The effects of the physical environment on a counselor's well-being and ability to provide optimal care
iv Table of Contents List of Tables vi List of Figures vii CHAPTER 1: INTRODUCTION AND STATEMENT OF THE PROBLEM 1 Background of the Problem 1 Statement of the Problem 3 Purpose of the Study 4 Research Questions 5 Nature of the Study 5 Definition of Terms 6 Assumptions and Limitations 7 Conclusions 9 CHAPTER 2: LITERATURE REVIEW 10 Theoretical Framework 10 Review of Literature 16 Evaluation of Viable Research Designs 24 Conclusion 26 CHAPTER 3: METHODOLOGY 27 Introduction 27 Research Design Model 28 Research Design Strategy 29 Sampling Design 30 Measures 30
v Data Collection 31 Data Analysis Procedures 32 Limitations 34 Ethical Issues 34 Conclusion 35 CHAPTER 4: RESULTS 37 Results 37 Data Analysis 59 CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS 61 Revisiting the Problem 61 Findings 63 Limitations 67 Counselor Implications 69 Recommendations: Directions for Future Research 72 REFERENCES 75 APPENDIX A . INTERVIEW QUESTIONS 81
vi List of Tables
Table 1. Scoring of the Maslach Burnout Inventory (EE: Emotional Exhaustion, DP: Depersonalization, PA: Pe rsonal Accomplishment) 39 Table 2. Individual participant resu lts on the Maslach Burnout Inventory 40
vii List of Figures Figure 1. Maslow’s Hierarchy of Needs, the original five-stage model. Shelter was defined as a basic bi ological and physiological need (modified from Maslow, 1943) 11 Figure 2. P1’s couch and chair used in counseling sessions 41 Figure 3. P1’s bookcase. Personal a nd professional books are stacked on the leftmost shelves while the remainder of the bookshelf is reserved for gifts from clients 41 Figure 4. P1’s desk area 42 Figure 5. P2’s office setting with a vi ew of the window and a plant in the corner 45 Figure 6. Computers used in P3’s couns eling office for biofeedback studies 48 Figure 7. Personal accessories in P3’s counseling office offer many conversation pieces with the hope of making clients feel more comfortable 49 Figure 8. Lighting in P3’s office setting 49 Figure 9. An example of P4’s counse ling environment during her equine therapy sessions 51
Figure 10. P5’s counseling office. P5 is still in the process of setting up his office after a recent move 55 Figure 11. P5’s personal accessories line the walls 56
1 CHAPTER 1. INTRODUCTION Humans are typically aware, responsive, and sensitive to their environment for survival (LaTorre, 2006). Researchers in a wide variety of disciplines including architecture, interior design, sociology, and environmental psychology have sensed that the places we inhabit can affect our t houghts, feelings, and be haviors (Bechtel & Churchman, 2002; Goelitz & Kahn, 2008). These researchers recognized the role of the environment’s ability to influence the mind and its potential as a healing tool. For years, traditional healthcare facility designs empha sized function, efficiency, and cost as primary determinants. As a consequence of th is perspective, there was often a disregard for the psychological and social needs of the professional as well as the client (Ulrich, 1991; 2006). Some mental health professionals speculate th at the physical setting and environment in which treatment occurs have an impact on both the treatment process and its outcome (Corey, Wallace, Harris, & Casey, 1984). Background of the Problem The relationships between the Chinese pr actice of Feng Shui, Maslow’s hierarchy of universal needs (Maslow, 1943) and R oger Ulrich’s theory of supportive design (Ulrich et al., 2008) may be important for the future of counseling. As early as 3,000 years ago, the Chinese practiced Feng Shui, an energy discip line that aims to create a harmonious environment in which an indivi dual’s energy was enhanced and supported through the environment. Feng Shui was based on the premise that people were affected by their surroundings. By adjusting, manipul ating, and balancing the environment, energy can flow more freely in the sett ing creating balance and harmony for the
2 inhabitant. The Chinese culture used Feng Shui within personal homes as well as to enhance public spaces such as treatment settings (Rossbach &Yun Lin, 1991). In other areas of the world, researchers from multi-disciplinary fields began to emphasize the role of the environment as a healing tool (Bechtel & Churchman, 2002). Formal investigations into how humans interact with their physical environment began in the 1940’s when Maslow began looking at universal human needs. The hierarchy of human needs developed by Maslow (1943) suggests shelter as one basic and universal human need, along with food and water. Maslow and Mintz (1956) took the theory of universal needs one step further by suggesting that the aesthetic condition of a room (beautiful, average, ugly) affected participants’ ratings on photographs of human faces. Participants in the pretty room were found to rate the photographs of faces as having more energy and well-being than those in the average or ugly room. This classic study suggested that the environment itself may influence behaviors and outcomes (Joye, 2007; Maslow & Mintz, 1956). During the 1980’s, healthcare organizations and health professionals revisited the effects of the physical environment on the therapeutic process. During this time, the holistic health movement gained momentum, promoting the notion of the therapeutic environment (Thomas, 2002). Today, architects as well as environmental psychologists are touting evidence that the physical design setting can improve health and well-being (MacStravic, 2005; Ulrich et al., 2008) as evidenced by Ulrich’s theory of supportive design. Supportive design states that environmental characteristics influence health outcomes.
3 Clinicians and scholars are beginning to describe theoretical and conceptual frameworks linking the environment with health and healing. They are unearthing clues about how to design spaces that promote st ress reduction, relaxation, and social intimacy (Kaplan & Kaplan, 2009). With this link, a deeper understanding of how the environment affects attitudes and behavior may emerge (Bechtel & Churchman, 2002). Only a few studies focused on the potential e ffects of the counseling setting on counselor efficacy (Anthony, 1998; Chaikin, Derlega, & Miller, 1976; Mintz, 1956; Miwa, 2006), and there continues to be a paucity of literature on the physical environment of counseling offices and the influence of the setting on counselor well-being and efficacy. Statement of the Problem The present research study attempted to discover, understand, and reveal the nature of characterist ics of the physical counseling envir onment that affect a counselor’s well-being and ability to provi de optimal care. Over forty years ago, Strong (1968) characterized counseling as an interpersonal influence proc ess. He suggested that counselors who enhance their perceived e xpertness, attractiveness, and worthiness increase a client’s involvement in the c ounseling process. Strong and Matross (1973) suggested that the more the client felt that the therapist possessed the acumen and the resources the more likely the client woul d invest in the therapeutic process. Although mental health professionals in tuitively believed fo r years that the environment in which change occurs influe nces treatment and outcome (Gross, Sasson, Zarhy, & Zohar, 1998), most current research focused on hospital settings and public spaces (Corey, Wallace, Harris, & Casey, 1984; Gross et al., 1998; Ulrich et al., 2008). Research on the counseling environment and its effect on counselors as well as clients
4 continue to be limited (Chaikin et al ., 1976; Miwa, 2006; Tsunetsugu, Miyazaki & Sato, 2005). In addition to a counselor’s theo retical orientation and the therapeutic relationship, the environment in which c ounseling occurs may be an aspect of consideration due to its potential healing eff ects and the significant implication research presented for the counseling profe ssion (Jarrett, 2006; Venolia, 1988). Creating an appealing and comfortable atmo sphere for the counselor seems to be important; counselors unhappy in their couns eling setting inadve rtently exhibit less positive attitudes and behaviors, influenc ing the therapeutic process (Baron, 1990; Goelitz & Kahn, 2008; Kaplan & Kaplan, 2009; Strong & Matross, 1973). Researchers in health care architectural design as we ll as environmental psychology determined a significant correlation between the well-being of both staff and patie nt and the physical characteristics of the environment (Bechte l & Churchma, 2002; Huelat, 2003; Ulrich, 1991, 2006); however, little literat ure exists specifically on the impact of the physical counseling environment on a counselor’s well -being and ability to provide optimal care (Jerrett, 2006; Kaplan & Kaplan, 2009). Purpose of the Study The purpose of the present study was to de fine and make more understandable the characteristics of a physical counseling envi ronment’s effect on a counselor’s well-being and ability to provide optimal care. It was hoped through this study to identify and provide insight into the key elements within a counseling setting that allow counselors to provide the best possible therapy to their cl ients. A paradigm shift may result as counselors begin to examine and analyze th e importance of environmental factors along
5 with the inter- and intra-psychic factors that impact the therapeutic process, treatments, and outcomes of clients. Research Questions The central research question was: What elements or characteristics of the physical counseling environment affect a coun selor’s well-being and ability to provide optimal care? Corollary research questi ons included but are not limited to: 1. What changes do counselors make in the counseling setting when they initially occupy the space? 2. Are there themes and patterns in the counseling setting that affect a counselor’s well-being and ability to provide optimal care? 3. What, if any, environmental features do counseling settings have in common? 4. What distinguishes a counseli ng office from other living spaces? Significance of the Research Study Data acquired during this study were analyzed for recurring patterns and emerging themes on the impact and nature of the physical counseling setting. These resulting patterns and themes provide a bett er understanding of how counselors can create counseling environments that promote heali ng and well-being while also enhancing the counseling relationship and therapeutic pr ocess (Pressly & Hees acker, 2001; Strong & Matross, 1973; Ulrich et al., 2008). Ultimat ely, the most significant finding was that the counselors interviewed, and possibly counselor s in general, do not give enough thought to how their physical counseling settings affect their well-being and efficacy.
6 Nature of the Study A phenomenological qualitative research design was utilized to determine the effects of the physical environment on a couns elor's well-being and ability to provide optimal care. By using this approach, an internal frame of re ference of the lived experience of the counselors provided data a bout the characteristics of the counseling setting that they deem important for op timum healing and well-being. The central purpose of using a phenomenological qualitati ve research design was to gather and explain data collected from of a series of videotaped intervie ws of counselors. The data gleaned was organized and analyzed for emer ging content, patterns, and themes. The emerging results provide future research ers with a philosoph ical foundation of understanding the phenomena from the construc t of the participating counselors’ points of view and lived experiences. From thes e interviews, hypotheses were generated for future quantitative research concerning the im pact and implications of the counseling setting on the counselor’s well-being a nd ability to provide optimal care. Definition of Terms and Key Concepts Using a framework of universal human needs as a basis for thinking about how places may influence health and well-b eing (Maslow & Mintz, 1956; Pressly & Heesacker, 2001), the researcher examined th e effects of the physical environment on a counselor’s well-being and efficacy. The st udy was conceptualized and operationalized by thinking about place effects on counselors. The following terms were defined in this study as: Counseling Setting : the room or environment in wh ich actual counseling occurs. Efficacy: The ability of the counselor to provide optimal care.
7 Emotional Environmental Elements : The emotional elements within the physical environment of the counseling setting may be described as the way the setting feels (Pressly & Heesacker, 2001; Ulri ch et al., 2008; Venolia, 1988). Mental Environmental Elements : The mental elements within the counseling setting defined as the messages imparted by the physical environment such as implied professionalism of the counselor (i.e. dipl omas, family photos, plants, and furniture; Pressly & Heesacker, 2001; Ulrich et al., 2008; Venolia, 1988). Physical Environmental Elements : The physical elements of the environment within the counseling room includes such common archit ectural characteristics of space as furniture and furniture design, color, lighting, smell, art and accessories, sound, and temperature (Pressly & Heesacker, 2001; Ulrich et al., 2008; Venolia, 1988). Well-being : A counselor’s biopsychosocial optimal functioning within the counseling profession. Well-being focuses on th e ability of the counselor to resist and hold up under pressure and stress, to avoid bur nout, cultivate resour ces, keep a positive outlook, move foreword, and provide optim al client care (Macintyre, Ellaway, & Cummins, 2002; Osborn, 2004). Assumptions and Limitations Assumptions Assumptions were made concerning the defi nition of key terms, the demographics of the volunteer participants, and the significance of the physical counseling environment. It was assumed that the defi nitions of terms provided gave a common and distinct meaning for the partic ipants as well as th e researcher (Berg, 2007). Age, gender, and experience presumably did not contribute to the nature of the data (Leedy & Ormrod,
8 2004; Meyer & Ponton, 2006). Finally, at the co re of the study was the assumption that the physical counseling environment had effect s on the counselors’ well-being and ability to provide optimal care. It was the goal of this study to describe and characterize the nature of these effects.
Limitations The present study was limited by its explorat ory, qualitative nature; the paucity of background literature; and the in terpretations of the counselor and volunteer participants. In addition, preconceived notions or personal experience that may have influenced or affected the data gathered were suspe nded. Bracketing, or suspension of personal experience, known as epoché, was a poten tial limitation to the study. This study investigated the perceptions a nd attitudes of mental health pr ofessionals to their personal counseling settings; it was exploratory in na ture and needs further research to test hypotheses that resulted from the robust emer gent data. The notion was that although studies were conducted on various aspects of health care environments and a few on counseling environments (Maslow & Mintz, 1956; Ulrich, 1991, 1993, 2006), research is still in early and formative stages. This qua litative study was straightforward and focused on general observations from both the research er and counselor participants in a natural setting. Data collected was limited by the insi ghts of the counselor participants and the researcher. Additionally, findings are subjec t to other interpretations. This study was confined to the interviewing and observing of licensed mental health professionals with one year or more experience in the mental health field. As a further limiting factor, interviews will be conducted within the mental health professional’s personal office.
9 Conclusion Researchers in a variety of di sciplines have sensed that th e places we inhabit can affect our thoughts, feelings, and behaviors. Clinic ians and scholars are beginning to describe theoretical and conceptual fram eworks that link the environmen t with health and healing. This study defined and made more understand able the characteristics of a physical counseling environment’s affect on a counsel or’s well-being and ability to provide optimal care. Using a phenomenological qual itative research design the study attempted to identify and provide insight into the key elements with in a counseling setting which allowed the participating counselor s to give the best possible th erapy to clients. Research findings involved interpreting the data in light of the personal lived experiences of mental health professionals and comparing the findi ngs with past litera ture and theory.
10 CHAPTER 2. LITERATURE REVIEW
A comparison and synthesis of theoretic al and conceptual research studies shed light on the relationships and links be tween architecture, inte rior design, sociology, and environmental psychology that may be generalized to the counseling setting. Expanding the discussion of the physical couns eling setting as it a ffects well-being and efficacy provides a justification and rationale for identifying essentials of the setting. Understanding the lived experience of counselor s to establish patterns, themes, and key elements within a counseling setting may a llow counselors to provi de the best possible therapy to their clients while fostering and maintaining their own se nse of well-being. Although some researchers explor ed the interdiscipl inary nature of environment as a facilitative tool (Bechtel & Churchman, 2002; Miwa, 2006; Pressl y & Heesacker, 2001; Ulrich et al., 2008), a gap in the literature exists in a ddressing the impact of the counseling environment specifically as it rela tes to counselors’ we ll-being and efficacy Theoretical Framework Environment as a facilitativ e healing tool has been explored throughout time and recorded in the literature. Three thousa nd years ago, the Chines e practiced an energy discipline, Feng Shui, aimed at creati ng an enhanced, harmonious, and supportive environment for an individual. Maslow (1943), a humanistic c linical psychologist, adopted a more holistic form of psychology, e xplored the environment as a healing tool, and theorized about a hierarchy of universal human needs that an individual must attain to be positively motivated and achieve optim al health and well-being. He organized these needs in order of importance to create a pyramid of physiological needs, safety needs, love and belonging needs, esteem need s, and ultimately, self-actualization needs
11 (Figure 1). Personal growth, well-being, and motivation could not occur until basic needs were met. Thus, if the lower level of needs were not met, anxiety resulted and an individual would begin to refocus and prioritize in an attempt to reclaim the deficient needs.
Figure 1: Maslow’s Hierarchy of Needs, the original five-stage model. Shelter was defined as a basic biological and physiological need (modified from Maslow, 1943).
Maslow’s 1943 theory suggested that safety, a basic human need, encompassed security of environment, health, and resources. If the environment, or shelter, that one inhabited was deficient, the individual would concentrate and focus time on creating an environment of safety and well-being. Until that need is met, the individual remains at a lower level of growth, well-being, and motivation (Figure 1). Maslow and Mintz (1956) took the theory of universal needs further and began to specifically study how the physical environment affects individuals. They conducted a study suggesting that the
12 aesthetic condition of a room, beautiful, average, or ugly, affected participants’ ratings on photographs of human faces. The study found that the participants in the pretty room, defined as being comfortable and aesthetically attractive, rated the photographs of faces as having energy and well-being. Participants in the ugly rooms not only rated the faces in the photographs as having less energy and well-being, but were more likely to complain of monotony, fatigue, and headaches, showing more irritability and hostility. Researchers in the 1960’s and 1970’s in disciplines such as architecture, interior design, and sociology studied the role of the environment as a facilitative and healing tool. As collaboration between researchers in these fields continued, environmental psychology emerged as a new field. Research professionals questioned what they needed to know about people that would help in the design of a building or space that would respond to people’s needs (Jerrett, 2006). Murray (1999) found that the creation of the built environment influenced the occupants enormously. Interior design researcher Manke (1996) determined that color powerfully impacted the psychological of individuals within their environment, both positive and negative. In addition, social and environmental researchers looked at how built environments affected the functioning of humans in everyday life. For example, Sommer (1974) wrote of sociofugal buildings and settings such as prisons and airports that discourage human contact and were hard, impervious to human imprint with such elements as cinder block walls, uncomfortable seating, and cold temperatures versus soft sociopedal buildings and settings which contain comfortable seating, personal art, and accessories (Bechtel & Churchman, 2002; Sommer, 1969, 1974).
13 One of the earlier studies on the coun seling setting specifically, conducted by Chaiken, Derlega and Miller (1976), hypothesize d that self-disclosure and therapeutic rapport would be significantly higher in a so ft versus hard counseling setting. They concluded counselors and therapists shoul d concern themselves with the physical environment of the counseling setting as a part of the entire therapeutic process (Chaikin & Derlega, 1974; Chaikin et al., 1976). While researchers examined the effects of the physical environment, social psychologist Strong (1968), postulated that a counselor’s social power determined the extent to whic h therapy was successf ul; in essence that counseling was an interpersonal process (Strong, 1968). Strong and Dixon (1971) then suggested that the social in fluence of a counselor’s expe rtness, attractiveness, and trustworthiness may affect the treatment out come of an individual. Therefore, the counselor’s influence was a result of the clie nt’s perception and a counselor’s perception of counselor resources. For example, cues such as office décor may affect the perceived expertness, attractiveness, and trustworth iness of the counselor (Grimes & Murdock, 1989; McNeill & Stoltenberg, 1989; Strong & Dixon, 1971) .
In this context, the therapist’s influence was a function of the client’s perception of therapist’s resources and expertise (Strong, 1968). Social influence in counseling has come to be regarded as a primary resear ch theme within the field of counseling psychology. This speaks to the notion that th ere were many dimensions to a successful therapy process, each needing to be research ed for potential cause and effect (Wampold & White, 1985). The third theory serving as a part of the framework for the proposed study was supportive design (Ulrich et al., 2008). Ulrich developed the theory which emerged as an
14 evidence-based model, a prominent foundation on which many health facilities were built. The theory of supportive design was an integration of environmental psychology, architecture, and interior design, incorporating Maslow’s hierarchy of needs and motivation and Strong’s theory of social influence. Supportive design links disciplines and was created to aid in the development of patient centered and driven environments with characteristics that help individuals cope with stress and create a sense of well-being and health. The theory of supportive design provided the opportunity to understand how the counseling setting was implicated as a supportive and therapeutic environment for counselors and clients. Environmental characteristics were shown to influence health (Ulrich, 1991, 1993, 2006). Research suggested that well designed environments (parks, healing gardens, and hospital rooms for example) can reduce anxiety, lower blood pressure, and lessen pain for individuals as evidenced in studies conducted by Ulrich. Ulrich (1992; 2006) increasingly integrated evolutionary theories such as Maslow’s hierarchy of universal needs into research as a way to build on the evidence that modern humans had a genetic readiness and need to respond positively to types of environments that were favorable to survival and well-being (Corey, 2001; Maslow, 1943; Rogers, 1995; Ulrich, 1993, 2006). Ulrich’s and Maslow’s theories, in combination with Strong’s theory of social influence can all come together within the walls of the counseling setting. When a counselor feels comfortable in the counseling environment, he or she will then make the client feel comfortable and secure as well. In addition, the client will have confidence in the counselor, and the counselor will have the ability to provide optimal care. Certain physical elements in the counseling setting may
15 emerge that consistently seem to facilitate a positive influence on the counselor as well as the client providing a setting for optimal care and client-counselor rapport. Problems and debates exist as they relate to the impact of environmental factors on counselors’ well-being and their ability to provide optimal care because of the way counseling was typically conducted and viewed (Macintyre et al., 2002). The scientist practitioner model of counseling assumes that counselors observe clients, gather data, form hypotheses for diagnosing, diagnose, and ultimately treat for outcome through the scientific method. However, counselors may forget to take into account or recognize factors other than the person to person relationship that exist, such as environmental characteristics, which may play a salient role in the therapeutic process (Macintyre et al., 2002; Pressly and Heesacker, 2001). Additionally, most research in the counseling field focused on the therapeutic process as person to person, considering client and counselor variables exclusively, omitting environmental or situational factors deemed irrelevant. This thinking may have lead to the fundamental attribution error and availability heuristic which occurs when people focus on person factors to the exclusion of situational or environmental factors in understanding behavior (Morrow & Deidan, 1992). Using the theoretical frameworks of universal needs and motivation (Maslow, 1943), social influence (Strong, 1968), and supportive design (Ulrich et al., 2008) to filter a review of the literature, it will be determined if the setting in which counseling occurs may affect the well-being of the counselor as well as the ability of the counselor to provide optimal treatment. With this information as evidence of need, the knowledge base may then move toward research to better understand and determine specifically what
16 physical elements in the counseling setting in crease a counselor’s well-being and ability to provide optimal care. Review of the Literature The literature review presented is a comp arison and synthesis of theoretical and conceptual research studies that may shed light on the relationships and links between architecture, interior design, sociology, environmental psychology, and counseling psychology. The review explores the interd isciplinary nature of environment as a facilitative tool and determines the exte nt of scientific research conducted linking environmental characteristics to mental hea lth professionals’ well-being and ability to provide optimal client care. Throughout th e literature review, it became evident that although research is growing, there is a gap in the literature that is directly relevant to the impact of the counseling environment on the counselor’s well-being and ability to provide optimal care. Scientists continue to focus their rese arch mainly on public buildings and spaces such as hospitals, schools, and prisons; pl aces where counseling often occurs. Yet researchers must extrapolate from the studies findings that can be translated to the counseling setting (Devlin & Arnelli, 2003; Higgins, Hall, Wall, Woolner & McCaughey, 2005). Three well-documented studies speak to the notion that ch aracteristics of an office setting contribute to such factors as perception of well-being by a client, as well as the ability of the professional to provide e xpertise and competent care (Bloom, Weigel, & Trautt, 1977; Chaikin et al., 1976; Maslow & Mintz, 1956).
17 The Influence of Room Environment on the Perception of Well-being Maslow and Mintz (1956) used the framew ork of universal needs to explore the perception of well-being in photographs of faces. Maslow and Mintz found that participants in the attractively decorated rooms rated the photographs more positively than the participants in unattractive rooms. The study tested three room conditions in an experimental approach designe d to describe the findings. A beautiful room had beige colored walls, indirect overh ead lighting, a soft armchair a nd a solid wood desk, artwork on the wall and personal accessories displaye d. The average room had grey colored walls, indirect overhead light, th e same desk and chair combination but only straight back chairs and nothing personal displayed. The ugly room had grey walls, an exposed overhead light bulb with no shade, two straight back chairs, and a small table instead of a desk. In addition, mops and trash cans were present in the room. Participants assigned to the beautiful room tended to describe it as comfortable, attractive, and pleasant. Part icipants in all three rooms we re then shown photographs of faces. The participants in the beautiful room reported that the faces seemed happier, had more energy, and an overall sense of well-be ing than the same photos rated in both the average and the ugly rooms. Building on th is study, Maslow and Mintz (1956) studied the long-term effects on the pa rticipants, and found that those in the ugly room most often complained about headaches and fatigue, and were more irritable and hostile than the participants in the beautiful room. The resu lts of these two studies provided the impetus for research on the influence of the room environment on c lient self-disclosure.