Most counseling practice cannot effectively occur in an environment outside of an office setting. It is just not efficient for a counselor to travel to see patients where they live. There are some models, such as home health, that use an “in home” approach, but the professionals rendering this service are reimbursed to a level which makes this feasible. For most of us, our patients have to come to us. This does not mean that you should ignore your environment with a take it or leave it mindset.
Those who have worked with me in the past know that I favor an “unoffice” type setting. I prefer my office to look like a living room, very cozy and comfortable. I currently have two offices where I see patients, one is more “officey” and one is cozier. Guess which one I usually see patients in? I have lamps vs. the harsh florescent lighting usually used in offices. I have fabric curtains that make the environment soothing. It makes me feel comfy just walking in.
Recently, I decided to use my less favorite office for a patient I was seeing and I thought it would make an interesting discussion. My patient has a long history of trauma and significant trust issues. I am humbled that they are working with me. The first time I met this person, we met in the “unfavorite” office. On our second visit, I considered moving to the other “favorite“ office, but did not because of several factors.
The first thing I thought of was that this would take the person aback. I wanted the setting to remain the same to give some stability to our brand new relationship. I am a believer that everything you do in counseling matters and so I like to stage the things I can. (Mind you, I’m not a control freak!) Coming to the same office and seeing things arranged in the same way lends a sense of stability to the counseling sessions. If you don’t believe me, the next time you see an anxious child, change something in your office between visits and see if they are not disturbed by it! An adult usually won’t even be conscious of something changed, but I feel that it impacts them.
The second thing that I thought of was trust. If you have ever done relaxation, meditation or hypnosis with someone, you know they have to have a certain level of trust before you can expect them to close their eyes and relax! For this reason, I felt that being in a room with bright lights would be more comfortable for this person.
Thirdly, because of the significant trust issues, I didn’t want to take them into a room that was more intimate. The seating is much closer together, it faces directly. I thought it would put this person a little on the defensive.
I have continued to see this person in counseling and I haven’t moved to the “favorite” office yet. I believe we are at a critical point and I don’t’ want to cause any disruption in the momentum if I can help it!!
Let me know if you have any thoughts about this topic. I’d love to hear what you think.