Tell me, how does this therapist’s office make you feel?
And while we’re at it, how about this one?
These images come courtesy of photographer Saul Robbins, whose “Initial Intake” project tries to capture the feel of Manhattan-based therapist offices from the patient’s point of view. In addition to its artistic purpose, the series has served a scientific one. For a few years now, environmental design researchers Jack Nasar of Ohio State and Ann Sloan Devlin of Connecticut College have used the photos to evaluate the impressions various office interiors convey and to determine which characteristics are shared by the best (above, top) and the worst (above, bottom).
While the couch may no longer be the symbol of a psychotherapy session, except perhaps in New Yorker cartoons, room décor still plays a big role in a patient’s experience. Studies have found that people judge a therapist’s competence and expertise based on the formality of an office and the number of diplomas on a wall. Then again, personal touches can serve to humanize the therapist and perhaps invite disclosures by the patient. Establishing the best backdrop for a therapeutic bond takes stylistic balance–perhaps more than therapists possess.
“Training for therapists pays relatively little attention to the role of the physical environment on patients’ perceptions of the quality of care they expect to receive,” Nasar and Devlin tell Co.Design in a joint email response. “We think our research is a good starting point for the education of therapists about these issues.”
For their first study, published in 2011, Nasar and Devlin showed 30 of Robbins’s photos to several different groups of test participants. Some groups rated the quality of care they expected to receive based on the images. Others rated their perception of therapist qualification and friendliness. All 242 test participants rated the importance of 23 design attributes–from color and carpet to diplomas and plants–and offered thoughts on what office characteristics in particular stood out to them.
Nasar and Devlin found that two of the 23 design factors held significantly more importance to the perception of the office than the rest: neatness and chair comfort. Order, space, style, and color of the setting formed a second-tier cluster in the ratings. Personal items, paintings, and diplomas held middling importance. Family pictures came in last.
Individual factors aside, the researchers identified two overarching design themes that carried considerable impact on the perception of a therapeutic setting. One was softness and personalization: a blend of comfortable, inviting seats with personal mementos and embellishments, as opposed to hard furniture styles and a rigid impersonal formality. The other was overall orderliness: a general cleanliness, organizational scheme, and lack of clutter.
The more an office reflected these elements, the higher test participants rated their expected quality of care from the therapy session, and the higher they rated the qualifications of the (unknown) therapist. The photo at the top of this post–filled with warm colors, a soft chair, a clean side table, and just enough personal items to add some character–ranked highest on both counts. Participants also chose it most often when asked to select a therapist they’d like to see based on office appearance alone.
Nasar and Devlin concluded that a soft and personalized office might provide a safe setting while an orderly one communicates professionalism and structure. But striking that balance wasn’t easy. The office below, for instance, scored very high on the perceived friendliness of the therapist, no doubt based on its soft and homey décor. It failed to convey the neatness required of a professional therapy setting, however, and when asked to choose a therapist based on office appearance alone, test participants ranked this one near the bottom.
In a follow-up study, published in 2012, Nasar and Devlin showed the same 30 office photographs to 32 licensed psychotherapists. They found that, generally speaking, therapists were less sensitive to the importance of an orderly office than potential patients were. But they did give higher ratings to office settings that reflected softness and personalization; their top-rated picture, shown below, has many of the same qualities as the one rated highest in the prior study (which finished second this time around).
Softness and personalization, as well as order, even emerged as critical office design themes in a more recent follow-up conducted outside the United States. The new work–done in collaboration with Ebru Cubukcu of Dokuz Eylul University in Turkey, and published this month in the journal Environment and Behavior–gathered responses from test participants in Turkey and Vietnam. The six design attributes considered most important to potential American patients for the 2011 study (neatness, chair comfort, order, space, style, and color) were among the seven leading factors this time around.
Nasar and Devlin tell Co.Design it’s “too early” to call this a universal preference for therapist offices that reflect softness, personalization, and orderliness, but that the evidence does point to “broadly shared preferences.” It would be even more useful to know whether or not a therapist’s office design has any measurable impact on patient improvement. Nasar and Devlin write that “the character of the setting can make a place more appealing and may subtly affect outcomes” in their 2011 paper, but until that subtlety is quantified, motivating therapists to think more about office design might be difficult.