PSYCHOTHERAPY AND COUNSELLING

II. Therapy Preparations: Venue & Setting for Psychotherapy and Counselling

Thought and preparations must be taken before an actual psychotherapy / counselling. Among the many preparations, one important consideration is the venue and setting for the psychotherapy / counselling.

Can psychotherapy / counselling be conducted anywhere? Technically yes, but it would be of more optimum practice to select and establish a venue that takes into account the following criterias.

Criterias of Venue for Psychotherapy / Counselling

1. Criteria of Appropriateness

Imagine setting-up a counselling centre for prostitutes on the second floor, above an on-going brothel on the first floor with a shared staircase. A therapist might perceive himself/herself as some sort of “moral crusader” who wants to provide psychotherapy / counselling services in the heart of depravity. But is it appropriate?

Each time the therapist (if a man) goes to the second floor, he might be mistakenly perceived as soliciting the services of prostitutes or worse, a pimp. If the therapist is a woman, she might be mistaken for a prostitute. At other times, brothel clients might mistakenly call-in to the centre looking for their favourite prostitutes. Besides these, the criminal elements of the prostitution ring might consider the centre to be a threat to them. This would pose a danger to the centre and everyone in it. In order to avoid misconceptions, misunderstandings, dangers and to establish clear lines of organizational, professional and clean service identity, the criteria of appropriateness should be the first consideration.

2. Criteria of Warmth and Safety

The criteria of warmth and safety should be practiced for the sake of the clients, therapist, staff members (if any) and visitors.

Warmth for Clients

In practicing psychotherapy and counselling, the warmth, safety and welfare of the clients must take first priority. This includes the perceptions and feelings of being in a warm and safe place. What constitutes a warm and safe place? Warmness is not just providing a

fireplace for physical warmth in cold climates, but more towards the practice of friendliness, emotional support and personalized attentiveness.

Friendliness, emotional support and personalized attentiveness should include kindness, amiableness and genialness. Staff and therapist must engage a client with kindness in the form of empathy. To be empathetic, we must be prepared to look through the eyes and frame of mind of the client. We must able to feel and share both in the negative and positive feelings of the client. The difference is that we are not overwhelmed by the emotions as the clients. It is only when we have empathy, that we can truly share our compassion to the clients. All interactions with our clients should be amiable. They should be treated as a friend (an equal) in need and not as a sick patient with a disorder. It is in this respect I disagree with the use of the term patient. It creates a feeling that the client is psychologically sick and is seeking our assistance for a cure. We don’t psychologically cure anybody and persons with psychological needs not necessarily have to be sick unless they have a medical or mental disorder which would mean that they must be referred to a medical doctor or psychiatrist. We must be genial in the form of being hospitable with our clients. If our clients are our friends than (especially by Asian standards), hospitality should be the trademark of our centres. Being hospitable is treating our clients as equals and providing for their immediate and necessary needs.

Safety of Clients

Safety should be practiced for the sake of the client, therapist, staff and visitors. All endangering factors that could possibly happen must be thought through and contingency plans and procedures must be in place for immediate execution in the event of such happenings. Endangering factors can be for / from the client, staff, visitors or therapist. Even circumstantial factors like fire, aggression from third parties, suicide attempts or violence should be considered in advance and the necessary plans must be drawn-up. I would like to especially point out endangering factors arising from: 1) Human errors; 2) Systems Failures and 3) Psychological complexities. In terms of human errors, it normally occurs due to ignorance, incompetence or carelessness of staff or therapist.

Let’s assume a female client walks in and seems to be in fear and terror. One look at her shows that she has been physically abused. And she is screaming that her husband is chasing after her to kill her. What should be the immediate response of any staff or therapist on duty? The most obvious but in practice the least thought of, is the physical security management (systems) of the centre. The staff and therapist must ensure that no third party can gain entrance into the premises without monitoring, verification and authorisation. This may necessitate the installation of safety grills, CCTV(s), key card access control and the utilization of common sense. To alleviate the fear of the client, the staff or therapist must assure the client that her husband can’t physically come in to abuse her. That she is safe. Failure to think through such trivial but important matters can lead to human errors and system’s failure. Here, I would like to point out that certain NGO(s) have the

tendency to commit human errors by majoring on the minors and minoring on the majors. They may spend money for the purpose of fund raising while neglecting expenditures on practical security management (systems) of their centres. Endangering factors can also arise out of psychological complexities. Let’s take the same case but in a different scenario. Let’s assume that unknown to the staff and therapist, the female client is suffering from Paranoid Personality Disorder. And her primary pervasive distrust and suspicion is her husband. There is no physical evidence of abuse although she claims her husband is seeking to kill her. She seems to be objective, rational and unemotional in her narratives. What should the staff or therapist on duty do? For the purpose of precaution and assurance of physical safety, the client should be made aware of the security management (systems) of the centre. But due to the psychological complexity of the client in which her narrative has no immediate evidence of abuse, no reference should be made to the husband or any authorities. This is what I mean by psychological complexity. If any action is taken on her husband based on her complaint without psychological verification, it would lead to legal problems and possible liabilities to the centre. Next, we should consider the criteria of comfortableness and pleasantness.

2. Criteria of Comfortableness and Pleasantness

In Freud’s practice of Psychoanalytical Psychotherapy, he used to make the client lie down on a couch, with him sitting in a chair behind the head of the client. Why? In the practice of Free Associations technique, this was the most comfortable and pleasant position and posture for the client to relax under therapy. Besides relaxation, the position and posture was a non-threatening way to engage the client. Psychotherapy / Counselling venues and settings have to consider the criteria of comfortableness and pleasantness. This can be done by paying attention to:

Quiet, Private but Externally Visible Space

The physical space or room used for psychotherapy should be quiet, private but externally visible. It should be reasonably sound-proofed to avoid distractions from surrounding noises as well as the accidental leaking-out of conversations. It must avoid the interferences and distractions of persons or activities. But above all, the client and therapist / counsellor must be visible from the outside for the purpose of process transparency and security. Process transparency and security are contingencies against attempts / allegations of physical or sexual molestations or abuse.

Comfortable and functional furniture

A non-expensive and simple sofa with back support and armrest are recommended. The positioning of the client’s sofa should be at an angle from that of the therapist / counsellor’s sofa to avoid direct eye-contact as to be psychologically non-threatening. The

client’s back should be to the back of the entrance of the room with the therapist / counsellor’s facing it at an angle. A small side table with enough space to hold a plastic bottle of water and tissue box should be placed beside the sofa and within reach of the client.

Physical Lighting

Any form of lighting that produce a heavy glare or shadows should be avoided. The positioning of the lighting must be such that it does not glare into the eyes of the client or the therapist / counsellor. The degree of lighting itself should be bright enough for taking notes but non-glaring and pleasant.

Time Piece

A time-piece (clock) must be located above and behind the head of the client but visible to the therapist / counsellor. However, the clock must not emit any notification sounds that may be distracting.

Room Colour Scheme

Special attention should be paid to the colour schemes of the room. Whatever colours that are used in the room must be one that creates a feeling of calmness, relaxation and ambience. All stressful and aggressive colours are to be avoided.

Greenery and Flowers

Potted plants, greenery and flowers may be arranged parsimoniously in an un-distracting manner to complement the colour scheme.

Avoidance of Pictures and Mementos

No personal or organizational pictures or mementos should be placed in the psychotherapy / counselling room that might portray any form of status symbol, disparity, lack or psychological inequality to a client.

Cleanliness

The room or space should be physically clean and free of any form of stench including food and beverage smells. Avoid using artificial fragrance as some clients can be allergic to such chemical odour.

Final Suggestions

Permission must be sought from the client before the installation of any audio-taping or video-taping of a session. For the purpose of security for the therapist / counsellor, an inconspicuous buzzer should be installed within the reach of the therapist / counsellor to signal for assistance from colleagues in cases of physical or psychological outbursts that

cannot be controlled and needs additional assistance. These foregoing suggestions on Venue & Setting for Psychotherapy and Counselling would go a long way in creating a warm, safe and comfortable environment for psychotherapy / counselling.