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Therapeutic Use of SpaceAnn Goelitz a & Abigail Stewart Kahn aa Hunter School of Social Work , USAb Sanctuary for Families , USAPublished online: 22 Sep 2008.

To cite this article: Ann Goelitz & Abigail Stewart Kahn (2008) TherapeuticUse of Space, Journal of Creativity in Mental Health, 2:4, 31-44, DOI: 10.1300/J456v02n04_04

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Therapeutic Use of Space:One Agency’s Transformation Project

Ann GoelitzAbigail Stewart-Kahn

ABSTRACT. The project described in this article addresses the therapeu-tic use of physical space in an outpatient counseling facility. It was theo-rized that an improved facility environment could be used as a practicetool when working with a vulnerable population. The authors undertookthe project with limited time and finances. The process of the change proj-ect is discussed in detail in an attempt to encourage other counseling facil-ities and social service agencies to consider such an effort. Related litera-ture from varied fields is reviewed. The article also relays client and stafffeedback regarding the redecorated space and addresses design consider-ations such as the relative strengths and drawbacks to involving clientsand staff in the process. doi:10.1300/J456v02n04_04 [Article copies availablefor a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mailaddress: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com>© 2006/2007 by The Haworth Press. All rights reserved.]

KEYWORDS. Physical environment, social work agency, therapeuticspace, environmental counseling, planned space design, creativity

Ann Goelitz is a PhD candidate at Hunter School of Social Work.Abigail Stewart-Kahn is affiliated with Sanctuary for Families.Address correspondence to: Abigail Stewart-Kahn, 222 East 34th Street, Apartment

1123, New York, NY 10016 (E-mail: abigail44@gmail.com).The authors would like to acknowledge the staff and patients of the Women’s

Health Project.

Journal of Creativity in Mental Health, Vol. 2(4) 2006/2007Available online at http://jcmh.haworthpress.com

© 2006/2007 by The Haworth Press. All rights reserved.doi:10.1300/J456v02n04_04 31

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INTRODUCTION

Attending counseling sessions can be a stressful experience for clients,and a number of factors influence their comfort with and commitment tothe experience. Among these factors is the safety and comfort of the thera-peutic environment. Indeed, there are a number of factors that promotewellness, including well-planned clinical environments (Arneill & Devlin,2002; Ulrich, 2000). For example, the literature indicates that softer andmore pleasant waiting rooms can reduce worry and anxiety for clients(Leather, Beale, & Santos, 2003; Ulrich). Also, having a waiting roomwhere staff discussions with one another are minimized would communi-cate respect and support feelings of calm in the waiting room. Thus, it be-comes important to plan and create counseling facility space with clientsand their stress levels in mind (Arneill & Devlin). This manuscript will re-view related literature and then describe one facility’s attempt to use spacetherapeutically. The Women’s Health Project Treatment and ResearchCenter, of the Addiction Institute at St. Luke’s/Roosevelt Hospital in NewYork, an outpatient mental health agency which treats women affected bytrauma and substance abuse, considered the environment from the clients’point of view when planning space improvements. This approach includedprocesses suggested by Gutheil (1992), such as taking the time to experi-ence how it felt to sit in client chairs and to see the environment from theirperspective.One premise of the effort was that space can be designed in such a way asto promote positive self-image for clients (Germain, 1978; Miskimins,1990), for instance by designing offices so that clients have pleasant thingsto look at when discussing upsetting subjects (Gutheil, 1996; Ulrich, 2000).Designing space with comfort in mind humanizes it (Rydeen, 2003). Forexample, access to natural light, nature, comforting music, and airflowthrough a space have all been shown to have positive, healing effects(Mroczek, Mikitarian, Vieira, & Rotarius, 2005). The sense of smell alsocontributes to ambiance, since agreeable odors have been found to reduceanxiety in clients (Schweitzer, Gilpin, & Frampton, 2004). One of the au-thors had designed her own office with clients in mind, including the use ofaromatherapy. This engendered many positive comments from clients andstaff, and was one of the precipitants for this project.

Staff at the Women’s Health Project, as is true at most agencies, hadbecome so used to the typical agency environment that the possibilityfor a therapeutic use of space had not been addressed (Germain, 1978;Gilmour, 2006; Gutheil, 1996). The authors hoped that changes in de-sign would become effective practice tools (Resnick & Jaffee, 1982) as

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they created a more home-like atmosphere and increased client comfort(Olsen, 1984; Gilmour). The project was undertaken with a very lowbudget and a minimum of effort. Clients, staff, and visitors to the facil-ity responded favorably, and many were enthusiastic about the project.The purpose of this manuscript is three-fold: first, to raise awarenessabout the importance of the positive therapeutic use of space; second, tohighlight, in some detail, how one counseling center undertook achange of space project on a tight budget; and finally, to document theeffort so that readers might learn from it without encountering the samedearth of literature the authors did when beginning the project. The au-thors hope this paper will encourage readers to initiate change at theiragencies or within their own office space.

BACKGROUND INFORMATION

We are dependent on our external environment in very direct ways(Fitch, 1970). Our physical environments affect who we are as individu-als (Hall, 1970). We consciously and unconsciously react to the spacearound us (Germain, 1981) as it stimulates emotions and anticipatorythoughts (Gutheil, 1992; Proshansky, Ittelson, & Rivlin, 1970; Resnick &Jaffee, 1982). Consequently, our physical environment can reduce or in-crease stress as it affects physiological comfort (Fitch; Ulrich, 2000).Since our well-being is dependent on physiological comfort, attendingto the environment can have an overall beneficial effect.

Anthropologists, environmental psychologists, architects, geogra-phers, and biologists have written about our relationship with the physi-cal environment (Germain, 1978). Architects and psychiatrists joined tolook at the affect of space on individuals (Seabury, 1971). The field ofenvironmental psychology began to incorporate the perspective ofspace into client treatment (Proshansky et al., 1970; Seabury). How-ever, this is still a relatively new and undervalued area of inquiry(Arneill & Devlin, 2002) with few empirical studies (Leather et al.,2003; Ulrich, 2000).

Although the field of social work and mental health counseling tradi-tionally takes a holistic view of clients, even its literature on the physi-cal environment is sparse. Social service agencies tend to focus on thesocial environment as a source of stress, often overlooking the impor-tance of the physical environment (Germain, 1981; Gutheil, 1992).Agencies should consider the affect of the physical environment on cli-ents as they design the office space (Fitch, 1970; Gilmour, 2006). How-

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ever, this dimension of care is often ignored, underutilizing space as apractice tool, missing its concrete and symbolic significance for clients,and thereby preventing a holistic view (Gutheil, 1996).

The Emotional Impact of the Waiting Room on Clients

Most research on health care’s physical environment has focused oninpatient settings rather than on waiting rooms and other areas of mentalhealth outpatient offices (Arneill & Devlin, 2002; Gilmour, 2006;Leather et al., 2003; Mroczek et al., 2005). This research has found thathealth care physical environments can either increase coping or causestress (Arneill & Devlin; Leather et al.; Ulrich, 2000). Miskimins(1990) states that physical environments “impact both the nature andcourse of treatment” (p. 878). Since health care waiting rooms are re-minders of physical and emotional difficulties, just being there can bestressful (Arneill & Devlin; Leather et al.). Health care agencies can in-advertently add to the stress with loud, bland, or unpleasant environ-ments (Germain, 1981). In contrast, a pleasant waiting room with acomfortable and relaxing atmosphere, magazines, and other distrac-tions can lower clients’ stress levels (Arneill & Devlin; Leather et al.;Ulrich).

Awareness of the environment is also important because the designof the counseling facility can encourage or discourage interaction(Germain, 1981; Gutheil, 1996; Leather at al., 2003; Schweitzer et al.,2004), affecting how clients relate to each other and to staff (Gutheil,1996). One study found that ambiance “facilitated self-disclosure byclients to hospital social workers” (Leather et al., p. 846). Furthermore,an uncomfortable seat and messy or unattractive office can impede theformation of an alliance between therapist and client (Gutheil, 1996).Issues of privilege, power, and classism can be seen in uncomfortableenvironments, which the literature identifies as environments ofsociofugality. These environments generally serve lower socioeco-nomic class clientele and discourage community, making clients feeluncomfortable. (Gutheil, 1992; Hall, 1970). Examples of environmentswith sociofugality include most hospitals, jails, and welfare offices. Incontrast, most homes and private therapist offices, which are more oftenutilized by the middle and upper socioeconomic class clientele, tend tocreate environments of sociopetality (Seabury, 1971). These spaces ex-ude warmth and acceptance, engendering connection as they bring peo-ple together and create a sense of community (Gutheil, 1992; Hall,1970). Environments with sociopetality encourage interaction and the

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development of a sense of place, creating an atmosphere in whichclients are more likely to feel respected by staff (Rydeen, 2003).

Institutional Values, Culture, and Quality of Care

While a facility’s physical environment affects coping and interac-tion among clients, it also provides them with information about thecounseling center or social service agency (Germain, 1981; Gutheil,1992, 1996). This includes information related to values and culture(Resnick & Jaffee, 1982; Sommer, 1977). Unpleasant waiting rooms orbathrooms, for example, send the message that clients are not valued(Germain; Gutheil, 1996). Because of this, the unattractive settings ofmany counseling centers can have a negative effect on clients’ sense ofthemselves as individuals (Germain; Gutheil, 1996).

There is also a relationship between quality of care and facility envi-ronments (Arneill & Devlin, 2002). Quality of care has been linked towarmth, empathy, and friendliness; if the counseling center environ-ment communicates these, clients tend to feel they will be well cared for(Arneill & Devlin). As far back as 1956, Maslow and Mintz found thatsubjects felt more energized and reported increased feelings of well be-ing in aesthetic surroundings (Rydeen, 2003). Sommer (1977), whowrote extensively on the topic, particularly relating to education, foundthat students participated more with certain classroom arrangements.

Other, more recent studies have linked positive student achievementwith a pleasant atmosphere (Rydeen, 2003). Research shows that whenthe agency/hospital environment is improved, clients rate it more posi-tively, and report greater satisfaction with treatment and increased wellbeing (Arneill & Devlin, 2002; Ittelson, Proshansky, & Rivlin, 1970;Lawson & Wells-Thorpe, 2002; Leather et al., 2003; Olsen, 1984). En-vironmental comfort was documented as one of the key factors linked toclient satisfaction, and changes in space resulted in shorter inpatientstays (Lawson & Wells-Thorpe). Changes to space have also beenfound to affect behavior by positively encouraging social interactionand energizing clients (Ittelson et al.; Olsen; Resnick & Jaffee, 1982).Ulrich (2000) outlines guidelines to utilize when considering clientspace. These guidelines include changing the environment so that itprovides clients with (a) a sense of control and privacy, (b) increasedsocial support, and (c) access to nature and other positive distractions.

The Environment and Support Staff

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In addition to the impact of space on clients, recent research has alsoidentified the importance of considering the environment as a way tosupport staff (Gilmour, 2006; Mroczek et al., 2005; Ulrich, 2000). Staffin the medical and mental health fields often struggle with burnout anddifficult work atmospheres, and their needs should also be consideredwhen designing space. Supporting this, Mroczek et al. highlight staffperception of their space as critical to their overall sense of comfort andagency in performing their jobs. Physical environment can have a posi-tive or negative impact on staff well-being and on their ability toperform difficult jobs successfully.

THE SPACE TRANSFORMATION PROJECT

Based on the positive response to one clinician’s office designed withtherapeutic space in mind, the agency decided to undertake an environ-mental change project for three reasons. First, mental health clients areoften anxious and the proximity of the agency can increase stress as itreminds them of their emotional difficulties (Arneill & Devlin, 2002;Leather et al., 2003). Despite this, most social service agencies do notconsider their clients’ stress when designing space. This is often trueeven for facilities caring for vulnerable individuals who may be evenmore sensitive to issues of space than most clients (Gutheil, 1996). Forinstance, there are arguably few populations more vulnerable than thosethe Women’s Health Project serves. The women treated here sufferfrom both trauma and addictions. Further, many of them have additionalissues such as financial instability, homelessness, other mental illness,and physical health problems. The second reason for the project is thatthere was no systematic organization of space and décor at theWomen’s Health Project. While some clinicians clearly used great carein decorating their offices with the clients’ comfort in mind, other of-fices were bare, and common spaces such as bathrooms felt cold, dirty,and institutional. Third, where clients previously had access to a waitingroom belonging to a program next door, this space was no longer avail-able for their use. It was therefore necessary to create a waiting room inthe very limited space in the front room of the offices that had hithertobeen used only as desk space for researchers and administrative sup-port.

One of the authors, a summer social work intern at the time, took pri-mary responsibility for moving the environmental change project for-ward. Unlike permanent staff with full caseloads and other re-

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sponsibilities, the intern had the time available to address neededchanges. In addition, the help of an administrative support staff personwas enlisted. This staff person knew the program, was creative andhandy, and had a very good eye for decorating. Spaces that needed at-tention were identified, such as the new waiting area, the client and staffbathrooms, the hallway, and some of the offices occupied by part-timestaff.

While high levels of staff involvement in environmental change pro-jects are recommended (Gutheil, 1996), the authors struggled with thebalance of staff involvement and time constraints. Because the summerintern who was the primary resource for the project was only availablefor a limited time, it was imperative that progress be made rapidly. In anattempt to compromise between the importance of staff involvementand time pressure, staff were informed of the change, invited to sharetheir ideas, and asked to bring in items from home to add to the décor.However, most were not actively involved in the process.

Understanding that the physical environment of the counseling cen-ter often communicates how the staff values clients (Germain, 1981;Gutheil, 1996), the intern set about to improve the space. To begin with,she attempted to remember what it felt like to arrive at the facility for thefirst time. She also utilized some of the seven questions suggested byArneill and Devlin (2002) when designing space. First, what is the ini-tial view that clients see when entering the office? In this case, the firstview was cluttered desk space used by researchers. Because the waitingroom needed to be created in this space, desks were moved away fromthe window, and a beautiful window seat became the client’s first viewupon entry.

Second, were the waiting room chairs comfortable? The authors satin chairs and agreed that a small back pillow would improve comfort.Additionally, the most desirable chairs were moved to the waiting roomarea in an attempt to make clients more comfortable, as recommendedby Gutheil (1996). Based on Arneill and Devlin’s (2002) questions, thechange project also sought to improve the quality of light in the waitingarea, adding lamps to warm the feeling of the room. Though the internwas unable to add more natural light, as suggested by Ulrich (2000), thechange project attempted to capitalize on and highlight the natural lightthat the space did have by improving access to window spaces and dec-orating windows in a way that draws one’s eye to the source of naturallight. Magazines and toys for the children were collected to improve thelevel of available distraction while waiting. The institutional feel of theoffices was also addressed with the addition of dried flowers and laven-

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der, improving the smell of the waiting area, offices, and bathrooms,which Schweitzer et al. (2004) have found can have a therapeutic effect.Finally, water and tea were made available to clients while they waited.

A change proposal for the waiting room and other areas was preparedbased on feasibility. A budget of $400 for the project was anticipated.To stay within this budget, the intern researched low cost stores, madeprice comparisons, and made the appropriate changes to the proposal.The finalized proposal and budget were approved by the Executive Di-rector. This approval was critical, not only because it provided access toneeded funds but because, as Gilmour (2006) highlights, institutionalsupport is an essential element in creating positive environments forclients.

The intern and administrative staff person shopped for the changeproject in the garment and flower districts of New York City and at vari-ous low-cost department stores. In the garment district, inexpensiveyards of light colored fabrics were purchased. This fabric was cut upand used to drape over windows as curtains and over file cabinets tosoften their look. They avoided the expense of window trusses by at-taching fabric to window frames using binder clips which were hiddenunder the fabric. Dried flowers and inexpensive baskets were also pur-chased, and flowers and potpourri were placed in the front room andbathrooms to improve the smell as recommended by Schweitzer et al.(2004). From discount stores, the intern and administrative staff personpurchased wall hangings to soften the feeling of the offices, pillows forchairs, and inexpensive frames in which they hung quotes relating to thetreatment model and selections of inspiring client poetry. Finally, assuggested by Olsen (1984), plants that helped to reduce the institutionalfeel of the offices were purchased at a local farmer’s market.

Additionally, other items were brought in from home by staff personsand, in one case, by a client who was inspired by the improved decor.This client brought in toys for the waiting room. The administrativesupport staff person who was so key to the effort brought in a rug thathad been sitting in her basement. The rug was used to cover all the elec-tric cords in the front room. As Arneill and Devlin (2002), Gilmour(2006), and Olsen (1984) have indicated, this is also the kind of changethat helps space feel more like a living room and less like an office.Other staff brought in curtains, stuffed animals, wire shelves found inthe trash that were put in the bathroom for plants and hand towels, and awooden shelf that was mounted near the front door to act as an inbox.This entire effort was completed in fewer than three months for some-what less than the $400 budget.

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PROJECT OUTCOME

The results observed upon completion of the environmental changeswere both subtle and overt. Some clients appeared not even to notice atfirst. Others made comments immediately. The support staff personwho had been a creative force in the redecorating effort put out a pad ofpaper asking clients to write down their comments. The following areexamples of the statements received, with minor corrections for gram-mar and spelling:

1. “The aromatherapy works very well with the scenery. It feels like ahome away from home, and when I am anxious and stressed or de-pressed I sit here and meditate. Afterwards I feel good. Thank youfor thinking of the way we feel and giving us this little space. . . .”

2. “Thank you very much for thinking about the clients. The spaceyou provided is nice, refreshing. It is relaxing, soothing and greatbefore starting the session. The reading material is appropriate.”

3. “Thank you very much for thinking about the client and theirneeds, as well as the needs of their children. It is very clean and mydaughter likes coming here, which makes it less stressful when Idon’t have a baby sitter.”

4. “Very, very, very nice and pretty. Comfortable. Great Improvement!”5. “The new waiting area is great. It feels very homey and comfort-

able. If someone comes stressed like myself [they] will feel somuch better sitting in the new waiting area. Thank you for makingit better and thinking of us patients.”

6. “The incense is suave, the area is very charming. I appreciate thetime you guys [took] to create that special little place.”

7. “Comfort is very important in a waiting area because most peopleare stressed while waiting and the look you have [is] more likehome. Thank you.”

8. “I never felt so comfortable being here to talk, smile, and say hello!This is a very special place. Thank you! God bless theWomen’s Health Project.”

The comments received verbally were similar. Most focused on thecomfortable, home-like atmosphere and the fact that the clients hadbeen considered important enough for the agency to make the changes.Many also commented on the use of scents to improve the ambiance.

It took more time to note the behavioral changes in clients. Prior tothe redecorating effort, when clients utilized a waiting room shared with

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another clinic, it was rare for them to interact with each other. Mostwould read, talk on the phone, close their eyes, or stare into space. In thenew waiting room, staff began to observe more interaction. As clientswaited, they often talked with each other. Even the children who camewith their mothers reacted differently. There had always been toys forthem, but now there were more and they were arranged invitingly. Notonly did children play with them more, but they also played with eachother, and frequently complained about having to leave.

Visitors to the facility also commented on the environment in a posi-tive way, mentioning how comfortable it was. A volunteer worker, forexample, said that it was one of the things that struck her about the coun-seling center and that made her want to work there. She subsequentlydecided to volunteer at the Women’s Health Project instead of anotheragency with an easier commute.

Mroczek et al. (2005) note the importance of staff members’ percep-tions of their environment when creating a supportive work space. Insome ways, the reactions of the Women’s Health Project staff to the en-vironmental change project were the most unexpected. Most were en-thusiastic about the changes. Some of the staff had contributed bybringing in things from home. Others were involved in the changesmade to their offices. The majority commented on the improvementsand praised the efforts of the instigators. There were a few, however,who were either not impressed by the changes or responded as thoughthey resented them, criticizing various details. This may have been be-cause they felt left out of the process. When one of the authors listenedto these staff members’ concerns, apologized for not having involvedthem more in the process, and provided ways for them to make somechanges of their own, they became enthusiastic as well, and the negativecomments ceased.

DISCUSSION

The clients’ responses illustrated their appreciation for the thought-fulness of the staff as well as for the results of the effort. The unspokenmessage from them was that they felt more valued and taken care of.Germain (1981) and Gutheil (1996) talked about ways unpleasant wait-ing areas can send messages that clients are not valued, potentially con-tributing to their negative self-image. Clients at the Women’s HealthProject are a particularly vulnerable population and, as such, may beeven more sensitive to unspoken messages (Gutheil). They may also be

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more sensitive to the effect of environmental improvements. JudithHerman (1992) discusses the importance of helping trauma clients buildconnections and establish safety via their environments. Comfortablefacility spaces with sociopetality may contribute to this process.

Not only did clients report feeling less stress because of the designchanges, but they also mentioned subtle changes such as the aroma-therapy contributing to their mood. Unpleasant odor was one of thecomplaints staff had heard from clients prior to the space changes. Theincidence of responses to the agency’s aromatherapy efforts seems tosupport what Schweitzer et al. (2004) have reported about pleasantodors reducing anxiety. Clients also responded positively to one of thegoals of the project, creating a more home-like atmosphere withsociopetality, underlining the importance of this aspect of facility spacedesign.

The effects of sociopetality, or homey atmosphere (Seabury, 1971),in the space design went beyond what was expected by the authors. Theenvironment was designed to be warm and comfortable, hopefully cre-ating a feeling of community in the agency (Gutheil, 1992; Hall, 1970),but the affect on clients’ interactions with each other was not antici-pated. By necessity, due to limited space, the chairs in the waiting areawere placed close together and around a table. Germain (1981) statedthat this kind of arrangement encourages interaction. The results the au-thors noted in this project support Germain’s statement. Anecdotal dataand informal observation showed that clients interacted more in the newwaiting area. This was most probably due to the combined effects of theseating arrangements and the pleasant surroundings. Rydeen (2003) as-serted that this kind of atmosphere encourages interaction and, accord-ing to Ulrich (2000), access to social support like this in health careenvironments can contribute to the healing aspect of space.

There are several areas of the project that could have been done dif-ferently had time not been a constraint. Ittelson et al. (1970) discussedthe complexity of the process of changing the agency environment, not-ing that there are many factors that need to be considered. Extensiveplanning, for example, can help to ensure a successful project, as can ampletime to discuss and implement the changes. Unfortunately, this projectwas only possible because of the help of the summer intern who wasthere for a limited time. Because of this time constraint, staff and clientinvolvement was limited.

The authors considered getting input from clients on the environmen-tal changes as recommended by Sommer (1977). It would also havebeen beneficial to invite the clients to participate in the decorating pro-

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cess. Although this was not possible due to the time constraints, severalcomponents of the project may have contributed to clients feeling moreinvolved. Clients who were members of a writing group presented theirpoetry to staff just prior to the decorating effort. Some of the poetry washung on the walls of the hallway near the bathroom. The trauma-relatedsentiments expressed in the poems helped make new clients feel moreaccepted and less alone. Current clients and writing group memberswere proud to see their efforts displayed. Slogans utilized in the traumagroups to encourage coping were also framed and hung in the bathroomand waiting area, providing another familiar link for clients andreminding them of their recovery effort.

Staff involvement was also limited by time. Another clinic in thebuilding that the authors looked to for inspiration was entirely decoratedby staff with contributions they brought in from home. Not only wouldthis have lowered the cost of the effort but it would have also avoidedsome of the staff reactions encountered, and the results might have beenmore personal. This would, however, have increased implementationtime, and may also have been unsuccessful since involving trainees andpredominantly part-time staff members would have been difficult.

It is important to note that it is possible that the written commentsfrom clients could have been influenced by several factors, potentiallyaffecting the conclusions drawn from them. Many clients spend little orno time in the waiting area because they go directly to therapists’ officesor group rooms. These clients may not have seen the note pad left out forcomments. Others may not have participated due to limited reading andwriting ability. Therefore, the input from clients was limited to thosewho spend time in the waiting area and who are literate. Those who didparticipate may have seen the notes written by others and been inclinedto write something similar, further influencing the responses received.

CONCLUSION

Understanding that it is important to create environments that pro-mote wellness (Arneill & Devlin, 2002; Ulrich, 2000), the authors un-dertook the environmental change project described above. The projectwas completed within a limited timeframe and with a small budget.Overall, reaction to the project was positive, though responses of clientsmay have been impacted by various factors. Staff feedback about the re-sults of the project was varied, though the majority was positive. Hadthere been more time to complete the project it would have been benefi-

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cial to generate more staff and client involvement. One concern in thisproject is that space changes were based on the authors’ understandingof what felt good to them, and not necessarily to the clients. It is con-ceivable, for example, that these spaces were not culturally relevant toclients at the agency whose backgrounds differ from those of theauthors. This is an area that warrants investigation.

As with many social service, health care, or counseling center envi-ronments, staff at the Women’s Health Project had become used to thepoor space arrangement and institutional feel of the environment. Simi-lar projects are important if we are to begin to improve the therapeuticquality of the space used in social service/counseling center settings.Additionally, empirical research is essential for understanding how bestto complete such projects, and to assess outcomes of change efforts.While it is clear to most mental health practitioners that care for clientsis primary, this care is rarely communicated through use of space. Sincethe environment is the first thing that a new client encounters when en-tering a counseling center or social service agency, counselors and othersocial service workers should champion the use of space as an effectivepractice tool rather than an impediment to progress.

REFERENCES

Arneill A. B., & Devlin, A. S. (2002). Perceived quality of care: The influence of thewaiting room environment. Journal of Environmental Psychology, 22, 345-360.

Fitch, J. (1970). Experiential basis for aesthetic decision. In H. Proshansky, W.Ittelson, & L. Rivlin (Eds.), Environmental psychology: Man and his physical set-ting (pp. 76-84). New York: Holt, Rinehart, and Winston, Inc.

Germain, C. (1978). Space: An ecological variable in social work practice. SocialCasework, 59, 515-522.

Germain, C. (1981). The physical environment and social work practice. In A.Maluccio (Ed.), Promoting competence in clients (pp. 103-124). New York: FreePress.

Gilmour, J. A. (2006). Hybrid space: Constituting the hospital as a home space for pa-tients. Nursing Inquiry, 13(1), 16-22.

Gutheil, I. (1992). Considering the physical environment: An essential component ofgood practice. Social Work, 37, 361-366.

Gutheil, I. (1996). Using the agency’s physical environment as a practice tool. SmithCollege Studies in Social Work, 66, 185-199.

Hall, E. (1970). The anthropology of space: An organizing model. In H. Proshansky,W. Ittelson, & L. Rivlin (Eds.), Environmental psychology: Man and his physicalsetting (pp. 16-27). New York: Holt, Rinehart, and Winston, Inc.

Herman, J. (1992). Trauma and recovery. New York: Basic Books.

Ann Goelitz and Abigail Stewart-Kahn 43

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ded

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anch

este

r L

ibra

ry]

at 0

7:00

17

Oct

ober

201

4

Ittelson, W., Proshansky, H., & Rivlin, L. (1970). The environmental psychology ofthe psychiatric ward. In H. Proshansky, W. Ittelson, & L. Rivlin (Eds.), Environ-mental psychology: Man and his physical setting (pp. 419-439). New York: Holt,Rinehart, and Winston, Inc.

Lawson, B., & Wells-Thorpe, J. (2002). The effect of the hospital environment on thepatient experience and health outcomes. The Journal for Healthcare Design andDevelopment, 33(3), 27-32.

Leather, P., Beale, D., & Santos, A. (2003). Outcomes of environmental appraisal ofdifferent hospital waiting areas. Environment and Behavior, 35, 842-869.

Miskimins, R. (1990). A theoretical model for the practice of residential treatment. Ad-olescence, 25, 867-890.

Mroczek, J., Mikitarian, G., Vieira, E. K., & Rotarius, T. (2005). Hospital design and staffperceptions: An exploratory analysis. The Health Care Manager, 24 (3), 233-244.

Olsen, R. (1984). The effect of the hospital environment: Patient reactions to tradi-tional versus progressive care settings. Journal of Architectural and Planning Re-search, 1, 121-136.

Proshansky, H., Ittelson, W., & Rivlin, L. (1970). The influence of the physcial envi-ronment on behavior: Some basic assumptions. In H. Proshansky, W. Ittelson, & L.Rivlin (Eds.), Environmental psychology: Man and his physical setting (pp. 27-37).New York: Holt, Rinehart, and Winston, Inc.

Resnick, H., & Jaffee, B. (1982). The physical environment and social welfare. SocialCasework, 63, 354-362.

Rydeen, J. (2003). Focusing on human factors. American School and University,75(12) 158-161.

Schweitzer, M., Gilpin, L., & Frampton, S. (2004). Healing spaces: Elements of envi-ronmental design that make an impact on health. The Journal of Alternative andComplementary Medicine, 10, 71-83.

Seabury, B. (1971). Arrangement of physical space in social work settings. SocialWork, 16, 43-49.

Sommer, R. (1977). Classroom layout. Theory into Practice, 16, 174-175.Ulrich, R.S. (2000, March). Evidence based environmental design for improving medical

outcomes. Retrieved August 8, 2007, from http://muhc-healing.mcgill.ca/english/Speakers/ulrich_p.html. Proceedings of the Healing by Design: Building Healthcare in the 21stCentury Conference. Montreal, Quebec, Canada.

RECEIVED: 07/05/07REVISED: 08/04/07

ACCEPTED: 08/15/07

doi:10.1300/J456v02n04_04

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