it’s offensive! It’s not needed! We need rooms that are nice and well planned in some way. In which the clients and we feel comfortable, and secure… That’s enough.

The milieu was understood as a form of communication. Some participants preferred rooms that were not square but divided in two parts, by a window or a corner, or had sloping roof, since they could be divided into one administrative part, with desk, computer, and papers, and another part with armchairs that invited dialogues. Such rooms facilitated a well-functioning logistic process and simultaneously a well-coming atmosphere.

Discussion

Our participants emphasised the relational aspects of clinical work and the uniqueness of each client. To them, the room and its decoration carried meaning and was a prerequisite for clinical encounters. Simultaneously the room became meaningful through the clinical relationship and could not be substituted with any room. According to the participants, the room, or logistics, should not be the centre of attention since full attention should be directed to the clients. The participants also reflected on their own need to like the room and feel comfortable, while underlining that the room is there for the client. The participants thus acknowledged the interactional aspects of clinical work.

Meaning making is an embodied process, connected to materiality and specific places. Experiences are shaped by the locations in which they take place, and simultaneously influenced by the individual’s prior experiences and expectations of these locations. Meaning making occurs in an environment that is reasonably stable. If the environment changes in unpredictable ways, meaning becomes fragmented rather than continuous, and a sense of belonging and trust is difficult to achieve (Augé, 1995; Frykman, 2012; Larsen, 2012). Moreover, a meaningful and therapeutic space is co-created by clinicians and clients, and clients tend to attach to the place (Curtis, Gesler, Fabian, Francis, & Priebe, 2007; Domash, 2014; Wood et al., 2013). Such a perspective is however not acknowledged when systems for booking consulting rooms are implemented (Andersson Bäck & Linda, 2016). The participants’ reflections on potential negative influence on borrowing or booking rooms illuminate the complexity of clinical work and how such complexity cannot be acknowledged by logistic systems, however effective they may seem. Their reflections might also be understood as warnings against a de-professionalisation of clinicians, who might be forced to subordination in a system that perceives clinical work as reducible to interchangeable functions (Forsell & Ivarsson Westberg, 2014).

In line with the study by Price and Paley (2008) our participants related that clinical work was influenced by external pressure such as not having enough time between clients or having to borrow or book consulting rooms. The participants also described that art committees or policymakers could influence the consulting rooms so that clinical needs could collide with other interests. Just like in the study of Price and Paley (2008), it thus came forth that the power of defining how rooms should be used did not necessarily reside with the clinicians. It should be acknowledged that also clients seldom have opportunities to influence the environment in which they are treated. Clients’ perceptions of what constitute a healing environment might differ from what stakeholders, architects, and clinicians find appropriate and clients might appreciate opportunities to contribute to the interior design and its decorations (Larsen & Topor, 2017). Moreover, people coming from varying cultural backgrounds might interpret built environments and interior designs differently. The Scandinavian design with its light colours, sparse decorations, and large windows, which are preferred in the Swedish health care system, might be perceived as meagre by people who are used to other forms of decorations. It should therefore be noted that the Scandinavian design ideal is rooted in a white middle-class culture that do not appeal to everyone (Leary, 2015).

In the psychodynamic tradition, the importance of the room and its boundaries has traditionally been underlined (Bondi & Fewell, 2003; Borys, 1994). Our results indicate that the room is equally important, and understood in similar ways, by participants who work from other perspectives and with varying client populations. It thus seems as if psychologists, working from various perspectives, understand spatial continuity as a prerequisite for clinical work, since spatial continuity permits attention towards the client, enables necessary spatial arrangements to be done, and creates a comfortable atmosphere. The participants sometimes used the word nice when they described the prerequisites of the consulting room. It is difficult to know what the word nice means for each unique participant, and it should be acknowledged that their perceptions of a nice environment might differ from each other, and also from the clients’ perceptions. As we understood the participants, the word nice does not mean that specific colours, artwork, or decorations were perceived as ideal. The word nice rather seems to refer to a milieu that is neither instrumental and non-personal, as booked consulting rooms tend to be, nor rundown or neglected, but communicates concern.

The participants understanding of consulting rooms as representing continuity, a welcoming atmosphere, and encounters, might be understood with reference to Winnicott’s theories. Winnicott (1960) used the word holding to denote an environment, psychological but also physical, characterised by empathy and continuity. In such an environment, the therapist strives to ‘live with’ the other through suffering and anxiety as well as joy and playfulness. The concept of a holding environment captures the psychological and physical space that our participants strived to provide their clients.

In this holding environment, also aesthetics was understood as important. The participants did however not ask for costly restored or decorated rooms, or neatly designed buildings. For the participants, a welcoming environment with a personal touch was more important. Their strivings to show something of themselves and their taste, without being too personal or provoking reactions in their clients nevertheless need to be reflected on. It is reasonable to ask whether it is possible to show one’s taste without showing something of one’s private life. Christina described how clients could feel that they did not ‘fit’ in too exclusive milieus. Personal taste evolves in a sociocultural context and become markers of lifestyle and social position. There is always a possibility that clients react to buildings, decorations and the clinicians’ ways of presenting themselves. Moreover, a milieu that is perceived as neutral will also invoke reactions. Objects invoke unpredictable chains of associations in the viewers, and we can never assume that objects or buildings evoke the same reactions in others as they do in ourselves (Bollas, 2000, 2009). Anita spoke about this when she described how a painting that was beautiful to her could be upsetting for the client, and the client’s reaction became important for the therapeutic process. Ideas of neutral or calming environments, artwork, and objects accordingly needs to be reflected on. Moreover, environments that are deigned to be neutral might be perceived as instrumental or non-welcoming. Clients often have a sense of disconnection and/or loneliness, and ‘neutrality’ could add too such experiences. As we understood our participant, they were aware of the complexities of the therapeutic room and its decorations and strived to provide their clients a room that was neither instrumental nor over-decorated with private objects.

Aesthetics was perceived as a way to show the client respect, but was not overemphasised. Curtis et al. (2007) found that clients could appreciate a new, clean building since this communicated respect. On the other hand, Laws (2009) found that members of a self-help group for psychiatric survivors sensed that neatly designed buildings and rooms with technical solutions could be perceived as uncomfortable. As researchers and clinicians we need to admit that there are contradictory needs, requirements, and strivings among clients, clinicians, policymakers, and others (Curtis et al., 2007). Moreover we need to acknowledge that clients and clinicians are diverse and have different preferences. Benton and Overtree (2012) underline the need to design and decorate treatment units in non-excluding ways. They for example describe that decorations with an exclusively heterosexual orientation might make client in the LBGT community feel excluded. It should therefore be acknowledged that the intention with our study is not to argue that any specific form of room should be implemented in mental health care units. Such an intention would represent an essentialist view on clients and clinical practice. Our intention is rather to investigate the meaning of consulting rooms and how they are understood and used by clinical psychologists. Nevertheless, our results indicate that there are some prerequisites that need to be fulfilled for a consulting room to be fully functioning. First of all, consulting rooms need to be stable so that the clients are provided a milieu and a clinical encounter that is predictable and protected from interruptions. Moreover, the rooms should be reasonably comfortable, with possibilities to arrange armchairs so that the clinical dialogue is not distracted by technology or administrative material. Moreover, there should be some possibilities to influence the milieu, for example through choosing artwork.

The participants did describe occasions when non-personal rooms were unproblematic. Neuropsychological testing or shorter contacts did not need a personal consulting room, but there should be spatial stability even during such intervention. If borrowed or booked rooms were exceptions, and did not interfere with clinical work, they were possible to handle. When there was a basic stability, both in interpersonal and spatial terms, changes could even be perceived as therapeutic. These perceptions are in line with Winnicott’s description of how minor environmental failures might support the capacity to handle frustration and separation. Adaption should not be complete, writes Winnicott; a complete environment resembles magic and thereby might counteract adaption to the reality (Winnicott, 1990).

In sum, a personal room that is reasonably restored, decorated with care, located not to far away from the reception, and with a minimum of complicated technical solutions is understood as adequate for psychologists working with varying interventions and client populations. In such rooms, the participants sensed that they were comfortable and able to encounter and hold each client with the attention each client deserves.

Methodological reflections

Our study has several limitations. We have not analysed the rooms discussed by the participants and we have not followed the participants in their clinical contexts. Moreover, the interview questions were open-ended. This approach excluded investigations of specific characteristics of the rooms, and the results might thus be somewhat imprecise. We have not acknowledged questions of gender, disability or ethnicity, which is a limitation. Future studies should specifically focus on such topics. It should also be noted that the participants represent a small number of psychologists. Therefore, generalisations should not be made. Moreover, it would be illuminating to interview clients about their perceptions of consulting rooms.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Elisabeth Punzi

Elisabeth Punzi is a clinical psychologist and an associate professor at the Department of Psychology, University of Gothenburg where she teaches psychoanalytic and humanistic-existential psychology, gender perspectives, and qualitative methodology. Her research concerns the meaning of artistic expressions for clients in mental health care, the possibilities of providing client-center mental health care, and the history of psychoanalysis, psychology and psychiatry.

Christoph Singer

Christoph Singer holds a PhD at the University of Paderborn where he teaches British Literary and Cultural Studies. His research deals with the  intersections of temporality, spatiality, identity, and narrative. Currently he is working on a study on narratives of waiting and delay.

Notes

1. This committee is part of a municipal institution responsible for public visual arts.