Chapter 3: Settings for Therapy
Therapy can take place in just about any reasonably soundproof room with enough space for a few chairs, but it’s remarkable how much difference the environment can make.
If your surroundings make you feel uneasy or unsafe, you’re probably going to remain closed off. On the other hand, if you’re comfortable with the space, it makes it much easier to open up to your therapist.
Different settings work for different people, so this is your opportunity to get a feel for things before you walk through the door for the first time.
Private Practice Offices
These are the kinds of offices you usually see on television or in the movies. Most real private offices are quite a bit smaller than those Hollywood sets, however. Large wood-paneled rooms covered with tasteful artwork and long rows of bookcases are very impressive, but the cost of renting such luxurious space is usually passed on to the client in the form of higher session fees.
If you find yourself in more modest surroundings, keep in mind that while leather furniture and antiques are pleasant, they don’t actually make therapy more effective.
Large group practices have a reception area and waiting room, very similar to what you’d see at a dental or medical practice. If you’re sensitive about privacy and confidentiality, you need to be aware that there will probably be other clients in the waiting area with you.
Smaller practices usually have a small, private waiting room and many single-person practices have no waiting room at all. On request, your therapist can probably schedule buffer time between sessions for added privacy.
The decor of a private office reflects the therapeutic approach and personality of the therapist. Styles range from very formal, with straight-backed chairs and academic credentials on the walls, to very homelike, with overstuffed recliners and craft decorations.
In most private offices, you’ll have access to a private bathroom. In some buildings, however, you may have to share a bathroom with other tenants.
While most hospitals have outpatient clinics, the type of space can vary from place to place. Some clinics are located in the hospital interior, and are treated just like any other department. Other clinics have separate parking lots and entrances and feel more like self-contained agencies or group practices.
Hospital-based clinics usually have easier access to medical resources than other settings. Communication between psychiatrists and non-medical therapists tend to be better in this setting, for example. In addition, if you’re taking medication, you may appreciate the convenience of getting your medication checkups and therapy in the same location.
You need to be aware of any strong feelings you have about hospitals. If you look at hospitals as clean, safe places staffed by caring experts, then the hospital setting has obvious advantages for you. On the other hand, if you experience high levels of anxiety just walking through the door, you need to consider how that might get in the way of your treatment. (Of course, if getting past your anxiety is your goal, this setting would be ideal.)
Hospitals have reception and waiting areas, so you will probably come in contact with other clients. Private bathrooms are usually available.
If you decide to seek therapy at a hospital-based clinic, be sure to arrive early for your first appointment. You may need some extra time to find parking and locate the clinic within the hospital.
Some agencies and counseling centers—especially those associated with hospitals or medical systems—are clean, bright, and modern. Others, unfortunately, have a shabby and outdated appearance.
Keep in mind that a center’s physical appearance reflects its level of funding; it is not an accurate guide to the quality of the services it offers. Good therapists practice in bad offices, and vice versa.
Almost all agencies and counseling centers have reception areas and waiting rooms. These common areas can get busy and crowded at times due to the steady stream of clients, caseworkers, insurance representatives, and government officials coming in and out of the building to attend meetings and consultations.
Though it can be off-putting at first, this busy environment does offer some advantages. Community counseling centers usually understand local issues better than other providers, and their connections in the government and non-profit communities means that they can get you access to people and services you wouldn’t have known about otherwise.
Another advantage of this setting is that most agencies and community counseling centers are located in buildings designed specifically to deliver services, with thick, soundproof walls and large rooms available for group meetings. Bathroom facilities will be shared with clients from other offices.
College and university-based counseling services are usually available to all enrolled students, not just those who live on campus. Larger universities will have waiting rooms and be somewhat similar to the agency setting described above. Smaller colleges may have just one office, similar in most ways to a private practice setting.
Counseling services for school-aged children vary by locality, but therapy will be delivered in a private room in the school building itself, or in a private office in the community.
Counseling is offered in churches, community centers, senior centers, or just about anywhere else in which private space can be set aside. Buildings with ample parking and large meeting spaces are particularly popular choices for group therapy sessions.
Waiting rooms and reception areas are rare, but because these spaces serve multiple purposes, you’re very likely to encounter other people from the community.
Some family therapists will work with you in your residence. If having a stranger in your home causes you anxiety, remember that your therapist is a professional providing a service, not a guest to be entertained.
At the top of an index card or a small piece of paper, write Settings. Below that, make a note of the two settings you’d most prefer.
- Private Practice Office
- Hospital Clinic
- Agency/Counseling Center
- School-Based Program
- Community/Religious Space