Best Practice for Therapeutic Environments

1 Qmcappd 8/27/2019 1 Best Practice for Therapeutic Environments A Guide for Clinicians and Administrators Introduction The Therapeutic environment is an essential consideration when evaluating best Practice for clinicians that are working with people who have health and/or mental health needs. The Therapeutic environment is a factor well before a person is seen for services. In fact, as soon as a person comes into the parking lot, lobby, or other space, the environment has an impact on how the person will perceive the experience. According to the American Psychological Association s Dictionary of Psychology, a Therapeutic atmosphere is, an environment of acceptance, empathic understanding, and unconditional positive regard in which persons feel free to verbalize and consider their thoughts, behaviors, and emotions and make constructive changes in their attitudes and reactions.

2 When a person comes into a Therapeutic environment, they should have a pleasant, beneficial experience. Throughout this document you can expect to encounter: Historical context pertaining to Therapeutic Environments What constitutes a Therapeutic environment Contexts that may be Therapeutic Recommendations for best Practice in regards to Therapeutic Environments , Special considerations to be made when establishing or evaluating Therapeutic Environments List of resources used in researching effective Therapeutic Environments Background and Rationale What is a Therapeutic environment? The Therapeutic environment is a constructed idea created before, during, and after experiences where services are rendered relative to health and/or mental health care.

3 By creating a Therapeutic environment, a person will be more at ease when coming in for services and will be likely to be more comfortable talking about sensitive topics, such as trauma. If an effective Therapeutic environment is established, a person will be more likely to be less resistant because there is a subconscious sense of safety. Creating a Therapeutic environment takes a conscious and intentional effort by the clinician and by those responsible for administration of programs. By creating a Therapeutic environment, a clinician can support progress toward treatment goals, personal growth, and positive change for people seeking services. Qmcappd 8/27/2019 2 There are various aspects that need to be considered when creating a Therapeutic environment such as: Physical, environmental, and emotional safety Interpersonal and intrapersonal boundaries Physical space Engagement and communication Safety is one of the most important considerations to be made when establishing a Therapeutic environment.

4 Perhaps a simple measure for considering safety is to ask yourself if you feel safe in Environments where you are working. If not, what could happen to make those Environments more safe? The office where intervention is happening must also be comfortable. If a person is uncomfortable, he or she may struggle to engage in therapy sessions. Engagement and communication are other aspects of the Therapeutic environment that are vital. A clinician must have an awareness of how engagement and assessment skills are used that foster a sense of genuine concern and authenticity. How did we get to where we are? Much has gone into what we perceive as an effective Therapeutic environment. For most people today, having a private, comfortable space is an important standard in creating a Therapeutic environment.

5 Of course, we know that there is much to consider and there are many different approaches to what such a space might look like. Whether consciously or not, many of the spaces used for Therapeutic purposes today are grounded in over 100 years of clinical Practice , mainly in psychology. (For more information, see Appendix A) Today, we still find ourselves moving between what an ideal approach may be. Intensive in-home and other home-based interventions are built upon the notion that the most Therapeutic response occurs in the home environment, usually between a child and his or her caretakers. Thus, the services are delivered in the home environment, which is obviously not controlled by the therapist. Conversely, more traditional family and individual therapy often occurs in an office space where the therapist completely controls the environment.

6 Which is best? Of course, there is no solid answer to the question other than both. Bringing the environment to consciousness Generally, it is important to consider two major factors in constructing a Therapeutic environment: 1) the physical space Qmcappd 8/27/2019 3 2) the interactive space These guidelines will be a resource for examining both of these areas as clinicians and administrators work toward creating optimal experiences for the people they serve. Intentionally attending to the Therapeutic environment takes energy, focus, planning, and evaluation in addition to fiscal resources. It is important that administrators and managers be onboard with efforts to enhance Therapeutic Environments . The Therapeutic environment needs to be consciously and continuously considered and analyzed to make sure that it enhances the experience of the people served.

7 Context of the Therapeutic Environment There are many different contexts in which Therapeutic Environments exists. Although many exist in a more traditional context today, models are moving towards integrated health care services. The populations most served in mental health services are individuals with: Severe and persistent mental illness Developmental disabilities Substance use disorder Each of these populations are served in a variety of locations and a variety of services are provided. Services that are provided usually should be specific to the populations that are served. Each population can benefit from the consideration of the Therapeutic environment. Each of these populations receive a variety of care from outpatient programs, day programs, and residential programs.

8 (For more information, see Appendix B) Recommendations For Optimal Therapeutic Environments Several studies by environmental psychologists have been conducted to determine what kind of environment is most pleasing and appropriate to people served. Many of these studies have used surveys to determine whether or not people have felt comfortable in the settings in which they have received counseling. There are many different components that go into consideration when discussing best Practice for Therapeutic Environments . Below, there will be a discussion on the recommendations for the physical/built location, milieu, Therapeutic relationships, interventions , and follow-up. Therapy can be conducted in private Practice offices, clinics, counseling centers, and community spaces, as well as in facilities, and in homes and other community-based locations.

9 Below are recommendations that address counseling centers, or offices in which there are several clinicians sharing a space where Therapeutic intervention is conducted. Qmcappd 8/27/2019 4 Physical or Built Environment Studies show that individuals start forming opinions and judgements about their experiences even before entering a building. Establishing a sense of security and safety before entering a counseling session is imperative for therapy sessions to be effective. There has not been a lot of research conducted on the location or parking; however, there has been a lot of research conducted on the physical space of Therapeutic Environments . Location Some articles discuss the ideal location of an office building. Some articles suggested that the office where therapy will be conducted should be located away from a main road, not close to a busy freeway or intersection.

10 The busyness and stress from an intersection or freeway could negatively impact Therapeutic work. The person is likely to feel more stressed coming from a crowded and stressful road situation. Parking Another consideration to be made is the size of parking lots. Studies have shown that parking lots should not be too vast in size, but still have enough parking spaces to accommodate the number of people served. Not having enough parking spots could give people the impression that they are not welcome or wanted. If possible, a parking lot with enough spaces for staff and visitors would be ideal. Also, clinicians and administrators should ensure that there is parking access for vehicles used by those with disabilities. Milieu The Therapeutic environment begins when an individual enters the building or location where services will be delivered.