Ryan Howes PhD, ABPP

In Therapy


Couch Eulogy

Changes in the therapy office

Posted Mar 26, 2010

Loveseat, we hardly knew ye.

After seven years of faithful service, my office couch has been retired. It was a warm and inviting brownish-tanish-beige, whatever that color is called. A neutral color. Fitting, because the couch gave neutral, unbiased support throughout its career. It never chose sides when inhabited by a fighting couple. It never complained when its cushions were punched in frustration. It held its own when weighed down by heavy emotions. There were approximately 27 gallons of salty tears shed by grieving, depressed, frustrated and joyful people on that sofa. Approximately.

Ol' Beige definitely gets a hero's farewell. My rough estimates show it logged around 25K total cheekhours of work. A respectable sum by any standard.

As strong as it was, Beige began showing its age about a year ago. It became apparent some spring/support issues were getting serious - the kind of thing where everything rolls toward the middle of the couch. That's okay for one person who wants to sit in the middle, but for couples who have a hard time even being in the same room, a couch that promotes physical intimacy due to midline sag was unwelcome.

One handy client suggested I just get a board to tuck under the cushions to give support. That worked great for a few months, but the cushions weren't made for that sort of thing and soon lost their squish. Before long it was like sitting on your sweatshirt in the bleachers. The day I heard someone plop down on the couch and noticed a slight creak in the plywood, the writing was on the wall.

I once wrote about the first session in therapy and joked about guessing how long a therapist has been in practice by surveying the furniture. It's true. Therapists who began work in the 80's tend to sport decor from that era. It's not (only) because we're cheap and unhip, but also due to the fact we tend to value consistency in our offices. Year after year, the same stuff. Why would we do this?

Clinicians are taught the importance of something called "the frame" in psychotherapy. The frame refers to the many professional boundaries such as the fee, length of sessions, meeting times, how we interact and the purpose of our relationship. According to Glen Gabbard (psychiatrist, author and In Therapy contributor) these boundaries "create a safe and secure context within which therapist and patient can enter a ‘play space' where feelings, perceptions, thoughts and memories can be played with and explored." Therapy colors within the lines of this frame.

This frame idea can apply to the physical space of the office as well. The thought is, continuity in our office reduces distractions for the client and keeps the focus on them. If I hung a new painting each week it might become the topic of conversation rather than the ongoing process within the client. If I had a bunch of family photos around it may be tempting to discuss them instead of the client's issues. Not only that, consistency within the office contributes to the safety many clients feel. Entering an environment that looks and feels the same week after week is comforting.

I asked my friends at PsychLinks what they thought of changes in their therapist's offices. Here's what they said:

  • Last week when I went to my therapist's office, the chair that I sit in had been moved about 3" and was angled just slightly different. I am embarrassed to say that it was all I could do to leave it where it was. I kept wanting to fix it.
  • I think like G if my chair was moved to a different place or even angled differently that would really bother me. I wouldn't feel as safe somehow.
  • Actually I think it would bother me if she got a new receptionist. I have a good relationship with the girl there and i think i would be a bit on edge with someone new.
  • I think for me if something changes once in a while it's OK, but when it happens constantly it kind of throws you and you have to stabilize again every time you go there.

As you can see, redecoration takes on a different role in a therapy office. I need to be aware of my client's response to the change and be willing to discuss their reactions. Many won't notice. Some will but won't care. Others will feel discomfort due to the change. They'll wonder what this change means, it will bring up thoughts of other transitions in their life and it may temporarily disrupt their feeling of safety. It's worth talking about. Clients come to therapy to change something and this gives us a good opportunity to explore how they feel about change.

Ol' Beige has been successfully donated and replaced. A friend once referred to it as my "woe inspiring couch." If that's true, an unsuspecting Goodwill customer is in for quite a surprise. I should have tucked a business card between the cushions.