We know that human behavior is influenced by our physical setting and environment. Environmental psychologists suggest that individuals react to places with either approach or avoidance expressed by a desire to stay, explore and build relationships or a desire not to (Bitner, 1992). Based on marketing research, Bitner (1992) recommends the first step of designing a space is to consider what desirable customer/client or employee behaviors the organization wants to elicit. Then, how does the physical space encourage those behaviors to achieve organizational goals?
Marketing research can inform how we approach designing optimal health care spaces from employee, clinician and patient perspectives. Environment influences outcomes, so it is especially important for the health care field to consider how spaces affect people (Pressly & Heesacker, 2001). In fact, proactive, evidence-based healthcare facility design is a burgeoning trend in health care (McCullough, 2010). It is recommended to consider the physical dimension, mental dimension (messages imparted by the physical environment) and emotional dimension (the way the environment feels and emotions that are evoked) when planning health care spaces (Pressly & Heesacker, 2001).
Spacing and Seating Arrangement
The configuration of chairs and other furniture in interpersonal interactions may have a significant influence on a person’s perception and behavior (Broekmann & Moller, 1973). Some studies suggest that an arrangement in which the space between the chairs is partially intersected by a desk may have the advantage of being open enough to encourage engagement, while offering a sense of protection when the counselee may experience uncertainty or anxiety (Broekmann & Moller, 1973; Haase & DiMattia, 1970). Another study found that desks between a counselor and client weren’t desired, so a counselor may want to check in with a client about seating (Pressly & Heesacker, 2001). An important takeaway from these studies is that having options for different configurations may be helpful for a variety of client presentations.
Studies on interpersonal distance in counseling indicate that clients prefer an intermediate distance between themselves and a counselor, ranging from 48 to 60 inches (Pressly & Heesacker, 2001). However, cultural considerations influence preferred distances and it can be helpful for a counselor to check in with a client about distance preferences and the client’s desired personal space.
Research on lighting is relatively conclusive regarding preferred lighting from a client perspective in a counseling setting. Studies have found that lighting affects impressions of a room, perceptions of the people in the room and the amount of self-disclosure (Miwa & Hanyu, 2006). Studies have also shown that natural light has a positive effect on stress and feelings of anxiety, so availability of natural light in a counseling setting may be helpful for reduction of negative symptoms (Dijkstra, Pieterse, & Pruyn, 2008; Pressly & Heesacker, 2001). Overall, dim or soft lighting is rated as more pleasant, relaxing, and calming than bright lighting.
Multiple studies have confirmed that soft lighting and natural lighting can support self-disclosure, create a more favorable impression of the counselor, and is perceived by clients and counselors as more desirable. Some studies have identified specific lighting preferences. Combinations of soft lighting, full-spectrum light and natural lighting has been shown to facilitate greater disclosure and positive impression of spaces (Pressly & Heesacker, 2001). Interestingly, research suggests using nonuniform lighting with diffused lighting closer to the client and brighter light farther away (Pressly & Heesacker, 2001). Based on the research on counseling spaces, lighting is one of the most important factors to consider when planning healthcare spaces.
Individual preferences contribute to inconsistency in research on response to color, with variations across age and gender (Dijkstra, Pieterse, & Pruyn, 2008). Studies on employee response to color can help to inform counseling room color choices. One study found depression, confusion and anger are associated with females working in low-saturated office colors (white, gray, and beige), while males experienced similar feelings in brighter office colors (Kwallek, Lewis, Lin-Hsiao, & Woodson, 1996). It may be helpful for health care organizations and professionals to consider marketing research on employee response to color when planning spaces.
Age is one factor that affects response to colors in our environment. Interestingly, children and young adults associate positive emotions with light colors and negative emotions with dark colors (Pressly & Heesacker, 2001). Blue is one favorite color of both genders for young and older adults, while green and red is preferred mostly by young adults (Pressly & Heesacker, 2001).
We also respond to colors physiologically. Colors like blue and violet decrease blood pressure, pulse and respiration, while warmer colors like red and orange increase heart rate and respiration (Ward, 1995). Overall, warm hues and high intensities promote visual activation and stimulation and cool hues and low intensities communicate subtlety and relaxation. White and other light colors can make small offices feel larger, while a larger space can feel more intimate by using darker colors (Pressly & Heesacker, 2001).
It is important for the counselor who occupies the space to feel comfortable, so neutral colors are also practical for counselors who share spaces. While keeping in mind that people do respond to color, counselors may choose to plan spaces that are appealing across demographics.
Healthcare organizations should consider privacy as a primary factor when planning spaces. Not surprisingly, rooms without privacy result in lower levels of self-disclosure (Pressly & Heesacker, 2001). One aspect to consider is if the walls are thin enough to hear people talking in a room with a closed door. White noise machines and additional soundproofing efforts may help to create more privacy.
Creating intimate and friendly spaces can facilitate desired therapeutic response. Plants, artwork and displaying credentials are important factors for counselors to consider when planning their space. Counselors may want to have indoor plants as there is some indication that plants promote positive impressions of counseling settings (Campbell, 1979; Pressly & Heesacker, 2001). From a study on inpatient preferences for hospital room artwork, findings indicate that patients consistently preferred texturally complex pictures of natural settings over poster images, pictures of people, urban scenes and abstract compositions (Carpman & Grant, 1984). Also, many counselors may consider whether or not to display their credentials. Studies have shown that displayed credentials positively influence perception of counselor competence (Pressly & Heesacker, 2001). Across the research, plants, artwork and other decorations have a significant impact on patient and counselee impressions of spaces, client disclosure and engagement in environment.
Physical accessibility should be considered for ethical and legal reasons. The Americans with Disability Act mandates that public spaces should be accessible to and negotiable by individuals with disabilities, and that spaces need to be large enough for a wheelchair to turn around (recommended 5 foot circumference). Health care professionals responsible for planning spaces may want to examine relevant local, state and federal policies to ensure appropriate accommodations.
Other Considerations: Smell, Sound, Texture and Temperature
Smell can be a powerful influence on how a person experiences his or her environment. Each person has individual preferences when it comes to smell — smells can trigger memories and even physical responses like headaches or nausea. Some people dislike smells of cologne and perfume, and certain food smells also may be undesirable. Aromatherapy is part of an integrated approach to therapy and involves using scents to evoke desired responses. It can be helpful to check in with clients about sensitivity to smells and use of scents in therapy spaces.
Sounds can be utilized in therapy settings to calm agitated clients and decrease stress. It may interesting to ask clients what sounds relax them or if they would like to listen to music during therapy.
Textures can also have an impact on perceptions of a room creating perception of spaces as soft and comfortable or hard and unwelcoming. Pressly and Heesacker (2001) recommend minimizing heavy textures in smaller spaces and using soft textured surfaces to absorb sound and increase a feeling of privacy. Also, flat or satin paint may be used to decrease glare and brightness, while high gloss or semi-gloss paint may be used to make a small room feel larger.
Room temperature also influences comfort and concentration of both counselors and clients. Health care organizations may want to consider an ideal range of comfortable temperatures for their facilities.
Research and Resources
Bitner, M. J. (1992). Servicescapes: The impact of physical surroundings on customers and employees. Journal of Marketing, 56, 57 – 71.
Broekmann, N. C., & Moller, A. T. (1973). Preferred seating position and distance in various situations. Journal of Counseling Psychology, 20(6), 504 - 508.
Campbell, D. E. (1979). Interior office design and visitor response. Journal of Applied Psychology, 64(6), 648 – 653.
Carpman, J.R., & Grant, M.A. (1984). Inpatient preferences for hospital room artwork [Research report #32]. Patient and Visitor Participation Project, Office of the Replacement Hospital Program, University of Michigan, Ann Arbor, MI.
Dijkstra, K., Pieterse, M. E., & Pruyn, A. Th. H. (2008). Individual differences in reactions towards color in simulated healthcare environments: The role of stimulus screening ability. Journal of Environmental Psychology, 28, 268 – 277.
Haase, R.F. & DiMattia, D.J. (1970). Proxemic behavior: Counselor, administrator, and client preference for seating arrangement in dyadic interaction. Journal of Counseling Psychology, 17, 319-325.
Kwallek, N., & Lewis, C.M. (1990). Effects of environmental color on males and females: A red or white or green office. Applied Ergonomics, 21, 275-278.
Kwallek, N., Lewis, C. M., Lin-Hsiao, J. W. D., & Woodson, H. (1996). Effects of nine monochromatic office interior colors on clerical tasks and worker moods. Color Research and Application, 21, 448 - 458.
McCullough, C. (2010). Evidence-based design. In C. McCullough (Ed.). Evidence-based design for healthcare facilities. Indianapolis, IN: Sigma Theta Tau International.
Miwa, Y., & Hanyu, K. (2006). The effects of interior design on communication and impressions of a counselor in a counseling room. Environment & Behavior, 38(4), 484-502. doi:10.1177/0013916505280084
Pressly, P. K., & Heesacker, M. (2001). The physical environment and counseling: A review of theory and research. Journal of Counseling and Development, 79(2), 148 – 160.
Ward, G. (1995). Colors and employee stress reduction. Supervision, 59, 3-5.
Center for Health Design: https://www.healthdesign.org/
Publication: A Visual Reference for Evidence-Based Design