In the design of new treatment spaces or the remodel of existing offices, there is much more to consider than the placement of the proverbial couch. Therapeutic aspects, aesthetically-pleasing elements, and creating a healthy environment are just some of the issues that help guide an analyst and his/her design team during the planning and design process. Psychoanalysts' design choices can greatly affect their patients' comfort levels and ultimately, their successful treatment.
Mali Mann, a member and training supervisor of the San Francisco Center for Psychoanalysis, enjoyed the same treatment space for more than 20 years of her career. Yet, in the last year, she has experienced two office moves and the impact on her patients was palpable. The first move proved intolerable because the space was not soundproof, allowing a great amount of external noise to filter in, and it resembled a standard clinical examination room. Now, Mann and her patients enjoy meeting in a warm, serene, and quiet office softly lit by recessed fixtures. Her psychoanalytical patients, who recline on her couch, enjoy a soothing, expansive view through a large window of the sky and a magnolia tree.
“Architecture plays such an important role in our treatment approach,” said Mann, who is also a clinical associate adjunct professor at the Stanford University School of Medicine. “Over the years, I've noticed that my patients form attachments to the objects and artwork in my office. Their psychic world connects itself to the external environment they share with their analyst. This has been more evident in particular for patients who suffer from earlier childhood developmental conflicts. When something externally changes or some objects are rearranged or replaced, even in the smallest way, patients can become disturbed and associate the difference with difficulties in their past. Therefore, keeping the analytical space stable and safe is of utmost importance in our analytical work.”
Evidence is growing on the impact of interior design on those suffering mental illness; fortunately, there are some relevant axioms that should be considered.
The patient's experience of his/her treatment doesn't begin in the waiting room or office, but rather at the entry to the building.
Corridors should be kept short and of a consistent dimension to avoid optical illusions.
The ceiling above a ramp should change slope at the same rate as the ramp.
Entries to treatment space should be well lit because many patients are drawn to light; doorways to an analyst's private space should be dimmer.
The use of imperfectly reflective surfaces that warp the image or abstract art in corridors, lobbies, and office spaces should be avoided.
As the goals of analysis may include increasing self-confidence and imparting coping skills, the psychoanalyst's office can be the ideal setting to serve as a tool to support recovery.
A simple way to show respect for patients, and help put them at ease, is by considering their view or line of sight during each session. Are they staring at a stack of paperwork or the back of a computer rather than a window or relaxing piece of artwork?
Through the use of half-height walls in a waiting room, patients can decrease unwanted stimuli by positioning themselves near the wall. This technique can also be used to increase patient privacy in a larger waiting space.
Patients will experience a sensation of independence by having the opportunity to personalize the treatment space through manipulation of operable blinds, windows, and thermostats.
Grace Dalman is a LEED®-accredited interior designer with Ratcliff and an associate member of the International Interior Design Association.
Lynn Drover is a LEED®-accredited member of the International Interior Design Association, certified in the State of California, and a senior associate with Ratcliff.
Terrie Kurrasch is a Fellow of the American College of Healthcare Executives and a member of the leadership team of the health care practice for Ratcliff, a planning, architecture, and interiors firm building on its more than 100-year legacy to design a sustainable future.
Doors in treatment spaces should not be hidden from the view of the patient. The feeling that they have the option to leave is empowering to most patients, whereas not having an exit in sight can make the patient feel trapped or claustrophobic.
It is widely held that natural light lessens depression symptoms and views of nature lower alpha wave rates. Ensure patients have the opportunity to look out a window onto nearby plant life. However, keep in mind that a view of people and cars can be distracting. In an urban area where these cityscape views are unavoidable, consider the use of higher windows in an office to allow natural light in the room while limiting the patient's view of the street.
The perception of safety can be just as important as safety elements themselves.
Patients are often most comfortable when they have the option to position themselves at the edges of a space, where they can see all of their surroundings.
Increasing numbers of the general public are becoming sensitive to volatile organic compounds (VOCs), off-gassing phthalates (from certain types of vinyl), and other triggers of asthma and multiple chemical sensitivities. Ensure your design team strives for low—or no—VOC finish materials, water-based carpet or wallcovering adhesives, and casework free of added formaldehyde.
Noise pollution affects patient stress levels. High ambient noise levels can make a space feel less private, making a patient less likely to share information they consider personal. Where possible, utilize sound-absorptive materials and consider the addition of “white” noise to induce calm and maintain audio privacy.
Design all patient space according to the principles of Universal Design, or at the very least, to be compliant with the Americans with Disabilities Act. With the return of disabled veterans from Iraq and Afghanistan, many cognitively impaired individuals will be adjusting to their newly-abled bodies and how to use them in public spaces. Ramps, wide doorways, and flexible furniture are just a few of the ways to accommodate this special patient population.
When these design opportunities and challenges have been met and incorporated into the therapeutic environment, the patient and analyst may experience a richer and more intimate treatment partnership.
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