The Therapy Room as an Integral Part of Pluralistic Practice
Anna Fox, Course Lead for BA Counselling and Therapeutic Practice, University of South Wales,
Like many practitioners I have been contemplating whether to continue working purely remotely or whether to resume face-to-face counselling, and have been looking at government guidelines, research and BACP recommendations, as well as talking to other colleagues to try to help me navigate this rather confusing dilemma.
During a discussion about this in a supervision session this week I became increasingly aware that much of the analysis and guidance I am reading relates (necessarily) to safety for ourselves and our clients. This of course is paramount; however, it misses an important element in counselling practice: the role of the therapeutic environment in counselling. As my supervisee and I talked about online counselling versus face-to-face counselling and the value of each medium, she reflected on what her therapy room meant to her and to her clients, and how she felt it was an important part of the therapeutic process. This led me to think further about the role of the counselling room as an integral part of pluralistic practice in enabling client preference and a collaborative approach to the therapeutic methods used.
An important aspect of pluralistic therapy is the concept of client preference, with clients being actively involved in the therapeutic process. Clients can be encouraged to express their treatment and activity preferences by being given access to books, assessment forms, and other resources available in the room which can increase their knowledge of the process. This may also reduce client anxiety and increase the likelihood of a shared decision-making approach (see What Kind of Client Preferences are There?)
Bringing the client’s own experiences of everyday life – such as music, art, and play activities – that they already relate to can affect preferences and create a more inclusive experience. In my practice I have found this particularly helpful when working with young children and people on the autistic spectrum, encouraging clients to actively explore the room and choose activities they wish to engage with or to bring in resources which they find comforting or wish to share. This can help to create a safer space for the client and provides feedback for me about further resources that might be useful to add into the room (see Client preferences: building bridges between therapy and everyday life).
Pluralistic practice also proposes that client needs can change during therapy and that as practitioners we need to be able to respond to those changing requirements:
Different explanations will be true for different people at different points in time and therefore different therapeutic methods will be most helpful for different clients at different instances.
Having access to a range of resources in the room can enhance client choice and a collaborative exploration of therapeutic methods available to us in responding to changing needs.
As counselling trainees, we are taught the importance of the therapeutic space in providing an atmosphere of healing and safety. And client preferences indicate that the therapeutic room is important to their overall experience of counselling.
Like many practitioners, I have worked in a variety of organisations and experienced working in different environments. At times I have been given the only available maths classroom, a large but barren multi-use room, and on one occasion a tiny room next to the student canteen. On reflecting on these different experiences, I can see how the physical environment affected the ways that I worked with clients, and how they responded to the therapeutic process. Working as a private practitioner now, I have the luxury of creating my own therapeutic space shaped around the needs of clients, and I view my counselling room as an element within my pluralistic practice. It has been used by clients as a creative space (a spaceship, a doctor’s office, and a play space); a learning environment for psycho-education and CBT work (using a whiteboard, posters, and worksheets); a safe space for empty chair work, guided imagery and trauma work; and a neutral space for safely leaving behind painful or valued material. It has also become a deeply spiritual space in which clients have felt safe to explore existential issues that they cannot explore anywhere else. My supervisee reflected that her counselling room felt at times like a ‘third entity’ in the therapeutic process, especially for clients for whom safety was an important consideration. When I reflect on my own experiences of personal therapy I don’t just remember the counsellors and the therapeutic work: my memories are also shaped by the feeling of walking up the stairs to the counselling room, of sitting in the reception room waiting, of the plants in the counselling room, and the softness of the chair as I curled up into it. These for me were a part of the therapeutic process.
My room is also an important part of the process for me as a pluralistic counsellor. It has helped me to shape my counselling style and to better understand how I work pluralistically as I have incorporated different resources based on client feedback and preference. It has given opportunities to incorporate different elements into my practice and has provided a neutral space for processing and creative thinking.
So as I contemplate a return to face-to-face work, I understand that our first consideration must be around risk assessments. Guidance suggests that we should minimise hard-to-clean surfaces (such as cushions, soft chairs, scarves etc.), and restrict use of shared items that are touched, such as pebbles, cards, pens etc. (See also Adapting your office for safe working with Covid-19). Yet this presents a challenge, as I wonder what the impact of this will be on my counselling room and pluralistic practice. I know that changing my room will have an impact on how I feel, but more importantly (as raised by my supervisee), what will the impact be on existing clients, especially those for whom the room has become an important element of their therapeutic journey? How do we meet their preferences in this situation, especially as they may already have had to cope with unwelcome changes to their therapeutic experience? I would like the opportunity to engage with others, not only in relation to the safety aspects of returning to face-to-face work, but also to the deeper, therapeutic challenges that this raises.