Article 1:

Whats in a therapy room?A mixed-methods study exploring clients and therapists views and experiences of the physical environment of the therapy room

Aim and objectives: To explore the importance of the physical space of therapy rooms (used for counselling/psychotherapy) to clients and therapists. To identify which aspects of therapy rooms are most important to clients and therapists and how these aspects contribute to an environment that is conducive or hindering to the therapy process. Method: This was a mixed-methods study, using a concurrent triangulation de- sign. Data were gathered using an online survey and semi-structured interviews. Quantitative and qualitative data were analysed using statistical analysis and thematic analysis, respectively. Participants were twenty-four clients who had experienced counselling or psychotherapy and twenty-one qualified therapists (psychologists, counsellors and psychotherapists). Findings: From the survey data, comfortable seating and room temperature, sound- proofing, no interruptions and accessibility of the room were identified as most important to clients and therapists. Participants reported that feeling physically comfortable and safe in a room enabled a greater engagement with the therapeu- tic process. Rooms with a clinical appearance were described as unhelpful. From the interview data, themes identified were as follows: comfort, the appearance and meaning of the room and the room as a workspace. Conclusions: The physical environment of the therapy room can play an important role in clients feeling comfortable and able to engage. It is important to consider the appropriateness of rooms for particular client groups/issues and consult with clients and therapists about therapy rooms. Further research is needed into the interaction between clients presenting issues and the room and the effect of cultural differ- ences upon the experience of therapy rooms.

INTRODUCTION AND RATIONALE

Counselling and psychotherapy in the UK that is not done online usually takes place in a room chosen or designated by the counsel- lor/therapist or service provider. There has been a lack of research into what impact (if any) the physical environment of a therapy room has on the client, therapist, process and outcome of the therapy. Pressly and Heesacker (2001) argue that therapists and therapy pro- viders often make fundamental attribution errors regarding clients and neglect the situational context of the therapy room, overlooking the less obvious influence of different elements of the environment.

There are important questions regarding whether the therapeu- tic space can influence client motivation, trust in the working alli- ance, the therapist's ability to work and client outcomes (Pearson & Wilson, 2012). For the purposes of this paper, the terms talking therapies or therapy will be used to encompass all forms of coun- selling and psychotherapy; the term therapist to describe the coun- sellor, psychotherapist, psychologist or practitioner delivering the therapy; and the term therapy room to denote the room where therapy takes place.

Increasingly, within services such as increasing access to psy- chological therapies (IAPT), a variety of different rooms are used for talking therapies, including GP surgeries and rooms in the commu- nity. Clients are often not given the opportunity to give feedback about the rooms they use (McLeod & Machin, 1998). There are also questions regarding which data gathering methods are appropriate. McKellar (2015), in assessing the state of research into psychiatric wards, argues that when measures have been used to gather data on service user perspectives regarding the environment, quantita- tive methods have usually been used, which do not accommodate a wider narrative.Given the lack of research, how then can therapists and service providers determine which aspects of the physical environment of the therapy room are significant factors and ensure that rooms they use are conducive to therapeutic conversations? increasing their prestige in the mind of the client and the expecta- tion of the help that may be received. Secondly, it provides a safe place where clients can feel safe and secure for the duration of the session. Feeling safe encompasses both a subjective emotional re- sponse to an environment, and more tangible aspects, such as not being overheard or at risk of physical harm.

The therapy room can also be seen as part of the frame of ther- apy (Gray, 2013), the important containing framework, within which therapy is conducted. Waldburg (2012) further suggested that the therapy room acts as a symbolic container for the client's story.

Backhaus (2008), in a large mixed-methods study of 226 clients and therapists in the United States, found that the physical environ- ment of therapy rooms can give rise to feelings of safety, comfort and relaxation and that client retention was significantly associated with a welcoming environment (as perceived by clients).

Pressly and Heesacker (2001), in their review of the literature regarding the physical space of therapy rooms, outlined the need for an environment that is facilitative of therapy processes such as developing rapport, self-disclosure and exploration. They also focus their overview of the literature on specific physical elements that either detract from or enhance the therapy process.

Very little has been written about the overall function, meaning and experience of the therapy room from the client's point of view.

Q.1. Identify the paradigm/tradition for the above article. You will need to motivate the choice of paradigm using examples from the articles as well as a critical discussion of the paradigms chosen.

Q.2 Identify the following elements of the research design for the above article. You will need to motivate using examples from the article, as well as theory from various sources.

Q.1.2.1 Research methodology.

Q.1.2.2 Type of research.