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Ii therapy preparations venue & setting for psychotherapy and counselling


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Thought and preparations must be taken before an actual psychotherapy / counselling. Among the many preparations, one important consideration is the venue and setting for the psychotherapy / counselling.
Can psychotherapy / counselling be conducted anywhere? Technically yes, but it would be of more optimum practice to select and establish a venue that takes into account the following criterias.

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Ii therapy preparations venue & setting for psychotherapy and counselling

  1. 1. PSYCHOTHERAPY AND COUNSELLING II. Therapy Preparations: Venue & Setting for Psychotherapy and Counselling Thought and preparations must be taken before an actual psychotherapy / counselling.Among the many preparations, one important consideration is the venue and setting for thepsychotherapy / counselling. Can psychotherapy / counselling be conducted anywhere? Technically yes, but it wouldbe of more optimum practice to select and establish a venue that takes into account thefollowing criterias. Criterias of Venue for Psychotherapy / Counselling 1. Criteria of Appropriateness Imagine setting-up a counselling centre for prostitutes on the second floor, above an on-going brothel on the first floor with a shared staircase. A therapist might perceivehimself/herself as some sort of “moral crusader” who wants to provide psychotherapy /counselling services in the heart of depravity. But is it appropriate? Each time the therapist (if a man) goes to the second floor, he might be mistakenlyperceived as soliciting the services of prostitutes or worse, a pimp. If the therapist is awoman, she might be mistaken for a prostitute. At other times, brothel clients mightmistakenly call-in to the centre looking for their favourite prostitutes. Besides these, thecriminal elements of the prostitution ring might consider the centre to be a threat to them.This would pose a danger to the centre and everyone in it. In order to avoid misconceptions,misunderstandings, dangers and to establish clear lines of organizational, professional andclean service identity, the criteria of appropriateness should be the first consideration. 2. Criteria of Warmth and Safety The criteria of warmth and safety should be practiced for the sake of the clients,therapist, staff members (if any) and visitors.Warmth for Clients In practicing psychotherapy and counselling, the warmth, safety and welfare of theclients must take first priority. This includes the perceptions and feelings of being in a warmand safe place. What constitutes a warm and safe place? Warmness is not just providing a
  2. 2. fireplace for physical warmth in cold climates, but more towards the practice offriendliness, emotional support and personalized attentiveness. Friendliness, emotional support and personalized attentiveness should includekindness, amiableness and genialness. Staff and therapist must engage a client withkindness in the form of empathy. To be empathetic, we must be prepared to look throughthe eyes and frame of mind of the client. We must able to feel and share both in thenegative and positive feelings of the client. The difference is that we are not overwhelmedby the emotions as the clients. It is only when we have empathy, that we can truly share ourcompassion to the clients. All interactions with our clients should be amiable. They shouldbe treated as a friend (an equal) in need and not as a sick patient with a disorder. It is in thisrespect I disagree with the use of the term patient. It creates a feeling that the client ispsychologically sick and is seeking our assistance for a cure. We don’t psychologically cureanybody and persons with psychological needs not necessarily have to be sick unless theyhave a medical or mental disorder which would mean that they must be referred to amedical doctor or physiatrist. We must be genial in the form of being hospitable with ourclients. If our clients are our friends than (especially by Asian standards), hospitality shouldbe the trademark of our centres. Being hospitable is treating our clients as equals andproviding for their immediate and necessary needs.Safety of Clients Safety should be practiced for the sake of the client, therapist, staff and visitors. Allendangering factors that could possibly happen must be thought through and contingencyplans and procedures must be in place for immediate execution in the event of suchhappenings. Endangering factors can be for / from the client, staff, visitors or therapist. Evencircumstantial factors like fire, aggression from third parties, suicide attempts or violenceshould be considered in advance and the necessary plans must be drawn-up. I would like toespecially point out endangering factors arising from: 1) Human errors; 2) Systems Failuresand 3) Psychological complexities. In terms of human errors, it normally occurs due toignorance, incompetence or carelessness of staff or therapist. Let’s assume a female client walks in and seems to be in fear and terror. One look ather shows that she has been physically abused. And she is screaming that her husband ischasing after her to kill her. What should be the immediate response of any staff ortherapist on duty? The most obvious but in practice the least thought of, is the physicalsecurity management (systems) of the centre. The staff and therapist must ensure that nothird party can gain entrance into the premises without monitoring, verification andauthorisation. This may necessitate the installation of safety grills, CCTV(s), key card accesscontrol and the utilization of common sense. To alleviate the fear of the client, the staff ortherapist must assure the client that her husband can’t physically come in to abuse her. Thatshe is safe. Failure to think through such trivial but important matters can lead to humanerrors and system’s failure. Here, I would like to point out that certain NGO(s) have the
  3. 3. tendency to commit human errors by majoring on the minors and minoring on the majors.They may spend money for the purpose of fund raising while neglecting expenditures onpractical security management (systems) of their centres. Endangering factors can also ariseout of psychological complexities. Let’s take the same case but in a different scenario. Let’sassume that unknown to the staff and therapist, the female client is suffering from ParanoidPersonality Disorder. And her primary pervasive distrust and suspicion is her husband. Thereis no physical evidence of abuse although she claims her husband is seeking to kill her. Sheseems to be objective, rational and unemotional in her narratives. What should the staff ortherapist on duty do? For the purpose of precaution and assurance of physical safety, theclient should be made aware of the security management (systems) of the centre. But dueto the psychological complexity of the client in which her narrative has no immediateevidence of abuse, no reference should be made to the husband or any authorities. This iswhat I mean by psychological complexity. If any action is taken on her husband based on hercomplaint without psychological verification, it would lead to legal problems and possibleliabilities to the centre. Next, we should consider the criteria of comfortableness andpleasantness. 2. Criteria of Comfortableness and Pleasantness In Freud’s practice of Psychoanalytical Psychotherapy, he used to make the client liedown on a couch, with him sitting in a chair behind the head of the client. Why? In thepractice of Free Associations technique, this was the most comfortable and pleasantposition and posture for the client to relax under therapy. Besides relaxation, the positionand posture was a non-threatening way to engage the client. Psychotherapy / Counsellingvenues and settings have to consider the criteria of comfortableness and pleasantness. Thiscan be done by paying attention to:Quite, Private but Externally Visible Space The physical space or room used for psychotherapy should be quite, private butexternally visible. It should be reasonably sound-proofed to avoid distractions fromsurrounding noises as well as the accidental leaking-out of conversations. It must avoid theinterferences and distractions of persons or activities. But above all, the client andtherapist / counsellor must be visible from the outside for the purpose of processtransparency and security. Process transparency and security are contingencies againstattempts / allegations of physical or sexual molestations or abuse.Comfortable and functional furniture A non-expensive and simple sofa with back support and armrest are recommended.The positioning of the client’s sofa should be at an angle from that of the therapist /counsellor’s sofa to avoid direct eye-contact as to be psychologically non-threatening. The
  4. 4. client’s back should be to the back of the entrance of the room with the therapist /counsellor’s facing it at an angle. A small side table with enough space to hold a plasticbottle of water and tissue box should be placed beside the sofa and within reach of theclient.Physical Lighting Any form of lighting that produce a heavy glare or shadows should be avoided. Thepositioning of the lighting must be such that it does not glare into the eyes of the client orthe therapist / counsellor. The degree of lighting itself should be bright enough for takingnotes but non-glaring and pleasant.Time Piece A time-piece (clock) must be located above and behind the head of the client butvisible to the therapist / counsellor. However, the clock must not emit any notificationsounds that may be distracting.Room Colour Scheme Special attention should be paid to the colour schemes of the room. Whatevercolours that are used in the room must be one that creates a feeling of calmness, relaxationand ambience. All stressful and aggressive colours are to be avoided.Greenery and Flowers Potted plants, greenery and flowers may be arranged parsimoniously in an un-distracting manner to complement the colour scheme.Avoidance of Pictures and Mementos No personal or organizational pictures or mementos should be placed in thepsychotherapy / counselling room that might portray any form of status symbol, disparity,lack or psychological inequality to a client.Cleanliness The room or space should be physically clean and free of any form of stenchincluding food and beverage smells. Avoid using artificial fragrance as some clients can beallergic to such chemical odour. Final Suggestions Permission must be sought from the client before the installation of any audio-taping or video-taping of a session. For the purpose of security for the therapist / counsellor,an inconspicuous buzzer should be installed within the reach of the therapist / counsellor tosignal for assistance from colleagues in cases of physical or psychological outbursts that
  5. 5. cannot be controlled and needs additional assistance. These foregoing suggestions onVenue & Setting for Psychotherapy and Counselling would go a long way in creating a warm,safe and comfortable environment for psychotherapy / counselling.