Therapeutic Office Designs Support Positive Doctor-Patient Alliances
There is a considerable body of literature confirming the relationship between mental well-being and good design practice. Evaluations of specific design interventions have shown that good design of a hospital’s environment leads to better clinical outcomes and less stress for patients and staff.1 Research also links environmental aspects, such as landscaping or natural elements, to the reduction of stress and the promotion of recovery from illness.2 The therapeutic office space can influence the relationship between psychiatrist and patient, as well as therapeutic outcomes.3
The counseling environment is regarded within clinical literature as having an effect on a patient’s sense of well-being.4 Patients’ experiences of such spaces can have a highly emotional dimension, which suggests that environment design should be investigated as a potential means to influence therapeutic efficacy.
Individuals have different abilities to censor or suppress their environments, and a patient has reduced capacity to exclude environmental distractions when stressed or anxious. This suggests that the environment of a therapeutic office may have more of an impact on these individuals who often arrive for an appointment in a distressed state. Findings also indicate that layout has strong psychological dimensions for patients in therapy and may form a pathway to addressing issues of the self.5 This suggests that the therapeutic office may be influential in patient anxiety levels and therapeutic efficacy.
Self-disclosure can be difficult for a patient and is less likely to happen when the patient is in an anxious or worried state.6 Linking the design of therapeutic offices to communication and patient self-disclosure is a major area of research. Not only does the physical environment affect patients, non-verbal communication variables have also been analyzed in therapeutic settings, including distance, body position, and body motion. Atmosphere, too, is implicated in therapeutic offices: Is the atmosphere conducive to thinking and reflection? Is the encouragement of conversation and discussion desirable? This implies that various design aspects are influential in patient self-disclosure, and in turn have an effect on therapeutic outcomes.
Supportive design strategies
Waiting area design strategies. Waiting area design strategies (see Table 1 for a summary) are predominantly concerned with physical and psychological privacy. This is a primary concern for patients and has an impact on their mental states before the therapeutic encounter as well as the extent to which they are able to engage in the therapy sessions.
Physical privacy relates to the visual and auditory environment. Psychological privacy relates to how safe or unsafe a patient feels when he or she may be seen and/or heard by others or hearing and seeing others. Patients can be overwhelmed with the magnitude of their own thoughts and feelings as well as those of others sharing the space and intruding in their own psychological space.
Therapeutic office interior layout design strategies. Therapeutic office interior layout design strategies (Table 2) relate to how the physical design of the space promotes patient self-disclosure, communication, empowerment, and psychological safety. Spatial arrangement affects self-disclosure, which directly underpins the therapeutic experience and outcomes. Empowerment relates to how the space might be flexible and how space can be adjusted to meet the needs of individual patients and allow them to enact and develop a sense of agency within physical space (Figure 1). Environments that are flexible and can be rearranged may be useful to promote self-disclosure and communication.
Dr Liddicoat is Research Fellow, Faculty of Architecture Building and Planning, University of Melbourne. Her research interests are at the nexus of architecture and health and include how the built environment can support well-being within hospital settings, and the role of design practice in mental health service environments. Dr Liddicoat reports no conflicts of interest concerning the subject matter of this article.
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