Wednesday, January 16, 2013

How Important is the Therapeutic Environment?

Therapy has come a long way from it's couch-lying Freudian beginnings. Therapists and clients have evolved in their relationships; now therapists (in some communities) are praised for their ability to properly self-disclose rather than being shunned for not maintaining an air of mystery. Personally, it has taken some time for me to evolve my thinking on patient-client interactions in regard to emails, phone calls, and text messages.  In no way does this mean I'm going to make homemade pasta, buy good wine, and show up at my therapist's home à la Kay Scarpetta, but I have learned to use electronic communications to my benefit. Though I'm learning to change with the times, I do believe some aspects of a patient-client relationship should not change, the most important of all being the therapeutic environment.

My therapist's office has been my safe space for over nine years now.  I've learned to cry there, to laugh, to love, to enjoy, and to let go.  I've always enjoyed the waiting room as much as (if not more than) the actual therapy room. Soft instrumental melodies waft from a  very 90's CD player, coffee and hot tea are readily available, and all of the staff are friendly and great to chat with.  I've shared hair-dying tips, crocheting secrets, and favorite cellphone games with various therapists and staffers who have passed by while I was waiting for my appointment. The environment is so inviting that I've made it a ritual to arrive at least ten minutes early to prep for my therapy session.

While I try not to be ultra-critical, I have been known to have a few opinions. So it should be no surprise that when I entered my therapist's waiting room and for the first time heard music with lyrics, I had a few questions.  I let those rattle around my brain for a while, thinking it to be a  fluke of some sort.  After about a month of the same type of music greeting me, I decided it was a blessing I had one of the last appointments at this particular office and took it upon myself to change the radio over to CD. Actually, the first time hearing a triggering song (I believe it was the song "Jumper") was what made me brave enough to change the stereo's settings.  It wasn't a big offense in my mind, but it was a curious change.

I held my tongue up until the time I first heard Christmas music upon entering the door.  It wasn't yet Thanksgiving and the carols were already going.  The local radio station the stereo was tuned in to had taken it upon itself to be the first station around to sound the "joys" of the season.  Although I observe Christmas, I am not Christian and understand that not everyone celebrates Christmas.  It's also a rough time of the year for me, as it is many others, and I have to go through my own personal rituals before I can really enjoy the season.  Learning that the music choice had little to do with thoughtfulness, I found nothing wrong with continuing my tradition of hitting the "CD" button on the stereo.

I found that my therapy group wasn't the only one attempting to incorporate holidays into their decor. Friends I have made online from various parts of the globe were saying the same things I was about what had happened to our previously safe spaces.  A couple of friends said the decor went straight from the front door, through the waiting room, and into the therapist's office.  I joked that I was lucky that I only had depressing carols to contend with, but the next session proved me wrong; decorations had spurt up all over the office.  Thankfully, I never had to deal with a problematic therapy room, but the decorations definitely depressed me.

I worried about the clients that came only for holiday-related issues and those who may be triggered by holiday decor for whatever reason.  I began to wonder if the decorating would ever end, as the decorations continued to spread in a naive attempt at incorporating all religions.  It's just not possible- the minute you include one religion you are probably offending another religion.  And if you don't represent a religion correctly you've offended many without even meaning to.  My arrive-early ritual turned into a sprint-last-minute pattern.

I began to wonder what the "official" stance on all of this is.  I found out if you Google the words "therapy office" and "holiday decor" you get little to no results.  Some articles about the importance of neutrality and thoughtfulness needed in decorating an office and then some research studies on quality perceptions of therapists based on office decor. It seems that either this is a non-issue for most or an issue that the internet has yet to shed light on.  Much like online therapy, which went without internet articles for quite a while, holiday decor seems to be an issue too taboo to cover.

For me, it's not a deal-breaker, but it has caused some shock.  One of the few things I could count on was my therapist's office and waiting room being a neutral place where the expectations of the outside world couldn't hurt me.  While everyone walking down the street "expected" me to be happy and joyous during the winter holidays, I could count on having a place to seek refuge.  Now, I have to make my own place of refuge, which perhaps is forcing me to grow emotionally.  While that's great- I love making progress- I still don't want to have to deal with dangling hearts and love songs for Valentine's Day.  I may just have to take the month of February off.

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