Rubber Bands and Chewing Gum

The other day I was chatting with a friend who has recently qualified as a therapist about therapy rooms. She’s about to embark on creating her own space and asked me- as a seasoned therapy goer- what I thought makes a good therapy room and wondered if I might write something that she could share with other therapists starting out.

Having sat (and dissociated!) in many different spaces over the years, I have some pretty strong opinions on what have and haven’t been the kind of environments that have felt conducive to good therapy. Here are some of the ideas I have had over the years with my other wonderfully mental friends about what we’d like to see in ‘the room’ – other than our lovely (or not so lovely) therapists of course!

I’ve seen way too many therapists (!) to talk about every room I’ve been in – although I do remember each of them clearly! (fucking Brian brain never forgets shit!) and will talk about some of the best and worst bits from some of the more recent ones here.

Something that might seem a bit weird, is that a big part of what I recall about the rooms isn’t actually visual at all. I’ve come to realise that I am quite a sensory person…and some of the things that can really bother me/make a difference are smells, sounds, and textures…! Like these things are a really big deal in addition to what I can see and how the room is laid out.

Oh but of course it would be this way, wouldn’t it?! I am, after all, the client who has her therapists spray her transitional object with their perfume or wash my stuffed elephant so it smells safe and familiar, and likes everything to be snuggly soft to touch and the lighting to be ‘just right’ and… and… and… (I could be an extra in Goldilocks And The Three Bears!).

It’s no wonder that I’m going to notice every fucking detail then is it?! Honestly, I don’t think many people or therapists have any idea about the sensory overload we can be dealing with just from being in the space, and that’s before we even get working with the human sat in front of us and all the interpersonal shit that brings up…it’s a wonder we ever get to talking about what our issues are – or maybe not – I certainly take my fucking time. Elle and I have been working together a year now and I think it’s safe to say I’ve been going at a snail’s pace after the fuck tonnes of preceding shit with therapists.

Right, let’s do this! I literally have no idea how to approach this -space by space or issue by issue…? We might bounce around a bit…just like my mind…so sorry!

I remember vividly the smell of the therapy room when I originally started working with Em in the NHS – it was that kind of hospital smell mixed with a sort of ageing decay and staleness of a space that desperately needed gutting and redecorating. The Psychotherapy Department was in a gorgeous old, stone building but one of the downsides of it was that the tiny rooms were set north facing. The windows were almost like arrow slits and didn’t open and so it was always cold, dark and kind of damp feeling.

I think over the years the brown, utilitarian, super hard-wearing carpet (that had the texture of a brillo pad) had soaked up years of grime and had that sort a pervasive musty smell. The smell became familiar but never comforting but it was not entirely offensive either.

The rest of the room was no better. Because there was no natural light, or air, we always had to have the light on – and of course being the NHS it was one of those fluorescent overhead office lights (no floor standing lamp with a soft glow here!). To add insult to sensory injury, the room was painted a lurid yellow colour – it almost looked like gloss on top of the woodchip – and was just totally jarring and seemed to not only reflect the harsh light from above but magnify it. The walls were bare and the whole room just felt sterile and devoid of life.

Like many therapy rooms I have been in, the seating was just two pretty uncomfortable chairs facing each other about two metres apart. I am lucky that I am reasonably average build but for anyone plus sized the seating would have caused real issues as the seat was narrow but had moulded high arms.

I know this two chairs facing each other is not unusual but, honestly, I find that set up really triggering for lots of reasons. I struggle to settle and feel comfortable in a therapy room and so being stuck in a narrow rigid seat is hard. I like to take my shoes off and tuck my feet up under me. And… as you all know by now, there are times when I absolutely need my therapist to sit beside me, hug me, hold my hand etc and single chairs just don’t allow for this at all.

I can’t tell you how many times I have drifted away into a painful dissociative state because I have not felt in close enough physical proximity to my therapist. Having said that, if you are a therapist who has no intention of ever getting physically close or offering that kind of reassurance to your client then stick with that set up because fuckkkk it’s painful to be on a sofa and have the therapist tell you that they’ll never sit beside you when you build up the courage to ask them to.

This is what happened to me when, a few years after finishing in the NHS, I made the catastrophic choice to go back and see Em in her private practice in her house.  Initially, she had the two-chair set up – you know the trusty Ikea ones that almost everyone has? Those chairs were more comfortable than the NHS ones but still felt distancing and I felt like I couldn’t move.

Em also had the matching footstool and would place it between us – so it felt like another barrier to being near her and like she was trying to barricade herself in. (I have lots of issues with positioning of furniture – even now with Elle!). Sometimes the feeing of disconnect and distance would make it feel like I was staring at an empty chair – like the little girl in Oliver Jeffers’ book ‘The Heart And The Bottle’ and that was really hard too.

About 18 months into the second round of therapy with Em, she changed up the room. It was better – previously she had really grim dark red curtains that weren’t quite long enough for the window, some pretty shit net curtains again that didn’t quite reach the window sill by about three inches, and odd green walls but it was ok enough. The window was behind me, so I never really had to look at the curtains or see anyone passing by in the street. Although if anyone ever came to the door to deliver something to the house I’d jump out my skin because the front door was essentially next to the window…and I couldn’t see.

The room itself was filled with lovely, reclaimed bookshelves and so I had plenty to let my eyes wander over when eye contact or even looking in Em’s general direction felt too much which was better than the sterility of the god awful NHS room.

Em’s revamped room was nicer, the shelving and books stayed and there were now neutral walls and curtains, and a much more comfortable cornflower blue leather sofa. It wasn’t very cosy, though – especially in winter! I think one of the things I would say is that Em’s room mirrored her personality type – cold and austere! A couple of cushions to hug to my body when things felt shit, or a blanket folded over the back of the sofa like Elle has, would have made it feel like there was some comfort to be had – especially as she was so anti offering anything of herself.

Another thing that was there throughout my therapy was a sick-looking spiky houseplant that was in good need of a repot and feed. Bearing in mind I saw Em for three years that poor plant never got any care and looked like it was at death’s door the whole time. Now, sure, it’s only a plant, but I think as a therapist if you are going to put plants in the room make sure they look healthy. If you can’t look after a plant, how will you care for your clients?!

The room was the room, though – and it was a marked improvement from anything I had been in before in college, university, at a local charity, and the NHS. But as I said, sensory stuff is an issue – and it was very much the case at Em’s house. Sometimes I would arrive and the lingering smell of the previous night’s cooking had made it into the therapy room – her kitchen was next to the therapy room and I think she must have been a fan of Thai Red Curry and Fish! Occasionally, the smell would be really strong and totally off-putting the moment I walked in the front door.

That’s not to say I am advocating for air-fresheners, plug-ins, or sprays or whatever else in the therapy room. I think people have quite strong preferences and reactions to smells and I’d be really cautious of trying to have any noticeable smell at all tbh. I think airing the place out is a good move, though, and the room should feel and smell clean just not strongly of anything in particular.

OMG! An aside… I remember one time (fuck me I am so fucking picky) but there was a crumpled up, used tissue under the book shelf beside Em and it was there for four weeks…

Anyway…

Back to the story!…

One of my friend’s therapists has scented candles that she asks the clients to smell when they meet and if there are any that they like they light that one for them in the future sessions and I think this is a really nice idea – as it gives the client the choice…to have something or nothing.

Another thing that would be a bit distracting/off-putting was external noise at Em’s. She seemed to like to put a load of washing on first thing on a Monday and Friday morning – I guess cashing in on her private practice wfh days – and the machine would always reach its spin cycle in my session. As I said, the kitchen was next to the therapy room and sound really travelled around the house, so it was very noticeable and not ideal. There was that, but what was worse was her husband wandering around in the hallway outside sometimes and often I could hear him chatting on the phone.

I’d like to say that other people coming and going is an unusual event in therapy but in my experience it isn’t. This has been way less of an issue with Elle because I see her in an office away from her home and so any footsteps are only from people who work in the building, but with Em and Anita I had too many uncomfortable experiences with family members.

You might remember me mentioning that when Anita’s adult daughter moved back in, she worked from home in her bedroom that was just down the hall from Anita’s therapy room. I could often hear her wandering around to go to the bathroom next to the therapy room or when she was on work calls… not good! If I could hear her, then there can be no doubt she must be able to hear me. The have been times I haven’t used my session time as I’ve wanted to knowing that I might be overheard – and that just should not happen.

It’s not just what’s going on in the house. It’s what happens when we arrive and leave, too. Do you remember the month where I met Anita’s daughter twice on the doorstep?…the second time we had a conversation whilst waiting for Anita!!… FUCK ME THAT WAS BAD!! Or the time I ran into Em’s husband as he mis-timed coming back from his bike ride?? Yeah, that was crap, too, and really unsettling especially at the end of the session which had been really difficult.

I think therapists who work from home need to be really careful about protecting their clients’ privacy and anonymity and need to have clear boundaries with the people that they live with to ensure that when they are working the family understand the importance of client confidentiality and expectations of therapy.

I feel like I am really moaning now and being critical – but this is my real experience and I’ve spent fucking thousands on therapy over the years so it’s probably worth saying!

Do I need to talk about barking dogs? Or can we just agree that this shouldn’t be a thing…particularly not three of them for half an hour at time!

Umm…what did I like about Anita’s room then if not the outside world? Lots. The room was light and airy.  She had a sofa and a chair in the room – which meant that she could always sit beside me if I wanted that. The room had stuff in it but I guess what you might call therapy stuff: rocks, crystals, shells, books…things that would/could be used as transitional objects. There was a nice picture on the wall, too. The space was clean and uncluttered but felt warm and welcoming.

She had a small fish tank in the room too and I used to like watching the fish. Although, sometimes if I was silent and/or dissociating I would become VERY aware of the sound of the filter running! But that’s probably just me. Essentially, the room had Anita’s personality in it but wasn’t personal – no family pictures or stuff like that (thank god!). It was the opposite of sterile, though. There were tissues in easy reach – although I never used them, as I would only ever cry when she was cuddling me and so she would end up with a damp top instead – lol!

If I ever went for an evening session the room was lit with a couple of salt lamps and a soft side light…at my request. I once turned up and she had the ‘big’ ceiling light on and it just felt way too bright and so instead we put on all the low lights and it felt way gentler. I think basically I am always needing to be in a space that goes softly on my nervous system.

Downsides to Anita’s room were that it was pretty small and so there was not much space to be anywhere but the couch. I quite like sitting on the floor sometimes. I like to draw, or write, or do activities with objects (like when Elle and I did the buttons) or maybe do breathing/grounding exercises and it would have been really too cramped for that and so it could feel a bit rigid being on a chair all the time.

Obviously, she couldn’t make the room larger and honestly for such a long time that room was such a sanctuary and holding space that other than making it a few feet bigger, there’s not a great deal I would have changed.

I was thinking recently again about rooms before my friend asked about it and I think a really good way of approaching therapy room set ups is to imagine you have a neurodiverse child that you’re tailoring the space to because actually most people would benefit from some or all of the provisions. Lots of therapists only work with adults and so gear their room up as an adult space and I think this is a massive error.

I like that Elle’s room has fidget toys and some games on the shelves even if I choose not to use them. I think having things like paper and colouring pens visible in the room is a nice idea, too (Hannah had that – I’ll give her one positive as the rest was utter shit!) as it lets the client know there is potential for all sorts of work to be done in the room.

All my recent therapists have had Russian dolls in their therapy rooms- it must be a thing! Ha – if only more of them actually entered into doing active parts work, eh?! I think having little figures or maybe a variety of toys would be a great idea for this.

A while back there was a teddy bear sitting in Elle’s therapy room one session, but I don’t know where he is now. I think one of the things I would really like to see in therapy rooms are a few soft toys. I think signalling to the client that their inner child is welcome is hugely important as so many people new to therapy have no idea what therapy can be…and soooooo many people have work to do with attachment and yet believe that it’s only ever their adult that is welcome in the room!

How nice would it be to see a friendly bear in the corner or sitting on a chair? Especially if you need a hug…and especially if the therapist is not necessarily a hugger. I can imagine how holding it would feel to be feeling vulnerable and small and a therapist asking if you’d like a bear to hold. Like what an invitation to that small part to remain in the room rather than flee. So many of us try desperately to push that part away – especially when we’re new to therapy – as we often associate those feelings as being shameful and unwelcome.

I think seeing a soft toy in the room would also let the client know that they could bring their own soft toys to session too (if that’s what they want – obviously some people would totally not want this at all!). I can’t tell you how many years I went to therapy with Elephant in my bag when I saw Em and not once did I feel brave enough to get her out … and there were times when I seriously could have done with being able to self-soothe with her soft ears as Em would never reassure me or try and get me back out of a dissociative state and would instead leave me in agony.

It would be lovely if sometimes therapists would say, “If you wanted you could bring a blanket or a teddy in – I’ve got these here and you’re very welcome to use them, but I also know sometimes we have our own special items and they are most welcome here.” Because even now – as an almost pro client I sometimes find it difficult to open the bag. Elle has not met Elephant yet – and there’s huge work around this plushie.

I mean I am edging closer – and am actually amazed that I asked Elle for Monty (transitional object) and then last week after a month brought him back and asked her to spray him with her perfume. All these things are possible, but it’s taken me YEARS to get here, and I think therapists could really help with this.

It’s not only about toys, though, is it? Ok, I’ll put my inner child to one side for a minute!

I like Elle’s room – it’s a nice size and feels containing and private. I like that her room has nods to what kind of person she is. She has a little pride flag in her pot plant (which is very much alive) and I think that this visual cue let me know immediately that I was safe with her. I know therapy school would probably say “don’t give away anything about your political beliefs or views on contentious issues” but finding out Em was a tory Brexiteer late on in our work was hideous. I would NEVER have worked with her had I have known our feelings on particular issues were so far apart and knowing Elle is an ally is really important to me.

But that’s a whole other story.

What don’t I like about Elle’s room?! I have mentioned it a few times now, but I fucking hate the coffee table that sits between us. Like I want to literally throw it to the side of the room…unless of course we are using it to do something with buttons or whatever! It’s something to do with feeling like there’s a deliberate physical barrier between us – can anyone see a recurring theme here?! I think also it stops me sitting on the floor.

I think the longer I have been in therapy the more I want to not be always stuck in a chair. Over the years, friends and I have said how nice it would be to have an area of the room that is deliberately floor based – whether that be floor cushions or beanbags – just a different kind of a space. I guess sometimes I would like to almost be in a nest! But just sitting comfortably cross-legged on a cushion would be nice, too. I think the more options there are the better as you never really know what you’re going to want or need when you go to your session.

If there was space in the room, I think it would be totally awesome to have a blackout tent with cushions and blankets and little fairy lights inside – again – think neurodiverse child need. Lol!

Elle has two clocks that seem to tick at alternate times – sometimes I can tune them out and other times they are all I can hear. I imagine most people wouldn’t even notice these things, but I have always been hypersensitive and hypervigilant and so literally EVERYTHING that goes on inside and outside the room registers with me…and it’s frankly exhausting!

There’s loads more I could say but I think I am more of less done here for today – 3500 words – yikes!

So, I’m going to undo everything I have just said in a paragraph!

Of course, the room is really important in creating an environment that feels containing and safe enough for us to open up in but, you know what? I would happily sit outside on the cold concrete in the pouring rain so long as I could sit beside Elle and be with her and talk to her. Because, you could have the absolute most perfect therapeutic space to work in but if your therapist isn’t a good fit and the relationship isn’t there – it’s a complete waste of time!

True stuff.

I’d love it if you could comment with some of your own ‘hits’ and ‘misses’ for therapy rooms as I’m sure this would help my friend a lot. There’s so many things – like drinks? Elle has water out if you want it. Some therapists do cups of tea. Some think you shouldn’t do any of this. What a frigging ridiculous minefield!