The Room

Come in, and have a seat…

All therapy happens somewhere! I have worked as a therapist in a variety of settings: first in various public teaching hospitals in Cape Town, then a year in a little barebones clinic on a military outpost in the middle of nowhere (where I painted the walls of my office yellow within my first week of arriving there). Then there were 4 years in a tiny office in a small private hospital in rural South Africa, then 2 years in a beautiful community clinic on the 6^th floor of an office building in the crazily busy Central district in Hong Kong. (I vividly remember the extremely steep hill up Wyndham Street, and the lady at the flower stall in front of the clinic – I always bought lilies from her!) After a long break in my therapy career (about 10 years!) I joined Felix & Sage Psychology here in Melbourne, first in Mt Dandenong road, and now here in our gorgeous clinic with the high ceilings and old-worldly charm in Wantirna Road. I have also had my fair share of hours in “the other chair”: sometimes my own therapy took place in big leather seats, sometimes in rooms with a view, sometimes in offices that were barely more than just two chairs facing each other.

Therapy rooms generally tend to be nice places. It usually reminds of a lounge room, with couches, armchairs, cushions, a coffee table (with a box of tissues on it), pretty pictures on the walls and often a shelf with books somewhere (the bibliophile in me is always attracted to the latter, whether I am in the therapist or client role!). Child therapists tend to have lots of wonderful things in their rooms: doll houses, arts and craft stuff, puppets, kinetic sand, playdough, sand trays and all sorts of toys. It is often like a magical world in there – no wonder most kids thoroughly enjoy therapy!

Some therapists like to have family photos in their offices. Others would never dream of even letting on that they have a partner or children. As discussed in the blog on boundaries, this is purely the personal choice of the therapist about how much about their personal lives they wish to disclose. In a clinic such as Felix & Sage, where no therapist has exclusive use of a certain therapy room, photos or other personal knick knacks are out of the question for obvious reasons. The rooms tend to be neutral spaces – friendly, and not too formal, but without anything that says too much about the personal identity of the psychologist who happens to be in that room on a certain day.

I am a firm fan of windows in a therapy room – apart from letting in natural light, a window is also a connection to the outside world, and a lovely link between the “therapy world” and the “real world out there”. Rooms without windows tend to make me feel cooped up and a little anxious, I don’t think I would ever willingly work in a space where I cannot open curtains or blinds and let the light in! As a therapist, I also enjoy my little ritual at the end of a busy day to draw the curtains close before I switch off the light.

Usually the therapist has his/her preferred chair, and the client uses the couch or other armchair. To avoid awkwardness with seating arrangements, I usually welcome clients into the room by saying “take a seat” and gesturing to the couch in quite an obvious way. In that way, I don’t feel out of my depth by not sitting in “my chair”, and the client doesn’t have any anxiety about having sat down in the “wrong” spot. Some therapists prefer to have their chairs close to the door of the office for safety reasons. Especially in high risk settings, it is important that the therapist always has an easy exit, should he or she feel threatened by an aggressive or intoxicated client. Sometimes therapy rooms come equipped with safety buttons or alarms, but this is not so common in private practice in my experience.

Especially for the treatment of anxiety disorders, therapists would very occasionally choose to do exposure treatment outside of the therapy room. After all, it does make more sense to confront fears in real life rather than only in our imagination! There are a couple of reasons why this is a rare occurrence nowadays. Firstly, confidentiality can be an issue if therapist and client are seen together in a public space. Secondly, liability and insurance issues could potentially be problematic (what happens if the client sues the clinic because he got hit by a car whilst the therapist was treating his fear of traffic in an actual street?). Thirdly, therapists often work on a very tight schedule, seeing a new client on every hour, and working outside the therapy rooms (e.g. travel to and from the places where the exposure therapy is done) could eat into valuable time resources.

Two other additional therapeutic spaces in the process of coming for psychotherapy are the following:

The waiting room, where clients sit down, grab a coffee, stare at their phones, and prepare themselves mentally for their sessions. This space should be friendly and open, and I cannot emphasise enough the value of a friendly and kind receptionist! This is where the client should be made to feel welcome even before their session starts. To have a receptionist greet you by name with a friendly hello or a small chat does absolute wonders to make clients feel accepted and seen.

The trip to and from the clinic, be it by car, public transport, bike or good old walking. I have always found that, as a client, the time of the travel to my session is very valuable to think about what I want to talk about. Similarly, the trip back home serves the beautiful function of letting thoughts and feelings from the session settle and start to digest. There is certainly a transitional aspect to the travel to and from therapy… something that unfortunately is lost with online telehealth sessions.

I have always found it fascinating that, as a client, the actual surroundings of the therapy room, are less important to me than it would have been if I were in the therapist role. If the therapist is good at what they do, if they create a warm and accepting space where risks can be taken and emotional openness can thrive, if they challenge at the right time, and contain at the right time, then it actually doesn’t matter that much what the room looks like. Actual therapy happens in what Irvin Yalom aptly calls “the space between us”: in connecting as two human beings, working together on the growth of the client in the context of emotional authenticity.

In the end, this is the therapy room: not the couch and the cushions and the coffee table but the sense of being heard, being seen, being “felt” and being validated. And that can happen pretty much anywhere.

PS: Here is a real blast-from-past from my 2 different offices in 2002! Note the floppy disks, old landline phone, brick of a mobile and a random tap without a sink… and what’s with all the sitting on the desks?!